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About Dr. Tom Frieden
Scientific articles by Dr. Tom Frieden on some major themes within health, health care, and public health.
Public Health Impact Pyramid
Dr. Frieden’s early work included a focus on antibiotic resistance, including from widespread inappropriate prescription of antibiotics, including a seminal article on the emergence of drug-resistant tuberculosis. This study led directly to a massive increase in city, state, and federal resources for and commitment to the control of tuberculosis. Dr. Frieden also conducted one of the first molecular epidemiologic studies of tuberculosis, documenting the importance of spread in hospitals and of laboratory contamination.
Dr. Frieden coined the term, “Interventional Epidemiology,” and emphasizes the importance of using data to drive progress. In New York City, he led efforts that rapidly stopped the largest outbreak of multidrug-resistant tuberculosis ever to occur in the United States, and drove tuberculosis case rates down with a program that became a national and international model. Dr. Frieden emphasizes the importance of public health tuberculosis clinics, of patient-centered services, and of recognizing and addressing the need for social change.
In addition to documenting the spread of multidrug-resistant tuberculosis, Dr. Frieden led an extensive review of how these organisms spread and what treatment is effective.* Learning from the legendary Dr. Karel Styblo, Dr. Frieden also emphasized the importance of accountability for the outcomes of every patient.
Dr. Frieden then moved to India, where he supported national and state programs to implement a large program that substantially improved detection, treatment, and monitoring of tuberculosis. One important component of this progress was deploying national consultants* to support progress. Working with the Tuberculosis Research Center - now the National Institute for Research on Tuberculosis of the Indian Council of Medical Research, the team in India implemented a Model DOTS Programme and documented rapid decline in prevalence of pulmonary tuberculosis. The team also showed that it was possible to increase case detection through a system of active monitoring of private laboratories, in a public-private partnership.
One of Dr. Frieden’s mentors, Dr. Colin McCord, documented that a Black man in Harlem was less likely to survive to age 65 than a man in Bangladesh. Dr. McCord suggested that Dr. Frieden investigate one of the leading causes of excess mortality in Central Harlem: liver disease. Dr. Frieden undertook a detailed case-control study that identified the cause: synergistic liver damage from the combination of alcohol use and viral hepatitis (hepatitis B and C).
As CDC Director, Dr. Frieden condemned past unethical research and established a system to track and advocate for the reversal of health disparities. For the first time, the CDC published regular, comprehensive reports on the state of health disparities, with a focus on areas where progress could be made through advocacy, program implementation, and empowering communities.
Dr. Frieden’s concept of a public health impact pyramid has been influential for health departments, community organizations, and others around the country and world. Following the footsteps of two of his mentors, Dr. George Comstock and Sir John Crofton, he outlined the need to address not only infectious diseases such as tuberculosis, but also the leading causes of ill health such as tobacco use, cardiovascular disease and cancer. He outlined a way forward to improve the health value of health care.
Dr. Frieden’s work includes analysis of the strengths and limitations of randomized clinical trials. Dr. Frieden outlined practical implementation, key lessons, and conceptual underpinning of public health action. He established the Take Care New York initiative and the “Winnable Battles” initiative at CDC, and summarized progress and challenges of two terms as NYC Health Commissioner under Mayor Bloomberg and two terms as CDC Director in the administration of President Barack Obama. With longtime colleague Dr. Kelly Henning, he outlined the public health requirements for rapid progress in global health. He also outlined how the world could achieve the ambitious United Nations target for reducing the leading causes of death by one third by 2030.
Tobacco use will kill one billion people in this century unless urgent action is taken. Tuberculosis was once described as, “Captain of all these men of death”. Tobacco — and the tobacco companies that market it — now has that dubious distinction. As New York City Health Commissioner, he implemented a comprehensive program that rapidly reduced tobacco use. He outlined the “dirty dozen” — 12 myths that undermine tobacco control. Along with Mayor Bloomberg, Frieden outlined how to prevent 100 million deaths from tobacco.
Mayor Bloomberg funded a program along the lines Dr. Frieden outlined, which had by 2021 prevented approximately 40 million deaths. He outlined the way forward in tobacco control, including implementing proven strategies and innovating to “reduce exposure of children to smoking imagery in movies, television, and social media; reduce youth access to tobacco (e.g., through changes in minimum age of purchase); decrease the addictiveness of cigarettes; and address the production, distribution, and marketing of tobacco.”
Joining in an important analysis led by Dr. Tom Farley, the authors showed that improved treatment of hypertension can save more lives than any other clinical intervention among adults. Frieden conceptualized the — ultimately unsuccessful - “Million Hearts” initiative to prevent heart attacks and strokes, including through use of standardized treatment protocols. Along with Mayor Bloomberg, he outlined how to save an additional 100 million lives globally through improved treatment of hypertension, reduced consumption of sodium, and elimination of artificial trans fat.
Unhealthy food is another leading cause of preventable death. In 2009, Dr. Frieden and colleagues, as part of a comprehensive approach to reducing obesity, advocated for a tax on sugar-sweetened beverages, the single leading driver of increased calorie consumption in the United States, of at least 1 cent per ounce. Excess sodium consumption is a leading health risk, contributing to an estimated 3 million deaths per year, and Dr. Frieden has advocated for public health action to reduce intake.
His initiative, Resolve to Save Lives, summarized priority actions to advance population sodium reduction and Dr. Frieden has countered inaccurate articles about sodium reduction, and shown that reducing sodium consumption can save lives and save money by putting choice into consumers’ hands. In New York City, he led the successful fight over calorie labeling that required chain restaurants to post calorie counts, thereby reducing calorie consumption, and banned artificial trans fats. Learning from Denmark, the trans fat ban became a global priority, and he and Dr. Tedros, the Director General of WHO, published an article on the REPLACE strategy, a roadmap to make the world trans fat free by 2023.
Dr. Frieden has been fully engaged in advancing an effective global response to the COVID-19 pandemic, including reviewing how to identify and interrupt superspreading events. This work builds on work from New York City advocating to apply public health principles to stop the HIV epidemic, documenting the impact of the World Trade Center attacks, and work at CDC helping to stop Ebola in West Africa. A core function of Dr. Frieden’s group, Resolve to Save Lives, is helping countries and the world become safer through global health security.
Reprints. Articles marked with * are available by request (all others are open source and available through the links). To request a reprint:
- Ron Haddock International Impact Award from the American Stroke Association, 2018
- MedShare Humanitarian Award, 2017
- Campaign for Tobacco Free-Kids Champion Award, 2016
- Courageous Leadership Award, National Rx Drug Abuse and Heroin Summit, 2016
- Modern Healthcare and Modern Physician, 50 Most Influential Physician Executives in Healthcare
- Arthur P. Gold Foundation Humanism in Medicine Award, 2015
- Time 100 Most Influential People, 2014
- Harvard School of Public Health Julius B. Richmond Award, 2014
- American Society for Clinical Pathology Patient’s Advocate Award, 2013
- Morehouse College, Innovative Creative Entrepreneurial Award, 2013
- Elected as member of the National Academy of Sciences, 2009
- Prize for Public Service Innovation, Citizens Budget Commission, 2009
- Milton and Ruth Roemer Prize for Creative Local Public Health Work, APHA, 2008
- American Diabetes Association's Distinguished Service Achievement Award, 2008
- The New York Observer’s 100 Most Powerful People in New York, 2008
- New York 1’s New Yorker of the Year 2006
- Governing Magazine’s Public Official of the Year 2005 Award
- Distinguished Service Award, Douglas (Tennessee) Community Health Council, 1982
- Distinguished Service Award, New York Psychiatric Hospital, 1978
- Science. New York University, 2017
- Science. Albert Einstein College of Medicine, 2017
- Science, Oglethorpe University, 2015
- Science, Oberlin College, 2012
- Public Service, Tufts University, 2011
Dr. Tom Frieden