Dr. Anne Schuchat joined the Centers for Disease Control and Prevention the late 1980s after her post-medical school training coincided with the rise of the HIV/AIDS crisis, giving her a firsthand look at a public health crisis.
That epidemic drove a one-year drop in life expectancy in 1993 — something that isn’t supposed to happen in a country like the U.S.
Now Dr. Schuchat, serving her second stint as acting CDC director under President Trump, is the public face of what is shaping into an even bigger health fight: the opioid-driven overdose crisis.
Hoping to turn the tide, the CDC is collecting emergency room data on who is overdosing — and where — to understand the problem and target resources, rather than waiting for death certificates.
Its first data dump, slated for Tuesday, is expected to be a sobering but informative look at the scope of the problem.
Though many prescribers have gotten the message, Dr. Schuchat said, the CDC is working with the Drug Enforcement Administration, private insurers and pharmacy chains to try to root out bad actors and change old habits.
“The pill mill guys — totally terrible,” she said. “But there are everyday people trying to do the right thing who didn’t get trained and then they were told, ‘Well, you’re not treating [pain] well enough,’ so they’re using more and more prescriptions.”
Legions of people got hooked on prescription painkillers in the past two decades. Some of them turned to heroin, which increasingly is cut with fentanyl, a potent synthetic opioid from overseas.
Worse than AIDS
Keith Humphreys, a Stanford University professor who tracks the issue, said the 42,000 opioid-related deaths tallied in 2016 undercounts the problem since coroners don’t always identify specific drugs on death certificates.
The adjusted number was likely 50,000, slightly higher than the roughly 48,000 who died of AIDS at its peak in 1995.
The overdose toll is widely expected to rise in 2017, once data are finalized.
“So opioids alone are worse than AIDS, and all drugs even more so,” Dr. Humphreys said.
Even as it grapples with the opioid crisis, the CDC is winding down one of the worst flu seasons in years. Its scientists on Friday said more than 100 children have died so far. The season may last until mid-April, although outbreaks appear to have peaked and hospital visits are on the decline.
The agency also is helping parts of the U.S. recover from a series of 2017 hurricanes and tracking the lingering effects of the Zika virus on newborns.
Dr. Schuchat said the CDC is undaunted by its hefty workload or the sudden departure of Director Brenda Fitzgerald, who resigned Jan. 31, one day after Politico reported that she had acquired stock in a tobacco company despite the agency’s anti-smoking mission. Dr. Fitzgerald also was unable to divest from older stocks, which created conflicts of interest with her job as director.
Dr. Schuchat returned as acting director — the same position she held at the start of Mr. Trump’s term.
Democrats on the Senate Committee on Health, Education, Labor and Pensions told Mr. Trump that they will be monitoring the selection process for a permanent leader. They want him to pick someone who will put science over ideology and “resolve any and all conflicts of interest so that she or he can fully engage, uninhibited by recusals, on all matters within the CDC’s purview.”
Dr. Schuchat said she doesn’t know when a director might be selected, and she deflected questions about her own prospects for the nomination.
Moving forward, Democrats in Congress want the CDC to take on another major task — gun violence research — after an assailant with a semi-automatic weapon killed 17 students and adults at a high school in Parkland, Florida, last month.
Health and Human Services Secretary Alex Azar recently told lawmakers that it is a topic worth exploring, since a recurring legislative ban known as the Dickey Amendment prohibits gun control advocacy but not research.
“We’re not supposed to lobby; that’s not our job. We’re an evidence-, science-based organization,” Dr. Schuchat said. “Our main issue is we’re not funded to do research.”
The CDC does conduct anti-violence surveillance that overlaps with gun activity — such as rates of domestic violence, suicide and homicides — even if it hasn’t tackled gun violence directly.
Dr. Schuchat said the agency will do the research if money is allocated.
The CDC is still tracking the Zika virus. Only three travelers have brought Zika cases with them to the U.S. mainland so far this year, though the CDC is urging Americans to be wary of local transmission when the weather gets warmer. The mosquito vector hasn’t gone anywhere, and similar viruses, such as dengue, have been known to flare up after dormant periods.
In the meantime, the CDC is continuing to track about 7,000 U.S. women who became infected while pregnant. Some of them gave birth to children with abnormally small heads or other defects. Those children will need follow-up care, though the CDC is tracking those who appeared to be healthy as well.
“It’s a key question of whether they will develop normally or whether there were more subtle effects of the Zika infection,” Dr. Schuchat said.
Credit: The Washington Times