In the New York Times, Professor Aaron Carroll, Chief Medical Officer of Indiana University, reflects on the deficiencies of the CDC (Centers for Disease Control and Prevention) and the FDA (Food and Drug Administration) and finds the problem to be that they are thinking of perfection in treating individual patients, rather than doing “good enough” for the whole population, and thus saving many more lives. https://www.nytimes.com/2022/01/14/opinion/covid-america.html.
Let me translate – these top health organizations have tremendous histories and reputations. The CDC wiped out smallpox in the entire world. The FDA forbade usage of thalidomide in the United States, and thus avoided the epidemic of limbless babies experienced in Europe (and also making a national hero of https://cfmedicine.nlm.nih.gov/physicians/biography_182.html.) But now these august organizations have fallen on bad times. The FDA has impeded proper COVID testing that all the European countries have succeeded in developing and distributing. The CDC has serially given confusing and confused directives on COVID-avoiding procedures. Aaron (a med school classmate and friend of my pediatrician stepdaughter) assigns blame to poor thinking, a conceptual confusion that he details.
He is not wrong. But, why? Why are they stuck in the mud, not thinking nor communicating well? If they have suddenly become stupid, why?
I have addressed the problem of organizational decline previously, and also discussed what to do about it. For the benefit of reading public, I reprised that argument in very condensed form in a letter to the editor of the New York Times that will no doubt remain unpublished, but I kind of like it.
To the Editor of the New York Times:
Aaron Carroll's argument that the CDC and FDA have made policy mistakes in always striving for the best for the individual but not for society has great merit. It leads one to ask, however, why?
Organizations are often birthed by idealistic, imaginative and charismatic leaders bent on achievement, and willing to make some mistakes and be criticized as they forge a new way forward. As the organizations age, they can become stolid bureaucracies with the major but unstated goal of not being blamed, and for individuals not to make mistakes and not to be fired. “Doing what we always do” can be a powerful defense, even when conditions change. The inability of both of these formerly-excellent but now myopic organizations to adapt to new emergency conditions with imagination and verve and focusing on the general good, would certainly seem to qualify them as blame-avoiders.
In fixing organizations as with fixing ailing physical bodies, arriving at a proper diagnosis is key. With the CDC and FDA, organizational sclerosis might be the proper diagnosis, and treatment might require a reimagining of the goals, procedures, organization and personnel of the bureaucracies in question.
Budd N. Shenkin
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