Tom Frieden

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Tom Frieden
Thomas Frieden official CDC portrait.jpg
16th Director of the Centers for Disease Control and Prevention
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
Born 1960 (age 56–57)
Education

Thomas R. Frieden has been since 2009 the Director of the U.S. Centers for Disease Control and Prevention (CDC) and Acting Administrator of the Agency for Toxic Substances and Disease Registry. He was appointed by President Barack Obama.[1] He previously served as Commissioner of the New York City Department of Health and Mental Hygiene (DOHMH) from 2002 to 2009.

Education[edit]

Frieden graduated from Oberlin College (B.A., 1982), Columbia University College of Physicians and Surgeons (M.D., 1986), and Columbia University Mailman School of Public Health (M.P.H., 1985). He completed a residency in internal medicine at Columbia-Presbyterian Medical Center and a sub-specialty fellowship in infectious diseases at Yale School of Medicine and Yale–New Haven Hospital.

Early career[edit]

Frieden's work on tuberculosis in New York City, initially as an Epidemic Intelligence Service Officer assigned by CDC and later as Assistant Commissioner of Health and Director of the DOHMH Bureau of Tuberculosis Control, fostered public awareness and helped improve city, state and federal public funding for TB control.[2][3] The epidemic was controlled rapidly, reducing overall incidence by nearly half and cutting multidrug-resistant tuberculosis by 80%.[4] The city's program became a model for tuberculosis control nationally and globally.[5][6]

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.[7][8][9][10] The program's 2008 status report estimated that the nationwide program resulted in 8 million treatments and 1.4 million lives saved.[11] While in India, Frieden worked to establish a network of Indian physicians to help India's state and local governments implement the program[12] and helped the Tuberculosis Research Center in Chennai, India, establish a program to monitor the impact of tuberculosis control services.[13][14]

New York City Health Commissioner[edit]

Frieden served as Commissioner of Health of the City of New York from 2002 to 2009.[15][16] At that time, the agency employed more than 6,000 people[17] and had an annual budget of about $1.5 billion.[18][19]

Tobacco control[edit]

Upon his appointment as Commissioner of Health, Frieden made tobacco control a priority,[20] resulting in a rapid decline[21] after a decade of no change in smoking rates. Frieden established a system to monitor the city's smoking rates, and worked with New York City Mayor Michael R. Bloomberg to increase tobacco taxes,[22] ban smoking in workplaces including restaurants and bars, and run aggressive anti-tobacco ads and help smokers quit.[23] The program reduced smoking prevalence among New York City adults from 21.6% in 2002 to 16.9% in 2007 – a change that represented 300,000 fewer smokers and could prevent 100,000 premature deaths in future years.[21][24] Smoking prevalence among New York City teens declined even more sharply, from 17.6% in 2001 to 8.5% in 2007, which was less than half the national rate.[25] The workplace smoking ban prompted spirited debate before it was passed by the New York City Council and signed into law by Mayor Bloomberg.[26] Over time, the measure gained broad acceptance by the public and business community in New York City.[27][28] New York City's 2003 workplace smoking ban followed that of California in 1994. Frieden supported increased cigarette taxes as a means of forcing smokers to quit, saying "tobacco taxes are the most effective way to reduce tobacco use."[29] He supported the 62-cent federal tax on each cigarette pack sold in the United States, introduced in April 2009.[30] One side effect of the increased taxes on tobacco in New York was a large increase in cigarette smuggling into the state from other states with much lower taxes, such as Virginia. The Tax Foundation estimated that "60.9% of cigarettes sold in New York State are smuggled in from other states".[31] In addition, some New Yorkers began to make their own cigarettes, and tobacco trucks were even hijacked. A 2009 Justice Department study found that “The incentive to profit by evading payment of taxes rises with each tax rate hike imposed by federal, state, and local governments”.[32]

Take Care New York[edit]

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.[33][34] By 2006, New York City had made measurable progress in eight of the ten priority areas.[35]

HIV and AIDS[edit]

As Health Commissioner, Frieden sought to fight HIV and AIDS with public health principles used successfully to control other communicable diseases.[36] The most controversial aspect of this strategy was a proposal to eliminate separate written consent for HIV testing. He believed the measure would encourage physicians to offer HIV tests during routine medical care,[37] as the CDC recommended.[38] Some community and civil liberties advocates fought this legislation, arguing it would undermine patients' rights and lead eventually to forced HIV testing.[39][40] In 2010, New York State passed a new law that eased the requirement for separate written consent in some circumstances.[41] On February 14, 2007, the New York City Department of Health and Mental Hygiene introduced the NYC Condom,[42][43] prompting Catholic League president Bill Donohue to respond, "What's next? The city's own brand of clean syringes?"[44] More than 36 million condoms were given away by the program in 2007.[45]

Diabetes[edit]

Frieden worked to raise awareness about diabetes in New York City, particularly among pregnant women,[46] 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.[47][48]

The New York City Board of Health's decision to require laboratories to report A1C test results generated a heated debate among civil libertarians, who view it as a violation of medical privacy and an intrusion into the doctor-patient relationship. Although patients may elect not to receive information from the program, there is no provision enabling patients to opt out of having their glycemic control data entered in the database.[49][50]

Food policies[edit]

To combat cardiovascular disease, New York City started to adopt regulations in 2006 to eliminate trans fat from all restaurants.[51][52][53] The restaurant industry and its political allies condemned the trans-fat measure as an assault on liberty by an overzealous "nanny state"[54][55] and the measure inspired similar laws in several other U.S. cities and the state of California.[56] The Health Department also required chain restaurants to post calorie information to raise consumer awareness of fast food's caloric impact. The measure required restaurant chains with 15 or more outlets to post calorie counts on menus and menu boards. It 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.[57] The New York City Board of Health then repealed and re-enacted a slightly different measure.[58] Most chains now post calorie information in their New York City outlets.[59][60] Section 4205 of the Patient Protection and Affordable Care Act, signed into law in 2010, requires menu labeling nationally, for restaurant chains, disclosing on the menu boards, calories, total calories, calories from fat, amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.[61]

Epidemiology[edit]

During Frieden's tenure as Commissioner, the Health Department expanded the collection and use of epidemiological data, launching an annual Community Health Survey[62] and the nation's first community-based Health and Nutrition Examination Survey.[63][64]

Electronic health records[edit]

To improve quality and efficiency of medical care, the agency launched a large community-based electronic health records project to improve preventive care for more than one million at-risk New Yorkers.[65]

Gun deaths[edit]

Despite his outspokenness, Frieden has had little to say about high rates of gun deaths in the United States. Asked CNN, "Why is the nation's leading public health official, a nonstop messaging machine, not talking about something that kills more than 30,000 people a year in the United States? That's more than the number of Americans who die of AIDS or colon cancer or prostate cancer. That's more than the number of people who died in the entire international Ebola outbreak last year."[66]

Director of CDC and Administrator of the Agency for Toxic Substances and Disease Registry[edit]

On May 15, 2009 the White House and the Department of Health and Human Services named Dr. Frieden the 16th director of the Centers for Disease Control and Prevention and administrator of the Agency for Toxic Substances and Disease Registry; he assumed his position on June 8, 2009 from the acting head, Dr. Richard E. Besser.[67]

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”.[68] Frieden had previously worked for the CDC from 1990 to 2002 as an Epidemic Intelligence Service Officer in New York City and then assigned to India as a Medical Officer as part of CDC’s tuberculosis control program.

Ebola epidemic[edit]

Frieden is decontaminated after visiting Ebola treatment unit in Liberia, August 2014

Frieden was a prominent figure in the US and global response to the West African outbreak of Ebola. His visits to West Africa beginning in August 2014 and a September 2014 CDC analysis projecting that the Ebola epidemic would increase exponentially to infect more than 1 million people within four months[69] prompted him to press for an international surge response.[70] At the peak of the response, CDC maintained approximately 200 staff per day in West Africa and approximately 400 staff per day at its Atlanta headquarters dedicated to the response; overall, approximately 1,900 CDC staff deployed to international and U.S. locations for approximately 110,000 total work days, and more than 4,000 CDC staff worked as part of the response.[71] In a Congressional hearing on October 16, 2014, Frieden was questioned for his handling of the Ebola crisis following the spread of the disease to two nurses from the original patient in the US.[72] The previous day, the response of the CDC to the crisis led Rep. Tom Marino (R-PA) to call for Frieden's resignation,[73] although others rallied to his defense.[74][75]

Zika epidemic[edit]

The introduction of Zika virus into the Americas, and the subsequent increase in the number of babies born with microcephaly and other severe neurological disorders,[76] and in particular spread of the Zika epidemic to the US territory of Puerto Rico and subsequently to the Miami, Florida area, resulted in CDC activating its Emergency Operations Center in January 2016.[77]

H1N1 Influenza[edit]

In response to the H1N1 influenza pandemic of 2009-2010, CDC scaled up the Vaccines for Children centralized distribution infrastructure to distribute H1N1 influenza vaccine. More than 330,000 vaccine shipments were sent to more than 75,000 health care providers; CDC’s work to rapidly distribute vaccine as soon as it became available and encourage use of antiviral medications prevented at least 1 million cases of influenza, 18,000 hospitalizations, and 600 deaths.[78][79]

Global Health[edit]

CDC works in more than 60 countries, both to protect Americans from external threats and to support health progress around the world.[80] Key global health programs address polio (through involvement as a founding partner of the Global Polio Eradication Initiative), HIV/AIDS (as a key implementing partner of the President’s Emergency Plan for AIDS Relief), and malaria (through development of core interventions of the President's Malaria Initiative).

Global Health Security[edit]

As a result of a 2012 CDC proposal and in collaboration with partners, in 2014 the US Government launched the Global Health Security Agenda to accelerate progress toward a world safe and secure from infectious disease threats.[81] CDC and partners currently work with more than 70 countries to develop health systems that prevent avoidable epidemics, detect threats early, and respond rapidly and effectively.[82]

Winnable Battles[edit]

In 2010, CDC identified six “winnable battles” against high-burden public health issues for which progress is possible but not ensured: tobacco, teen pregnancy, nutrition and food safety, healthcare-associated infections, HIV, and motor vehicle safety. CDC and partners have made progress, although are not on track to meet all of the ambitious targets.[83]

Tobacco control[edit]

Rates of cigarette smoking among adults and youth are at all-time lows, with 10 million fewer smokers in 2015 than in 2009. CDC’s Tips from Former Smokers campaign,[84] the first paid, national tobacco education campaign, has helped at least 400,000 Americans quit smoking since the campaign began in 2012, and is highly cost effective.[85]

Opioid abuse and overdose[edit]

Rates of opioid prescriptions have quadrupled since 1999, causing an epidemic of addiction, overdose, and death;[86] this epidemic has evolved to include heroin and illicitly produced fentanyl. In 2016, CDC released a guideline on opioid prescribing for chronic pain for primary care providers; drastic improvements in management of both pain and addiction are needed.[87]

Million Hearts[edit]

CDC worked closely with the Centers for Medicare and Medicaid Services on the Million Hearts initiative,[88] which set a goal of preventing a million heart attacks and strokes in five years through public heath action to reduce smoking, sodium consumption, and artificial trans fat use, and in clinical settings to improve aspirin use, smoking cessation, and management of hypertension and cholesterol.[89] Although the initiative is likely to reach more than half of this target, preventing more than 500,000 cardiovascular events by 2016, it is not likely to reach the one million mark.


Publications[edit]

Awards[edit]

References[edit]

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External links[edit]

Awards and achievements
Preceded by
Neal L. Cohen
New York City
Department of Health and Mental Hygiene
Commissioner

2002–2009
Succeeded by
Thomas A. Farley
Preceded by
Monique Dixon
Diana Reyes
NY1's New Yorker of the Year Succeeded by
Common Cents