CDC Reorganizes, Science and Policy Rumble

Hero Holding the Beacon for LeanderThe tension between science and policy at CDC is inevitable. But that tension has never been in plain view more than during the COVID-19 pandemic. And so, citing a “botched” response to the pandemic, CDC director Rochelle Walensky says that she will launch a sweeping reorganization of the agency.

Her announcement was thin on specifics. But two things are clear enough. She intends for the agency to respond more quickly in public health emergencies. At the same time, she intends for it to be more accoutable to the public.

So it’s not extremely likely that the tension between science and policy will diminish at CDC because of this. If anything, that tension may rise.

Acting Faster

Though the news of Walensky’s plan to reorganize offers few specifics, the priority is clearly to act quickly and authoritatively. To get new information out more quickly, the agency will rely more on preprints to get information out without waiting for peer reviews.

But it’s worth remembering that preprints come with a number of issues. For example, it was through a preprint that the world first learned of the possibility of using hydroxychloroquine to treat COVID. It turned out to be a false lead, but killing the misinformation that it spawned was challenging to say the least. Jonathan Swift summed up the problem centuries ago:

“Falsehood flies, and the truth comes limping after it, so that when men come to be undeceived, it is too late. The Jest is over, and the tale has had its effect.”

First and Right

We have our doubts that opening the floodgates on unvetted data will solve the CDC’s challenge. After all, CDC has long said that in a health crisis, the agency must “be first, be right, and be credible” in its communications.

To be right and be credible means that the agency must discern the truth of any health problem. That includes the importance of recognizing the limits of available knowledge – not jumping on presumptions and hunches as if they are the same as truth. Because if speed comes at the expense of accuracy, then credibility will inevitable suffer.

Discerning and Constructive

None of this is to say that the agency cannot act decisively. This is where a clear separation between policy and science can be helpful. There is always a leap of faith when we translate finite scientific knowledge into policy.

For decades now, CDC has made that leap in forming policies to address obesity. But what the agency has failed to do is to be clear about the limits of our knowledge about this chronic disease. Instead, they offer false assurances that “we know what works” to overcome obesity. We need less of this.

Be first, be right, and be credible is good advice from the CDC and for the CDC. We hope the agency will follow its own advice.

Click here, here, here, and here for more on the CDC reorganization and the challenges it faces.

Hero Holding the Beacon for Leander, painting by Evelyn De Morgan / WikiArt

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August 18, 2022

6 Responses to “CDC Reorganizes, Science and Policy Rumble”

  1. August 18, 2022 at 6:43 am, Joe Gitchell said:

    Thank you for this analysis, Ted–really helpful and agree with your conclusions. Director Walensky faces a lot of very tough challenges, immersed in tradeoffs.

    Betraying my biases, I would hope that CDC might also learn some lessons from their efforts around EVALI. For more on this, see this story from Marc Gunther: https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187.

    Joe

    Disclosures
    My employer, PinneyAssociates, provides consulting services regarding tobacco harm minimization and vaping products to JUUL Labs, Inc, on an exclusive basis. I also own an interest in a nicotine gum that has not been developed nor commercialized.

  2. August 18, 2022 at 8:45 am, John DiTraglia said:

    The COVID thing was a steep learning curve that is still evolving. Even the smartest, quickest and most circumspect was bound to have issues on top of politics by the lunatics.

  3. August 18, 2022 at 9:01 am, Elizabeth Anderson-Hoagland said:

    I too agree that the CDC’s motto of get it right the first time is important to build trust.

    But in reply to Joe Gitchell, a not insignificant number of EVALI cases were in vaping products made with nicotine. Perhaps off-brand or black market products yes, but until further information came in it would have been malfeasance to claim that nicotine-containing products were safe. The first case in my state was from a nicotine-alone product.

    • August 18, 2022 at 12:41 pm, Ted said:

      I agree with you, Elizabeth. A quick, careful response is important.

      But it also becomes important not to promote a moral panic about vaping when better information is available. The EVALI acronym, which CDC still uses, seems to promote the misperception that e-cigarettes are dangerous and no better than smoking, if not worse.

      https://medium.com/the-great-vape-debate/the-cdcs-evali-screwup-ff09f4c3e187

  4. August 18, 2022 at 11:43 am, Joe Gitchell said:

    Thank you for noting this point, Elizabeth, and I agree with you that it was reasonable to guide with a blanket “avoid all vaping” message early in that outbreak.

    The questions remain, however: when did it stop being reasonable, and even now does CDC’s messaging convey the right information to the right people? And these answers are very relevant to the ” be credible” part of CDC’s objectives.

    If you’re game, I’d be happy to find a time to chat more. I do think that this is still really important from a trust/credibility perspective.

    Thank you.

    Joe

    Disclosures
    My employer, PinneyAssociates, provides consulting services regarding tobacco harm minimization and vaping products to JUUL Labs, Inc, on an exclusive basis. I also own an interest in a nicotine gum that has not been developed nor commercialized.

  5. August 19, 2022 at 6:17 am, Joe Gitchell said:

    And for those who still haven’t had enough context around CDC, nicotine, and health communications (and trust), please see this detailed twitter thread from Mike Pesko, a professor of economics at Georgia State University. He had originally sent it in December of last year but re-upped this morning and it fits.

    https://twitter.com/mikepesko/status/1468932559098757127

    Joe

    Disclosures
    My employer, PinneyAssociates, provides consulting services regarding tobacco harm minimization and vaping products to JUUL Labs, Inc, on an exclusive basis. I also own an interest in a nicotine gum that has not been developed nor commercialized.