BMJ 2017;358:j4233 doi: 10.1136/bmj.j4233 (Published 2017 September
13) Page 1 of
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FEATURE
Brenda Fitzgerald: Trump’s public
health chief wants to
partner with industry
The new head of the US Centers for Disease Control and Prevention has received
praise for obstetrics campaigns, writes Jeanne Lenzer, but criticism
for supporting quackery
and using Coca-Cola’s money to fund anti-obesity programmes
Jeanne Lenzer associate editor, The BMJ, USA
When President Donald Trump named Brenda Fitzgerald as the new director of the US Centers for Disease Control and Prevention in June, several public health officials praised his choice to lead the seminal public health institute.
Georges Benjamin, executive director of the American Public Health Association, commended Fitzgerald, saying she is a “strong choice” to lead the
apex public health agency. His statement read, “From her work as a practising
obstetrician-gynecologist
to her recent service as the commissioner of the Georgia Department of Public Health, Dr Fitzgerald is more than prepared to face the health challenges of our time.”
scientific rigour and ensuring institutional independence from industry—Fitzgerald may not be such a surprising choice.
Bad science
Fitzgerald is a fellow of the American
Academy of Anti-Aging Medicine (A4M),
an organisation that promotes homeopathy, unproved stem cell therapies, plastic surgery, “bio-identical” hormones, and testing saliva and blood to “individualize” therapy with supplements and hormones to stave off ageing.
On her professional website, Fitzgerald informed patients
that she had special
training in the use
of
“bio-identical” hormones and supplements to treat problems such as osteoporosis, “middle
3 4
Others praised her position on abortion because she has said that the choice should be
between a woman and her doctor—although she also has favoured restrictions on government payments for abortions.
As health commissioner of Georgia from 2011 to 2017,
age spread,” sex hormone problems, and general ageing.
Steven Goldstein, a professor
of obstetrics and gynaecology
at the New York University School of Medicine, told Forbes’s reporter Rita Rubin
that he was “shocked” by Fitzgerald’s affiliation with the A4M, calling anti-ageing treatments “snake
5
Fitzgerald helped to reduce the high proportion of elective deliveries that took place before 39 weeks’ gestation in the state. She launched a
campaign to inform healthcare
providers that early elective deliveries led to “an increase in neonatal intensive care admissions, increased antibiotic use, and increased respirator use.” Her campaign led to a drop in early deliveries from 65% of elective
deliveries to just 3%,
and after a new Medicaid exclusion to pay for early deliveries, the rate fell further to 1%.1
Fitzgerald says that she practises what she preaches, “I typically hit the ground running by 6 am. I start with 30
minutes on the treadmill or around my neighborhood. A little sun salutation yoga and then I’m ready for breakfast—and I love
breakfast. A pot of green tea and scrambled eggs with salsa and a slice of avocado are among my favorites.”2
She might seem to be an unlikely
pick for Trump, who relishes fast food; has said that women who have abortions should face punishment; and whose budget plan includes a 17% cut in funding for the CDC.
But a closer look at Fitzgerald suggests that
when it comes to two of the most important tasks of the agency—ensuring
oil” that “plays on people’s worst fears about their mortality.”
In response
to a query from The BMJ about scientific rigour at the CDC, Fitzgerald said, “As director of CDC, I am committed to both science based decisions and [as] a former health commissioner, I also understand
the importance of supporting states and clinicians, who are on the frontlines protecting the health of communities and treating patients, and making sure they have the state-of-the-art health information they need.”
But, Vikas Saini, president of the Lown Institute in Brookline, Massachusetts, told The BMJ that Fitzgerald’s embrace of unproved remedies “raises the risk that one of the world’s leading public health institutions may embrace the growing trend to permit anecdotes and observational data into regulatory decisions, instead of being a
steadfast champion of rigorous science.”
Under
the influence
The CDC has been under fire for accepting industry funding, including from Coca-Cola.6 7 (The agency began “winding down” its ties to Coca-Cola around 2013.) As health
commissioner of Georgia, Fitzgerald was criticised after she accepted $1m (£760
BMJ 2017;358:j4233 doi: 10.1136/bmj.j4233 (Published 2017 September
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000;
€840 000) from Coca-Cola to fund a programme
to reduce childhood obesity that focused on exercise to control weight gain without mentioning the role of fizzy drinks in the child obesity epidemic. Despite earlier criticism,
Fitzgerald has declined to say whether she will reject future funding from the drinks giant, telling the New York Times that she would consider any proposals through the agency’s standard review process.7
Besides Coca-Cola, the CDC is funded by several drug and device manufacturers,8 a practice Fitzgerald defended in her statement to The BMJ, saying, “Public-private partnerships can be
powerful tools that help extend
government’s ability to save lives, solve problems, and speed innovation.”
Saini says that Fitzgerald’s work on reducing elective induction of labour is “important and
laudable,” but he is worried
that her willingness to partner the CDC with industry comprises a clear conflict of private interests with the public interest. This, he says “will continue to reduce trust in our institutions at a time when we need it more than ever.”
Competing interests: I have read and
understood BMJ policy on declaration of interests and have
no relevant
interests to declare.
Provenance and peer review: Commissioned;
not externally
peer reviewed..
1 Fitzgerald B. Improving care for women and infants in Georgia. Georgia Fiscal Management Conference 2014. http://georgiafmc.org/annual%20conference/2014/2014Presentations/ DPHImprovingCare.pdf.
2 Member Spotlight. Brenda Fitzgerald. 2017. http://www.astho.org/StatePublicHealth/ Member-Spotlight-Brenda-Fitzgerald/2-23-17/.
3 Dr Brenda Fitzgerald FAQs. Internet archive. 2010. https://web.archive.org/web/ 20100823214125/http://www.drbfitz.com:80/index.php?pid=23
4 Levitz E. Trump’s CDC pick peddled ‘anti-aging’ medicine to her gynecologic patients.
New York Magazine 2017 Jul. http://nymag.com/daily/intelligencer/2017/07/trumps-cdc- pick-peddled-anti-aging-medicine-to-patients.html
5 Rubin R. New CDC head Fitzgerald
peddled controversial “anti-aging medicine” before
leaving private practice. 2017. https://www.forbes.com/sites/ritarubin/2017/07/09/new- cdc-head-fitzgerald-peddled-controversial-anti-aging-medicine-before-leaving-private- practice/.https://www.forbes.com/sites/ritarubin/2017/07/09/new-cdc-head-fitzgerald- peddled-controversial-anti-aging-medicine-before-leaving-private-practice/
6 Waters R. Trump's pick to head CDC partnered
with Coke, boosting agency's longstanding ties to soda giant. Forbes 2017 Jul 10. https://www.forbes.com/sites/robwaters/2017/07/ 10/trumps-pick-to-head-cdc-partnered-with-coke-boosting-agencys-longstanding-ties-to- soda-giant/.https://www.forbes.com/sites/robwaters/2017/07/10/trumps-pick-to-head-cdc- partnered-with-coke-boosting-agencys-longstanding-ties-to-soda-giant/.
7 Kaplan S. New CDC chief saw Coca-Cola as ally in obesity
fight. New York Times 2017 Jul 22. https://www.nytimes.com/2017/07/22/health/brenda-fitzgerald-cdc-coke.html.
8 Lenzer J. Centers for Disease Control and Prevention: protecting the private good?BMJ 2015;358:h2362. doi:10.1136/bmj.h2362 pmid:25979454.
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