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Internal Dissension Grows as CDC Faces Big Threats to Public Health

"I would describe it as a kind of Alice in Wonderland environment where the CDC director is like the Queen of Hearts," the senior official said. "You know, 'Off with their heads.' It's a very autocratic and unpredictable environment."

An internal report on the widely publicized statistical mistake in the obesity study found that some scientists had questioned the calculations but did not push their concerns because "they did not feel it would make any difference," because Gerberding was one of the study's authors.

Centers for Disease Control and Prevention Director Julie L. Gerberding, right, denies that the agency is riddled with widespread discontent and demoralization. (David Brown -- The Washington Post)

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By some estimates, nearly 40 top managers have left or are planning to, motivated partly by dissatisfaction with the changes and partly by the coincidence that a generation of CDC officials is becoming eligible for retirement. The result is that many top jobs have been filled by officials in an acting capacity, including five of the CDC's seven long-standing centers plus the National Immunization Program and the newly created National Center for Health Marketing.

The reorganization and departures come against a backdrop of complaints by some that the agency's historical independence has been seriously compromised. The AIDS prevention program in particular has been dogged by controversy, with scientists arguing that too much emphasis was being put on promoting abstinence, instead of condom use and sex education.

"There's an ideological focus that's inconsistent with the science," said Margaret Scarlett, who left the CDC's AIDS program in 2001 after 15 years with the agency. "Political ideology is being substituted for science."

National Academy Criticism

In its report, the National Academy panel said the smallpox vaccine effort fell far short at least in part because the agency failed at answer key concerns about the program's necessity and safety.

"The ability of the Centers for Disease Control and Prevention to speak authoritatively as the nation's public health leader, on the basis of the best available scientific reasoning, was severely constrained, presumably by the top levels of the executive branch," the panel wrote.

Gerberding immediately rejected the critique. In an earlier interview, she had disputed the charges that the agency has allowed politics to influence science, that she has failed to protect the agency from damaging budget cuts, stifled dissent or that any of the problems have hampered the agency's work.

"I think we'll get through this difficult period of change and end up in a situation where we're concentrating on our job, which is to protect people's health," she said.

Gerberding acknowledged that some people may be leaving because they are unhappy with the changes but said there is a new generation of qualified scientists waiting to move up.

"It's very sad to see some of our revered leaders move on," she said. "But it's also an opportunity to bring in newer and younger people. It's healthy sometimes to get new people with new ideas."

Current and former officials disagree on whether the turmoil is affecting the CDC's performance, but one informal analysis circulating inside the agency suggests the number of new research projects and published scientific papers has fallen as retirements have spiked.

Outside authorities were mixed in their assessments.

"The CDC is going through a change that's long overdue," said Michael Osterholm, a leading infectious-disease expert at the University of Minnesota.

Others, while saying they remain highly supportive both of the agency and the need for change, said the depth and duration of the discord was unusual and alarming.

"There's a very intense malaise and demoralization among the CDC staff," said Alfred Sommer, dean of the Johns Hopkins Bloomberg School of Public Health. "The CDC is our thin gray line when it comes to public health, and so you've got to be concerned."

Local, state and national public health leaders said they are especially worried that the reorganization is affecting their ability to work with the agency and that the budget cuts would mean a loss of hundreds of millions of dollars for programs to boost bioterrorism preparedness, immunize children, promote good health habits and fight chronic health problems.

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