A leading Aids researcher and proponent of medication-assisted therapy for addiction has been appointed to oversee the US Centres for Disease Control and Prevention, reports The New York Times. Alex M Azar II, secretary of the Health and Human Services Department, announced that the agency’s new director would be Dr Robert R Redfield, a professor at the University of Maryland School of Medicine in Baltimore and co-founder of the Institute for Human Virology.
“Dr Redfield has dedicated his entire life to promoting public health and providing compassionate care to his patients,” Azar said. “We are proud to welcome him as director of the world’s premier epidemiological agency.”
The report says Redfield, 66, will replace Dr Brenda Fitzgerald, who resigned in January after just six months on the job. Fitzgerald left amid criticism of her investments with her husband in tobacco and health care companies that posed potential conflicts of interest.
The report says Redfield oversees clinical care and research at the virology institute, which provides HIV treatment to more than 6,000 patients in the Baltimore-Washington area and more than 1m people in Africa and the Caribbean. The institute, with an annual budget of more than $105m, also studies other chronic viral illnesses and cancer.
Azar called Redfield’s decades of science and clinical work – especially in the field of HIV/Aids – “peerless.” He added that the treatment network Redfield operates in Baltimore for patients with HIV and hepatitis C would help him “hit the ground running” on a top priority, “combating the opioid epidemic.”
The report says news of Redfield’s appointment has revived criticisms about some of his policy stances and research practices that date back to an earlier period in the Aids epidemic. He came under fire for advocating broad Aids testing and the screening of military personnel for the virus. In addition, his research into a potential treatment vaccine led to allegations of data distortion and a military investigation; no evidence of misconduct was found. His record has prompted Senator Patty Murray, the ranking Democrat on the health committee, to oppose his appointment, although some advocates for Aids patients now say they support him for the job.
A graduate of Georgetown University and its School of Medicine, Redfield did his residency at the Walter Reed Army Medical Centre, then stayed on as a researcher in the military, focusing on Aids. In 1996, he launched the virology institute with Dr Robert C Gallo, who developed the blood test for HIV, the human immunodeficiency virus.
The report says Redfield has longstanding ties to various government agencies. He served on two advisory panels for the National Institutes of Health from 2002 to 2006, when Azar was general counsel and then deputy secretary of the Department of Health and Human Services. Redfield’s high profile on Aids research and policy matters has made him a perennial candidate for the CDC job. He has been a small donor to Republican Party committees, giving about $2,000 in total.
In 2016, the institute was awarded more than $138m in five-year grants from the CDC to combat HIV/Aids and other health problems in Kenya, Nigeria, Tanzania and Zambia. It also has a substantial portfolio of corporate-sponsored research, whose underwriters have included Aventis, Gilead, Human Genome Sciences, Merck and Schering.
Kathleen Kennedy Townsend, a Democrat and former lieutenant governor of Maryland, praised Redfield. “He has a wonderful bedside manner and is loving and devoted to his patients,” said Townsend, who served on the institute’s board.
Terry Lierman, chair of the institute’s Board of Advisors, said Redfield’s work treating HIV patients who were also addicts made him a great choice for the job. “In particular, Dr Redfield has much experience in treating addiction as a co-morbidity to HIV and incorporating addiction treatment into a patient’s overall primary care,” Lierman said. “This appointment is refreshingly not about politics, but about quality, competence and compassion.’’
Medical careers run in Redfield’s family. The report says both his parents worked at the National Institutes of Health, and two of his children are doctors. His wife, Joy, is a nurse whom he met while they were delivering babies together.
As the nation’s public health agency, the CDC is charged with controlling disease outbreaks, ensuring the safety of food and water, and helping reduce the leading causes of death, among them heart disease, cancer, stroke and diabetes. The agency has a budget of more than $7.2bn, and a staff of more than 12,000 employees working in the US and around the world.
The CDC was recently in the spotlight when Azar said he believed the agency should resume research on gun violence, which it drastically cut more than 20 years ago. Redfield’s views on gun violence research and other contentious issues such as access to abortion and sexual health education are not yet known.
The report says his work in Aids research and policy has generated concern over the years, in particular for his call in the mid-1980s to late 1980s for widespread Aids testing and screening of military recruits for HIV. While pushing for broader Aids testing during routine exams as a means to contain the epidemic, Redfield also called for reducing the stigma associated with the disease. At a congressional hearing in August 1987, Redfield recommended regular testing, at doctor’s appointments and hospitalisations, as well as for marriage license applicants, and incorporating the test into the practice of medicine, according to news reports. But he also said, “We have to tell people it’s anti-American to discriminate against people who have the Aids virus.”
In the early 1990s, Redfield was the subject of a military investigation after colleagues suspected that he overstated the therapeutic effects of an experimental Aids vaccine at presentations and in a report. The investigation led to a correction in some published data, according to documents. Several high-level colleagues, however, felt the military should have been tougher on Redfield, who they felt raised false hopes about the efficacy of a treatment vaccine he was developing. At the time, Public Citizen’s Health Research Group sued to gain the records and made them public.
In a 1992 letter to Colonel Donald Burke, the director of the division of retrovirology, Major Craig W Hendrix, director of the Air Force HIV programme, wrote that the credibility of the military’s efforts on retroviral research was at risk and under scrutiny. “Severe, painful steps must be taken less we dishonour the honest labours of so many colleagues and patients within our research consortium. We cannot continue to deceive.”
The report says Hendrix, now a professor at Johns Hopkins University School of Medicine, recalled the incident, which he now uses as a case study in ethics. “The facts didn’t line up,” Hendrix said. “I can’t know if it was intentional, but I think every scientist has to be the most sceptical of their own data, and the most careful, because nobody else will have all the raw data.”
The report says Senator Murray wrote to President Trump, mentioning the Army investigation, which criticised Redfield for a faulty analysis of vaccine trial data, and premature presentation of the information. “This pattern of ethically and morally questionable behaviour leads me to seriously question whether Dr Redfield is qualified to be the federal government’s chief advocate and spokesperson for public health,” Senator Murray wrote.
But Gregg Gonsalves, an Aids activist and assistant professor at the Yale School of Public Health, said he was optimistic about Redfield’s appointment, noting that many people’s views on Aids and other public health issues have evolved over the years, along with the science.
“We don’t have to be defined by our pasts, but Dr Redfield has to clarify where he stands now on key issues and place himself firmly in the mainstream of evidence-based public health,” Gonsalves said.
Jesse Milan Jr, president and CEO of Aids United, said that Redfield had contacted them to convey that he would embrace the group’s goals. Those include supporting needle exchanges for drug users, to prevent the spread of HIV through dirty needles, and pre-exposure prophylaxis, the use of an anti-HIV medication to prevent getting the virus.
“I heard him commit to our entire HIV prevention toolbox and to supporting health equity for the entire spectrum of marginalised and stigmatised people,” Milan said. “If he’s appointed, I can assure you we will hold him to it.”
The report says Redfield did not respond to requests for comment.
[link url="https://www.nytimes.com/2018/03/21/health/cdc-robert-redfield-aids.html?emc=edit_th_180322&nl=todaysheadlines&nlid=425053800322"]The New York Times report[/link]