Today President Obama appointed Thomas Frieden, New York City's crusading health commissioner, as head of the Centers for Disease Control and Prevention. Frieden, an infectious disease specialist who is known mainly as an enthusiastic advocate of New York's strict smoking ban, heavy cigarette taxes, trans fat ban, and mandatory calorie counts on restaurant menu boards, embodies the CDC's shift from illnesses caused by microbes to illnesses caused by lifestyle choices. "Dr. Frieden is an expert in preparedness and response to health emergencies," Obama said today, "and has been at the forefront of the fight against heart disease, cancer and obesity, infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records." Some of these things are not like the others. When it comes to justifying the use of force, there is a crucial difference between health risks imposed by others (such as bioterrorists or TB carriers) and health risks that people voluntarily assume (by smoking or overeating, for example). In the former case, even those who believe that government should be limited to protecting individual rights can see a strong argument for intervention; in the latter case, intervention can be justified only on paternalistic or collectivist grounds. Frieden either does not recognize or does not care about this distinction. Consider this anecdote recounted by The New York Times:
Dr. Alfred Sommer, emeritus dean of the Johns Hopkins Bloomberg School of Public Health, who was on the team that recommended Dr. Frieden as New York's health chief in 2002, recalled interviewing him shortly after the Sept. 11 attacks. Dr. Frieden had flown to New York from India, where he was living and working on tuberculosis control.
Before he left India, he was asked about his top priority, Dr. Sommer said. "Oh, well, that's easy, Al," Dr. Sommer recalled him replying. "Tobacco. Tobacco is killing more people, and that's my top priority."
"Tom, I don't disagree that tobacco is a real scourge, but have you heard of 9/11?" Dr. Sommer said he countered.
"Of course I know about that, but bioterrorists are not going to kill more New Yorkers than tobacco is," Dr. Frieden said.
For contemporary public health officials, it's all about the numbers. The aim is to minimize total morbidity and mortality, whatever their cause. This calculus leaves no room for freedom of choice.
More on Frieden here. In "An Epidemic of Meddling," a 2007 Reason article, I explored the totalitarian logic of public health, a major theme of For Your Own Good, my book on the anti-smoking movement.