The Friedan appointment and the dilemma of public health

Mayor Bloomberg’s health director, Tom Friedan, is off to head the CDC, and it’s not surprising that Obama has selected him. He’s a pragmatist and an innovator, and sometimes he just doesn’t get it—pretty much like Obama himself so far.

Friedan and Bloomberg can be proudest of their take-no-prisoners stance on smoke-free environments, which has become so standard that it’s easy to forget that how unpopular it once was to force people outside of bars and restaurants to light up. But they rammed it through, which was necessary at the time and also a reminder that the two of them tend toward ramming as a modus operandi.

Bloomberg is an arrogant piece of work and likes to get his way, and public health has long suffered from that approach. The way tuberculosis was handled in the early twentieth century is not a noble chapter in the field given the abuses of immigrants and individuals tossed into quarantine with no real concern for their well-being. On the other hand, when TB threatened to take off again 20 years ago, the city went back to fairly Draconian control measures, and the numbers came back down.

We can see the tensions resurface now with the swine flu scare as officials try to decide whether to close schools or shut down other activities in the name of our collective welfare, and few would deny them the powers needed. But there is more sensitivity now to the inevitable tendency to use these powers on the weak and politically unconnected before hitting the big guys.

AIDS provided more lessons. The grassroots movement did a lot to sensitize health officialdom not just to individual rights but also to the public health benefits of taking a humane, cooperative approach and joining forces with representatives of those affected from gay men’s volunteer groups to IV drug user advocates and sex-worker unions. There, Friedan’s record is a mixed bag as the city moves steadily toward mass testing to identify new HIV cases and away from the more complicated issue of how to prevent transmission from occurring in the first place.

That’s where Friedan’s worst error of his tenure occurred, the ridiculous brouhaha he drummed up over the allegedly drug-resistant strain of HIV found in a meth user and trumpeted at a news conference that turned out to be completely untrue. Friedan succumbed to the ‘disease outbreak’ mode so comfortable for public health types, and he looked dumb as shit. But he’ll fit right in at CDC whose approach to AIDS these days leans more toward disease-detection than sexual health promotion. It’s a technician’s response and acquiesces to the country’s ongoing inability to grapple with human sexuality.

Meanwhile, the city’s new anti-smoking campaigns are as tough and uncompromising as ever. They remind us that kicking ass is sometimes a good thing. . . and sometimes not.