Tom Frieden

Tom Frieden
Tom Frieden
16th Director of the Centers for Disease Control and Prevention
Incumbent
Assumed office
June 8, 2009
President Barack Obama
Preceded by Julie Gerberding
New York City Health Commissioner
In office
2002–2009
Mayor Michael Bloomberg
Personal details
Political party Democratic

Dr. Thomas R. Frieden is the Director of the U.S. Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). He was New York City Health Commissioner from 2002–2009.

Contents

Education

Frieden graduated from Oberlin College (BA), Columbia University College of Physicians and Surgeons (MD) and Columbia University's Mailman School of Public Health (MPH). He completed training in internal medicine at Columbia-Presbyterian Medical Center and sub-specialty training in infectious diseases at Yale University. One brother, Jeffry Frieden, is a noted international political economist and the Stanfield Professor of International Peace at Harvard University.[1] His other brother, Ken Frieden, the B.G. Rudolph Professor at Syracuse University, specializes in nineteenth-century literature. [2]

Early career

Frieden's work on TB in New York fostered public awareness and helped improve public funding (city, state and federal) for tuberculosis control.[3][4] The epidemic was controlled rapidly, reducing overall incidence by nearly half and cutting multidrug-resistant tuberculosis by 80%.[5] The city's program became a model for tuberculosis control.[6][7] From 1996 to 2002, Frieden was based in India, assisting with national tuberculosis control efforts. As a medical officer for the World Health Organization on loan from the CDC, he helped the government of India implement the Revised National Tuberculosis Control Program (RNTCP).[8][9][10][11] The 2008 RNTCP status report estimates the nationwide program resulted in 8 million treatments and 1.4 million saved lives.[12] While in India, Frieden worked to establish a network of Indian physicians to help India's state and local governments implement the program[13] and helped the Tuberculosis Research Center in Chennai, India, establish a program to monitor the impact of tuberculosis control services.[14][15]

Issues

Dr. Frieden served as head of the New York City DOHMH from 2002–2009.[citation needed] The agency employees more than 6,000 people[16] with an annual budget of $1.5 billion.[17] He also chaired the New York City Board of Health, pursuing "an unapologetically aggressive public health agenda,"[7] Frieden led a period marked by improvements in the health of New Yorkers as well as sometimes fierce controversy.[18]

Frieden has been criticized by interest groups from across the political spectrum – especially advocates for the tobacco and restaurant industries. The New York Post quipped that Frieden had turned the city into a “nanny state on steroids.” These criticisms did not diminish after he was appointed as Director of the Centers for Disease Control and Prevention. “Frieden's stick-over-carrot, for-your-own-good approach to public health is no longer confined to the Big Apple," the industry-backed Center for Consumer Freedom wrote on its blog. "Get ready, because the 'nanny state on steroids' is going national.” (Politico.com) Despite his contentious stance on many issues, Frieden was selected by Governing Magazine as a Public Official of the Year in 2005, and NY1's New Yorker of the Year in 2006.

Tobacco Control

Upon his appointment as Health Commissioner in January 2002, Frieden made tobacco control an immediate priority,[19] resulting in a rapid decline[20] after a decade of no change in smoking rates. Frieden established a system to monitor the city's smoking rate, and worked with New York City Mayor Michael R. Bloomberg to increase tobacco taxes,[21] ban smoking from workplaces including restaurants and bars, and run aggressive anti-tobacco ads and help smokers quit.[22] The program reduced smoking prevalence among New York City adults from 21.6% in 2002 to 16.9% in 2007– a change that represents 300,000 fewer smokers and could prevent 100,000 premature deaths in future years.[20][23] Smoking prevalence among New York City teens declined even more sharply, from 17.6% in 2001 to 8.5% in 2007, and is now less than half the national rate.[24] The workplace smoking ban prompted spirited debate before it was passed by the New York City Council and signed into law by Mayor Bloomberg.[25] Over time, the measure has gained broad acceptance by the public and business community in New York City.[26][27] New York City's 2003 workplace smoking ban was among those following California's ban in 1994. Frieden supports increased cigarette taxes as a means of forcing smokers to quit, saying "tobacco taxes are the most effective way to reduce tobacco use."[28] Frieden supported the 62-cent Federal tax on each cigarette pack sold in the United States, introduced in April 2009.[29]

Take Care New York

Frieden also introduced Take Care New York, the city's first comprehensive health policy. This program targeted ten leading causes of preventable illness and death for concerted public and personal action.[30][31] By 2006, New York City had made measurable progress in eight of the ten priority areas.[32]

HIV/AIDS

New York City is an epicenter of the HIV epidemic in the United States. As Health Commissioner, Frieden has sought to fight HIV/AIDS with public health principles used successfully to control other communicable diseases.[33] The most controversial aspect of this strategy was a proposal to eliminate separate written consent for HIV testing. Frieden believes the measure would encourage physicians to offer HIV tests during routine medical care,[34] as the CDC recommends.[35] Some community advocates and civil libertarians fought this legislation in the belief that it would undermine patients' rights and lead eventually to forced HIV testing.[36][37] In 2010, New York State passed a new law that eased the requirement for separate written consent in some circumstances.[38] On 14 February 2007, the NYCDHMH also introduced the NYC Condom,[39][40] prompting Catholic League president Bill Donohue to respond,"What's next? The city's own brand of clean syringes?[41]" More than 36 million were given away in 2007.[42]

Diabetes

Confronted with what he called a growing "epidemic" of diabetes in New York City (in reality, the rate of growth mirrored national trends), Frieden worked to raise awareness, particularly among pregnant women,[43] and established an involuntary, non-disclosed hemoglobin A1C diabetes registry that tracks patients' blood sugar control over several months and report that information to treating physicians in an effort to help them provide better care.[44][45] The New York City Board of Health's decision to require laboratories to report A1C test results has generated a heated debate among civil libertarians, who view it as a violation of medical privacy and an intrusion into the doctor-patient relationship.[46] Even though patients can choose to not receive information from the program, there is no provision enabling patients to opt out of having their glycemic control data entered in the database. The New York City DHMH asserts that the A1C registry can help reduce the risk of blindness, kidney failure, leg amputations and early death among people with diabetes.[47] But according to a May 21, 2010 PowerPoint presentation prepared by the NYC Department of Health and Mental Hygiene,[48] as of 31 December 2009, the program was only reaching 16% of New York City residents with diabetes. The New York City DHMH has provided little if any solid evidence to validate its assertions about improved patient outcomes, although "outcome evaluation [is] currently being designed" and completion is anticipated by 2011.[48]

Food Policies

To combat cardiovascular disease, New York City has adopted regulations since 2006 to eliminate artificial trans fat from all restaurants.[49][50][51] The restaurant industry and its political allies condemned the trans-fat measure as an assault on liberty by an overzealous "nanny state,"[52][53] but compliance has exceeded 90% among New York City restaurants, and the measure has inspired similar laws in several US cities and the state of California.[54] The Health Department also required chain restaurants to post calorie information to raise consumer awareness of fast food's caloric impact. The measure requires chains with 15 or more outlets to post calorie counts on menus and menu boards. It has prompted two lawsuits by the New York State Restaurant Association. In the first, New York State Restaurant Association v. New York City Board of Health, a U.S. District Court judge ruled that federal law pre-empted New York City's action and overturned it.[55] The NYC Board of Health then repealed and re-enacted the measure,[56] which took effect in May 2008.[citation needed] Most chains now post calorie information in their New York City outlets, despite a pending legal challenge, and customers have experienced widespread "sticker shock.".[57][58] National health reform legislation, the Patient Protection and Affordable Care Act, requires menu labeling nationally by 2012.[59]

Epidemiology

During Frieden's tenure as Commissioner, the Health Department has greatly expanded the collection and use of epidemiological data, launching an annual Community Health Survey[60] and the nation's first community-based Health and Nutrition Examination Survey.[61][62]

Electronic Health Records

To improve quality and efficiency of medical care, the agency also launched the nation's largest community-based electronic health records project to improve preventive care for more than one million at-risk New Yorkers.[63]

Director of CDC and Administrator of ATSDR

On 15 May 2009 the White House and the Department of Health and Human Services named Dr. Frieden the 16th director of Centers for Disease Control and Prevention (CDC) and administrator of the Agency for Toxic Substances and Disease Registry (ATSDR); he assumed his position on 8 June 2009 from the acting head, Richard E. Besser.[64]

On announcing Frieden’s appointment, President Obama said, “America relies on a strong public health system and the work at the Centers for Disease Control and Prevention is critical to our mission to preserve and protect the health and safety of our citizens.[65]” Frieden had previously worked for the CDC from 1990 to 2002 as an Epidemic Intelligence Service Officer in New York City and then as part of CDC’s tuberculosis control program.

Bloomberg Philanthropies

Dr. Frieden also served as health advisor to New York City Mayor Michael Bloomberg, supporting the Bloomberg Initiative to Reduce Tobacco Use.[65] This initiative aims to prevent more than 100 million tobacco-related deaths worldwide[66] by promoting tobacco control in developing countries. By mid-2008, the initiative had funded more than 100 organizations in 36 nations,[23] with a focus on China and India, where more than 40% of the world's smokers live.[67] Bloomberg's effort was joined by the Bill & Melinda Gates Foundation in 2008.[23]

Publications

Awards

References

  1. ^ http://www.people.fas.harvard.edu/~jfrieden/
  2. ^ http://thecollege.syr.edu/profiles/pages/frieden-ken.html
  3. ^ Lobato MN, Wang YC, Becerra JE, Simone PM, Castro KG (2006). "Improved Program Activities Are Associated with Decreasing Tuberculosis Incidence in the United States". Public Health Reports 121 (2): 108–15. PMC 1525263. PMID 16528941. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1525263. 
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  5. ^ TB Annual Summary: 2006. New York: New York City Department of Health and Mental Hygiene. 2008. http://www.nyc.gov/html/doh/downloads/pdf/tb/tb2006.pdf. [page needed]
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  7. ^ a b Steinhauer, Jennifer (14 February 2004). "Gladly Taking The Blame For Health In the City". The New York Times. http://www.nytimes.com/2004/02/14/nyregion/gladly-taking-the-blame-for-health-in-the-city.html. Retrieved 8 July 2009. 
  8. ^ Drazen JM (October 2002). "A milestone in tuberculosis control". New England Journal of Medicine 347 (18): 1444. doi:10.1056/NEJMe020135. PMID 12409549. 
  9. ^ Khatri GR, Frieden TR (October 2002). "Controlling tuberculosis in India". New England Journal of Medicine 347 (18): 1420–5. doi:10.1056/NEJMsa020098. PMID 12409545. 
  10. ^ Udwadia ZF, Pinto LM (2007). "Review series: the politics of TB: the politics, economics and impact of directly observed treatment (DOT) in India". Chronic Respiratory Disease 4 (2): 101–6. doi:10.1177/1479972307707929. PMID 17621578. 
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  13. ^ Frieden TR, Khatri GR (September 2003). "Impact of national consultants on successful expansion of effective tuberculosis control in India". The International Journal of Tuberculosis and Lung Disease 7 (9): 837–41. PMID 12971666. http://openurl.ingenta.com/content/nlm?genre=article&issn=1027-3719&volume=7&issue=9&spage=837&aulast=Frieden. 
  14. ^ Subramani R, Radhakrishna S, Frieden TR, et al. (August 2008). "Rapid decline in prevalence of pulmonary tuberculosis after DOTS implementation in a rural area of South India". The International Journal of Tuberculosis and Lung Disease 12 (8): 916–20. PMID 18647451. http://openurl.ingenta.com/content/nlm?genre=article&issn=1027-3719&volume=12&issue=8&spage=916&aulast=Subramani. 
  15. ^ Narayanan PR, Garg R, Santha T, Kumaran PP (2003). "Shifting the focus of tuberculosis research in India". Tuberculosis 83 (1–3): 135–42. doi:10.1016/S1472-9792(02)00068-9. PMID 12758203. 
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  19. ^ Steinhauer, Jennifer (15 February 2002). "Commissioner Calls Smoking Public Health Enemy No. 1 and Asks Drug Firms for Ammunition". The New York Times. http://www.nytimes.com/2002/02/15/nyregion/commissioner-calls-smoking-public-health-enemy-no-1-asks-drug-firms-for.html. Retrieved 8 July 2009. 
  20. ^ a b Centers for Disease Control and Prevention (CDC) (June 2007). "Decline in smoking prevalence--New York City, 2002-2006". Morbidity and Mortality Weekly Report 56 (24): 604–8. PMID 17585290. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a4.htm. 
  21. ^ Altman, Alex (6 June 2008), "When Are Cigarette Taxes Too High?", Time, http://www.time.com/time/nation/article/0,8599,1812426,00.html, retrieved 8 July 2009 
  22. ^ Frieden TR, Mostashari F, Kerker BD, Miller N, Hajat A, Frankel M (June 2005). "Adult Tobacco Use Levels After Intensive Tobacco Control Measures: New York City, 2002–2003". American Journal of Public Health 95 (6): 1016–23. doi:10.2105/AJPH.2004.058164. PMC 1449302. PMID 15914827. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1449302. 
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  24. ^ The Lancet (January 2008). "New York City's bold antitobacco programme". Lancet 371 (9607): 90. doi:10.1016/S0140-6736(08)60078-1. PMID 18191665. 
  25. ^ Chang C, Leighton J, Mostashari F, McCord C, Frieden TR (August 2004). "The New York City Smoke-Free Air Act: second-hand smoke as a worker health and safety issue". American Journal of Industrial Medicine 46 (2): 188–95. doi:10.1002/ajim.20030. PMID 15273972. 
  26. ^ Cooper, Michael (23 October 2003). "Poll Finds Smoking Ban Popular". The New York Times. http://www.nytimes.com/2003/10/23/nyregion/metro-briefing-new-york-manhattan-poll-finds-smoking-ban-popular.html. Retrieved 8 July 2009. 
  27. ^ Rutenberg, Jim; Lily Koppel (6 February 2005). "In Barrooms, Smoking Ban Is Less Reviled". The New York Times. http://www.nytimes.com/2005/02/06/nyregion/06xsmoke.html. Retrieved 8 July 2009. 
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  29. ^ Jonsson, Patrik (17 November 2009). "Federal and state governments look to smokers for more tax revenue: Though they hit poor Americans hardest, stiff taxes on tobacco can reduce healthcare costs by billions". Christian Science Monitor. http://www.csmonitor.com/USA/2009/0411/p90s01-usgn.html. Retrieved 8 August 2010. 
  30. ^ "Cause of Death or Illness, New York City, 2002, and Amenability to Intervention". Take Care New York: A Policy for a Healthier New York City. New York City Department of Health and Mental Hygiene. March 2004. pp. 57–61. http://www.nyc.gov/html/doh/downloads/pdf/tcny/tcny-policy.pdf. Retrieved 9 July 2009. 
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  33. ^ Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ (December 2005). "Applying public health principles to the HIV epidemic". New England Journal of Medicine 353 (22): 2397–402. doi:10.1056/NEJMsb053133. PMID 16319391. 
  34. ^ Mandavilli A (April 2006). "Profile: Thomas Frieden". Nature Medicine 12 (4): 378. doi:10.1038/nm0406-378. PMID 16598275. 
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  41. ^ http://gothamist.com/2007/02/15/condoms_1.php
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