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Who is Dr. Richard E. Besser?
The Obama administration appointed 6’6” Richard Eric Besser, M.D., acting director of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, on January 23, 2009. He replaced Julie Gerberding, M.D., who led the cantankerous centrifugal federal agency for six years. William Gimson III, the agency’s chief operating officer, was the original choice to succeed Dr. Gerberding, but “people familiar with the agency said Dr. Besser was named instead because Mr. Gimson [was] not a medical doctor, a qualification considered important to head the public health agency even temporarily.” (1-2) The designation of Dr. Besser as acting director of CDC is “effective until a permanent CDC director is appointed and enters on duty,” noted a U.S. Department of Health and Human Services (of which CDC is a unit) report. (3)
Dr. Besser represented the CDC at the Sunday, April 26, 2009, White House press briefing at which federal officials declared a national public health emergency because of the current swine influenza outbreak in several states of the USA. (4) A representative from the U.S. Department of Health and Human Services (DHHS) was not at the press conference. Charles E. Johnson, a public accountant by background, former President George W. Bush appointee, and former chief financial officer of DHHS, is currently serving as acting secretary of DHHS. Kathleen Sebelius, currently governor of Kansas, has yet to be confirmed as DHHS secretary. (5) Meanwhile, “[t]he White House brushed off questions about whether a lack of top health officials was making more difficult President Barack Obama’s response to a swine flu outbreak.” (6)
Richard E. Besser received his Bachelor of Arts degree in economics from Williams College in Williamstown, Massachusetts. (7) His background before college has not yet emerged. Following graduation from college, Dr. Besser “spent a year traveling around the world, primarily in Southern and Southeast Asia,” where “he became sensitized to the enormity of global health disparities.” (8) He then attended medical school at the University of Pennsylvania School of Medicine, followed by a residency in pediatrics at the Johns Hopkins Hospital, Baltimore, Maryland (circa 1988-1991).
Following completion of his pediatric residency, he took a job (now long is not specified) in the megacity of Dhaka (about 7 million people), the capital of and largest city in Bangladesh, at the International Centre for Diarrhoeal Disease Research, a non-governmental organization (NGO) established in 1978. There he worked on a polio vaccine study and gained intensive experience in “the management of diarrheal diseases including cholera.” (8-9) “The Centre has a cross-cultural environment with 95% local Bangladeshi staff including researchers, medical officers, administrators, and health workers, and 5% international staff primarily from academic and research institutions engaged in global health research.” (10) Dr. Besser first learned about the Epidemic Intelligence Service (EIS) headquartered at the CDC in Atlanta, Georgia, while spending time with an EIS officer performing a rapid health assessment in a refugee camp in Bangladesh. (8,11) Founded in 1951, the EIS is “a two-year, post-graduate program of service and on-the-job training for health professionals interested in the practice of epidemiology,” says its website. “Since 1951, more than 2,700 EIS officers have responded to requests for epidemiologic assistance within the US and throughout the world.” The program accepts 70-80 persons to enter its program each year, who then “play a major role” in the implementation of CDC’s various missions. (11)
Dr. Besser states he completed a pediatric chief residency also at Johns Hopkins Hospital and then matriculated in the EIS program at CDC. He did not remain with the CDC, however, after completing the two-year program. Instead, he moved to the University of California, San Diego, Medical Center, where he accepted a job as director of the combined internal medicine and pediatric residency program and an appointment as associate professor of pediatrics. (12) He also worked with the local San Diego public health department to help control tuberculosis and became board certified by and fellow with the American Academy of Pediatrics. (13) He remained in San Diego for five years, he says, and then left, noting, “Although this was a wonderful time in my life, I missed CDC and the opportunity to work at a national level on public health issues.” (8) In 1991, Dr. Besser was again at CDC, this time as an EIS officer in the Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (NCID). The NCID has since morphed to the “Enteric Diseases and Epidemiology and Laboratory Branches” subsequent to a CDC reorganization. (14-15) Besser’s claim to fame during his employment in this unit was to identify fresh-pressed apple cider from unwashed apples as the source of an outbreak of Escherichia coli 0157:H7 in southeastern Massachusetts in 1991. (16) Dr. Besser had been sent as an “enterics” medical epidemiologist to Massachusetts to investigate the outbreak of diarrhea and hemolytic uremic syndrome, a severe form of the infection characterized by kidney failure and anemia. Four young children in the Fall River area developed kidney failure, and local hospital officials called in investigators from the CDC. Twenty-seven people aged 2 to 70 were infected with the E. coli organism. Besser and his colleagues subsequently published their findings in the Journal of the American Medical Association in 1993. (17) On a personal note, Dr. Besser met his future wife in the Boston area during the E.coli outbreak investigation. She is Jeanne Besser, a graduate of Brown University with a degree in English and an author and syndicated food writer and stylist, who has written for the Atlanta Journal-Constitution for over eight years. (18) A description of all of Dr. Besser’s experiences, contributions, exploits, and endeavors at CDC since 1991is beyond the scope of this article. Several must suffice. He declares, “One of the highlights of my career was being the founder and medical director of Get Smart: Know When Antibiotics Work, a program promoting the appropriate use of antibiotics. This program works through partners to change the way in which these essential drugs are used, hopefully reducing the spread of antimicrobial resistance. Through this work, I have learned the importance of partnership, teamwork, and accountability. We have been able to document a 40% decline in antibiotic use for children over the past decade. While this is not directly attributable to our campaign, it does demonstrate the ability of well-designed public health programs to change practice.” (8,19-20) Another EIS highlight recalled by Dr. Besser was “was being part of the team to help control the cholera pandemic in Central and South America. ‘I worked on investigating an outbreak that came in on an airliner [Aerolineas Argentinas from Argentina to Los Angeles]. One hundred people were infected [developed cholera from a seafood salad served during the flight]. Our investigation highlighted the lack of preparedness of the medical community for recognizing and treating this disease, although cholera was rampant in parts of South America. It really brought home for me the importance of preparedness for this sort of natural event, given how easily infectious diseases can be introduced from any part of the world.’” (8,21) Dr. Besser also worked as the CDC liaison to the Federal Bureau of Investigation in Florida and on the investigative team in Washington, D.C., during the October and November 2001 anthrax attacks on the East Coast of the US. This experience and his feelings about antibiotic overuse in general caused him intense consternation when anthrax response plans developed in the field suggested permitting people to stockpile their own set of anthrax antibiotics at home. (22) He lectured, “Many people might take the pills unnecessarily…either because of a false alarm or to treat an infection for which less powerful drugs should be used. That could exacerbate the already problematic increase in drug-resistant bacteria. ‘We’re not averse to revisiting assumptions,’ Besser said, ‘but it’s very concerning when large amounts of broad-spectrum antibiotics are in people's medicine cabinets.” (22) Dr. Besser became director of the Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) at CDC on August 29, 2005, famously only two hours before Hurricane Katrina made landfall. (23) He said, “Coming on board with COTPER at the beginning of a crisis let me see our strengths and gaps as well as the enormous talent across the agency. As an agency, CDC really stepped up to the plate in working with federal, state, and local partners to face a disaster on an unprecedented scale in this country. We must now make sure to learn from this experience to improve our preparedness and response for future emergencies.” (8)
In his position as COTPER director, Dr. Besser acknowledged, “CDC recognizes the enormous burden of chronic diseases and other health issues. However, COTPER focuses on urgent threats: infectious diseases, new and emerging infectious diseases, on-going large-scale food borne outbreaks, pandemic threats, deliberate threats (like the World Trade Center in 2001 and the following anthrax attacks), and natural disasters.. Concerns have also been raised about climate change and the possibility that this will lead to increasing threats of natural disasters.” (24) COTPER is responsible for the Strategic National Stockpile, which is a large inventory of medicine and medical supplies available free to the American public in a public health emergency, such as the one we are now engaged in over an emerging swine flu outbreak, as described elsewhere! (4,25-27) Dr. Besser retired from the directorship of COTPER to become acting director of CDC on January 23, 2009, as noted above. Editorial Comment Dr. Besser is a fine choice for director of CDC. He is a physician with an interest in economics and extensive experience as a clinician treating real patients—both pediatric and adult. He has demonstrated skills as an academician, public health officer, epidemiologist, and administrator. He has worked internationally as a clinician and public health physician. He has published many scholarly articles about his experiences in public health medicine, most times not as lead author (suggesting he gets along with others in teams). He spoke carefully and well at the White House press conference on April 26, 2009 at which federal officials announced a swine flu-based national public health emergency. He is curious and energetic and, so far, measured in his approach to protecting the nation’s health. He has the requisite level of formal education and professional experience to do well in the very challenging position of CDC director. Notes:
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