Thomas R. Frieden (born December 7,1960) is an American infectious disease and public health physician. He serves as president and CEO of Resolve to Save Lives,a global initiative working to prevent epidemics and cardiovascular disease. Launched in 2017 as a five-year initiative,it became an independent non-profit organization in 2022.[1][2][3][4][5]
From 1995 to 2001,Frieden worked as a technical advisor for the World Bank,health and population offices.[12] From 1996 to 2002,Frieden worked in India,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.[22][23][24][25] The program's 2008 status report estimated that the nationwide program resulted in 8million treatments and 1.4million lives saved.[26] While in India,Frieden worked to establish a network of Indian physicians to help India's state and local governments implement the program[27] and helped the Tuberculosis Research Center in Chennai,India,establish a program to monitor the impact of tuberculosis control services.[28][29]
New York City Health Commissioner,2002 to 2009
Frieden served as Commissioner of Health of the City of New York from 2002 to 2009. At the time of his appointment,the agency employed 6,000 staff and had an annual budget of $1.6billion.[30]:8 During Frieden's tenure as Commissioner,the Health Department expanded the collection and use of epidemiological data,[31] launching an annual Community Health Survey[32] and the nation's first community-based Health and Nutrition Examination Survey.[33][34]
New York City's life expectancy at birth increased by 3 years,from 77.9 years in 2001 to 80.9 years in 2010,a faster increase than the national average.[35]
Tobacco control,2002 onward
Upon his appointment as Commissioner of Health,Frieden made tobacco control a priority,[36] resulting in a rapid decline[37] 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,ban smoking in workplaces including restaurants and bars,and run aggressive anti-tobacco ads and help smokers quit.[38] The program reduced smoking prevalence among New York City adults from 21% in 2002 to 17% in 2007 which represented 300,000 fewer smokers.[37][39] 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.[40] The workplace smoking ban prompted spirited debate before the New York City Council passed it and Mayor Bloomberg signed it into law.[41] Over time,the measure gained broad acceptance by the public and business community in New York City.[42][43] New York City's 2003 workplace smoking ban followed that of California in 1994. Frieden supported increased cigarette taxes as a means of reducing smoking and preventing teens from starting,saying "tobacco taxes are the most effective way to reduce tobacco use."[30]:23–38 He supported the 62-cent federal tax on each cigarette pack sold in the United States,introduced in April 2009.[44] 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".[45] 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".[46]
Waiving written consent for HIV testing,2004
Frieden introduced the city's first comprehensive health policy,Take Care New York,which targeted ten leading causes of preventable illness and death for public and personal action.[47][48] By 2007,New York City had made measurable progress in eight of the ten priority areas.[49]
As Health Commissioner,Frieden sought to fight HIV and AIDS with public health principles used successfully to control other communicable diseases.[50] A very controversial aspect was the proposal to eliminate separate written consent for HIV testing. He believed the measure would encourage physicians to offer HIV tests during routine medical care,[51] as the CDC recommended.[52] Some community and civil liberties advocates fought this legislation,arguing it would undermine patients' rights and lead eventually to forced HIV testing.[53][54] In 2010,New York State passed a new law that eased the requirement for separate written consent in some circumstances.[55] Frieden's perspective is now widely accepted,[56] and on February 14,2007,the New York City Department of Health and Mental Hygiene introduced the NYC Condom,[57][58] prompting Catholic League president Bill Donohue to respond,"What's next? The city's own brand of clean syringes?"[59] More than 36million condoms were given away by the program in 2007.[60]
Diabetes test result reporting,2006
Frieden worked to raise awareness about diabetes in New York City,particularly among pregnant women,[61] and established an involuntary,non-disclosed hemoglobin A1C diabetes registry which tracks patients' blood sugar control over several months and reports the information to treating physicians to help them provide better care.[62][63]
The New York City Board of Health's decision[64] to require laboratories to report A1C test results generated a heated debate among civil libertarians,who viewed 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.[65][66]
Transfat plan,2006
In September 2006,the city proposed to restrict trans fat served in New York restaurants.[67][68][69] New York City's trans fat ban followed mandatory labeling of trans fat by the Food and Drug Administration (FDA),was credited with saving lives and preceded by more than a decade the FDA's action to ban trans fat from food throughout the United States.[70]
CDC Director,Agency for Toxic Substances and Disease Registry Administrator,2009–2017
On announcing Frieden's appointment,President Obama called him "an expert in preparedness and response to health emergencies" who in seven years as New York City's health commissioner was "at the forefront of the fight against heart disease,cancer and obesity,infectious diseases such as tuberculosis and AIDS,and in the establishment of electronic health records."[8]
Ebola epidemic,2014
Frieden is decontaminated after visiting Ebola treatment unit in Liberia,August 2014
Frieden was prominently involved 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 could increase exponentially to infect more than 1million people within four months[73] prompted him to press for an international surge response.[74] At the peak of the response,CDC maintained approximately 200 staff per day in West Africa and about 400 staff per day at its Atlanta headquarters;overall,about 1,900 CDC staff deployed to international and U.S. locations for about 110,000 total work days,and more than 4,000 CDC staff worked as part of the response.[75] In a Congressional hearing in October 2014,Frieden was asked about his handling of the Ebola crisis after the disease had spread to two nurses from a patient in the US.[76] The day prior,Rep. Tom Marino (R-PA) had called for Frieden's resignation,[77] though others rallied to his defense.[78][79]
During Frieden’s tenure as CDC director,he identified “winnable battles”:tobacco use,teen pregnancy,HIV,healthcare-associated infections,nutrition and physical activity,and motor vehicle fatalities. Tobacco use decreased from 21% to 15%,teen pregnancy decreased,three of four targeted healthcare-associated infections decreased,one of two targeted foodborne infections decreased,breastfeeding at six months increased,and motor vehicle fatalities decreased. There was little or no progress reducing childhood obesity,catheter-associated urinary tract infections,or foodborne illness from Salmonella.[80] A Public Health Associate Program trained new public health specialists at state and local health departments.[81] Frieden called antimicrobial resistance “a threat to our economic stability and to modern medicine”[82] and drew attention to the overprescription of and increase in deaths from opioids[83] and oversaw a controversial CDC on prescribing practices.[84] The guideline was criticized for resulting in excessive restrictions on opioid prescribing;critiques were at least in part the result of opioid industry influence.[85]
Resolve to Save Lives
In 2017,Frieden started leading an initiative called "Resolve to Save Lives" to prevent cardiovascular disease and epidemics.[86] The effort is funded by Bloomberg Philanthropies,the Chan Zuckerberg Initiative and the Bill &Melinda Gates Foundation.[87] Proposed strategies are being tried in various countries [88][89] including India,[90] China,[91] and Nigeria.[92] These strategies include working with the World Health Organization to eliminate trans fat,[93][94][95] reduce salt consumption worldwide.[96][97] and scale up treatment for high blood pressure. The salt reduction effort is controversial,with some scientists stating that lower sodium intake may harm some people.[98][99] The initiative also works to make countries better prepared for epidemics and have funding to fill preparedness gaps.[100][101][102]
Frieden appeared widely in US and global media during the COVID-19 pandemic and became a leading voice sharing science-based analysis of the pandemic via Twitter,while advocating for increased pandemic preparedness,vaccine equity,and stronger public health systems.[103][104] He appeared on many news shows including The Today Show,CBS News,CNN,PBS,Good Morning America,BBC World News,MSNBC,[105][106][107][108][109][110] and was quoted in The New York Times,[111] The Wall Street Journal,[112] The Washington Post,[113] STAT,[114] The Hill,[115] and published articles in leading outlets including on pandemic preparedness,[116] global health security,[117] primary health care,[118] and cardiovascular health.[119] Frieden's op-eds on the pandemic were published in The New York Times,[120] The Wall Street Journal,[116] The Washington Post,[104] and Foreign Affairs.[121]
Frieden argued against both broad-based lockdowns [122] and school closures [123] and supported mask use,[124] selective indoor closures when hospitals were overwhelmed pre-vaccine,and COVID-19 vaccination.[125] In March 2020,he warned that COVID-19 could kill one million Americans;[126] the U.S. death toll exceeded one million by 2022.[127]
Frieden co-authored a commentary with Former CDC Directors Jeffrey Koplan,David Satcher,Julie Gerberding,and Richard Besser calling for public health to lead the response to the pandemic,and for a reform of the CDC and US public health system.[128][129] Frieden identified CDC errors during the COVID-19 pandemic and joined other former directors to support a more robust CDC [130] and resist calls to dismantle the agency.[131] He suggested ways forward to rebuild trust in and effectiveness of public health,including the need to improve disease tracking systems,minimize mandates,and make progress on issues that matter to communities.[132] He has argued that the main lessons of the COVID-19 pandemic are the need for a public health renaissance,robust primary health care,and resilient individuals and communities.[133]
In April 2022,Frieden led the transition of Resolve to Save Lives to become an independent,U.S.-based not-for-profit organization after five years of rapid expansion incubated at Vital Strategies.[5]
Working with the World Health Organization,Resolve to Save Lives partnered with countries to expand trans fat bans to more than 40% of the world population.[5][134][135] It is estimated that these bans will save millions of lives.[136][137] Frieden has noted that cardiovascular disease kills far more people than Covid,and called for more action to reduce its three leading preventable causes:tobacco use,hypertension,and air pollution.[138] Resolve to Save Lives supports treatment of hypertension and diabetes,[139] and created Simple,an app to improve care of patient care.[140] The organization has highlighted unsung successes in public health,including Epidemics That Didn't Happen,[141] and proposed a global target[142] to reduce the risk of the next pandemic,7-1-7:[143] 7 days to find every outbreak,1 day to report it to public health,and 7 days to have all essential control measures in place.[144][145] The 7-1-7 target has been adopted by the World Health Organization [146] and more than two dozen countries [147] and can accelerate improvements in preparedness.[148]
Public Health Concepts and Advocacy
Frieden developed the "Public Health Impact Pyramid," an influential framework that organizes public health interventions from societal changes to individual counseling based on their population impact and effort needed.[149][150] His work in public health analytics has emphasized the importance of using multiple forms of evidence beyond randomized controlled trials. Building on work by Nobel Laureate Angus Deaton and others,he has argued that although trials provide valuable evidence,other study designs may better answer some public health questions.[151] In global health policy,Frieden has advocated for restructuring World Bank health spending,[152] eliminating cholera as both an immediate priority and preparation for future pandemics,[153] and developing epidemic-ready primary health care systems.[154] He has also called for more aggressive responses to emerging threats such as avian influenza.[155]
In 2018,Frieden faced misdemeanor charges of forcible touching,third-degree sexual abuse and second-degree harassment.[160][161] All charges were dropped. He pled guilty to disorderly conduct.[162][163][164]
Frieden, Thomas R.; Berwick, Donald M. (September 29, 2011). "The 'Million Hearts' Initiative — Preventing Heart Attacks and Strokes". New England Journal of Medicine. 365 (13): e27. doi:10.1056/NEJMp1110421. PMID21913835.
Radhakrishna, S; Frieden, TR; Subramani, R; Santha, T; Narayanan, PR; Indian Council of Medical, Research. (March 2007). "Additional risk of developing TB for household members with a TB case at home at intake: a 15-year study". The International Journal of Tuberculosis and Lung Disease. 11 (3): 282–8. PMID17352093.
Frieden, TR (March 2005). "Tuberculosis control: critical lessons learnt". The Indian Journal of Medical Research. 121 (3): 140–2. PMID15802753.
Frieden, Thomas R. (October 16, 1996). "A Multi-institutional Outbreak of Highly Drug-Resistant Tuberculosis". JAMA. 276 (15): 1229–35. doi:10.1001/jama.1996.03540150031027. PMID8849750.
↑ Begun, James; Malcolm, Jan (2014). Leading Public Health: a Competency Framework. New York: Springer Publishing Company. ISBN9780826199072. OCLC881417295.
↑ Narayanan, P.R.; Garg, R.; Santha, T.; Kumaran, P.P. (2003). "Shifting the Focus of Tuberculosis Research in India". Tuberculosis. 83 (1–3): 135–142. doi:10.1016/S1472-9792(02)00068-9. PMID12758203.
1 2 Farley, Tom (2015). Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives. New York: W.W. Norton. ISBN978-0393071245.
↑ "Cause of Death or Illness, New York City, 2002, and Amenability to Intervention". Take Care New York: A Policy for a Healthier New York City. New York City Department of Health and Mental Hygiene. March 2004. pp.57–61. CiteSeerX10.1.1.694.662.
↑ Steinbrook R. (February 2006). "Facing the Diabetes Epidemic – Mandatory Reporting of Glycosylated Hemoglobin Values in New York City". New England Journal of Medicine. 354 (6): 545–548. doi:10.1056/NEJMp068008. PMID16467539.
↑ Bloomgarden ZT (2006). "A1C in New York City". Medscape Diabetes & Endocrinology. Retrieved February 1, 2017.
↑ Steenhuysen J (December 30, 2016). "More work lies ahead to fight Zika, other threats: CDC chief". Reuters. Retrieved July 23, 2019. Frieden, appointed by President Barack Obama to run the CDC in 2009, will hand in his resignation on Jan. 20, the day of President-elect Donald Trump's inauguration.
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