The Next Attack on CDC Could Be Even Worse

Who will prevent Americans from drowning?

Ordinarily, I post only once a week, but this is an emergency.

The CDC firings and budget cuts are stupid, they’re destructive, and they’ll lead to unnecessary deaths of Americans. Just for starters, it is beyond cruel to eliminate the units that combat our #1 killer (smoking) or that prevent lead poisoning of children. But I’m terrified that Kennedy’s next step will be even worse.

To explain, I have to trot out an overused parable. Please forgive me if you’ve already heard some version.

The Parable

An internist and an epidemiologist take a hike in the woods. Walking alongside a creek, they hear a faint cry for help and spot a body floating in the water. The internist leaps in, pulls the victim out of the creek, does CPR, and revives him. A few minutes later, as the internist is still catching his breath, the two spot a second body floating down the creek. The internist jumps in the water again, pulls out the second victim, and revives him with CPR too. The epidemiologist just watches.

Soon a third body appears in the creek. The internist, now exhausted, turns to the epidemiologist - only to find him walking away. “What the hell are you doing?” the internist yells. “Aren’t you going to help me?” The epidemiologist says over his shoulder, “I’m going upstream to find out why they’re falling in.”

That’s what CDC does. It goes upstream. It finds out – that is, uses science to learn what is causing people to fall from health into the stream of sickness. And then it takes action – does something to prevent people from falling in.

For the epidemiologist in the parable, taking action could mean installing a warning sign or a guard rail on the slippery slope above the creek, or it could mean calling the police to arrest the person who’s pushing people into the creek. For CDC epidemiologists, taking action can mean issuing recommendations to individuals on what food not to eat or what vaccines to get, or it can mean asking enforcement agencies to ban dangerous products or put up barriers around toxic waste sites.

Services vs. Prevention

The internist is providing services, and the epidemiologist is preventing illness. Neither of these actions can substitute for the other. As a society, we should do both. But, by constantly responding to cries for help, we tend to provide services at the expense of prevention.

Even in government, I’ve found that many don’t understand the concept of prevention. Many left-leaning folks there seem to think the only purpose of government is to provide services to people who are overlooked or mistreated by the private sector. Too many times, working in public health agencies, I’ve been asked, “how many people did you serve last year?” I’ve never known how to respond. Is closing a restaurant to prevent salmonella infections “serving people”? If so, how many?

Even when they are understood, preventive actions are rarely popular. The internist in the parable may be hailed as a hero for saving drowning people. He should be. But the public health practitioner who installs a guardrail to prevent people from falling into the creek is more likely to be called an anti-freedom bureaucrat. Not that I’m complaining. (Ok, I am complaining.) But the larger point is that because preventive actions are unpopular, even people in government tend to resist them.

As a result, in government, the gravitational pull toward responding to problems by only providing services can be overwhelming.

The Disaster of Transferring CDC to AHA

What does this have to do with Kennedy’s plans? Last week the Associated Press reported that most CDC units will be transferred into Kennedy's new Administration for a Healthy America (AHA). The units involved would be the centers responsible for environmental health and for prevention of chronic diseases, injuries, birth defects, and maybe even HIV, other sexually transmitted diseases, and viral hepatitis. Internal CDC rumors are that this reorganization is a near certainty and is imminent.

As I wrote last week, AHA is a ludicrous mashup of HHS units, built mainly on the backbone of the Health Resources and Services Administration (HRSA) and the Substance Use and Mental Health Services Administration (SAMHSA). Even setting aside the question of how many CDC staffers would be willing to move from Atlanta to Washington, this reorganization would be an utter disaster.

Moving CDC to HRSA/SAMHSA would be asking agencies that provide services to take on responsibility for prevention. It won’t work.

The explicit mission of CDC is prevention: to “protect people from health threats”. But the mission of HRSA is to provide resources and services for the health care system, and the mission of SAMHSA is to provide services for people with mental illness or engaging in substance abuse.

SAMHSA and HRSA are run by therapists and people who deliver health care services. I’m sure they are caring people who want nothing more than to help others. But they don’t find out the source of health problems, they don’t do science, and they don’t take action on prevention. They are unlikely to have the stomach for preventive steps that are unpopular. Asking HRSA/SAMHSA to oversee prevention would be like asking the internist at the creek to supervise the epidemiologist. That epidemiologist would end up as just one more CPR medic.

Alternatively – and I shudder as I write this - CDC units could be put directly under the control of Kennedy.

Kennedy is correct about this one thing: most of today’s leading killers are not infectious diseases. That means that these CDC units devoted to non-infectious causes of death are especially crucial to our health. The proposed reorganization could mean that there are no longer science-based people preventing heart disease, stroke, diabetes, opioid overdoses, violence, unintentional injuries, or neural tube defects.

If the rumors are true, Congress should stop Kennedy now - before he cleaves CDC in two and leaves it for dead.