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Dr Tom Frieden Public Health

About Dr. Tom Frieden

Scientific articles by Dr. Tom Frieden on some major themes within health, health care, and public health.

Dr. Tom Frieden's scientific publications cover infectious and non-infectious diseases, health and public health policy, and broad concepts of effective action to save lives.

About

Dr. Tom Frieden has written more than 250 influential scientific articles to sound the alarm about emerging health threats, investigate health risks, document control of disease, and provide conceptual leadership on a broad range of health, health care, and public health topics.

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.

Health Disparities — Addressing Racism, Inequality, and Health Injustice

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.

Broad Perspective on Public Health

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

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.”

Heart and Brain Health

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.

Food Policy

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.

Health Emergencies

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:

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Selected Honors and Awards

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

Honorary Doctorates

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

Photograph of Dr. Tom Frieden for Media

Scientific Articles

Featuring a single article of ongoing health relevance

Protecting Hearts and Brains

March 2021

Sometimes errors are instructive.

We made an ambitious goal of protecting 1 million heart attacks and strokes over a 5-year period through the Million Hearts program. We failed.

What's the diagnosis of our failure? Politics. It's not just in the Covid pandemic that political interference with public health science costs lives. It happens every day, and sometimes causes even more deaths than caused by the toxic combination of Covid+politics.

This month we published this analysis of failure – and specific, actionable recommendations for how to make progress.

Let's start with the basics: The US has a shorter life expectancy, with more disability, and higher health care spending, than any other country in our income bracket. Have a good look at the figure below to see how the US has become a negative outlier.

(And don't think shorter life means less time lived with disability. The opposite is true. On average, the shorter the life, the more of it is lived with disability.)

It's not a small problem. Average life expectancy in the US is 6 years shorter than the places like Hong Kong and Japan and Italy, Spain and Australia.

There are a lot of reasons for the shorter life expectancy, in particular health disparities by race, sex, and location.

Two actions would make big improvements in life expectancy (as would improving economic opportunity, education, and other fundamental changes that are needed but likely to take longer).

Comprehensive tobacco control, including regulation of the amount of nicotine in all forms of tobacco, including cigarettes and e-cigarettes. (Basically, make smoked tobacco non-addictive and limit the addictive potential of all forms of nicotine sold legally. The latter is already done in some countries, the former would be a world first – and long overdue.)
Reduce sodium consumption through mandatory limits on the amount of sodium in food, as well as other comprehensive interventions.

In addition, improvement in hypertension treatment – the health care intervention that can save the most lives – could greatly reduce health disparities and improve life expectancy.

Here's the full article. Now, how can we have the societal will to get this implemented?

Article: https://jamanetwork.com/journals/jama/fullarticle/2777651

And, unusually, the Annex (linked here)is even more important and interesting than the article.

Hope you enjoy it!

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Effective Implementation

February 2021

Public health is, to a great degree, a management problem. What needs to get done is often clear, but the gap between what we as a society know we should do, and what we actually do, is great. Why?

A few years ago, I outlined the six components of effective public health implementation.

Innovation. Innovation is essential, ranging from new vaccines and medicines, to information systems, communication techniques, and more. Smallpox was eradicated through continuous introduction and implementation of innovations, including new organizational methods, new ways to find smallpox cases, new approaches to targeting which groups to vaccinate, new types of needles, and new ways to vaccinate different groups of people.
Technical package. The most effective public health programs are based on an evidence-based technical package: a selected group of related interventions that, together, will achieve and sustain substantial and sometimes synergistic improvements. A technical package of proven interventions sharpens and focuses what otherwise might be vague commitments to “action” by committing to implementation of specific interventions known to be effective. It avoids a scattershot approach of using a large number of interventions, many of which have only a small impact. Simplicity is key to success.
Management. Management of public health activities is particularly difficult because, unlike in the private sector where metrics such as product sales provide prompt feedback on performance, there is often no automatic, accurate, and affordable way to track public health program performance in real time. In addition, the impact of public health programs may not be evident for months or years. Honest and transparent assessment of progress or the lack thereof—even or especially if temporarily inconvenient or embarrassing because of lack of progress—is critical to allow continuous improvement.
Partnerships. Coalitions are essential to progress. Getting many organizations to collaborate can be slow and frustrating, but is needed to support budgetary, legislative, or regulatory change and to implement new or improved programs. Government programs are more likely to succeed—and to be sustained—when organizations outside of government advocate for them.
Communication. Effective communication includes not only conveying but also absorbing and acting on information from media, social media, and in-person communication. Of all the many failures of the US federal response to Covid in 2020, perhaps the most damaging was the failure to communicate effectively.
Political commitment. Public health programs are sometimes not adopted because of the “prevention paradox,” according to which “a preventive measure that brings large benefits to the community offers little to each participating individual.” Large gains in population health often come from small changes for many people rather than from large changes for fewer people. For this reason, leadership, communication, and partnerships are essential for progress.

To implement public health programs effectively, it's essential to get the science right – this leads to having an appropriate technical package and innovating to improve that package continuously. And it's also essential to manage well, including communicating effectively and creating coalitions. But unless the politics is aligned, even the best designed and best managed public health programs will fail. At Resolve, our team recently confirmed this finding in an assessment of the Covid response around the world. Strong public health programs can be undermined by bad governance. This doesn't make effective management of public health programs any less important, but does emphasize the importance of promoting governance based on science and facts, openly and objectively derived.

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Is Public Health "Nanny State"?

January 2021

Never in our lifetimes has there been as much controversy about public health action as there is now, during the Covid pandemic. Irresponsible leadership accounts for much but not all of the failure of the response in the United States and elsewhere.

It's timely to review basic principles. I outlined these in an article for the New England Journal of Medicine a few years ago. Government’s Role in Protecting Health and Safety.* NEJM 2013;368(20):1857-9.

There are, fundamentally, three areas where public heath action reflects a responsible, responsive government. For each, there are long-standing, well-accepted examples as well as newer applications which are controversial now but which will likely be well accepted in future years.

First, promoting free and open information. We expect nutrition-facts panels on our food and inserts in our medications, but these are hard-won gains. Graphic pack warnings on cigarettes and public reporting of health care provider performance will likely become available in the future, but are being blocked now. In Covid, basic information about how each community is doing or even how much Covid is in each area, hasn't been available until now, but will be soon.

A second core role of government is protecting people from harms caused by other people. It's astounding to realize now, but drunk driving was once not taken seriously as a public health problem. There's a saying: “your right to swing your fist ends at my nose”.

Government has a responsibility to protect individuals from unhealthy environments, whether the sources of health risks are natural (e.g., mosquito infestation) or created by people or organizations. Few Americans now question government's role in preventing sale of contaminated food, water, and medications; reducing alcohol-impaired driving; or protecting workers and communities from industrial toxins.

Smokefree laws illustrate the growing acceptance of actions that protect people from others' behavior. Such laws are often controversial when introduced, with opponents predicting reduced hospitality-industry profits and decrying infringement of personal freedoms, but they gain acceptance as people see the health benefits — and no harm to businesses.

In Covid, mandates to wear masks protect us from other people and actions such as business limitations and closures can reduce spread, saving lives.

A third key role of government is to protect and promote health through population-wide action. Governmental action is often a more effective and efficient means of protecting health than the actions of individuals. Immunization mandates, fluoridation of water, iodization of salt, and micronutrient fortification of flour are classic examples of this type of action; many were controversial initially but are widely accepted today because they save money and reduce illness, disability, and death.

In Covid, examples of this type of action include government involvement to improve production and distribution of diagnostics, protective equipment, and vaccines. And, most importantly, vaccination. The more and sooner people get vaccinated, the safer and better protected we will all be.

When government fails to protect and improve people's health, society suffers. Opponents of public health action often fail to acknowledge the degree to which individual actions are influenced by marketing, promotion, and other external factors.

Government has a responsibility to implement effective public health measures that increase information available to the public and decision makers, protect people from harm, promote health, and create environments that support healthy behaviors. The health, financial, and productivity gains from public health actions benefit individuals and society.

Saving Lives Through Health Care

December 2020

This article by Tom Farley, Mehul Dalal, Farzad Mostashari and me answered a question is easy to ask but that for some odd reason had not been answered in the scientific literature previously: How can you save the most lives through health care?

Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med 2010;38:600-9.

Treatment of hypertension is, far and away, the most effective single intervention. When this article was written a decade ago, there was more belief in the value of aspirin for the primary prevention of heart disease. It is now clear that the benefit of aspirin for primary prevention is modest at best, although it is still very important for people who have had a heart attack or other vascular problem. My father, a cardiologist, used to say wryly that the best time to give a patient an aspirin is 30 minutes before they have their heart attack. But for blood pressure, control thoughout life is very important. Not for nothing is hypertension called the silent killer.

This article formed the basis of the Million Hearts program in the United States and of the effort of Resolve to Save Lives to save 100 million lives around the world.

Reprints. Articles marked with * are available by request (all others are open source and available through the links). To request a reprint:

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Centers for Disease Control - April 2021

Strengthening public health systems around the world

It's a little known fact that one person – Dr. Joseph Mountin – not only founded the US Centers for Disease Control and Prevention (initially named the Communicable Disease Center), but also started a seminal study, the Framingham Heart Study. In both cases, Mountin changed the direction of health, and public health, first in the United States, and eventually, around the world.

The Framingham study has been of central importance to understanding the role of hypertension and cholesterol in heart disease and stroke.

And the Centers for Disease Control has grown from communicable disease roots to encompass all causes of ill health, and from the United States to regions and countries around the world.

During the Covid pandemic, the Africa Centers for Disease Control and Prevention has played an important role strengthening laboratory services, outbreak control, communication, and data dissemination throughout the continent. Analogously, the Nigeria Centre for Disease Control has supported the states of that country to respond more effectively to Covid and many other infectious disease outbreaks.

There are discussions about establishing other CDCs in more regions and more countries around the world. There are useful resources for countries and regions to do so and a strong network, although the most important factor in success is the leadership, and particularly the founding leadership, of the institution.

While at the US CDC as director, I joined former director Dr. Jeff Koplan in summarizing why stronger national public health institutions – CDCs – are important to improving global health. We identifed 16 potential functions of such agencies (Table below), and outlined some pros and cons of including these functions.

A crucial issue is the independence of the CDC. Here's what we wrote in that article, more than a decade ago, about National Public Health Institutes (NPHIs, the generic name for CDCs):

"To be effective, an NPHI must have credibility and be independent, technically expert, and apolitical, which requires independence from parent ministries of health on technical issues. But if an NPHI is seen as being too independent, it might not be able to address important health challenges."

Each country, and region will need to establish, adapt, and improve their public health infrastructure. Public health institutes can be important resources to strengthen the ability to find, stop, and prevent health threats. To be effective, linkages are essential – with state/city/provincial/local CDCs, with health care systems, with social services, and with communities and the public

On February 15, 2020, I published an article in the bulletin of the China CDC outlining 5 key characteristics of an effective NPHI: funding, staff, connections with other organizations, technical independence, and effective communication.

When I stepped down as US CDC director in January of 2017, I identified the top threat to the organization to be maintaining technical independence. For every public health organization, this is essential – to be close enough to the government for its recommendations to be acted on, and faithful to science so that public trust is established, maintained, and strengthened.

Citation: Frieden TR, Koplan JP. Stronger national public health institutes for global health. Lancet 2010;376(9754):1721-2.

Bibliography (with links)

Full bibliography with hyperlinks - and notations for articles that can be requested from this site *.

Reprints. Articles marked with * are available by request (all others are open source and available through the links). To request a reprint:

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Frieden TR, Lee CT, Bochner AF, Buissonnière M, McClelland A. 7-1-7 : an organising principle, tartget, and accountability metric to make the world safer from pandemics. Lancet. 2021[online] S0140-6736(21)01250-2
Frieden TR., Buissonniere M. Will a Global Preparedness Treaty Help or Hinder Pandemic Preparedness? BMJ Global Health. 2021;6;e006297:1-3
Morgan OW., Aguilera X., Ammon A., Amuasi J., Soce Fal I., Frieden T. Disease surveillance for the COVID-19 era: time for bold changes. 2021. S0140-6736(21)01096-5
Sahoo SK., Pathni AK., Kaur P., Kunwar A., Sharma B., Farrell ML., Moran AE, Komrska J., Frieden TR. A Predictive Tool for Forecasting Anti-Hypertension Medication Requirements in Low-and-Middle-Income Countries. Journal of Hypertension. 2021;39;e273-e274
Frieden TR., Foti KE. National Initiatives to Prevent Myocardial Infarction and Stroke. JAMA. 2021; 0905
Frieden TR., Buissonniere M., McClelland A. The world must prepare now for the next pandemic. BMJ Global Health. 2021;6:e005184.
Frieden TR, Rajkumar R., Mostashari F. We Must Fix US Health and Public Health Policy. AJPH. 2021; 111(4):623-627
Talisuna A., Yoti Z., Lee C., Frieden TR., Moeti MR. The urgent need for a global commitment to protect healthcare workers. BMJ Global Health. 2020;5:e004077: 1-2.
Frieden TR. Perspectives: China Can Substantially Reduce Its High Burden of Stroke and Heart Attack. China CDC Weekly. 2020, 2(40): 780-782.
Hoffer-Hawlik MA, Moran AE, Burka D, Kaur P, Cai J, Frieden TR, Gupta R. Leveraging Telemedicine for Chronic Disease Management in Low- and Middle-Income Countries During Covid-19. Global Heart. 2020; 15(1): 63.
Frieden TR, Cash-Goldwassser S. Of Masks and Methods. Annals of Internal Medicine. 2020; https://doi.org/10.7326/M20-7499.
Dooley SW, Frieden TR. We Must Rigorously Follow Basic Infection Control Procedures to Protect Our Healthcare Workers from SARS-CoV-2. Infect Control Hosp Epidemiol. 2020;3:1-3.
Salam A, Huffman MD, Kanukula R, Prasad EH, Sharma A, Heller DJ, Vedanthan R, Agarwal A, Rodgers A, Jaffe MG, Frieden TR, Kishore SP. Two‐drug fixed‐dose combinations of blood pressure‐lowering drugs as WHO essential medicines: An overview of efficacy, safety, and cost. J Clin Hypertens. 2020;00:1-11.
Frieden TR, Cobb LK, Leidig RC, Mehta S, Kass D. Reducing Premature Mortality from Cardiovascular and Other Non-Communicable Diseases by One Third: Achieving Sustainable Development Goal Indicator 3.4.1. Global Heart. 2020;15(1):50.
Ide N, Ajenikoko A, Steele L, Cohn J, J Curtis C, Frieden TR, Cobb LK. Priority Actions to Advance Population Sodium Reduction. Nutrients. 2020;12(9):1-20.
Cobb LK, Frieden TR, Appel LJ. No U-turn on sodium reduction. J Clin Hypertens. 2020;00:1-5.
Brady TM, Padwal R, Blakeman DE, Farrell M, Frieden TR, Kaur Dip P, Moran AE, Jaffe MG. Blood pressure measurement device selection in low-resource settings: Challenges, compromises, and routes to progress. J Clin Hypertens. 2020;00:1-10.
Frieden TR, Lee CT. Identifying and interrupting superspreading events—implications for control of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis. 2020;26(6):1059-1066.
Frieden TR, Varghese CV, Kishore SP, Campbell NRC, Moran AE, Padwal R, Jaffe MG. Scaling up effective treatment of hypertension-A pathfinder for universal health coverage. J Clin Hypertens (Greenwich). 2019;21(10):1442-1449.
Shahpar C, Lee CT, Wilkason C, Buissonnière M, McClelland A, Frieden TR. Protecting the world from infectious disease threats: now or never. BMJ Glob Health. 2019;4(4):e001885.
Kontis V, Cobb LK, Mathers CD, Frieden TR, Ezzati M, Danaei G. Three public health interventions could save 94 million lives in 25 years. Circulation. 2019;140(9):715-725.
Jaffe MG, Frieden TR, Campbell NRC, et al. Recommended treatment protocols to improve management of hypertension globally: A statement by Resolve to Save Lives and the World Hypertension League. J Clin Hypertens (Greenwich). 2018;20:829-836.
Frieden TR, Jaffe M. Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors. J Clin Hypertens. 2018;20:208‐211.
Ghebreyesus TA, Frieden TR. REPLACE: A roadmap to make the world trans fat free by 2023. Lancet. 2018;391:1978–1980.
McClelland A, Frieden TR. Understanding, preventing, and stopping epidemics. Lancet. 2018;391(10139):2489-2490.
Frieden TR, Bloomberg MR. Saving an additional 100 million lives.* Lancet.2017;17;391(10121):709-712.
Kostova D, Chaloupka FJ, Frieden TR, Henning K, Paul J Jr, Osewe PL, Asma S. Noncommunicable disease risk factors in developing countries: policy perspectives. Prev Med. 2017;105S:S1-S3.
Kolodny A, Frieden TR. Ten steps the federal government should take now to reverse the opioid addiction epidemic.* JAMA. 2017;318(16):1537–1538.
Frieden TR. Evidence for Health Decision Making — Beyond Randomized, Controlled Trials. N Engl J Med. 2017;377:465-75.
Richards CR, Iademarco MF, Atkinson D, Pinner RW, Yoon P, MacKenzie WR, Lee B, Qualters JR, Frieden TR. Advances in public health surveillance and information dissemination at the Centers for Disease Control and Prevention. Public Health Reports. 2017;124(4):1-8.
Frieden TR, Wright JS, Conway PH. Is rapid health improvement possible? Lessons from the Million Hearts initiative. Circulation. 2017;135(18):1677-1680.
Frieden TR, Ethier K, Schuchat A. Improving the health of the United States with a “Winnable Battles” initiative.* JAMA. 2017; 17(9).
Redd SC, Frieden TR. CDC’s evolving approach to emergency management. Health Security.* 2017;1:1-12.
Frieden TR. A Safer, Healthier U.S.: The Centers for Disease Control and Prevention, 2009–2016. AJPM. 2017;3:263-75.
Frieden TR, Schuchat A, Petersen LR. Zika virus 6 months later. JAMA 2016;316:1443-1444.
Frieden TR. Foreword: CDC’s response to the 2014-2016 Ebola epidemic – West Africa and United States. MMWR Suppl 2016;65(3):1-3.
Cogswell ME, Mugavero K, Bowman BA, Frieden TR. Dietary sodium and cardiovascular disease risk – measurement matters. New Engl J Med 2016; 375:580-586.
Frieden TR. Sodium reduction – saving lives by putting choice into consumers’ hands.* JAMA 2016; 316:579-580.
Frieden TR. Ten things I wish someone had told me when I became a health officer.* AJPH 2016;106(7):1214-1218.
Frieden TR, Houry D. Reducing the risks of relief – the CDC opioid-prescribing guideline. New Engl J Med 2016;374:1501-1504.
Frieden TR. Foreword: Strategies for Reducing Health Disparities — Selected CDC-Sponsored Interventions, United States, 2016. MMWR Suppl 2016;65(1):1.
Frieden TR, Foti KE, Mermin J. Applying public health principles to the HIV epidemic – How are we doing? NEJM 2015;373(23):2281-7.
Frieden TR. The future of public health. NEJM 2015;373(18):1748-1754.
Frieden TR, Damon IK. Ebola in West Africa – CDC’s role in epidemic detection, control, and prevention. EID 2015;21(11):1897-1905.
Tappero JW, Thomas MJ, Kenyon TA, Frieden TR. Global health security agenda: building resilient public health systems to stop infectious disease threats. Lancet 2015;385:1889-91.
Angell SY, De Cock KM, Frieden TR. A public health approach to global management of hypertension. Lancet 2015;385:825-7.
Frieden TR. Foreword: Use of selected clinical preventive services to improve the health of infants, children, and adolescents – United States, 1999-2011. MMWR Surveill Summ 2014;63(Suppl 2):1-2
Frieden TR, Brudney KF, Harries AD. Global tuberculosis: perspectives, prospects, and priorities.* JAMA 2014;312(14):1393-4.
Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. Ebola 2014—new challenges, new global response and responsibility. NEJM 2014;371(13):1177-80.
Jaffe HJ, Frieden TR. Improving health in the USA: progress and challenges. Lancet 2014;384(9937):3-5.
Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies—tackling the opioid-overdose epidemic. NEJM 2014;370(22):2063-6.
Frieden TR. Foreword: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR Surveill Summ 2014;63(Suppl 1):1-2.
Frieden TR, Tappero JW, Dowell SF, Hien NT, Guillaume FD, Aceng JR. Safer countries through global health security. Lancet 2014;383(9919):764-6.
Frieden TR. Tobacco control progress and potential.* JAMA 2014;311(2):133-4.
Frieden TR. Foreword: CDC health disparities and inequalities report—United States, 2013. MMWR Surveill Summ 2013;62(Suppl 3):1-2.
Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health 2014;104(1):17-22.
Frieden TR, Coleman King SM, Wright JS. Protocol-based treatment of hypertension: a critical step on the pathway to progress.* JAMA 2014;311(1):21-2.
Etienne CF, Tappero JW, Marston BJ, Frieden TR, Kenyon TA, Andrus JK. Cholera elimination in Hispaniola. Am J Top Med Hyg 2013;89(4):615-6.
Gunn JP, Barron JL, Bowman BA, Merritt RK, Cogswell ME, Angell SY, Bauer UE, Frieden TR. Sodium reduction is a public health priority: reflections on the Institute of Medicine’s Report, Sodium Intake in Populations: Assessment of Evidence. Am J Hypertens 2013;26(10):1178-80.
Frieden TR. Government’s Role in Protecting Health and Safety.* NEJM 2013;368(20):1857-9.
Lurie N, Manolio T, Patterson AP, Collins F, Frieden T. Research as part of a public health emergency response. NEJM 2013;1251-5.
Frieden TR. Foreword: Use of selected clinical preventive services among adults – United States, 2007-2010. MMWR Surveill Summ 2012;61(2):1-2.
Frieden TR, Garfield RM. The cover. Dimensions of global health, 2012.* JAMA 2012;307(19):2006.
Frieden TR, DeCock KM. The CDC’s Center for Global Health. Lancet 2012;379(9820):986-8.
Sacco RL, Frieden TR, Blakeman DE, Jauch EC, Mohl S. What the Million Hearts initiative means for stroke: a presidential advisory from the American Heart Association/American Stroke Association. Stroke 2012;43(3):924-8.
Periago MR, Frieden TR, Tappero JW, De Cock KM, Aasen B, Andrus JK. Elimination of cholera transmission in Haiti and the Dominican Republic. Lancet 2012;379:193-286.
Frieden TR. Epidemic Assistance by the Centre for Disease Control Prevention 1946-2005: Afterword. Am J Epidemiol 2011;174(11 Suppl):113-4.
Frieden TR. Foreword: Public health then and now: celebrating 50 years of MMWR at CDC. MMWR Surveill Summ 2011;60(Suppl 4):1.
Frieden TR. Foreword: CDC Health Disparities and Inequalities Report - United States, 2011. MMWR Surveill Summ 2011;14;60:1-2.
Millett GA, Crowley JS, Koh H, Valdiserri RO, Frieden TR, et al. A way forward: the National HIV/AIDS Strategy and reducing HIV incidence in the United States. J Acquir Immune Defic Syndr 2010;55(Suppl 2):144-7.
Frieden TR, Berwick DM. The “Million Hearts” initiative – preventing heart attacks and strokes.* NEJM 2011;365(13):e27.
Dowell SF, Tappero JW, Frieden TR. Public health in Haiti – challenges and progress. NEJM 2011;364(4):300-301.
Frieden TR, Koplan JP. Stronger national public health institutes for global health. Lancet 2010;376(9754):1721-2.
Frieden TR, Collins FS. Intentional infection of vulnerable populations in 1946-1948: another tragic history lesson.* JAMA 2010;304(18):2063-2064.
Redd SC, Frieden TR, Schuchat A, Briss PA. 1918 and 2009: a tale of two pandemics. Public Health Rep 2010;125(Suppl 3):3-5.
Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med 2010;38:600-9.
Nguyen TQ, Clark N; 2006 NYC Anthrax Working Group, Karpati A, Goldberg A, Paykin A, Tucker A, Baker A, Almiroudis A, Fine A, Tsoi B, Aston C, Berg D, Weiss D, Connelly E, Beaudry G, Weisfuse I, Durrah JC, Prudhomme J, Leighton J, Ackelsberg J, Mahoney K, Van Vynck L, Lee L, Moskin L, Layton M, Wong M, Raphael M, Robinson M, Phillips M, Jones M, Jeffery N, Nieves R, Slavinski S, Mullin S, Beatrice ST, Balter S, Blank S, Frieden TR, et al. Public health and environmental response to the first case of naturally acquired inhalational anthrax in the United States in 30 years: infection of a New York City resident who worked with dried animal hides. * J Public Health Manag Pract 2010;16:189-200.
Frieden TR, Dietz W, Collins J. Reducing childhood obesity through policy change: acting now to prevent obesity. Health Aff (Millwood) 2010;29:357-63.
Frieden TR, Briss PA. We Can Reduce Dietary Sodium, Save Money, and Save Lives. Ann Intern Med 2010;152:526-7.
Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010;100:590-595.
Frieden TR, Teklehaimanot A, Chideya S, Farmer P, Kim JY, Raviglione MC. A road map to control malaria, tuberculosis, and human immunodeficiency virus/AIDS. * Arch Intern Med 2009;169:1650-2.
Farley TA, Caffarelli A, Bassett MT, Silver L, Frieden TR. New York City's fight over calorie labeling. Health Aff (Millwood) 2009;1098-109.
Chamany S, Silver LD, Bassett MT, Driver CR, Berger DK, Neuhaus CE, Kumar N, Frieden TR. Tracking diabetes: New York City's A1C Registry. * Milbank Q 2009;87:547-70.
Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR, Bassett MT. Cholesterol control beyond the clinic: New York City's trans fat restriction. Ann Intern Med 2009;151:129-34.
Frieden TR, Henning, KJ. Public health requirements for rapid progress in global health. Global Public Health 2009;4:323-337.
Brownell KD, Frieden TR. Ounces of Prevention -- The Public Policy Case for Taxes on Sugared Beverages. N Engl J Med 2009;360:1805-1808.
Ellis JA, Gwynn C, Garg RK, Philburn R, Aldous KM, Perl SB, Thorpe L, Frieden TR. Secondhand smoke exposure among nonsmokers nationally and in New York City. * Nicotine Tob Res 2009;11:362-70.
Frieden TR. Lessons from tuberculosis control for public health. * Int J Tuberc Lung Dis 2009;13:421-428.
Thorpe LE, Upadhyay UD, Chamany S, Garg R, Mandel-Ricci J, Kellerman S, Berger DK, Frieden TR, Gwynn C. Prevalence and control of diabetes and impaired fasting glucose in New York City. Diabetes Care 2009;32:57-62.
Gwynn RC, Garg RK, Kerker BD, Frieden TR, Thorpe LE. Contributions of a Local Health Examination Survey to the Surveillance of Chronic and Infectious Diseases in New York City. Am J Public Health 2009;99:152-159.
Frieden TR, Myers JE, Krauskopf MS, Farley TA. A Public Health Approach to Winning the War against Cancer. Oncologist 2008;13:1306–1313.
Springer CM, Tannert Niang KM, Matte TD, Miller N, Bassett MT, Frieden TR. Do medical students know enough about smoking to help their future patients? Assessment of New York City fourth-year medical students' knowledge of tobacco cessation and treatment for nicotine addiction. Acad Med 2008;83:982-989.
Farfel M, Digrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson D, Frieden TR, Thorpe L. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health 2008;85:880-909.
Subramani R, Radhakrishna S, Frieden TR, Kolappan C, Gopi PG, Santha T, Wares F, Selvakumar N, Narayanan PR. Rapid decline in prevalence of pulmonary tuberculosis after DOTS implementation in a rural area of South India. Int J Tuberc Lung Dis 2008;12:916-920.
Torian LV, Wiewel EW, Liu K, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med 2008;168:1181-1187.
McKinney CM, Klingler EJ, Paneth-Pollak R, Schillinger JA, Gwynn RC, Frieden TR. Prevalence of Adult Male Circumcision in the General Population and a Population at Increased Risk for HIV/AIDS in New York City. Sex Transm Dis 2008;35:814-817.
Bassett MT, Dumanovsky T, Huang C, Silver LD, Young C, Nonas C, Matte TD, Chideya S, Frieden TR. Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007. Am J Public Health 2008;98:1457-1459
Frieden TR, Bassett MT, Thorpe LT, Farley TA. Public health in New York City, 2002-2007: confronting epidemics of the modern era. International Journal of Epidemiology 2008; 37: 966-977.
Gwynn RC, McQuistion HL, McVeigh KH, Garg RK, Frieden TR, Thorpe LE. Prevalence, diagnosis, and treatment of depression and generalized anxiety disorder in a diverse urban community. Psychiatr Serv 2008;59:641-647.
Schillinger JA, McKinney CM, Garg R, Gwynn RC, White K, Lee F, Blank S, Thorpe L, Frieden TR. Seroprevalence of herpes simplex virus type 2 and characteristics associated with undiagnosed infection: New York City, 2004. Sex Transm Dis 2008;35:599-606.
Myers J, Frieden TR, Bherwani KM, Henning KJ. Ethics in public health research: Privacy and public health at risk: Public health confidentiality in the digital age. Am J Public Health 2008;98:793-801.
Van Wye G, Kerker BD, Matte T, Chamany S, Eisenhower D, Frieden TR, Thorpe L. Obesity and diabetes in New York City, 2002 and 2004. Prev Chronic Dis 2008 Apr;5:A48.
Rehm CD, Matte TD, Van Wye G, Young C, Frieden TR. Demographic and behavioral factors associated with daily sugar-sweetened soda consumption in New York City adults. J Urban Health 2008;85:375-385.
Frieden TR, Mostashari F. Health care as if health mattered. * JAMA 2008; 299:950-952.
Nguyen TQ, Gwynn RC, Kellerman SE, Begier E, Garg RK, Pfeiffer MR, Konty KJ, Torian L, Frieden TR, Thorpe LE. Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004. AIDS 2008;22:281-287.
Foerster SB, Silver LD, Kohatsu ND, Frieden TR, Bassett MT, and Horton MB. Childhood obesity on the front lines. Am J Prev Med 2007;33:S175-177.
Ellis JA, Perl SB, Frieden TR, Huynh M, Ramaswamy C, Gupta LS, Kerker BD. Decline in smoking prevalence – New York City, 2002–2006. MMWR 2007;56:604-608.
Frieden TR, Bloomberg MR. How to prevent 100 million deaths from tobacco. Lancet 2007;369:1758-61.
Frieden TR, Sbarbaro JA. Promoting adherence to treatment for tuberculosis: the importance of direct observation. Bull World Health Org 2007;85:407-409.
Tuberculosis Research Centre, Indian Council of Medical Research. Radhakrishna S, Frieden TR, Subramani R, Santha T, Narayanan PR. Additional risk of developing TB for household members with a TB case at home at intake: a 15-year study. Int J Tuberc Lung Dis 2007;11:282–288.
Torian LV, Henning KJ, Kellerman SE, Frieden TR. Striving toward comprehensive HIV/AIDS surveillance: The view from New York City. Public Health Rep 2007;122(Suppl.1):4-6.
Subramani R, Santha T, Frieden TR, Radhakrishna S, Gopi PG, Selvakumar N, Sadacharam K, Narayanan PR. Active community surveillance of the impact of different tuberculosis control measures, Tiruvallur, South India, 1968-2001. Int J Epidemiol 2006; 36:387-93.
Munsiff SS, Ahuja SD, King L, Udeagu C-C, Dorsinville M, Frieden TR, Fujiwara PI. Ensuring accountability: the contribution of the cohort review method to tuberculosis control in New York City *. Int J Tuberc Lung Dis 2006;10:1133-1139.
Torian LV, Blank S, Kellerman SE, Frieden TR, Ho DD, Markowitz M, Boden D, Parker MM, Philpott S, Roome A, McKenna MT, Folks T, Heneine W. Investigation of a new diagnosis of multidrug-resistant, dual-tropic HIV-1 infection — New York City, 2005. MMWR 2006;55:793-796.
Thorpe LE, Gwynn RC, Mandel-Ricci J, Roberts S, Frieden TR, Tsoi B, Berman L, Porter K, Ostchega Y, Curtain LR, Montaquila J, Mohadjer L. Study design and participation rates of the New York City health and nutrition examination survey, 2004. Prev Chronic Dis [serial online] 2006;3:A94.
Cummings KM, Hyland A, Fix B, Bauer U, Celestino P, Carlin-Menter S, Miller N, Frieden TR. Free nicotine patch giveaway program: 12-month follow-up of participants. * Am J Prev Med 2006;31:181-184.
Larson K, Levy J, Rome MG, Matte TD, Silver LD, Frieden TR. Public health detailing: A strategy to improve the delivery of clinical preventive services in New York City. Public Health Rep 2006;121:228-234.
Walsh J, Fraser G, Hunt E, Husband B, Nalluswami K, Pollard K, Reynolds S, Urdaneta V, Weltman A, Aston C, Balter S, Beatrice S, Beaudry G, Berg D, Clark N, Frieden T, Karpati A, Layton M, Lee L, Leighton J, Moskin L, Mullin S, Phillips M, Paykin A, Prud’homme J, Slavinski S, Tucker A, Weisfuse I, Weiss D,Wolsk G, et al. Inhalation anthrax associated with dried animal hides--Pennsylvania and New York City, 2006. MMWR 2006;55:280-2.
Radhakrishna S, Frieden TR, Subramani R, Narayanan PR. Value of dual testing for identifying tuberculous infection. * Tuberculosis 2006;86:47-53.
Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ. Applying public health principles to the HIV epidemic. N Engl J Med 2005;353:2397-2402.
Thorpe LE, Mostashari F, Hajat A, Nash D, Karpati A, Weber T, Winawer S, Neugut AI, Awad A, Zevallos M, Remy P, Frieden TR, for the Citywide Colon Cancer Control Coalition (C5). Colon cancer screening practices in New York City, 2003: results of a large random-digit dialed telephone survey. Cancer 2005;104:1075-1082.
Thorpe LE, Berger D, Ellis JA, Bettegowda V, Brown G, Matte T, Bassett M, Frieden TR. Trends and racial/ethnic disparities in gestational diabetes among pregnant women in New York City, 1990-2001. Am J Public Health 2005;95:1536-1539.
Frieden TR, Blakeman DE. The dirty dozen: 12 myths that undermine tobacco control. Am J Public Health 2005;95:1500-1505.
Kumar MKA, Dewan PK, Nair, PKJ, Frieden TR, et al. Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001-2002. Int J Tuberc Lung Dis 2005;9:870-6.
Miller N, Frieden TR, Liu S, et al. Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation. Lancet 2005;365:1849-54.
Frieden TR, Mostashari F, Kerker BD, Miller N, Hajat A, Frankel M. Adult tobacco use levels after intensive tobacco control measures: New York City, 2002–2003. Am J Public Health. 2005; 95(6):1016-1023.
Georgeson M, Thorpe LE, Merlino M, Frieden TR, Fielding JE. Shortchanged? An assessment of chronic disease programming in major US city health departments. * J Urban Health 2005;82:183-190.
Frieden TR, Munsiff SS. The DOTS strategy for controlling the global tuberculosis epidemic. * Clin Chest Med 2005;26:197-205.
Frieden TR. Tuberculosis control: critical lessons learnt. * Indian J Med Res 2005;121:140-2.
Mostashari F, Kerker BD, Hajat A, Miller N, Frieden TR. Smoking practices in New York City: the use of a population-based survey to guide policy-making and programming. J Urban Health 2005;82:58-70.
Santha T, Garg R, Subramani R, Chandrasekaran V, Selvakumar N, Sisodia RS, Perumal M, Sinha SK, Singh RJ, Chavan R, Ali F, Sarma SK, Sharma KM, Jagtap D, Frieden TR, et al. Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India. * Int J Tuberc Lung Dis 2005;9:61-68.
Leng JCF, Thorpe LE, Feldman GE, Thomas PA, Frieden TR. The volume and capacity of colonoscopy procedures performed at New York City hospitals in 2002. Prev Chronic Dis [serial online] 2005; 2:1-7.
Frieden TR. Asleep at the switch: local public health and chronic disease. Am J Public Health 2004;94:2059-2061.
Thorpe LE, Frieden TR, Laserson KF, Wells G, Khatri GR. Seasonality in tuberculosis, India: is it real and what does it tell us?. * Lancet 2004;364:1613-1614.
Singh AA, Frieden TR, Khatri GR, Garg R. A survey of tuberculosis hospitals in India. Int J Tuberc Lung Dis 2004;8:1255-1259.
Thorpe LE, List DG, Marx T, May L, Helgerson SD, Frieden TR. Childhood obesity in New York City elementary school students. Am J Public Health 2004;94:1496-1500.
Fielding JE, Frieden TR. Local knowledge to enable local action. Am J Prev Med 2004;27:183-184.
Frieden TR. Take Care New York: a focused health policy.* J Urban Health 2004;81:314-316.
Chang C, Leighton J, Mostashari F, McCord C, Frieden TR. The New York City smoke-free air act: second-hand smoke as a worker health and safety issue. * Am J Ind Med 2004;46:188-195.
Thorpe LE, Mostashari F, Karpati AM, Schwartz SP, Manning SE, Marx MA, Frieden TR. Mass smallpox vaccination and cardiac deaths, New York City, 1947. Emerg Infect Dis 2004;10:917-920.
Balasurbramanian R, Garg R, Santha T, Gopi PG, Subramani R, Chandrasekaran V, Thomas A, Rajeswari R, Anandakrishnan S, Perumal M, Niruparani C, Sudha G, Jaggarajamma K, Frieden TR, Narayanan PR. Gender disparities in tuberculosis: a report from a rural DOTS programme in south India. * Int J Tuberc Lung Dis 2004;8:323-332.
Selvakumar N, Sudhamathi S, Duraipandian M, Frieden TR, Narayanan PR. Reduced detection by Ziehl-Neelsen method of acid-fast bacilli in sputum samples preserved in cetylpyridium chloride solution. Int J Tuberc Lung Dis 2004;8:248-252.
Cook S, Maw KL, Munsiff SS, Fujiwara PI, Frieden TR. Prevalence of tuberculin skin test positivity and conversions among healthcare workers in New York City during 1994 to 2001. Infect Control Hosp Epidemiol 2003;24:807-813.
Frieden TR, Khatri GR. Impact of national consultants on successful expansion of effective tuberculosis control in India. Int J Tuberc Lung Dis 2003;7:837-841.
Radhakrishna S, Frieden TR, Subramani R. Association of initial tuberculin sensitivity, age and sex with the incidence of tuberculosis in south India: a 15-year follow-up. Int J Tuberc Lung Dis 2003;7:1083-1091.
Gopi PG, Subramani R, Radhakrishna S, Kolappan C, Sadacharam K, Shantha T, Frieden TR, Narayanan PR. A baseline survey of the prevalence of tuberculosis in a community in south India at the commencement of a DOTS programme. Int J Tuberc Lung Dis 2003;7:1154-1162.
Frieden TR, Mostashari F, Schwartz SP, et al. Cardiac deaths after a mass smallpox vaccination campaign -- New York City, 1947. MMWR 2003;52;933-936.
Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis.* Lancet 2003;382:887-899.
Frieden TR, Driver CR. Tuberculosis control: past 10 years and future progress.* Tuberculosis 2003;83:82-85.
Selvakumar N, Govindan D, Chandu NA, Frieden TR, Narayanan PR. Processing sputum specimens in a refrigerated centrifuge does not increase the rate of isolation of M. Tuberculosis. J Clin Microbiol 2003;41:469-471.
Sterling TR, Lehmann HR, Frieden TR. Impact of DOTS compared with DOTS-plus on multidrug resistant tuberculosis and tuberculosis deaths: decision analysis. BMJ 2003; 326:1-6.
Santha T, Renu G, Frieden TR, Subramani R, Gopi PG, Chandrasekaran V, Selvakumar N, Thomas A, Rajeswari R, Balasubramanian R, Kolappan C, Narayanan PR. Are community surveys to detect tuberculosis in high prevalence areas useful? Results of a comparative study from Tiruvallur District, South India. Int J Tuberc Lung Dis 2003;7(3):258-265.
Narayanan S, Das S, Garg R, et al. Molecular epidemiology of tuberculosis in a rural area of high prevalence in South India: implications for disease control and prevention. J Clin Microbiol 2002;40:4785-4788.
Frieden TR. Can tuberculosis be controlled? Int J Epidemiol 2002;31:894-899.
Khatri GR, Frieden TR. Rapid DOTS expansion in India – lessons for the world. Bull World Health Org 2002;80:457-463.
Selvakumar N, Prabhakaran E, Rahman F, Frieden TR, Santha Devi, T. Washing of new microscopic glass slides in dichromate solution does not influence sputum AFB smear results. Int J Tuberc Lung Dis 2002;6:270-271.
Selvakumar N, Prabhakaran E, Rahman F, Frieden TR, Santha Devi, T. Evaluation of the phenol ammonium sulfate sedimentation smear microscopy method diagnosis of pulmonary tuberculosis. J Clin Microbiol 2002;40:3017-3020.
Khatri GR, Thorpe L, Frieden TR. Progress toward tuberculosis control – India. MMWR 2002;51:229-232.
Selvakumar N, Rahman F, Rajasekaran S, Narayanan PR, Frieden TR. Inefficiency of 0.3% carbol fuchsin in Ziehl-Neelsen staining for detecting acid-fast bacilli. J Clin Microbiol 2002;40:3041-3043.
Pablos-Mendez A. Gowda DK, Frieden TR. Controlling multidrug-resistant tuberculosis and access to expensive drugs: a rational framework. Bull World Health Org 2002; 80:489-495.
Frieden TR, Sbarbaro JA. The slippery slope to sloppy DOTS. Int J Tuberc Lung Dis 2002;6:371-372.
Santha TS, Garg, R, Frieden TR, et al. Risk factors associated with default, failure and death among tuberculosis patients--southern India, 2000. Int J Tuberc Lung Dis 2002;6:780-789.
Khatri GR, Frieden TR. Controlling tuberculosis in India. New Engl J Med 2002;347:1420-1445.
Murthy KJR, Frieden TR, Yazdani A, Hreshikesh P. A public-private partnership in tuberculosis control: experience in Hyderabad, India.* Int J Tuberc Lung Dis 2001;5:354-359.
Sackoff J, Torian L, Frieden TR. TB prevention in HIV clinics in New York City.* Int J Tuberc Lung Dis 2001;5:123-128.
Radhakrishna S, Frieden TR, Subramani R, Kumaran PP. Trends in the prevalence and incidence of tuberculosis in South India. Int J Tuberc Lung Dis 2001:5:142-157.
Frieden TR, Lerner BH, Rutherford BR. Lessons from the 1800s: tuberculosis control in the new millenium. Lancet 2000;355:1085-1092.
Khatri GR, Frieden TR. The status and prospects of tuberculosis control in India.* Int J Tuberc Lung Dis 2000;4:193-200.
Cook SV, Fujiwara PI, Frieden TR. Rates and risk factors for discontinuation of rifampicin. Int J Tuberc Lung Dis 2000;4:118-122.
Frieden TR. Directly observed treatment, short-course (DOTS): ensuring cure of tuberculosis.* Ind J Pediatrics 2000;67:S21-27.
Frieden TR, Ozick L, Henning KJ, et al. Chronic liver disease in Central Harlem: the role of alcohol and viral hepatitis. Hepatology 1999;29:883-888.
Sherman LF, Fujiwara PI, Cook SV, Bazerman LB, Frieden TR. Patient and health care system delays in the diagnosis and treatment of tuberculosis.* Ind J Tuberc Lung Dis 1999;3:1088-1095.
Wilberschied LA, Kaye K, Fujiwara PI, Frieden TR. Extrapulmonary tuberculosis among foreign-born patients, New York City, 1995-1996.* J Immigrant Hlth 1999;1:65-75.
Gasner MR, Maw KL, Feldman GE, Fujiwara PI, Frieden TR. The use of legal action in New York City to ensure treatment of tuberculosis. New Engl J Med 1999;340:359-366.
Frieden TR. Can tuberculosis be controlled? Ind J Tuberc 1998;45:65-72.
Sackoff J, Torian L, Frieden TR, et al. Purified protein derivative testing and tuberculosis preventive therapy for HIV-infected patients in New York City. AIDS 1998;12:2017-2023.
Scholten JN, Fujiwara PI, Frieden TR. Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993. Int J Tuberc Lung Dis 1998;3:31-41.
Sullivan EA, Geoffroy P, Weisman R, Hoffman R, Frieden TR. Isoniazid poisonings in New York City. J Emerg Med 1998;16:57-59.
Washko, RM, Hoefer H, Keihn TE, Armstrong D, Dorsinville GJ, Frieden TR. Mycobacterium tuberculosis in a green winged macaw (Ara chloroptera): report with public health implications. J Clin Microbiol 1998;36:1101-1102.
Washko RM, Robinson E, Frieden TR. Tuberculosis transmission in a high school choir.* J Sch Health 1998;68:256-259.
Nivin B, Nicholas P, Gayer M, Frieden TR, Fujiwara PI. A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. Clin Infect Dis 1998;26:303-307.
Fujiwara PI, Cook SV, Rutherford CM, et al. A continuing survey of drug-resistant tuberculosis, New York City, April 1994.* Arch Int Med 1997;157:531-536.
Pablos-Mendez A, Knirsch C, Barr GR, Lerner BH, Frieden TR. Nonadherence in tuberculosis treatment: predictors and consequences in New York City.* Am J Med 1997;102:164-170.
Feldman G, Srivastava P, Eden E, Frieden TR. Detention until cure as a last resort: New York City’s experience with involuntary in-hospital civil detention of persistently non-adherent tuberculosis patients. Sem Resp Crit Care Med 1997;18:493-501.
Fujiwara PI, Larkin C, Frieden TR. Directly observed therapy in New York City: history, implementation, results, and challenges.* Clin Chest Med 1997;18:135-148.
Munsiff SS, Joseph S, Ebrahimzadeh A, Frieden TR. Rifampin mono-resistant tuberculosis, New York City, 1993-1994. Clin Inf Dis 1997;25:1465-1467.
Layton MC, Henning KJ, Alexander TA, Gooding AL, Reid C, Heymann BM, Leung J, Gilmore DM, Frieden TR. Universal radiographic screening for tuberculosis among inmates upon admission to jail. Am J Pub Health 1997;87:1335-1337.
Frieden TR, Sherman LF, Maw KL, et al. A multi-institutional outbreak of highly drug-resistant tuberculosis: epidemiology and clinical outcomes.* JAMA 1996;276:1229-1235.
Pablos-Mendez A, Sterling T, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis.* JAMA 1996;276:1223-1228.
Kaye K, Frieden TR. Tuberculosis control: the relevance of classic principles in an era of acquired immunodeficiency syndrome and multidrug resistance. Epidem Reviews 1996;18:52-63.
Washko RM, Frieden TR. Tuberculosis surveillance using death certificate data, New York City, 1992. Public Health Rep 1996;111:251-255.
Friedman LN, Williams MT, Singh TP, Frieden TR. Tuberculosis, AIDS, and death among substance abusers on welfare in New York City. N Engl J Med 1996;334:828-833.
Frieden TR, Woodley CL, Crawford JT, Lew D, Dooley SW. The molecular epidemiology of tuberculosis in New York City: the importance of nosocomial transmission and laboratory error. * Tuberc Lung Dis 1996;77:407-413.
Layton MC, Cantwell MF, Dorsinville GJ, Valway SE, Onorato IM, Frieden TR. Tuberculosis screening among homeless persons with AIDS living in single-room-occupancy hotels. Am J Pub Health 1995;85:1556-1559.
Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City -turning the tide. New Engl J Med 1995;333:229-233.
Sullivan EA, Kreiswirth BN, Palumbo L, Kapur V, Musser JM, Ebrahimzadeh A, Frieden TR. Emergence of fluoroquinolone-resistant tuberculosis in New York City.* Lancet 1995;345:1148-50.
Frieden TR, Cairns G, Dorsinville M, Larkin C. Tuberculosis in New York City’s homeless. Pharos Alpha Omega Alpha Honor Med Soc 1995;58:45.
Driver CR, Luallen JJ, Good WE, Valway SE, Frieden TR, Onorato IM. Tuberculosis in children younger than five years old: New York City.* Ped Inf Dis J 1995;14:112-117.
Sterling T, Frieden TR. Isoniazid preventive therapy in areas of high isoniazid resistance. Arch Int Med 1995;155:1622-1628.
Driver CR, Frieden TR, Bloch AB, Onorato IM. Drug resistance among tuberculosis patients, New York City, 1991 and 1992. Public Health Rep 1994;109:632-636.
Frieden TR. Tuberculosis control and social change. Am J Pub Health 1994;84:172-173.
Frieden TR, Fujiwara PI, Ruggiero D, et al. Tuberculosis clinics. Am Rev Resp Crit Care Med 1994;150:893-894.
Hamburg MA, Frieden TR. Tuberculosis transmission in the 1990s.* N Engl J Med 1994;330:1750-1751 [editorial].
Mathieu J, Henning K, Bell E, Frieden TR. Typhoid fever in New York City: 1980-1990. Arch Int Med 1994;154:1713-1718.
Coronado VG, Beck-Sague CM, Hutton MD, Davis BJ, Nicholas P, Villarreal C, Woodley CL, Kilburn JO, Crawford JT, Frieden TR, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital: epidemiologic and restriction fragment length polymorphism analysis.* J Infect Dis 1993;168:1052-1055.
Frieden TR, Munsiff SS, Low DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76-79.
Frieden TR, Bia FJ, Heald PW, Eisen RN, Patterson TF, Edelson RL. Cutaneous cryptococcosis in a patient with cutaneous T-cell lymphoma receiving therapy with photopheresis and methotrexate.* Clin Infect Dis 1993;17:776-778.
Frieden TR, Sterling T, Pablos-Mendez A, et al. The emergence of drug resistant tuberculosis in New York City. N Engl J Med 1993;328:521-526.
Pozsic C, Kinney J, Breeden D, et al. Approaches to improving adherence to antituberculous therapy -- South Carolina and New York, 1986-1991. MMWR 1993;42:74-76.
Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers.* Ann Intern Med 1992;117:191-196.
Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA. Vitamin A levels and measles severity: New York City.* Am J Dis Child 1992;146:182-186.
Frieden TR, Biebuyck J, Hierholzer WJ. Lung abscess from group A beta-hemolytic streptococcus: case report and review.* Arch Intern Med 1991;151:1655-1657.
Frieden TR, Mangi R. Inappropriate use of oral ciprofloxacin.* JAMA 1990;264:1438-1440.
Frieden TR, Bia F. Recurrent aseptic meningitis for 24 years: diagnosis and treatment of an associated lesion. Yale J Biol Med 1990;63:1-4.
Garfield R, Frieden TR, Vermund S. Health related outcomes of war in Nicaragua. Am J Pub Health 1987;77:615-618.
Frieden TR, Garfield R. Popular participation in health in Nicaragua.* Health Pol Plan 1987; 2:162-170.
Garfield R, Frieden TR. Social and demographic characteristics of Nicaraguan health volunteers.* Int Quart Health Ed 1987;7:123-134.

Book

211. Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, Editor. Geneva: World Health Organization, 2004.

Selected Letters, Reports, Chapters, etc.

212. Moran AE, Whelton PK, Frieden TR. Chlorthalidone and Hydrochlorothiazide for Treatment of Patients with Hypertension. JAMA Internal Medicine 2020; 1739 [letter].

213. Frieden TR. Still not ready for Ebola. Science 360 2018 (6393):1049.

214. Kishore SP, Salam A, Rodgers A, Jaffe MG, Frieden TR. Fixed-dose combinations for hypertension. Lancet. 2018;392(10150):819-820.

215. Time to deliver: report of the WHO Independent High-level Commission on Noncommunicable Diseases. Geneva: World Health Organization; 2018. License: CC BY-NCSA 3.0 IGO.

216. Frieden TR. Reducing sodium intake in the population. JAMA.* 2016;316(23):2550-2551.

217. Frieden TR. Thomas Frieden. In: The service minded physician. CreateSpace Independent Publishing Platform: 2014.

218. Frieden TR. Information is power. America’s Health Rankings: A call to action for individuals and their communities. United Health Foundation; 2011: 7-10 [commentary].

219. Frieden TR. New York City's diabetes reporting system helps patients and physicians. Am J Public Health. 2008;98:1543-1544.

220. Perl SB, Ellis JA, Vichinsky LE, Larson K, Levy J, Silver L, Bassett MT, Frieden TR. Smoking cessation strategies in New York City: 2002-2006. In: Progress in smoking and health research. New York: Nova Publishers; 2007: 89-115.

221. Myers JE, Henning KJ, Frieden TR, et al. Written consent for human immunodeficiency virus testing. Public Health Rep 2007; 122:433-434 [letter].

222. Frieden TR, Munsiff SS, Desai Ahuja S. Outcomes of multidrug-resistant tuberculosis treatment in HIV-positive patients in New York City, 1990–1997.* Int J Tuberc Lung Dis 2007; 11:116–118 [letter].

223. Frieden TR, Sbarbaro JA. Family observation of antituberculosis treatment. Lancet 2006; Jun 24; 367:2055 [letter].

224. Frieden TR, Kellerman SE, Das-Douglas M. Public health principles for the HIV epidemic. N Engl J Med 2006; 354:877-8 [author reply to letter].*

225. Frieden TR. Lack of directly observed treatment affects tuberculosis relapse rates.* Am J Respir Crit Care Med 2006;173:359 [letter].

226. Bassett MT, Frieden TR, Deitcher DR, Matte TD. Strategies that promote health in cities: A local health department’s perspective.* In: Galeo S, Vlahov D, editors. Handbook of urban health: Populations, methods, and practice. New York: Springer; 2005.

227. Frieden TR. The New York case: lessons being learned.* Ann Intern Med 2005;143:760.

228. Frieden TR, Perl SB. Controlling the state of tobacco in the City of New York: a model for cancer and disease prevention. Cancer Prevention 2005;6:1,6 [newsletter].

229. Frieden TR. Fighting the costs of smoking. In: The business case for reducing workforce tobacco dependence. American Cancer Society, 2005.

230. Frieden TR. Frieden responds. Am J Public Health 2005;95:931-2* [letter].

231. Frieden, TR. What are the main consequences of false-positive and false-negative sputum smears? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

232. Frieden, TR. How can public and private sectors cooperate to detect, treat and monitor tuberculosis cases? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

233. Toman K, Frieden TR. What is intermittent treatment and what is the scientific basis for intermittency? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

234. Toman K, Espinal M, Frieden TR. What is the therapeutic effect and what is the toxicity of antituberculosis drugs? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

235. Frieden, TR. How can the emergence of drug resistance be prevented? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

236. Toman K, Espinal M, Frieden TR. Is primary drug resistance a menace to the control of tuberculosis? In: Toman’s tuberculosis: case detection, treatment and monitoring – Questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

237. Espinal M, Frieden T. What are the causes of drug-resistant tuberculosis? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

238. Frieden TR. Can tuberculosis be controlled? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

239. Luelmo F, Frieden TR. What are the indicators of an effective tuberculosis control programme? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

240. Raviglione M, Frieden TR. What are examples of effective tuberculosis control programmes? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

241. Luelmo F, Frieden TR. What are the relative priorities for a tuberculosis control programme, and what activities should not be undertaken? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

242. Frieden TR. How can tuberculosis control services be promoted and sustained? In: Toman’s tuberculosis: case detection, treatment and monitoring – questions and answers. 2nd ed. Frieden T, editor. Geneva: World Health Organization, 2004.

243. Galvez MP, Frieden TR, Landrigan PJ. Obesity in the 21st century. Environ Health Perspect 2003;111:A684-5 [editorial].

244. Feldman GE, McCord CW, Bassett MT, Frieden TR. Screening for colorectal cancer.* JAMA 2003;290:191 [letter].

245. Sterling T, Munsiff SS, Frieden TR. Management of latent tuberculosis infection in immigrants.* New Engl J. Med 2003;348:1289-1292 [letter].

246. Udwadia ZF, Schaller JG, Starke J, Khatri GR, Frieden TR. Controlling tuberculosis in India. New Engl J Med 2003;348:758-759 [letter].

247. Sterling TR, Lehmann HP, Frieden TR. Impact of DOTS and DOTS-plus on multidrug resistant TB: authors’ reply. BMJ 2003;327:164 [letter].

248. Thorpe LE, Mostashari F, Berger DK, Cobb LK, Helgerson SD, Frieden TR. Diabetes is epidemic.* NYC Vital Signs 2003:2(1);1-4.

249. Thorpe LE, Mostashari F, Berger DK, Feldman G, Karpati AM, Cobb LK, Helgerson SD, Frieden TR. Cancer screening in New York City: we can do much better.* NYC Vital Signs 2003:2(2);1-4.

250. Karpati AM, Matte T, Kass D, Garg R, Mostashari F, Thopre LE, Frieden TR. Asthma can be controlled. NYC Vital Signs 2003:2(4);1-4.

251. Feldman GE, McCord CW, Frieden TR. Preventing colorectal cancer. City Health Information 2003:22(2);1-4.

252. Berger DK, McCord CW, Frieden TR. Diabetes prevention and management.* City Health Information 2003:22(3);1-8.

253. Frieden TR, Narain JP. Tuberculosis control – progress, prospects, and perspectives.* Chest [Indian Edition] 2002;3:63-64 [editorial].

254. Cegielski JP, Chin DP, Espinal MA, Frieden TR, Raviglione MC, Cruz RR, Talbot EA, Weil DEC, Zaleskis R. The global tuberculosis situation: progress and problems in the 20th Century, prospects for the 21st Century.* Infectious Disease Clinics of North America 2002;16:1-58.

255. Frieden TR, Khatri GR. Multidrug-resistant tuberculosis.* In: JP Narain, ed., Tuberculosis epidemiology and control. 1st ed. World Health Organization: Regional Office for South-East Asia, New Delhi, 2002.

256. McCord CW, Repetto P, Frieden TR. Treating nicotine addiction.* City Health Information 2002:21(6);1-8.

257. Khatri GR, Frieden TR, Rai SN. Prevention and control of multidrug-resistant tuberculosis.* South-East Asia Regional Office of WHO, 2002.

258. Frieden TR. Tuberculosis control: an annotated bibliography. World Health Organization: Regional Office for South-East Asia, New Delhi, 2001, SEA/TB/233.

259. Frieden TR, Mullins J. Research for action: understanding and controlling tuberculosis in India.* World Health Organization: Regional Office for South-East Asia, New Delhi, 2000, ISBN 97 9022 223 9.

260. Fujiwara PI, Frieden TR. TB control in New York City: a recent history.* TB Notes 2000, US Public Health Service, 9-12.

261. Joint review of tuberculosis in India.* World Health Organization: Regional Office for South-East Asia, New Delhi, 2000 (WHO/SEA/TB/224).

262. Frieden TR. Tuberculosis control in India.* Centers for Disease Control and Prevention. TB Notes 1999;2:20-24.

263. Frieden TR. The microscope: a practical guide. World Health Organization: Regional Office for South-East Asia, New Delhi, 1999.

264. Weyer K, de Kantor IN, Kim SJ, Frieden TR, et al. Laboratory services in tuberculosis control (Parts I, II, and III). World Health Organization, Geneva, 1999.

265. Frieden TR. Directly observed therapy and treatment completion. Am J Pub Health 1999;89:604-605 [letter].

266. Frieden TR. Directly observed treatment for tuberculosis. Lancet 1999;353:146 [letter].

267. Frieden TR. Directly observed treatment, short-course: the strategy that ensures cure of tuberculosis patients.* In: Sharma, SK, ed., Textbook of tuberculosis (Jaypee Brothers, New Delhi, 2001).

268. Frieden TR, Kumaresan J. Directly observed treatment, short-course: annotated bibliography.* World Health Organization, Geneva, 1997.

269. Frieden TR. Clarifying the issues in tuberculosis control. Am J Pub Health 1996;86:267-268 [letter].

270. Frieden TR. The phylogeny of Mycobacterium tuberculosis.* Tuberc Lung Dis 1996;77:291 [letter].

271. Frieden TR. Investigation of contacts to tuberculosis cases.* Introduction and conclusion (New York City Department of Health, 1996)

272. Frieden TR. New York City TB drug costs and regimens.* TB Notes 1996;2:5-6.

273. Fujiwara PI, Frieden TR. Tuberculosis epidemiology and control in the inner city.* In: Rom WN, Garay, SM, eds. Tuberculosis. Boston: Little, Brown and Company; 1996:99111.

274. Frieden TR. Obituary: Arthur B. Robins. Am J Public Health 1995;85:1723.

275. Frieden TR, Sterling TR, Simone PM. Tuberculosis in a neighborhood bar.* N Engl J Med 1996;334 [letter].

276. Frieden TR, Larkin C, Dorsinville M. Realities of directly observed therapy, New York City.* TB Notes. November, 1995.

277. Frieden TR, Dorsinville M, DeLott F, et al. Update on the DOT experience in New York City.* TB Notes, Spring/Summer 1995.

278. Frieden TR, Simone PM, Castro KG. Laryngeal tuberculosis.* N Engl J Med 1995;332:610 [letter].

279. Frieden TR, Hamburg MA. Transmission of tuberculosis.* N Engl J Med 1994;331:1095-6 [letter].

280. Frieden TR, Dooley SW. Drug resistant tuberculosis in New York City.* N Engl J Med 1993;329:135 [letter].

281. Frieden TR, Munsiff SS, Low DE, Kreiswirth B. Vancomycin-resistant enterococci.* Lancet 1993;342:616 [letter].

282. Frieden TR, Fujiwara PI. Tuberculosis treatment.* City Health Information 1992;11(5):1-4.

283. Frieden TR, Pearson ML, Jereb JA. Drug-resistant and nosocomial tuberculosis, New York City, 1991.* Centers for Disease Control EPI-AID 91-42-2. December 31, 1991.

284. Frieden TR. Typhoid fever in New York City, 1990.* Field Epidemiology Report, CDC, 1991.

285. Frieden TR. As Americans die for lack of medical care.* The New York Times. 1984 Apr 23; Sect. A:14 (col.4) [letter].

286. Frieden TR. “Nicaragua rural y las jornadas populares de salud (Rural Nicaragua and the Popular Health Campaigns).” Report to the Nicaraguan Ministry of Health. August, 1983.

287. Frieden TR. Marketing survey and market analysis: Douglas [Tennessee] Community Health Clinic. Report to the Board of Directors. July 31, 1982, 51 pp.

* Denotes articles that are behind a paywall or unavailable on the internet. For reprints of these, email contact@tomfriedenpublichealth.net and paste the details of the article.

Themes

Health Emergencies

Countries around the world face a perfect storm of converging threats. Covid is the latest but far from the last health emergency the world will face.

Covid is the most recent health emergency, but one of only a many in recent years. On average, one new pathogen with substantial potential for human harm is discovered every year.

The Global Health Security Agenda is an important initiative to reduce global risk. But outbreaks and epidemics of HIV, Zika, Ebola, drug-resistant bacteria, cholera, and more demonstrate our ongoing vulnerability to microbial onslaught and sneak attack. The articles in this section outline some of those risks - and some succesful responses that are important to learn from.

Featured Article

Frieden TR, Tappero JW, Dowell SF, Hien NT, Guillaume FD, Aceng JR. Safer countries through global health security. Lancet 2014;383(9919):764-6.

Selected articles with summary and commentary

Global Health Security

Shahpar C, Lee CT, Wilkason C, Buissonnière M, McClelland A, Frieden TR. Protecting the world from infectious disease threats: now or never. BMJ Glob Health. 2019;4(4):e001885.

Health cannot be protected by Ministries of Health alone.16 Many sectors need to be involved in order to increase and sustain investment,17 build long-term capacity and implement policies affecting health in the food, security and animal sectors. In many countries, the JEE was the first opportunity for these sectors to work together. This group should continue to collaborate in order to prioritise which gaps to fill first, begin implementation, increase domestic financing and monitor progress. High-level support (eg, from presidential or prime minister offices) is essential for countries to take action. Engagement by journalists and civil society can convey that increased health security is essential.18 This support can help counter the pattern of a temporary surge of activity followed by waning interest, as typically seen after a major outbreak.

For the first time in history, the world has an in-depth understanding of how prepared most countries are to deal with epidemic diseases and of what must be done to improve preparedness. To save lives, funded, prioritised, well-planned actions must be implemented at scale as soon as possible, supported by a network of partners working together to support countries to step up their capacities to prevent, detect and respond to public health threats and make the world safer.

Redd SC, Frieden TR. CDC’s evolving approach to emergency management.* Health Security. 2017;1:1-12.

We reviewed experience from 2009 through 20017, drawing lessons from the H1N1 influenza pandemic, Ebola, Zika, and many tother emergencies. Our fundamental conclusion: the best emergency preparation is getting everyday systems to work well to find, stop, and prevent health threats, with the ability to scale these systems up quickly and robustly.

Frieden TR, Schuchat A, Petersen LR. Zika virus 6 months later. JAMA 2016;316:1443-1444.

The Zika epidemic was the most complex emergency CDC had faced. It required involvement of a broad range of expertise: virology, entomology, vector control, reproductive health, birth defects, laboratory development, pathology, and more. We're still learning about how to control it, and why the impact was so different in different places.

Tappero JW, Thomas MJ, Kenyon TA, Frieden TR. Global health security agenda: building resilient public health systems to stop infectious disease threats. Lancet 2015;385:1889-91.

This collection of artilces outlines the rationale and needs for the Global Health Security Agenda. The world now has a good sense of what is needed, where, how to address these needs, and how much it will cost to do so. What's lacking is action to meet these needs - with money, technical support, and strengthening operational capacities.

HIV/AIDS

Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ. Applying public health principles to the HIV epidemic. N Engl J Med 2005;353:2397-2402. and Frieden TR, Foti KE, Mermin J. Applying public health principles to the HIV epidemic – How are we doing? NEJM 2015;373(23):2281-7.

In 2005, I called for the application of public health principles to the HIV epidemic (table below). This was highly controversial at the time. Since then, the view has been widely accepted and applied, and we review the substantial, although far from complete progress, since, and concluded that, "The combination of patient empowerment, community engagement, clinical excellence, and public health focus on outcomes and impact could make management of HIV infection a model for combating other chronic diseases."

Torian LV, Wiewel EW, Liu K, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med 2008;168:1181-1187.

Delay in diagnosis of HIV results in both avoidable illness in the person diagnosed, and increased risk of spread to others. Addressing the root causes of delayed diagnosis and treatment is essential to controlling the HIV epidemic.

Ebola

Frieden TR, Damon IK. Ebola in West Africa – CDC’s role in epidemic detection, control, and prevention. EID 2015;21(11):1897-1905. and Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. Ebola 2014—new challenges, new global response and responsibility. NEJM 2014;371(13):1177-80.

The Ebola epidemic was the most challenging emergency of my 15 years leading public health programs. Thousands of CDC staff worked for years in West Africa to help end the epidemic. Although as I said publicly early on, it was never "in the cards" for Ebola to spread widely in the United States, the epidemic caused a degree of fear and politicization in the public and by politicians that foreshadowed the deadly errors made in the US response to Covid in 2020.

Martin Meltzer's model of Ebola is one of the greatest modeling stories in public health history - and not widely enough known. Samantha Power's book outlines the impact his worst-case scenario had within the United States government and global community. But less well appreciated is the fact that his projection of what would happen with fast, effective action matched what did happen stunningly well, as shown in this figure below.

I outlined this in a brief (2 minute) video that I wish more people would watch - because models have been so poorly understood and used during the Covid pandemic.

About Ebola, we made one specific and one general conclusion.

"The Ebola virus is a formidable enemy. If a single case is missed, a single contact becomes ill and isn't isolated, or a single lapse in infection control or funeral-practice safety occurs, another chain of transmission can start."

"We believe that stopping outbreaks in a way that leaves behind stronger systems to identify, stop, and prevent future health threats is a moral imperative."

Haiti including cholera

Periago MR, Frieden TR, Tappero JW, De Cock KM, Aasen B, Andrus JK. Elimination of cholera transmission in Haiti and the Dominican Republic. Lancet 2012;379:193-286.

It's possible to eliminate cholera from Haiti and the Dominican Republic - but requires persistence and political commitment.

Dowell SF, Tappero JW, Frieden TR. Public health in Haiti – challenges and progress. NEJM 2011;364(4):300-301.

The earthquake and cholera epidemic were devastating, and even before these events, Haiti had, by far, the worst health status of any country in the hemisphere. But it would be a mistake to fail to recognize the many areas where dedicated health workers and community volunteers have made substantial progress. This progress demonstrates that more progress is definitely possible.

Note: The earthquake also resulted in the death of Diana Caves, a dedicated and inspiring CDC staffer who was in the country on a short-term assignment to help improve prevention and control of HIV. This was the one death in the line of duty which occurred in my time as CDC director from 2009-2017. I will never forget meeting with her family to inform them. We established an award to recognize staff early in their career.

Drug-resistant bacteria

Antibiotics have saved millions of lives, but drug-resistance threatens to usher in a post-antibiotic time. In April of 1991, acting on a tip from an alert clinician, I conducted a study of every patient in New York City with tuberculosis. The results were alarming, and resulted in a substantial increase in funding and attention. We were ultimately able to control the outbreak, which was largely driven by spread in hospitals, and was the largest outbreak of multi-drug resistant tuberculosis the United States has experienced. Another bacteria, vancomycin-resistant enterocci, didn't spread widely. In 1990, while an infectious disease fellow, I wrote of the widespread inappropriate use of antibiotics.

Frieden TR, Sterling T, Pablos-Mendez A, et al. The emergence of drug resistant tuberculosis in New York City. N Engl J Med 1993;328:521-526.

Frieden TR, Munsiff SS, Low DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76-79

Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers.* Ann Intern Med 1992;117:191-196.

Nivin B, Nicholas P, Gayer M, Frieden TR, Fujiwara PI. A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. Clin Infect Dis 1998;26:303-307.

Frieden TR, Mangi R. Inappropriate use of oral ciprofloxacin.* JAMA 1990;264:1438-1440.

Malaria

Writing with Dr. Tedros, now WHO Director General, and others, we outlined a way forward to control of malaria, tuberculosis, and HIV.

Frieden TR, Teklehaimanot A, Chideya S, Farmer P, Kim JY, Raviglione MC. A road map to control malaria, tuberculosis, and human immunodeficiency virus/AIDS. * Arch Intern Med 2009;169:1650-2.

World Trade Center / Health Registries

I became health commissioner in January, 2002, when the World Trade Center remains were still burning. We established a registry to track health effects and facilitate benefits for survivors and those suffering from the health, including mental health, complications. Rapid creation of health registries to better understand and support those effected by health emergencies is an important public health function, and must be done quickly and sensitively.

Farfel M, Digrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson D, Frieden TR, Thorpe L. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health 2008;85:880-909.

Vitamins and infections

There's a long and interesting history of the interaction of nutrition and infection. In the early 1900s, anti-tuberculosis activists helped to create milk stations so children could receive wholesome milk as a nutritional supplement. During my training as an Epidemic Intelligence Service Officer of the Centers for Disease Control, I documented that vitamin A levels were low among children in New York City with measles. This resulted in a new recommendation to provide vitamin A to young children with measles in the United States.

While working in India, we gradually realized that tuberculosis has substantial seasonality: there is a much higher rate in cold weather in the north of the country, but no seasonality in the south of the country which doesn't have a winter season. (I was memorably informed that Chennai has three seaons: hot, hotter, and hottest.) The figure below is striking in showing this. Very high seasonality in the cold winter months in the north, and none in the hot winter months in the south. The reasons for this seasonality are not yet definitively known, but vitamin D deficiency in the colder months, when people are inside more, is a leading and plausible hypothesis, for which there is increasing evidence.

Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA. Vitamin A levels and measles severity: New York City.* Am J Dis Child 1992;146:182-186.

Thorpe LE, Frieden TR, Laserson KF, Wells G, Khatri GR. Seasonality in tuberculosis, India: is it real and what does it tell us?* Lancet 2004;364:1613-1614.

Reprints. Articles marked with * are available by request (all others are open source and available through the links). To request a reprint:

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Tuberculosis

Tuberculosis reflects societal structures, and tuberculosis control reflects the competence of government.

Forgetting is the key challenge in tuberculosis control. Political leaders forget the poor and disenfranchised, who are most likely to contract and die of tuberculosis. Health leaders forget simple, low-technology interventions and therefore neglect the core work of treatment observation, field supervision, and cohort monitoring and evaluation. Patients forget how sick they were and may stop medications when symptoms subside.

Dr. Frieden sounded the alarm on the emergence of drug resistant tuberculosis. For more than a decade following this, Dr. Frieden led investigation and control of tuberculosis, first in New York City, then, in support of national and state governments, in India.

Reprints. Articles marked with * are available by request (all others are open source and available through the links). To request a reprint:

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Featured article

Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City — turning the tide. New Engl J Med 1995;333:229-233.

In New York City, Dr. Frieden documented explosive spread of multidrug-resistant tuberculosis in hospitals and elsewhere. In a seminal article, he and colleagues described the citywide 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 ever done, documenting the importance of spread in hospitals and of laboratory contamination.

Interventional Epidemiology

Dr. Frieden coined the term, “Interventional Epidemiology,” and emphasizes the importance of using data to drive progress protecting health. 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 has consistently emphasized the importance of public health tuberculosis clinics, of patient-centered services, and of recognizing and addressing the need for social change.

Dr. Frieden then moved to India, where he supported the 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 district progress. Dr. Frieden also emphasized the importance of a rigorous assessment of how and to what extent tuberculosis could be controlled, depending both on the epidemiological context and program performance. Working with the legendary 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.*

As he was preparing to leave India after five years working there on secondment from the United States Centers for Disease Control and Prevention to the World Health Organization (WHO), WHO asked him to edit a class textbook on tuberculosis. Dr. Frieden completed this work in 2001; WHO published it in 2004, and it remains available online and through WHO.

More recently, Dr. Frieden and colleagues reviewed areas where tuberculosis detection, treatment and monitoring have gone off course globally, concluding:

“Forgetting is the key challenge in tuberculosis control. Political leaders forget the poor and disenfranchised, who are most likely to contract and die of tuberculosis. Health leaders forget simple, low-technology interventions and therefore neglect the core work of treatment observation, field supervision, and cohort monitoring and evaluation. Patients forget how sick they were and may stop medications when symptoms subside.

The hallmark of tuberculosis is persistence—the persistence of M tuberculosis for life in most infected people and persistence of reproducing bacilli during the initial weeks of treatment. This must be matched by persistence with basic tuberculosis control principles, not just in planning but in actual implementation. Innovation in tuberculosis control programs is crucial, and new technology can and should be appropriately used, but must accompany effective core public health practice.”

Dr. Frieden has also emphasized the many lessons that tuberculosis control has for public health, concluding that, “By implementing evidence-based practices, ensuring operational excellence, using information systems that facilitate accountability and evaluation, and obtaining and maintaining political support, we can address the public health challenges of the twenty-first century.”

Cancer

Although there is appropriate focus on finding cures for cancer, most cancers could be prevented with currently available programs. Public health progress is essential to winning the war on cancer.

Cancer is far more easily prevented than cured. Primary prevention works through reduction in risk factors and changes to the environment, especially reducing tobacco use. The World Health Organization's MPOWER package outlines effective action to protect people against tobacco.

Cancer can also be prevented by reducing alcohol consumption through policies such as alcohol taxes and limits on alcohol sales, and by restoring caloric balance through policies such as creating healthier food environments and engineering the built environment to increase opportunities for physical activity.

Vaccination is an effective approach to preventing specific virus‐associated cancers, such as human papillomavirus vaccine to prevent cervical and oropharyngeal cancer and hepatitis B virus vaccine to prevent hepatocellular cancer.

Secondary prevention reduces cancer mortality through screening and early treatment; this approach has been used successfully for breast and cervical cancer and is particularly underused against colon cancer.

Progress can be made in all three approaches to cancer prevention, but will require a greater emphasis on public health programs and public policy. Winning the war on cancer will require a much larger investment in prevention to complement efforts to improve treatment.

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Featured article

Frieden TR, Myers JE, Krauskopf MS, Farley TA. A Public Health Approach to Winning the War against Cancer. Oncologist 2008;13:1306–1313.

Ever since 1971, when the United States declared a "War on Cancer", and even before, there has been appropriate fear and focus on defeating cancer. Siddhartha Mukherjee's fantastic book, Emperor of All Maladies, recounts the biography of cancer.

Although there has been progress in the past 50 years, cancer remains a leading cause of death, particuarly among younger people. What's particularly tragic is that many means to reduce cancer are readily available, but not being implemented.

Tobacco control

First and foremost is tobacco control. Tobacco causes about one third of all deaths from cancer. The MPOWER package outlines what's needed to reduce tobacco use.

Alcohol policy

Of the main interventions for tobacco control, taxation is the most important. Countries could end the tobacco epidemic by taxing, increasing tax enforcement with a track and trace approach, fully funding comprehensive tobacco control, and by regulating the nicotine content in combustible tobacco down to non-addictive levels and allowing use of controlled-dose non-combustible nicotine as this is done.

Alcohol causes nearly 4% of the global cancer burden. Daily alcohol consumption, even in low amounts, can enhance carcinogenesis. Chronic heavy alcohol use is associated with cancers of the oral cavity, larynx, pharynx, esophagus, liver, colon, rectum, and breast.

Many public policy options exist for alcohol control. Alcohol availability can be reduced through various regulations, and as with tobacco control, taxes can increase the price of alcohol, the social environment can be altered to discourage consumption, and assistance can be provided to those with or at risk for problem drinking.

Nutrition

Obesity is associated with a higher incidence of many cancers, including cancers of the endometrium, kidney, gallbladder (in women), breast, colon, and esophagus. It has been estimated that, in the U.S., if the prevalence of overweight and obesity was reduced, some 90,000 cancer deaths could be prevented every year.

Obesity has more than doubled in the U.S. in the past 25 years. Human genes have not changed rapidly enough to cause this epidemic; changes in diet and physical activity over the past few decades are to blame. These changes are caused by the transformation of the modern environment. A public health approach to obesity must alter the environmental context for healthy eating and increased physical activity.

An international review estimated that increased fruit and vegetable consumption could prevent 5%–12% of the worldwide cancer burden, and 20%–30% of upper gastrointestinal cancers. Specific dietary patterns may also be associated with greater risk from, or protection against, certain cancers.

Vaccination

Certain viral infections are proven to cause cancer, and vaccination against these viruses can prevent cancers from developing. Cervical cancer and hepatocellular cancer are strongly linked to infection with human papilloma virus (HPV) and hepatitis B virus (HBV), respectively. There is increasingly strong evidence of the association of many oropharyngteal cancers with HPV as well. Prevention of both these virus‐associated cancers rests on strong government policies and programs to ensure high levels of vaccination coverage in entire populations. These include broad‐based rather than targeted recommendations about who should be vaccinated, vaccination mandates enforced at the time of school entry, government subsidies that offer vaccination at reduced or no cost, and convenient provision of vaccines.

HPV can be detected in virtually every case of cervical cancer. More than 20 million people in the U.S. are currently infected with this sexually transmitted infection, with 6.2 million people infected annually. The HPV vaccine protects against most oncogenic HPV.

Hepatocellular cancer, which kills about 320,000 people globally each year, is believed to be attributable in about 80% of cases to viral hepatitis, particularly HBV. Infants infected perinatally have a 90% risk of developing chronic HBV infection, whereas <5% of those infected at ≥5 years of age will develop chronic infection. The risk of developing hepatocellular cancer is 100 times higher among those with chronic HBV infection.

Many countries attempt to vaccinate all infants against HBV, a practice that has contributed to dramatic declines in HBV prevalence. It is also important to provide postexposure prophylaxis to infants born to hepatitis B surface antigen–positive women.

Secondary prevention

Screening is responsible for important progress in cancer prevention, reducing mortality from cancers of the breast, cervix, skin, colon, and possibly prostate. Yet screening for colon cancer, the second leading cause of cancer death in the U.S., lags. Although detecting colorectal cancers when still localized results in a 90% survival rate, most are not diagnosed at these early stages. Mammography and Papanicolaou testing have achieved much higher coverage in their respective target populations.

Patients are also reluctant to undergo colonoscopy or sigmoidoscopy because it is a complex procedure that requires uncomfortable preparation. Many interventions to increase screening rates have been devised, some with significant success; a patient navigator system in three New York City hospitals increased screening volumes by 50%, and overall colonoscopy screening rates increased from 42% to 60% between 2003 and 2006.

Conclusion

As with infectious disease control in the past century, public health strategies that implement a range of interventions can have a dramatic effect reducing cancer. It's time to greatly strengthen prevention, especially primary prevention, to the paradigm of cancer control, and to recognize that prevention requires not just medical care but also strong public health and primary care systems and effective public policy.

Heart and Brain Health

Cardiovascular disease is the world's leading killer, leading cause of health disparities, and the major driver of health care spending. Public health action can prevent at least 100 million deaths.

Despite being the leading cause of mortality and premature death, cardiovascular disease is largely preventable through simple, inexpensive, but underused actions. With financial and political capital, there has been substantial progress against HIV infection, malaria, tuberculosis, vaccine-preventable disease, and many causes of maternal and infant mortality. But of the more than $35 billion the world spends on development assistance in health, less than 1% goes toward prevention of cardiovascular disease.

In addition to , three specific interventions – artificial trans-fat elimination, dietary sodium reduction, and effective treatment of high blood pressure – can reduce the burden of cardiovascular disease, and can be implemented now.

Featured article

Frieden TR, Bloomberg MR. .* Lancet.2018;17;391(10121):709-712.

Although tobacco is the world's leading cause of death, hypertension actually kills more people each year - and more than all infectious diseases combined.

To reduce hypertension, both prevention and treatment are needed. Although weight loss and increased physical activity and adoption of healthier overall diets, can reduce hypertension, these interventions are difficult to scale up for population-wide impact. In contrast, two initiatives - sodium reduction and hypertension treatment - can reduce stroke and heart attack rapidly.

Sodium reduction, along with trans fat elimination, are covered in detail in the section of this site. For hypertension treatment, substantial improvement is possible and needed.

The Panel below outlines the five essential components of effective treatment of hypertension.

Each of these five components requires meticulous attention to detail in planning and execution.

Treatment of hypertension can - and should be - pathfinder for better primary health care. And better primary health care is the most important and most neglected part of our health care system.

This article summarizes lessons learned in the first years of the Resolve to Save Lives hypertension management program, operated in coordination with the World Health Organization and other partners. Hurdles to hypertension control have been identified, with most related to limitations in the health care system rather than to patient behavior. Treatment according to standardized protocols should be started as soon as hypertension is diagnosed, and medical practices and health systems must closely monitor patient progress and system performance.

Years of intensive work identified these key lessons:

We advocated for protocol-based treatment early on - learning lessons from tuberculosis, HIV, and immunization programs. Standardization makes quality improvement possible. It's sometimes criticized as "cookbook medicine," but this is a misguided critique. The best health care systems, including Kaiser-Permanente in the U.S., use protocols. Clinicians can depart from the protocol by simply noting the reason in a few words. Without protocols, there's far too much of what is euphemistically called "unwarranted clinical variability" - a fancy name for malpractice. Most patients with hypertension, all over the world, are underdiagnosed and undertreated.

Hypertension is probably the easiest chronic non-communicable disease to treat, since blood pressure measurement for diagnosis and monitoring is simple, drug regimens can be once daily and inexpensive, and treatments exist that do not need laboratory monitoring. However, hypertension is adequately controlled in only about 13% of people with the disorder worldwide.

We launched a well-conceptualized initiative to prevent one million heart attacks and stroked in the United States in 5 years in 2011.

Despite a lot of hard work and some important progress, the sad answer to the question asked by the title of this article has been: "Yes, but it didn't happen."

An ambitious attempt to take a public health approach to diabetes care in New York City, based on mandatory reporting of A1C levels. Despite extraordinary effort, the impact was minimal. I don't regard this as a failure, but as a successful attempt at something that needed to be tried. Public health – and I – learned a lot, and some patients benefited. People with diabetes are at much higher risk of serious complications. Controlling their blood pressure, treating them with statins, and managing their glucose can all improve their health – in that order of impact/priority.

Took us nearly 3 years to complete this work. It's one of those amazingly simple questions and it's ust astonishing that it hadn't been asked and answered before. The countries of the world all convened and agreed to Sustainable Development Goals. Good. Including control of the leading killers. Even better. Focusing on a 30% reduction of the risk of death from heart disease, cancer, stroke, and chronic lung disease. Great. But a plan or accountability for actually doing so? Nothing. So we outlined what would be needed to reach this ambitious and appropriate goal. The 7 livesaving programs:

Fixed-dose combinations can improve adherence to medications and control of blood pressure.

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Policy including Disparities

Policy change is the royal road to progress. Public health has identified policies proven to save lives, and public health evaluation can identify additional policies for further progress.

Health departments must continue to handle traditional public health priorities as well as emerging infectious diseases. They must also increasingly address terrorism detection, preparedness, and response. But it is even more urgent that they adjust to the epidemiological transition from communicable to chronic disease. All too many are asleep at the switch.

Public Health Policy

The public health impact pyramid provides a framework to prioritize action to save and improve lives. At the base are socioeconomic factors such as poverty, education, access to health care, and elimination of health disparities. One level above that are actions that make the default action healthier, such as clean air and clean water laws. Above that are clinical interventions that last years or even a lifetime. Clinical interventions such as treatment of hypertension are one level above that, and counseling and education are at the top. The lower on the pyramid, the larger the impact, but effective programs often work at every level.

Generally, working at the bottom level of the pyramid makes the default decision the healthy decision for people. It's harder for communities to achieve healthy change at this level, but easier for people to stay healthy. The higher up on the pyramid, the lower the impact and the greater the individual effort needed.

Many programs work at every level of the pyramid. Change may take many years, and there may be synergy between working at upper levels and generating the political will to improve the lower levels.

Along the side is surveillance, which is crucially important to improving health. This requires the ongoing, systematic collection, analysis, and interpretation of data with dissemination to those who need to know.

If a program is going well, surveillance data can protect it from attack and preserve it. If a program is going poorly, surveillance is crucial to make that known and lead to progress.

The concept of the pyramid is applicable to a wide range of health problems. Powerpoint slides outlining this in seven different areas are available for download here. I hope you like them!

Lessons from Tuberculosis

TB control is effective when it combines two essential components: a practical, implementable, proven technical package, and political commitment. Political commitment is also essential to implement other interventions that can improve health, including healthier air, water and food, as well as programs to prevent or reduce tobacco smoking, cardiovascular disease, cancer, obesity and other growing public health problems. By implementing evidence-based practices, ensuring operational excellence, using information systems that facilitate accountability and evaluation, and obtaining and maintaining political support, we can address the public health challenges of the twenty-first century.

Asleep at the Switch

Surveillance
Environmental interventions
Regulations
Clinical care
Outbreak detection, investigation, and control
Case management and contact tracing
Immunization
Health education

For this to occur, there must be more funding for public health – and the willingness to expend political capital.

The biggest difference between control of infectious disease and control of non-communicable diseases is that microbes, unlike the tobacco, alcohol, unhealthy food, and other causes of illness, don't have lobbyists.

"Nanny State"?

What is government's role in protecting health? Does new public health action in chronic disease control represent inappropriate "nanny state" action?

Promoting free and open information
Protecting individuals from harm caused by other people or groups
Taking societal action to protect and promote health.

These are not "nanny state" actions, these are life-saving actions that support both personal and societal responsibility.

Elimination of Health Disparities

Health disparities can be overcome by innovative, well-designed, and consistently evaluated programs that build viable and sustainable long-term partnerships and inspire political commitment through effective implementation and communication.

Elimination of health disparities isn't just one aspect of public health action, it suffuses all of the public health approach. Disparities by race, ethnicity, age, income, gender, gender identiy, and more persist in the United States and in virtually every country in the world.

In the United States, Black people live shorter lives than White people, and are often affected by negative health trends earlier, and more severely, than others. This has been the case during the Covid pandemic.

There are many things we must do to address disparities. Pushing for fundamental change. Recognizing and reversing racist, sexist, and other pervasive and harmful realities. Expanding empathy.

Public health starts with surveillance. Bill Foege likes to call this, "Knowing the truth." When it comes to disparities, surveillance is one form of bearing witness.

At CDC, I insisted that we start an annual "Surveillance Summary" on disparities. CDC had never done anything like this before, although confronting disparities has been an important part of CDC work since it's creation 75 years ago.

Bearing Witness

Announcing this onging report in January of 2011, I noted our "commitment to socioeconomic justice and shared responsibility". Some key findings of that first report:

Lower income residents report fewer average healthy days. The correlation between poor health and health inequality at the state level holds at all levels of income.
Both the poor and the wealthy experience the negative health effects of air pollution; racial/ethnic minority groups, who are more likely to live in urban counties, continue to experience a disparately larger impact.
Large disparities in infant mortality rates persist. Infants born to black women are 1.5 to 3 times more likely to die than infants born to women of other races/ethnicities.
Men of all race/ethnicities are two to three times more likely to die in motor vehicle crashes than are women, and death rates are twice as high among American Indians/Alaska Natives.
Menofallagesandrace/ethnicitiesareapproximatelyfourtimesmorelikelytodiebysuicidethanfemales
The suicide rate among American Indians/Alaskan Nativess and non-Hispanic whites is more than twice that of blacks, Asian Pacific Islanders and Hispanics.
Prescription drug abuse now kills more persons than illicit drugs, a reversal of the situation 15–20 years ago.
Men are much more likely to die from coronary heart disease, and black men and women are much more likely to die of heart disease and stroke than their white counterparts. Coronary heart disease and stroke are not only leading causes of death in the United States, but also account for the largest proportion of inequality in life expectancy between white and Black people, despite the existence of low-cost, highly effective preventive treatment.
There also are large racial/ethnic disparities in preventable hospitalizations, with Black people experiencing a rate more than double that of whites.
Disparities continue to widen as HIV rates increase among black and American Indian/Alaska Native males, as well as MSM, even as rates hold steady or are decreasing in other groups.
Rates of adolescent pregnancy and childbirth have been falling or holding steady for all racial/ethnic minorities in all age groups. However, disparities persist as birth rates for Hispanic and non-Hispanic black women are 3 and 2.5 times those of whites, respectively.
Younger people and men are more likely to binge drink and consume more alcohol than older people and women. The prevalence of binge drinking is higher in groups with higher incomes and higher educational levels, although people who binge drink and have lower incomes and less educational attainment levels binge drink more frequently and, when they do binge drink, drink more heavily. American Indian/Native Americans report more binge drinking episodes per month and higher alcohol consumption per episode than other groups.
Tobacco use is the leading cause of preventable illness and death in the United States. Despite overall declines in cigarette smoking, disparities in smoking rates persist among certain racial/ethnic minority groups, particularly among American Indians/Alaska Natives. Smoking rates decline significantly with increasing income and educational attainment.

I note that two fundamental failings of the U.S. health system are lagging health improvement and severe health disparities.

In 1966, Martin Luther King said that “Of all the forms of inequality, injustice in health care is the most shocking and inhumane”. We have made some but not nearly enough progress in reducing the barriers to equitable health care and to health equity. We should work with what he called “the fierce urgency of now” to eliminate this form of inequality wherever and whoever it affects.

Cardiovascular disease is the leading cause of death in the United States. Non-Hispanic Black adults are at least 50% more likely to die of heart disease or stroke before age 75 years than their non-Hispanic white counterparts.

It's not enough to shine a light on injustice; it's important to act to end injustice. In this report, we highlighted programs that empowered communities and reduced health disparities. These included HIV prevention programs, motor vehicle crash prevention programs led by an inspiring coalition of Native American leaders, and, most strikingly, the Vaccines for Children program.

Created in the wake of measles outbreaks which occured in the U.S. in the early 1990s, the Vaccines for Children program (VFC) provides vaccines at no cost to children who might otherwise not be vaccinated because of inability to pay. The program has substantially increased childhood vaccination rates, and constant cycles of program evaluation ensure that VFC continues to have maximum impact.

VFC has eliminated disparities in coverage for many vaccines although some disparities in coverage, while reduced, persist for Hispanic and black children.

Specific Actions

As one example, reducing teen and unintended pregnancy is an important means to reduce health disparities. Dr. Allan Rosenfield revolutionized the field of reproductive health with one essential insight. As an obstetrician, Allan was acutely aware that women wanted more control over their reproductive future. Until Allan did the studies, this hadn't been well documented, and well-intentioned but ill-advised programs wrote about "population control" and mistakenly feared an imminent Malthusian catastrophe.

The fact is that teen and unintended pregnancy often results in the intergenerational transmission of poverty. By fighting for reproductive rights, public health can help empower women to take control of their health.

In this tradition, we focused on reducing teen pregnancy as a key goal of the Winnable Battles initiative. With partners from around the country, the ambitious goals were met, and teen pregnancies and births were reduced dramatically. I believe that our efforts are part of what resulted in a more rapid decline in teen births starting around 2010.

Hypertension prevention and control is a good example of a program that can improve health generally and also greatly reduce health inequalities. It can't be emphasized strongly enough that hypertension is the leading single health condition contributing to the difference in life expectancy between Black and White Americans.

General Actions

It's good to fight for incremental progress, but it's important to recognize that the persistent health disparities in the U.S. are, literally, killing people. That's why it's also important to address more basic causes of health inequality – the lower parts of the health impact pyramid

I argued that in addition to specfic actions to better diagnose and treat tuberculosis, we needed to "improve the social and economic environment that provides the substrate for the tuberculosis epidemic in the United States and abroad."

Why does this article have special meaning for me? Because the then-director of the World Health Organization's tuberculosis control programme read it, liked it, and decided to recruit me and send me to India as a result of this. What followed were the five hardest but most meaningful years of my professional life, supporting India as it scaled up tuberculosis control services to save millions of lives.

At the CDC, with the leadership of John Auerbach, we developed the "HI-5" inititiave – measures that could improve health in 5 years or less. The focus on the bottom two levels of the health impact pyramid, and include 14 proven ways to improve health, ranging from better physical activity programs in schools to better public transportation, ealy childhood education, earned income tax credits, and home improvement loans and grants.

Health Care Policy

There's a faction of public health that believes that health care is too controversial, expensive, and ineffective to merit much attention. This perspective isn't as off-base as it might seem. Most health improvement doesn't come from health care, but rather from either broad social changes (education, income) or classic public health measures (clean water and clean air, fluoridation, smoke-free public places, taxation of tobacco, alcohol, and other unhealthy products, etc.).

As New York City health commissioner, I tried to improve health care, with a focus on the poorest and sickest communities: the South Bronx, Harlem, and Central Brooklyn. Among a range of programs we launched, we created an electronic health record initiative for medical practices in these areas.

We asked a simple question: what is the best way to save lives with health care. Remarkably, that hadn't been answered in the medical literature, so we had to do the analysis. The result is striking: blood pressure control, by a long shot.

However, health care isn't structured to maximize health.

Health Care If Health Mattered

We noted that electronic health records (EHRs) could greatly improve care, but only when combined with payment reform that changed the incentives. We concluded: "unless the clinicians involved receive meaningful additional payment for delivering better health to their patients, the health information technology and practice redesign cannot be replicated, sustained, or expanded."

This remains an unfulfilled promise and potential of health reform in the United States.

Drug Use and Overdose

Alcohol

Studying this was complicated but with a superb research assistant, Mattie Dickerson, we completed a detailed case-control study with a clear conclusion: synergistic liver toxicity from alcohol and viral hepatitis. Either viral hepatitis or heavy alcohol use is bad for your liver, but both of them together are particularly bad. Years later, this was one additional reason CDC recommended routine testing for hepatitis C. As I said at the time we made this recommendation, "You may not remember all that you did in the 1960s, but your liver does." Avoiding alcohol is particularly important for people with hepatitis B or C infections.

Geoffrey Rose wrote about alcohol harms in his classic book, Preventive Medicine.

“Of all the threats to human health, it is alcohol which causes the widest range of injury. It shortens life, being variously held responsible for between 1% and 10% of all adult deaths in industrialized countries. It shrinks the brain and impairs the intellect. It causes failure of the liver, heart and peripheral nerves. It contributes to depression, violence and the breakup of personal and social life. It has been blamed for a quarter of all deaths on the road – divided about equally among drunk drivers, drunk pedestrians and innocent victims.”

Opiates

The epidemic of opiate overdose reflects a combination of medical error, underlying socioeconomic stress, and failed public policy.

Ultimately, addressing drug and alcohol use will require broad social and economic action as well as specific measured to reduce harm.

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Public Health Practice

The "How" of successful public health programs

You Want To Be A Health Leader?!

Politics has been called the art of the possible, and running a public health program can be accurately described in the same way.

In January of 2002, with the embers of the World Trade Center still burning, I was sworn in as New York City Health Commissioner. (In an archaic tradition, the cost of this was 15 cents, payable to the City Clerk.)

I had been running public health tuberculosis programs for more than a decade, but this was a much larger responsibility – one of the largest public health departments in the United States, with 6,000 staff and a budget of $1.6 billion per year. In May 2009, I was sworn in as Director of the US Centers for Disease Control and Prevention (no 15 cent fee that time). Based on 15 years of experience I summarized* ten things I wish I had known before I held these two positions.

Get and disseminate good data. Data are the lifeblood of public health. With rapid information
flow, being first, credible, and correct is both increasingly challenging and increasingly important.
Do the hard stuff first. Success requires identifying aligned interests of partners, stakeholders, and the political and administrative leadership of a jurisdiction.
Find, fight, and win winnable battles. Look for important issues that are in the sweet spot – neither foregone conclusions, nor hopeless tilting at windmills. Don't expect to win them all – if you are, you're not choosing challenging enough issues.
Support and hire great people. Early in my career one of my mentors gave me the great advice that my job was to hire great people then to protect them from the ... flowing down from above.
Manage communicable diseases and environmental health. These are core public health issues, and if a health agency isn't able to keep them well managed, it will not be able to succeed at other key initiatives.
Do not cede the clinical realm. There's too large of a chasm between public health and clinical care. We need synergy. Public health can improve clinical care, and clinical care is essential for many public health goals.
Learn and manage the budget cycle. At the most basic level, the job of a health director is to get as large a budget as possible, and spend it as well as possible. There are seasons for budget initiatives, and cycles (emergencies, elections, etc.) when it becomes possible to obtain additional resources. Every well-conceptualized, well-written proposal eventually gets funded.
Manage the context. Effective communication with the public, political leaders, administrative directors, clinicians, and many others is importnat. Being able to state clearly and simply what a problem and a solution is makes implementing that solution much more feasible. Managing the context requires active engagement with communities in order to understand their values and perceptions.
Never surprise your boss. Most health officers are appointed by elected officials; in a good working relationship, elected officials will defer to the health officer on scientific and technical issues. Conversely, the health officer must not only respect that elected officials have the final say on policy issues but also recognize that they face pressures often invisible to the health officer. Providing advance warning of events or breaking news is essential to maintain a relationship of mutual respect and trust.
Follow core principles. These were highlighted by Dr. Walter Dowdle of the CDC:

Be a diligent steward of the funds entrusted to your agency.
Provide an environment for intellectual and personal growth and integrity.
Base all public health decisions on the highest quality scientific data, openly and objectively derived.
Place the benefits to society above the benefits to the institution.
Treat all persons with dignity, honesty, and respect.

🚧 UNDER CONSTRUCTION 🚧

Effective Programs

Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health 2014;104(1):17-22.

Global Public Health

Frieden TR, Henning, KJ. Public health requirements for rapid progress in global health. Global Public Health 2009;4:323-337.

Frieden TR, DeCock KM. The CDC’s Center for Global Health. Lancet 2012;379(9820):986-8.

Winnable Battles

Frieden TR. A Safer, Healthier U.S.: The Centers for Disease Control and Prevention, 2009–2016. AJPM. 2017;3:263-75.

Take Care, New York

Frieden TR, Bassett MT, Thorpe LT, Farley TA. Public health in New York City, 2002-2007: confronting epidemics of the modern era. International Journal of Epidemiology 2008; 37: 966-977.

Frieden TR. Take Care New York: a focused health policy.* J Urban Health 2004;81:314-316.

Practice-Based Evidence

Frieden TR. Evidence for Health Decision Making — Beyond Randomized, Controlled Trials. N Engl J Med. 2017;377:465-75.

Surveillance

Gwynn RC, Garg RK, Kerker BD, Frieden TR, Thorpe LE. Contributions of a Local Health Examination Survey to the Surveillance of Chronic and Infectious Diseases in New York City. Am J Public Health 2009;99:152-159.

Public Health Institutes

Frieden TR, Koplan JP. Stronger national public health institutes for global health. Lancet 2010;376(9754):1721-2.

Confidentiality and Privacy

Myers J, Frieden TR, Bherwani KM, Henning KJ. Ethics in public health research: Privacy and public health at risk: Public health confidentiality in the digital age. Am J Public Health 2008;98:793-801.

Future of Public Health

Frieden TR. The future of public health. NEJM 2015;373(18):1748-1754.

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Food Policy

Unhealthy nutrition is, by some accounts, the world's leading cause of preventable illness, disability, and death. Public health action can make healthier food choices the default value, saving lives.

Introduction

Unhealthy food kills more than 10 million people every year through obesity, diabetes, and other health complications. It must be a public health priority to prevent stunting and its consequences (including cognitive impairment, reduced productivity, and poor health) and in low-income areas that means improving access to clean water and basic sanitation. But malnutrition is often mistakenly thought of as undernutrition and starvation alone (which are, tragically, making a comeback during the COVID-19 pandemic), when in fact it means unhealthy nutrition – whether too little, too much, or not the right kind of food.

Although the rise in obesity in high-income countries has received much attention, overweight and obesity have also increased rapidly in low- and middle-income countries, as have their health consequences. The rise in overnutrition is the consequence of changing food systems, including increases in the availability of cheap, highly processed foods which have limited nutritional value. Healthy eating isn’t just about eating the right amount of food, but also about eating the right foods.

A comprehensive, coordinated strategy to prevent childhood obesity that incorporates policy interventions to make healthy dietary and physical activity choices easier is likely to achieve the greatest benefits.

Obesity

We can reduce obesity through a three-pronged strategy: altering relative food prices, shifting our exposure to food, and improving the image of healthy food while making unhealthy food less attractive.

Diets high in sugar are a major cause of obesity, diabetes, and cardiovascular disease. Added sugar is a major component of highly processed food. Sugary drinks are particularly damaging, and are estimated to cause a quarter million deaths each year.

In the United States, increased consumption of sugary drinks has been the single largest cause of the increased imbalance in calorie intake. Front-of-pack warning labels and taxes on sugary drinks have been shown to reduce consumers’ purchases of sugary beverages, and should be implemented.

In 2009, along with Kelly Brownell, I wrote about the importance of taxes on sugary beverages: Ounces of Prevention -- The Public Policy Case for Taxes on Sugared Beverages.

We cited the classic Wealth of Nations by Adam Smith: "Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation."

I was unable to get a soda tax approved by Albany in my time as New York City Health Commissioner, or at the federal level during my time as Director of the Centers for Disease Control and Prevention.

President Obama mused about the importance of a soda tax (which I prefer to call a health tax than a sin tax!), but industry pushback was furious. This is understandable – an earlier industry publication had described soda taxes as "the greatest threat" to their sales. All the more reason to push for it! Now dozens of states and countries have implemented soda taxes, with large decreases in soda consumption as a result, but higher taxes, in more places, are still needed.

Labeling can also make a difference. One of the most fascinating initiatives in my years as Commissioner was New York City's fight over calorie labeling. We implemented mandatory calorie labeling through the Board of Health, were sued by the restaurants on the basis that this was "compelled speech", a violation of the First Amendment, among other grounds. We lost the initial legal battle but ultimately prevailed. It was fascinating that fast food restaurants referred to their menu boards as their "most valuable real estate".

In the years since this initiative, Chile has shown the way to a global best-practice: bold stop signs on unhealthy food. This causes producers to change the options so that they are healthier and makes it easier for consumers to choose healthier food. Alternative labeling systems such as traffic lights may sound good, but don't change behavior – they are too complex and confusing for consumers, which is why the food industry doesn't oppose them!

Elimination of Artificial Trans Fat

Trans fat increases the risk of heart attack, and eliminating it from the global food supply would prevent an estimated 17 million deaths over the next 25 years. Most trans fat is produced artificially by introducing hydrogen gas into a liquid oil, making it solid at room temperature – and, unfortunately, in coronary arteries as well.

Eliminating artificial trans fat is feasible, cost-effective, and can happen quickly. WHO set an ambitious but achievable goal of eliminating artificial trans fat from the global food supply by 2023.

In 2018, our organization partnered with WHO to develop the REPLACE Action Package. This package provides actionable, easy-to-use tools that countries can adapt to create, implement, and enforce regulations that eliminate artificial trans fats from the food supply.

Dr. Tedros and I published REPLACE: A roadmap to make the world trans fat free by 2023 in The Lancet.

The momentum to make the world trans fat free is growing. Denmark was the first country to take action in 2003. Today, 31% of the global population live in countries that ban trans fat and an additional 10% live in countries that have enacted regulations due to go into effect soon. Last year, Turkey, Brazil, and India all enacted regulations limiting trans fats, strengthening protections for more than one billion people.

Much of this progress built on innovation in Denmark, which we learned from when I was Health Commissioner of New York City. We described our experience in this article: Cholesterol control beyond the clinic: New York City's trans fat restriction.

Interestingly, the food industry didn't attack NYC's trans fat initiative. They realized that fighting for their right to continue to put a toxic artificial substance into the food of people when very few people realized they were doing this was a no-win for them!

Reduction of Sodium Consumption

Excess intake of dietary sodium kills an estimated three million people each year. Governments around the world have committed to reducing salt intake by 30% by 2025. Some, such as the United Kingdom and South Korea, have made progress with comprehensive approaches targeting packaged food, salt added in the home, and salt in restaurant and takeaway foods.

Action to reduce salt intake should be scalable and sustainable, have the potential to result in a large health benefit, and demonstrate proven effectiveness. If no proven strategies exist to address important sources of salt, innovative interventions should be implemented and evaluated rigorously.

Governments have a role to play in salt reduction by ensuring that the food they serve, fund, or sell is healthy and low in salt. Resolve recently partnered with WHO to release a toolkit that provides countries with the resources they need to take action today. No government should purchase, sell, or subsidize unhealthy food.

Scientific error

One of the most frustrating aspects of sodium reduction efforts has been a serious methodological error by some academic researchers. I had – naively! – assumed that a superb study that documented, definitively, the source of this error would put a stake through this deadly error.

The "U" or "J" shaped curve (with higher death rates at both the high and low levels of sodium intake) is an artifact of badly done studies. We wrote about that here: No U-turn on sodium reduction.

"The recent study by He et al. provides powerful empiric evidence that the J shape is an artifact and does not represent an actual causal relationship (Figure 1).17 Using long‐term data from the Trials of Hypertension Prevention follow‐up study, a trial in which people were randomized to reduce sodium intake for 18‐48 months, they found that the linear relationship between measured sodium intake (based on three to seven 24‐hour urine samples) and mortality changed to an artifactual J‐shaped relationship when estimation equations commonly applied to spot urine samples were used. As the Figure shows, the actual linear relationship (solid line, Panel A) becomes an artifactual J shape (solid line, Panel B) when the equation is used, and the actual linear relationship documented with multiple 24‐hour specimens is attenuated when a single 24‐hour specimen is used (solid line, Panels C and D).

OK, I'll admit that's a bit wonky. But if you go into it, it is crystal clear that there's a linear relationship between sodium intake and risk of death. We go into the measurement issues more here: Dietary sodium and cardiovascular disease risk – measurement matters.

Consumer choice!

There's a fundmental narrative that's important as well: Sodium reduction – saving lives by putting choice into consumers’ hands.*

"Although sodium reduction has been proposed as a public health strategy in the United States for more than 4 decades, there has been no progress reducing consumption. One reason for this lack of progress is the continued ubiquity of dietary sodium in the US food supply.

High blood pressure is the leading cause of death from heart disease and stroke in the United States, contributing to more than 1000 deaths per day. One in 3 US adults—more than 70 million people—have hypertension, and only half have it controlled. Another 1 in 3 adults have prehypertension, and each 20-point increase in systolic blood pressure above 115 mm Hg doubles the risk of death from heart disease and stroke; risk increases at levels below which blood pressure is treated with medication currently. However, there is strong evidence, including a recent analysis of more than 100 randomized clinical trials, that sodium reduction reduces blood pressure in adults.2

Does it matter?

Nine of 10 US adults and children consume too much sodium, and even modest reductions in sodium intake are associated with substantial health benefits. Average sodium intake (≈3400 mg/day) is well in excess of the 2300 mg/d recommended by the 2015-2020 Dietary Guidelines for Americans. It is estimated that a decrease in sodium intake by as little as 400 mg/d could prevent 32 000 myocardial infarctions and 20 000 strokes annually.3 Reducing sodium intake by 1200 mg/d may reduce the number of people with hypertension by nearly 11 million. Over a decade, this reduction could prevent up to an estimated 500 000 deaths and may save an estimated $100 billion in health care costs.3,4 In addition to, and working synergistically with, improved treatment of hypertension, sodium reduction is the most scalable intervention to reduce blood pressure; no other intervention would have as large a population reach and effect.

Could sodium reduction hurt?

Some researchers claim that sodium reduction could harm a segment of the general population. Although there are short-term physiologic responses to marked short-term sodium reduction, interventions lasting 4 weeks or longer do not adversely affect blood lipids, catecholamine levels, insulin metabolism, or renal function. In contrast, excess dietary sodium intake, even in the absence of elevated blood pressure, may adversely affect the heart, kidneys, brain, and blood vessels.

Reducing sodium in the food supply will not cause insufficient sodium consumption. Recommended sodium intake is far higher than physiologic need; the estimated average requirement of 1500 mg/d accommodates groups with extreme physiologic sodium excretion (e.g., professional athletes).

Is evidence strong enough ?

A robust body of evidence supports the health benefits of sodium reduction. There is incontrovertible evidence of a direct, dose-response relationship between sodium and blood pressure. There is also evidence that sodium reduction prevents cardiovascular disease based on trends in cardiovascular events related to sodium reduction at the population level,5 meta-analysis of trials to reduce sodium intake,6 and well-designed long-term cohort studies showing that lower sodium intake is associated with reduced cardiovascular events (despite the small number of events resulting in limited statistical power).7

The debate about dietary sodium reduction stems in part from a few studies with inconsistent findings at lower levels of estimated sodium intake. These reports have created a “false aura of scientific controversy around dietary salt.”8

Flawed research should not stall public health interventions to increase consumer choice over sodium intake and save lives.

Currently, consumers cannot choose how much sodium to consume because more than 70% of the sodium consumed is in food before it reaches the table. Half of adults report attempting to reduce their sodium intake, yet 90% consume excess sodium. Past educational efforts have placed the burden on the consumer, with the result that sodium intake has not changed. Changes in the food supply, made gradually over time, will enable individuals to reduce sodium intake.10 This will put choice back into consumers’ hands, letting them decide how much sodium to consume."

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Tobacco

Unless urgent action is taken, tobacco will kill 1 billion people in the 20th Century. We can end the epidemic of tobacco-caused disability and death.

Mass murderers

Tobacco has replaced tuberculosis as "Captain of all these men of death." Unlike infectious disease threats, the vector that spreads tobacco is a business – the tobacco industry. Tobacco continues to kill more than half a million people in the U.S. every year, and more than 8 million people every year around the world.

As Health Commissioner in New York City, I made tobacco control my top priority. We raised the tax on tobacco, made public places smoke-free, ran hard-hitting anti-tobacco ads, supported smokers to quit, and more. And, after a decade in which there were no decreases in use, we made progress, as this article and others and the figure below show. We used data to drive and direct progress. One of the most challenging initiatives was the smoke-free air law*; smoke-free laws now cover more than billion people around the world.

In an early media interview, I commented that for a decade my enemy had been a microbe, the tuberculosis bacillus, but that now it was a really low life form, the tobacco executive.

It was a good line, but problematic. I received a letter from the Phillip Morris company, which was then headquartered in New York City. (They later moved out, citing the smokefree workplace law.)

The letter from Phillip Morris noted that describing people as a low life form was a type of hate speech. I had to admit that they were right. So, from then on, I referred to tobacco executives in objective terms: as mass murderers.

Myths

One of the challenges to tobacco control – in addition to the tobacco industry vector and the addictiveness of nicotine – is a set of myths.

Drew Blakeman and I summarized the "dirty dozen" – 12 myths that undermine tobacco control.

MYTH #1: PEOPLE HAVE FREE CHOICE WHETHER OR NOT TO SMOKE
We all like to think we are creatures of complete free will. However, free will in the case of tobacco is subverted by advertising and addiction. More than 80% of all regular smokers began smoking by the time they were 18 years old. Most smokers want to quit.26 However, the tobacco industry ensures that there is enough nicotine in every cigarette to keep people addicted, and production
methods and chemical additives increase nicotine delivery.
MYTH #2: EVERYONE KNOWS HOW BAD SMOKING IS
Most people are generally aware that smoking is not healthy, but instances of poor knowledge about the health risks abound. Relatively few women are aware of gender-specific health risks, including cervical cancer, osteoporosis, early menopause, miscarriage, ectopic pregnancy, and infertility. Fewer than half of Canadian adults aged 55 to 74 years identified smoking as a major cause of heart disease. Cigarettes cause disease in nearly every organ of the body.
MYTH #3: JUST A FEW CIGARETTES A DAY CAN’T HURT The risk of cardiovascular disease becomes evident with the consumption of 3 to 5 cigarettes a day. Cardiovascular disease may be caused by exposure to carbon monoxide and other combustion products, which suggests that any “reduced risk” tobacco product that is ignited and inhaled is unlikely to significantly decrease tobacco-related illness and death from cardiovascular causes.
MYTH #4: “LIGHT” CIGARETTES ARE LESS HARMFUL Despite decades of the tobacco industry marketing light cigarettes that are purported to have lower tar and nicotine content, there is no meaningful difference in smoke exposure or health risks among cigarettes with different tar and nicotine yields. Many low-tar, light, or ultra-light cigarette smokers unconsciously compensate for artificially reduced machine-measured tar and nicotine levels by smoking more cigarettes, inhaling smoke harder and deeper into the lungs, and blocking filter ventilation holes to increase the concentration of inhaled smoke. The tobacco industry has been aware of this compensation by smokers for at least the last 4 decades.
MYTH #5: IT’S EASY TO STOP SMOKING; IF PEOPLE WANT TO QUIT, THEY WILL The tobacco industry has admitted privately that tobacco has an addictive potential similar to opium. Nicotine may be comparable to heroin, cocaine, and alcohol in addiction potential. Most smokers want to quit and make at least 1 quit attempt each year.
MYTH #6: CESSATION MEDICATIONS DON’T WORK Medications greatly increase the likelihood smokers will quit. Ideally, every smoker would be counseled to quit at every clinical encounter, and every smoker who wants to quit should be provided medications, free of charge, to increase their chance of success.
MYTH #7: ONCE A SMOKER, ALWAYS A SMOKER Most Americans who have ever smoked have already quit, and anyone can quit.
MYTH #8: SMOKERS MAY DIE EARLIER, BUT ALL THEY LOSE ARE A COUPLE OF BAD YEARS AT THE END OF LIFE . The average smoker who dies from tobacco-related causes loses about 14 years of life. Among nonsmokers, 95% of that additional time will be spent without disability. Not smoking extends life, including disability-free life, and compresses disability into a shorter period of time. Elderly smokers have the physical health expected of people 2 to 4 years older and the mental health expected of people 10 years older than their actual age. Smoking increases the risk that an older person will lose his or her independence, and it reduces the chance of regaining autonomy. It is never too late to quit—even people who quit after decades of smoking improve their health and their life expectancy.
MYTH #9: SECOND-HAND SMOKE MAY BE A NUISANCE, BUT IT ISN’T DEADLY Second-hand smoke causes illness, disability, problems for infants exposed in utero – it kills.
MYTH #10: TOBACCO IS GOOD FOR THE ECONOMY The tobacco industry argues that tobacco creates employment, raises tax revenues, and contributes to the gross domestic product. However, the societal costs of tobacco use far outweigh any economic benefits. The World Bank concluded that money not spent on cigarettes would instead be spent on other goods and services that in turn would generate other jobs and economic activity to replace any that would be lost from the tobacco industry. In the United States, completely eliminating tobacco from the economy would result in an estimated net increase of more than 130 000 jobs nationwide.
MYTH #11: WE’VE ALREADY SOLVED THE TOBACCO PROBLEM Despite declining smoking prevalence, there are more than a billion smokers in the world and tobacco remains the leading cause of death in the U.S. and globally. Although there are many important health issues that also demand attention, in tobacco control is that we have proven interventions. Higher taxes, expansion of smoke-free environments, increased use of cessation treatments, public education, and more have all been proven to decrease tobacco use.
MYTH #12: THE TOBACCO INDUSTRY NO LONGER MARKETS TO KIDS OR UNDERMINES PUBLIC HEALTH EFFORTS The tobacco industry remains the leading cause of tobacco use globally, continues to try to undermine public health control measures, and actively promotes use in kids to replace their dying customers.

Bloomberg Initiative

In 2005, Mayor Mike Bloomberg asked me to help him develop his global health philanthropy. Working on nights, weekends, and vacations (with approval to do this pro bono from the NYC Conflict of Interest Board), we developed the Bloomberg Initiative to Reduce Tobacco Use, and announced it in an article in The Lancet in 2007: How to prevent 100 million deaths from tobacco. The calculation actually added up to 158 million (table below), but we wanted to underpromise and overdeliver. In the more than a decade since, Mike Bloomberg has donated more than $1 billion to tobacco control programs in countries around the world, with more than 35 million lives saved so far.

In just 5 countries, new policies and programs resulted in a reduction of the number of smokers by more than 30 million

The World Health Organization summarizes the status of tobacco control in periodic reports. As of 2013, there was some but not nearly enough progress, as I summarized* in the table below.

In their most 2019 report, WHO noted that the number of people protected by at least one effective tobacco control measure had quadrupled since 2007. Although there has been good progress, much more progress is needed, particularly to increase tobacco taxation – the single most effective intervention. The table below shows how much further the world has to go to stop the tobacco epidemic.

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On the web

Bibliography (with links)

Full bibliography with hyperlinks - and notations for articles that can be requested from this site *.

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Frieden TR, Lee CT, Bochner AF, Buissonnière M, McClelland A. 7-1-7 : an organising principle, tartget, and accountability metric to make the world safer from pandemics. Lancet. 2021[online] S0140-6736(21)01250-2
Frieden TR., Buissonniere M. Will a Global Preparedness Treaty Help or Hinder Pandemic Preparedness? BMJ Global Health. 2021;6;e006297:1-3
Morgan OW., Aguilera X., Ammon A., Amuasi J., Soce Fal I., Frieden T. Disease surveillance for the COVID-19 era: time for bold changes. 2021. S0140-6736(21)01096-5
Sahoo SK., Pathni AK., Kaur P., Kunwar A., Sharma B., Farrell ML., Moran AE, Komrska J., Frieden TR. A Predictive Tool for Forecasting Anti-Hypertension Medication Requirements in Low-and-Middle-Income Countries. Journal of Hypertension. 2021;39;e273-e274
Frieden TR., Foti KE. National Initiatives to Prevent Myocardial Infarction and Stroke. JAMA. 2021; 0905
Frieden TR., Buissonniere M., McClelland A. The world must prepare now for the next pandemic. BMJ Global Health. 2021;6:e005184.
Frieden TR, Rajkumar R., Mostashari F. We Must Fix US Health and Public Health Policy. AJPH. 2021; 111(4):623-627
Talisuna A., Yoti Z., Lee C., Frieden TR., Moeti MR. The urgent need for a global commitment to protect healthcare workers. BMJ Global Health. 2020;5:e004077: 1-2.
Frieden TR. Perspectives: China Can Substantially Reduce Its High Burden of Stroke and Heart Attack. China CDC Weekly. 2020, 2(40): 780-782.
Hoffer-Hawlik MA, Moran AE, Burka D, Kaur P, Cai J, Frieden TR, Gupta R. Leveraging Telemedicine for Chronic Disease Management in Low- and Middle-Income Countries During Covid-19. Global Heart. 2020; 15(1): 63.
Frieden TR, Cash-Goldwassser S. Of Masks and Methods. Annals of Internal Medicine. 2020; https://doi.org/10.7326/M20-7499.
Dooley SW, Frieden TR. We Must Rigorously Follow Basic Infection Control Procedures to Protect Our Healthcare Workers from SARS-CoV-2. Infect Control Hosp Epidemiol. 2020;3:1-3.
Salam A, Huffman MD, Kanukula R, Prasad EH, Sharma A, Heller DJ, Vedanthan R, Agarwal A, Rodgers A, Jaffe MG, Frieden TR, Kishore SP. Two‐drug fixed‐dose combinations of blood pressure‐lowering drugs as WHO essential medicines: An overview of efficacy, safety, and cost. J Clin Hypertens. 2020;00:1-11.
Frieden TR, Cobb LK, Leidig RC, Mehta S, Kass D. Reducing Premature Mortality from Cardiovascular and Other Non-Communicable Diseases by One Third: Achieving Sustainable Development Goal Indicator 3.4.1. Global Heart. 2020;15(1):50.
Ide N, Ajenikoko A, Steele L, Cohn J, J Curtis C, Frieden TR, Cobb LK. Priority Actions to Advance Population Sodium Reduction. Nutrients. 2020;12(9):1-20.
Cobb LK, Frieden TR, Appel LJ. No U-turn on sodium reduction. J Clin Hypertens. 2020;00:1-5.
Brady TM, Padwal R, Blakeman DE, Farrell M, Frieden TR, Kaur Dip P, Moran AE, Jaffe MG. Blood pressure measurement device selection in low-resource settings: Challenges, compromises, and routes to progress. J Clin Hypertens. 2020;00:1-10.
Frieden TR, Lee CT. Identifying and interrupting superspreading events—implications for control of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis. 2020;26(6):1059-1066.
Frieden TR, Varghese CV, Kishore SP, Campbell NRC, Moran AE, Padwal R, Jaffe MG. Scaling up effective treatment of hypertension-A pathfinder for universal health coverage. J Clin Hypertens (Greenwich). 2019;21(10):1442-1449.
Shahpar C, Lee CT, Wilkason C, Buissonnière M, McClelland A, Frieden TR. Protecting the world from infectious disease threats: now or never. BMJ Glob Health. 2019;4(4):e001885.
Kontis V, Cobb LK, Mathers CD, Frieden TR, Ezzati M, Danaei G. Three public health interventions could save 94 million lives in 25 years. Circulation. 2019;140(9):715-725.
Jaffe MG, Frieden TR, Campbell NRC, et al. Recommended treatment protocols to improve management of hypertension globally: A statement by Resolve to Save Lives and the World Hypertension League. J Clin Hypertens (Greenwich). 2018;20:829-836.
Frieden TR, Jaffe M. Saving 100 million lives by improving global treatment of hypertension and reducing cardiovascular disease risk factors. J Clin Hypertens. 2018;20:208‐211.
Ghebreyesus TA, Frieden TR. REPLACE: A roadmap to make the world trans fat free by 2023. Lancet. 2018;391:1978–1980.
McClelland A, Frieden TR. Understanding, preventing, and stopping epidemics. Lancet. 2018;391(10139):2489-2490.
Frieden TR, Bloomberg MR. Saving an additional 100 million lives.* Lancet.2017;17;391(10121):709-712.
Kostova D, Chaloupka FJ, Frieden TR, Henning K, Paul J Jr, Osewe PL, Asma S. Noncommunicable disease risk factors in developing countries: policy perspectives. Prev Med. 2017;105S:S1-S3.
Kolodny A, Frieden TR. Ten steps the federal government should take now to reverse the opioid addiction epidemic.* JAMA. 2017;318(16):1537–1538.
Frieden TR. Evidence for Health Decision Making — Beyond Randomized, Controlled Trials. N Engl J Med. 2017;377:465-75.
Richards CR, Iademarco MF, Atkinson D, Pinner RW, Yoon P, MacKenzie WR, Lee B, Qualters JR, Frieden TR. Advances in public health surveillance and information dissemination at the Centers for Disease Control and Prevention. Public Health Reports. 2017;124(4):1-8.
Frieden TR, Wright JS, Conway PH. Is rapid health improvement possible? Lessons from the Million Hearts initiative. Circulation. 2017;135(18):1677-1680.
Frieden TR, Ethier K, Schuchat A. Improving the health of the United States with a “Winnable Battles” initiative.* JAMA. 2017; 17(9).
Redd SC, Frieden TR. CDC’s evolving approach to emergency management. Health Security.* 2017;1:1-12.
Frieden TR. A Safer, Healthier U.S.: The Centers for Disease Control and Prevention, 2009–2016. AJPM. 2017;3:263-75.
Frieden TR, Schuchat A, Petersen LR. Zika virus 6 months later. JAMA 2016;316:1443-1444.
Frieden TR. Foreword: CDC’s response to the 2014-2016 Ebola epidemic – West Africa and United States. MMWR Suppl 2016;65(3):1-3.
Cogswell ME, Mugavero K, Bowman BA, Frieden TR. Dietary sodium and cardiovascular disease risk – measurement matters. New Engl J Med 2016; 375:580-586.
Frieden TR. Sodium reduction – saving lives by putting choice into consumers’ hands.* JAMA 2016; 316:579-580.
Frieden TR. Ten things I wish someone had told me when I became a health officer.* AJPH 2016;106(7):1214-1218.
Frieden TR, Houry D. Reducing the risks of relief – the CDC opioid-prescribing guideline. New Engl J Med 2016;374:1501-1504.
Frieden TR. Foreword: Strategies for Reducing Health Disparities — Selected CDC-Sponsored Interventions, United States, 2016. MMWR Suppl 2016;65(1):1.
Frieden TR, Foti KE, Mermin J. Applying public health principles to the HIV epidemic – How are we doing? NEJM 2015;373(23):2281-7.
Frieden TR. The future of public health. NEJM 2015;373(18):1748-1754.
Frieden TR, Damon IK. Ebola in West Africa – CDC’s role in epidemic detection, control, and prevention. EID 2015;21(11):1897-1905.
Tappero JW, Thomas MJ, Kenyon TA, Frieden TR. Global health security agenda: building resilient public health systems to stop infectious disease threats. Lancet 2015;385:1889-91.
Angell SY, De Cock KM, Frieden TR. A public health approach to global management of hypertension. Lancet 2015;385:825-7.
Frieden TR. Foreword: Use of selected clinical preventive services to improve the health of infants, children, and adolescents – United States, 1999-2011. MMWR Surveill Summ 2014;63(Suppl 2):1-2
Frieden TR, Brudney KF, Harries AD. Global tuberculosis: perspectives, prospects, and priorities.* JAMA 2014;312(14):1393-4.
Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. Ebola 2014—new challenges, new global response and responsibility. NEJM 2014;371(13):1177-80.
Jaffe HJ, Frieden TR. Improving health in the USA: progress and challenges. Lancet 2014;384(9937):3-5.
Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies—tackling the opioid-overdose epidemic. NEJM 2014;370(22):2063-6.
Frieden TR. Foreword: Strategies for reducing health disparities—selected CDC-sponsored interventions, United States, 2014. MMWR Surveill Summ 2014;63(Suppl 1):1-2.
Frieden TR, Tappero JW, Dowell SF, Hien NT, Guillaume FD, Aceng JR. Safer countries through global health security. Lancet 2014;383(9919):764-6.
Frieden TR. Tobacco control progress and potential.* JAMA 2014;311(2):133-4.
Frieden TR. Foreword: CDC health disparities and inequalities report—United States, 2013. MMWR Surveill Summ 2013;62(Suppl 3):1-2.
Frieden TR. Six components necessary for effective public health program implementation. Am J Public Health 2014;104(1):17-22.
Frieden TR, Coleman King SM, Wright JS. Protocol-based treatment of hypertension: a critical step on the pathway to progress.* JAMA 2014;311(1):21-2.
Etienne CF, Tappero JW, Marston BJ, Frieden TR, Kenyon TA, Andrus JK. Cholera elimination in Hispaniola. Am J Top Med Hyg 2013;89(4):615-6.
Gunn JP, Barron JL, Bowman BA, Merritt RK, Cogswell ME, Angell SY, Bauer UE, Frieden TR. Sodium reduction is a public health priority: reflections on the Institute of Medicine’s Report, Sodium Intake in Populations: Assessment of Evidence. Am J Hypertens 2013;26(10):1178-80.
Frieden TR. Government’s Role in Protecting Health and Safety.* NEJM 2013;368(20):1857-9.
Lurie N, Manolio T, Patterson AP, Collins F, Frieden T. Research as part of a public health emergency response. NEJM 2013;1251-5.
Frieden TR. Foreword: Use of selected clinical preventive services among adults – United States, 2007-2010. MMWR Surveill Summ 2012;61(2):1-2.
Frieden TR, Garfield RM. The cover. Dimensions of global health, 2012.* JAMA 2012;307(19):2006.
Frieden TR, DeCock KM. The CDC’s Center for Global Health. Lancet 2012;379(9820):986-8.
Sacco RL, Frieden TR, Blakeman DE, Jauch EC, Mohl S. What the Million Hearts initiative means for stroke: a presidential advisory from the American Heart Association/American Stroke Association. Stroke 2012;43(3):924-8.
Periago MR, Frieden TR, Tappero JW, De Cock KM, Aasen B, Andrus JK. Elimination of cholera transmission in Haiti and the Dominican Republic. Lancet 2012;379:193-286.
Frieden TR. Epidemic Assistance by the Centre for Disease Control Prevention 1946-2005: Afterword. Am J Epidemiol 2011;174(11 Suppl):113-4.
Frieden TR. Foreword: Public health then and now: celebrating 50 years of MMWR at CDC. MMWR Surveill Summ 2011;60(Suppl 4):1.
Frieden TR. Foreword: CDC Health Disparities and Inequalities Report - United States, 2011. MMWR Surveill Summ 2011;14;60:1-2.
Millett GA, Crowley JS, Koh H, Valdiserri RO, Frieden TR, et al. A way forward: the National HIV/AIDS Strategy and reducing HIV incidence in the United States. J Acquir Immune Defic Syndr 2010;55(Suppl 2):144-7.
Frieden TR, Berwick DM. The “Million Hearts” initiative – preventing heart attacks and strokes.* NEJM 2011;365(13):e27.
Dowell SF, Tappero JW, Frieden TR. Public health in Haiti – challenges and progress. NEJM 2011;364(4):300-301.
Frieden TR, Koplan JP. Stronger national public health institutes for global health. Lancet 2010;376(9754):1721-2.
Frieden TR, Collins FS. Intentional infection of vulnerable populations in 1946-1948: another tragic history lesson.* JAMA 2010;304(18):2063-2064.
Redd SC, Frieden TR, Schuchat A, Briss PA. 1918 and 2009: a tale of two pandemics. Public Health Rep 2010;125(Suppl 3):3-5.
Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med 2010;38:600-9.
Nguyen TQ, Clark N; 2006 NYC Anthrax Working Group, Karpati A, Goldberg A, Paykin A, Tucker A, Baker A, Almiroudis A, Fine A, Tsoi B, Aston C, Berg D, Weiss D, Connelly E, Beaudry G, Weisfuse I, Durrah JC, Prudhomme J, Leighton J, Ackelsberg J, Mahoney K, Van Vynck L, Lee L, Moskin L, Layton M, Wong M, Raphael M, Robinson M, Phillips M, Jones M, Jeffery N, Nieves R, Slavinski S, Mullin S, Beatrice ST, Balter S, Blank S, Frieden TR, et al. Public health and environmental response to the first case of naturally acquired inhalational anthrax in the United States in 30 years: infection of a New York City resident who worked with dried animal hides. * J Public Health Manag Pract 2010;16:189-200.
Frieden TR, Dietz W, Collins J. Reducing childhood obesity through policy change: acting now to prevent obesity. Health Aff (Millwood) 2010;29:357-63.
Frieden TR, Briss PA. We Can Reduce Dietary Sodium, Save Money, and Save Lives. Ann Intern Med 2010;152:526-7.
Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health 2010;100:590-595.
Frieden TR, Teklehaimanot A, Chideya S, Farmer P, Kim JY, Raviglione MC. A road map to control malaria, tuberculosis, and human immunodeficiency virus/AIDS. * Arch Intern Med 2009;169:1650-2.
Farley TA, Caffarelli A, Bassett MT, Silver L, Frieden TR. New York City's fight over calorie labeling. Health Aff (Millwood) 2009;1098-109.
Chamany S, Silver LD, Bassett MT, Driver CR, Berger DK, Neuhaus CE, Kumar N, Frieden TR. Tracking diabetes: New York City's A1C Registry. * Milbank Q 2009;87:547-70.
Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR, Bassett MT. Cholesterol control beyond the clinic: New York City's trans fat restriction. Ann Intern Med 2009;151:129-34.
Frieden TR, Henning, KJ. Public health requirements for rapid progress in global health. Global Public Health 2009;4:323-337.
Brownell KD, Frieden TR. Ounces of Prevention -- The Public Policy Case for Taxes on Sugared Beverages. N Engl J Med 2009;360:1805-1808.
Ellis JA, Gwynn C, Garg RK, Philburn R, Aldous KM, Perl SB, Thorpe L, Frieden TR. Secondhand smoke exposure among nonsmokers nationally and in New York City. * Nicotine Tob Res 2009;11:362-70.
Frieden TR. Lessons from tuberculosis control for public health. * Int J Tuberc Lung Dis 2009;13:421-428.
Thorpe LE, Upadhyay UD, Chamany S, Garg R, Mandel-Ricci J, Kellerman S, Berger DK, Frieden TR, Gwynn C. Prevalence and control of diabetes and impaired fasting glucose in New York City. Diabetes Care 2009;32:57-62.
Gwynn RC, Garg RK, Kerker BD, Frieden TR, Thorpe LE. Contributions of a Local Health Examination Survey to the Surveillance of Chronic and Infectious Diseases in New York City. Am J Public Health 2009;99:152-159.
Frieden TR, Myers JE, Krauskopf MS, Farley TA. A Public Health Approach to Winning the War against Cancer. Oncologist 2008;13:1306–1313.
Springer CM, Tannert Niang KM, Matte TD, Miller N, Bassett MT, Frieden TR. Do medical students know enough about smoking to help their future patients? Assessment of New York City fourth-year medical students' knowledge of tobacco cessation and treatment for nicotine addiction. Acad Med 2008;83:982-989.
Farfel M, Digrande L, Brackbill R, Prann A, Cone J, Friedman S, Walker DJ, Pezeshki G, Thomas P, Galea S, Williamson D, Frieden TR, Thorpe L. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees. J Urban Health 2008;85:880-909.
Subramani R, Radhakrishna S, Frieden TR, Kolappan C, Gopi PG, Santha T, Wares F, Selvakumar N, Narayanan PR. Rapid decline in prevalence of pulmonary tuberculosis after DOTS implementation in a rural area of South India. Int J Tuberc Lung Dis 2008;12:916-920.
Torian LV, Wiewel EW, Liu K, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med 2008;168:1181-1187.
McKinney CM, Klingler EJ, Paneth-Pollak R, Schillinger JA, Gwynn RC, Frieden TR. Prevalence of Adult Male Circumcision in the General Population and a Population at Increased Risk for HIV/AIDS in New York City. Sex Transm Dis 2008;35:814-817.
Bassett MT, Dumanovsky T, Huang C, Silver LD, Young C, Nonas C, Matte TD, Chideya S, Frieden TR. Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007. Am J Public Health 2008;98:1457-1459
Frieden TR, Bassett MT, Thorpe LT, Farley TA. Public health in New York City, 2002-2007: confronting epidemics of the modern era. International Journal of Epidemiology 2008; 37: 966-977.
Gwynn RC, McQuistion HL, McVeigh KH, Garg RK, Frieden TR, Thorpe LE. Prevalence, diagnosis, and treatment of depression and generalized anxiety disorder in a diverse urban community. Psychiatr Serv 2008;59:641-647.
Schillinger JA, McKinney CM, Garg R, Gwynn RC, White K, Lee F, Blank S, Thorpe L, Frieden TR. Seroprevalence of herpes simplex virus type 2 and characteristics associated with undiagnosed infection: New York City, 2004. Sex Transm Dis 2008;35:599-606.
Myers J, Frieden TR, Bherwani KM, Henning KJ. Ethics in public health research: Privacy and public health at risk: Public health confidentiality in the digital age. Am J Public Health 2008;98:793-801.
Van Wye G, Kerker BD, Matte T, Chamany S, Eisenhower D, Frieden TR, Thorpe L. Obesity and diabetes in New York City, 2002 and 2004. Prev Chronic Dis 2008 Apr;5:A48.
Rehm CD, Matte TD, Van Wye G, Young C, Frieden TR. Demographic and behavioral factors associated with daily sugar-sweetened soda consumption in New York City adults. J Urban Health 2008;85:375-385.
Frieden TR, Mostashari F. Health care as if health mattered. * JAMA 2008; 299:950-952.
Nguyen TQ, Gwynn RC, Kellerman SE, Begier E, Garg RK, Pfeiffer MR, Konty KJ, Torian L, Frieden TR, Thorpe LE. Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004. AIDS 2008;22:281-287.
Foerster SB, Silver LD, Kohatsu ND, Frieden TR, Bassett MT, and Horton MB. Childhood obesity on the front lines. Am J Prev Med 2007;33:S175-177.
Ellis JA, Perl SB, Frieden TR, Huynh M, Ramaswamy C, Gupta LS, Kerker BD. Decline in smoking prevalence – New York City, 2002–2006. MMWR 2007;56:604-608.
Frieden TR, Bloomberg MR. How to prevent 100 million deaths from tobacco. Lancet 2007;369:1758-61.
Frieden TR, Sbarbaro JA. Promoting adherence to treatment for tuberculosis: the importance of direct observation. Bull World Health Org 2007;85:407-409.
Tuberculosis Research Centre, Indian Council of Medical Research. Radhakrishna S, Frieden TR, Subramani R, Santha T, Narayanan PR. Additional risk of developing TB for household members with a TB case at home at intake: a 15-year study. Int J Tuberc Lung Dis 2007;11:282–288.
Torian LV, Henning KJ, Kellerman SE, Frieden TR. Striving toward comprehensive HIV/AIDS surveillance: The view from New York City. Public Health Rep 2007;122(Suppl.1):4-6.
Subramani R, Santha T, Frieden TR, Radhakrishna S, Gopi PG, Selvakumar N, Sadacharam K, Narayanan PR. Active community surveillance of the impact of different tuberculosis control measures, Tiruvallur, South India, 1968-2001. Int J Epidemiol 2006; 36:387-93.
Munsiff SS, Ahuja SD, King L, Udeagu C-C, Dorsinville M, Frieden TR, Fujiwara PI. Ensuring accountability: the contribution of the cohort review method to tuberculosis control in New York City *. Int J Tuberc Lung Dis 2006;10:1133-1139.
Torian LV, Blank S, Kellerman SE, Frieden TR, Ho DD, Markowitz M, Boden D, Parker MM, Philpott S, Roome A, McKenna MT, Folks T, Heneine W. Investigation of a new diagnosis of multidrug-resistant, dual-tropic HIV-1 infection — New York City, 2005. MMWR 2006;55:793-796.
Thorpe LE, Gwynn RC, Mandel-Ricci J, Roberts S, Frieden TR, Tsoi B, Berman L, Porter K, Ostchega Y, Curtain LR, Montaquila J, Mohadjer L. Study design and participation rates of the New York City health and nutrition examination survey, 2004. Prev Chronic Dis [serial online] 2006;3:A94.
Cummings KM, Hyland A, Fix B, Bauer U, Celestino P, Carlin-Menter S, Miller N, Frieden TR. Free nicotine patch giveaway program: 12-month follow-up of participants. * Am J Prev Med 2006;31:181-184.
Larson K, Levy J, Rome MG, Matte TD, Silver LD, Frieden TR. Public health detailing: A strategy to improve the delivery of clinical preventive services in New York City. Public Health Rep 2006;121:228-234.
Walsh J, Fraser G, Hunt E, Husband B, Nalluswami K, Pollard K, Reynolds S, Urdaneta V, Weltman A, Aston C, Balter S, Beatrice S, Beaudry G, Berg D, Clark N, Frieden T, Karpati A, Layton M, Lee L, Leighton J, Moskin L, Mullin S, Phillips M, Paykin A, Prud’homme J, Slavinski S, Tucker A, Weisfuse I, Weiss D,Wolsk G, et al. Inhalation anthrax associated with dried animal hides--Pennsylvania and New York City, 2006. MMWR 2006;55:280-2.
Radhakrishna S, Frieden TR, Subramani R, Narayanan PR. Value of dual testing for identifying tuberculous infection. * Tuberculosis 2006;86:47-53.
Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ. Applying public health principles to the HIV epidemic. N Engl J Med 2005;353:2397-2402.
Thorpe LE, Mostashari F, Hajat A, Nash D, Karpati A, Weber T, Winawer S, Neugut AI, Awad A, Zevallos M, Remy P, Frieden TR, for the Citywide Colon Cancer Control Coalition (C5). Colon cancer screening practices in New York City, 2003: results of a large random-digit dialed telephone survey. Cancer 2005;104:1075-1082.
Thorpe LE, Berger D, Ellis JA, Bettegowda V, Brown G, Matte T, Bassett M, Frieden TR. Trends and racial/ethnic disparities in gestational diabetes among pregnant women in New York City, 1990-2001. Am J Public Health 2005;95:1536-1539.
Frieden TR, Blakeman DE. The dirty dozen: 12 myths that undermine tobacco control. Am J Public Health 2005;95:1500-1505.
Kumar MKA, Dewan PK, Nair, PKJ, Frieden TR, et al. Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001-2002. Int J Tuberc Lung Dis 2005;9:870-6.
Miller N, Frieden TR, Liu S, et al. Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation. Lancet 2005;365:1849-54.
Frieden TR, Mostashari F, Kerker BD, Miller N, Hajat A, Frankel M. Adult tobacco use levels after intensive tobacco control measures: New York City, 2002–2003. Am J Public Health. 2005; 95(6):1016-1023.
Georgeson M, Thorpe LE, Merlino M, Frieden TR, Fielding JE. Shortchanged? An assessment of chronic disease programming in major US city health departments. * J Urban Health 2005;82:183-190.
Frieden TR, Munsiff SS. The DOTS strategy for controlling the global tuberculosis epidemic. * Clin Chest Med 2005;26:197-205.
Frieden TR. Tuberculosis control: critical lessons learnt. * Indian J Med Res 2005;121:140-2.
Mostashari F, Kerker BD, Hajat A, Miller N, Frieden TR. Smoking practices in New York City: the use of a population-based survey to guide policy-making and programming. J Urban Health 2005;82:58-70.
Santha T, Garg R, Subramani R, Chandrasekaran V, Selvakumar N, Sisodia RS, Perumal M, Sinha SK, Singh RJ, Chavan R, Ali F, Sarma SK, Sharma KM, Jagtap D, Frieden TR, et al. Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India. * Int J Tuberc Lung Dis 2005;9:61-68.
Leng JCF, Thorpe LE, Feldman GE, Thomas PA, Frieden TR. The volume and capacity of colonoscopy procedures performed at New York City hospitals in 2002. Prev Chronic Dis [serial online] 2005; 2:1-7.
Frieden TR. Asleep at the switch: local public health and chronic disease. Am J Public Health 2004;94:2059-2061.
Thorpe LE, Frieden TR, Laserson KF, Wells G, Khatri GR. Seasonality in tuberculosis, India: is it real and what does it tell us?. * Lancet 2004;364:1613-1614.
Singh AA, Frieden TR, Khatri GR, Garg R. A survey of tuberculosis hospitals in India. Int J Tuberc Lung Dis 2004;8:1255-1259.
Thorpe LE, List DG, Marx T, May L, Helgerson SD, Frieden TR. Childhood obesity in New York City elementary school students. Am J Public Health 2004;94:1496-1500.
Fielding JE, Frieden TR. Local knowledge to enable local action. Am J Prev Med 2004;27:183-184.
Frieden TR. Take Care New York: a focused health policy.* J Urban Health 2004;81:314-316.
Chang C, Leighton J, Mostashari F, McCord C, Frieden TR. The New York City smoke-free air act: second-hand smoke as a worker health and safety issue. * Am J Ind Med 2004;46:188-195.
Thorpe LE, Mostashari F, Karpati AM, Schwartz SP, Manning SE, Marx MA, Frieden TR. Mass smallpox vaccination and cardiac deaths, New York City, 1947. Emerg Infect Dis 2004;10:917-920.
Balasurbramanian R, Garg R, Santha T, Gopi PG, Subramani R, Chandrasekaran V, Thomas A, Rajeswari R, Anandakrishnan S, Perumal M, Niruparani C, Sudha G, Jaggarajamma K, Frieden TR, Narayanan PR. Gender disparities in tuberculosis: a report from a rural DOTS programme in south India. * Int J Tuberc Lung Dis 2004;8:323-332.
Selvakumar N, Sudhamathi S, Duraipandian M, Frieden TR, Narayanan PR. Reduced detection by Ziehl-Neelsen method of acid-fast bacilli in sputum samples preserved in cetylpyridium chloride solution. Int J Tuberc Lung Dis 2004;8:248-252.
Cook S, Maw KL, Munsiff SS, Fujiwara PI, Frieden TR. Prevalence of tuberculin skin test positivity and conversions among healthcare workers in New York City during 1994 to 2001. Infect Control Hosp Epidemiol 2003;24:807-813.
Frieden TR, Khatri GR. Impact of national consultants on successful expansion of effective tuberculosis control in India. Int J Tuberc Lung Dis 2003;7:837-841.
Radhakrishna S, Frieden TR, Subramani R. Association of initial tuberculin sensitivity, age and sex with the incidence of tuberculosis in south India: a 15-year follow-up. Int J Tuberc Lung Dis 2003;7:1083-1091.
Gopi PG, Subramani R, Radhakrishna S, Kolappan C, Sadacharam K, Shantha T, Frieden TR, Narayanan PR. A baseline survey of the prevalence of tuberculosis in a community in south India at the commencement of a DOTS programme. Int J Tuberc Lung Dis 2003;7:1154-1162.
Frieden TR, Mostashari F, Schwartz SP, et al. Cardiac deaths after a mass smallpox vaccination campaign -- New York City, 1947. MMWR 2003;52;933-936.
Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis.* Lancet 2003;382:887-899.
Frieden TR, Driver CR. Tuberculosis control: past 10 years and future progress.* Tuberculosis 2003;83:82-85.
Selvakumar N, Govindan D, Chandu NA, Frieden TR, Narayanan PR. Processing sputum specimens in a refrigerated centrifuge does not increase the rate of isolation of M. Tuberculosis. J Clin Microbiol 2003;41:469-471.
Sterling TR, Lehmann HR, Frieden TR. Impact of DOTS compared with DOTS-plus on multidrug resistant tuberculosis and tuberculosis deaths: decision analysis. BMJ 2003; 326:1-6.
Santha T, Renu G, Frieden TR, Subramani R, Gopi PG, Chandrasekaran V, Selvakumar N, Thomas A, Rajeswari R, Balasubramanian R, Kolappan C, Narayanan PR. Are community surveys to detect tuberculosis in high prevalence areas useful? Results of a comparative study from Tiruvallur District, South India. Int J Tuberc Lung Dis 2003;7(3):258-265.
Narayanan S, Das S, Garg R, et al. Molecular epidemiology of tuberculosis in a rural area of high prevalence in South India: implications for disease control and prevention. J Clin Microbiol 2002;40:4785-4788.
Frieden TR. Can tuberculosis be controlled? Int J Epidemiol 2002;31:894-899.
Khatri GR, Frieden TR. Rapid DOTS expansion in India – lessons for the world. Bull World Health Org 2002;80:457-463.
Selvakumar N, Prabhakaran E, Rahman F, Frieden TR, Santha Devi, T. Washing of new microscopic glass slides in dichromate solution does not influence sputum AFB smear results. Int J Tuberc Lung Dis 2002;6:270-271.
Selvakumar N, Prabhakaran E, Rahman F, Frieden TR, Santha Devi, T. Evaluation of the phenol ammonium sulfate sedimentation smear microscopy method diagnosis of pulmonary tuberculosis. J Clin Microbiol 2002;40:3017-3020.
Khatri GR, Thorpe L, Frieden TR. Progress toward tuberculosis control – India. MMWR 2002;51:229-232.
Selvakumar N, Rahman F, Rajasekaran S, Narayanan PR, Frieden TR. Inefficiency of 0.3% carbol fuchsin in Ziehl-Neelsen staining for detecting acid-fast bacilli. J Clin Microbiol 2002;40:3041-3043.
Pablos-Mendez A. Gowda DK, Frieden TR. Controlling multidrug-resistant tuberculosis and access to expensive drugs: a rational framework. Bull World Health Org 2002; 80:489-495.
Frieden TR, Sbarbaro JA. The slippery slope to sloppy DOTS. Int J Tuberc Lung Dis 2002;6:371-372.
Santha TS, Garg, R, Frieden TR, et al. Risk factors associated with default, failure and death among tuberculosis patients--southern India, 2000. Int J Tuberc Lung Dis 2002;6:780-789.
Khatri GR, Frieden TR. Controlling tuberculosis in India. New Engl J Med 2002;347:1420-1445.
Murthy KJR, Frieden TR, Yazdani A, Hreshikesh P. A public-private partnership in tuberculosis control: experience in Hyderabad, India.* Int J Tuberc Lung Dis 2001;5:354-359.
Sackoff J, Torian L, Frieden TR. TB prevention in HIV clinics in New York City.* Int J Tuberc Lung Dis 2001;5:123-128.
Radhakrishna S, Frieden TR, Subramani R, Kumaran PP. Trends in the prevalence and incidence of tuberculosis in South India. Int J Tuberc Lung Dis 2001:5:142-157.
Frieden TR, Lerner BH, Rutherford BR. Lessons from the 1800s: tuberculosis control in the new millenium. Lancet 2000;355:1085-1092.
Khatri GR, Frieden TR. The status and prospects of tuberculosis control in India.* Int J Tuberc Lung Dis 2000;4:193-200.
Cook SV, Fujiwara PI, Frieden TR. Rates and risk factors for discontinuation of rifampicin. Int J Tuberc Lung Dis 2000;4:118-122.
Frieden TR. Directly observed treatment, short-course (DOTS): ensuring cure of tuberculosis.* Ind J Pediatrics 2000;67:S21-27.
Frieden TR, Ozick L, Henning KJ, et al. Chronic liver disease in Central Harlem: the role of alcohol and viral hepatitis. Hepatology 1999;29:883-888.
Sherman LF, Fujiwara PI, Cook SV, Bazerman LB, Frieden TR. Patient and health care system delays in the diagnosis and treatment of tuberculosis.* Ind J Tuberc Lung Dis 1999;3:1088-1095.
Wilberschied LA, Kaye K, Fujiwara PI, Frieden TR. Extrapulmonary tuberculosis among foreign-born patients, New York City, 1995-1996.* J Immigrant Hlth 1999;1:65-75.
Gasner MR, Maw KL, Feldman GE, Fujiwara PI, Frieden TR. The use of legal action in New York City to ensure treatment of tuberculosis. New Engl J Med 1999;340:359-366.
Frieden TR. Can tuberculosis be controlled? Ind J Tuberc 1998;45:65-72.
Sackoff J, Torian L, Frieden TR, et al. Purified protein derivative testing and tuberculosis preventive therapy for HIV-infected patients in New York City. AIDS 1998;12:2017-2023.
Scholten JN, Fujiwara PI, Frieden TR. Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993. Int J Tuberc Lung Dis 1998;3:31-41.
Sullivan EA, Geoffroy P, Weisman R, Hoffman R, Frieden TR. Isoniazid poisonings in New York City. J Emerg Med 1998;16:57-59.
Washko, RM, Hoefer H, Keihn TE, Armstrong D, Dorsinville GJ, Frieden TR. Mycobacterium tuberculosis in a green winged macaw (Ara chloroptera): report with public health implications. J Clin Microbiol 1998;36:1101-1102.
Washko RM, Robinson E, Frieden TR. Tuberculosis transmission in a high school choir.* J Sch Health 1998;68:256-259.
Nivin B, Nicholas P, Gayer M, Frieden TR, Fujiwara PI. A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. Clin Infect Dis 1998;26:303-307.
Fujiwara PI, Cook SV, Rutherford CM, et al. A continuing survey of drug-resistant tuberculosis, New York City, April 1994.* Arch Int Med 1997;157:531-536.
Pablos-Mendez A, Knirsch C, Barr GR, Lerner BH, Frieden TR. Nonadherence in tuberculosis treatment: predictors and consequences in New York City.* Am J Med 1997;102:164-170.
Feldman G, Srivastava P, Eden E, Frieden TR. Detention until cure as a last resort: New York City’s experience with involuntary in-hospital civil detention of persistently non-adherent tuberculosis patients. Sem Resp Crit Care Med 1997;18:493-501.
Fujiwara PI, Larkin C, Frieden TR. Directly observed therapy in New York City: history, implementation, results, and challenges.* Clin Chest Med 1997;18:135-148.
Munsiff SS, Joseph S, Ebrahimzadeh A, Frieden TR. Rifampin mono-resistant tuberculosis, New York City, 1993-1994. Clin Inf Dis 1997;25:1465-1467.
Layton MC, Henning KJ, Alexander TA, Gooding AL, Reid C, Heymann BM, Leung J, Gilmore DM, Frieden TR. Universal radiographic screening for tuberculosis among inmates upon admission to jail. Am J Pub Health 1997;87:1335-1337.
Frieden TR, Sherman LF, Maw KL, et al. A multi-institutional outbreak of highly drug-resistant tuberculosis: epidemiology and clinical outcomes.* JAMA 1996;276:1229-1235.
Pablos-Mendez A, Sterling T, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis.* JAMA 1996;276:1223-1228.
Kaye K, Frieden TR. Tuberculosis control: the relevance of classic principles in an era of acquired immunodeficiency syndrome and multidrug resistance. Epidem Reviews 1996;18:52-63.
Washko RM, Frieden TR. Tuberculosis surveillance using death certificate data, New York City, 1992. Public Health Rep 1996;111:251-255.
Friedman LN, Williams MT, Singh TP, Frieden TR. Tuberculosis, AIDS, and death among substance abusers on welfare in New York City. N Engl J Med 1996;334:828-833.
Frieden TR, Woodley CL, Crawford JT, Lew D, Dooley SW. The molecular epidemiology of tuberculosis in New York City: the importance of nosocomial transmission and laboratory error. * Tuberc Lung Dis 1996;77:407-413.
Layton MC, Cantwell MF, Dorsinville GJ, Valway SE, Onorato IM, Frieden TR. Tuberculosis screening among homeless persons with AIDS living in single-room-occupancy hotels. Am J Pub Health 1995;85:1556-1559.
Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City -turning the tide. New Engl J Med 1995;333:229-233.
Sullivan EA, Kreiswirth BN, Palumbo L, Kapur V, Musser JM, Ebrahimzadeh A, Frieden TR. Emergence of fluoroquinolone-resistant tuberculosis in New York City.* Lancet 1995;345:1148-50.
Frieden TR, Cairns G, Dorsinville M, Larkin C. Tuberculosis in New York City’s homeless. Pharos Alpha Omega Alpha Honor Med Soc 1995;58:45.
Driver CR, Luallen JJ, Good WE, Valway SE, Frieden TR, Onorato IM. Tuberculosis in children younger than five years old: New York City.* Ped Inf Dis J 1995;14:112-117.
Sterling T, Frieden TR. Isoniazid preventive therapy in areas of high isoniazid resistance. Arch Int Med 1995;155:1622-1628.
Driver CR, Frieden TR, Bloch AB, Onorato IM. Drug resistance among tuberculosis patients, New York City, 1991 and 1992. Public Health Rep 1994;109:632-636.
Frieden TR. Tuberculosis control and social change. Am J Pub Health 1994;84:172-173.
Frieden TR, Fujiwara PI, Ruggiero D, et al. Tuberculosis clinics. Am Rev Resp Crit Care Med 1994;150:893-894.
Hamburg MA, Frieden TR. Tuberculosis transmission in the 1990s.* N Engl J Med 1994;330:1750-1751 [editorial].
Mathieu J, Henning K, Bell E, Frieden TR. Typhoid fever in New York City: 1980-1990. Arch Int Med 1994;154:1713-1718.
Coronado VG, Beck-Sague CM, Hutton MD, Davis BJ, Nicholas P, Villarreal C, Woodley CL, Kilburn JO, Crawford JT, Frieden TR, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital: epidemiologic and restriction fragment length polymorphism analysis.* J Infect Dis 1993;168:1052-1055.
Frieden TR, Munsiff SS, Low DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76-79.
Frieden TR, Bia FJ, Heald PW, Eisen RN, Patterson TF, Edelson RL. Cutaneous cryptococcosis in a patient with cutaneous T-cell lymphoma receiving therapy with photopheresis and methotrexate.* Clin Infect Dis 1993;17:776-778.
Frieden TR, Sterling T, Pablos-Mendez A, et al. The emergence of drug resistant tuberculosis in New York City. N Engl J Med 1993;328:521-526.
Pozsic C, Kinney J, Breeden D, et al. Approaches to improving adherence to antituberculous therapy -- South Carolina and New York, 1986-1991. MMWR 1993;42:74-76.
Pearson ML, Jereb JA, Frieden TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers.* Ann Intern Med 1992;117:191-196.
Frieden TR, Sowell AL, Henning KJ, Huff DL, Gunn RA. Vitamin A levels and measles severity: New York City.* Am J Dis Child 1992;146:182-186.
Frieden TR, Biebuyck J, Hierholzer WJ. Lung abscess from group A beta-hemolytic streptococcus: case report and review.* Arch Intern Med 1991;151:1655-1657.
Frieden TR, Mangi R. Inappropriate use of oral ciprofloxacin.* JAMA 1990;264:1438-1440.
Frieden TR, Bia F. Recurrent aseptic meningitis for 24 years: diagnosis and treatment of an associated lesion. Yale J Biol Med 1990;63:1-4.
Garfield R, Frieden TR, Vermund S. Health related outcomes of war in Nicaragua. Am J Pub Health 1987;77:615-618.
Frieden TR, Garfield R. Popular participation in health in Nicaragua.* Health Pol Plan 1987; 2:162-170.
Garfield R, Frieden TR. Social and demographic characteristics of Nicaraguan health volunteers.* Int Quart Health Ed 1987;7:123-134.