In late December, Effect Measure reacted to former CDC director Dr. Julie Gerberding’s hiring as President of Merck Vaccines. With customary cogency and insight, Revere addresses the problem of the so-called Revolving Door.
At The Great Beyond, Daniel Cressey notes that Dr. Gerberding, while at CDC, was accused of promoting the Bush Administration’s agendas at the cost of scientific accuracy. Naturally, now that she is heading for Merck, many are concerned about what looks like a cozy relationship between official agencies and pharmaceutical companies.
Merck says that its vaccine arm is worth $5 billion. It “markets vaccines for 12 of the 17 diseases for which the U.S. Advisory Committee for Immunization Practices currently recommends vaccines,” according to the company’s press release.
Dr. Gerberding was close to the vaccine world as head of CDC. In fact, during her tenure there CDC’s Advisory Committee on Immunization Practices (ACIP) called for the implementation of immunization against human papillomavirus and varicella zoster (chicken pox) virus and the agency pushed for expanded immunization against seasonal flu; within 10 months of her (January ’09) departure from CDC, the ACIP had issued recommendations for the use of anthrax vaccine and Cervarix and Gardasil vaccines against HPV. Gardasil is a Merck product.
But the problem is more than the “revolving door” metaphor implies. To have a door there must be a wall — a clear demarcation between inside and out. As if corporations (pharmaceutical companies among them) were outside of the official system, eager to get the ear of those inside.
Whereas it seems that there isn’t really much of a wall between official health agencies and big business at all. To be an official today means taking a veritable oath of loyalty to corporate solutions. The official has to deal in risk. She has to be ready to sell risk as a kind of debt: people should want to avoid risk, just as they avoid debt; but if their behaviors put them “at risk,” they can relieve it through “lifestyle” correction. You can refinance if you know how.
The correction that allegedly relieves risk usually involves the use of better products. Cut out trans fats, lower your cholesterol, elevate your mood, hop on a treadmill, lose weight, drink responsibly, get seasonal flu vaccine, get swine flu vaccine, wait patiently while the full-body scanners are used at the airport, eat more vegetables, wear sunblock, use hand sanitizer. Health officials’ job is to get the means for personal risk reduction to the sorry at-risk population. Have hand-sanitizer dispensers installed in public buildings. Distribute condoms. Publish recipes for healthy meals.
Notably, health officials are not supposed to argue for any of the things that would actually make a difference to the public’s overall health: redress wealth disparities, provide excellent primary care for everyone (including immigrants), or build more decent and affordable housing. When was the last time you heard a health official call for a campaign against poverty?
The official has to pitch personal risk reduction, in other words. She has to be ready to support high-cost, individualized approaches to improving the public’s health — or well-being, which, Dr. Michael Fitzpatrick astutely notes at Spiked!, has replaced health as the main objective of modern Good Works .
Health officials keep faith with the dogma of risk avoidance. Corporations preach risk reduction and peddle the wares by which people can restructure their lives — and avoid risk. The wall separating government policy makers from corporate solutions gets more and more flimsy.
Tags: advertising, epidemics, germs, health department, housing policy, Medicine, moral entrepreneurship, moralism, preparedness, swine flu, trans fat.
This entry was posted on Friday, January 1st, 2010 at 9:43 am and is filed under Ethics, Health Professions, public health, Risk. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.
Hello, Philip Alcabes:
I served as a science administrator in the CDC after a career as an academic research professor working on behavior change interventions for health and safety. My perspective on people like Gerberding changed enormously after the move from academe to government. Outsiders have no idea how the Federal government operates and tend to employ analysis techniques that rival the fever swamps of Oliver Stone’s imagination writing the next movie screenplay. It’s just assumed that when somebody in the government does something with which you disagree that they must be reckless, stupid, ideological, greedy, or imperious. It’s unimaginable that they are just following laws and regulations or doing what pretty much anyone else would do in the same situation.
Julie Gerberding did an outstanding job especially compared to her predecessor and her successor. She took a marginally functional agency and actually made it work. Imagine if she’d been in charge during the H1N1 crisis. Do you think she’d have promised 120 million doses or hyped the danger? She might have saved Secretary Sebelius from herself. Gerberding did a great job of balancing the exquisite dynamic tension between science, democracy, bureaucracy, politics, health, and business. Folks who would criticize her say more about their own zealotry (often conflated with “science”) than anything she’s done.
Of course, as a former Fed who took the oath, everything I say must be considered suspect, right?
This is an excellent blog and I’ll check in again.
Steve
Thanks for your comment, Steve. I appreciate having an insider’s perspective. There’s considerable praise for CDC’s handling of H1N1 in Donald McNeil. Jr.’s piece in today’s NY Times — I wonder what to make of the contrast, disapprobation for Dr. Gerberding on the one side, plaudits for CDC under Dr. Frieden on the other. Anyway, thanks for your insights.
Hello, Philip:
I haven’t read the NYT piece and will operate gladly from your description . . . lots of factors would explain the difference in perspective. I’d guess the NYT guy has favorable prior experience with Dr. Freiden from NYC days. I’d guess the NYT writer likes advocacy oriented Feds as long as the advocacy is in the writer’s direction. Gee whiz, most of the elite press is in the bag for the progressive agenda in health and I think that Dr. Gerberding was too practical and also too good of a public servant for their tastes.
Everyone likes to use government as a hammer when they are the ones holding the hammer. It obviates the need to do any serious thinking about the entire problem. “We know we’re right, now show me the nails.”
Try and get a Fed job for a year. It will change your religion.
Best wishes,
Steve