Thomas R. Frieden

= Thomas R. Frieden, MD, MPH =

Dr. Thomas R. Frieden (December 7, 1960 - ) has been New York City Health Commissioner since 2002. He led efforts that controlled a large outbreak of drug-resistant tuberculosis in New York City in the early 1990s, and went on to help India implement a tuberculosis control program that has saved more than 1.6 million lives since 1997. As head of the [http://www.nyc.gov/html/doh/html/home/home.shtml New York City Department of Health and Mental Hygiene Health] , he has overseen initiatives to reduce smoking, eliminate artificial trans fat from restaurant food, require posting of calorie information in chain restaurants, and expand the use of electronic health records.

Career

Tuberculosis Control in New York City

As an Epidemic Intelligence Service Officer for the Centers for Disease Control and Prevention (CDC) from 1990 to 1992, Frieden documented the spread of tuberculosis, including multidrug-resistant tuberculosis, in New York City.¹ His work fostered public awareness and helped improve public funding (city, state and federal) for TB control.² In 1992, he was appointed assistant commissioner and director of the Health Department’s [http://home2.nyc.gov/html/doh/html/tb/tb.shtml Bureau of Tuberculosis Control] , where he faced a large and fast-growing epidemic of tuberculosis, including HIV-related and drug-resistant tuberculosis.^1,4 New York City rapidly controlled the epidemic, reducing overall incidence by nearly half and cutting multidrug-resistant tuberculosis by 80%.⁵ The city's program became a model for tuberculosis control.^6,7

Tuberculosis Control in India

From 1996 to 2002, Frieden was based in India, assisting with national tuberculosis control efforts. As a medical officer for the World Health Organization on loan from the CDC, he helped the government of India implement the [http://www.tbcindia.org/ Revised National Tuberculosis Control Program] .^{8, 9, 10, 11} By 2006, this program had expanded to cover the entire country¹² and as of mid-2008 had treated 9 million patients, saving more than 1.6 million lives.¹³ The program publishes detailed quarterly reports on the quality of tuberculosis treatment in every district of India.¹⁴ During this time, Frieden established a network of Indian physicians to help India's state and local governments implement the program.¹⁴He also helped the Tuberculosis Research Center in Chennai, India, establish a program to rigorously monitor the impact of tuberculosis control services.^16,17

Health Commissioner, New York City

As Health Commissioner, Frieden oversees a New York City mayoral agency with more than 6,000 employees and an annual budget of $1.5 billion.¹⁸ He also chairs the New York City Board of Health.

Pursuing "an unapologetically aggressive public health agenda,"⁷ Frieden has overseen a period marked by improvements in the health of New Yorkers as well as sometimes fierce controversy.¹⁹ On his appointment as Health Commissioner in January 2002, Frieden made tobacco control an immediate priority.²⁰ After a decade with no change in smoking rates, New York City's tobacco control program triggered a rapid decline. ²¹ Frieden established a system to monitor the city's smoking rate, and worked with New York City Mayor Michael R. Bloomberg to increase tobacco taxes,²² ban smoking from workplaces including restaurants and bars, and run aggressive anti-tobacco ads and help smokers quit.²³ The program reduced smoking prevalence among New York City adults from 21.6% in 2002 to 16.9% in 2007 – a change that represents 300,000 fewer smokers and could prevent 100,000 premature deaths in future years.^21,24 Smoking prevalence among New York City teens declined even more sharply, from 17.6% in 2001 to 8.5% in 2007, and is now less than half the national rate.²⁵ The workplace smoking ban prompted spirited debate before it was passed by the New York City Council and signed into law by Mayor Bloomberg.²⁶ Over time, the measure has gained broad acceptance by the public and business community in New York City.^27,28 When the city adopted its workplace smoking ban, only one state (California) had gone smoke-free, and no country had taken national action. By 2008, most Americans were protected by state or local smoke-free laws,²⁹ and more than a dozen countries had adopted them.³⁰

Frieden also introduced [http://home2.nyc.gov/html/doh/html/tcny/index.shtml Take Care New York] , the city's first comprehensive health policy. This program targeted ten leading causes of preventable illness and death for concerted public and personal action.^31,32 By 2006, New York City had made measurable progress in eight of the ten priority areas.³³

New York City is an epicenter of the HIV epidemic in the United States. As Health Commissioner, Frieden has sought to fight HIV/AIDS with public health principles used successfully to control other communicable diseases.³⁴ The most controversial aspect of this strategy was a proposal to eliminate separate written consent for HIV testing. Frieden believes the measure would encourage physicians to offer HIV tests during routine medical care,³⁵ as the CDC recommends.³⁶ Some community advocates and civil libertarians fought this legislation in the belief that it would undermine patients' rights and lead eventually to forced HIV testing.^{37, 38} The New York State legislature has yet to repeal the written-consent requirements. The NYC Health Department also introduced the [http://www.nyc.gov/html/doh/html/condoms/condoms.shtml New York City Condom] ,^{39, 40} and now gives away more than 35 million of them annually, despite minor opposition from religious and traditional-values groups.

Confronted with a growing epidemic of diabetes in New York City, Frieden has worked to raise awareness, particularly among pregnant women,⁴¹ and has established a hemoglobin A1C [http://home2.nyc.gov/html/doh/html/diabetes/diabetes-nycar.shtml diabetes registry] that tracks patients' blood sugar control over several months and reports that information to treating physicians to help them provide better care.^{42, 43} The New York City Board of Health's regulation to require laboratories to report A1C test results generated a heated debate among civil libertarians, who view it as a violation of medical privacy and an intrusion into the doctor-patient relationship,⁴⁴ although patients can choose not to receive information from the program. The New York City Health Department asserts that the [http://home2.nyc.gov/html/doh/html/diabetes/diabetes-nycar.shtml A1C registry] can help reduce the risk of blindness, kidney failure, leg amputations and early death among people with diabetes.⁴⁵

To combat cardiovascular disease, New York City has adopted regulations since 2006 to eliminate artificial trans fat from all restaurants.^44,45,46 The restaurant industry and its political allies condemned the trans-fat measure as an assault on liberty by an overzealous "nanny state,"^46,49 but compliance has exceeded 90% among New York City restaurants, and the measure has inspired similar efforts by several US cities and the state of California.⁵¹ The Health Department also required chain restaurants to post calorie information in order to raise consumer awareness of fast food's caloric impact. The measure requires chains with 15 or more outlets to post calorie counts on menus and menu boards. It has prompted two lawsuits by the [http://www.nysra.org/ New York State Restaurant Association] . In the first, a U.S. District Court judge ruled that federal law pre-empted New York City's action and overturned it.⁵² The NYC Board of Health then repealed and re-enacted the measure,⁵³ which took effect in May 2008. Most chains now post calorie information in their New York City outlets, despite a pending legal challenge, and customers have experienced widespread "sticker shock."^54,55

During Frieden's tenure, the New York City Health Department has greatly expanded the collection and use of epidemiological data, launching an annual [http://www.nyc.gov/html/doh/html/survey/survey.shtml Community Health Survey] ⁵⁶ and the nation's first community-based [http://www.nyc.gov/html/doh/html/hanes/hanes.shtm Health and Nutrition Examination Survey] .^1,47,57

To improve quality and efficiency of medical care, the agency also launched the nation's largest community-based [http://www.nyc.gov/html/doh/html/pcip/pcip.shtml electronic health records project] to improve preventive care for more than one million at-risk New Yorkers.⁵⁹

Life expectancy has reached record highs in New York City since 2002,^48,60 and the city is now considered a national model for emergency preparedness.^{49, 50, 62}

Frieden has been criticized by interest groups from across the political spectrum; advocates for the tobacco and restaurant industries have been especially vehement.⁶⁵ But civic associations and the media have generally supported his efforts. He was Governing Magazine's Public Official of the Year in 2005,⁶⁶ and New York 1's New Yorker of the Year in 2006.⁶⁷ Despite frequent attacks by the conservative "New York Post",^51,52,68 he has garnered favorable press coverage,^{7,32,71,72,73,74,75,76} and has appeared on many national news programs, including "60 Minutes"⁷⁷ and Charlie Rose.⁷⁸

Bloomberg Philanthropies

As health advisor to Michael Bloomberg, Frieden helps with the [http://www.globaltobaccocontrol.org/ Bloomberg Initiative to Reduce Tobacco Use] .⁷⁹ This initiative aims to prevent more than 100 million tobacco-related deaths worldwide⁸⁰ by promoting tobacco control in developing countries. By mid-2008, the initiative had funded more than 100 organizations in 36 nations,^24,81 with a focus on China and India, where more than 40% of the world's smokers live.⁸² Bloomberg's effort was joined by the Bill & Melinda Gates Foundation in 2008.²⁴

Education

Frieden graduated from Oberlin College (BA), Columbia University College of Physicians and Surgeons (MD) and Columbia University’s School of Public Health (MPH). He completed training in internal medicine at Columbia-Presbyterian Medical Center and sub-specialty training in infectious diseases at Yale University.

Publications

Frieden has published more than 200 medical journal articles, book chapters and editorials, including:
(* indicates links to Pub Med instead of the primary source)

2008

Frieden TR, Basset MT, Thorpe LT, Farley TA. Public health in New York City, 2002-2007: confronting epidemics of the modern era. Int J Epidemiology. 2008 [Epub ahead of print] . [http://www.ncbi.nlm.nih.gov/pubmed/18540026?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum* www.ncbi.nlm.nih.gov/pubmed/18540026?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum*] .

Frieden TR, Mostashari F. Health care as if health mattered. JAMA. 2008;299:950-952. [http://jama.ama-assn.org/cgi/content/extract/299/8/950?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Frieden+2008%5C&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT http://jama.ama-assn.org/cgi/content/extract/299/8/950?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Frieden+2008%5C&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT] .

Myers J, Frieden TR, Bherwani KM, Henning KJ. Privacy and public health at risk: public health confidentiality in the digital age. Am J Public Health. 2008;98:793-801. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=American%20Journal%20of%20Public%20Health%5BJour%5D%20AND%202008%5Bpdat%5D%20AND%20Myers%20J%5Bfirst%20author%5D http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=American%20Journal%20of%20Public%20Health%5BJour%5D%20AND%202008%5Bpdat%5D%20AND%20Myers%20J%5Bfirst%20author%5D] .

Subramani R, Radhakrishna S, Frieden TR, et al. 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. [http://www.ingentaconnect.com/content/iuatld/ijtld/2008/00000012/00000008/art00008 www.ingentaconnect.com/content/iuatld/ijtld/2008/00000012/00000008/art00008] .

2007

Ellis JA, Perl SB, Frieden TR, et al. Decline in smoking prevalence – New York City, 2002-2006. MMWR. 2007;56:604-608. [http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a4.htm www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a4.htm] .

Frieden TR, Bloomberg MR. How to prevent 100 million deaths from tobacco. Lancet. 2007;369:1758-1761. [http://www.thelancet.com/journals/lancet/article/PIIS014067360760782X/abstract www.thelancet.com/journals/lancet/article/PIIS014067360760782X/abstract] .

2005

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. [http://content.nejm.org/cgi/reprint/353/22/2397.pdf http://content.nejm.org/cgi/reprint/353/22/2397.pdf]

Frieden TR, Blakeman DE. The dirty dozen: 12 myths that undermine tobacco control. Am J Public Health. 2005;95:1500-1505. [http://www.ncbi.nlm.nih.gov/pubmed/16051930?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum www.ncbi.nlm.nih.gov/pubmed/16051930?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum] .

Frieden TR, Mostashari F, Kerker BD, et al. Adult tobacco use levels after intensive tobacco control measures: New York City, 2002-2003. Am J Public Health. 2005;95:1016-1023.
[http://www.ncbi.nlm.nih.gov/pubmed/15914827?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum www.ncbi.nlm.nih.gov/pubmed/15914827?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum] .

Miller N, Frieden TR, Liu S, et al. Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation. Lancet.2005;365:1849-1854. [http://www.thelancet.com/search/results?search_mode=cluster&search_cluster=thelancet&search_text1=Effectiveness+of+a+large-scale+distribution+programme+of+free+nicotine+patches%3A+a+prospective+evaluation&x=11&y=16 www.thelancet.com/search/results?search_mode=cluster&search_cluster=thelancet&search_text1=Effectiveness+of+a+large-scale+distribution+programme+of+free+nicotine+patches%3A+a+prospective+evaluation&x=11&y=16] .

2004

Chang C, Leighton J, Mostashari F, et al. 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. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=2004%20%5Bpdat%5D%20AND%20Chang%20C%5Bauthor%5D%20AND%20The%20New%20York%20City%20Smoke www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=2004%20%5Bpdat%5D%20AND%20Chang%20C%5Bauthor%5D%20AND%20The%20New%20York%20City%20Smoke] .

Frieden TR, ed. Toman's Tuberculosis: Case Detection, Treatment and Monitoring – Questions and Answers. 2nd ed. Geneva, Switzerland: World Health Organization, 2004. [http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=2155 www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=2155]

Frieden TR. Asleep at the switch: local public health and chronic disease. Am J Public Health. 2004;94:2059-2061. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=%22American%20journal%20of%20public%20health%22%5BJour%5D%20AND%20Frieden%5Bauthor%5D%20AND%20Asleep www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=%22American%20journal%20of%20public%20health%22%5BJour%5D%20AND%20Frieden%5Bauthor%5D%20AND%20Asleep] .

Frieden TR. Take Care New York: A focused health policy. J Urban Health. 2004;81:314-316. [http://www.springerlink.com/content/e3k550333u61n506/ www.springerlink.com/content/e3k550333u61n506/] .

2003

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. [http://www.ingentaconnect.com/content/iuatld/ijtld/2003/00000007/00000009/art00005 www.ingentaconnect.com/content/iuatld/ijtld/2003/00000007/00000009/art00005] .

Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis. Lancet. 2003;382:887-899.
[http://www.thelancet.com/journals/lancet/article/PIIS0140673603143334/abstract www.thelancet.com/journals/lancet/article/PIIS0140673603143334/abstract]

Frieden TR, Driver CR. Tuberculosis control: past 10 years and future progress. Tuberculosis (Edinb). 2003;83:82-85. [http://www.tuberculosisjournal.com/article/S1472-9792(02)00060-4/abstract www.tuberculosisjournal.com/article/S1472-9792(02)00060-4/abstract]

2002

Frieden TR. Can tuberculosis be controlled?Int J Epidemiol. 2002;31:894-899. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=2002%5Bpdat%5D%20AND%20Frieden%20TR%5Bauthor%5D%20AND%20Can%20tuberculosis%20be%20controlled%3F www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=2002%5Bpdat%5D%20AND%20Frieden%20TR%5Bauthor%5D%20AND%20Can%20tuberculosis%20be%20controlled%3F] .

Khatri GR, Frieden TR. Controlling tuberculosis in India. New Engl J Med. 2002;347:1420-1445. [http://content.nejm.org/cgi/reprint/347/18/1420.pdf http://content.nejm.org/cgi/reprint/347/18/1420.pdf] .

1999

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. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=%22Hepatology%20%28Baltimore%2C%20Md.%29%22%5BJour%5D%20AND%201999%5Bpdat%5D%20AND%20Frieden%20TR%5Bauthor%5D http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=%22Hepatology%20%28Baltimore%2C%20Md.%29%22%5BJour%5D%20AND%201999%5Bpdat%5D%20AND%20Frieden%20TR%5Bauthor%5D] .

1996

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. [http://www.ncbi.nlm.nih.gov/pubmed/8849750?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum www.ncbi.nlm.nih.gov/pubmed/8849750?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum] .

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.
[http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=407%5Bpage%5D%20AND%201996%5Bpdat%5D%20AND%20Frieden%5Bfirst%20author%255 www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=407%5Bpage%5D%20AND%201996%5Bpdat%5D%20AND%20Frieden%5Bfirst%20author%5] .

1995

Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City – turning the tide. New Engl J Med. 1995;333:229-233. ( [http://content.nejm.org/cgi/reprint/333/4/229.pdf http://content.nejm.org/cgi/reprint/333/4/229.pdf] )

1993

Frieden TR, Munsiff SS, Low DE, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet 1993;342:76-79. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=Lancet%60%5BJour%5D%20AND%2076%5Bpage%5D%20AND%201993%5Bpdat%5D www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=Lancet%60%5BJour%5D%20AND%2076%5Bpage%5D%20AND%201993%5Bpdat%5D] .

1992

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. [http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=%22American%20journal%20of%20diseases%20of%20children%20%281960%29%22%5BJour%5D%20AND%20182%5Bpage%5D%20AND%201992%5Bpdat%5D www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=%22American%20journal%20of%20diseases%20of%20children%20%281960%29%22%5BJour%5D%20AND%20182%5Bpage%5D%20AND%201992%5Bpdat%5D]

References

1. 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. [http://content.nejm.org/cgi/content/abstract/328/8/521 http://content.nejm.org/cgi/content/abstract/328/8/521] .
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4. Frieden TR, Fujiwara PI, Washko RM, Hamburg MA. Tuberculosis in New York City – turning the tide. N Engl J Med. 1995;333:229-233. [http://content.nejm.org/cgi/content/abstract/333/4/229 http://content.nejm.org/cgi/content/abstract/333/4/229] .

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External Links

Centers for Disease Control and Prevention ( [http://www.cdc.gov/ www.cdc.gov] )

Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control ( [http://www.jhsph.edu/global_tobacco www.jhsph.edu/global_tobacco] )

New York City Department of Health and Mental Hygiene ( [http://www.nyc.gov/health www.nyc.gov/health] )

New York City Department of Health and Mental Hygiene, Bureau of Tobacco Control ( [http://www.nyc.gov/health/smokefree www.nyc.gov/health/smokefree] )

New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control ( [http://www.nyc.gov/health/tb www.nyc.gov/health/tb] )

Tuberculosis Control – India, Revised National Tuberculosis Control Programme ( [http://www.tbcindia.org/ www.tbcindia.org] )

World Health Organization ( [http://www.who.int/ www.who.int] )