What Ails The CDC

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But what really troubles the most vocal critics is their sense that the CDC's devotion to pure science--a long-established mandate to follow the trail of medical evidence wherever it leads--has been sabotaged. AIDS specialists today feel that they are being constrained not to say anything positive about condoms, while others complain that more cash bonuses are being given to administrators than to researchers. "It's the policies and the direction of the institute I'm most concerned about," says Dr. Brad Woodruff, an epidemiologist in the organization's Maternal and Child Nutrition Branch. Woodruff is particularly incensed that the agency's new jet, which is supposed to be for medical emergencies, was used by HHS Secretary Mike Leavitt to make promotional appearances on behalf of President Bush's Medicare drug plan.

The centerpiece of Gerberding's reorganization was her decision to replace the agency's 11 often insular centers with four coordinating bodies that would, in theory, respond to emergencies with more agility. Closer contact between infectious-disease and environmental experts, Gerberding says, has already resulted in faster tests for detecting botulism.

But some within the agency complain that the main difference they have seen so far is that their work is more likely to be second-guessed. "Scientists feel less empowered to make decisions," says Dr. Stephen Cochi, who has worked at the CDC for 24 years, currently in the Global Immunization Division. "There's more bureaucratic filtering." Decisions that were routinely made in Atlanta, he and others say, must now be approved by higher-ups in Washington. Requests for anything but emergency travel have to be made 90 days in advance.

As in so many other internecine battles, it can be hard to tell where the whining stops and the real problems begin. The CDC was due for a major overhaul, and it's human nature--even among scientists--to resist change. What started off as hallway grumbling, however, has grown into an ugly public ruckus, thanks to an unofficial employee blog www.cdcchatter.net and a few well-directed Freedom of Information requests from the Atlanta Journal-Constitution.

Through it all, Gerberding has stood firm. "The CDC was not broken," she says. "The reason to undergo this [reorganization] is that the world was changing so dramatically." As for charges of political interference, she is unapologetic. "This is a public-health agency, and by its very nature, we're never going to satisfy every single constituency," she says candidly. "I tell [Administration officials] this is the science. This is the recommendation. What they do with it is beyond my control."

Not everybody blames Gerberding for the turmoil. "I don't think anyone denies that there's a morale problem at the CDC," says Dr. Georges Benjamin, executive director of the American Public Health Association. But he attributes much of the upheaval to government-wide belt tightening rather than to Gerberding's reorganization, noting that core programs at the CDC have been cut 4.5% in each of the past two fiscal years. He and other experts believe that the agency needs at least $15 billion a year to do all the jobs it has been assigned--nearly twice the current budget of $8.5 billion.

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