By David Montgomery
Washington Post Staff Writer
Wednesday, April 29, 2009
Tall and camera-ready, Richard E. Besser resembles someone who is not a doctor but plays one on television. Except that he is a doctor who right now must also play one, while some of us are washing our hands 20 times a day to ward off the new incarnation of swine flu.
Besser is acting director of the Centers of Disease Control and Prevention in Atlanta. Such aplomb: He is a scientist who has mastered the healer's delicate art of simultaneously projecting deep concern and profound calm, telling national audiences to worry but not to worry.
Is he worried? What does he think is going to happen?
"Outbreaks don't follow the plan we lay out for them," Besser says in a phone interview.
In other words, he knows what he doesn't know. And that's reassuring, somehow. Maybe it's a tone-of-voice thing.
He has been bringing his well-groomed, unflappable bedside manner to the morning network shows and the evening cable shows. News briefings are sandwiched at midday. Meanwhile he monitors the course of the disease, consults with state and federal officials, plans for vaccine development and calibrates the CDC's response -- which he always characterizes as "very aggressive" and "bold."
In these television encounters, the news anchors inevitably approximate the role of the anxious parent, while Besser plays the reassuring -- but not too reassuring -- family doctor who soothes without sugarcoating. He is 49 -- old enough to be a little paternal (he's married with two sons) and young enough to adapt to a crisis so unpredictable that it makes a hurricane look like a church service.
"The things we learned when we were little -- covering a cough, frequent hand-washing -- if people do these things it will decrease the spread," he says.
"Is it an emergency or not?" Diane Sawyer persists, her voice rising edgily, furrowing her brow on ABC.
"I want people to understand we are concerned," Besser says with great empathy. "We'll tell you what we know when we know it, and we're being very aggressive at trying to understand and control this outbreak. . . . People need to be ready for the idea that we could see more severe cases in this country, and possibly deaths."
Besser has been in the hot seat at the center of one disaster or another going all the way back to his "disease detective" days at the CDC in the early 1990s, when he tracked apple cider laden with E. coli that was making people sick around Boston. One word describes what his job requires him to be: ready.
In 2005, on the morning he started his last job -- the CDC's head of emergency response -- Hurricane Katrina hit Louisiana.
In the eerie way one emergency can foreshadow another, the CDC's post-Katrina report said the hurricane experience helped the agency "prepare for the world's worst potential infectious-disease emergency: pandemic influenza."
This is no pandemic yet, but once again, Besser is on the case.
"You learn how to talk to people in a setting of crisis, and not be overly reassuring," he says. "You try to empower people" -- with information -- "and by empowering them you allow them to channel that concern."
Most doctors handle patients one at a time. Besser takes them on by the hundreds, the thousands, the . . . well, one does not want to speculate.
He also still treats pediatric patients as a volunteer in a clinic in Atlanta a couple of times a week. He was giving a physical exam to a teenager in January when he got word he was being elevated to acting CDC director from his career civil service post. He was to keep the director's chair warm until Tom Daschle could be confirmed as secretary of health and human services and name his own CDC chief. Daschle's nomination fell through. Kathleen Sebelius was confirmed yesterday, and she will pick someone. Maybe him, maybe not. Right now he has bigger things to worry about.
He has followed a winding career path from economics major at Williams College to pediatrician in Baltimore to the upper ranks of the nation's health disaster team.
After college, he traveled the world for a year and "became sensitized to the enormity of global health disparities," he said in a 2005 employee profile published by the CDC. He received his medical degree from the University of Pennsylvania in 1986. After a pediatric residency at Johns Hopkins, he took a job for a year in Bangladesh at a diarrheal disease research center, and learned about "epidemic intelligence" -- or disease detective work.
"It clicked," Besser says. "I knew what I wanted to do."
Ready: Two years ago Besser gave a speech in Oklahoma City about public health, where he warned against complacency.
"We've been talking about a potential pandemic of influenza for several years," he said. "Well, it hasn't come yet, and as I give talks around the country, people say, 'Whatever happened to that bird flu?' Well, it's still out there. We're still watching."
Staff research director Lucy Shackelford contributed to this report.
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