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Hello and welcome to Healthbeat’s new weekly report that aims to provide context about important topics in public health from around the United States.
My name is Dr. Jay K. Varma, and I am a physician, epidemiologist, and public health expert currently serving as chief medical officer at Fedcap, a national nonprofit focused on economic mobility and well-being for vulnerable communities. (The views expressed here are my own and do not represent Fedcap.)
The goal of this report is to highlight and explain key stories that are shaping public health in the United States, from policy to research to outbreaks. The topics I choose are inherently subjective, informed by my background as a public health practitioner who has worked domestically and globally in government, academia, and the private sector. As this report evolves, please send ideas to me about topics you think need greater attention or perspectives that differ from my own.
Public health in the United States is undergoing dramatic changes, and, while I lament many of them, I am also an optimist. I believe that this period of change is also an opportunity to advance health protection, opportunity, and social justice at all levels of our society. As former Centers for Disease Control and Prevention Director Bill Foege (more on him later) said, “Bet on the optimists. You need the optimist to say, ‘We’re going to try to do it.’”
CDC not updating data on vaccine-preventable diseases
Last year was marked by the Department of Health and Human Services making major changes in policy, staffing, and funding at the CDC with a particular focus on immunizations and vaccine-preventable disease programs. While the consequence of that is primarily being measured in outbreaks — such as the rising outbreak of measles in South Carolina — it can also now be measured in one of CDC’s most critical functions: disease surveillance.
Academic researchers found that, of 82 regularly updated and publicly available CDC databases, 38 (46%) are no longer being updated regularly. Which databases have been most impacted? “Of the 38 paused databases, 33 (87%) were vaccination-related topics compared with none of the 44 current databases,” the authors write. The epidemiologist in me can’t help but conclude this pattern is not due to random or topic-neutral decision-making. The data show a near-perfect association between vaccines and data collection: Vaccination-related databases were paused, and others largely were not.
We can only speculate about why this might be happening. It could be that there simply are not enough staff to do these updates, because of staffing cuts. It could be that staff are available but otherwise occupied, including possibly making databases compliant with new requirements related to gender and other Diversity, Equity, and Inclusion-related topics. It could be that they have been instructed to focus on other health conditions. Or it could be a combination of all of these.
What we do know is that surveillance — counting who gets sick or dies — is the foundation of all public health, and that, when public health agencies do not measure a disease, the public and policy-makers begin to think that the disease is not a problem.
For example, if a policy maker sees that the CDC is reporting fewer flu-related deaths in children, then they might erroneously conclude that flu is not a problem and seasonal flu vaccination is not so necessary.
The invisibility of public health activities like surveillance to the general public is also what makes these activities so susceptible to distortion and to funding cuts. I applaud these researchers for conducting surveillance of CDC’s surveillance databases, because diseases only count when they are actually counted.
Early detection of cancer through blood tests? Buyer beware
One health condition that always gets high-profile attention is cancer. Rather than one specific disease, cancer is hundreds of different diseases, all of which are characterized by the uncontrolled growth and spread of abnormal cells in the body. While five-year death rates for people diagnosed with cancer are declining in the United States, companies are increasingly advertising to the public ways they can detect and treat cancer earlier, specifically blood tests otherwise known as “liquid biopsies” or “multi-cancer early detection” tests.
Sure enough, during the Super Bowl on Sunday night, the direct-to-consumer medical platform Hims & Hers promoted its latest offering: pay $750 on top of your usual annual subscription price and receive the Galleri test (manufactured by Grail Diagnostics) for cancer detection.
My inherent bias is to be skeptical of companies selling these tests to consumers until there is strong evidence that they work, such as large studies in diverse populations in which people are followed for several years.
The Super Bowl ad for the Galleri tests shows a man breathing a sign of relief when he looks at his phone and sees a result that says, “No cancer signal detected.” In fact, in the largest study done on Galleri, the test had an overall sensitivity of 51.5%, suggesting that a result that reads “no cancer signal detected” could be inaccurate up to 50% of the time.
I was not surprised to hear the news recently about another up-and-coming company in this field, Cancer Check Labs, that is being investigated for fraud.
The Securities and Exchange Commission complaint says investors in Cancer Check Labs were told their money would fund research, clinical trials, and Food and Drug Administration or European approval for a blood-based cancer screening device. What happened instead, according to the SEC, is that more than $10 million was diverted for personal spending and unrelated ventures.
While the complaint focuses on securities fraud, not medical fraud, it describes a familiar pattern in the consumer blood testing space: bold scientific claims, vague regulatory promises, and little evidence that the underlying technology works as advertised.
The most high-profile example of this was Theranos, in which a company moved rapidly from medical device development to direct-to-consumer testing without demonstrating analytical validity (does the test measure what it says it’s measuring?), clinical validity (does the test provide information useful to a person’s health?), or real world benefit (does the test help detect and cure cancer earlier?).
Unfortunately, the existence of a blood test on the market does not mean it has actually been proven accurate, useful, or safe. As more companies promote early cancer detection through blood screening, this case underscores the need for strong regulatory oversight and for all of us to be skeptical of claims unless there is high-quality independent evidence that the tests work. The UK National Health Service is currently running one such trial on the Galleri test: a randomized control trial of more than 140,000 people to evaluate whether this test actually reduces the incidence of late-stage cancer and cancer death, with results expected this year.
The legacy of two men on public health in the 20th century
At the beginning of this report, I mentioned Bill Foege, former CDC director, who died on Jan. 24. A week earlier, another scientist with an important impact on public health died: Peter Duesberg. The legacies of these two men could not be more different.
Foege focused his career on reducing human suffering. He helped lead the eradication of smallpox and mentored generations of public health leaders. He believed that evidence, humility, and collective action could change history. He never stopped reminding students that certainty is dangerous and kindness is essential.
Duesberg followed a different path. Once a respected virologist who did pioneering work showing that viruses can cause cancer, he rejected overwhelming evidence that HIV causes AIDS and used his scientific credentials to amplify falsehoods across the world. His words encouraged people to refuse lifesaving treatment and shaped policies that contributed to hundreds of thousands of preventable deaths.
Foege taught that progress comes from questioning tradition while staying anchored to data, ethics, and social justice. Duesberg modeled what happens when certainty hardens into ideology, healthy skepticism becomes dangerous denial, and arrogance drives activism.
Foege used language to build trust, share credit, and widen the circle of care. Duesberg used language to inflame and to malign people and institutions that save lives.
If you want to be inspired, take 25 minutes to watch Foege’s 2016 graduation speech at Emory University.
Here’s one of my favorite excerpts: “I keep wondering why I was not born in a village in New Guinea. I am no self-made person. I was born in this country, urged on by family, traveled roads paid for by government, went to schools that required thousands of people to put together … I avoided dying of tuberculosis, food poisoning, toxic water because of a government, rarely appreciated. Not because I deserved it but because of a coalition of government, religious institutions, and public and private groups, all conspiring to help me.”
Until next week,
Jay
Dr. Jay K. Varma, who is recognized globally for his leadership in the prevention and control of infectious disease, writes about public health for Healthbeat. He has guided epidemic responses, developed policies, and implemented programs that have saved lives across Asia, Africa, and the United States. He is based in New York. Contact Jay at jvarma@healthbeat.org.
