Re: Report: CDC wastes millions

[Guest guest]

Hey KC and Sharon,

Oh my gosh! What a great find regarding the deceit in medicine in the US.

You guys are awesome. I got the link to work.

_http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e7

2b780-363a-4777-b841-20925a304d20_

(http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e72b\

780-363a-4777-b841-20925a304d20)

************************************** See what's free at http://www.aol.com.

[Guest guest]

Have just skimmed that Senate doc on the CDC. Pulled out a few choice

quotes. There are MANY more.

_http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e7

2b780-363a-4777-b841-20925a304d20_

(http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e72b\

780-363a-4777-b841-20925a304d20)

DRUG LEGALIZATION CONFERENCE:

HHS and CDC sponsored an August 19-20, 2005, Utah conference hosted by the

Harm

Reduction Project and the Harm Reduction Coalition — organizations that

support tacit

legalization of drugs, including methamphetamine. Several sessions planned

for the conference

appear to promote illegal drug use and risky sexual behavior such as, “We Don

’t Need a ‘War’

on Methamphetamine,†and “You Don’t Have to Be Clean & Sober. Or Even

Want

to Be!â€

One of the presenters had earlier been quoted as saying, “For a lot of

people, meth use is a rite of

passage and it really does increase sexual pleasure.†He also criticized

current so-called safer

sex messages promoting condom use every time as no longer effective and

instead encouraged

“harm reduction techniques†during risky sexual behavior.14

PORN STARS HEADLINE CDC-FUNDED SAFE-SEX EVENT:

In July 2002, a CDC-funded group in Missouri called Blacks Assisting Blacks

Against AIDS

(BABAA) hired Memphis gay porn star Edgar Gaines, whose movie name is Bobby

Blake, to

attend a “safe-sex†event at the BABAA’s Executive Director’s downtown

loft. Gains was paid

$500 from a syphilis elimination grant.20 The porn star appeared at the

event in a towel and

cowboy boots.

One CDC auditor who was in California to review the STOP AIDS workshops,

such as “Booty

Call†and “Men for Hire,†is reported to have told another CDC employee,

“

I would take my

mother to this.â€

AUDIT FINDS GROUP’S ACTIVITIES ENCOURAGE SEXUAL ACTIVITY AND ARE OBSCENE …

YET

CDC CONTINUED TO FUND GROUP:

In April 2003, the CDC-funded Stop AIDS Project of San Francisco hosted a

four-part “erotic

writing workshop†where participants were to “Start by exploring your

fantasies and get support

for you [sic] creative writing process.â€8

In response to congressional inquiry, it was reported that in 2000, the Stop

AIDS Project of San

Francisco received $698,000 in federal funds, including CDC HIV prevention

grants and that

these funds were used to fund the activities listed above.9

In 2001, HHS’s Inspector General (IG) noted that two other CDC-funded STOP

AIDS Project

HIV prevention workshops, entitled “Booty Call†and “Great Sex,â€

“could be

viewed as

‘encourag[ing], directly … sexual activity’ in violation of CDC’s

guidance

… and as ‘obscene,’

Despite receiving millions of dollars from the federal government in the

past few years,

according to the Asian & Pacific Islander Wellness Center’s website, in the

last 17 years the

organization only has “served over 600 HIV-positive A & PIs.â€

************************************** See what's free at http://www.aol.com.

[Guest guest]

I can't get the link to work.

In a message dated 6/12/2007 9:02:46 PM Pacific Daylight Time,

snk1955@... writes:

Hey KC and Sharon,

Oh my gosh! What a great find regarding the deceit in medicine in the US.

You guys are awesome. I got the link to work.

__http://coburn.http://cobuhttp://cobhttp://coburn.http://cob & <WBR>FileS<WBR>F

_

(http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e7)

2b780-363a-4777-2b780-363a-4777-2b780-3

(_http://coburn.http://cobuhttp://cobhttp://coburn.http://cob & <WBR>FileS<WBR>F

ileSto<WBR>FileS<WBR>FileStore__

(http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e72b\

780-363a-4777-b841-20925a304d20) )

************************************** See what's free at http://www.aol.com.

[Guest guest]

The link that was just posted for one reason or another is no longer

working and this article does not seem to appear any longer in the

AJC. It's a pdf file and in case the 115 pages does not appear below

here is the new link;

Be sure to copy the full link to post in your address bar.

http://coburn.senate.gov/ffm/index.cfm?

FuseAction=Files.View & FileStore_id=0e72b780-363a-4777-b841-

20925a304d20

THE UNITED STATES SENATE

SUBCOMMITTEE ON FEDERAL FINANCIAL MANAGEMENT,

GOVERNMENT INFORMATION AND INTERNATIONAL SECURITY

MINORITY OFFICE

UNDER THE DIRECTION OF SENATOR TOM COBURN

RANKING MINORITY MEMBER

JUNE 2007

CDC OFF CENTER

A review of how an agency tasked

with fighting and preventing disease has

spent hundreds of millions

of tax dollars for failed prevention efforts,

international junkets,

and lavish facilities, but cannot

demonstrate it is controlling disease.

HTTP://COBURN.SENATE.GOV/FFM/

2

As part of my commitment to question how Washington spends your

money, I plan

to release a series of oversight reports on federal agencies. My

hope is that this effort

will assist federal agencies and those of us in Congress overseeing

their budgets, to

reign in wasteful spending, to demand measurable results from

programs and

grantees, and to reevaluate current spending before asking Congress

and taxpayers

to send more.

I hope that agencies and other congressional committees alike will

welcome this

oversight and work with us to help identify even more areas of

waste, fraud, and

abuse and new ways to better prioritize our nation's limited

financial resources.

As this report notes, " CDC Off Center " was not produced because of

any personal

animosity against the CDC, nor the good people it employs. As a

practicing

physician, I have consulted CDC's experts and materials to help me

successfully

treat my patients, and I value the good work it is capable of doing.

Unfortunately in

many areas, CDC is just one among many federal agencies that I

believe is not

properly living up to its own mission.

For some reason, the federal government has a difficult time

prioritizing spending

and demanding measurable results from those entrusted with billions

of hardearned

tax dollars to help carry out its crucial missions. I believe that

you, the

American taxpayer, deserve better.

As President Lincoln said, we are a " government of the people, by

the people, for the

people " and to uphold that principle we need your help. As part of

my ongoing effort

to shine the light on the federal government, I encourage anyone

with examples of

government waste, fraud, or abuse to let us know about it.

To submit a tip (anonymously, if you wish) through the Internet,

please visit my tip

page: http://coburn.senate.gov/ffm/index.cfm?

FuseAction=SubmitATip.Home.

Or to submit a tip by mail to my subcommittee office, please mail to:

Senator Tom Coburn

Subcommittee on Federal Financial Management, Government

Information, and

International Security

340 Dirksen Senate Office Building

Washington, DC 20510

With your help we can begin making a difference and change the way

Washington

works.

Sincerely,

Tom Coburn, M.D.

United States Senator

3

TABLE OF CONTENTS

EXECUTIVE

SUMMARY..............................................................

..................................................... 4

I.

BACKGROUND...........................................................

............................................................. 5-7

The Centers for Disease Control and Prevention (CDC)

• CDC's History

• CDC's Funding

II.

FINDINGS.............................................................

.................................................................… 8

CDC Facilities: Lavish Spending or Priority

Needs? ................................................. 8-22

• CDC's $106 million R. Harkin Global Communications (and

Visitor) Center

• CDC's new $109.8 million Arlen Specter Headquarters and Emergency

Operations

Center has $10 million in furniture

• CDC's $200,000 fitness center includes $30,000 saunas and rotating

light shows

• CDC's new Hawaii office announced by Hawaii Senator who oversees

CDC funds

CDC Targets Diseases … Results Still Pending: ………………………………..…. 23-80

• CDC's prevention funding for HIV/AIDS: $5 billion over seven years

• Of CDC's $2.6 billion in HIV/AIDS grants, some have no objectives

and are " abysmal, "

yet funded anyway

• CDC's domestic HIV/AIDS program: results not demonstrated

• CDC-funded events featuring porn stars, transgender beauty

pageants, and flirting classes

• CDC's $45 million for conferences featuring prostitutes, protests,

and beach parties

• CDC announces plan to eliminate syphilis: five years later rates

up overall and 68

percent among men

• CDC's $335 million kid-targeted media campaign to fight obesity:

advertising success

but health impact unknown

• CDC addresses serious health issues like land development and bike

paths

• CDC and guns as a " health problem "

CDC's Statistic Problems and Fraud: ………………………………….…….……... 81-86

• CDC revises U.S. obesity deaths by 1,400 percent in nine months

• CDC Inspector General investigations find over $1 million in fraud

in just three cases

It Pays to be a CDC Employee: …………………….……………………………… 87-103

• CDC pays $1.7 million to Hollywood liaison; ex-employee runs

liaison shop

• CDC's top financial officers take home a quarter of a million

dollars in bonuses

• The revolving door: how a former CDC executive lands CDC contracts

worth millions

for minority-owned companies

• CDC pays two former employees $250,000 to help build morale

• HHS Secretary uses CDC's leased jet for meetings and speeches: CDC

defends use

How CDC Funding is Counterintuitive: ……………………………………........ 104-110

• CDC-funded bar night and manual on how to throw an alcohol party

• CDC sets bioterrorism results-oriented goals after spending

billions

III.

RECOMMENDATIONS......................................................

............................................... 111-113

IV.

CONCLUSION...........................................................

........................................................... 114

APPENDIX.............................................................

.....................................................................1

15

• AIDS Funding Chart

4

EXECUTIVE SUMMARY

A recent survey showed that Americans overwhelmingly know of the

Centers for Disease

Control (CDC) and most give it positive remarks for the job they

believe CDC is doing.1

Bolstered by this public perception, year after year, supporters of

the CDC seek additional funding

for the agency, often under the auspices of making America healthier

and safer.

Yet while CDC has been given millions, and in some cases billions,

of dollars to help prevent certain

diseases among Americans, for many of these diseases the rates have

not decreased, but have stayed

the same or even increased under CDC's watch. In the case of HIV,

despite spending billions of

dollars, CDC cannot even report how many Americans have the

communicable disease.2

This is not to say that CDC is not trying to tackle these diseases,

or that the people who work at

the agency are intentionally misusing taxpayers' hard-earned money.

A review of recent CDC

expenditures, however, demonstrates that a reprioritization of CDC

funding and a review of the

approach to certain types of disease prevention are long overdue.

In fiscal year 2007, the CDC has a budget of $10 billion and a

stated mission " To promote health

and quality of life by preventing and controlling disease, injury,

and disability. "

The CDC's website says the agency, " pledges to the American people:

To be a diligent steward of

the funds entrusted to it. …To place the benefits to society above

the benefits to the institution " and

it lists as one of its core values " accountability. " The mission

statement continues: " As diligent

stewards of public trust and public funds, we act decisively and

compassionately in service to the

people's health. We ensure that our research and our services are

based on sound science and meet

real public needs to achieve our public health goals. " 3

This report seeks to hold CDC accountable to the taxpayers and to

highlight spending decisions that,

in some instances, appear to demonstrate questionable stewardship of

public funds.

1 " CDC, FAA, NIH, FDA, FBI and USDA Get the Highest Ratings of

Thirteen Federal Government Agencies, "

Interactive ® online survey of 2,337 adults between January

11 and 18, 2007,

http://www.prnewswire.com/news/index_mail.shtml?

ACCT=104 & STORY=/www/story/02-06-

2007/0004521666 & EDATE=.

2 " Disease Burdens in the United States, " Congressional Research

Service (CRS) Memorandum to Senator Tom

Coburn (R-OK) from CRS Specialist in Public Health and Epidemiology

Domestic Social Policy Division, dated

March 12, 2007.

3CDC website, http://www.cdc.gov/about/mission.htm,

http://www.cdc.gov/fmo/PDFs/half

FY06AppropFactsheet.pdf, accessed October 2006.

5

I. BACKGROUND

CDC's History1

The Centers for Disease Control and Prevention (CDC) was founded in

1946 to help control

malaria, and today it makes up one of the 13 major operating

components of the Department of

Health and Human Services (HHS).

CDC says it has " remained at the forefront of public health efforts

to prevent and control

infectious and chronic diseases, injuries, workplace hazards,

disabilities, and environmental

health threats. " It is responsible for applying " research and

findings to improve people's daily

lives " and responding to health emergencies.

Working with states and other partners, CDC provides a system of

health surveillance to monitor

and prevent disease outbreaks (and other public safety threats,

including bioterrorism),

implement disease prevention strategies, and maintain national

health statistics. CDC also

guards against international disease transmission, with personnel

stationed in more than 25

foreign countries.

The agency espouses the following agency-wide " health impact goals " :

Healthy People in Every Stage of Life

All people, and especially those at greater risk of health

disparities, will

achieve their optimal lifespan with the best possible quality of

health in every

stage of life.

Healthy People in Healthy Places

The places where people live, work, learn, and play will protect and

promote

their health and safety, especially those at greater risk of health

disparities.

People Prepared for Emerging Health Threats

People in all communities will be protected from infectious,

occupational,

environmental, and terrorist threats.

Healthy People in a Healthy World

People around the world will live safer, healthier and longer lives

through

health promotion, health security, and health diplomacy.

1 All information from CDC website,

http://www.cdc.gov/about/default.htm, accessed February 2007.

6

CDC Funding1

CDC FUNDING STEADILY INCREASING:

CDC's funding has almost tripled over the past decade, with large

increases coming after the

2001 anthrax attacks and the 2005 avian flu scare. Yet, depending on

which CDC document

taxpayers refer to, the agency's funding is either increasing or

decreasing.

NOT " COUNTING " BILLIONS OF DOLLARS:

For example, in one year's budget documents, CDC states in a small

footnote to a chart,

" Funding does not include transfers to CDC from the Department of

State Office of the Global

AIDS Coordinator [OGAC] ($439.0 million in FY2005), as part of the

President's Emergency

Plan for AIDS Relief. " 2 Following publication of the budget with

this footnote, an additional

$600,000 was transferred from OGAC to CDC, bringing the total

transfer to CDC to $439.6

million in FY2005.3 In other words, CDC did not " count " almost a

half a billion dollars in its

budget for HIV/AIDS, even though that money was transferred to and

spent by CDC on

HIV/AIDS.

In subsequent budget documents, CDC again states in a small footnote

to HIV/AIDS spending,

" Funding does not include transfers to CDC from the Department of

State Office of the Global

AIDS Coordinator ($604 million in FY 2006), as part of the

President's Emergency Plan for

AIDS Relief. " 4 Evidently, the number cited by CDC in its own budget

documents, is not

accurate. In fact, $604 million was not even a " real " number but

only an estimate (though

taxpayers would not know that from reading the document) and the

actual amount transferred

from OGAC to CDC in FY2006 was $578.2 million.5

In FY07, CDC so far has received $815 million from OGAC, a figure

which CDC reports is

" likely to increase " before the end of the fiscal year, as OGAC

is " likely to transfer additional

money later this year. " 6

Perhaps there is a budgetary reason why CDC does not " count " over a

$1.8 billion dollars it has

received and spent over the last few years on HIV/AIDS, but doing so

makes it complicated for

researchers to compare actual CDC expenditures from year to year.

FOLLOWING THE MONEY:

If researchers try to calculate CDC's budget by only counting what

Congress appropriates

directly to the CDC, they may leave out billions of dollars in

spending such as the HIV/AIDS

funding noted above.

Taxpayers should follow the line in CDC budget tables that refers to

the total program levels,

rather than the line for total Labor, HHS, and Education

Appropriations funding, which

sometimes does not include supplemental appropriations (such as

avian flu funding) and does not

count billions in transferred funds from other agencies to CDC.7

7

Figure 1. CDC's Budget by Fiscal Year (FY)8

2.8

7.2

0.4

0.6

0.8

2.6 2.4 2.8 3.3

3.7

5.1

7.7 7.4

8

8.6

9.19

0

2

4

6

8

10

FY95

FY96

FY97

FY98

FY99

FY00

FY01

FY02

FY03

FY04

FY05

FY06

FY07

Dollars in Billions

1 CDC FY06 Budget Summary,

http://www.cdc.gov/fmo/PDFs/FY06budgetreqsummary.pdf, page 29; CRS

report

" Labor, Health and Human Services, and Education: FY2006

Appropriations, " updated February 22, 2006,

http://www.congress.gov/erp/ra/pdf/RL32952.pdf; CRS report " Labor,

Health and Human Services, and Education:

FY2007 Appropriations, " updated March 21, 2007,

http://www.congress.gov/erp/ra/pdf/RL33576.pdf. Note: In

FY2006 the CDC's funding included $4.3 in the Labor/HHS/Education

Appropriations bill and $76 million in the

Interior Appropriations bill (for the Agency for Toxic Substances

and Disease Registry (ATSDR)), as well as $1.6

billion in terrorism funds, $1.5 billion in vaccines for children,

and $2.2 million in user fees.

2 " FY 2006 CDC/ATSDR Functional Table Financial Management Office, "

January 26, 2006,

http://www.cdc.gov/fmo/PDFs/FY06FundFunctAreaTable.pdf.

3 E-mail correspondence between CDC Program Analyst and the office

of Senator Tom Coburn, May 2, 2007.

4 HHS Fiscal Year 2008 Justification of Estimates for Appropriation

Committees,

http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf.

5 Footnote 3, op. cit.

6 Ibid.

7 See page 34 of CDC's FY06 Budget Summary,

http://www.cdc.gov/fmo/PDFs/FY06budgetreqsummary.pdf; page

31 of CDC's FY08 Justification of Estimates for Appropriation

Committees,

http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf.

8 The FY95 through FY05 funding figures come from the " CDC Funding

History " graph on page 36 of CDC's

FY06 Budget Summary

(http://www.cdc.gov/fmo/PDFs/FY06budgetreqsummary.pdf). Based on the

FY04-FY06

figures (see page 34 of same document), it appears the CDC Funding

History chart reflects the historical total

program funding levels, which would includes terrorism funding and

give a more accurate calculation for taxpayer

funds CDC actually received. The increase in FY02 funding reflects

one-time terrorism preparedness funding not

reflected in FY03, according to CDC. The additional $439.6 million

shown in red for FY05 is the amount

transferred to CDC from the OGAC, according to a footnote in the

FY06 Budget Summary and an updated and

unpublished figure from CDC. The FY06 funding figure is from the

table on page 31 in the FY08 Justification of

Estimates for Appropriation Committees that reports the total

CDC/ATSDR funding level for FY06 was $8.6

billion, and that this funding level does not count $604 million in

money spent on HIV/AIDS that was transferred

from OGAC (http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf).

According to updated and unpublished

information from CDC, the report of OGAC transferring $604 million

to CDC was an estimate (though the

justification document fails to mention this fact) and the actual

amount transferred to CDC was $578.2 million

(shown in the figure above in red). The FY07 figure of $9.19 billion

is from " FY2007 Joint Resolution [CDC] Detail

Table, " http://www.cdc.gov/fmo/PDFs/FY_2007_JR_Detail_Table.pdf,

accessed May 2007. The OGAC FY07

transfer of $815 million (shown in the figure above in red) is based

on an unpublished CDC figure which is " likely

to increase " before the end of the fiscal year, as OGAC is " likely

to transfer additional money later this year. "

CDC budget

totals

Funds

transferred to

CDC from the

Office of the

Global AIDS

Coordinator

(OGAC)

8

II. FINDINGS

CDC FACILITIES: LAVISH SPENDING OR PRIORITY NEEDS?

CDC's $106 million R. Harkin Global Communications

( & Visitor) Center: a Metaphor for Agency's Prioritization1

Since 1996 the CDC had a visitor center which drew 15,000 visitors a

year. The agency itself is

located in Atlanta, Georgia, home to one of the largest 24-hour

cable news networks. Yet when

faced with static HIV transmission rates, e-coli outbreaks, and the

threat of bioterrorism, CDC

spent $106 million of taxpayers' dollars to build a lavish new

visitor center, which includes a 70-

foot-wide by 25-foot-tall video wall of plasma television screens

inside its new communications

center, which houses a $20 million new studio for communicating

CDC " information. "

The CDC spent $106 million to fund the new 202,000 square foot

R. Harkin Global

Communications Center in Atlanta, Georgia, which includes a

conference center, an information

center, and a media services facility.2 In 2005, the U.S. Senate

voted to name the building after

Senator Tom Harkin, a Democrat from Iowa, who at the time was the

ranking member on the

appropriations committee which funds the CDC.3 The Center has been

built amid a sloping

" greenscape " with a stream running over and around artificial rocks

where rainwater is collected

and sent down the stream to a pond and then pumped back up to the

top of the slope and sent

9

down again.4 It has limestone bridges, waterfalls and Japanese

gardens and fountains, according

to the Wall Street Journal (WSJ).5

The WSJ reports a CDC spokesman said that the Visitor Center portion

of the building will be " a

world class destination, " with red ants, rats, monkeys, art work and

a giant model mosquito, all

of which will make the museum a " must-see place for tourists. " 6

According to the Washington Post, CDC director Dr. Gerberding

has dubbed this structure

" a metaphor " for the new CDC.7 The WSJ called it " CDC's new Taj

Mahal. " 8

In response to congressional inquiry, the CDC reported that the

visitor center portion of the

building, which includes a scientific education and exhibit area,

cost $6.9 million to construct

and comprises 20,500 square feet or 10 percent of the building.9 Dr.

Gerberding said " this new

building houses the distance learning capabilities, video and audio

production facilities,

conference space, and other information resources that are essential

for quickly and effectively

communicating CDC's science, research and health-protection

information to the many people

who need it. " 10 The studio equipment, installation, and software

programming cost $18.6

million, and the " Audio Visual Integration " equipment, installation,

and software programming

cost $5.1 million.11

THERE ALREADY WAS A CDC VISITOR CENTER:

The new center replaces another 3,500 square foot CDC visitor

center, in existence since 1996,

which drew approximately 15,000 visitors a year.12 Called the Global

Health Odyssey Museum,

the museum was advertised as showing visitors " how public health and

the CDC's efforts reach

into their daily lives " with a mission of teaching its visitors

about the CDC, public health, and

the benefits of prevention.13 Emphasis was placed on increasing

visitors' awareness of the role

of the individual in preventing disease, injury, and death. The

visitor center museum consisted

of a small exhibit area with an attached theater and served as both

a visitors' center and an

interactive educational facility. The Global Health Odyssey tour

began with a 5-minute

introductory video and then visitors viewed a series of four

displays illustrating CDC's work.

Historic exhibits and artifacts followed, with an overview of CDC's

heritage and its development

over the years. Visitors could also enter the Discovery Theater to

view educational videos,

demonstrations, and hear CDC volunteer speakers on a variety of

topics.14

It is not clear why CDC prioritized its spending on a new visitor

center when it already had one.

CDC'S CENTER FEATURES WALL OF PLASMA'S TV'S CALLED " THE GLOBAL

SYMPHONY " :

According to the new Visitor Center's website:

" [The] Global Symphony [top right photo on previous page] is an

unparalleled multimedia

installation highlighting the world of CDC and public health. …

Public health

messages are communicated through intriguing narratives alternated

with visual

vignettes. The installation serves as an introduction to CDC and

public health for all

visitors. Recently, the Global Symphony featured three, three-minute

stories that describe

in depth CDC's contributions to the elimination of polio, the

eradication of Legionnaire's

disease, and the battle to stem the rise of obesity in the United

States. The stories are

10

complemented by a wide range of statistics on public health topics

ranging from

HIV/AIDS to worker safety. " 15

It is unclear why an agency that is tasked with controlling and

preventing diseases is spending

millions of dollars budgeted for those fights on a wall of plasma

televisions displaying " visual

vignettes. "

The 70-foot-wide by 25-foot-tall video wall is " a very welcoming

environment, " and " a complex

ballet of light and display, " according to Archi Tech Magazine. " The

program that would be

displayed on this array of rear-projection and plasma screenage is a

complex digital ballet of

hundreds of video elements that play randomly … The payoff was a

unique information

environment that makes what many consider to be an intimidating

place at a time of global

pandemic warnings a lot more welcoming. " 16

Though the architectural community applauds its design, most

taxpayers would agree a federal

agency should not be working to make its lobby more welcoming, but

to make its work more

effective.

According to the Congressional Research Service, the CDC spent more

than $1 billion on

construction and repairs of its buildings and facilities from fiscal

years 2000 to 2005.17

HARKIN CENTER EXHIBIT TEACHES ABOUT BENEFITS OF ENTHUSIASM:

CDC argues that its visitor center can help educate Americans on

healthy living. Few taxpayers

would question the need for Americans to live healthy lives, but

whether or not hosting an

exhibit detailing the health benefits of " enthusiasm " is the best

use of CDC's resources is a

question some rightfully might ask.

From October 2006 through January 2007, the CDC's Harkin Center

featured " Through the Eyes

of the Eagle: Illustrating Healthy Living for Children " where " [t]

hrough Native American

characters and scenes, the stories engage children in the joys of

physical activity and healthy

living as they learn about diabetes prevention. " 18

One of the components of the exhibit dealing with healthy living

involved " enthusiasm. "

According to the CDC website:

" Enthusiasm can be reflected in joy, in determination, and in quests

for learning.

It can be part of keeping our bodies, minds, and spirits in balance.

For many

people, it has something to do with being grateful for the gifts we

have been

given.

" It can be part of finding out what activities you like to do or

want to try. People

can be enthusiastic about many different things. Some are

enthusiastic about

dance or sports. Some people are enthusiastic about nature. They may

enjoy

hiking or camping. …Others may enjoy fishing or walking along the

beach.

Some people are enthusiastic about going to school. They enjoy

studying and

learning many different things. …Some people are enthusiastic about

helping

others. They may enjoy helping their family at home or their

neighbors in the

11

community. Some may enjoy doing volunteer work to help people they

do not

know. Some people are enthusiastic about being artistic or creative.

They may

enjoy painting or weaving. Some may enjoy writing poetry or music.

Enthusiasm can go up and down. And sometimes we have experiences that

make us just very sad. Our energy and enthusiasm can get low.

Remember, you

are not alone. " 19

HARKIN CENTER EXHIBIT FEATURES " WOMAN " MADE OF VEGETABLES

Perhaps the CDC decided to invest $6.9 million in a new visitor

center so it could highlight

critical disease fighting tools such as a " woman " made out of

vegetables, which was one display

featured at the Harkin Center. The CDC did not simply feature

this " woman, " but the agency

actually helped pay to create the vegetable woman, though most

taxpayers would put " produce

art " on the bottom of the list of things CDC should be purchasing

with limited federal funds.

Meanwhile, CDC researchers have reported that fewer than a third of

more than 300,000 people

surveyed in 2005 said they ate the absolute minimum recommended

number of fruits and

vegetables, which health experts say should be at least five

servings a day of fruit and vegetables,

or, better yet, three to five servings of fruit and four to eight

servings of vegetables every day.

" In 2005, approximately 32.6 percent of the U.S. adult population

surveyed consumed fruit two

or more times per day, and 27.2 percent ate vegetables three or more

times per day, " Heidi

Blanck and colleagues wrote in the CDC's weekly report on death and

disease. The authors

concluded that that CDC and other agencies need to do more to

persuade Americans to eat fruits

and vegetables.20

It's hard to imagine this task is accomplished by spending tax

dollars to create a woman made of

vegetables and putting " her " in the CDC's lobby in Atlanta.

From January 22 through April 6, 2007, the Global

Health Odyssey/Tom Harkin Global Communications

Center featured an interactive exhibit entitled " The

Changing Face of Women's Health. " The exhibit

was created " with funding from the Centers for

Disease Control and Prevention (CDC), National

Institutes of Health (NIH), MetLife Foundation, and

Pfizer Women's Health. " 21

12

1 Photos: www.cdc.gov;

http://www.splis.com/pdf/52dfb09be832bffee6a9fceb542c9f30.pdf#search=

%22tvs%20harkin%20center%22;

http://www.tvsa.com/index.asp.

2 February 13, 2006 HHS response letter to Senator Tom Coburn's

January 11, 2006 written inquiry, signed by

, Office of the Secretary, re: Building #19; Letter

to the editor from Dr. Gerberding, CDC

Director, Wall Street Journal, December 23, 2005; Note: The building

was originally going to be named the Visitor

and Education Center according to the CDC Foundation,

http://www.cdcfoundation.org/frontline/2004/helps_outfit_cdcs_new_vis

itor__education_center.aspx. accessed

November 2006.

3 Senator Inouye (D-HI) amendment (S.Amdt. 2222) to the FY06

Labor/HHS/Education Appropriations bill

(H.R. 3010), October 25, 2005, agreed to by the full Senate by voice

vote.

4 " CDC's Redesign Eyes Security, Collegiality, " Washington Post,

August 29, 2005.

5 " Deadly Avian Spending Virus, " Wall Street Journal, December 14,

2005.

6 Ibid.

7 Footnote 4, op. cit.

8 Footnote 5, op. cit.

9 Footnote 2, HHS response letter, op. cit.

10 Footnote 2, letter to the editor, op. cit.

11 Supra footnote 2, HHS response letter.

12 " CDC plans snazzy new visitors center, " The Atlanta Journal-

Constitution, October 1, 2003.

13 " Member Spotlight: Global Health Odyssey, " E-Newsletter of the

National Association of Health Education

Centers, May 31, 2002, http://www.nahec.org, accessed October 2006.

14 Ibid.

15CDC website,

http://www.cdc.gov/gcc/exhibit/exhibitions_permanent.htm, accessed

October 2, 2006.

16 " Lighting The Way CDC Visitors Center; Facility demonstrates a

complex ballet of light and display, " Archi Tech

Magazine, 2006, http://architechmag.com/avawards2006/visitor/,

accessed November 2006.

17 CRS response to Senator Tom Coburn's request, September 2005.

FY00-05 CDC construction and repair project

expenditures equal $1,044,083,943. FY 2000: $45,732,105; FY 2001:

$72,609,521; FY 2002: $260,558,270; FY

2003: $83,697,080; FY 2004: $211,778,967; and FY 2005: $269,708,000.

18 " CDC Exhibit Open to the Public, " The Weekly, October 3, 2006,

http://www.theweekly.com/news/2006/October/03/CDC_exhibit.html,

accessed October 2006.

19 CDC website, http://www.cdc.gov/diabetes/eagle/enthusiasm.html,

accessed October 2006.

20 " Americans still not eating their veggies, CDC says, " Reuters,

March 15, 2007.

21 Office of Women's Health, http://www.cdc.gov/women/exhibit/,

accessed March 2007. Note: The CDC Fruit and

Vegetable account, from which the funds likely came to pay for the

vegetable " woman, " had a budget of $1.4

million in FY06 and $1.4 million in FY07 according to " FY2007 Joint

Resolution [CDC] Detail Table, "

http://www.cdc.gov/fmo/PDFs/FY_2007_JR_Detail_Table.pdf, accessed

May 2007.

13

CDC's New $109.8 Million Arlen Specter Headquarters and

Emergency Operations Center has $10 Million in Furniture

No one disputes the need for CDC's employees to work in professional

surroundings with its

researchers having access to state-of-the-art technology. Whether or

not taxpayers' funds are

best spent on $10 million worth of top-of-the-line furniture,

however, is another matter.

The CDC spent $109.8 million to build the new 325,000 square foot

Arlen Specter Headquarters

and Emergency Operations Center in Atlanta, Georgia.1 In 2005, the

U.S. Senate voted to name

the building after Senator Arlen Specter, a Republican from

Pennsylvania, who at the time was

the chairman of the appropriations committee which funds the CDC.2

According to the CDC,

the new Headquarters building " promotes collaboration by

consolidating in one building

employees from across the agency, particularly the Office of the

Director, the Emergency

Operations Center, and the Office of Terrorism Preparedness and

Emergency Response. " 3

In response to congressional inquiry, the CDC reported that

furniture in the Operations Center

cost $9.8 million.4 According to one CDC source, this amounts to

over $12,000 per person

working in the building.5 CDC also reported that the building

equipment " audio visual systems,

monitors/screens, [and] teleconferencing " amounted to $6 million.6

According to a CDC source,

TVS, the company that designed the furniture package for the

building, included Scandanvian

" Randers guest chairs, " which reportedly cost $590 each.7

According to the Congressional Research Service, the CDC has spent

more than $1 billion on

building construction and repairs of its buildings and facilities

from fiscal years 2000 to 2005.8

1 February 13, 2006, HHS response letter to Senator Tom Coburn's

January 11, 2006 written inquiry, signed by

, Office of the Secretary, re: Building #21; building

and room photos from architectural firm

TVSA's website, http://www.tvsa.com/index.asp, accessed October 2006.

2 Senator Inouye (D-HI) amendment (S.Amdt. 2222) to the FY06

Labor/HHS/Education Appropriations bill

(H.R. 3010), October 25, 2005, agreed to by the full Senate by voice

vote.

3 CDC website, http://www.cdc.gov/about/facilities.htm, accessed

October 2006.

4 Photos from http://www.tvsa.com/index.asp; Footnote 1, HHS

response letter, op. cit., Building #21; " furniture

(chairs, tables, work stations, file cabinets, etc.) $9,872,413. "

5 CDC Chatter, March 21, 2006 posting,

http://www.cdcchatter.net/index.php?

name=News & file=article & sid=100 & thold=1 & mode=thread & order=0,

accessed October 2006.

6 Supra footnote 1, HHS response letter, Building #21; " equipment

(audio visual systems, monitors/screens,

teleconferencing) $6,014,900. "

14

7Footnote 5, op. cit. Note: Randers guest chairs pictured here

http://moderndimension.com/eneu/

OS/catalog/seating/stacking_chairs/stacking_chairs/Also_Chair_o0.htm#

, appear to match the chairs in the

TVSA photo of furniture in the Specter building, thus seeming to

confirm the posting.

8 CRS response to Senator Tom Coburn's request, September 2005. FY00-

05 CDC construction and repair project

expenditures equal $1,044,083,943. FY 2000: $45,732,105; FY 2001:

$72,609,521; FY 2002: $260,558,270; FY

2003: $83,697,080; FY 2004: $211,778,967; and FY 2005: $269,708,000.

15

CDC's " Modest " $200,000 Fitness Center:

Includes saunas, zero-gravity chairs, and " mood enhancing " light

shows

Keeping America healthy is part of the CDC's core mission. Many

federal facilities,

including Congress, have fitness centers for their employees to

assist them in maintaining

healthy lifestyles and many charge employees to use the on-site

facility.1 Some federal

agencies have negotiated discounted rates for their employees at

America's numerous

private and non-profit sports and fitness clubs. The CDC choose to

build a new state-ofthe-

art fitness center called the Lifestyle Facility, located inside a

$21 million, five-story

building on the CDC's Atlanta campus, and give its employees free

access.2 It is not

necessarily the building of a new CDC fitness center that some

taxpayers may question,

but the decision to spend tax dollars on some of the center's more

lavish attributes, such

as on light shows, high-tech (and high-cost) mood chairs, and saunas.

The 16,000-square-foot center features a large light-filled training

room and over

$200,000 in equipment, including more than 70 strength-training and

cardiovascularpriming

machines, according to the CDC and the Associated Press (AP).3

The center also features: a 12-bike indoor cycling room with images

of the Tour de

France and other race courses flashing on the walls, an aerobics

room with seven Gravity

Training System machines, saunas in the locker rooms, and two " quiet

rooms, "

reminiscent of " Star Trek, " that allow employees to sit in zero-

gravity chairs in a dark

room listening to music and viewing a panel of changing pastel

lights.4 The architecture

firm TVS used bamboo and river stones " to add extra, welcoming

touches, " according to

the AP.5

In February 2006, in response to congressional inquiry regarding the

cost of the new

CDC buildings, CDC told Congress " The [fitness center] project does

not fund any

exercise equipment. CDC will use current fitness center equipment in

the new space "

(emphasis added).6 And yet, not even a year later, CDC admitted to

Congress that it

spent $200,000 in taxpayer funds for new fitness center equipment.7

" No Sweat! [CDC employee] gets a

sneak peek at the sauna before the

opening of the new building and

Lifestyle center. "

" As you lie in the zero gravity chair in

the quiet room, you can watch a

mood-enhancing light show. The chair

takes the stress and pressure off your

joints and back. "

16

According to the CDC, its Office of Health and Safety purchased the

$200,000 in

exercise equipment from CDC's program support funds. Included in

that total are the

following costs:

• 2 rotating pastel lights (pictured above) at a total cost of

$2,000;

• 2 zero-gravity chairs at a cost of $1,750 each, for a total of

$3,500;

• 2 " dry-heat saunas " (pictured above) at a cost of $15,000 each,

$30,000

total;

• 1 sound system, with eight " sound zones " at a cost of $70,000;

• 12 bikes at a total cost of $9,540;

• 9 " spinning certifications " at a total cost of $2,249.558; and

• 7 Gravity Training System machines at a cost of $2,895 each, for a

total

cost of $21,143.9

According to a CDC employee newsletter, the quiet rooms — which are

to be made

available by appointment — have " music, and mood lighting, and each

has a chair that is

designed with a `zero gravity' seating position which helps to

relieve muscle tension,

increase circulation and reduce pressure on your heart and spine. As

you lie in the zero

gravity chair in the quiet room, you can watch a mood-enhancing

light show. " One

employee who had tested the light show reported, " They change from

green to blue, very

soothing. Color can really affect your mood. " 10

In response to congressional inquiry, CDC defended these

expenditures:

" The rotating pastel lights, sound system, sauna and zero gravity

chairs are

facility attributes that enhance the overall health and wellness

experience for

patrons. …CDC's new fitness center adheres to Federal guidelines for

fitness

facilities and is considered a modest facility by government and

corporate sector

standards. …The rotating pastel lights, sound system, sauna and zero

gravity

chairs are comparable to health and wellness attributes at

Department of Defense

[DOD] Naval Installations at Bremerton and Bangor, the Home Depot

Wellness

Center, the YMCA – Buckhead in Atlanta, Blue Cross Blue Shield and

Merrill

Lynch. " 11

Some taxpayers might question why a taxpayer-funded agency with a

limited budget and

a mission of fiscal accountability is modeling its fitness center on

those of private, forprofit

companies. In addition, the DOD Bremerton and Bangor facilities

mentioned as

models for the new CDC fitness center do not appear to have gone

through the regular

funding process, but were instead funded through the earmarks of

their home state's U.S.

Senator.12 Earmarked projects are not subject to the regular federal

oversight process and

the process of earmarking has recently come under intense scrutiny,

in part because it

diverts funds from agency priorities to projects labeled home-

state " pork. "

Of the 15,000 CDC employees and contract workers, the gym now sees

visits from

approximately 600 employees a month.13 The new facility replaced an

older, out-of-date

gym that had only three treadmills (compared to the eight in the new

facility), and

reportedly frequently had at least one out of order.

17

A CDC spokesman told the AP, " We want this to become a model for

companies and

others to copy. " 14 The CDC newsletter predicted, " From quiet,

meditation rooms for

relaxation, to wonderful outdoor spaces for walking and stretching,

to the massive

strength and cardio areas, this center will turn heads for

certain! " 15

Taxpayers might well question whether or not the CDC's mission of

fighting and

preventing diseases includes designing employee fitness centers that

will turn heads, or

be models for private companies.

1 Congress, unlike the CDC, charges its employees for use of the gym.

2 " CDC Practices What It Preaches, " CDC Connects (employee

newsletter), July 19, 2006; photo captains taken

directly from newsletter.

3 E-mail correspondence from HHS Legislative Affairs to the office

of Senator Tom Coburn, dated December 8,

2006; " CDC Opens Model Employee Fitness Center, " The Associated

Press (AP), November 27, 2006.

4 AP, Ibid.

5 Id.

6 February 13, 2006 HHS response letter to Senator Tom Coburn's

January 11, 2006 written inquiry, signed by

, Office of the Secretary, re: Building #20.

7 Footnote 3, e-mail correspondence, op. cit.

8 Spinning is a type of exercise class that uses stationary

bicycles. Presumably the certifications are for people to

teach these exercise classes at the Lifestyle Facility.

9 Supra footnote 3, e-mail correspondence.

10 Footnote 2, op. cit.

11 Supra footnote 3, e-mail correspondence.

12 Document entitled " Washington State Military Construction

Appropriations 1998 – 2005 " from the office of

Senator Patty Murray (D-WA), which lists two Washington State

earmarks in Fiscal Year 1999: " Fitness facility,

NAVSUBASE, Bangor $ 1,117,000 " and Fiscal Year 2001: " Fleet

recreation center, Bremerton $1,400,000 " with a

note that these are " Additions or Increases by Senator Murray, "

http://murray.senate.gov/defense/milcon.pdf,

accessed December 2006.

13 Supra footnote 3, AP.

14 Ibid.

15 Supra footnote 2.

18

Hawaii Politician Who Oversees CDC Funding

Announces New CDC Hawaiian Office

There are two ways to ensure the growth of a federal agency: create

jobs in desirable areas to live

and work, and spread out resources and programs into as many of the

states and districts of

Members of Congress who fund the agency as possible. CDC is on track

to do both with a recent

announcement that the agency is likely opening a university-

affiliated office in Honolulu that

may serve as a model for other CDC-university affiliated offices.

CDC WEST: A MILE FROM WAIKIKI?

At the suggestion of a former CDC employee, and current University

of Hawaii Institute director

Duane Gubler, CDC officials traveled to Hawaii to discuss the

possibility of the agency opening

an office in Honolulu in the summer of 2007. CDC would partner with

the University of Hawaii,

whose main campus is located just a mile from the famous Waikiki

beach. The CDC is

interested in the Hawaiian location, according to a CDC official who

visited, because of its

proximity to Asian and Pacific nations and also because it hopes to

collaborate with the NIHfunded

secure laboratory at the medical school's Asia-Pacific Institute of

Tropical Medicine and

Infectious Diseases.1

Gubler, who suggested the Hawaii-CDC partnership, was director of

the CDC's Fort ,

Colorado, infectious disease laboratory before joining Hawaii's

medical school three years ago,

where he currently serves as Director of the Asia-Pacific Institute

of Tropical Medicine and

Infectious Diseases.2 News reports indicate Gubler is considered a

national authority on

infectious disease, and he told a reporter that he was working with

his former colleagues to

develop a business plan " to move ahead with CDC West and to embed a

CDC office " at the

Institute he directs. 3

SENATOR ANNOUNCES CDC SAYS " ALOHA " TO TROPICAL ISLAND OUTPOST:

That this new CDC office would be located in Hawaii, the state of

the second highest ranking

Senator on the committee that funds the CDC, could be just a

coincidence.

19

It also could be a coincidence that the same Senator, Senator

Inouye (D-HI), was first to

announce the finalization of what had been reported as a proposal.

Hawaii news reported on

April 10, 2007, that CDC was contemplating an office in Hawaii. On

April 19, 2007, Senator

Inouye issued a press release entitled, " Centers for Disease Control

and Prevention to Set up

`Forward Base' in Hawaii to Strengthen Asia-Pacific Disease

Detection and Response. " 4 The

release stated the Senator had been informed by the Director of the

CDC that it was opening an

office in his home state.

This office is not the first time CDC and Hawaii have teamed up;

evidently the first project was

done at the request of the Senator. " Several years ago, the Centers

for Disease Control and

Prevention, at Senator Inouye's request, established a small

occupational health center at the

University of Hawaii at Hilo, " the press release noted (emphasis

added). " It has taken the lead in

addressing the public health implications of volcano emissions and

childhood asthma. " 5

A SMALL STATE AND UNIVERSITY CONTINUE TO RECEIVE TOP DOLLAR IN

EARMARKS:

" While the funding and the location of the [new] field station still

need to be worked out, it is

clear that the CDC is committed to expanding its Asia-Pacific focus

with Hawaii having a key

role, " Senator Inouye said.6 Senator Inouye sits on the

appropriations committee that funds the

CDC, and will likely play a large role in securing funds for an

agency under his jurisdiction to

start an outpost in the state he represents.

It appears Hawaii and its university may have benefited from Senator

Inouye's appropriations

committee seat in the past:

• The State of Hawaii received $432.7 million in earmarks in fiscal

year 2005, which

earned it the third-highest ranking in earmarks per capita.7

• In fiscal year 2005, the University of Hawaii was ranked eighth

among the top earmark

recipients in the entire nation, receiving $87.8 million from

congressional appropriators.8

• In 2003, the University of Hawaii-Manoa was ranked fourth among

the " Top Recipients

of Pork " because it received $30.6 million in earmarks from

congressional appropriators.9

In response to congressional inquiry, CDC reported that in grants

and contracts (not including

the vaccines for children program) the state of Hawaii received a

total of $22.2 million from the

CDC in 2006. This amount included $818,349 for infectious disease

and over $8 million for

terrorism preparedness and emergency response.10

UNIVERSITY DOESN'T TRACK EARMARKS … UNLESS THEY ARE BEING " CUT " :

On September 25, 2006, the University of Hawaii (the location for

the CDC's new office)

responded to a congressional inquiry requesting a detailed list of

and amount of federal

appropriations earmarked to the University since 2000.

The University wrote:

" We do not maintain a separate list of congressionally directed

appropriations [earmarks] at

the University of Hawaii. We do maintain a listing of all Federal

contracts and grants

received that includes congressionally directed appropriations and

competitively awarded

20

contracts and grants. However, we do not annotate whether the

contract or grant received

is a result of a congressionally directed appropriation or a

successful application to a

competitive solicitation " (emphasis added).11

Yet by March 5, 2007, (not even six months later) after Congress

passed the fiscal year 2007

funding bill largely without earmarks, the University of Hawaii's

main campus at Manoa

suddenly could track how many earmarks it received in fiscal year

2006 down to the exact dollar

amount and specific grant number.

The University was not tracking the earmarks to notify or even

update the inquiring oversight

committee in Congress, but to report on how much it stood to " lose "

in federal funding because

Congress funded the 2007 fiscal year under a continuing resolution.

The University claimed the

absence of earmarks in the continuing resolution equaled a " net

loss " of over $8 million for the

campus from 2006 to 2007 — though no explanation was given as to why

it assumed funds for

2006 earmarks would continue in 2007, when earmarks, by definition,

are line-items added to

one-year appropriations bills by Members of Congress.

Though the University told Congress in 2006 that it did not track

whether its grants or contracts

were received as earmarks, not only did the University of Hawaii at

Manoa report that it received

$9,241,171 in fiscal year 2006 earmarks, but it actually titled the

document

" CTAHR_Loss_of_Earmarks.pdf. " 12

POLITICIAN KNEW BEFORE INSTITUTE:

Raising additional questions about how and why CDC made its decision

to open a new Hawaiian

office, news reports indicate that those at the future home of the

CDC Hawaiian outpost first

learned a decision had been made through the press release of their

home-state Senator.

According to the Star Bulletin, " Dr. Duane Gubler, director of the

University of Hawaii's Asia-

Pacific Institute for Tropical Medicine and Infectious Diseases,

said he did not know of the

decision until he saw [senator Inouye's] news release. `I wasn't in

the loop in discussions with

the senator, so it caught me by surprise, but it's the kind of

surprise you'd like to receive,' he

said. " 13

CDC OFFICIAL SAYS IT'S HARD TO WORK WITH OTHER COUNTRIES " FROM

ATLANTA " :

BUT CDC SENT EMPLOYEES ABROAD UNDER SAME JUSTIFICATION:

Sage, CDC's portfolio management project director who

visited the Hawaii site, said

opening a Hawaii office would help the agency rapidly detect and

respond quickly to emerging

threats and would help CDC work more closely with other countries on

responding to

emergencies and building closer working relationships with

them. " That's hard to do from

Atlanta, " he said.14

Sage told The Honolulu Advisor that CDC representatives in Hawaii

could provide a front line

for the agency and travel to areas in Asia and the Pacific more

quickly than those coming from

the headquarters.15 This " front line " reportedly is going to start

with two CDC employees in

Hawaii, even though dozens of CDC employees are already stationed in

the countries and

regions Sage discussed. For example, CDC currently has officials

stationed in Asia and the

Pacific, many under this same front-line rationale. CDC also spends

$3 million a year in

21

taxpayer funds to lease a private jet for emergency travel, which

the agency reports has helped

get employees on location faster.16

In 2001, CDC told Congress that it had full- or part-time employees

stationed with outside

agencies in Asia and the Pacific, including in China, India,

Vietnam, Korea, the Philippines,

Thailand, Bangladesh, Cambodia, Indonesia, and Nepal.17

These " outside agency " CDC

employees join an unreported number of employees at official CDC

offices, which are located in

countries such as China.18

In response to congressional inquiry, to date CDC has not been able

to provide documentation

that describes a Hawaii office or any other office between mainland

U.S. and Asia as part of its

disease control and prevention planning. Nor has CDC been able to

provide any documentation

that such offices were included in or envisioned in any of the

agency's strategic plans.19 In

addition, a new office is not in the President's fiscal year 2007 or

2008 budget, though news

reports say the Hawaii office could open as early as the summer of

2007.

OFFICE INITIALLY MAY HOUSE STAFF OF TWO, BUT FUTURE EXPANSION EYED:

According to news reports, if a proposal to partner with the

University of Hawaii's medical

school is approved, the CDC will base a manager and medical

epidemiologist in Honolulu.

Reports also note the possibility of a future expansion of the

Hawaii office staff, including

relocating CDC training and technical personnel to the tropical

island.20

CDC's Sage told the Honolulu Advertiser, " CDC has never had a

similar partnership with a

university and it could serve as a model for others if successful. "

Once universities around the country (and their home-state

politicians) get word that the CDC

will set up outposts on college campuses, it is not hard to imagine

the outposts multiplying

exponentially, along with CDC's budget request and number of full-

time federal employees.

Simply locating offices at universities in the states of every

Member of the House and Senate

Appropriations Committee (the committee that oversees CDC's budget)

would fill the national

landscape with CDC outposts. If asserting a public health interest

is all that is needed to start a

CDC office a mile from Waikiki beach, taxpayers should bunker down

for big financial waves

on the horizon.

1 " CDC mulls opening Hawaii facility, " United Press International

(UPI), April 10, 2007.

2 Ibid.

3 Id.; " CDC eyes Hawaii as key defense for outbreaks: The federal

agency would partner with UH to create an early

warning system, " Star Bulletin, April 14, 2007.

4 Senator Inouye's press release, dated April 19, 2007,

http://www.inouye.senate.gov/, accessed April 2007.

5 Ibid.

6 Id.

7 Porkbusters' extrapolation of White House Office of Management and

Budget (OMB) list of 2005 appropriations

earmarks,

http://porkbusters.org/2007/04/omb_releases_earmark_data_fun.php#comm

ents, accessed April 2007;

http://www.whitehouse.gov/omb/earmarks/public-site-preview/by-

state/summary.html.

8 Ibid.

22

9 " Government & Politics: Top Recipients of Pork, " The Chronicle of

Higher Education, September 26, 2003.

10 " CDC Funds for State and Local Health Departments, Universities,

& Other Public and Private Agencies " Draft

FY2006, provided by HHS legislative to the Office of Senator Tom

Coburn, ranking member of the Federal

Financial Management Subcommittee.

11 Letter from University of Hawaii President McClain to

Senator Tom Coburn, Chairman of the

Subcommittee on Federal Financial Management, Government

Information, and International Security, dated

September 25, 2006, http://coburn.senate.gov/ffm/index.cfm?

FuseAction=Files.View & FileStore_id=3c5fba3f-26d9-

46ff-ab17-45b1c6224f74 in response to request from Senator Coburn

dated July 27, 2006,

http://coburn.senate.gov/ffm/index.cfm?

FuseAction=Files.View & FileStore_id=f3737254-4808-4d32-a4c3-

9c3e09c6ce9f.

12 " ative State Research, Education, and Extension Service

Comparison of Actual FY 2006 and Estimated FY

2007, " document posted on University of Hawaii at Manoa's website,

dated March 5, 2007,

http://www.ctahr.hawaii.edu/vincent/earmarks/CTAHR_Loss_of_Earmarks.p

df, accessed April 2007.

13 " CDC picks isles as epidemic outpost; The U.S. Centers for

Disease Control and Prevention will put Hawaii at the

forefront of a disease war, " Star Bulletin, April 20, 2007.

14 " CDC discusses Isle lab with UH med school, The Honolulu

Advertiser, April 10, 2007.

15 Ibid.

16 " Cabinet official is primary user of CDC jet, " The Atlanta

Journal-Constitution, June 16, 2006; " CDC Plane

Decreases Response Time, Increases Readiness, " CDC website document,

last modified June 14, 2006,

http://www.bt.cdc.gov/planning/cdc_plane.asp, accessed April 2007.

17 Letter from CDC Director Koplan, M.D., to Representative

Mark Souder, dated April 26, 2001, which lists

full- and part-time CDC employees stationed with " outside agencies "

in Asia and the Pacific.

18 " Most Chinese HIV-AIDS cases unaware of infection, " AFP wire in

Taipei Times, March 3, 2004.

19 Multiple e-mail and phone contacts between CDC legislative

affairs and the Office of Senator Tom Coburn, April

2007.

20Footnote 13, op. cit.

23

CDC TARGETS DISEASES … RESULTS STILL PENDING:

CDC Versus HIV/AIDS

$5 Billion over Seven Years in Prevention Funding

Includes International Junkets, Fraud, & " Widespread Deficiencies "

Human Immunodeficiency Virus (HIV) is a communicable infection that

causes the disease

Acquired Immune Deficiency Syndrome (AIDS), and one of the top-

funded diseases at CDC.

The agency will spend $837 million on domestic HIV/AIDS activities

in FY2007, according to

the HHS Budget Office.1 Each year CDC is given more than three-

quarters of a billion dollars to

fight and prevent HIV and AIDS in the U.S., and yet after spending

billions of dollars, CDC year

after year continues to report to Congress that an estimated 40,000

people are infected with HIV

annually.2 This number of new infections has remained unchanged for

12 years. Taxpayers are

justified in asking if infection rates are not changing, what has

this agency — tasked with the

nationwide prevention of HIV/AIDS — done with the $5 billion

domestic HIV/AIDS prevention

budget it has received and spent over the past seven years?3

The answer lies in a complicated morass of politics and missing

statistics, as well as a lack of

internal accountability and oversight procedures. Like few diseases,

HIV/AIDS funding levels

are highly politicized, with attempts to modify funding or even

question grant expenditures being

met with extremely heavy resistance and frequent ad hominem attacks

on the questioner (one

AIDS activist called those attempting to do oversight on prevention

funding " right-wing

jihadists " ).4 Even standard oversight practices, such as auditing

grantees' financial records,

expected practice in other industries, are met among HIV/AIDS

grantees with public relations

campaigns and cries to the media of partisan attacks.5

Every year CDC presents its budget request to the congressional

appropriations committee, and

every year, the witnesses testify that HIV/AIDS is a horrible, yet

mostly preventable, disease

plaguing our nation. The agency and the administration then request

additional or level funding

for domestic prevention efforts. Past financial irregularities and

lack of measurably successful

outcomes (such as a reduced rate of infections) do not appear to

affect the funding level, or

politicians' eagerness to direct funds toward fighting the disease.

This environment helps to

continue the cycle of what some call AIDS " exceptionalism " and the

creation of an " AIDS

industry " that has grown up around and makes a living off government

funding.6

Inspector General and budget reports have questioned how CDC spends

its HIV/AIDS funding,

whether the agency was measuring success as reducing the rate of

HIV/AIDS, or whether

" success " to the CDC meant merely detailing how the agency spent all

the funds it received from

the taxpayers. Recently the agency has begun to reform by announcing

goals and performance

measures to account for the billions of dollars appropriated.

Congress has responded to the lack

of statistics by requiring that by 2011, states report the disease's

case numbers in a uniform

manner. Meanwhile, the CDC's latest request for HIV/AIDS domestic

prevention funding is an

increase over its previous year funding.

24

$5 BILLION OVER SEVEN YEARS IN CDC PREVENTION FUNDING:

In FY2007, federal government spending on HIV/AIDS is estimated to

be $23.3 billion,

including $15.4 billion on treatment and $2.7 billion on prevention.7

Approximately 93 percent of FY2007 HHS discretionary funding for

HIV/AIDS is allocated to

three HHS agencies: CDC, which supports HIV/AIDS prevention

programs; the National

Institutes of Health (NIH), which supports HIV/AIDS research; and

the Health Resources and

Services Administration (HRSA), which administers the White

CARE Act, an HIV/AIDS

care, services, and treatment program.8

In FY2007, HIV/AIDS programs within HHS account for 71 percent of

federal HIV/AIDS

spending, a total of $16.5 billion for both discretionary and

entitlement programs. Within the

HHS discretionary budget, funding for HIV/AIDS research, prevention,

and treatment programs

has increased from $200,000 in FY1981 to an estimated $6.2 billion

in FY2007.9

CDC will be spending $837 million on HIV/AIDS activities in FY2007,

according to the HHS

Budget Office.10 (Note: This total includes the following accounts

not included in Figure 2

below: Infectious Diseases Control, Chronic Disease Prevention,

Health Promotion, and

Genomics, and Birth Defects, Developmental Disabilities, Disability

and Health.)

The $837 million figure does not include the almost $123 million

that comes to CDC as part of

the Global AIDS Program.11 Nor does the total, it is worth

repeating, include the $815 million it

has already received from the Department of State's Office of the

Global AIDS Coordinator

(OGAC) nor any additional funds in FY07.12 CDC does not " count "

these hundreds of millions

of dollars from OGAC when releasing its budget, which has the

potential to mislead researchers

and taxpayers alike when they try to determine how much money CDC

has been allocated to

fight HIV/AIDS. " 13

Figure 2. CDC's Domestic HIV/AIDS Funding by Fiscal Year14

0

100

200

300

400

500

600

700

800

900

1000

FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08

Dollars in Millions

Fiscal Year

Appropriations

Administrative Costs

Assumed Administrative Costs

FY08 Budget Request

25

CHANGE IN BUDGET CALCULATIONS COMPLICATES YEAR-TO-YEAR COMPARISONS:

In fiscal year 2004, CDC adjusted its budget calculation process; no

longer listing administrative

and management costs for HIV/AIDS in the HIV/AIDS budget. Instead,

those costs now are

counted elsewhere, thus complicating subsequent year-to-year

HIV/AIDS budget comparisons.

The Congressional Research Service reported CDC's administrative and

management costs for

HIV/AIDS in FY04 and FY05, based on CDC's unpublished, internal

calculations.

Subsequently, CDC stopped calculating and providing such figures and

thus FY06-FY08

administrative and management costs are unavailable.15 For Figure 2

above, it is assumed that

administrative costs for the CDC's HIV/AIDS programs have remained

constant since FY05.

Figure 3. HHS Discretionary Funding for HIV/AIDS16

0

750

1500

2250

3000

3750

4500

5250

6000

FY81

FY83

FY85

FY87

FY89

FY91

FY93

FY95

FY97

FY99

FY01

FY03

FY05

FY07

Dollars in Millions

Appropriated Funds

CDC SETS AND MISSES 5-YEAR GOAL TO CUT HIV IN HALF:

In January 2001, the CDC announced its " three-part plan to cut

annual HIV infections in the

United States in half within five years. " The agency sought to

reduce by half the number of

Americans who contract HIV each year, from 40,000 people to 20,000

people.17 In 2006, CDC

testified before Congress that there are still an estimated 40,000

people a year infected with

HIV.18 In other words, the CDC goal has not yet been met; in fact

the number of new infections

has remained unchanged, despite billions in domestic expenditures.

CDC STILL DOES NOT KNOW HOW MANY AMERICANS HAVE HIV:

Though the CDC is able to come up with statistics on how many

Americans are bitten by dogs

each year (4.7 million), it cannot report how many Americans

currently are living with HIV.19

According to the CDC, approximately 40,000 new people in the United

States become infected

26

with HIV each year.20 That estimate has been repeated in CDC

statistics since 1995, regardless

of federal HIV spending.21

Year after year, CDC releases volumes of data on HIV and AIDS,

including estimated rates of

infection for certain areas and states and rates of infection among

racial and gender subgroups,

but nowhere in these reports does CDC release the numbers of

Americans infected with virus

that causes AIDS.

In June 1988, a Presidential Commission on the HIV epidemic reported

to President

Reagan that CDC was an " obstacle to progress " in HIV. The Commission

noted a " Lack of

strong CDC leadership in the public health community for obtaining

and coordinating HIV

infection data. " 22

The 1988 Commission recommended that every " reasonable effort " be

made to increase the

precision of the HIV prevalence and infection rate. Despite years of

CDC funding to fight HIV,

the Commission wrote that " As of March 1988, CDC acknowledged that a

precise statement of

the prevalence and rate of spread of HIV infection in the general

population is still not

available. " And yet, almost 20 years later, CDC still does not have

an actual count of Americans

living with HIV, and still relies on an estimate for the number of

new annual infections.

In 2005, at a national HIV prevention conference, CDC released two

possible estimates for

calculating HIV and AIDS cases from two years earlier. One of the

estimates calculated that " at

the end of 2003 an estimated 1,039,000 to 1,185,000 persons in the

United States were living

with HIV/AIDS, with 24-27% undiagnosed and unaware of their HIV

infection. Of these,

417,000 persons were living with HIV (not AIDS), 415,000 were living

with AIDS, and

252,000-312,000 were undiagnosed. " 23 This estimate is frequently

used by HIV/AIDS groups

and it has been repeated by CDC in congressional testimony.

AFTER 20 YEARS OF FUNDING, NO UNIFORM STATE REPORTING OF HIV CASES:

The CDC does not know how many Americans have HIV because despite

over 20 years of

federal funding to support states' efforts to track the disease,

there currently is not a uniform,

nationwide reporting system for HIV cases. This has been due, in

part, to the fact that some

states adopted different reporting protocols for HIV rather than

following long-standing

protocols for reporting cases of communicable disease.

In 1998, 20 states and the District of Columbia had their own coded

system for recording

confirmed HIV cases using, for example, patients' initials, or

social security numbers to create a

coded record.24 Reportedly these code-based systems were adopted

under the political pressure

of AIDS activists who claimed that due to the stigma surrounding

HIV/AIDS in the early years

of the disease, there was a fear that name-based reporting would

discourage HIV testing.25

Instead of trying to require confidential, name-based reporting for

HIV cases, CDC actually

opposed congressional legislation to implement it nationwide.

Despite the fact that since the

1980s, all states have reported AIDS cases to the CDC under a

confidential, name-based

reporting protocol, in 1998, Helene Gayle, Director of the CDC's

National Center for HIV, STD,

and TB Prevention, testified before Congress that proposed

legislation requiring name-based

reporting for HIV cases " would not add further public health

benefit. " She testified that the

27

legislation " departs from the CDC Guidelines and science-based

public health practice by

mandating reporting of all HIV-positive tests, by client name,

without any provision to support

the continuation of anonymous testing. " When Gayle was asked how

many states had reported

breaches of confidentiality in name-based testing, she admitted that

none had reported any

breaches.26

At the same time the agency was testifying against more accurate,

name-based reporting

methods, CDC itself would not count HIV reports from states if they

did not come in following

confidential, name-based reporting protocols. The agency left the

coded reports out of its

statistics due to concerns there was double counting of HIV patients

and the fact that the

different codes could not be reconciled with the name-based

reporting system.27

Before the reauthorization of the White Care Act in 2000, HRSA

distributed funding to

states through a formula using CDC data on AIDS cases in each state,

because every state used a

names-based system for AIDS reporting, unlike HIV reporting. This

had the effect of some

areas getting more HIV/AIDS funding even though their AIDS patients

may have already died,

while areas with high numbers of HIV cases which had not progressed

to AIDS in large

numbers, were not receiving adequate treatment funds for their

patients due to the funding

calculations. In 2000, Congress required that HIV data (from names-

based reporting states only)

be included for fiscal year 2007 White funding allocations.

This deadline was delayed for

some states with certain circumstances.

As of December 2005, only 37 states reported their HIV/AIDS cases in

a names-based reporting

system which was tallied by CDC.28 Thirteen states, the District of

Columbia, and Puerto Rico

used a coded system and these 15 jurisdictions, according to one

report, might have accounted

for almost one-third of all AIDS cases in 2002 (28.7 percent).29 In

other words, the CDC was

collecting records but not counting perhaps one third of all

Americans with HIV/AIDS due to

how the data were being reported.

In December 2005, CDC sent a letter to governors of all the non-

names-based reporting states

warning, " Data from non-name-based systems cannot be included in the

counts for the [

White HIV/AIDS federal funding] formulas. Therefore, states that use

non-name-based systems

are at risk for losing federal dollars. "

JUST AN EDUCATED GUESS ON NUMBERS FOR FIVE MORE YEARS:

Starting in 2011, the White HIV/AIDS Treatment Modernization

Act of 2006 conditions

federal HIV/AIDS funds on states having name-based reporting of

HIV/AIDS cases, not codebased

systems.30 Facing the loss of millions of dollars, most

jurisdictions reportedly will work to

switch their systems, though such a switch will be costly and time-

consuming.31

States have slowly come into compliance with HIV reporting protocols

and as of December

2006, 51 areas (46 states and five territories) were conducting HIV

surveillance using

confidential, name-based methods.32

According to the Associated Press, " The names of people infected

with HIV will be tracked in

all 50 states by the end of 2007. " Illinois switched to names-based

reporting in 2006,

Massachusetts switched in January 2007 and the remaining three

states: Vermont, land and

28

Hawaii, are quickly moving toward adopting names-based surveillance.

That more than $1.4

billion will be distributed in 2007 based on the names-based funding

formula is credited with the

switch of the final hold-out states.33

Despite the CDC's yearly budget of over $800 million to track and

prevent the spread of HIV in

the U.S., until the states and territories all report uniformly,

there will only be estimates of how

many Americans live with HIV. The most recent estimate currently

available is for three years

ago, and that estimate varies by 150,000 people, or more than 10

percent of the cases.

HISTORICAL ESTIMATES FOR U.S. HIV INFECTIONS:

In response to congressional inquiry, CDC released a graph which

shows the estimated HIV

infection prevalence. HIV prevalence includes all people with HIV

infection who are alive at a

given point in time, whether or not they have progressed to AIDS. In

addition to the estimated

new HIV transmissions each year, newer drug therapies are helping

people with HIV and AIDS

to live longer, a fact which contributes to some of the increases

shown.

FIGURE 4. PEOPLE IN THE U.S. LIVING WITH HIV/AIDS

34

29

FIGURE 5. PEOPLE IN THE U.S. LIVING WITH HIV/AIDS & YEARLY NEW HIV

CASES

35

Figure 5 was included in the CDC's 2006 testimony before Congress.

The light blue

line shows the estimated incidence rate, which is how many new

people each year are

estimated to have contracted HIV. According to the CDC's testimony,

an estimated

40,000 people contract the disease each year, a statistic that has

held steady since

1995.

30

FIGURE 6. 480,000 NEW HIV INFECTIONS IN 12 YEARS

According to unpublished CDC data, the HIV/AIDS prevalence in 1995

was estimated to be

903,265 cases. This means that according to CDC estimates, in 1995,

over nine-hundred

thousand people in the U.S. had HIV, whether or not the virus had

progressed to AIDS.36 In

2006, CDC testified before Congress that each year an estimated

40,000 new people are infected

with HIV in the U.S.37

The flat HIV incidence line in Figure 5 may be read by the casual

observer as if the infection rate

is holding steady and therefore is under control. But in actuality,

it is an inexcusable failure that

despite billions of dollars in CDC HIV prevention efforts, each year

an estimated 40,000 new

people in the U.S. contract HIV, a communicable and preventable

disease. 38 The full impact of

40,000 new infections each year is more clearly evident in Figure 6,

which demonstrates the

cumulative effect of 40,000 new HIV infections each and every year.

This is not an epidemic

that has " stabilized, " as some have suggested, but rather an

epidemic that continues to spread

unabated.39

Using CDC statistics, over the 12 years shown, an estimated 480,000

people in the United States

contracted HIV. Figure 6 does not purport to show how many people

were living with an HIV

infection that had not progressed to AIDS, because CDC does not have

those numbers or

historical estimates and it is possible that some of the 40,000

newly infected people each year

progressed to AIDS and died and or died of some other cause.

Currently, CDC can only provide

a one year 2003 estimate of those with only HIV (as discussed

above), or a historical estimate

that combines HIV and AIDS cases (HIV prevalence shown in Figures 4

and 5).

31

CDC'S GLOBAL AIDS FUNDING:

In FY2000, for the first time, Congress provided $34.8 million for

CDC's Global AIDS Program

(GAP), and an additional $11.9 million for global HIV prevention and

research through the

FY2000 emergency supplemental appropriations. In FY2001, Congress

appropriated $104.5

million to CDC's GAP (of which $3 million was committed to Health

Resources and Services

Administration's (HRSA) International Training and Education Center

on HIV). In FY2002,

funding increased again to $143.7 million. Congress provided about

the same level of funding in

FY2003: $142.6 million for GAP and an additional $40 million for the

Prevention of Mother-to-

Child HIV Transmission (PMTCT) Initiative. Funding for GAP remained

about the same in

FY2004; when it received $142.7 million and an additional $149.1

million for the PMTCT

Initiative.40

These funding figures are in addition to global HIV/AIDS funding

transferred from OGAC and

totaling over $2 billion in the past four years: FY2004: $230.6

million, FY2005: $439.6 million,

FY2006 $578.2 million, and FY2007: $815 million so far (a figure

that is likely to increase,

according to the CDC).41

HIV/AIDS PREVENTION EQUALS INTERNATIONAL TRIPS, FRAUD, & " WIDESPREAD

DEFICIENCIES "

The topics summarized below each appear in further detail in

subsequent sections of this report:

Taxpayer-Funded " Prevention " Activities (see pages 42-47):

CDC has used its prevention funds to support HIV/AIDS organizations,

some of which have

very targeted HIV/AIDS prevention missions. Reports indicate some of

these groups have

used taxpayer HIV/AIDS prevention dollars to hold transgender beauty

contests, zoo trips,

and classes where men are taught how to flirt and write erotically,

among other activities.

Conference Talk Isn't Cheap:

In response to congressional inquiry, HHS reported that from FY2000

through FY2005, the

CDC spent a total of $44.7 million on conferences, which includes

its HIV/AIDS conference

costs.42 CDC has spent millions on conferences, sending more than

500 CDC employees to

international HIV/AIDS conferences, including 157 employees to

Vancouver, 90 to

Barcelona and 20 to Thailand (down from the 48 originally scheduled

to attend).

Conference Circuit (see pages 48-60):

Recent HIV/AIDS conferences supported by and attended by the CDC,

its employees, and its

grantees have been described as " boisterous political circuses " for

the AIDS industry, and

those in it that make a living off HIV and AIDS.43 Some examples of

CDC attended and

funded conferences include:

• A 2002 Barcelona conference that cost U.S. taxpayers $3.6 million

(in HHS costs alone,

not including expenditures by USAID and the State Department), where

the U.S.

Secretary of HHS was shouted down by protestors during his speech.

Also in the

32

audience were 236 HHS attendees, including 90 CDC attendees, though

the Vatican,

which through its Catholic facilities runs 26 percent of all AIDS

treatment centers in the

world and treats one-in-every-four AIDS patients, was not invited to

attend.44

• A 2003 CDC-funded conference in New Orleans featuring a sexually

graphic

" entertainment " segment about the Vice President of the United

States and a workshop

on how to defund abstinence education.45 Taxpayers paid at least

$300,000 for this

prevention conference and the HIV/AIDS prevention group hosting the

conference, the

National Minority AIDS Council (NMAC), received $4.7 million in

federal funds the

same year as the conference. 46

• A 2004 Thailand conference attended by 17,000 delegates included

more than 130 U.S.

federal employees, 20 of whom were CDC employees (not including

employees stationed

in Asia).47 The event also featured Brazilian dresses made of

condoms, a drag show, art

shows, and fashion parades.

• A 2006 Toronto conference, attended by 26,000 people, including 78

HHS employees (of

whom many were CDC employees), which cost U.S. taxpayers $315,000.48

The

conference included presentations from researchers who said

countries must recognize

prostitution as " legitimate legal work. " 49 One convention center

exhibit featured three

prostitutes lying on a satin-covered bed, which was designed

to " look like a typical

workplace. " 50 One prostitute from Thailand was described

as " standing amid pillows and

sex toys in the [conference's Stiletto] Lounge. To cheers from a

crowd of around 200

people, she demanded health insurance, paid vacation and job

security. " 51 The

conference also featured a workshop on finding a woman's erotic

zone, one on how to

apply condoms through " sex stunts, " and a display of explicit

artwork, all of which were

described as " hugely popular " at the 16th International AIDS

Conference.52

• A fall 2006 conference in Hollywood, Florida, drew 3,500 people,

of whom 92 were

federal employees, including 67 from the CDC. The HIV/AIDS

prevention conference

cost U.S. taxpayers over $410,000 and, among other things, included

a session on

lobbying, a Latin Fiesta featuring a " sizzling fashion show, " and a

beach party that

included a 15-foot-high sand sculpture of the CDC-funded sponsor's

logo.53 The

executive director of the conference's sponsor, NMAC (a group that

in 2004 received

$3.9 million in government funds and spent $1.4 million on

conferences and $1 million

on consultants), questioned the government's commitment to HIV/AIDS

funding.54

Funds for Three International Trips to Talk About HIV Could Have

Spared 150,000

Infants From HIV (see pages 50, 52, and 54):

If the funds CDC spent to register 20 employees for a Thailand

conference and to send 90

employees to a Barcelona conference to talk about HIV/AIDS, had

instead been used to

buy and administer Nevirapine (a retroviral drug that costs less

than $4 a dose and has

proven to prevent HIV transmission from mother to child with the

administration of just

two doses), more than 115,000 infants around the world could have

been spared from

HIV infection. This does not count the more than 40,000 infants that

could have avoided

HIV infection if HHS had not sent 78 employees (including an

undetermined number of

CDC employees) to Toronto to talk about HIV/AIDS at a cost to the

federal taxpayers of

33

over $300,000. For the cost of these three international conferences

alone, more than

150,000 newborns could have been treated with Nevirapine and

prevented from

contracting HIV.

UNAIDS estimates that 1,800 children worldwide become infected with

HIV each day,

the vast majority of whom are newborns.55 UNAIDS estimates that in

2005, just less

than eight percent of pregnant women in low- and middle-income

countries had access to

services that could prevent the transmission of HIV to their

babies.56

Inspector General Uncovers Significant Problems Among $2.6 Billion

HIV/AIDS

Prevention Grants (see pages 38-40):

CDC's HIV/AIDS prevention grants were found to have " widespread

deficiencies "

during fiscal years 1999 through 2003 — during which time more than

$2.6 billion was

awarded by CDC for state and local HIV/AIDS grants. These findings,

contained in a

September 2005 HHS Inspector General (IG) report, show a pattern of

mismanagement, a

lack of oversight, and in one documented example, a willingness of a

CDC employee to

make up grantee accomplishments simply to keep his projects

running.57 According to

the IG report, " Awards for 14 of the 15 grants lacked clear,

specific objectives providing

a basis for assessing grantees' accomplishments, and, in fact, 2 of

those 14 grants

contained no objectives at all. "

IG Finds HIV/AIDS Grantees Misuse CDC Funds, Including to Lobby (see

pages 84-86):

The HHS IG found a possible misuse of federal HIV/AIDS funds in its

audit of the CDCfunded

Multicultural AIDS Center (MAC) of Boston, Massachusetts. Over the

course of

two years, MAC received $948,000 from the CDC: $408,000 during 2001

and $180,000

during 2002 from CDC via the Commonwealth of Massachusetts

Department of Public

Health's HIV/AIDS Prevention & Education ative Agreement, and

$360,000 in

fiscal year 2002 from the CDC under the Community Coalition

Development (CCD)

Project.58

According to the IG audit released in January 2003, " two MAC

employees, whose

salaries were paid with CDC funds, appeared to be involved in

lobbying activities — an

unallowable charge under federal regulations. …t is possible that

a portion of the

[FY02] total charges of $360,000 to the CDC's Community Coalition

Development

Project may have supported unallowable lobbying activities... " The

misused CDC funds

had been inteded " to sustain, improve, and expand HIV prevention

services for

racial/ethnic minority populations. " 59

Another IG investigation involved the Washington, D.C.-based

National Latina/o

Lesbian, Gay, Bisexual and Transgender Organization (LLEGO), which

was awarded a

five-year CDC HIV/AIDS education grant, including a first-year 2004

grant of $1.15

million. In August 2004, five months after it received its federal

grant, LLEGO closed its

doors and filed for Chapter 7 bankruptcy after drawing down $989,255

of its CDC

funds.60 The federal government is seeking to reclaim more than

$700,000 from LLEGO

in bankruptcy court, though it has so far been an unsuccessful

effort.61

34

The HHS Inspector General determined LLEGO had incurred $703,181

in " unallowable

costs, " instead of on the promised HIV/AIDS education

efforts. " LLEGO engaged in

activities not covered by CDC's program announcement, including

lobbying, fundraising

and advocating on behalf of gay issues, " the report concluded.62

Funds Go Out, But Results Unknown (see page 41):

Despite spending billions of dollars, the CDC HIV/AIDS prevention

programs have been

rated as " not performing " and having not demonstrated results,

according to the Office of

Management and Budget's (OMB) program assessment.63 This rating

indicates that a

program has not been able to develop goals or collect data to

determine whether it is

working. 64 The OMB report noted that CDC's HIV/AIDS program " does

not have

incentives and procedures to make gains more broadly or ways of

measuring annual

improvements. "

1 " AIDS Funding for Federal Government Programs: FY1981-FY2008, "

Congressional Research Service (CRS),

updated March 8, 2007. See Appendix for additional information.

2 " A Glance at the HIV/AIDS Epidemic, " CDC, January 2007,

http://www.cdc.gov/hiv/resources/factsheets/At-AGlance.

htm#3; " Domestic HIV/AIDS Surveillance: Current Trends and Status of

HIV Reporting, " testimony of

S. Janssen, M.D., CDC's Director, Divisions of HIV/AIDS

Prevention National Center for HIV, STD, and

TB Prevention, Coordinating Center for Infectious Diseases, before

the Senate Homeland Security and

Governmental Affairs Subcommittee on Federal Financial Management,

Government Information, and International

Security, June 23, 2005,

http://hsgac.senate.gov/_files/CDCHIVAIDStestimonyFINAL.pdf; " The

HIV/AIDS

Epidemic: 20 Years in the U.S, "

http://www.whitehouse.gov/onap/facts.html citing CDC AIDS statistics

through

June 2000, http://www.cdc.gov/hiv/stats/hasr1201.htm.

3 " AIDS Funding for Federal Government Programs: FY1981-FY2007, CRS,

updated April 18, 2006,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf; CDC FY08 Budget

Justification,

http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf; See Appendix for

further detail.

4 " U.S. Warns AIDS Group on Funding; CDC Cites S.F. Programs

That `Appear to Encourage' Sex, " Washington

Post, June 14, 2003.

5 " Bush Administration Policies on Sex Education, Funding for AIDS

Groups `Hampering' Anti-AIDS Efforts,

Organizations Say, " Kaiser Daily HIV/AIDS Report, October 1, 2002;

Daily HIV/AIDS Report, August 20, 2002;

Inside the Beltway, The Washington Times, December 13, 2002.

6 " Have We Treated AIDS Too Well? Rationing and the Future of AIDS

Exceptionalism, " by J. Casarett,

MD, MA, and D. Lantos, MD, ls of Internal Medicine, 1 May

1998, Volume 128, Issue 9,

http://www.annals.org/cgi/content/full/128/9/756; " World spends too

much in the fight against Aids, " The Financial

Times, August 14, 2006, http://www.ft.com/cms/s/c2fb7574-2bbd-11db-

a7e1-0000779e2340.html, accessed

November 2006.

7 " AIDS Funding for Federal Government Programs: FY1981-FY2008, "

CRS, updated March 8, 2007,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf.

8 Ibid.

9 Id.

10 Id.

11 " Trends in U.S. Global AIDS Spending: FY2000-FY2007, " CRS,

December 26, 2006, RL33771.

12 E-mail correspondence between CDC Program Analyst and the office

of Senator Tom Coburn, May 2, 2007.

13 " FY2006 CDC/ATSDR Functional Table Financial Management Office, "

January 26, 2006,

http://www.cdc.gov/fmo/PDFs/FY06FundFunctAreaTable.pdf; HHS Fiscal

Year 2008 Justification of Estimates for

Appropriation Committees

http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf.

14 Figure 2 is calculated using unpublished and published data from

CDC regarding CDC HIV/AIDS prevention, in

addition to " AIDS Funding for Federal Government Programs: FY1981-

FY2007, " Congressional Research Service

(CRS), updated April 18, 2006,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf; " AIDS Funding for

Federal

35

Government Programs: FY1981-FY2008, " CRS, Updated March 8, 2007,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf; HHS Fiscal Year

2008, Centers for Disease Control and

Prevention, Justification of Estimates for Appropriation Committees,

page 103,

http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf, accessed February

2007; " Trends in U.S. Global AIDS

Spending: FY2000-FY2007, " CRS, updated December 26, 2006; and e-mail

correspondence and phone

communication with CRS analysts, February-March 2007. The totals

shown include CDC-wide domestic

HIV/AIDS funding, which consists of the following: HIV, Viral

Hepatitis, STD, and TB Prevention funding (State

and Local Health Departments, Directly Funded Community, National,

Regional and Other Organizations, and CDC

Research, Surveillance Analysis, Technical Assistance, and Program

Support) and administrative and management

costs. The totals do not include CDC's HIV/AIDS funding through

Infectious Diseases Control funding; Chronic

Disease Prevention, Health Promotion, and Genomics funding; Birth

Defects, Developmental Disabilities, Disability

and Health funding, which are calculated under a different

accounting method in recent years and therefore cannot

reliably be compared year to year. The totals also do not include

funds from the Global AIDS program, either

directly from Congress or indirectly through the Office of the

Global AIDS Coordinator (OGAC). The FY07 figure

is from " FY2007 Joint Resolution [CDC] Detail Table, "

http://www.cdc.gov/fmo/PDFs/FY_2007_JR_Detail_Table.pdf, accessed

May 2007. (See Appendix for further

detail on FY01-08 funding).

15 " AIDS Funding for Federal Government Programs: FY1981-FY2007, "

CRS, updated April 18, 2006,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf, HIV/AIDS

expenditures " have been comparably adjusted

downward to reflect the new budget structure at CDC that excludes

administrative and management costs. The

FY2004 adjustment was about $68 million, and the FY2005 adjustment

was about $74 million; " HHS Fiscal Year

2008, Centers for Disease Control and Prevention, Justification of

Estimates for Appropriation Committees, page

103, http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf, accessed

February 2007.

16 " AIDS Funding for Federal Government Programs: FY1981-FY2008, "

Table 2. HHS Discretionary Funding for

HIV/AIDS, CRS, updated March 8, 2007,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf. (Note: these figures

do

not include over $2 billion in funds for Global AIDS that were

transferred from the OGAC.) The FY07 figure is

based on the Continuing Resolution level prior to passage of

H.J.Res. 20 (Public Law 110-5), which was $6,236.93

million plus $45 million in additional HIV funds received by CDC in

Public Law 110-5 ($6281.93 million total).

The FY07 figure does not contain an additional $75 million for HRSA

White funding.

17 " CDC Aims to Cut New AIDS Infections In Half by Shifting

Prevention Strategy, " Wall Street Journal, February

7, 2001, http://www.aegis.com/news/wsj/2001/WJ010204.html, accessed

November 2006.

18 Footnote 2, Dr. Janssen's testimony, op. cit.

19 " National Dog Bite Prevention Week, " CDC website,

http://www.cdc.gov/ncipc/duip/biteprevention.htm,

accessed February 2007.

20 Supra footnote 2, Dr. Janssen's testimony.

21 Ibid, see Figure 1 of testimony.

22 Executive Summary of the " Report of the Presidential Commission

on the Human Immunodeficiency Virus

Epidemic Submitted to the President of the United States, " June 24,

1988.

23 " Basic Statistics, " CDC, October 16, 2006,

http://www.cdc.gov/hiv/topics/surveillance/basic.htm#hivest, quoting

" Estimated HIV prevalence in the United States at the end of 2003.

National HIV Prevention Conference; June

2005; Atlanta, Abstract T1-B1101, " Glynn M, P.,

http://www.aegis.com/conferences/NHIVPC/2005/T1-

B1101.html, accessed November 2006.

24 Background briefing document prepared for the House Subcommittee

on Health and Environment of the

Committee on Commerce hearing on the HIV Partner Protection Act

(H.R. 4431), September 29, 1998.

25 See " Open Letter to Public Health Officials Regarding Names-Based

HIV Reporting, " February 1999,

http://www.glaa.org/archive/1999/namesletter0221.shtml, accessed

February 2007.

26 CDC testimony before the House Subcommittee on Health and

Environment of the Committee on Commerce

hearing on the HIV Partner Protection Act (H.R. 4431), September 29,

1998.

27 Information from CDC Policy Analyst's phone conversation with

Office of Senator Coburn, January 23, 2007.

28 " Senator Feinstein Calls on CDC To Accept California's HIV Data, "

press release dated May 7, 2004,

http://feinstein.senate.gov/04Releases/r-cdc-hiv.htm, accessed

November 2006.

29 Ibid. As of December 31, 2002, 10 areas (California, Hawaii,

Illinois, Kentucky, land, Massachusetts, Rhode

Island, Vermont, the District of Columbia, and Puerto Rico) had

implemented a code-based system to conduct case

surveillance for HIV infection. Other areas (Delaware, Maine,

Montana, Oregon, and Washington) had implemented

a name-to-code system for conducting HIV infection surveillance:

initially, names were collected and, after any

necessary public health follow-up, names were converted to codes.

Connecticut allowed cases of HIV infection in

adults and adolescents to be reported by name or code; New Hampshire

allowed HIV cases to be reported with or

36

without a name. Data on cases of HIV infection from these areas were

not included in the 2002 HIV data tables,

according to CDC's HIV/AIDS Surveillance Report 2002,

http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2002repo

rt/technicalnotes.htm.

30 Committee Report Number 109-695, accompanying the White

HIV/AIDS Treatment Modernization Act of

2006.

31 Ibid.; Letter from State of California's Health and Human

Services Agency Department of Health Services to

health and HIV/AIDS officers, dated August 15, 2006,

http://www.dhs.ca.gov/AIDS/HIVReporting/pdf/LTR_Guidance_to_LHJs_08-

14-06%20signed.pdf, accessed March

2007.

32 CDC FY08 Budget Justification,

http://www.cdc.gov/fmo/PDFs/FY08_CDC_CJ_Final.pdf.

33 " HIV Patient Names To Be Tracked Across U.S.: Illinois Switched

To Names-Based Reporting In 2006, "

Associated Press, March 30, 2007.

34 CDC graph provided to the office of Senator Tom Coburn, February

2007.

35 Supra footnote 2, graph in Dr. Janssen's testimony.

36 Figure provided upon request to the office of Senator Tom Coburn

by CDC legislative affairs in e-mail

correspondence dated February 13, 2007. The number corresponds with

the HIV prevalence line for 1995 in Figures

4 and 5. According to the CDC, this figure is an estimated

number " within a range " and is not a " true case coun[t].

There is a 95% chance that the actual count is within the range

(i.e., 95% confidence interval). "

37 Supra footnote 2, Dr. Janssen's testimony.

38 Ibid.

39The CDC website states, " In the United States, the annual number

of new HIV infections has decreased from a

peak of more than 150,000 in the mid-1980s and has stabilized since

the late 1990s at approximately 40,000. "

http://www.cdc.gov/hiv/topics/aa/cdc.htm, page last reviewed March

09, 2007.

40 " Trends in U.S. Global AIDS Spending: FY2000-FY2007, " CRS,

December 26, 2006,

http://www.congress.gov/erp/rl/pdf/RL33771.pdf.

41 Footnote 12, op. cit.

42 October 4, 2005 letter from HHS to Senator Coburn, signed by

Assistant Secretary , CDC

" Conference Support Expenditures/Projections by OPDIV/STAFFDIV, "

FY2000: $8,558,352; FY01: $6,982,795;

FY02: $7,642,681; FY03: $6,926,825; FY04: $7,056,486; FY05

Projections: $7,577,478; for a total of $44,744,647

(Note: CDC Off Center includes later conferences not reflected in

these totals).

43 " A Political Circus Is Part of the AIDS Meeting, " op-ed, The New

York Times, July 20, 2004.

44 " AIDS Conference Excludes Vatican, " ZENIT News Agency, July 11,

2002, www.zenit.org.

45 " 'Bush bashing' spoils AIDS conference, " The Washington Times,

October 7, 2003,

http://www.washingtontimes.com/national/20031006-101719-6969r.htm.

46 Ibid.

47 " Scientists rip US for cutbacks to global AIDS summit, " NATURE

MEDICINE, July 2004.

48 May 16, 2006 letter to Rep. Garrett (R-NJ) from HHS, signed

by Steiger, Special Assistant for the

Secretary of International Affairs.

49 " Legalizing sex trade key to cutting HIV, activists tell AIDS

conference, " The Canadian Press, August 17, 2006.

50 Ibid.; " Sex workers march for rights at AIDS conference, " Reuters

Health, August 16, 2006; " Sex workers are

part of the solution " workshop,

http://www.aids2006.org/PAG/PSession.aspx?s=961, accessed January

2007.

51 Ibid., Reuters.

52 " Sex sells AIDS prevention message at conference, " Agence France

Presse, August 15, 2006; " Where is the

Pleasure in Safer Sex? " workshop,

http://www.aids2006.org/PAG/PSession.aspx?s=815, accessed January

2007.

53 " US Conference on AIDS, " Housing Works AIDS Issues Update,

September 29, 2006,

http://www.hwadvocacy.com/update/archives/2006/09/us_conference_o.htm

l, accessed October 2006; October 2006

HHS response to an inquiry from Senator Tom Coburn's office

reporting that: 5 employees from HRSA, 14

employees from SAMHSA, 67 employees from the CDC, 5 employees from

NIH, and one NIH contractor were

scheduled to attend and that HRSA spent $5,827 and CDC spent

$405,000 on the conference; NMAC website,

http://www.nmac.org/conferences___trainings/usca/agenda/3893.cfm,

accessed October 2006; and e-mailed reports

from attendees sent to Senator Tom Coburn's office.

54 2004 National Minority AIDS Council IRS form 990,

http://www.guidestar.org/FinDocuments/2004/521/578/2004-521578289-

021e9463-9.pdf, Note: the form does not

distinguish between federal, state, or local government

funding; " AIDS activists urge more funds for treatment, "

South Florida Sun-Sentinel, September 23, 2006.

55 " 2006 Report on the Global AIDS Epidemic, " UNAIDS,

http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp,

accessed November 2006.

37

56 Ibid.

57 " Management of HIV/AIDS Prevention Grants by the Centers for

Disease Control and Prevention, " HHS

Inspector General (IG), September 2005, A-04-03-08011,

http://www.oig.hhs.gov/oas/reports/region4/40308011.pdf.

58 " Audit of HIV/AIDS Activities at the Multicultural AIDS Coalition

for the Period July 1, 2000 through

September 30, 2002, " HHS IG, A-01-02-01503, "

http://oig.hhs.gov/oas/reports/region1/10201503.pdf.

59 CDC's " Final FY 2004 GPRA Annual Performance Plan, Congressional

Justification Submission, " February

2003, http://www.cdc.gov/od/perfplan/2003/2003perf.pdf

60 " Review of grants issued to the National Latina/o Lesbian, Gay,

Bisexual, and Transgender Organization, " HHS

IG, June 2006, A-03-05-00351,

http://oig.hhs.gov/oas/reports/region3/30500351.pdf.

61 Ibid.; E-mail correspondence from CDC Policy Analyst to office of

Senator Tom Coburn dated February 5, 2007.

62 " Gay Latino group asked to repay federal grants, " McClatchy

Newspapers, October 8, 2006,

http://www.azcentral.com/news/articles/1008gay-latino-

group1008.html, accessed November 2006.

63 OMB Program Assessment, Domestic HIV/AIDS Prevention,

http://www.whitehouse.gov/omb/expectmore/summary.10000254.2005.html.

64 Expectmore.gov.

38

Some of CDC's $2.6 Billion in HIV/AIDS Prevention Grants

Have No Objectives, Are " Abysmal, " and Have Significant

Problems … But Are Funded Anyway

CDC's HIV/AIDS prevention grants were found to have " widespread

deficiencies " during fiscal

years 1999 through 2003 — during which time more than $2.6 billion

was awarded by CDC for

state and local HIV/AIDS grants. These findings, contained in a

September 2005 HHS Inspector

General (IG) report, show a pattern of mismanagement, a lack of

oversight, and in one

documented example, a willingness of a CDC employee to make up

grantee accomplishments

simply to keep his projects running.1 This IG report shows a

disturbing trend that for years and

years, once grantees were in the HIV/AIDS grant system, they had

access to a never-ending pool

of taxpayer dollars, regardless of their performance.

NO OBJECTIVES NEEDED TO WIN SOME CDC HIV/AIDS GRANTS:

According to the IG report, " Awards for 14 of the 15 grants

[reviewed] lacked clear, specific

objectives providing a basis for assessing grantees'

accomplishments, and, in fact, 2 of those 14

grants contained no objectives at all.

" …The objective of one grant, for example, was to evaluate the

effectiveness of other grants and

to `provide evaluation resources' to assist other grantees in

measuring their own effectiveness.

However, the grantee could not develop an evaluation protocol

acceptable to CDC during the 3-

year grant period and was unable to perform an intended study, even

though it expended all grant

funds. A grantee official stated that the organization never

understood what CDC wanted it to

do. "

NO ACCOMPLISHMENTS NEEDED TO WIN ADDITIONAL FUNDS:

Of the 15 grants audited by the IG, the CDC awarded continuation

grants to 13 organizations,

even though they had reported few or no accomplishments or had

failed to submit required

accomplishment reports.

" CDC awarded continuation grants to all of the 13 organizations with

multiyear projects even

though the grantees had reported little in the way of actual

accomplishments or had failed to

report their accomplishments on a timely basis, " the IG found.

In some instances, the IG's office observed, and CDC project

officers confirmed, that " awards

were based on the available funding levels rather than on a

realistic determination of the amount

actually needed to carry out specific functions. When an existing

grantee failed to reapply for

continuation funds, for example, the previously earmarked funds were

simply reallocated among

the remaining grantees regardless of specific needs " (emphasis

added).

One project officer " termed a grantee's performance `abysmal' but

told us that he had been

instructed not to restrict funding on any grants, " according to the

IG report.

39

NO BACKGROUND CHECK PERFORMED FOR CDC GRANTEES:

Despite regulations requiring audits, the IG noted, " Files for 11 of

the 15 grants did not contain

an audit report for any of the 5 years in our audit period, or any

evidence that the reports had

been obtained, and none of the files contained audit reports for

every year. Further, 14 of the 15

grant files had no evidence that CDC personnel had queried databases

that catalogued previous

grant awards to identify grantees that had been debarred or placed

on special restrictions because

of significant operational problems. The 15th file indicated that

CDC staff checked the databases

for 1 of the 5 years but contained no evidence that they analyzed

the data.

" If CDC personnel had reviewed A-133 audit reports … they would have

noted that 8 of the 15

grantees were in weak financial positions or had significant

management and/or operating

deficiencies. " 2

CDC CITES SIGNIFICANT PROBLEMS BUT RENEWS GRANTS ANYWAY:

The IG report notes, " The grant files showed that technical

reviewers had noted significant

deficiencies in 10 of the 13 organizations applying for continuation

grants, but CDC did not

require corrective action as a condition of the awards. The files

contained no evidence that CDC

personnel asked 5 of the 10 grantees to provide additional

information in response to the noted

deficiencies. Further, although grant files contained no evidence of

any response from four of

the five organizations that had been requested to provide additional

information, CDC took no

additional action. "

ACCOMPLISHMENTS DOCTORED BY CDC STAFF:

One project manager interviewed by the IG's auditors was found to

have " consistently overstated

grantees' accomplishments " and " acknowledged that he had done so

because he had no choice

but to characterize his grantees' accomplishments as at least

acceptable to keep his project

going. "

In another example, a project office told the auditors " that he

believed he had to prepare

technical reports praising grantees to maintain their funding and

acknowledged that he had

prepared inaccurate and unsupported reports. "

DESPITE $74 MILLION SPENT ON ADMINISTRATIVE COSTS, CDC CLAIMS LACK OF

RESOURCES TO MONITOR GRANTS:

The CDC, in response to the IG's report cited above, admitted " an

overarching need to better

monitor grants and to better comply with grant administration

requirements ... At the same time,

CDC recognizes that competing priorities and restricted resources

hamper the ongoing ability to

better document all aspects of grant administration. " 3

The year CDC cited restricted resources as a reason it was hampered

in watching over grantees,

it is estimated the HIV/AIDS prevention administration and

management budget was $74

million, or 9.4 percent of CDC's HIV/AIDS domestic budget.4

40

NEVER TOO LATE TO START MONITORING PERFORMANCE:

In the summer of 2001, President W. Bush's Administration

launched the President's

Management Agenda, which requires agencies to work to improve

government performance. In

response to this, and a full twenty years after the federal

government started funding HIV/AIDS

programs, " CDC began in 2002 to identify high-quality outcome

measures to more accurately

monitor the performance of programs. CDC began including performance

measures into all new

grants and cooperative agreements as a term and condition of the

award … In addition, grantees

are now required to address progress toward achieving the measurable

outcomes of the

performance goals … and discuss measures of effectiveness in

progress reports " (emphasis

added).5

1 All references in this section are from this Inspector General

(IG) Report (unless otherwise noted): " Management

of HIV/AIDS Prevention Grants by the Centers for Disease Control and

Prevention, " HHS IG, September 2005, A-

04-03-08011, http://www.oig.hhs.gov/oas/reports/region4/40308011.pdf.

2 OMB Circular A-133 contains information on Audits of States, Local

Governments, and Non-Profit Organizations.

3 Letter to Deputy Inspector General for Audit Services from CDC's

Chief Operating Officer, dated May 12, 2005,

as contained in Appendix to IG report,

http://www.oig.hhs.gov/oas/reports/region4/40308011.pdf.

4 " AIDS Funding for Federal Government Programs: FY1981-FY2007, "

CRS, updated April 18, 2006,

http://www.congress.gov/erp/rl/pdf/RL30731.pdf.

5 Footnote 3, op. cit.

41

CDC's Domestic HIV/AIDS Program: Results Not Demonstrated

Despite spending billions of dollars over the past decade, the CDC

HIV/AIDS programs —

intended to prevent HIV infection and reduce the incidence of HIV-

related illness through

research, surveillance and grants for HIV/AIDS prevention

activities — have been rated as " not

performing " and having not demonstrated results, according to the

Office of Management and

Budget's (OMB) program assessment.1

An OMB rating of " Results Not Demonstrated " indicates that a program

has not been able to

develop acceptable performance goals or collect data to determine

whether it is performing. 2

The OMB review reported that initially the domestic HIV/AIDS

program " made progress on

reducing new infections from 120,000 in the late 1980's to 40,000 in

the mid-1990's, but this

level has not changed for several years. …The program has taken

steps to improve the efficiency

of Federal operations, but does not have incentives and procedures

to make gains more broadly

or ways of measuring annual improvements " (emphasis added).3

CDC TRACKS THE MONEY, JUST NOT THE RESULTS OR COST EFFECTIVENESS

The following are the results of the OMB assessment of CDC's HIV

prevention program4:

Budget Review Question:

• Is the program budget aligned with the program goals in such a way

that the impact of

funding, policy, and legislative changes on performance is readily

known?

Answer:

• No. CDC's budget is currently aligned for financial accounting

purposes, not for

measuring performance.

Budget Review Question:

• Does the program demonstrate improved efficiencies and cost

effectiveness in achieving

program goals each year?

Answer:

• No. There are no measures of efficiency nor cost-effectiveness for

this program. CDC's

new initiative, " Advancing HIV Prevention: Strategies for a Changing

Epidemic, " has the

potential to improve agency efficiency in meeting the program goals.

Taxpayers have a right to expect that an agency spending billions on

preventing diseases should in

fact be tracking whether or not those diseases are being prevented,

should be demanding results

and efficiency from its grantees, and should be eliminating non-

performing grantees from future

eligibility for grants. While CDC currently is trying to reformulate

its process in light of OMB's

failing assessment, the fact that there was not a system in place

for monitoring performance —

after more than two decades and billions of dollars in HIV/AIDS

spending — is unconscionable.

1 OMB Program Assessment, Domestic HIV/AIDS Prevention,

http://www.whitehouse.gov/omb/expectmore/summary.10000254.2005.html,

http://www.whitehouse.gov/omb/expectmore/detail.10000254.2005.html

2 Expectmore.gov.

3 Footnote 1, op. cit.

4 Ibid.

42

CDC-Funded Events Feature Porn Stars & Prostitute Tips,

Transgender Beauty Contests, and Flirting Classes

HIV is a deadly, communicable disease, with known transmission

methods and identifiable highrisk

populations. Yet, since 1995, CDC reports that every year an

estimated 40,000 Americans

are infected with HIV. Taxpayers may question whether or not CDC's

decision to award

prevention grants to certain groups may in fact be to blame for some

of these new infections that

could have — and should have — been prevented.

Instead of focusing efforts on partner-notification, risk avoidance,

early diagnosis through

routine testing, and other proven epidemiological approaches for

preventing the spread of

communicable diseases, all too often many of CDC's largest grantees

were hosting events that

produced questionable, if any, results and in some cases promoted

activities in direct

contradiction with known risk-behaviors for spreading the disease.

One of CDC's largest HIV/AIDS grantees was cited for actually using

CDC prevention funds to

encourage sexual behavior. CDC guidelines for AIDS assistance

programs direct that no funds

are to " be used to provide education or information designed to

promote or encourage, directly,

homosexual or heterosexual sexual activity or intravenous substance

abuse. " 1 They further note

that this shall " not be construed to restrict the ability of an

education program to provide accurate

information about … [AIDS], provided that any informational

materials used are not obscene. " 2

After years of congressional inquiry, CDC finally sent a warning

letter to the offending group

whose activities were encouraging sexual behavior.

RELATIONS WITH MALE PROSTITUTES:

On April 10, 2003, the CDC-funded Stop AIDS Project of San

Francisco, California hosted an

event regarding " Men for Hire. " The featured speaker was ph

Itiel, who, it was advertised,

" presents practical tips and covers the seven guidelines for safe

and friendly relations with

escorts. " 3 Mr. Itiel had authored a number of books, including A

Consumer's Guide to Male

Hustlers (which purports to " acquaint readers who have a vigorous

sexual appetite with a

resource " ) and Sex Workers As Virtual Boyfriends. Shortly after the

event, he released Escort

Tales: The Trophy Boy and Other Stories.4

Mr. Itiel told one newspaper that his workshop was an appropriate

prevention tool. " Stop AIDS

gives options to people where safe sex is discussed and I did

discuss safe sex at length. …My

subject was singled out because the powers that be don't view

prostitution in a positive light. "

According to the Bay Area Reporter, Mr. Itiel argues sleeping with a

sex worker is a way to

engage in safe sex, " If you pick up a sex worker, you have complete

control of the situation. …

If you go to a sex club, you can have sex with say 10 people who had

sex with another 10

people. If you go to a sex worker, you couldn't afford to see

someone 10 times a day. Plus, he

has less sex and is exposed to fewer diseases, logically. " 5

43

FLIRTING 101:

On February 10, 2004, the CDC-funded Stop AIDS Project of San

Francisco hosted a two-hour

workshop that was advertised as instructing participants how " to

flirt with greater finesse. " The

event was entitled " Got Love? #2 - Flirt / Date / Score. " 6

ZOO TRIPS FOR HIV POSITIVE PEOPLE:

In April 2002, the CDC-funded Stop AIDS Project of San Francisco

hosted a zoo trip as part of

its HIV prevention program for those who are already infected with

HIV. According to the

CDC, zoo trips and other social outings are important to prevention

efforts because it helps to

create a " social network " or " peer group " to " influence positive

behaviors, " which CDC

described as reinforcing and promoting " safe sex norms. " 7 The CDC

reported a total of 27

people participated in the zoo trip. The costs included

transportation and staff time and the

passes were provided by the zoo.

EROTIC WRITING CLASSES:

In April 2003, the CDC-funded Stop AIDS Project of San Francisco

hosted a four-part " erotic

writing workshop " where participants were to " Start by exploring

your fantasies and get support

for you [sic] creative writing process. " 8

AUDIT FINDS GROUP'S ACTIVITIES ENCOURAGE SEXUAL ACTIVITY AND ARE

OBSCENE … YET

CDC CONTINUED TO FUND GROUP:

In response to congressional inquiry, it was reported that in 2000,

the Stop AIDS Project of San

Francisco received $698,000 in federal funds, including CDC HIV

prevention grants and that

these funds were used to fund the activities listed above.9

In 2001, HHS's Inspector General (IG) noted that two other CDC-

funded STOP AIDS Project

HIV prevention workshops, entitled " Booty Call " and " Great

Sex, " " could be viewed as

`encourag[ing], directly … sexual activity' in violation of CDC's

guidance … and as `obscene,'

and thus not in compliance with CDC guidance. " 10

Despite the IG's 2001 findings, the CDC-funded organization

advertised the next year for

another " Booty Call " workshop, which again provoked congressional

inquiries, and subsequently

was cancelled on the day of the event. The organization said the

event was cancelled for low

turnout.11

The IG followed up with the STOP AIDS Project and, according to a

2003 letter to the House

Subcommittee on Criminal Justice, Drug Policy and Human Resources,

the CDC claimed that

" the design and delivery of STOP AIDS prevention activities was

based on current accepted

behavioral science theories in the areas of health promotion. " 12

44

CDC AUDITOR WOULD INVITE MOM TO GRAPHIC WORKSHOPS:

One CDC auditor who was in California to review the STOP AIDS

workshops, such as " Booty

Call " and " Men for Hire, " is reported to have told another CDC

employee, " I would take my

mother to this. " 13

CDC WARNS GROUP, YET FEDERAL FUNDS STILL FLOW:

Despite some CDC employees' comfort with the federally funded

workshops, in June of 2003,

CDC Director Dr. Gerberding wrote to San Francisco-based STOP

AIDS Project that some

of the group's HIV prevention workshops violate the ban on

encouraging sexual activity and

asked the group to discontinue the workshops. 14 According to news

reports, she threatened to

revoke as much as $500,000 in federal grants if the group failed to

comply.15

STOP AIDS Project's spokesperson told one newspaper that she

was " shocked " by the CDC

letter and the director of the San Francisco health department said

that he supports the workshops

and would use city funds to supplement the Stop AIDS Project budget

if the group lost federal

funds. " We in San Francisco believe that to reach the men who have

sex with men who are at

highest risk of HIV transmission, we need to speak the same language

they do, and we need to

have workshops that draw them in. " 16

One local AIDS activist questioned this rationale. " Stop AIDS

Project claims that they can only

reach at risk gay men by putting on provocative programs like Booty

Call, " said AIDS activist

Petrelis of San Francisco. " By their own admission, this

program has a low turn out as

those they are trying to reach have either been turned off or tuned

out their provocative

workshops. And while Stop AIDS Project is wasting and misusing

federal HIV resources, the

City's HIV rate is soaring to the highest levels in 20 years,

according to the SF [san Francisco]

health department. " 17

Another AIDS activist seems to imply that no amount of government

oversight is reasonable

when it comes to CDC prevention funding: " The message you send not

just to STOP AIDS

Project, but to thousands of grass-roots prevention groups across

the country, is that a group of

right-wing jihadists with political power will be looking over their

shoulders as they attempt to

meet the prevention needs of their communities, " Terje ,

executive director of the

National Association of People with AIDS, wrote to CDC Director

L. Gerberding.18 At the

time of his " jihadists " comment, 's group, the National

Association of People with

AIDS, was the recipient of $1.4 million in federal grant funds (much

of it likely from CDC), and

it continued to receive over $1.3 million a year for the next two

fiscal years.19

PORN STARS HEADLINE CDC-FUNDED SAFE-SEX EVENT:

In July 2002, a CDC-funded group in Missouri called Blacks Assisting

Blacks Against AIDS

(BABAA) hired Memphis gay porn star Edgar Gaines, whose movie name

is Bobby Blake, to

attend a " safe-sex " event at the BABAA's Executive Director's

downtown loft. Gains was paid

$500 from a syphilis elimination grant.20 The porn star appeared at

the event in a towel and

cowboy boots.21 After an investigation, the money was subsequently

reimbursed to the CDC and

45

the group fired the two people in charge. " We felt that even with

[Gaines] being at the event with

just a towel and boots on was totally inappropriate and something we

don't condone, " said

Donnell , a lawyer and vice chairman of the group's board.22

The event also prompted the St. Louis Health Department to cancel

the remaining $6,000 of its

$96,000 syphilis prevention grant to Blacks Assisting Blacks Against

AIDS, according to a news

report. The grant reportedly was the smaller of two grants BABAA

received through the city

from the CDC. In 2002, it was reported that BABAA received a total

of approximately $1.6

million in government assistance.23

According to one news report, the St. Louis City auditors' report

noted the AIDS group bought

$14,487 in equipment without following federal bidding rules and

billed one of its grants $3,642

more for salaries than it actually paid employees. The chairman of

BABAA's board told a

newspaper the group hoped to win back the syphilis grant and would

continue serving AIDS

patients.24

CDC-FUNDED DRAG CONTEST:

25

On May 12, 2001, the Mr./Ms. UTOPIA pageant entitled " Jewel of the

Pacific " was held at the

Southeast Community College Auditorium. U.T.O.P.I.A is The United

Territories of Polynesian

Islanders' Alliance, a 501©(3) located in San Francisco,

California. The organization was

formed " to provide support to the Polynesian Gay, Lesbian, Bisexual,

and Transgender

community. " 26 A flyer for the event notes " funding by the Centers

for Disease Control and

Prevention " and " Partial funding by Centers for Disease Control and

Prevention through Asian

& Pacific Islander Wellness Center. " According to a person answering

the phone number listed

on the flyer, the event was primarily a transgendered contest,

although anyone was welcome to

enter.27 HIV testing was advertised as being available on-site at

the event.

The Asian & Pacific Islander Wellness Center, the group noted in the

flyer as passing CDC

funding through to the pageant, has a mission " to educate, support,

empower and advocate for

Asian and Pacific Islander [A & PI] communities — particularly A & PIs

living with, or at-risk for,

HIV/AIDS. " In 2001, the Center's revenue was almost $3 million. In

2003, according to its

website, its revenue was a little less than in 2001, but still near

$3 million. While federal funding

figures are unavailable for 2001, the group reports the federal

government provided 38 percent of

their 2003 budget, which would equal approximately a million

dollars. In 2005, the federal

government's portion grew to 49 percent of its $3.366 million

budget, or over $1.6 million.28

46

According to CDC data, Asian-Americans have one of the lowest HIV

and AIDS rates in the

United States. " At the end of 2004, an estimated 212,572 persons

were known to be living with

HIV (not AIDS) in the 35 areas with confidential name-based HIV

infection reporting since

2000: 49% were black, 34% white, 15% Hispanic, and 1% each were

American Indian/Alaska

Native and Asian/Pacific Islander. At the end of 2004, approximately

415,193 persons in the

United States were living with AIDS: 43% were black, 35% white, 20%

Hispanic, and [less

than] 1% each were American Indian/Alaska Native and Asian/Pacific

Islander " (emphasis

added). 29

Despite receiving millions of dollars from the federal government in

the past few years,

according to the Asian & Pacific Islander Wellness Center's website,

in the last 17 years the

organization only has " served over 600 HIV-positive A & PIs. " 30

1 " Interim Revision of Requirements for Content of AIDS-Related

Written Materials, Pictorials, Audiovisuals,

Questionnaires, Survey Instruments, and Educational Sessions Used in

Centers for Disease Control and Prevention

Assistance Programs, " Federal Register, June 15, 1992.

2 Ibid.

3 Stop AIDS website, http://www.stopaids.org/;

http://www.stopaids.org/mod.php?

mod=calendar & op=show_event & event_id=391, accessed April 2003.

4 Amazon.com, http://www.amazon.com/s/ref=nb_ss_gw/104-2691215-

9413507?url=searchalias%

3Dstripbooks & field-keywords=ph+Itiel+ & Go.x=12 & Go.y=11 & Go=Go,

accessed October 2006.

5 " Stop AIDS on defensive again, " Bay Area Reporter, June 19, 2003.

6 STOP AIDS website,

http://www.stopaids.org/programs/events/index.html, accessed

February 2004.

7According to CDC officials on a conference call with the House

Government Reform Committee in response to

congressional inquiries, April 19, 2002.

8 STOP AIDS website, http://www.stopaids.org/, accessed April 2003.

9 " Federal Funding of San Francisco Stop AIDS Project, " Memorandum

from HHS Inspector General Janet

Rehnquist to Secretary Tommy , October 12, 2001. SAP was

awarded " almost $698,000 in Calendar

Year 2000 to provide outreach services, develop and hold workshops,

and train members of the community as

workshop providers… We thus believe that CDC funding was used to

support all Project activities. "

10 Letter from HHS Inspector General Janet Rehnquist to HHS

Secretary Tommy , entitled " Federal

Funding of San Francisco Stop AIDS Project – INFORMATION, " dated

October 12, 2001, Note: brackets in

original letter.

11 " CDC to SF AIDS group: Cancel `Booty Call' event, " blog posting

by Petrelis, April 26, 2002,

http://www.indybay.org/newsitems/2002/04/26/1250021.php, accessed

October 2006.

12 February 2003 letter from the CDC, signed by CDC director Dr.

Gerberding, as quoted in " CDC Asks Stop

AIDS Project To Discontinue `Controversial' HIV Prevention

Programs, " Kaiser Daily HIV/AIDS Report, June 16,

2003.

13 " Science Gets Sacked, " The Nation, September 1, 2003.

14 " AIDS program could lose funding over explicit material, " USA

Today, June 16, 2003.

15 " U.S. Warns AIDS Group on Funding; CDC Cites S.F. Programs

That `Appear to Encourage' Sex, " Washington

Post, June 14, 2003.

16 Ibid; AP/Philadelphia Inquirer, June 16, 2003, as reported in

Kaiser Daily HIV/AIDS Report, June 16, 2003.

17 Footnote 11, op. cit.

18 Footnote 15, op. cit.

19According to fedspending.org, the National Association of People

with AIDS received the following amounts in

federal grants: FY03: $1,158,927; FY04: $1,363,236; and FY05:

$1,315,114,

http://www.fedspending.org/faads/faads.php? & recipient_name=National%

20Association%20of%20People%20with

%

20AIDS & record_num=f500 & detail=0 & datype=T & reptype=r & database=faads & sor

tby=f.

20 " Two who hired porn star are fired, " St. Louis Post-Dispatch,

November 6, 2002.

47

21 Ibid.

22 Id.; Note: the group has since changed its name to Regional

Education Advocacy Coalition on HIV/AIDS

(REACH) according to " AIDS Group May Go Under, Says Audit; Agency's

Budget Might Plummet with Cuts in

Grants, " St. Louis Post-Dispatch, March 18, 2004.

23 " Auditors Finds More Problems with AIDS Agency that Used Federal

Funds to Hire Porn Star, " St. Louis Post-

Dispatch, January 28, 2003.

24 Ibid.

25 2001 Mr./Ms. UTOPIA pageant photos on UTOPIA website,

http://www.polyutopia.com/, accessed November

2006.

26 UTOPIA website, http://www.polyutopia.com, accessed November 2006.

27 E-mail report from House Subcommittee on Criminal Justice, Drug

Policy and Human Resources staffer, dated

May 7, 2003.

28 The Asian & Pacific Islander Wellness Center website,

http://apiwellness.org/financial_account.html, accessed

November 2006.

29 CDC's 2004 HIV/AIDS Surveillance Report

http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006supp

_vol12no1/commentary.htm;

http://www.cdc.gov/hiv/topics/surveillance/basic.htm#aidsrace;

http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006supp

_vol12no1/table9.htm.

30 The Asian & Pacific Islander Wellness Center website, updated in

2006, http://apiwellness.org/livhiv.html,

accessed November 2006.

48

CDC-Funded Conferences

Was $45 million spent on conferences the best use of taxpayer funds?1

Though professional conferences are essential in many fields, CDC-

funded conferences appear to

have evolved into an industry unto themselves that year after year

meets — often in the warmer

climates during the colder months — to decry the lack of spending in

their particular field. Even

conference participants acknowledge that their colleagues travel

from conference to conference

essentially talking to each other and fighting each other over the

pot of federal funding.2 It seems

little time is spent reflecting on what could be done on the ground

to actually fight HIV, for example,

if taxpayer funds were not spent on transcontinental flights, hotel

accommodations, and large

registration fees to attend conference after conference.

In response to congressional inquiry, HHS reported that from FY2000

through FY2005, the CDC

spent $44.7 million on conferences.3 Taxpayers have a right to ask

if the CDC spending $45

million on conferences in just six years alone was the best use of

taxpayer funds.

The following is just a sample of some of the conferences CDC funded:

YOUTH CONFERENCE FEATURING ABORTION GROUPS, MTV, AND LOBBYING:

The CDC was listed as a platinum sponsor for a June 1-4, 2004,

Global Health Council youth

conference in Washington, D.C., that was to feature International

Planned Parenthood (IPPF),

the United Nations Population Fund (UNFPA), MoveOn.org, and MTV, as

well as an " advocacy

day " on Capitol Hill.4

The event entitled " Youth and Health: Generation on the Edge "

featured the head of the UNFPA

as a keynote speaker. UNFPA lost U.S. federal funding for violating

U.S. law through its

support of and involvement in China's coercive one-child policy. 5

In one undercover

investigation, a UNFPA representative in China was found to share an

office with the Chinese

official responsible for enforcing the one-child policy — an

official who carried out his work

through coercive and forced abortion and sterilization.6 UNFPA has

been unapologetic about its

work in China and it started a grassroots effort in response to the

loss of U.S. funding. The

CDC-funded youth conference was not only honoring the UNFPA head

with a spot as a featured

speaker, but it actually scheduled a conference session so the UNFPA

could share how it was

mobilizing its supporters to donate more money in response to the

loss of U.S. federal funds.

The CDC-sponsored conference also featured an IPPF speaker who

helped develop a " youth

manifesto " with a goal that " society must recognise the right of all

young people to enjoy sex

and to express their sexuality in the way that they choose " and

that " sexual and reproductive

health services for young people must be confidential. " 7 This

terminology is frequently used by

IPPF and others in the industry to oppose parental notice and

consent efforts regarding

contraception and abortion for minors. IPPF is one of the largest

abortion-performing

organizations in the world, and its director-general was quoted as

saying abortion is a " human

right " that her group would not sign away.8

49

After congressional backlash, HHS, CDC, and USAID pulled their

collective $365,000 in

financial support for the conference, which according to HHS

spokesman Bill Pierce was due to

a law prohibiting federal dollars to be spent on lobbying. He said

the group's plans to hold an

" advocacy day " on Capitol Hill would have violated that law.9

DRUG LEGALIZATION CONFERENCE:

HHS and CDC sponsored an August 19-20, 2005, Utah conference hosted

by the Harm

Reduction Project and the Harm Reduction Coalition — organizations

that support tacit

legalization of drugs, including methamphetamine. Several sessions

planned for the conference

appear to promote illegal drug use and risky sexual behavior such

as, " We Don't Need a `War'

on Methamphetamine, " and " You Don't Have to Be Clean & Sober. Or

Even Want to Be! " 10

The CDC sent six employees to the conference and $13,500 in CDC

funds were used to support

the conference.11 According to the CDC Director, proper protocols

were not followed regarding

the CDC grantee getting the required CDC approval for expenditure of

federal funds.12

According to a press release, the Deputy General Counsel of the

Oklahoma State Bureau of

Narcotics and Dangerous Drugs Control canceled his participation in

the conference when he

learned about its " disturbing content [and t]he Oklahoma State

Bureau of Narcotics and

Dangerous Drugs Control conveyed to Dr. Coburn's office their

frustration about being

misinformed by conference organizers. " 13

One of the presenters had earlier been quoted as saying, " For a lot

of people, meth use is a rite of

passage and it really does increase sexual pleasure. " He also

criticized current so-called safer

sex messages promoting condom use every time as no longer effective

and instead encouraged

" harm reduction techniques " during risky sexual behavior.14

MILLIONS SPENT ON AIDS CONFERENCES:

Atlanta 2001: In the spring of 2001, the CDC's HIV/AIDS prevention

director notified

community-based HIV/AIDS organizations that they could use federal

funds to attend an

upcoming conference entitled " Capacity building for HIV Prevention "

in Atlanta, Georgia.

Specifically CDC noted, " Your cooperative agreement funds may be

used to support travel,

lodging, per diem expenses, and registration fees for your

attendance at this meeting " which was

to help enhance their skills in the areas of organizational and

infrastructure development;

intervention design, implementation and evaluation, community

mobilization, and HIV

prevention community planning participation. One of the skills for

these grantees: learning to

dance. The preliminary agenda for Wednesday, April 4, 2001, included

instruction on the skills

of " Cultural Dance — Latin Dance " with a " Disco to follow. "

Hundreds of CDC employees travel to talk:

In response to congressional inquiry, CDC reported the following

number of CDC employees

attending international AIDS conferences:15

• 1992/Amsterdam: 43

• 1993/Berlin: 50

50

• 1994/Yokohama, Japan: 30 (estimate)

• 1996/Vancouver: 157

• 1998/Geneva: 80

• 2000/Durban: 68

• 2002/Barcelona: 90

• 2004/Thailand: 20

• 2006/Toronto: 78 HHS employees (includes CDC employees)

16

Barcelona conference attendee protests

U.S. treatment of people with AIDS

Barcelona 2002: The 14th International Conference on AIDS held in

Barcelona, Spain, in July

2002 hosted 236 HHS attendees, including 90 CDC attendees, and cost

taxpayers $3.6 million in

federal funds. In response to congressional inquiry, HHS reported

travel costs made up over $1

million of the total cost to taxpayers.17 The CDC alone, it was

reported, spent $908,866 on travel

to this conference.18 HHS Secretary Tommy flew to Barcelona

to deliver an address

on HIV/AIDS on behalf of the U.S. (which gives more money to fight

the disease than any

nation in the world), but was " shouted down " by protestors and was

unable to be heard.

Despite the fact that 26 percent of all AIDS treatment centers in

the world are Catholic facilities,

and that the Catholic Church looks after one-in-every-four AIDS

patients, the conference held in

Barcelona, Spain, excluded the Vatican.19

CDC Trip Funds Could Have Spared More Than 113,000 Newborns from HIV

If the funds CDC spent on travel to send 90 employees to Barcelona

to talk about

HIV/AIDS instead had been spent on Nevirapine (a retroviral drug

that costs less

than $4 a dose and has proven to prevent HIV transmission from

mother to child

with the administration of just two doses), more than 113,000

infants around the

world could have been treated and spared from HIV infection.

51

UNAIDS estimates that 1,800 children worldwide become infected with

HIV each day, the vast

majority of whom are newborns.20

UNAIDS estimates that in 2005, just less than 8 percent of

pregnant women in low- and middle-income countries had access to

services that could prevent

the transmission of HIV to their babies.21

New Orleans 2003: On September 18-21, 2003, the CDC-funded National

Minority AIDS

Council (NMAC) sponsored a 2,800-person AIDS conference in New

Orleans featuring an

entertainer who, in a skit described by attending AIDS activists

as " extremely graphic, " boasted

that she had sexual relations with Vice President Dick Cheney.

Carole Bernard, director of

communications for NMAC, said the song was well-received, " the

feedback that we have gotten

is that they loved her song. People cheered and applauded. " 22

According to news reports, the conference received at least $300,000

in funding from several

HHS agencies (including CDC and the Health Resources and Services

Administration (HRSA)),

while the U.S. Agency for International Development (USAID) and the

U.S. Department for

Housing and Urban Development (HUD) also were listed on the

conference program as

" government partners. " The conference also featured a workshop

entitled " Abstinence-Based vs.

Comprehensive Sexuality Education, " where a presenter " provided a

blueprint to get abstinence

education defunded and out of schools, " according to one attendee.23

A separate workshop

presenter argued that abstinence education is politically motivated

and " harmful " to children.24

In 2003, NMAC received $4.7 million a year in federal funds. 25

Thailand 2004: The 15th International AIDS Conference in Bangkok,

Thailand, drew more than

17,000 delegates and according to one report, " Science took a back

seat to the concurrent

sessions on social, economic, legal, policy making and other aspects

of AIDS. Three elephants

depicted on the conference logo became an unintentional symbol of

the boisterous political

circuses that AIDS conferences have become. " 26 Another report

said, " What began in 1985 as an

annual gathering of scientists, aimed at sharing laboratory findings

and information from the

battlefronts in the war on H.I.V., has been transformed into a

meeting of 17,000 consultants,

bureaucrats and activists fighting one another for money to build a

huge global AIDS treatment

program, employing tens of thousands of people. " 27

The event also featured, " Brazilian dresses made of condoms [and] a

drag show from Indonesia

… [along with] dozens of other cultural performances, art shows,

fashion parades and films from

around the world [that] will be featured at the international AIDS

conference this month in

Bangkok to break the monotony of scientific sessions, " according to

event organizers.28

In response to congressional inquiry, federal agencies reported that

more than 130 federal

employees, including 20 CDC employees, attended the event. This

number does not include

employees stationed in Asia.29 The CDC originally, and in violation

of HHS restrictions,

planned to send 48 employees.30

The registration fee was between $800 and $1,250 per person, which

amounted to between

$16,000 to $25,000 in registration fees alone for non-Asia-based CDC

employees, not counting

travel expenses and hotel costs. 31 If the originally planned 48 CDC

employees had attended,

registration costs would have totaled between $38,400 and $60,000.

52

The U.S. Ambassador on AIDS said of the Thailand conference, " You

really need to say was the

value that was generated by this kind of a conference worth that

kind of money or could part of

that money be spent more efficiently in some other directions in

order to fight HIV/AIDS.

…There is a kind of an industry that's developed of people who spend

their time talking to each

other … I think we need to evaluate … that the value that is

generated by the cost of bringing

them here, is something that's justified as opposed to putting that

money in other parts of our

HIV efforts. " 32

One report said, " The sound bites from last week's AIDS conference

in Bangkok were straight

out of a movie. " 33 AIDS activists denounced the Bush

Administration and

abstinence-until-marriage education. " The United States contributes

more money for AIDS than

any other country. Yet participants in Bangkok still harshly

criticized the Bush administration

for doing too little, emphasizing a policy of abstinence and

severely restricting the number of

government scientists allowed to attend the conference. " 34

Philadelphia 2004: In March 2004, a CDC-sponsored STD Prevention

Conference in

Philadelphia included a 200-person, anti-abstinence education

protest organized by, among other

groups, Housing Works, a New York-based group that received more

than $1.9 million in

funding from the Department HUD in 1999 and 2000.35 The same week

the protesting grantees

gathered, the House Government Reform Committee voted to reduce the

CDC's event and

conference funding by $7 million calling the events " luxuries " and

saying past conferences have

been " noted for ... political, rather than public health content. " 36

A CDC spokesman said, " The

protest ... took place outside of the venue and it occurred after

the session had ended, " adding

that the conference provided a forum for scientists to share " new

information about advances in

STD prevention. " 37

CDC Trip Funds Could Have Spared Thousands of Newborns from HIV

Just using the CDC employees' Thailand conference registration fees,

between 2,000 to 3,125 infants around the world could have been

treated

with two doses of Nevirapine (a retroviral drug that costs less than

$4 a dose

and has proven to prevent HIV transmission from mother to child with

the

administration of just two doses) and spared from HIV infection.

53

Toronto 2006:

Laxmi Narayan Tripathi, a transvestite from India, looks at a dress

made of condoms by Brazilian artist Bertini, along with

another condom dress by the same artist, on exhibit at the

International AIDS conference in Toronto38

" T-shirts, condoms, grant proposals and 20,000 people. It must be

the International Aids

Conference in Toronto … the biennial jamboree for what now

constitutes an `Aids industry'

engaging everything from big pharma to `anthropologists for sex

workers' rights' groups.

Nearly every participant makes a living in this industry. " 39

The 16th Annual International AIDS conference held August 13-18,

2006 in Toronto, Canada,

included 26,000 participants from 170 countries, approximately 3,000

of whom were

journalists.40 One report estimated conferees were spending at least

$13 million on the

conference, assuming $500 per participant.41

In response to congressional inquiry, HHS reported it planned to

spend $315,000 on the

International AIDS Conference in Toronto, Canada, as well as send 78

federal employees.42 The

costs included $170,000 for hotel and per diems, $45,000 for

registrations, $65,000 for airfares,

$15,000 for a share of a booth, and $20,000 for a satellite HRSA

meeting regarding the

President's emergency plan for AIDS relief (PEPFAR).43

The conference included presentations from researchers who said

countries must recognize

prostitution as " legitimate legal work, " in both criminal law and

labor codes, to fight HIV and

other diseases among " sex workers " and the broader population. 44

One convention center

exhibit, sponsored by Stella, the Montreal " sex workers " alliance,

featured three prostitutes lying

on a satin-covered bed, which was designed to " look like a typical

workplace. " According to a

Stella representative, at least 24 prostitutes from 21 countries,

whom she referred to as " sex

workers, " were on scholarship to attend the Toledo conference.45 One

prostitute from Thailand

was described as " standing amid pillows and sex toys in the

[conference's Stilleto] Lounge. To

cheers from a crowd of around 200 people, she demanded health

insurance, paid vacation and

job security. " 46

The conference also featured a workshop on finding a woman's erotic

zone, one on how to apply

condoms through " sex stunts, " and a display of explicit artwork, all

of which were described as

" hugely popular " at the 16th International AIDS Conference.47 Also

featured was clothing made

54

from condoms, by artist Bertini of Sao o, Brazil, who

has " been making her condom

fashions for 10 years. " 48

Reports indicated that the Bush Administration, which has funded the

world's largest donor

program for HIV/AIDS, repeatedly came " under attack " for focusing on

abstinence and

monogamous relationships over condom distribution in the prevention

of HIV/AIDS and also for

refusing to fund needle-exchange programs for drug addicts or any

activities " promoting

prostitution. " 49 (The U.S. focus on these areas and the

restrictions on funds were enacted into

law by the United States Congress by overwhelming majorities in both

the House and the Senate.

The law does not prohibit the federal government or its grantees

from providing health assistance

to prostitutes.50) According to the U.S. Global AIDS Coordinator,

the U.S. planned to distribute

477 million condoms in 2006, up from 320 million in 2001.51

, the UN Secretary General's Special Envoy for HIV/AIDS

in Africa, said in his

closing session keynote speech, " What has to happen, I think, is

that we place a temporary

moratorium on the endless, self-indulgent proliferation of meetings,

seminars, roundtables,

discussion groups, task forces ad nauseam, plus the production of

reports, documents,

monographs, statistical data ad repetition, and concentrate every

energy at country level. " 52

Federal Trip Funds Could Have Spared

Almost 40,000 Newborns from HIV

If the funds HHS spent sending 78 employees to Toronto to talk

about HIV/AIDS had been spent on Nevirapine (a retroviral

drug that costs less than $4 a dose and has proven to prevent

HIV transmission from mother to child with the administration

of just two doses), more than 39,000 infants around the

world could have been treated and spared from HIV

infection.

If the 26,000 Toronto conference attendees, who it was

estimated spent $13 million to attend, had instead pooled their

resources for retroviral drugs, they could have treated 1.63

million infants.

55

Hollywood, Florida 2006:

Photo from NMAC registration form 53

More than 3,500 people involved in AIDS work gathered in Hollywood,

Florida, in September

2006 for The U.S. Conference on AIDS (USCA), sponsored by the

National Minority AIDS

Council (NMAC).54 In response to congressional inquiry, it was

reported that 92 federal

employees attended this conference, including 67 from the CDC, and

that over $410,000 in

federal funds were spent on the conference.55

Conference registration ranged from $360 to $595 per person.56 Thus,

conference registration

alone for CDC employees was between $33,120 to $54,740, not

including transportation and

lodging. According to one news report, federal HHS funds paid

for " scholarships " that enabled

" at least 950 " people to attend the conference, which may have cost

$342,000 in registrations

alone. 57

Activists attending the conference said President Bush and Congress

have cut money for

education campaigns that teach youth and adults how to prevent the

AIDS virus through safe sex

and abstinence and are not increasing funds to treat additional

cases of HIV that the widespread

testing will find. NMAC's government relations director

asked, " Where's the money? " 58

In fiscal year 2006, the federal government spent $21.05 billion in

2006 on HIV/AIDS, including

$13.8 billion on treatment, and $2.2 billion on prevention.59

Despite the federal government

spending billions of federal HIV/AIDS funds (including grants to

NMAC, one of the largest

HIV/AIDS grant recipients), there are a reported 40,000 new cases of

HIV each year.60

According to its 2005 IRS 990 filing, NMAC received $3.5 million in

government funds, spent

$1.5 million on conferences, and earned $435,695 million from

conference registrations. The

group paid its executive director $172,652 in salary and $8,633 in

deferred compensation, and

provided him with a $4,368 expense account. In 2005, NMAC spent

$588,855 on consultants —

down from the over $1 million it paid consultants in 2004.61

The Hollywood, Florida conference included a session on lobbying, a

Latin Fiesta, featuring a

" sizzling fashion show, " and a beach party that included a 15-foot

high sand sculpture of the

NMAC and USCA logo.62

56

2006 STD CONFERENCE FEATURING THE DANGERS OF ABSTINENCE:

The CDC scheduled a 2006 National STD Prevention Conference with a

panel entitled " Are

Abstinence-Only-Until-Marriage Programs a Threat to Public Health? "

The panel was to be

made up of speakers who claim abstinence-until-marriage programs are

not effective and are

even dangerous.

Among the announced panelists was the vice president for public

policy of the Sexuality

Information and Education Council of the United States (SIECUS), a

federally funded advocacy

group that promotes contraception-based, sex-education programs and

has spearheaded a

campaign to stop federally funded abstinence education programs.63

The CDC scheduled the

SIECUS panelist to speak about a report critical of abstinence

curricula that was prepared by the

partisan congressional staff on the House Government Reform

Committee for Democrat

Congressman Henry Waxman of California.64 Though the " Waxman Report "

was released to the

press, it was not a peer-reviewed scientific document published in

any scientific journal.

Like SIECUS, Congressman Waxman, a long-time proponent of federally

funded, contraceptivebased,

(often graphic) sex-education programs, has repeatedly called for

the defunding of federal

abstinence education programs.65 This despite the fact that

according to one report, in 2002

alone, the government spent $12 promoting contraception and condom

use for every $1 it spent

to encourage teens to abstain from sexual activity.66

Another presenter was to focus on why states take federal abstinence

funds and why some

implement abstinence education instead of comprehensive,

contraception-based education to

" better understand the political process involved to modify these

unfortunate circumstances. " 67

Abstinence programs, the presenter was to argue, " are not

empirically supported and have been

tied to actually raising STD infection rates. "

Yet an April 2003 study published in Adolescent and Family Health

found that increased

abstinence accounted for 67 percent of the decline in pregnancy rate

for teen girls ages 15 to 19,

and 51 percent of the drop in the birth rate for single teen girls

was attributed to abstinence. A

similar study released in the August 2004 Journal of Adolescent

Health attributes 53 percent of

the decline in pregnancy rates for 15-17 year olds to decreased

sexual activity, which was larger

than the decline attributed to contraceptive use.68 A study released

in April 2007 of four of the

400 federally funded abstinence programs reported that " Contrary to

concerns raised by some

critics of … abstinence[-until-marriage] funding, however, program

group youth were no more

likely to have engaged in unprotected sex than control group

youth. " 69

The CDC's scheduled panel was in direct opposition to what the CDC's

director called " the first

line of defense against HIV/AIDS. " In her 2002 speech accepting the

appointment to the

Director of the CDC, Dr. Gerberding reminded those present

that CDC's core identity is as

an " agency that promotes `safer, healthier people' in all

communities. " She went on to define

healthier people as including " healthy youth – who are physically

fit and abstain from smoking

and sexual activity that poses a threat of HIV and STDs. " Dr.

Gerberding spoke of the

successful HIV prevention program in Uganda and said, " Abstinence

and monogamy, along with

the avoidance of risky behaviors, are the first line of defense

against HIV/AIDS. " 70

57

After a congressional inquiry from Congressman Mark Souder (R-IN)

questioned the panel's

balance, the CDC changed the panel to include two supporters of

abstinence education programs,

and cancelled the presentation on Congressman Waxman's report.71 In

response to CDC actually

balancing the panel with both proponents and opponents of federal

abstinence-until-marriage

programs, Congressman Waxman sent a letter to HHS Secretary Leavitt

claiming, " In effect, it

appears that presentations at a public health conference were

censored because they criticized

abstinence-only education. This attempt at thought control should

have no place in our

government. " 72

TAXPAYERS PAY FOR CONFERENCE TRIPS FOR GRANTEES

IN ADDITION TO FEDERAL EMPLOYEES:

It is not just the federal employees who use tax dollars to travel

to conferences, but some of the

grantees themselves use CDC grant funds to pay for their trips. A

grant application from the

Better World Advertising (BWA) company, which received a $520,000,

12-month CDC contract

for HIV prevention services, included a provision that the

grantee's " Project Coordinator will

attend at least one HIV Prevention related conference this funding

cycle. " 73

The CDC continued to fund this group and pay for its conference

travel, despite some of its

previously controversial work. For example, one CDC-funded BWA

commercial, which

included a shirtless transgender with breasts, was rejected for day-

time airing by a local

television station. BWA's owner evidently felt that the innocence of

children was an unfair

standard for buying air time. He told the Bay Area Reporter, " What

KGO [the local station] said

is that children six or seven years old will see it and ask their

parents about it and they won't

know what to say, " said Les Pappas, president of Better World

Advertising, which produced the

ads and had offered the station $12,000 to air them during daytime

TV. " It's outrageous. " 74

Two years later the group again came under fire for placing a

cartoon penis and syphilis sores on

bus shelters. The owner of the advertising space told the San

Francisco Chronicle, " Things like

that come up, and we're sensitive to it, especially when there are

children around. …We just

asked them to tone down the graphics is all. " Again BWA's Les Pappas

pushed back, " Since it's

a public health thing, I think it calls for people to be a little

more enlightened. " 75

CONCLUSION

Whether or not it can be demonstrated that grantees benefit from

attending federally

funded conferences, one thing is clear: the conference circuit

appears to have taken on a

life of its own, with grantees and federal employees traveling from

one conference to

another on the taxpayers' dime. At some point, the CDC will need to

decide whether or

not spending $45 million over the last six years on conferences is

the best use of limited

federal funds to prevent and control diseases. Perhaps putting an

end to the all-expensepaid

visits to the international HIV " biennial jamboree " and putting the

money saved

toward the direct reduction of mother-to-child transmission of HIV

would be a start.76

Until such a reprioritization occurs, cries of lack of funding

emanating from participants

at CDC-funded luxury conferences will continue to ring somewhat

hollow.

58

1 CDC's website claims the agency, " pledges to the American people:

To be a diligent steward of the funds

entrusted to it [and to] ensure that our research and our services

are based on sound science and meet real public

needs to achieve our public health goals; "

http://www.cdc.gov/about/mission.htm, accessed October 2006.

22004 op-ed by Laurie Garrett, The New York Times, as quoted in

Nature, August 2006,

http://www.nature.com/nature/journal/v442/n7103/full/442602a.html;

' keynote address to Toronto

AIDS Conference, August 18, 2006,

http://www.stephenlewisfoundation.org/news_speech_item.cfm?news=1382,

accessed October 2006.

3 October 4, 2005 letter from HHS to Senator Tom Coburn, signed by

Assistant Secretary , CDC

" Conference Support Expenditures/Projections by OPDIV/STAFFDIV "

FY2000: $8,558,352; FY01: $6,982,795;

FY02: $7,642,681; FY03: $6,926,825; FY04: $7,056,486; FY05

Projections: $7,577,478; for a total of $44,744,647

(Note: CDC Off Center includes later conferences not reflected in

these totals).

4 " Outrage as HHS joins MoveOn.org, " The Hill, April 22, 2004.

5 Letter to Congress from Secretary of State Colin , July 21,

2002,

http://www.house.gov/hensarling/rsc/doc/UNFPAletter.pdf.

6 Testimony of phine Guy, Director of Governmental Affairs,

America 21, before the House Committee on

International Relations hearing entitled " Coercive Population

Control in China: New Evidence of Forced Abortion

and Forced Sterilization, " October 17, 2001,

http://commdocs.house.gov/committees/intlrel/hfa75761.000/hfa75761_0.

HTM, accessed October 2006.

7 " Preliminary Program, Youth and Health: Generation on the Edge, "

Global Health Council 31st Annual

Conference, June 1-4, 2004, www.globalhealth.org, accessed May 2004;

International Planned Parenthood Youth

Manifesto, http://www.ippf.org/NR/rdonlyres/8D8B8E8E-9224-47A6-8626-

A0906F79DBBA/0/youthmanifesto.pdf, accessed October 2006.

8 " Fearing Audit, Group Repays $700,000 Used to Fund Abortions, " The

Washington Times, Oct. 5, 2000.

9 " Health Council's Chief Criticizes Administration, " Washington

Post, June 4, 2004;

http://www.washingtonpost.com/wp-dyn/articles/A13851-2004Jun3.html.

10 August 16, 2005 letter from Senators Grassley, Brownback, DeWine,

Inhofe, Coburn, and Graham to HHS

Secretary Leavitt.

11 October 28, 2005 letter from CDC Director Gerberding, M.D.

to Senator Coburn in response to

congressional inquiry.

12 Ibid.

13 " Coburn Criticizes U.S. Department of Health and Human Services

for Offering Tacit Support of Meth

Legalization, " press release from the office of Senator Coburn,

August 17, 2005.

14 " Meth conference to focus on `comprehensive care;' Organizers

want to explore mix of drug, unsafe sex, HIV, "

Washington Blade, August 12, 2005, quoting Shernoff,

http://washingtonblade.com/2005/8-

12/news/national/meth.cfm, accessed October 2006.

15 HHS indicated that the 2004 figure does not include the field

staff already in Asia, though it is not clear if the

totals from other years have similar exclusions.

16 " Scientists rip US for cutbacks to global AIDS summit, " July

2004, Nature Medicine; photo of 2002 Barcelona

AIDS conference (PWA stands for people with AIDS).

17 Follow-up letter from 28 House Republicans to HHS Secretary Tommy

, October 10, 2002, in response

to his first reply to a July 17, 2002 congressional letter regarding

the Barcelona, Spain AIDS Conference.

18 Ibid.

19 " AIDS Conference Excludes Vatican, " ZENIT News Agency, July 11,

2002, www.zenit.org

20 " 2006 Report on the Global AIDS Epidemic, " UNAIDS, May 2006,

http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp,

accessed October 2006.

21 Ibid

22 " `Bush bashing' spoils AIDS conference, " The Washington Times,

October 7, 2003,

http://www.washingtontimes.com/national/20031006-101719-6969r.htm,

accessed October 2006.

23 Ibid.

24 Id.

25 Id.

26 " A Political Circus Is Part of the AIDS Meeting, " op-ed, The New

York Times, July 20, 2004.

59

272004 op-ed by Laurie Garrett, The New York Times, as quoted in

Nature, August 2006,

http://www.nature.com/nature/journal/v442/n7103/full/442602a.html,

accessed October 2006.

28 " Bangkok AIDS Meeting to Feature Drag Show, " Associated Press,

July 2, 2004.

29 Footnote 16, Nature Medicine, op. cit.

30 " U.S. cuts 28 CDC experts at forum, " The Atlanta Journal-

Constitution, July 25, 2004.

31 " Activists fume over cost of `access for all' AIDS conference in

Bangkok " , Agence France Presse, June 29, 2004;

" U.S. Tax Dollars Funding International Conferences?, " Family News

in Focus, July 19, 2004,

http://www.family.org/cforum/fnif/news/a0032922.cfm, accessed

October 2006. Early registration (presumably

before Thailand taxes) was reported as $800, standard registration

was $900, while late registration was $1,250 after

taxes, which still totals at least $16,000, if all CDC employees

registered early and $38,400 as the lowest possible

cost had the original 48 employees scheduled to attend not been cut

back to 20 attendees.

32 " Interview With Ambassador Randall Tobias: International AIDS

Conference, Bangkok, Thailand, " Kaiser

Family Foundation, July 14, 2004,

http://www.kaisernetwork.org/aids2004/tobias, accessed October 2006.

33 " AIDS Activists Misfiring, " op-ed, The Washington Post, July 19,

2004, http://www.washingtonpost.com/wpdyn/

articles/A60578-2004Jul18.html.

34 Footnote 26, op. cit.

35 " Federal funds for event attacked, " The Washington Times, March

12, 2004,

http://washingtontimes.com/national/20040311-113621-4202r.htm.

36 House Committee on Government Reform Views and Estimates on the

Fiscal Year 2005 Budget of the United

States.

37 Footnote 35, op. cit.

38 Reuters photo and caption, August 17, 2006,

http://mdn.mainichimsn.

co.jp/photospecials/graph/060818condomfs/, accessed October 2006.

39 " World spends too much in the fight against Aids, " The Financial

Times, August 14, 2006,

http://www.ft.com/cms/s/c2fb7574-2bbd-11db-a7e1-0000779e2340.html.

40 Official conference press release, http://www.aids2006.org/,

accessed October 2006; " Missed chance for U.S.:

Bush's funding curbs means world won't hear many success stories, "

editorial/op-ed, The Gazette (Montreal),

August 15, 2006.

41 " AIDS meeting is just a pricey photo-op, " Ottawa Citizen, August

16, 2006.

42 HHS letter to Rep. Garrett (R-NJ) signed by

Steiger, Special Assistant for the Secretary of

International Affairs, dated May 16, 2006.

43 Ibid.

44 " Legalizing sex trade key to cutting HIV, activists tell AIDS

conference, " The Canadian Press, August 17, 2006.

45 Ibid; " Sex workers march for rights at AIDS conference, " Reuters

Health, August 16, 2006; " Sex workers are part

of the solution " workshop, http://www.aids2006.org/PAG/PSession.aspx?

s=961, accessed October 2006.

46 Ibid., Reuters.

47 " Sex sells AIDS prevention message at conference, " Agence France

Presse, August 15, 2006; " Where is the

Pleasure in Safer Sex? " workshop,

http://www.aids2006.org/PAG/PSession.aspx?s=815, accessed January

2007.

48 " Making condoms stylish for everyone, " Reuters Health, August 17,

2006.

49 " US AIDS chief denies morality comes before life, " The Financial

Times, August 16, 2006;

" US-led war on drugs `inadvertently fuelling HIV epidemic', "

Aidsmap.com, August 16, 2006.

50 See text of key provisions:

http://www.house.gov/hensarling/rsc/doc/rights%20under%20HIV-AIDS%

20law.pdf.

51 Footnote 49, U.S. AIDS chief, op. cit.

52 Footnote 2, ' address, op. cit.

53 Photo from NMAC registration form,

http://www.nmac.org/PDFDownloads/USCA_reg_form.pdf.

54 " US Conference on AIDS, " Housing Works AIDS Issues Update,

September 29, 2006,

http://www.hwadvocacy.com/update/archives/2006/09/us_conference_o.htm

l, accessed October 2006.

55 October 2006 HHS response to an inquiry from Senator Tom Coburn's

office reporting that: 5 employees from

HRSA, 14 employees from SAMHSA, 67 employees from the CDC, 5

employees from NIH, and one NIH

contractor were scheduled to attend and that HRSA spent $5,827 and

CDC spent $405,000 on the conference.

56 NMAC registration form,

http://www.nmac.org/PDFDownloads/USCA_reg_form.pdf, accessed October

2006.

57 " Coburn to investigate AIDS conference spending: Fashion show,

luxury suite with grand piano deemed

wasteful, " Washington Blade, October 20, 2006,

http://www.washblade.com/2006/10-20/news/national/coburn.cfm,

accessed October 2006 (950 scholarships multiplied by early

registration fee of $360 = $342,000).

60

58 " AIDS activists urge more funds for treatment, " South Florida Sun-

Sentinel, September 23, 2006.

59 " AIDS Funding for Federal Government Programs: FY1981-FY2007, "

updated April 18, 2006, Congressional

Research Service, http://www.congress.gov/erp/rl/pdf/RL30731.pdf.

60 " A Glance at the HIV/AIDS Epidemic, " CDC, January 2007,

http://www.cdc.gov/hiv/resources/factsheets/At-AGlance.

htm#3, accessed February 2007.

61 2004 and 2005 National Minority AIDS Council IRS form 990, (Note:

the form does not distinguish between

federal, state, or local government funding),

http://www.guidestar.org/FinDocuments/2005/521/578/2005-

521578289-028784c1-9.pdf,

http://www.guidestar.org/FinDocuments/2004/521/578/2004-521578289-

021e9463-

9.pdf.

62 NMAC website,

http://www.nmac.org/conferences___trainings/usca/agenda/3893.cfm,

accessed October 2006; emailed

reports from attendees to Senator Tom Coburn's office.

63 " No New Money/No More Money " campaign against funding

for " abstinence-only-until-marriage programs, "

http://www.nonewmoney.org/. " Now that it is clear there is no sound

research supporting these programs, no

support in the public health community and no support by the

American people, we are asking Congress to stop

funding these harmful programs, " said , vice president

for public policy at the Sexuality Information

and Education Council of the U.S. as quoted in June 6, 2006, SIECUS

press release entitled " 200 Organizations

Launch Nationwide Campaign to Stem Funding for Abstinence-Only-Until-

Marriage Programs; No Supporting

Research and No Public Support Exists, "

http://www.siecus.org/media/press/press0125.html, accessed October

2006.

64 " The Content of Federally Funded Abstinence-Only Education

Programs, " prepared for Rep. Henry A. Waxman,

Committee on Government Reform, minority staff, December 2004,

http://oversight.house.gov/Documents/20041201102153-50247.pdf.

65 Curricula use by comprehensive sex education programs that Rep.

Waxman supports, contain sexually explicit

material that, for example, have students practice unrolling condoms

on bananas, cucumbers, fingers, or model

phalluses as well as encouraging teens to practice mutual

masturbation and watch erotic movies, according to

" Comprehensive Sex Education vs. Authentic Abstinence: A Study of

Competing Curricula, " Shannan ,

Rector, and G. Pardue, The Heritage Foundation, 2004,

http://www.heritage.org/Research/Abstinence/bg1718.cfm; " Chastity

czar' wants abstinence to be cool, " Atlanta

Journal-Constitution, December 4, 2004.

66 " Government Spends $12 on Safe Sex and Contraceptives for Every

$1 Spent on Abstinence, " by G.

Pardue, E. Rector, and Shannan , The Heritage

Foundation, January 14, 2004,

http://www.heritage.org/Research/Abstinence/bg1718.cfm, accessed

October 2006.

67 " Prevention and Politics: Understanding the Role of the State as

an Actor in the Sex Education Policy Debate, "

jo M. Oster, Pennsylvania State University,

http://cdc.confex.com/cdc/std2006/techprogram/P11419.HTM.

68 " Waxman Report Is Riddled with Errors and Inaccuracies, " by

G. Pardue, The Heritage Foundation,

December 2, 2004,

http://www.heritage.org/Research/Abstinence/wm615.cfm, citing Mohn,

Tingle, and Finger, " An

Analysis of the Causes of the Decline in Non-Marital Birth and

Pregnancy Rates for Teens from 1991 to 1995, "

Adolescent and Family Health, Vol. 3, Issue 1, April 2003, and

Santelli et al., " Can Changes in Sexual Behaviors

Among High School Students Explain the Decline in Teen Pregnancy

Rates in the 1990s? " Journal of Adolescent

Health, Vol. 35, No. 2, August 2004.

69 " Impacts of Four Title V, Section 510 Abstinence Education

Programs; Final Report, " Trenholm,

Barbara Devaney, et al., Mathematica Policy Research, Inc., April

2007,

http://aspe.hhs.gov/hsp/abstinence07/report.pdf

70 Remarks by Dr. L. Gerberding, CDC Director, Atlanta,

Georgia, July 3, 2002.

71 " Health Experts Criticize Changes in STD Panel, " Washington Post,

May 9, 2006; " CDC Censors Panel at the

2006 National STD Prevention Conference, " SIECUS Policy Updates, May

2006,

http://www.siecus.org/policy/PUpdates/pdate0247.html, accessed

October 2006.

72 " STD panel's change stirs questions; A lawmaker asks why HHS got

involved in a forum on abstinence, "

Philadelphia Inquirer, May 11, 2006.

73 Federal CDC contract with Better World Advertising, January 1,

2003-December 31, 2003. Total contract

amount: $520,000. Program name: " HIV Stops With Me. "

74 " KGO bans HIV prevention commercials from daytime TV, " Bay Area

Reporter, September 21, 2000.

75 " Criticism over syphilis ad campaign; Firm says cartoon penis too

graphic for bus shelters, " The San Francisco

Chronicle, June 25, 2002.

76 Footnote 39, op. cit.

61

CDC Announces Plan to Eliminate Syphilis:

Five Years Later Syphilis Rates Up Overall and Up 68% for Men

While one of the CDC's main missions is preventing diseases, the

agency has a pattern of

announcing million-dollar campaigns targeted at one particular

disease and its elimination.

Syphilis has been the focus of one such campaign costing hundreds of

millions of tax dollars,

and yet the rates of the disease are going up.

In 1999, in a report calling for the elimination of syphilis, the

CDC announced a national goal to

" to reduce [primary and secondary] P & S syphilis cases to 1,000 or

fewer and to increase the

number of syphilis-free counties to 90% by 2005. " 1 Congress

responded by nearly doubling the

CDC's syphilis budget in 2001 to an amount that was three times the

funds allocated to the

disease just two years earlier. As the funding went up,

unfortunately, so too did the reported

cases of sexually transmitted syphilis. From 1999 to 2004, the

reported syphilis rates among

men not only did not decrease but actually increased by 68 percent.

CDC analysis suggests that

64 percent of all adult P & S syphilis cases in 2004 were among

homosexual men, up from an

estimated five percent in 1999. Syphilis rates also increased among

African Americans in 2004,

for the first time in more than a decade, including significant

increases among black men (up

22.6 percent from 2003 to 2004).2

In 2005, CDC's own STD surveillance statistics reported: " Syphilis:

Cases Increase for Fifth

Consecutive Year. The rate of primary and secondary (P & S) syphilis —

the most infectious

stages of the disease — decreased throughout the 1990s, and in 2000

reached an all-time low.

However, over the past five years [from 2000-2005], the syphilis

rate in the United States has

been increasing. " 3

WHAT IS SYPHILIS?

Syphilis is a sexually transmitted disease caused by the bacteria

Treponema pallidum. The

disease usually can be cured with antibiotics. It is highly

contagious during the primary and

secondary stages: a single sexual encounter with a person who has

syphilis results in infection

about one third of the time. An infected person who does not get

treatment may infect others

during the first two stages when lesions (sores) are present. The

bacterium enters the body

through mucous membranes, such as those in the vagina or mouth, or

through the skin. Within

hours, the bacterium reaches nearby lymph nodes, and then spreads

throughout the body by way

of the bloodstream. In its late stages, untreated syphilis, although

not contagious, can cause

serious heart abnormalities, mental disorders, blindness, other

neurological problems and death.

Syphilis also can infect an unborn child in the womb, and can

sometimes infect newborns,

causing birth defects and other serious mental and physical

problems. 4 This type of syphilis is

known as congenital syphilis. Congenital syphilis infections among

infants are largely

preventable if mothers receive appropriate diagnosis and treatment

during prenatal care. Death

of the unborn child or newborn infant occurs in up to 40 percent of

pregnant women who have

untreated syphilis.5

62

In its early stages, this sexually transmitted disease may produce

open sores, making it easy for

patients to spot and doctors to diagnose. Even asymptomatic

infections are easily identified

through testing, and the disease usually can be quickly and cheaply

cured with just one dose of

penicillin. Traditional approaches to STD control — patient

education, easy access to testing

and treatment, and door-to-door tracking of at-risk sexual partners —

reportedly are costeffective

ways to prevent and stop the spread of the disease. 6

CDC SPENDS $269 MILLION ON ELIMINATION EFFORT …

YET 58,116 NEW REPORTED CASES SINCE 1998:7

FY98: $2.4 million

FY99: $10.1 million

FY00: $18.8 million

FY01: $33.750 million

FY02: $33.306 million

FY03: $37.241 million

FY04: $33.901 million

FY05: $33.613 million

FY06: $33.102 million

FY07: $33.173 million

FIGURE 7. NEW CASES CLIMB DESPITE LARGE FUNDING INCREASES

CDC Syphilis Funding vs. New Syphilis Cases

7191

6158

7383

8953

6359

8167

6766

7139

$0.0

$5.0

$10.0

$15.0

$20.0

$25.0

$30.0

$35.0

$40.0

FY 98 FY 99 FY 00 FY 01 FY 02 FY 03 FY 04 FY 05 FY 06 FY 07

CDC Syphilis Funding (Dollars in Millions)

5,500

6,000

6,500

7,000

7,500

8,000

8,500

9,000

9,500

10,000

Number of Reported Syphilis Cases Each Year

Source: Center for Disease Control

Cases

Funding level

CDC announces

elimination campaign

63

IF AT FIRST YOU DON'T SUCCEED, CHANGE THE GOAL'S DEADLINE … TWICE:

In 1999, the CDC first announced a national goal to " to reduce P & S

[primary and secondary]

syphilis cases to 1,000 or fewer and to increase the number of

syphilis-free counties to 90% by

2005. " 8

In a 2004 program assessment, the CDC's long-term measures for STDs

included " eliminating

syphilis by 2008 " (three years after the original elimination goal).9

In May 2006, CDC announced a " reframing " of the syphilis elimination

effort. The agency

named the effort, " Together We Can: The national plan to eliminate

syphilis from the United

States " and declared that " CDC's vision is to create a dynamic,

evidence-based and culturally

competent prevention and control action plan for the elimination of

syphilis from the United

States. By 2010 [five years later than the 1999 effort, and two

years later than the 2004

assessment indicated], interim elimination targets will be to reduce

rates of primary and

secondary syphilis in the United States to less than 2.2 per 100,000

population; congenital

syphilis to fewer than 3.9 per 100,000 live births; and Black:White

racial disparities to a ratio of

less than 3:1. " 10

… OR CUT A FEW CASES BY NOT COUNTING U.S. TERRITORIES:

Even though its prevention mission extends to preventing diseases,

such as syphilis, in U.S.

territories, CDC frequently leaves out the U.S. territories of Guam,

the Virgin Islands, and Puerto

Rico when reporting syphilis statistics to the press.11 While they

are small territories with small

populations, leaving these U.S. territories out of the syphilis case

count results in hundreds of

fewer new cases reported each year, thus sometimes making the

picture rosier than it is.

SYPHILIS ELIMINATION FUNDS USED TO HIRE GAY PORN STAR:

During CDC's first campaign to eliminate syphilis, one CDC grantee

used federal syphilis

elimination funds to hire a porn star. In July 2002, a CDC-funded

group in Missouri called

Blacks Assisting Blacks Against AIDS (BABAA) hired Memphis gay porn

star Edgar Gaines,

whose movie name is Bobby Blake, to attend a " safe-sex " event at the

then executive director's

downtown loft. He was paid $500 from a syphilis elimination grant.12

The porn star appeared at the event in a towel and cowboy boots.13

After an investigation, the

money was subsequently reimbursed to the CDC and the group fired the

two people in charge

(including the executive director). " We felt that even with [Gaines]

being at the event with just a

towel and boots on was totally inappropriate and something we don't

condone, " said Donnell

, a lawyer and vice chairman of the group's board.14

The event also prompted the St. Louis Health Department to cancel

the remaining $6,000 of its

$96,000 syphilis prevention grant to Blacks Assisting Blacks Against

AIDS, according to a news

report. The grant reportedly was the smaller of two BABAA received

through the city from the

CDC. In 2002, it was reported that BABAA received a total of

approximately $1.6 million in

government assistance.15

64

According to one news report, the St. Louis City auditors' report

noted the AIDS group bought

$14,487 in equipment without following federal bidding rules and

billed one of its grants for

$3,642 more in salary costs than it actually paid out to employees.

The chairman of BABAA's

board told a newspaper the group hoped to win back the syphilis

grant and would continue

serving AIDS patients.16

HHS SECRETARY TELLS GRANTEES TO HIRE THEIR OWN STRIPPERS:

After this event led to additional congressional inquiries and audit

requests of federal prevention

funding, AIDS-advocacy groups launched media efforts claiming they

were the " target of

intimidation " by the Bush administration.17

According to one news report, " Health and Human Services Secretary

Tommy G.

didn't beat around the bush when he sat down [on October 31, 2002]

with representatives of

several AIDS-advocacy groups. …`Now with the audits, you've got to

realize that not everyone

agrees with you and me in Congress. When you take federal dollars

and have a sex party or a

gay stripper you're going to have audits. Maybe you should use other

money to hire a stripper.

Audits are there to find out what's working. I believe in audits.' " 18

Reports from the meeting did not indicate whether the HHS Secretary

informed attendees that

events with strippers are likely counterproductive to HHS's and

CDC's disease prevention goals

or, at the very least, are not on any respected lists of successful

disease prevention strategies.

EASY TO CURE, YET CDC'S GOAL REMAINS ELUSIVE:

The CDC's reframed 2006 elimination effort noted that, " Despite

recent challenges, generally

low syphilis rates provide an opportunity to achieve this goal.

Syphilis elimination is possible

because the disease is easy to cure once diagnosed, and because the

syphilis epidemic is

concentrated in a small number of geographic areas. In 2004, more

than 50 percent of infectious

(also called primary and secondary, or P & S) syphilis cases were

reported from just 20 U.S.

counties.

" Elimination of syphilis would have far-reaching public health

benefits because it would remove

two serious consequences of the disease — increased likelihood of

HIV transmission, and

serious complications in pregnancy and childbirth, such as

spontaneous abortions, stillbirths, and

congenital syphilis (syphilis among newborns who acquired it from

their mothers). "

THOUGH THERE IS SOME PROGRESS TO REPORT AMONG WOMEN AND INFANTS:

According to the CDC, rates of congenital syphilis have declined 39

percent, while overall, there

has been a 92 percent decrease in cases of congenital syphilis since

1991. Because, untreated

syphilis during pregnancy can lead to stillbirth, neonatal death, or

infant disorders, such as

deafness, neurological impairment, and bone deformities, this

progress has had a significant

impact on many lives.

Also, from 1999 to 2004, primary and secondary syphilis rates " among

all women have

decreased 55 percent (from 2.0 to 0.9 cases per 100,000). " 19

65

PLAYING WITH STATISTICS:

While there was temporary success with decreasing rates among

African Americans, CDC

statistics show the syphilis rates began to climb back up among this

subgroup in 2004. Instead of

reporting this known setback, CDC's fiscal year 2007 budget summary —

which justifies the

agency's budget request — uses old statistics to report " significant

progress " in its syphilis

elimination campaign. The report states, " Between 1999 and 2004,

primary and secondary

syphilis rates among black Americans have decreased 37 percent (from

14.3 to 9.0 cases per

100,000) " (emphasis added). 20 While this five year decrease was

significant, leaving out the

years directly proceeding the 2007 budget (which showed something

other than " significant

progress " ), could be an oversight or could be seen as CDC

intentionally using statistics that

advance the agency's request for additional funding.

CDC THEORY ON SETBACKS — HIGH-RISK BEHAVIOR & " HOMOPHOBIA " :

The 2006 " Together We Can " CDC initiative notes:

" Despite these gains, however, overall rates of primary and

secondary syphilis have been on

the rise since 2001 presenting challenges and new opportunities for

reframing our efforts. By

2004, more than 60% of new diagnoses of P & S syphilis were estimated

to occur in men who

have sex with men (MSM), with HIV-positive MSM bearing a

disproportionate burden of

disease. The rising incidence of syphilis in MSM is in part

attributable to recent increases in

high-risk sexual behavior. High rates of new sex partner acquisition

and partner change rates

with rises in unprotected … sex have been documented across the

United States.

" The reasons for the increases are complex, however HIV sero-sorting

[the practice of

choosing or sorting one's sexual partners based on their HIV

status], safer sex fatigue,

recreational drug use (especially crystal methamphetamine), and HIV

treatment optimism

combined with expansions in venues and networks that facilitate

risky behaviors, have been

identified among the major driving factors. " 21

One observer reports that, in fact, crystal methamphetamine causes

erectile dysfunction (E.D.),

but the advent of E.D. drugs such as Viagra has helped to counter

the effect and, in combination

with popular " circuit parties " among homosexual men, has led to the

spread of HIV (and

presumably other sexually transmitted diseases, such as syphilis).22

CDC, without explanation or supporting evidence, appears to

correlate an individual's decision

to engage in risky sexual behavior with the feelings that society

reportedly has regarding

homosexuality: " All this has occurred within the context of

homophobia and discrimination

being experienced by many MSM. " 23

Dr. Khalil Ghanem, assistant professor of medicine at s Hopkins

University School of

Medicine, agrees increasing rates among gay men could be attributed

to illicit drug use and

" safe-sex fatigue, " but also notes that prevention messages might

have been " drowned out " due

to publicized reports of how AIDS medications are working. " We've

been seduced by these

amazing drugs and we've fallen behind in our prevention efforts, "

Dr. Ghanem told Medical

66

News Today. " We have to get back on track with prevention messages.

That's the only way we

will curb this outbreak. " 24

CDC'S TUSKEGEE SYPHILIS EXPERIMENTS HINDERS EFFORTS; CDC EMPLOYEE

INEXPLICABLY SAYS BLACKS NEED TO TAKE " THE RESPONSIBILITY " FOR

TUSKEGEE

According to the CDC, syphilis elimination efforts meet with

distrust and therefore some

resistance in the African American community because of the federal

government's involvement

with a study later known as the " ethically unjustified " Tuskegee

human experiments.25

In 1932, the United States Public Health Service (PHS), in

cooperation with the Tuskegee

Institute (an institute founded to educate free men, former slaves,

and their children), initiated a

study in Macon County, Alabama, to determine the effects of

untreated syphilis. The study

would last until 1970 and follow 399 black men diagnosed with

syphilis.

Though in 1943 penicillin was widely known and used to cure

syphilis, the study subjects were

not offered penicillin and local physicians, draft boards and PHS

venereal disease eradication

programs were given a list of the " subjects " to ensure they would

not be treated. After the media

exposed the study, it was halted in 1970.26

The Tuskegee syphilis study was a covert medical research study.

However, it was widely

known in medical circles because articles about it were published in

major medical journals. As

late as 1969, a committee at the CDC examined the study and agreed

to allow it to continue.27

In 1995, CDC brought together " African American external consultants

to participate in a

consultation meeting with Center for Disease Control and Prevention

(CDC) staff, during which

they could explore new ways to define and frame the problem of

syphilis in the South among

African Americans. The group was asked to consider potential

intervention strategies to address

the epidemic. " The group discussed " the Tuskegee Study and its

legacy " and it was mentioned

that that CDC had never officially apologized for the Tuskegee Study

(though President Bill

Clinton subsequently issued a national apology in May 1997).28

According to the meeting minutes, a CDC employee appears to blame

African Americans for the

unethical experiments imposed on them:

A CDC staff person commented, " This is not as simple as people want

to make it, like

people do with racism. Racism is a very complex thing, not as simple

as we like to try to

make it. The experiment could not have been done without the help of

the Tuskegee

Institute. If blacks do not take the [their share of]

responsibility, then such an incident

could certainly happen again. "

Note: the phrase " their share of " is added in brackets by the CDC

editor, thus indicating it was

not in the original CDC employee's quote.

67

MEETING THE GOAL:

After steady increases in federal funding and millions of dollars

spent trying to eliminate

syphilis, CDC is left with at least one gross misuse of funds in a

community with rising syphilis

rates, and with a fluctuating disease elimination deadline. As one

commentator wrote,

" Eliminating syphilis was going to be another notch in the belt of

public health. But the disease

and the people spreading it are not cooperating. " 29

Yet eliminating syphilis is still a worthwhile and hopefully

attainable goal for the CDC. It is not

clear whether CDC's third deadline for eliminating syphilis using

an " evidence-based and

culturally competent prevention and control action plan " will

finally propel the agency toward

meeting its goal.30 Patient education, access to testing and

treatment, tracking of at-risk sexual

partners, and better screening of syphilis grantees should be an

integral part of the CDC's

syphilis elimination effort. Paying grantees to hire porn stars

should not be.

1 " The National Plan to Eliminate Syphilis from the United States, "

CDC, October 1999,

http://www.cdc.gov/stopsyphilis/plan.pdf;

http://www.cdc.gov/stopsyphilis/SEEPlan2006.pdf elimination is

defined

by the CDC " as the absence of sustained transmission of the disease. "

2 http://www.cdc.gov/stopsyphilis/plan.pdf.

3 " Trends in Reportable Sexually Transmitted Diseases in the United

States, 2005, " CDC's STD Surveillance 2005,

http://www.cdc.gov/STD/stats/trends2005.htm CDC's STD Surveillance

2005.

4 " Sexually Transmitted Diseases, Syphilis, " The Merck Manual of

Medical Information--Home Edition, February

2003,

http://www.merck.com/mmhe/print/sec17/ch200/ch200b.html; " Healthbeat,

" Illinois Department of Public

Health, http://www.idph.state.il.us/public/hb/hbsyph.htm.

5 " Sexually Transmitted Diseases, An Overview for Women, " CDC/OD

Office of Women's Health,

November, 1997, http://www.thebody.com/cdc/stdoverview.html.

6 " SYPHILIS: The Persistent Public Enemy: Syphilis is cheap and easy

to cure. It ought to be extinct in the U.S. It's

not, " Kaiser Special Report, July 18, 2000,

http://www.kaisernetwork.org/reports/2000/07/kr000718.1.htm.

7 CDC funding information provided January 9, 2007 and January 17,

2006 in response to request from Senator

Coburn's office. Some of these budget figures are also included in

CDC's FY06 Budget Request Summary,

http://www.cdc.gov/fmo/PDFs/FY06budgetreqsummary.pdf. Reported cases

of P & S Syphilis taken from yearly

CDC STD Surveillance reports for 50 U.S. States, the District of

Columbia and three U.S. territories: Guam, Puerto

Rico, and the Virgin Islands (STD Surveillance 2005 - Syphilis,

Table 24 Primary and secondary syphilis,

http://www.cdc.gov/std/stats/tables/table24.htm; STD Surveillance

2003 - Syphilis, Table 26 Primary and secondary

syphilis, http://www.cdc.gov/std/stats03/tables/table26.htm; and STD

Surveillance 2002 - Syphilis, Table 27

Primary and secondary syphilis,

http://www.cdc.gov/std/stats02/tables/table27.htm). Though CDC often

omits the

P & S cases of the three territories when it is quoted in news

reports, the agency's syphilis budget includes a mandate

to fight the disease in these territories and thus the territories'

cases are included in Figure 7. Note: The number of

cases corresponds to the calendar year, while the funding figures

correspond to the fiscal year. For example, in

calendar year 1998, CDC reported 7191 primary and secondary syphilis

cases, while it received $2.4 million in

fiscal year 1998, which encompassed October 1997 through September

1998. FY07 figure from " FY2007 Joint

Resolution [CDC] Detail Table, "

http://www.cdc.gov/fmo/PDFs/FY_2007_JR_Detail_Table.pdf, accessed May

2007.

8 Footnote 1, op. cit.

9 CDC: Sexually Transmitted Diseases and Tuberculosis 2004 Program

Assessment,

http://www.whitehouse.gov/omb/expectmore/detail.10002162.2005.html.

10CDC's " Together we can: The national plan to eliminate syphilis

from the United States, May 2006, "

http://www.cdc.gov/stopsyphilis/SEEPlan2006.pdf.

68

11 " Rates Of Syphilis In US Gay And Bisexual Men On The Rise, "

Medical News Today, May 1, 2007,

http://www.medicalnewstoday.com/medicalnews.php?newsid=69150 and

Syphilis Fact Sheet, CDC website,

http://www.cdc.gov/std/syphilis/STDFact-Syphilis.htm, accessed May

2007, both use syphilis case numbers that

exclude cases in the territories. Yet the " Syphilis Elimination

Effort; State & Outlying Area Profiles: includes the

three territories under profiles for syphilis elimination,

http://www.cdc.gov/stopsyphilis/state.htm, accessed May

2007.

12 " Two who hired porn star are fired, " St. Louis Post-Dispatch,

November 6, 2002. Note: the group has since

changed its name to Regional Education Advocacy Coalition on

HIV/AIDS (REACH) according to " Missouri:

AIDS Group May Go Under, Says Audit, " St. Louis Post-Dispatch, March

18, 2004.

13 Ibid.

14 Id.; " AIDS Group May Go Under, Says Audit; Agency's Budget Might

Plummet with Cuts in Grants, " St. Louis

Post-Dispatch, March 18, 2004.

15 " Auditors Finds More Problems with AIDS Agency that Used Federal

Funds to Hire Porn Star, " St. Louis Post-

Dispatch, January 28, 2003.

16 Ibid.

17 " Bush Administration Policies on Sex Education, Funding for AIDS

Groups `Hampering' Anti-AIDS Efforts,

Organizations Say, " Kaiser Daily HIV/AIDS Report, October 1, 2002;

Daily HIV/AIDS Report, August 20, 2002.

18 Inside the Beltway, The Washington Times, December 13, 2002.

19 CDC Budget Request Summary Fiscal Year 2007, dated February 2006,

http://www.cdc.gov/fmo/PDFs/FY07budgetreqsummary.pdf.

20 Ibid.

21 Footnote 10, op. cit.

22 " Deconstructing Reporting on HIV and AIDS: Public health

professionals and veteran reporters outline common

mistakes in coverage and discuss how to avoid them, " by Bob Roehr,

Center for Integration and Improvement of

Journalism, http://www.ciij.org/newswatch?id=152, accessed January

2007.

23 Supra footnote 10.

24 Footnote 11, op. cit.

25 " The Tuskegee Timeline, " CDC website,

http://www.cdc.gov/nchstp/od/tuskegee/time.htm; " Racism and

Research: The Case of the Tuskegee Syphilis Study, " by Brandt,

Hastings Center Report, December 1978, p.

21; Ad Hoc Advisory Panel, Dept. of Health, Education, and Welfare

(later renamed HHS), " Final Report of the

Tuskegee Syphilis Study, " 1973.

26 " Prejudice and the Medical Profession: Racism, Sometimes Overt,

Sometimes Subtle, Continues to Plague U.S.

Health Care, " by , SJ, PhD, Health Progress, September-

October, 2003, Volume 84, Number 5,

http://www.chausa.org/Pub/MainNav/News/HP/Archive/2003/09SeptOct/arti

cles/HP0309f.htm, accessed January

2007.

27 Ibid., citing T. W. Murrell, Syphilis and the American Negro, "

JAMA, vol. 54, no. 11, 1910, p. 847; and H. H.

Hazen, " Syphilis in the American Negro, " JAMA, vol. 63, no. 13,

1914, p. 463.

28Meeting notes from " Affected by Syphilis, In the South and Among

African Americans, " Interdenominational

Theological Center, Atlanta, Georgia, July 18, 1995, page 64,

http://www.cdc.gov/stopsyphilis/plan.pdf; " The

Tuskegee Syphilis Study, "

http://www.anairhoads.org/govexperiments/tuskegee.shtml.

29Footnote 22, op. cit.

30 Supra footnote 10.

69

CDC's $335 Million Kid-Targeted Media Campaign:

Advertising Success But Health Impact Unknown

It began in fiscal year 2001 as a $125 million earmark for a Youth

Media Campaign at the CDC,

an earmark that was inserted into a massive spending bill by the

subcommittee chairman

managing the bill, Congressman Porter (R-IL).1 It became a five-

year, $335 million,

congressionally earmarked CDC campaign of advertising on television,

on the radio, and on the

Internet, to try to encourage children ages 9-13 (so-

called " tweens " ) to be physically active on a

daily basis.

The " national, multicultural, social marketing campaign " was called

VERB, which comes from

the " verbs " children are encouraged to perform, such as run, splash,

hike, jump, and dance.2 The

program's motto is " VERB it's what you do! " According to its

website, VERB aims to make

" physical activity cool and fun for tweens. " 3

CDC TAKES TO THE AIRWAVES & TAKES MILLIONS TO THE PR FIRMS:

On average, American children 8-to-18-years old watch three hours a

day of television.4 CDC

took advantage of this fact by buying large amounts of advertising,

mostly on cable channels

such as Nickelodeon and Disney, essentially telling kids to watch

less television and go be

active.5

The following three advertising agencies collectively received over

$170 million in tax dollars:

el (Chicago),6 Saatchi & Saatchi (New York City), and

360 (Hispanic/Latino

audience). 360 then subcontracted to A Partnership, Inc.

(Asian American/Pacific

Islander audience), G & G Advertising (American Indian/Alaska Native

audience), and PFI

Marketing (African American audience).7

The hundreds of millions of federal dollars were successful in

raising awareness among so-called

tweens about the VERB campaign — 74 percent of those surveyed had

heard about the

campaign one year later — but whether or not the tweens did anything

about it is another

question.8

CDC justified spending millions to advertise VERB to teenagers by

noting that " Obesity costs

the country $117 billion dollars a year in medical expenses.

Marketing programs like this one

are proving to be successful in reducing the health and economic

impact of this disease and are

encouraging us to adopt similar strategies to address other priority

health problems. " 9

70

SURVEY DOESN'T SHOW CORRELATION — BUT CDC CLAIMS SUCCESS:

In February 2004, CDC put out a press release claiming success

because a survey showed VERB

" is Working " and that " Survey Findings Prove the VERB Campaign is

Motivating Youth to Get

Active. " 10 In actuality, the survey findings, published in the

journal Pediatrics found that tweens

VERB had a very high level of awareness about VERB, and that some

subgroups of children

were more active, but what was less clear (despite the authors'

claims in one section) was

whether or not VERB was causing or even affecting the children's

activity levels.

The survey's authors concluded that, " Promoting physical activity

with child-focused

commercial advertising shows promise, " but also indicated that the

survey found:

" no overall effect on free-time physical activity sessions was

detected at the totalpopulation

level[;]

" At the total-population level, no relationship was found between

levels of awareness

and percentage of children engaging in organized physical activity

[; and]

" No pattern of effects was detected for the previous-day physical

activity measure or the

measure of trying a new physical activity in the past 2 months "

(emphasis added).11

KIDS DO ONE MORE ACTIVITY … WORTH HUNDREDS OF MILLIONS OF TAX

DOLLARS?

What the authors found, and what CDC highlighted in its press

release claiming success, was

that certain subgroups of interviewed children were more active a

year after the VERB campaign

started than before. The fact that these children knew about the

VERB campaign and were more

active than their peers who did not know about the VERB campaign led

the CDC to claim that

VERB motivated the change. The study's authors reported, " The

finding that 9- to 10-year-old

children overall engaged in 1.1 more sessions of activity in their

free time than did those not

exposed to the campaign is a notable difference " (emphasis added).12

The conclusion: the VERB program is deemed by the CDC as a " success "

story in fighting

childhood obesity because after hundreds of millions of taxpayer

dollars spent on advertising,

some children in a targeted group did one more activity in their

free time, which may or may not

be related to their having watched a CDC-funded ad.

The taxpayer-funded activities through VERB include:

ViRTS: Tweens can create their own physical activity tracking log by

creating a

ViRT, " a virtual player that tweens energize by recording the time

they spend being

physically active; "

Play Without Borders: " Students can check out popular games from

around the

world and discover new ways to play; " and

Yellow Ball: VERB yellowball " is a big, bouncy, world-changing idea

that was

created to spread play to every kid in America. Here's the deal.

We're scattering

thousands of yellow balls all across the country. It's up to you to

find one, play with

it, and most importantly, pass it on. …Nothing replaces the rush and

exhilaration of

71

physical activity. Yellowball ignites desire for physical activity

freeing kids to play out

their dreams — I can't NOT play! " 13

CDC's VERB campaign also provided Crossover Community Organization

Kits for

organizations that directly serve tweens, which included taxpayer

funded bracelets, wrist bands

and vinyl inflatable basketballs.14

CONGRESS DEFUNDS VERB … YET IT KEEPS ON GOING …

Congress defunded the VERB campaign in 2006 and yet CDC continued to

promote and operate

the campaign in 2006. In response to congressional inquiry, CDC

reported that the 2006 VERB

activities were funded through the previous year's appropriations.

The approximately $51.1

million in VERB 2006 expenditures included: $36.8 million for

advertising, $8.6 million for

events (including " multiple in-market events to directly reach

tweens across the nation in their

communities such as the VERB mobile tour, VERB guerilla marketing,

and VERB street

teams " ), $1.9 million for Community & In-school projects (including

those at summer camps),

$1.9 million for a Tween Website (http://www.verbnow.com/) featuring

a " places to play "

activity finder, " pro tips " for several sports, VERB e-cards, jokes,

and the Yellowball " blog-aball "

(which allows tweens to blog their latest Yellowball activities),

and $1.9 million for public

relations outreach.15 According to CDC, the VERB program was to

officially end on September

30, 2006, and the website was to end on December 31, 2006.16

1 Federal Register, December 4, 2006,

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.

gpo.gov/2006/pdf/E6-20417.pdf;

Congressional Testimony by Diane Canova of Research to Prevention to

House Subcommittee on Labor-HHSEducation

Appropriations, May 14, 2003,

http://www.researchtoprevention.org/html/pressevents/events6-

2003canova.pdf, accessed October 2006.

2 " VERB, " House Republican Study Committee (RSC) document, dated

February 2006, FY01 - $125 million, FY02-

$68 million, FY03 - $51 million, FY04 - $32 million, FY05 - $59

million, FY06 - $0 (defunded),

http://www.house.gov/hensarling/rsc/doc/020106_VERB_1Pager.doc.

3 VERB website, http://www.cdc.gov/youthcampaign/index.htm.

4 " Generation M: Media in the Lives of 8–18 Year Olds, " by

DF, Foehr UG, Rideout V., Kaiser Family

Foundation, 2005, http://www.kff.org/entmedia/entmedia030905pkg.cfm.

5 " Children: Year-1 Results of the VERB Campaign, " Pediatrics 2005;

116; 277-284, by Duke and D.

Heitzler, n Huhman, Lance D. Potter, Faye L. Wong, W.

Banspach, C.,

http://pediatrics.aappublications.org/cgi/reprint/116/2/e277.

6 el website, http://www.frankel.com/frankel.htm. Note: As of

October 2006, this agency also represents

Mcs, Cuervo (an alcoholic beverage company), and Coca-Cola.

7 E-mail from CDC employee to House RSC staffer in response to

congressional inquiry, February 23, 2007.

8 Ibid.

9 Dr. Marks, director of CDC's National Center for Chronic

Disease Prevention and Health Promotion, as

quoted in a February 17, 2004 CDC press release on VERB,

http://www.cdc.gov/od/oc/media/pressrel/r040217.htm.

10 Ibid.

11 Footnote 5, op. cit.

12 Ibid.

13 VERB website,

http://www.cdc.gov/youthcampaign/materials/tweens/index.htm.

14 VERB Materials for Tweens, VERB website,

http://www.cdc.gov/youthcampaign/materials/tweens/crossover_cbo/order

/index.htm, accessed July 2005.

15 " VERB: Still Doing? " RSC Blog, Posted by le Cannon, September

05, 2006,

http://www.house.gov/hensarling/RSC/blog.shtml.

16 Ibid. Note: as of June 2007, the website was still available

online.

72

CDC Addresses Serious Health Issues

Like Land Development and Bike Paths

At times it seems the CDC intentionally inserts itself into

controversial political topics,

frequently picking sides under the pretext of public health. While

property owners, legislatures,

and environmentalists battle it out in the public square over land-

use issues, the Centers for

Disease Control and Prevention provided the resources to produce a

paper decrying " sprawl. "

The CDC funded, and CDC employees co-wrote, a paper published in

2001 by the political

advocacy group Sprawlwatch, which is a " slow-growth " special

interest organization.1 The

CDC-funded paper defines the term sprawl as " uncontrolled, poorly

planned, low-density, and

single-use community growth [that] depends on individual motor

vehicles to flourish. "

" THOUGHTLESS DEVELOPMENT " AT AMERICA'S PERIL:

The CDC-funded paper hypothesizes that the health of Americans is

suffering due to urban

sprawl and a dependency on automobiles. The Director of the CDC's

National Center for

Environmental Health criticizes (without defining)

America's " thoughtless " development: " As

America increasingly becomes a nation that permits and even

encourages thoughtless

development and unmanaged growth, the impact of these factors grows

clearer, and we ignore

them at our peril. "

Though many new property developments are built with sidewalks and

even bike paths, the

CDC's Environmental Health Director asserts, " There is a connection,

for example, between the

fact that the urban sprawl we live with daily makes no room for

sidewalks or bike paths and the

fact that we are an overweight, heart disease-ridden society. "

Evidently, the CDC director implies, public health officials cannot

encourage people to exercise,

if they do not first ensure the people have " welcoming " exercise

environments. " It is dishonest

to tell our citizens to walk, jog, or bicycle when there is no safe

or welcoming place to pursue

these `life-saving' activities. " 2

PAPER ASSERTS VIOLENCE STEMS FROM COMMUNITIES WITHOUT PARKS:

The paper's authors might be accused of oversimplifying America's

woes when they write, " The

question that remains is whether communities want to spend money up

front to create an

environment that prevents violence and increases psychological well-

being or whether they want

to spend money after the fact to address the violence and stress

which results from communities

without parks and communal areas. "

In fact, local police reports reflect the reality that parks

sometimes can become hangouts for gang

members and locations for neighborhood crime.3

73

… AND PARKING LOTS ENCOURAGE SEDENTARY LIVING:

The paper describes residential areas that reflect " the supposition

that people will drive to most

destinations. " And says that certain designs " encourage sedentary

living habits " such as parking

lots " built as close as possible to final destinations to increase

convenience and safety for

motorists. "

YET CDC'S OWN STUDY SHOWS SUBURBANITES THE HEALTHIEST:

Yet, an official CDC study released the same year, in September

2001, entitled " Health, United

States, 2001, " found that suburbanites are the healthiest people in

the country, exercising more

and living longer than residents of rural and urban areas.4

The official CDC report, for example, found that suburban women are

the group least likely to

be obese. Furthermore, a 2000 study in the American Journal of

Public Health concluded that

city-dwellers face a greater mortality risk compared to people

living in suburbs or rural areas,

even after controlling for demographic differences such as age,

race, sex, education, income, and

marital status.5 The same study also found that suburbanites are the

most physically active

group.6

In a letter dated January 14, 2002, Congressman Mark Souder (R-IN),

the Chairman of the

House Subcommittee on Criminal Justice, Drug Policy, and Human

Resources, requested

additional information about the study from the CDC, but to date CDC

officials have never

responded.

1 " Creating A Healthy Environment: The Impact of the Built

Environment on Public Health " , undated 2001 paper by

J. , MD, MPH, Kochtitzky, MSP, Centers for

Disease Control and Prevention,

http://www.sprawlwatch.org/health.pdf, accessed November 2006.

2 Ibid., Preface by J. , MD, MPH, Director of CDC's

National Center for Environmental Health.

3 Gangs and Gang Violence A Regional Perspective 2005, Gaithersburg

land Police Department,

http://www.sepcrc.org/pr/GANGSANDGANGVIOLENCE.pdf; " Activity Drives

I.V. Park Improvement Plans, " Daily

Nexus, September 24, 2006, http://www.dailynexus.com/article.php?

a=11946.

4 CDC's " Health, United States, 2001 With Urban and Rural Health

Chartbook, "

http://www.cdc.gov/nchs/pressroom/01news/hus01.htm,

http://www.cdc.gov/nchs/data/hus/hus01.pdf.

5 " Excess mortality among urban residents: how much, for whom, and

why? " J.S. House, et al., American Journal of

Public Health, December 2000.

6 " Why the Centers for Disease Control Hates the Suburbs, "

HealthFactsandFears.com, July 30, 2002,

http://www.reason.org/commentaries/schwartz_20020730.shtml#ref1,

accessed November 2006.

74

CDC & Guns as a " Health Problem "

In l979, the U.S. Surgeon General published the first national

agenda for health promotion and

included reducing interpersonal violence among the top 15

priorities.1 This began a gradual

involvement of the federal health agencies in violence prevention

and guns.

CDC CREATES SECTION TO INVESTIGATE GUN VIOLENCE:

In the late 1980s, the CDC created the Intentional Injuries Section

within the Division of Injury

Epidemiology and Control. The section, according to its acting chief

Dr. O'Carroll, was

focused " not on firearms, but on homicides. We've tried to bring a

somber approach to

determining what role firearms have in violence, " he told the

Journal of the American Medical

Association (JAMA) in 1989. " Clearly, if three fourths of homicides

are caused by firearms, we

have to look at their role. " 2

Dr. O'Carroll's quotes in this JAMA article set off a firestorm

regarding CDC's role with guns

and gun control. The article said:

" Bringing about `gun control,' which itself covers a variety of

activities from registration to

confiscation, was not the specific reason for the [CDC's violence

prevention] section's

creation, O'Carroll says. However, the facts themselves tend to make

some form of

regulation seem desirable, he says: `The way we're going to do this

is to systematically build

a case that owning firearms causes death.' " 3

Dr. O'Carroll also was quoted by JAMA as saying:

" We're doing the most we can do, given the political realities. The

problem is you have

polemicists from both camps [gun control advocates and opponents]

exerting influence, and

Congress is very wary. Even the question of parents restricting

their own children's use of

firearms causes some people to get upset " (brackets inserted in

original article).4

These quotes were used by gun rights defenders to show the CDC — an

agency created to study

and prevent diseases — was changing its mission to not only study

guns but to promote gun

control.

Dr. O'Carroll wrote a letter to the editor of JAMA saying:

" … I do not believe [the February 3, 1989 JAMA article] accurately

portrays either my

approach to injury prevention research or that of the Centers for

Disease Control. …I am

correctly described as saying that the CDC will bring a sober,

scientific approach to

determining what effect the accessibility of firearms may have on

the risk of violent injury.

Unfortunately, the next paragraph misquotes me and indicates quite

the opposite — that the

CDC is trying `to systematically build a case that owning firearms

causes deaths.' …We at

the CDC have been careful to avoid such a biased approach. " 5

75

GUN CONTROL NOW OR GUN CONTROL EVENTUALLY?

Three years later, CDC officials were still explaining their work

with guns, again provoking

controversy. In a June 10, 1992 article entitled, " Let's Be Clear:

Violence is a Public Health

Problem, " three CDC doctors, including Dr. O'Carroll and Dr.

Rosenberg (who would later

direct CDC's center studying guns) wrote: " Just as we were able to

save countless lives from

motor vehicle injuries without banning cars, we can save many lives

from firearm injuries

without a total ban on firearms. " The use of the phrase " total ban, "

raised the specter that a

partial ban on firearms was something the CDC researchers and the

agency itself may have been

contemplating. The authors continued, " Parents should be encouraged

and assisted in every

possible way to prevent their children from carrying guns or having

unsupervised access to

guns. " 6 For the parents who teach their children to hunt using

guns, this quote was also

controversial.

On June 25, 1992, soon after the violence-is-a-health-problem

article appeared, CDC created the

National Center for Injury Prevention and Control (NCIPC), which

increased the former section

that studied firearms to an entire center dedicated to injury

prevention.7 The NCIPC's mission

was to increase research and monitoring of injuries caused by fire

and accidents, which the unit

determined included firearms-related injuries.8 By 1995, $2.3

million, or five percent, of the

NCIPC's budget of $46 million went to firearm-related research.9

In 1993, the NCIPC Director's Mark Rosenberg was interviewed for a

Rolling Stone article

entitled " Gunning for guns. " The article said:

" [Government] Firearms [working group] co-chair Rosenberg says the

group is looking

to develop strategies to `reframe the debate' on guns. `We're trying

to get away from this

notion of gun control,' Rosenberg says. He envisions a long-term

campaign, similar to

those on tobacco use and auto safety, to convince Americans that

guns are, first and

foremost, a public-health menace. `We didn't have to ban cars,' he

says `We made cars

safer. We made roads safer. We reduced drunk driving.' " 10

Some skeptics might note that the end goal for those focused

on " long-term campaigns " on

tobacco use, for example, was to actually stop all Americans from

smoking and to use lawsuits to

drive American tobacco companies out of business.

CDC OFFICIALS FEATURED AT GUN CONTROL EVENTS AND AGENCY FUNDS USED

TO ADVOCATE GUN CONTROL:

According to a report sent to the U.S. Senate by the watchdog group

Doctors for Integrity in

Policy Research Inc. (DIPR), at the Handgun Epidemic Lowering Plan

(HELP) strategy

conference in 1993 and again in 1995, the CDC's NCIPC researchers

and staff were listed as

faculty for a conference " described by its organizer as

uniting `concerned professionals' to assist

in making it `socially unacceptable for private citizens to have

handguns.' " 11

76

The CDC's NCIPC also funded a spring 1995 Injury Prevention Network

Newsletter entitled,

" Women, Guns and Domestic Violence, " which included an article

entitled " What Advocates

Can Do. " The article included advice for researchers and CDC public

health staffers such as:

• " Put gun control on the agenda of your civic or professional

organization. Release a

statement to the media or explain in your organization's newsletter

why gun control is a

woman's (or nurses' or pediatricians'...) issue.

• " …Make your support for federal, state, and local gun laws known

to your representative.

This may include: Opposing repeal of the assault weapons ban;

maintaining support for

the Brady Law; restricting ammunition availability by caliber and

quantity; increasing

enforcement of federal firearm laws; maintaining restrictions on

issuance of concealed

weapons permits...

• " Organize a picket at gun manufacturing sites, perhaps with

posters showing pictures of

victims of gun violence. (Modeled after the Madres de los

Desaparecidos in Argentina

and Chile; this can evoke a very powerful moral image.)

• " Work for campaign finance reform to weaken the gun lobby's

political clout.

• " Boycott publications that accept advertising from the gun lobby

or manufacturers ...

Launch a program aimed at getting pediatricians [involved] ... Get

media attention for

your events. Encourage your local police department to adopt a

policy prohibiting

officers from recommending that citizens buy guns for protection … " 12

Mercy, M.D., Director of the Violence Prevention Division of

the CDC, gave a March 11,

1995 interview that reported, " Dr. Mercy and others who are alarmed

at the increase in handgun

injuries and deaths hope that out of this broadened perspective, a

perspective based on scientific

inquiry, Americans will begin to move more cautiously in regard to

the purchase and ownership

of firearms. Dr. Mercy said, `The public often buys without taking

into account the risks. There

is little evidence to show that handguns have a protective

effect.' " 13

The CDC Division Director is also quoted questioning the marketing

campaigns of gun

manufactures. " Efforts to highlight the risks of handgun ownership

have been made more

difficult, however, by the advertising campaigns of gun

manufacturers that present what

advocates of gun control regard as misinformation, particularly with

regard to the protection

claim. `Some companies are trying to expand their markets by

targeting women,' Dr. Mercy

said, `suggesting that women have most to fear from strangers,

whereas the greatest danger of

violence is from co-habitants.' " 14

CONGRESS GETS INVOLVED:

In October 1995, a letter signed by eight Senators, including

Senators Bob Dole (R-KS) and

Trent Lott (R-MS), said that the CDC's NCIPC agency was wasteful,

biased and driven by

" preordained political goals and not from the desire for scientific,

balanced and unbiased inquiry.

....This CDC program can be cut with no diminution of service in

administering the public

interest, and at a savings to the taxpayer. " 15

77

CONGRESS QUESTIONED CDC'S INVOLVEMENT WITH GUNS:

On March 6, 1996, the House Appropriations Subcommittee on Labor,

Health and Human

Services, and Education held a hearing where testimony focused on

what one witness reported

were " the CDC's NCIPC's use of suspect data, skewed study

populations, dubious research

models, and result-oriented research. " Testimony, according to the

same witness, was also

offered " concerning the inappropriate diversion of taxpayer monies

to research for dissemination

of partisan newsletters, as well as the participation of NCIPC staff

and researchers in partisan

anti-gun gatherings. " 16

In July 1996, the House Appropriations Committee passed an amendment

by Congressman Jay

Dickey (R-AR) to an appropriations bill to shift $2.6 million away

from the NCICP, an amount

determined to be equivalent to funds spent by the NCIPC for its gun

campaign. When the

appropriations bill came before the full House on July 11, 2006,

Congresswoman Nita Lowey

(D-NY) unsuccessfully attempted to restore the NCICP's $2.6 million

budget for firearm

research.17

Congresswoman Lowey argued, " Gun violence in America is a public

health emergency.

According to Dr. Lundberg, an editor of the Journal of the

American Medical

Association, `There is no question now that violence is a public

health issue. Research to end

this epidemic of violence is absolutely vital and it must continue.' "

Congressman Dickey countered that " this is an issue of federally

funded political advocacy. We

have here an attempt by the CDC through the NCIPC, a disease control

agency of the Federal

Government, to bring about gun control advocacy all over the United

States through seminars,

through the staff members and through the funding of different

efforts all over the country just

on this one issue, to raise emotional sympathy for those people who

are for gun control. It is a

blatant attempt on the part of government to federally fund lobbying

and political advocacy.

Rather than calling violence a disease and guns as a germ, these

people should be looking at the

other root causes of crime: Poverty, drug trade, gangs, and children

growing up without parental

support, and the cruel trap of welfare dependency. Those things have

more to do with crime

control than trying to come at it from a disease definition. " 18

Congresswoman Pelosi, the future Speaker of the House, urged

support for the

amendment saying, " We need CDC research and expertise to help inform

the Nation, to help gun

owners have safety. " 19

Congressman Bob Barr (R-GA) said, " Look up the word `disease' in the

dictionary, at least any

legitimate dictionary. I have done it. There is no reference in any

dictionary that I can find that

says that accidents or handgun injuries or murders are a disease.

There is a reason why they are

not found within a definition of disease. They are not diseases. …[T]

he Centers for Disease

Control have not eradicated disease. In other words, they have work

left to do, very important

work they could be doing. Yet they are devoting scarce resources for

a political agenda that is,

pure and simple, a political agenda … [and t]he political agenda is

well-documented. " 20

78

Finally, Congressman Jim Barcia (D-MI) pointed out that NCIPC's work

is duplicative, that

" firearms violence is studied already by a number of agencies within

the Department of Justice,

including the National Institutes of Justice and the Bureau of

Justice Statistics as well as the

Bureau of Justice Assistance and other programs. In fact, Dr. Arthur

Kellermann, an NCIPC

grantee recipient who has received millions of taxpayer dollars to

study firearms, recently

received a grant from the Department of Justice to study firearms

violence, a clear indication of

the duplicative nature of NCIPC's work in this area. " 21

Congresswoman Lowey's amendment to restore funds was defeated by a

158-263 vote in the

House of Representatives. The House-Senate conference did restore

the funds, but earmarked

the money to study traumatic brain injuries instead, and thus the

CDC's 1997 budget for firearm

injury related research dropped 80 percent to $500,000.22

CDC CAN STILL STUDY GUNS BUT GRANTEES CANNOT PROMOTE GUN CONTROL:

The final bill signed into law also included specific language

inserted by Congressman

Obey (D-WI) and Congressman Bob Livingston (R-LA) that stated: " None

of the funds made

available for injury prevention and control at the Centers for

Disease Control and Prevention

may be used to advocate or promote gun control. " 23

Congress modified the CDC gun control provision in the annual

appropriations bill for fiscal

year 2003 to read: " None of the funds made available for injury

prevention and control at the

Centers for Disease Control and Prevention may be used, in whole or

in part, to advocate or

promote gun control " (emphasis added). The appropriations committee

also included new report

language which reads in part:

" The conferees acknowledge that the purpose of this proviso is to

prohibit Federal funds

from being used to lobby for or against the passage of specific

Federal, State or local

legislation intended to advocate or promote gun control. The

conferees understand that

the CDC's responsibility in this area is primarily data collection

and the dissemination of

information and expect research in this area to be objective and

grants to be awarded

through an impartial, scientific peer review process. The conferees

instruct the CDC to

provide a detailed report, within 90 days of enactment, on the steps

the CDC has taken to

ensure this restriction is being followed. " 24

In an undated letter to its grantees, the directors of the CDC's

NCIPC and the Procurement and

Grants Office stated that:

" CDC interprets the appropriations and conference report language

regarding gun control

to mean that CDC's funds may not be spent on political action or

other activities

designed to affect the passage of specific Federal, State, or local

legislation intended to

restrict or control the purchase or use of firearms. This new

appropriations requirement

still supports CDC's work to:

• collect and support the collection of data related to firearm-

related injuries;

79

• engage in objective scientific, public health research awarded

through an

impartial, scientific peer review process, directed to preventing

injuries related

to violence and firearms; and

• publish and disseminate the results of firearm-related injury

research and

surveillance data.

" Importantly, recipients of CDC funds are subject to the same

limitations in using CDC

injury prevention and control funds. Recipients are expected to

establish appropriate

fiscal control and other mechanisms to ensure that CDC funds are not

used to promote

specific legislation that restricts or controls the purchase or use

of firearms through

conferences, public events, publications, and `grassroots'

activities. " 25

These provisions continue to be included in the annual

appropriations bills, and thus CDC

currently is not prohibited from studying guns and gun violence as a

disease or a health problem,

but merely is prohibited from allowing its grantees and funds to be

used for gun control

advocacy.26

OVER A DECADE LATER CDC TASKFORCE SAYS EFFECTS OF GUN CONTROL LAWS

UNKNOWN:

In October 2003, the CDC published findings from the Task Force on

Community Preventive

Services which " conducted a systematic review of scientific evidence

regarding the effectiveness

of firearms laws in preventing violence, including violent crimes,

suicide, and unintentional

injury. " The Task Force " found insufficient evidence to determine

the effectiveness of any of

the firearms laws or combinations of laws reviewed on violent

outcomes. " 27 The Task Force

also found insufficient evidence to determine whether the laws

reviewed reduce (or increase)

specific violent outcomes because much " existing research suffers

from problems with data,

analytic methods, or both. " 28

So after years of CDC classifying guns as a public health threat and

after years of CDC funding

groups that advocate gun control laws, the CDC's own research

concludes it is not known

whether gun control laws reduce or even increase violent crimes.

1 " Ideological and Civil Liberties Implications of the Public Health

Approach to Guns, Crime and Violence, "

G. Kessler quoting Prothrow-Stith and Weissman 1991,

http://www.saf.org/journal/10_civil.html,

accessed November 2006.

2 " Epidemiologists Aim at New Target: Health Risk of Handgun

Proliferation, " Journal of the American Medical

Association (JAMA), February 3, 1989.

3 Ibid.

4 Id.

5 " CDC's Approach to Firearm Injuries, " letter to the editor signed

by O'Carroll, MD, MPH, Center for

Environmental Health and Injury Control, CDC, JAMA, July 21, 1989.

6 " Let's be clear: violence is a public health problem, " Rosenberg

ML, O'Carroll PW, KE, JAMA, June 10,

1992.

7 NCIPC website, http://www.cdc.gov/ncipc/anniversary/default.htm.

8 " Hot Guns, Firearms Industry: The Gun Battle Over Science, "

Kistner, Frontline PBS, May 1997,

http://www.pbs.org/wgbh/pages/frontline/shows/guns/procon/injuries.ht

ml, accessed November 2006; " The Federal

Factoid Factory on Firearms and Violence: A Review of CDC Research

and Politics, " H. Blackman, Ph.D.,

80

National Rifle Association paper presented at the annual meeting of

the Academy of Criminal Justice Sciences

Chicago, Illinois, March 8-12, 1994.

9 Ibid, PBS.

10 " Gunning for Guns, " by Francis Wilkinson, Rolling Stone, December

9, 1993.

11 January 1, 1996 letter to Senator Arlen Specter, Labor, Health

and Human Services, and Education, and Related

Agencies subcommittee chairman, from Dr. C. Waters, IV,

Eastern Director, DIPR,

http://teapot.usask.ca/cdn-firearms/Suter/disband.cdc, accessed

October 2006.

12 " Docs, Guns, and the CDC, " The New American, A. Faria, Jr.,

MD, September 30, 1996,

http://thenewamerican.com/tna/1996/vo12no20/vo12no20_guns.htm.

13 " Gun Control: New Approaches, " M. , America, March

11, 1995,

http://pqasb.pqarchiver.com/americapress/access/1507735.html?

dids=1507735:1507735:1507735 & FMT=ABS & FM

TS=ABS:FT:PAGE & date=Mar+11%2C+1995 & author=%

2C++M & pub=America & edition= & start

page=26 & desc=Gun+control%3A++New+approaches.

14 Ibid.

15 Supra footnote 8, PBS.

16 Footnote 12, op. cit.

17 Departments of Labor, Health and Human Services and Education,

and Related Agencies Appropriations Act of

1997, Congressional Record pages: H7280-7287, July 11, 1996.

18 Ibid

19 Id.

20 Id.

21 Id.

22 Supra footnote 8, PBS;

http://clerk.house.gov/evs/1996/roll302.xml, Lowey amendment,

printed as amendment

number 4 in the Congressional Record of July 9, 1996, to increase

funds appropriated in the bill for the Center for

Disease Control research activities by $2.6 million and reduce funds

appropriated for Health Resources and Services

Administration commensurately. " The intent of the amendment is to

fund research into firearm-related injuries. "

23 Footnote 17, op. cit., according to floor statements from Rep.

Obey.

24 Public Law 108-7, House Report 108-10; Note: report language is

not legally binding but it accompanies the law,

and is taken as guidance from the appropriations committee by those

agencies receiving the funds under the law.

25 CDC website, http://www.cdc.gov/ncipc/res-opps/restrictions.htm,

accessed October 2006.

26 The report language accompanying the FY06 appropriations bill

(Report Number 109-143) included the

following: " Gun Control Advocacy.--The Committee recommendation

maintains language carried in the fiscal year

2005 bill and prior years prohibiting federal funds from being used

to lobby for or against the passage of specific

federal, state or local legislation intended to advocate or promote

gun control. The Committee understands that the

CDC's responsibility in this area is primarily data collection and

the dissemination of that information and expects

that research in this area to be objective and grants to be awarded

through an impartial, scientific peer review

process. "

27 " First Reports Evaluating the Effectiveness of Strategies for

Preventing Violence: Firearms Laws: Findings from

the Task Force on Community Preventive Services, " Recommendations

and Reports, October 3, 2003,

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5214a2.htm, accessed

October 2006.

28 Ibid.

81

CDC'S STATISTIC PROBLEMS AND FRAUD

CDC revises U.S. obesity deaths by 1,400% … then backtracks

Death toll falls from 400,000 to 365,000 to 25,814 in less than a

year

There's an old saying about lies, damned lies, and statistics. While

most Americans have grown

to trust the statistics that come out of the CDC, some of that

trust, at least as far as obesity death

statistics goes, might have been misplaced.

OBESITY ANNOUNCED AS NUMBER TWO KILLER IN THE NATION:

In March 2004, just months after CDC launched a high-profile effort

against obesity, the CDC

claimed obesity causes 400,000 deaths a year.1 The claim appeared in

a study, published in the

March 10, 2004 issue of the Journal of the American Medical

Association (JAMA), which

estimated there were 435,000 deaths associated with tobacco use

compared with 400,000 deaths

from " poor diet and physical inactivity. " 2 The study's four authors

included the CDC's Director,

Dr. Gerberding.

As the study was released, CDC officials issued dire warnings and

urged the nation to take

action.3 According to one news report, " Some critics in the food

industry and academia contend

that the CDC ignored early signs that its death estimates were

flawed to avoid undermining its

ongoing crusade against obesity. " 4

A May 2004 article in Science magazine quoted various researchers

and anonymous CDC

employees who said the evidence behind the obesity numbers

were " weak " or " loosey-goosey. "

Critics noted that the study's authors added an arbitrary number of

deaths from poor nutrition

(15,000) to the obesity category, which inflated the statistics.5

A CDC scientist says internal discussions on these issues got " very

contentious " months before

publication and left some feeling that the conclusions were not

debatable.6 The authors

disagreed and one explained that the stipulated 15,000 deaths from

poor nutrition in the obesity

section, for example, represent a " conservative estimate " obtained

by tripling 4,242, the number

of death certificates citing this cause in 2000.7

82

In January 2005, the CDC admitted making calculation errors and

lowered its death estimate to

365,000 — but still ranked obesity as the number two most

preventable cause of U.S. deaths.8

OBESITY ANNOUNCEMENT REVISED 1,400 PERCENT — NOT AS DEADLY AS ONCE

THOUGHT:

But in April 2005, in the Journal of the American Medical

Association (JAMA), the CDC revised

its estimate to put the annual death toll from obesity at only

25,814. The April 2005 numbers are

15 times less than the earlier estimate and drop obesity to the

seventh most preventable cause of

death, behind car crashes and gunshot wounds.9

The study, led by M. Flegal of the National Center for

Health Statistics, a branch of

the CDC, analyzed mortality according to a person's BMI, or body

mass index, which measures

weight and height. The study showed that being modestly overweight,

but not obese, " was not

associated with excess mortality " or a shorter life expectancy. In

fact, the research studied

showed that being overweight is actually less of a mortality risk

factor than being of normal

weight.

" The major reason our numbers are lower is that we used some new

data sets that provide more

recent, better information, " said on, senior

epidemiologist for the CDC, who was

an investigator in the study. Dr. Gerberding, the CDC's

Director, said the CDC will strive

to improve its methods for calculating the health consequences of

obesity.10

CDC PRESS CONFERENCE ANNOUNCES OBESITY IS STILL BAD:

In June 2005, the CDC Director held a press conference where she

acknowledged potential flaws

in the April 2005 JAMA study led by Flegal. " It is not okay to be

overweight. People need to be

fit, they need to have a healthy diet, they need to exercise, " she

said. " I'm very sorry for the

confusion that these scientific discussions have had. " 11

Some scientists from the Harvard School of Public Health, the

American Heart Association and

the American Cancer Society have rejected the conclusions from

Flegal's April 2005 study,

saying the study's main flaw was that it included people with health

problems, such as cancer

and heart disease, who tend to weigh less because of those problems.

No one discounts that obesity is a serious problem in America. The

American Obesity

Association estimates that 64.5 percent of adult Americans,

approximately 127 million people,

are categorized as being overweight or obese. Accurately compiling

statistics in a nation of

hundreds of millions of people is challenging, and accurately

tracking weight, which many

people consider private and personal information, obviously has its

limitations. But the fact that

CDC, the agency tasked with helping to prevent and control disease

and which testifies yearly

before Congress about the diseases " caused " by obesity, released

estimates adjusted by 1,400

percent within just one year, does not lead to confidence in CDC

statistics and may lead to public

confusion about obesity. Such confusion can be a deadly complication

in an area of disease

prevention that directly affects millions of people's lives.

83

1 " Study is seen as clouding risks to the overweight, " Boston Globe,

May 9, 2005.

2 " Obesity Is Now on Everyone's Plate, " JAMA, 2004; 291: 1186-1188.

3 Footnote 1, op. cit.

4 Ibid.

5 " Public Enemy Number One: Tobacco or Obesity? " Science, May 7,

2004.

6 Ibid.

7 Id.

8 " CDC says obesity deaths overestimated, " The Washington Times,

April 20, 2005.

9 Ibid.

10 Id.

11 " CDC Chief Backs Away From Report On Obesity, " Associated Press,

June 3, 2005.

84

IG Investigates Abuse of CDC Funds

Just three investigations find over a million dollars misused

While some CDC grant recipients react with outrage at the mere

suggestion that their books be

audited, the Inspector General managed to find, in just three cases

(two of which were

HIV/AIDS grantees), the misuse of over a million dollars in CDC

funds.1

MASSACHUSETTS:

The HHS Inspector General (IG) found a possible misuse of federal

HIV/AIDS funds in its audit

of the CDC-funded Multicultural AIDS Center (MAC) of Boston,

Massachusetts. Over the

course of two years, MAC received $948,000 from the CDC: $408,000

during 2001, $180,000

during 2002 from CDC via the Commonwealth of Massachusetts

Department of Public Health's

HIV/AIDS Prevention and Education ative Agreement, and

$360,000 in fiscal year 2002

from the CDC under the Community Coalition Development (CCD)

Project.2

According to the IG audit released in January 2003, " two MAC

employees, whose salaries were

paid with CDC funds, appeared to be involved in lobbying activities —

an unallowable charge

under federal regulations. …t is possible that a portion of the

[FY02] total charges of $360,000

to the CDC's Community Coalition Development Project may have

supported unallowable

lobbying activities. "

The stated purpose of the program for which MAC received funds

is " to improve and support the

health of the African American communities disproportionately

affected by HIV, sexually

transmitted diseases (STDs), tuberculosis (TB) and substance abuse

within their respective

communities. " 3 Funds made available under this program must support

activities directly related

to primary HIV prevention and the prevention of other STDs, TB, and

substance abuse,

according to the IG report. The misused CDC funds had been

intended " to sustain, improve, and

expand HIV prevention services for racial/ethnic minority

populations. " 4

In 2003, the House Subcommittee on Criminal Justice, Drug Policy and

Human Resources asked

HHS what, if any, actions were taken against MAC for violating

federal lobbying laws and

misusing funds for African American communities, though, to date, no

response has been

received.5 In response to congressional inquiry in 2007, CDC

reported that MAC has not

received CDC funds since 2002.6

WASHINGTON, D.C.:

CDC gave the Washington-based National Latina/o Lesbian, Gay,

Bisexual and Transgender

Organization (LLEGO) federal funds for HIV/AIDS education, including

$1.15 million in 2004,

for the first year of a five-year grant. But in August 2004, five

months after it received its

federal grant, LLEGO closed its doors and filed for Chapter 7

bankruptcy after drawing down

$989,255 of the CDC grant.7

85

The HHS IG determined LLEGO had incurred $703,181 in " unallowable

costs, " instead of

funding promised HIV/AIDS education efforts. " LLEGO engaged in

activities not covered by

CDC's program announcement, including lobbying, fund-raising and

advocating on behalf of

gay issues, " the report concluded. In 2003, for instance, the

organization's leaders rallied in

Tallahassee, Florida, to support adoption by same-sex couples. The

same year, the

organization's leaders rallied in Sacramento to support same-sex

marriages. According to a

news report, the organization further urged federal lawmakers to

oppose a 2004 bill that would

strip federal courts of the chance to hear challenges to the Defense

of Marriage Act, which

declares that states are not obliged to recognize same-sex marriages

performed in other states.8

The federal government is seeking to reclaim more than $700,000 from

LLEGO in bankruptcy

court, though the group's bankruptcy attorney said the former

employees " are the only ones who

are going to get paid, because of the limited amount of money

available … If there's anything

left, it will go for taxes, " he told a reporter.9

In response to congressional inquiry, CDC reported that it had filed

in bankruptcy court and was

placed on the creditor list. As of February 2007, " CDC has not

recovered [any] funds. " 10

GEORGIA:

In May 2006, the Director of the CDC's Coordinating Center for

Health Promotion pleaded

guilty in federal court to a charge of theft of government funds for

padding her travel expense

accounts by an estimated $7,500. Over a three year period, Donna

Stroup submitted dozens of

fraudulent claims and altered receipts for expenses not covered by

the agency. Often, she wrote

off personal expenses as FedEx or copying charges. One such charge

for $106.22 was described

as PowerPoint slides, when instead it was a purchase from Filene's

Basement department store.

According to the Atlanta-Journal Constitution, in 2004, Stroup " was

one of the authors of a

widely reported study that said obesity was about to overtake

smoking as the nation's leading

cause of death. " (See: " CDC revises U.S. obesity deaths by 1,400% …

then backtracks " (page

81).) Stroup has since resigned.11

ARE THERE MORE CASES?

With billions of dollars spent annually on grant programs and

hundreds of millions spent on

grant administration and management, taxpayers would be justified in

wondering how many

more cases of waste and abuse exist, but have yet to be investigated.

1 " Bush Administration Policies on Sex Education, Funding for AIDS

Groups `Hampering' Anti-AIDS Efforts,

Organizations Say, " Kaiser Daily HIV/AIDS Report, October 1, 2002;

Daily HIV/AIDS Report, August 20, 2002;

Inside the Beltway, The Washington Times, December 13, 2002.

2 " Audit of HIV/AIDS Activities at the Multicultural AIDS Coalition

for the Period July 1, 2000 through September

30, 2002, A-01-02-01503 " ,

http://oig.hhs.gov/oas/reports/region1/10201503.pdf.

3 Ibid.

4 CDC's " Final FY 2004 GPRA Annual Performance Plan, Congressional

Justification Submission, " February 2003,

http://www.cdc.gov/od/perfplan/2003/2003perf.pdf, accessed January

2007.

5 E-mail correspondence from House Subcommittee on Criminal Justice,

Drug Policy and Human Resources to

HHS, dated May 5, 2003.

86

6 E-mail correspondence from CDC Policy Analyst to office of Senator

Tom Coburn dated February 5, 2007.

7 HHS Inspector General " Review of grants issued to the National

Latina/o Lesbian, Gay, Bisexual, and Transgender

Organization, " June 2006, A-03-05-00351,

http://oig.hhs.gov/oas/reports/region3/30500351.pdf.

8 " Gay Latino group asked to repay federal grants, " McClatchy

Newspapers, October 8, 2006,

9 Ibid.; Footnote 6, op. cit.

10 Supra footnote 6.

11 " CDC staffer pleads guilty to fraudulent claims, " The Atlanta

Journal-Constitution, May 19, 2006.

87

IT PAYS TO BE A CDC EMPLOYEE

CDC Spends $1.7 Million for Hollywood Liaison Grant

Terrorism and Toxic Substance Funds Tapped

Former CDC Employee on Receiving End of Tinseltown Grant

1

Some employees watch soap operas on their lunch break or while their

boss is not looking, but at

the CDC watching soap operas is part of the job description for the

those with CDC's

Entertainment Education Program.

The CDC Entertainment Education Program collaborates

with " entertainment industry leadership

to provide accurate depictions of healthy living at all life stages "

and also works to provide

" public health experts as a resource to entertainment industry

writers. " 2 It seeks to " raise

awareness and behavioral change " by providing " accurate depictions

of healthy living at all

stages of life … to entertainment industry leadership for possible

inclusion in television

storylines. " 3

In other words, the CDC spends tax dollars to ensure that when a

made up character in a

fictitious TV show talks about a health topic, he or she talks about

it accurately.4

WHY CDC IS WATCHING DAYTIME AND PRIMETIME DRAMAS:

According to the CDC, " Popular entertainment provides an ideal

outlet for sharing health

information and affecting behavior. " CDC says that since many

Americas learn about health

issues from television, " we believe that prime time and daytime

television programs, movies,

talk shows and more, are great outlets for our health messages. " 5

A question taxpayers might consider appropriate: should the CDC

spend $1.9 million to help

Hollywood develop its plotlines, and does this type of assistance

justify the use of terrorism

funds?

88

$1.75 MILLION CDC TAX DOLLARS SPENT SO FAR IN LIAISON WITH HOLLYWOOD

(IN

ADDITION TO $1.51 MILLION FROM THREE OTHER AGENCIES); MORE IN THE

PIPELINE:

CDC's Entertainment Education Program began a collaborative project

with the University of

Southern California Annenberg's Norman Lear Center on September 30,

2001, with $300,000 in

federal funding. The Lear Center announced its " Hollywood, Health &

Society " program in an

April 2002 press release. 6

The Lear Center program has been the sole award recipient of CDC's

Entertainment Education

Program. The total CDC funding awarded to the Hollywood, Health &

Society program to date

is as follows:

$300,000 in fiscal year 2001

$400,000 in fiscal year 2002

$406,900 in fiscal year 2003

$281,500 in fiscal year 2004

$188,544 in fiscal year 2005

$158,500 in fiscal year 2006

$ 18,386 in fiscal year 2007

____________________________

CDC Total: $1.75 million7

The Lear Center has received funding from three other federal

agencies in addition to the CDC.

The National Cancer Institute (NCI) at the National Institutes of

Health added additional

taxpayer funds in 2006, along with the Agency for Healthcare

Research and Quality (AHRQ),

and the Health Resources Services Administration's (HRSA) Division

of Transplantation.8

Grants from these four federal agencies to the Norman Lear Center's

Hollywood, Health &

Society program equaled $513,500 in 2006 and $3.26 million from FY01-

FY07.9

The National Institutes of Health's NCI found " left over resources "

in its end of the year 2006

budget and used them to send $250,000 for the Hollywood-based

liaison, according to the

Institute's response to congressional inquiry. NCI, from 2003

through 2006, has spent $1.25

million on the Hollywood, Health, and Society program. Of these

funds, $1.1 million was " for

program operations " and $150,000 was " for evaluation of outcomes. " 10

The Hollywood, Health, and Society program received $55,000 from

AHRQ in FY06, an agency

which also paid out $55,000 in FY05 to the program.11

HRSA contributed $50,000 in 2006 and $100,000 in 2007 to the

Hollywood liaison grant and,

according to the agency, its organ transplant experts were able to

correct " misinformation " about

organ donations in fictitious television storylines such as those

on " ER, " " House, " " Grey's

Anatomy, " " Young & Restless, " and " General Hospital. " 12

89

TERRORISM FUNDS AMONG THOSE TAPPED TO FUND T.V. SHOW LIAISON:

Of the $1.75 million CDC funds spent so far on the Hollywood liaison

program, $1.31 million

came from the Office of the Director's budget, $178,500 came from

the Health Marketing

budget, and $80,000 came from the Environmental Health and Injury

budget.13

Most puzzling, in a time of limited federal funds and agency calls

for additional funds to prepare

for potential bioterrorism attacks, is the decision to spend $55,000

from the CDC terrorism

account (from the Health Education & Communication allotment), and

$18,386 from the Agency

for Toxic Substances and Disease Registry budget on the Hollywood

program.14

CDC SPENDS APPROXIMATELY $6,000 PER TELEVISION EPISODE CONSULT:

CDC reported that efforts by the Hollywood, Health & Society program

under its cooperative

agreement with the CDC have resulted in over 400 television

episodes " which have contained

public health information " nearly 90 of which " presented public

health issues in major

storylines. " 15

In response to congressional inquiry, CDC reported that from

September 2001 through August

2006, there were 281 television episodes requiring " CDC Topics and

Expert Consultations " and

an additional 29 episodes for the remainder of 2006 and the

beginning of 2007 that received

consultation (though it is not specified which of the four agencies

performed these 29

consultations).16 For $1.75 million in taxpayer funds, CDC's

cooperative agreement with the

Lear Center produced CDC topics and consultations for a total of

somewhere between 281 and

310 episodes. This amounts to spending between $6,228 and $5,645 to

consult per episode.

SOLE AWARD RECIPIENT IS HEADED BY FORMER CDC EMPLOYEE:

The Hollywood, Health & Society program (funded by CDC's

Entertainment Education

Program) named Vicki Beck as its first program project director.

Beck's last job just happened

to be running the Entertainment Education Program as a CDC employee.

17 In fact, not only had

Beck run the CDC program, but she is credited with establishing the

whole CDC entertainment

program in the first place.18

How Beck created an office of entertainment at the CDC, watched as a

Hollywood-based grantee

won the sole grant from the federal agency, and then months later

found herself as director of

that very same grantee's CDC-funded program, is a case study in how

it pays to be a former

CDC employee.

In response to congressional inquiry, CDC reported that Vicki Beck's

CDC resignation was

effective January 15, 2002, and though she was working for the

Entertainment Education

Program at CDC in September 2001 (when the Lear Center was informed

of the CDC funding

award), she " did not participate in any aspect of the review or

grant process. " 19

The Lear Center's April 2002 release announcing its Hollywood

program's launch bragged that

its new director Beck was " until earlier this year " directing the

Entertainment-Education

90

Program at the CDC's headquarters in Atlanta.20 The fact that Beck

did not personally choose

the Hollywood, Health & Society program (that would later employ

her) as a grantee, does not

overshadow the fact that while she has been directing the Hollywood-

based program, it received

$1.7 millions tax dollars from an office she helped create at the

CDC.

HOLLYWOOD LIAISON GRANT TO RECEIVE $700,000 IN 2007; AND CDC LIKELY

TO SEND

$820,000 TO $1.2 MILLION OVER FIVE YEARS:

Responses from the four federal agencies funding the Hollywood,

Health & Society program

indicate the program has received over $3.2 million since its

inception. But the Hollywood

liaison program is not ending after receiving $1.7 million from the

CDC (including from its

terrorism budget), $1.25 million from the NCI, $150,000 from HRSA,

and $110,000 from

AHRQ.

In fact, CDC has announced the availability of a one-year, $700,000

cooperative agreement for

2007 to continue the work begun by the Hollywood, Health & Society

program in 2002. The

agency is soliciting grant proposals through June 7, 2007, for a non-

profit, state or local

government, or tribal entity to work with CDC in a cooperative

agreement for a " project period

length " of five years.21 There is nothing precluding the Lear

Center's " Hollywood, Health &

Society " program from winning this next 5-year cooperative agreement.

In response to congressional inquiry, CDC reported that the $700,000

award will come from four

different agencies — CDC, NCI, HRSA, and AHRQ — with CDC

contributing approximately

$220,000 of the total amount. CDC's 2007 portion of the cooperative

agreement will include

$160,000 from its Health Marketing budget and $60,000 from the

Agency for Toxic Substances

and Disease Registry (ATSDR) budget. CDC did note in its

congressional response that, " it is

possible that CDC will increase its funding allocation prior to and

after the award date

(September 30, 2007). " 22

Despite CDC's report that three other agencies will join it in

funding the $700,000 grant for

2007, only HRSA has budgeted any funds. HRSA has contributed

$100,000 toward the new

grant in 2007. Of the two other agencies that are reportedly part of

the interagency grant: AHRQ

reported that it has no records " of any funds for this [interagency

Agreement] in FY 2007 " and

that " There has not been a request submitted " and NCI stated, " The

availability of funds for

obligation to CDC [contract with the Hollywood, Health, and Society

program for 2007] is still

not known. " 23

When asked how much CDC plans on funding for the remaining four

years of this new five-year

liaison grant, CDC replied " We expect that CDC funding would be

$150,000 to $250,000/year. "

So together with the $220,000 first-year award amount, over the next

five years CDC expects to

spend between $820,000 and $1.22 million to ensure that fictional

television shows contain

accurate health messages in their storylines.

91

" BEST INTEREST " OF THE FEDERAL GOVERNMENT?

The CDC's new request for applications (RFA) notes the project

period length is five years,

though continuation of awards for the entertainment industry liaison

will be contingent on the

" availability of funds, evidence of satisfactory progress by the

recipient (as documented in

required reports), and the determination that continued funding is

in the best interest of the

Federal government. " 24 The RFA does not mention how awarding

$700,000 for a Hollywood

liaison is " in the best interest of the Federal government. "

HOW A CDC EMPLOYEE STARTED A HOLLYWOOD LIAISON OFFICE (AND LATER

BECOMES

AN OFFICE GRANTEE):

CDC employee Vicki Beck " established and was director of an

entertainment education

program " at CDC " where she conducted research and provided education

and outreach to the

entertainment industry. " 25 Though the program was not specifically

authorized by Congress,

CDC appears to have used its broad mandate to disseminate health

messages as a justification for

getting involved with Tinseltown.26

Beck's role at CDC's entertainment education program

included " conducting research on soap

opera and prime time viewers, " establishing an awards program for TV

shows, and hosting an

" agenda-setting conference for entertainment education. " 27

CDC PROGRAM BEGAN WITH SOAP OPERA AWARDS:

While she was at CDC, Beck started " The Sentinel for Health Award

for Daytime Drama " in

1999 to give awards to soap operas that accurately featured health

themes. ABC's " One Life to

Live, " CBS's " The Young and The Restless " and " The Bold and The

Beautiful " were among the

first to receive the CDC award.28 The Award, which started in 2000

and previously went to four

soap operas a year, has grown to also include the categories of

prime time comedy, prime time

drama, prime time minor storyline, and Spanish-language telenovela.

From cruise ship sanitation to genital warts, the CDC Sentinel for

Health Awards " recognize

exemplary TV storylines that best inform, educate and motivate

viewers to make choices for

healthier and safer lives. " 29

FEDERAL HEALTH EXPERTS JUDGE T.V. SHOWS:

According to the Health Awards website, CDC and NCI experts take

time out of their busy days

controlling, preventing, and studying diseases to judge fictitious

television shows for accuracy.

Finalists that survive the expert scrutiny then move on to the

second round of judging for

" entertainment value and potential benefit to the viewing

audience. " 30

WHAT $1.7 MILLION TAX DOLLARS HAS BOUGHT IN HOLLYWOOD:

CDC officials persuaded producers of NBC's " ER " to place a condom

poster on the set " as a

roundabout way of getting the health message to TV viewers, " and

made sure that a bioterrorism

92

scenario on Fox's " 24 " is accurate.31 CDC also makes sure the proper

federal agency is

referenced in a show, trying to correct past mistakes where one show

depicted NIH personnel

doing tasks that would more likely have been the CDC's

responsibility.32 And all these

resources are provided to the entertainment industry free of charge,

courtesy of four federal

health agencies spending American tax dollars.

" We've focused on being a resource for TV writers who call us all

the time, " Vicki Beck told

one reporter. " They've got an idea, they want, say, a certain

character to suffer from a specific

disease, and they need to talk to an expert on that topic to see, in

fact, whether that makes sense.

We then put them in touch with whomever can best help them, whether

that person is with the

CDC or UCLA or NCI or NIH, wherever. " 33

Beck's federal funded program has worked with writers

from " ER, " " Grey's Anatomy, "

" House, " the various " Law & Order " and " CSI " shows, " Star

Trek, " " Desperate Housewives, "

and numerous soap operas such as " General Hospital, " among others.

FROM FEDERALLY FUNDED TV TO FEDERALLY FUNDED VIDEO GAME CONSULTING?

The former CDC employee, turned CDC grant recipient is now looking

to branch out to what she

calls " new emerging media " such as video games, especially since the

TV networks are putting

more and more interactive technologies on their web sites.34

Vicki Beck told the Hollywood Reporter, " For example, NBC currently

has over a dozen games

on its Web sites, including `Wheelchair Challenge' on its `ER' Web

page, and we want to be a

resource for the game makers, to assist them when, say, they need to

know how a wheelchair

needs to be used. We can put them in touch with the experts who the

game developers' writers

need for that sort of information. " 35

CDC IS NOT ALONE IN FUNDING HOLLYWOOD LIAISONS:

While CDC and its three collaborating agencies (NCI, HRSA, and AHRQ)

are paying for the

Lear Center Hollywood liaison, federally funded forays into

Hollywood do not end there.

Evidently tax dollars also supported a CDC " smoking prevention

employee " from 2002 to 2004

to try and get Hollywood movie producers to cut back on on-screen

smoking.36

The Department of Defense (DOD) and Department of Homeland Security

(DHS), the Central

Intelligence Agency (CIA), and the National Aeronautics and Space

Administration (NASA)

have all paid federal employees to outreach to Hollywood.37 The

Department of Homeland

Security (DHS) hired Bobby Faye Ferguson in 2004 as DHS's " liaison

to the entertainment

industry, " a post that carried a yearly salary of over $100,000.38

She is still employed by DHS

and spends an additional $10,000 a year to cover travel, expenses,

and equipment/supplies.39

Ferguson previously helped fill the Hollywood liaison slot at NASA.40

The Department of Defense has an " Air Force Entertainment Liaison

Office " and a website

entitled, " Wings Over Hollywood. " 41 The Department of the Army uses

its public affairs office

93

in Los Angeles as " the entertainment industry's direct liaison to

the United States Army. " 42 The

CIA has a " Publications & Film Industry Liaison. " 43

COULD MEDIA AFFAIRS OFFICE MULTITASK?

No one is suggesting that CDC not answer questions posed of it from

the taxpaying public,

including the taxpaying public in Hollywood. In fact, the CDC has a

media relations department

that fields similar questions and requests for expert interviews

from members of the news

media.44 The Entertainment Education Program at CDC functions to

reach out to the " media " of

entertainment. One possible solution that would save the taxpayers

money, eliminate the need

for a CDC entertainment office, and free up potentially millions of

dollars in funding, would be

to have CDC's media affairs office field questions from the

entertainment industry. If many

Americans are getting some health news from fictional television

shows, as CDC claims, then

the media affairs office seems like a logical nexus.

The Army, as noted above, currently uses public affairs employees to

work with Hollywood —

perhaps the CDC could set up a similar service (without an on-

location office).

A ROLE BEST FILLED BY THE PRIVATE SECTOR?

It is hard to argue in this day and age that television producers do

not have an incentive, without

federal taxpayer involvement, to get their storylines correct.

Television shows that are entirely

about medicine such as " ER " and " House, " for example, risk losing

credibility with their viewers

unless they get their medicine and the health storylines correct.

Advertisers on those shows,

including many related to the health industry, serve as another

layer of built-in accountability.

With the multi-billion dollar television industry, million-dollar-

per-episode salaries for TV

actors, and millions of dollars of revenue from daytime and prime-

time dramas, should it be a

priority for taxpayers to have CDC-funded Hollywood liaisons to help

producers get the health

storylines correct?

If there is such an overwhelming need for a liaison to a multi-

billion dollar industry, perhaps

CDC could use existing personnel whose job descriptions already

include connecting health

experts with those reporting on health matters. Or, more fiscally

prudent, perhaps Hollywood

could fund the liaison itself. Conventional wisdom might cause

taxpayers to ask, why would

Hollywood pay for something if the federal government is giving it

to them for free?

1 Graphic from 2007 entry form,

http://learcenter.org/pdf/Sentinel07Entry.pdf, accessed April 2007.

2 2007 CDC Notice of Availability of Funds for ative Agreement

for the Development, Operation, and

Evaluation of an Entertainment Education Program, CDC-RFA-HM07-702,

http://www.cdc.gov/od/pgo/funding/HM07-702.htm, accessed May 2007.

3 Ibid.

4 Id.

5 CDC Entertainment Education website,

http://www.cdc.gov/communication/entertainment_education.htm,

accessed April 2007.

6 " Public Health Expertise Brought to Entertainment Industry by USC

Annenberg's Norman Lear Center, " USC

Annenberg News, April 2, 2002,

94

http://annenberg.usc.edu/AboutUs/PublicAffairs/AbergNews/release20020

402.aspx; " AIDS drives plots on TV, "

USA TODAY, August 7, 2007,

http://www.usatoday.com/life/television/news/2006-08-07-aids-on-

tv_x.htm; " A

healthy approach to game development; Playing Games, " Hollywood

Reporter, August 17, 2006,

http://www.hollywoodreporter.com/hr/search/article_display.jsp?

vnu_content_id=1003019257.

7 May 11, 2007 e-mail response from CDC official in response to

inquiry from Senator Tom Coburn's office.

8 Norman Lear Center website,

http://www.learcenter.org/html/projects/?cm=hhs, accessed April 2007.

9 May 11, 15, 18 and 30, 2007 e-mail responses from CDC and HHS

officials in response to inquiry from Senator

Tom Coburn's office.

10 May 18, 2007 e-mail correspondence from HHS Legislative Affairs

regarding NIH's contribution, in response to

congressional inquiry from the office of Senator Tom Coburn. " NCI

support of the program has come at the end of

each fiscal year, with left over resources being obligated for the

CDC contract at the end of the fiscal year. " NCI

spent the following funds " FY03: $300,000 for program operations and

$50,000 for evaluation of outcomes; FY04:

$300,000 for program operations and $50,000 for evaluation of

outcomes; FY05: $250,000 for program operation

and $50,000 for evaluation of outcomes; FY06: $250,000 for program

operation; FY07 - The availability of funds

for obligation to CDC [contract with the Hollywood, Health, and

Society program] is still not known. …NCI does

not know if it will have end-of-the-year funds available this year

or if funds will be available in FY08. If funds are

available, the NCI support would still be provided through the

[$700,000] interagency agreement that CDC is now

re-competing. "

11 May 17, 2007 e-mail correspondence from HHS Legislative Affairs

regarding AHRQ's contribution, in response

to congressional inquiry from the office of Senator Tom Coburn.

12 May 30, 2007 e-mail response from HHS and HRSA officials in

response to inquiry from Senator Tom Coburn's

office

13 Footnote 7, op. cit.

14 Ibid.; May 15, 2007 e-mail response from CDC official in response

to follow-up inquiry from Senator Tom

Coburn's office.

15 Footnote 2, op cit.

16 Supra footnote 7, " Attachment A - Television Episodes.xls "

and " Attachment B - Upcoming Air Dates 2006-2007

TV Season.xls. "

17 Footnote 6, USC Annenberg News, op. cit.

18 Norman Lear Center bio on Vicki Beck,

http://learcenter.org/incEngine/incEngine_Player_minimum.php?

content=cm & inc=PRINT & cm=beck, accessed

April 2007.

19 Supra footnote 7, " The University of Southern California was

informed of the award on September 24, 2001. The

budget year started September 30, 2001. "

20 Supra footnote 6, USC Annenberg News.

21 Supra footnote 2.

22 May 15, 2007 e-mail response from CDC official in response to

follow-up inquiry from Senator Tom Coburn's

office.

23 Footnote 9, op. cit.

24 Supra footnote 2.

25 Footnote 18, op. cit.

26 Supra footnote 2.

27 Supra footnote 18; " Summary Report: Setting a Research Agenda for

Entertainment-Education, May 23-24, 2000,

Atlanta, Georgia, A Conference Sponsored by CDC's Office of

Communication,

http://www.cdc.gov/communication/eersrcha.htm, accessed April 2007.

28 Footnote 5, op. cit.

29 " Sentinel for Health Awards " webpage at the Norman Lear Center,

http://learcenter.org/html/projects/?cm=hhs/sentinel, accessed April

2007.

30 Ibid.

31 Supra footnote 6, Hollywood Reporter.

32 " CDC tries to ensure shows get their medical plots right; The

agency just wants TV to follow standard doctor

advice: First, do no harm, " The Associated Press, April 21, 2007.

33 Supra footnote 6, Hollywood Reporter.

34 Ibid.

35 Id.

95

36 Id.

37 CRS Memo to the Subcommittee on Federal Financial Management,

Government Information and International

Security/Senate Committee on Homeland Security and Governmental

Affairs, dated May 4, 2007, in response to

congressional inquiry, regarding " Offices and Programs in Federal

Departments and Agencies That Act as Liaisons

to the Entertainment Industry. "

38 USA Today, March 8, 2005 and March 2004 DHS job posting on

www.usajobs.com, as quoted by the House

Republican Study Committee's " Department of Homeland Security Hires

Hollywood Liaison, " May 2005,

http://www.house.gov/hensarling/rsc/gov_waste.shtml.

39 Footnote 37, op. cit.

40 Footnote 38, op. cit.

41 " Wings Over Hollywood, The U.S. Air Force Entertainment Liaison

Office " website,

http://www.airforcehollywood.af.mil/index2.html, accessed April 2007.

42 " Movie and Entertainment FAQ's, " U.S. Army Outreach website,

http://www4.army.mil/outreach/offices/losAngeles/questions/,

accessed April 2007.

43 Supra footnote 38.

44CDC Media Relations, http://www.cdc.gov/od/oc/media/index.htm.

96

CDC's Top Financial Officers Take Home Bonuses

Sometimes it pays to be in government — literally. Since Bush

Administration appointee Dr.

L. Gerberding became the director of the CDC in 2002, the

people managing the agency

have seen their share of bonuses rise.

According to the New York Times (NYT), the top three CDC financial

officers have taken in more

than a quarter million dollars in bonuses over the last several

years. Taxpayers have paid out

$285,637 in bonuses since 2002 for the CDC's chief operating

officer, chief financial officer,

and director of finance.1 Bonuses are as follows:

$147,863 in premium bonuses (those greater than $2,500) from 2002

through the first half of

2006 for CDC's chief operating officer (COO), H. Gimson III;

$84,894 in bonuses from 2002 through the first half of 2006 for

CDC's chief financial officer,

Barbara W. ;

and $52,880 in premium bonuses from 2002 through early 2006 for

CDC's former director of

finance, C. Tibbs.2

CDC's COO Gimson, bonus recipient, has stated: " These are

one-time recognitions, and

I'm proud to have received [them]. …We are committed to rewarding

the outstanding achievers

at CDC. "

According to a NYT analysis of CDC's financial records, since Dr.

Gerberding became

director of the centers in 2002, " finance and other management

officials have received a growing

share of the bonuses. The share of premium bonuses given to those

within the director's office

has risen at least tenfold under Dr. Gerberding's leadership. " 3

In 2005, the records show that officials in Dr. Gerberding's office

received 60 premium bonuses

totaling $515,075, or about four percent of all bonuses granted

within the centers, compared to

the $30,000 in bonuses given out in 2000 (0.4 percent of the bonuses

distributed agency wide) in

the office of the previous director.

Before Dr. Gerberding's appointment, members of the CDC director's

inner circle rarely

received premium bonuses of $2,500 or more. After her arrival, cash

awards increased, the NYT

reported. The bonuses for Mr. Gimson, the COO, which included seven

cash awards, were

approximately twice the amount granted to any other CDC employee.4

CDC explained the bonuses as part of an Administration priority to

transform the CDC's

management and told the New York Times, " If we want to retain

people, we need to recognize

them. We are operating in a highly competitive environment. " 5

1 " Inner Circle Taking More of C.D.C. Bonuses, " The New York Times

(NYT), September 17, 2006; " Finance Office

of Disease Control Agency Is Slipshod, Federal Report Says, " NYT,

September 30, 2006.

97

2 " CDC official replaced in wake of finance probe, " Atlanta Journal-

Constitution, October 4, 2006. Mr. Tibbs has

been reassigned from director of finance to chief management

official in the CDC's Office of Workforce and Career

Development.

3 Footnote 1, " Finance Office, " op. cit.

4 Footnote 1, " Inner Circle, " op. cit.

5 Ibid., quote from Glen Nowak, chief of media relations at the CDC.

98

The Revolving Door: How a Former CDC Executive Lands

CDC Contracts Worth Millions for Minority-Owned Companies

1

Jack , former CDC employee

& minority-owned company executive

While CDC employees' pay may not be equal to those in the private

market, contractors who

previously were employed by the CDC appear to have found a lucrative

way to make their CDC

connections pay off.

In 1999, Arthur " Jack " retired as the CDC's chief financial

officer and the head of

management and operations after a 35-year career with the agency. A

year after his departure, he

became a CDC consultant, and since 2000, the CDC has given almost

$22 million in work to two

companies affiliated with , according to reviews of federal

documents by The Atlanta

Journal-Constitution (AJC). The CDC has hired 's firms 79

times — 67 times without

competitive bidding — for jobs ranging from helping to plan a

sweeping reorganization of the

agency's management to compiling five news clippings a day for top

CDC executives.2

Under a CDC program that gives contracting preferences to small,

minority-owned businesses,

two firms employing (who is a white male) won CDC contracts.

McKing Consulting

Corp. (where in 2004 was a vice president in charge of an

Atlanta office) and

Management Assistance Corp. (where he was a vice president from 1999

to 2002) both got

contracts either without bidding or after competing only against

other minority-owned firms.

Lawyers for both companies told the ACJ that before they hired

the firms had done little

or no business with the CDC.

In fact, before hiring , McKing Consulting had obtained only

one contract from the CDC,

said Joanne Zimolzak, a lawyer for the company. Since the former CDC

CFO came on board,

CDC has awarded McKing 76 jobs, worth $14.6 million. In 66

instances, according to a

database of CDC contracts reviewed by the AJC, the agency gave work

to McKing without

seeking competitive bids. For other work, McKing competed with as

few as three other

minority-owned firms. CDC officials noted in purchasing documents

that the company's

99

employees " already have a thorough understanding of the

organizational structure and

administration " of agency programs. McKing, the officials wrote,

was " perhaps the only

available contractor. "

McKing helped the CDC update its smallpox response plan, evaluated a

women's health

program, and provided laboratory analysts, among other jobs. The

agency also hired McKing

several times for communications and web design jobs. The CDC's

Office of Terrorism and

Preparedness Response hired McKing to provide a consultant

for " administrative support. "

Among the consultant's required qualifications: " knowledge of front

office etiquette. "

When asked about the CDC/ connection, Rapoport, a

lawyer for McKing

Consulting, said " this is not uncommon … The revolving door is how

the country seems to

operate. " When CDC officials need outside help, Rapoport said, " it

wouldn't surprise me if they

felt more comfortable if they had someone like Mr. there. "

Gimson, the CDC's chief operating officer, said companies

connected with former CDC

employees such as receive no special treatment. However, in

an earlier interview,

Gimson said, referring to : " There's certainly an advantage.

He knows the people at

CDC, and they know him. …He would reach out to individuals he would

know. Probably more

so, they would reach out to him. "

About 45 minority-owned firms qualify for contracting preferences at

the CDC, Gimson said. Of

the agency's 31 active contracts with minority businesses, McKing

held 15, a government report

from late 2003 indicated. In addition, 17 former CDC employees work

as consultants to CDC

through contracts with 's firm.

was prohibited by federal law from doing business with his

former agency for one year

after his departure, and from working as a consultant on projects in

which he had been directly

involved as a federal official. According to CDC officials,

went to some lengths to

follow the law, and sought guidance on becoming a contractor for

federal agencies. One former

CDC ethics official noted, " It's legal and ethical for them to come

back under certain

circumstances. Mr. walked a straight and narrow line. "

Records do reflect that he

appears to have followed these guidelines.

Before starting with McKing Consulting in 2002, worked for

Management Assistance,

another minority-owned business. A little over a year after he

started there (which coincided

with his having been retired from CDC for a little over a year), the

company received its first

contract from the CDC, the first of three it would get while

employing . He " marketed

and obtained " two of the contracts, worth about $6 million, a

company lawyer told the AJC, but

played no role in the third deal, worth $1.2 million. One of the

contracts negotiated was

awarded with no competitive bidding.

1 Drawing of Jack that appears on McKing Consulting website,

http://mcking.com/execs.shtml, accessed

March 2007.

2 All references from " Former workers cash in at CDC: Ex-employees

take `revolving door' back to agency, where

they steer millions to outside contractors, " The Atlanta Journal-

Constitution, May 19, 2004.

100

CDC's Interim Ombudsmen and Former Employees

Paid $250,000 to Help Build Employee Morale

New Full-Time Morale Office to Cost Over $1 Million

At a time of constrained budgets, growing threats of bioterrorism

and disease outbreaks, CDC

decided to spend hundreds of thousands of dollars on outside

contractors to help improve

employee morale and the quality of life at CDC. It just happens that

the two men hired under a

temporary CDC contract are former CDC employees, who work for a firm

founded by a former

CDC official. The interim ombudsmen have recommended that CDC make

the morale job a fulltime

post, a proposition that would likely cost taxpayers millions of

dollars over the next decade.

And the CDC wasted little time and has begun a search for a full-

time ombudsman.

On October 1, 2006, the CDC hired two former CDC managers to serve

as interim ombudsmen

under a one-year, $250,000 contract.1 The interim ombudsmen, ph

McDade and Gerald

Naehr, both work for Consulting, a firm founded by CDC's

former Deputy Chief

Operations Officer ph 2 Their job is to serve " as an

additional resource for employees

to use in addressing their workplace concerns, " to help improve the

workplace and also the

" quality of work-life at CDC. " 3

CDC employees can only contact the Atlanta-based office seven hours

a day, from 9 a.m. to 4

p.m., Monday through Friday.4 According to The Atlanta Journal-

Constitution (AJC), " The idea

of a CDC ombudsman came in part from discussions five former CDC

directors had with

Gerberding last spring when they raised concerns that poor morale

and an exodus of top

managers were putting the agency and its public health mission at

risk. " 5

ONE PERCENT OF CDC EMPLOYEES CONTACT OMBUDSMAN OFFICE:

In a short, e-mailed report from the CDC ombudsmen to all CDC

employees, it was reported that

from October 2006 through January 2007, the ombudsmen have had a

total of 26 inquiries

involving 38 persons.6 They reported that of the 26 inquiries, eight

were about personnel

problems (pay, promotion, or benefits); eight involved CDC policy or

management systems;

eight were concerns about the workplace environment; one was about

office inefficiency; and

one was about a technical problem. Nine of the 26 inquiries were

resolved; six were referred to

other employee resources at CDC; and work on 11 inquiries was

reportedly still in progress.

In a March 2007 letter to Senator Grassley (R-IA), CDC

Director Dr. Gerberding wrote,

" Approximately 50 persons, or less than 1 percent of CDC employees,

have contacted [the

ombudsmen's] office since September 2006. " 7

According to an April 2007 report from the ombudsman's

office, " During the period from

October, 2006–March 22, 2007, we had 98 visitors to the Ombudsman

Office (i.e., persons who

contacted us by telephone or e-mail or came to our office to discuss

workplace-related

problems). " Collectively, these 98 visitors registered 89 concerns.8

101

TAXPAYERS FOOT BILL FOR PRICEY MORALE CONSULTATIONS:

Out of the more than 15,000 CDC employees and contract workers, this

contact rate amounts to

taxpayers funding the ombudsman's office for approximately $2,551

per person visiting or

$2,809 per complaint.

The CDC ombudsman office staff also has visited ombudsman offices at

the National Institutes

of Health, U.S. Food and Drug Administration, and the Tennessee

Valley Authority (the nation's

largest public power company) " to understand how those offices

operate and to identify the best

approaches for CDC's Ombudsman Office " and has met at least once

with the CDC director to

discuss problems and possible solutions.9

THE GROWTH OF GOVERNMENT — CDC POSTS OPENING FOR FULL-TIME " OMBUDS " :

The interim ombudsmen recommended to the CDC director that the

agency establish a

permanent CDC ombudsman office with a full-time director to continue

their work, and the

director indicated that she planned to follow the suggestion. Dr.

Gerberding's spokesman told

the AJC, " She's both impressed and pleased with the work to date and

is committed to moving

forward with the next steps in the creation of the ombudsman's

office. " 10

On April 9, 2007, the CDC posted a job opening for a new, Atlanta-

based CDC ombudsman to

be paid at a GS-15 salary level. That salary level is between

$107,800 and $140,200 per year,

which amounts to $1.1-$1.4 million over the next 10 years. According

to the posting, " The

incumbent will serve as an Ombuds for the CDC, and will interact

with, listen to, and receive and

analyze complaints, problems or questions from customers. " 11

1 " CDC to hire full-time ombudsman, " The Atlanta Journal-

Constitution (AJC), January 23, 2007.

2 Consulting, Inc. website,

http://www.carterci.com/history.htm, accessed April 2007.

3 " Subject: Report from CDC's Ombudsman Office, January 2007, " e-

mail from CDC Ombudsman

Announcements, published by the AJC, January 23, 2007.

4 Ibid.

5 Footnote 1, op. cit.

6 Ibid.; " Ombudsmen Program, " e-mail from CDC Director Dr.

Gerberding, January 22, 2007, published by the

AJC, January 23, 2007.

7 Letter from Dr. Gerberding to Senator Grassley dated

March 5, 2007, published by the AJC, March

23, 2007,

http://alt.coxnewsweb.com/ajc/pdf/cdc/gerberdingletter.pdf, accessed

April 2007.

8 " Ombudsman Quarterly Report, " e-mailed report to all CDC employees

from the Ombudsman Office, April 4,

2007, published by the AJC, April 5, 2007.

9 Footnote 3, op. cit.

10 Supra footnote 1.

11 USAJOBS, Ombudsman GS-301-15, Open Period April 09, 2007 to

Monday, April 30, 2007,

http://jobsearch.usajobs.opm.gov/getjob.asp?

JobID=56080704 & AVSDM=2007%2D04%2D09+07%3A50%3A32 &

Logo=0 & q=ombudsman & FedEmp=Y & sort=rv & vw=d & brd=3876 & ss=0 & FedPub=Y & SUBMI

T1.x=0 & SUBMIT1.

y=0, accessed April 2007.

102

HHS Secretary Uses CDC's Leased Jet for Meetings and Speeches:

CDC Defends Use

The CDC has a $3 million, annual lease on a 14-seat Gulfstream III

jet, which costs $3,000 for

every flight hour, in addition to the $252,000 a-month-cost the CDC

pays for 24-hours-a-day,

365-days-a-year jet access. Since December 2005, the agency has

leased the jet through Phoenix

Air Group, a Georgia aviation company. From January to June 2006,

the Atlantic Journal-

Constitution (AJC) reports that flight logs indicate the CDC had

used the jet for 43 total hours,

three times for emergencies and three times for training exercises,

at a cost of $164,000.1

In addition to this jet, as of May 2007, CDC also has access to two

other, smaller jets that remain

on call in certain circumstances, such as dealing with stockpiles of

medicines and supplies for

public health emergencies. Together these two smaller jets cost $3.8

million a year for 180 flight

hours, and cost $2,286 for each additional flight hour.2

JET-SETTING HHS SECRETARY:

According to an analysis of the CDC's Gulfstream III's flight logs

by the AJC, Health and

Human Services (HHS) Secretary Leavitt used the jet for HHS

business travel on 19

trips to more than 90 cities from January through mid-June 2006, at

an additional flight hour cost

to taxpayers of $720,000.3

According to the Secretary's spokesman, these trips fall under

congressional authorization that

allows the CDC to share the jet with the HHS secretary " in times of

emergencies " and during

" significant events. " However, according to ABC News, the law makes

clear that those

significant events should be " unpredictable " disasters like Katrina,

not scheduled meetings and

speeches.4

Secretary Leavitt's spokesman told the AJC that Secretary Leavitt

used the plane to visit places

around the country to help millions of senior citizens sign up for

the new Medicare Part D drug

benefit, to personally assess some of the early problems with the

program, to help mobilize the

country in its preparations for a possible influenza pandemic, and

to travel to New Orleans to

help the city rebuild its health care infrastructure.5

Secretary Leavitt defended his use of the jet saying he makes use of

it only when commercial

travel is too slow to meet his schedule. " Actually, there's nothing

political about this, " he told

ABC News. " This is carrying out the business of the Department of

Health and Human

Services. " 6

103

On two occasions in 2006, the CDC needed the jet for medical

emergencies, but Secretary

Leavitt was using it so the CDC had to hire another jet at

additional taxpayer expense.7

CDC CALLS SECRETARY'S JET TRAVELS " CRITICALLY IMPORTANT " :

According to " talking points " from the CDC's communication director,

e-mailed out the

morning the original ACJ article appeared, " It is absolutely

imperative that CDC have access to

these planes. These planes directly support our mission to be able

to mobilize people and

supplies on a moment's notice to protect our nation's health. Time

is precious and in some cases

minutes can make the difference between life and death. …The costs

of these planes are

necessary to insure that CDC personnel with necessary supplies can

be wheels up within two

hours of notification. …Secretary Leavitt['s] … trips are critically

important to address two of

the biggest health challenges facing our country right now —

Medicare and Pandemic

planning. " 8

A document posted on the CDC website explains in further detail some

other recent uses for the

jet including: helping to rush an emergency supply of botulism anti-

virus across the country so it

could be shipped to Thailand for a possible outbreak, investigating

a case in New York City of

inhalation anthrax, and monitoring an outbreak of mumps in Kansas.

The document notes that

the jet can be dispatched only for official use " for mission

requirements, such as transporting a

sampling team or specimens, or other official travel, such as agency

business, typically only after

a favorable comparison with the cost of commercial travel. " 9 The

document is silent regarding

plane use for public appearances to promote Medicare prescription

drug benefits or whether or

not those trips were authorized after comparisons with commercial

travel.

CONGRESSIONAL EFFORTS TO RESTRICT USE FAIL:

Language was inserted in the Senate version of the fiscal year 2007

HHS funding bill to restrict

CDC aircraft travel " for emergency use only, " but the restriction

language ultimately was

dropped out of the bill passed in January 2007 by the new 110th

Congress.10

1; " Cabinet official is primary user of CDC jet, " Atlanta Journal-

Constitution (AJC), June 14, 2006; " Health chief

shouldn't use CDC jet, " AJC, June 16, 2006; photo from CDC website,

www.cdc.gov.

2 " CDC rarely uses costly leased jets, " AJC, May 28, 2007.

3 Footnote 1, Cabinet official, op. cit

4 " HHS Secretary's Use of CDC Jet Cost Taxpayers $720,000:

Leavitt Authorized to Use Private Plane

Only in Emergencies, Not for Political Business " ABC News, June 17,

2006,

http://abcnews.go.com/WNT/story?id=2085927.

5 Supra footnote 1.

6 Footnote 4, op. cit.

7 Ibid.

8 E-mail from Donna M. Garland, Director, CDC Office of Enterprise

Communication, June 14, 2006.

9 " CDC Plane Decreases Response Time, Increases Readiness, " CDC

website document, last modified June 14,

2006, http://www.bt.cdc.gov/planning/cdc_plane.asp, accessed

November 2006.

10 Departments of Labor, Health and Human Services, and Education,

and Related Agencies Appropriations Act,

2007 (S. 3708), " SEC. 221. …Provided, That travel on such aircraft

shall be restricted for emergency use only. "

104

HOW CDC FUNDING IS COUNTERINTUITIVE:

CDC-funded Bar Night

and Manual on How to Throw an Alcohol Party

Some CDC grantees justify the use of non-traditional or risqué

approaches " to reach their

target population, " but it would seem the CDC would draw the line at

grantees actually

promoting activities shown to increase the diseases CDC is trying to

fight. Research has

demonstrated time and time again that drinking alcohol, especially

in excess, is considered

a risk factor for spreading sexually transmitted diseases (STDs),

such as HIV. Alcohol has

been shown to decrease a person's inhibitions, which in turn may

lead to risky behavior,

including risky sexual behavior.

Unfortunately, in the case of one San Francisco HIV prevention

group, its risqué approach

trumped sound public policy and taxpayers were left footing the bill.

CDC-FUNDED MAGAZINE DETAILS HOW TO THROW A HOUSE PARTY:

The CDC-funded STOP AIDS Project (SAP) of San Francisco received

nearly $700,000 a

year in federal HIV prevention funds from the CDC. SAP published a

Winter 1999/2000

resource magazine for black gay and bisexual men of the San

Francisco Bay area entitled

" Our Love. " The magazine, which states that it was funded " with a

grant from the Centers

for Disease Control and Prevention, " includes an article

entitled " Party at BJ's, " which

explains how to have a " house party " and how much alcohol to serve.1

THE PARTY AT BJ'S ARTICLE EXPLAINS HOW ALCOHOL HELPS A HOUSE PARTY:

" The Drinks

" One more thing. It may not be a necessity but it sure helps. And

that is

alcohol. You don't have to go broke trying to get enough booze for

the whole

creation to drink, but a selection is a must. Since you have invited

people

from all of your social circles, you know there will be wine-heads,

the beernuts,

the cocktail lushes, and a few folks who simply don't touch the

stuff.

And everyone should have a cup in their hand of something that will

hit the

spot. Here's what to do. And you may look like a suicidal drunk in

the line at

the grocery store, but go and buy a little bit of every kind of

drink. At least

two kinds of wine, red and white. Get at least two kinds of liquors,

dark and

light (rum and vodka). Have a few beers in the fridge, maybe a 12

pack or

two. Have enough juice and soft drinks to use as mixers and to drink

straight.

And splurge with a little grenadine and some lime. It doesn't have

to be a full

bar, but keep smiles on the peoples faces with selection. "

105

TARGET AUDIENCE HAS HIGH PERCENTAGE OF HIV INFECTION:

A May 2001 CDC study of men who have sex with men (MSM) in six major

U.S.

cities found that nearly one in every three gay or bisexual African

American men is

HIV-positive, and prevalence rates in this population continue to

climb.2 In addition,

in 2005, black gay men still represented over 30 percent of the new

HIV/AIDS cases

among gay men and over 50 percent of the new cases are young adults.3

YET CDC FUNDING WAS USED TO ENCOURAGE USE OF ALCOHOL, A KNOWN HIV

RISK

FACTOR:

According to CDC's own studies and resources, alcohol increases the

risk for HIV.

" The use of alcohol and illegal drugs continues to be prevalent

among some MSM

and is linked to risk factors for HIV infection and other STDs.

Substance use can

increase the risk for HIV transmission through the tendency toward

risky sexual

behaviors while under the influence and through sharing needles or

other injection

equipment. …[Methamphetamines and other " party " drugs] along with

alcohol and

nitrate inhalants ( " poppers " ), have been associated with risky

sexual practices

among MSM. " 4

So the STOP AIDS Project targeted a high-risk, high-rate-of-

infection population with an

article on how to throw an alcohol party … and it was done using

CDC's HIV prevention

funds. If the target audience followed the CDC-subsidized

instructions and hosted a booze

party that led to risky sexual behavior, it is possible that more

HIV infections could have

been the result.

BAR NIGHT FOR HIV+ MEN:

Two years later, the same CDC-funded group hosted a " Bar Night " at

Club Rendezvous

advertised as " A social event with other HIV+ men. " According to the

invite, " Nonalcoholic

drinks and bar nuts provided. Mixed drinks, beer, and wine are

available for

purchase. Come find out what question is on everyone's mind! " 5

To recap: a group that receives federal funds spends money to target

not only a high-risk

population, but one actually carrying the communicable disease HIV,

and hosts the targeted

event at a bar with alcohol, a known risk factor for spreading HIV.

1 Winter 1999/2000 STOP AIDS resource magazine for black gay and

bisexual men of the San Francisco Bay

area entitled " Our Love, " page 5.

2 " Assessing the Impact of HIV/AIDS on African Americans, News and

Features, " AmfAR AIDS research,

March 21, 2002, http://www.amfar.org/cgi-bin/iowa/news/record.html?

record=58, accessed December 2006.

3 " Tracking AIDS, " a PBS NewsHour with Jim Lehrer, June 15, 2005,

http://www.pbs.org/newshour/bb/health/jan-june05/aids_6-15.html,

accessed December 2006.

4 CDC website,

http://www.cdc.gov/hiv/topics/msm/resources/factsheets/msm.htm,

accessed January 2007.

5 " PF Bar Night Polk, " Tuesday, May 7, 2002, sponsored by the STOP

AIDS Project,

http://www.stopaids.org/mod.php?

mod=calendar & op=show_event & event_id=119, accessed May 2002.

106

CDC Sets Bioterrorism Results-Oriented Goals After Spending Billions

While L.A. spends CDC grant money on gift bags, Hollywood actors,

Santa Claus books, and a pool safety video …

1

In the post 9/11 environment, Congress has significantly increased

funding for homeland

security threats such as bioterrorism. As political observers have

noted, Members of

Congress tend to fight over how this funding gets distributed with

nearly everyone

claiming his or her state or district as a possible target for

terrorism. The bioterrorism

grants distributed to states through CDC have became part of this

political in-fighting, as

Congress directed CDC to dole out the taxpayers' money across all 50

states, and directly

to four metropolitan cities. Even though CDC was required to spread

the grant money

across the country, CDC does not appear to have developed an

adequate system of

measuring how states were spending the funding and whether or not

states were prepared

for bioterrorist attacks after spending the billions of taxpayers'

dollars sent their way.

In 2004, the CDC distributed $849.6 million for bioterrorism

preparedness grants, part of

$1.3 billion Congress approved that year for states, territories,

and four metropolitan

areas: Los Angeles County, Chicago, New York City, and Washington,

D.C.2 It was the

third installment since Congress increased public health

preparedness grants following

the terrorist attacks and anthrax mailings of 2001. According to the

HHS Inspector

General (IG), bioterrorism funding began in 1999, but CDC funding

for bioterrorism

preparedness increased 1,276 percent from $66.7 million in fiscal

year 2001 to $918

million in FY2002.3 From August 1999 until 2004, CDC allocated over

$2 billion to 50

states and 12 localities in bioterrorism preparedness grants.4

L.A. COUNTY SPENDS $2 MILLION IN CDC BIOTERRORISM FUNDS ON

QUESTIONABLE

EXPENSES; CDC SAYS IT DOESN'T HAVE TIME TO SCRUTINIZE GRANTS:

5

Over a two year period, from 2002 to 2004, the CDC released more

than $2.7 billion

nationwide in bioterrorism grants, with Los Angeles County receiving

$83 million — $14

107

million of which went unspent. In 2006, the county was given an

additional $27.9

million.6

Spending every federal dollar received, and not necessarily spending

it wisely, appeared

to be the goal of L.A. County in 2003. The county's bioterrorism

preparedness director,

according to a report in the L.A. Times, told her staff in May 2003

about a meeting to

" emphasize the importance " of spending all the grant money given to

the county. " We

have repeatedly assured Dr. Fielding [the county's public health

director], and the Board

[of Supervisors], that we will not forgo any of this money, " Grigsby

wrote. " Please be

able to demonstrate how we can make this happen. " 7

And make it happen they did. An L.A. Times review found that L.A.

County spent more

than $2 million of its CDC bioterrorism grant money for questionable

purchases of

services and supplies unrelated to bioterrorism, and found that " at

times, the spending has

stretched the definition of terrorism readiness.8

The county used CDC bioterrorism funds to hire Hollywood actors

to play patients in a half-day smallpox vaccination drill in 2004.

The tab for taxpayers: $57,045 for the firm to hire the actors,

$10,000 for gift certificates, $13,600 for pens, digital thermometers

and bags to hold the gifts, and thousands more for food and

transportation.9 The county's public health director told the L.A.

Times it was much

cheaper to use paid actors than county employees.

L.A. County also spent more than $128,000 in CDC bioterrorism

funds " for tchotchkes

[trinkets] to be given away to the public, including letter openers,

whistles, magnets,

mouse pads, flashlights, pens, travel toothbrushes and emergency

kits. The department

spent $1,000 on nylon discs for Public Health Week, emblazoned with

the slogan

`Nutrition and Physical Activity: Keys to Health.' And it spent

$4,145 on clipboards,

notepads and stress balls to give away at a forensic epidemiology

conference. " 10

Some other expenditures funded by CDC's bioterrorism grants to L.A.

County include:

• " At least $170,000 to train department staff on how to put

together videos to be

viewed online. Two videos have been produced: one on the role of

public health, the

other on home pool safety.11

• " A $4,675 teleprompter so that Fielding and others can `face the

camera and be able

to read a prepared speech,' plus nearly $450 in upgrades to the

teleprompter, $2,187

for a laptop to write scripts for the teleprompter and $3,392 for

a `very special

portable microphone for excellent quality remote interviews and

scene descriptions,'

according to the expense reports. Hundreds more went to replace a

podium that had

been `damaged by rodents.'

• " More than 70 high-end desk chairs at about $600 each and about

800 computers,

although only 171 staff members are funded by the bioterrorism

grant. " [The

County's public health director told the L.A. Times the computers

are used by public

health employees who may be needed to respond to a disaster.]

108

• " $4,629 for printer cartridges because of an `increased amount of

bite reports' related

to West Nile.

• " Assorted inexpensive but puzzling items such as

motivational posters, a $46 mahogany tape dispenser and

four copies of the book `The Leadership Secrets of Santa

Claus.' " 12 [Note: The Santa book begins, " Believe you

me, having to smile and be jolly everyday when you're

wearing the same thick, hot, red-wool suit (that itches

like crazy) is no picnic. " 13]

PREPAREDNESS EQUALS DISTRIBUTING TOKEN GIFTS WITH EMERGENCY CONTACT

INFORMATION:

The director of the UCLA Center for Public Health and Disasters,

which has received

hundreds of thousands of dollars from the county to conduct training

exercises, told the

L.A. Times, " The county is better prepared than most counties in the

United States to

handle a large-scale public health emergency " and that some of the

questionable expenses

are indeed related to emergency preparedness. He said the trinkets,

for instance, have the

health department's contact information or web address, so they

could be useful in an

emergency.14

CDC DOESN'T " HAVE THE TIME " TO DETECT WASTE:

According to the L.A. Times, " The CDC does not have the time to

scrutinize every

expense, [director of CDC's division of state and local readiness

Alison] and

[senior CDC official Donna] Knutson said. The agency expects grant

recipients to

commission outside audits. " 15

CDC REFOCUSES FUNDING GOALS TO MEASURE OUTCOME IN 2005:

Though CDC bioterrorism funding began in 1999 and increased over

1,000 percent in

2002, it was not until 2005 that CDC announced a new results-

oriented focus that would

measure how states and localities were meeting bioterrorism goals.

Previously, CDC funding guidelines focused on activities planned or

areas reached, a

measurement method one grantee described as asking, " How many

meetings did you

have? " 16

According to a 2004 Office of Management and Budget (OMB) review of

CDC's

bioterrorism grant program, CDC funding was not tied to

accomplishment of annual and

long-term performance goals. OMB reported that in 2004 the CDC was

still working to

establish " outcome oriented goals and targets for preparedness. " The

review did note that

congressional requirements to distribute the funds to all the states

and locations took

109

some accountability measures out of CDC's hands: " since states

determine allocation of

total funding, CDC can not tie funding levels to achievement of

specific goals. " 17

In May of 2005, when announcing $862.8 million in bioterrorism grant

funding, the CDC

announced it was switching to a focus on " preparedness goals or

measurements. " 18 The

CDC confirmed the goals were new: " The preparedness goals or

measurements — that is

a new piece to the cooperative agreement, " CDC spokesman Von Roebuck

told one news

outlet. " They have not been in there before. They do build a bit up

on the past

recommendations as far as key points that we wanted to have covered.

They actually are

a work in progress. " 19 The Atlanta Journal-Constitution (AJC) also

made note of the new

agency requirements, " [in 2005], the CDC began asking states for

information that shows

how well they could perform in case of a bioterrorism attack "

(emphasis added).20

The new goals fall under the headings " Prevent, Detect/Report,

Investigate, Control,

Recover, and Improve " and outline particular outcomes, tasks, and

measures of

performance required by grantees under each goal.21 When determining

whether or not

they are meeting the goal of detecting and reporting dangerous

agents in tissue, food, or

environmental samples, for example, grantees are now required to

measure their ability to

send a sample potentially containing an infectious agent to a

reference laboratory within

60 minutes of the sample collection.

The CDC's measurement goals now call for speeding up the

identification of causes, risk

factors, and appropriate interventions for threats to public health,

such as being able to

start an epidemiologic investigation within three hours after an

unusual pattern of disease

cases is detected. 22

" We're very pleased to see the switch " in approach, Aggie

Leitheiser, assistant

commissioner for the Health Protection Bureau in the Minnesota

Department of Health,

told one news outlet. " Rather than `How many meetings did you have?'

[the CDC is

asking], `Can you show you're able to act effectively?' " 23

According to news reports, the Senate Finance Committee was working

with a CDC

whistleblower in the spring of 2006 to determine whether " taxpayers

have gotten their

money's worth " from the $3.8 billion grant program for states to

bolster public health

preparedness in case of a bioterrorist attack. The whistleblower

reportedly expressed

concern about whether the grants were being used effectively. That

investigation follows

on the heels of reports from the HHS IG raising concerns about the

suitability of some

purchases and questioning why some of the bioterrorism funding went

unspent. Some IG

reports have found that bioterrorism funding was inappropriately

used to pay for general

expenses affected by local budget cuts, the AJC reports.24

BILLIONS SPENT ON PREPAREDNESS, BUT CDC SAYS IT DOESN'T NECESSARILY

KNOW

HOW TO MEASURE IT:

A full six years after bioterrorism funding began, the director of

CDC's Coordinating

Office for Terrorism Preparedness and Emergency Responses told the

AJC that CDC still

is trying to figure out " how to quantify preparedness. " 25

110

After billions of tax dollars were spent funding preparedness

grants, it would seem

taxpayers could expect that CDC, the agency in charge of dispensing

these funds, would

have progressed beyond grappling about what it means to be prepared.

1 A microscopic view of the anthrax bacteria, Washington Post image

from Fort Detrick, land,

http://www.washingtonpost.com/wp-

dyn/nation/specials/attacked/bioterrorism/, accessed March 2007.

2 " HHS Awards $849 Million to Improve Public Health Preparedness, "

HHS press release, dated June 17,

2004, http://www.hhs.gov/news/press/2004pres/20040617.html, accessed

March 2007.

3 " State and Local Bioterrorism Preparedness, " HHS Inspector General

Report, December 2002, OEI-02-

01-00550, http://oig.hhs.gov/oei/reports/oei-02-01-00550.pdf.

4 " Nationwide Audit of State and Local Government Efforts to Record

and Monitor Subrecipients' Use of

Public Health Preparedness and Response for Bioterrorism Funds, " HHS

Inspector General Report, August

2004, A-05-04-00027,

http://oig.hhs.gov/oas/reports/region5/50400027.pdf; According to

the IG report,

CDC bioterrorism preparedness funding equaled: $40 million for

FY2000, $41 million for FY2001, $982

million for FY2002-FY2003, and $1.016 billion for FY2004.

5 County of Los Angeles Public Health Emergency Preparedness and

Response website graphic,

http://www.labt.org/.

6 " County aims anti-terrorism cash at some unusual targets, " Los

Angeles Times, March 6, 2006.

7 Ibid.

8 Id.

9 Id.

10 Id.

11 The County has a pool safety video online, last updated in May of

2006, which may be the video referred

to in the L.A. Times article,

http://www.lapublichealth.org/ivpp/injury_topics/Water%

20Safety/pool_safety_VideoShort.wmv, accessed

March 2007.

12 Supra footnote 6.

13 Leadership Secrets of Santa Claus,

http://www.amazon.com/Leadership-Secrets-Santa-

Claus/dp/1885228554, accessed March 2007.

14 Supra footnote 6.

15 Ibid.

16 " New federal bioterrorism funds tied to specific goals, " CIDRAP

News, May 23, 2005,

http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/may2305grant

s.html, accessed March 2007.

17 " Detailed Information on the CDC: State and Local Preparedness

Grants Assessment, "

http://www.whitehouse.gov/omb/expectmore/detail.10001052.2005.html.

18 " HHS Announces $1.3 Billion in Funding to States for Bioterrorism

Preparedness, " HHS Press Release

dated May 13, 2005,

http://www.hhs.gov/news/press/2005pres/20050513.html, accessed March

2007.

19 Footnote 16, op. cit.

20 " Investigators on trail of CDC bioterror grants, " The Atlanta

Journal-Constitution, May 20, 2006,.

21 CDC's ative Agreement Guidance for Public Health Emergency

Preparedness

http://www.bt.cdc.gov/planning/guidance05/pdf/annoucement.pdf;

http://www.bt.cdc.gov/planning/coopagreement/, accessed March 2007.

22 Supra footnote 16.

23 Ibid.

24 Footnote 20, op. cit.

25 Ibid.

111

III. RECOMMENDATIONS

" An ounce of prevention is worth a pound of cure, " or so the adage

goes. Prevention,

measured in health care terms, is worth trillions of dollars saved

in medical costs,

increased productivity, improved quality of life, and added years of

healthy living. Over

the last century, for example, the average U.S. lifespan has

increased by more than 30

years, with 25 of these added years attributed to prevention.1

Billions of dollars are spent every year on prevention and health

promotion by the federal

government, but the cost of care for preventable conditions is

growing. Federal efforts to

prevent disease sometimes are hampered by programs designed to spend

taxpayer funds,

but lacking methods to measure success and require results as a

condition for receiving

federal funding, and also by duplicative and overlapping prevention

efforts among

numerous federal departments and agencies.

With its mission of preventing and controlling disease, the CDC

stands in a unique

position to positively affect the lives of millions of Americans.

WHY CONSTANT CALLS TO INCREASE CDC FUNDING MISS THE MARK:

Calls from CDC supporters, and, not surprisingly, CDC grantees, to

increase CDC's

funding year after year, ignore the fact that CDC should undergo a

reevaluation and a

reprioritization process before the American taxpayers continue to

increase its budget.2

The Campaign for Public Health, for example, seeks to increase the

CDC's budget to $15

billion by 2012, which would add approximately $5 billion to the

agency's FY2007

funding. The campaign seeks to advance efforts " in support of a

level of funding that

will enable the CDC to fulfill its mission `to protect health and

quality of life by

preventing and controlling disease, injury and disability.' " 3 The

Campaign is built on the

premise that more money is required for CDC to fulfill its mission,

though nowhere does

the campaign or its supporters call for an examination of current

funding to see if funding

is even the problem, or the only solution to the problem.

Not surprisingly, the Campaign's website does not mention the fact

that 21 of the 40

groups on its advisory council supporting the effort to increase CDC

funds actually get

CDC funding themselves. Over the last five years, these 21 advisory

groups have

received over $300 million from the CDC.4

In March 2007, the Campaign for Public Health launched a D.C. media

market ad

campaign that had the tag line: " Protect the CDC and Increase Its

Budget. " 5 The ad was

signed by 21 organizations, 12 of which collectively received over

$60 million in the last

five years from the CDC.6

112

It is not hard to see why organizations, even non-profit

organizations, that receive money

from an agency would have a self-interest in promoting additional

funding for that

agency.

While many of the groups in this campaign, and others advocating

funding increases,

have altruistic motives to help those afflicted with some particular

disease, they overlook

the possibility that reprogramming hundreds of millions of

questionably targeted dollars

(from conferences, for example), could go a long way toward meeting

disease-specific

funding goals.

As this " CDC Off Center " report demonstrates, hundreds of millions

of tax dollars are

used for questionable purposes with often unknown or immeasurable

results.

GETTING CDC BACK ON TRACK:

CDC should get back on track toward accountability and responsible

disease control by

implementing the following six recommendations:

• CDC (and the politicians that fund it) should require the reviews

of existing

programs, the consolidation of overlapping programs, and the

elimination of

ineffective programs.

• CDC should reprioritize its funding and efforts toward preventing

and controlling

diseases. Period.

• Prevention programs should be science-based, subject to rigorous

audits and

reviews, and continued funding should be tied to measurable outcomes.

• CDC programs and grantees should not promote or support unhealthy

or risky

behaviors, and those that do so should be defunded.

• CDC preparedness programs should include regular drills and tests

to assess and

correct weaknesses in planning or execution and allow for a

reprogramming or

reprioritization of funding.

• CDC should reexamine the profligate spending in its own backyard.

Creating a

theme-park-like campus in Atlanta, with Japanese gardens, a wall

full of plasma

screen televisions showing vignettes to visitors, and installing

employee saunas

and mood-enhancing light shows, strays from CDC's mission to be good

stewards

of limited taxpayer dollars.

1 " Guide to Smart Prevention Investments, " Partnership for

Prevention, Fall 2001.

http://prevent.org/images/stories/Files/publications/Invest_Final.pdf

, accessed March 2007.

2 " Background: Mission and History, The Campaign for Public Health, "

http://www.fundcdc.org/cph_bkgd_main.htm, accessed March 2007.

3Ibid.

113

4 May 18, 2007 e-mail from CDC to Senator Tom Coburn's office in

response to congressional inquiry. Of

the Campaign's advisory council listed on its website

http://www.fundcdc.org/cph_leadership_main.htm as

of May 2007, the following received CDC funding in the last 5 years:

American Cancer Society, American

College of Emergency Physicians, American College of Preventive

Medicine, American Medical

Association, American Public Health Association, American Red Cross,

American Society for

Microbiology, American Trauma Society, Association for Prevention

Teaching and Research, Association

of Schools of Public Health, Association of State and Territorial

Health Officials (only two of five fiscal

years available), Association of University Centers on Disabilities,

Home Safety Council, Infectious

Diseases Society of America, March of Dimes, National Association of

County and City Health Officials

(only two of five fiscal years available), Parent Project,

Partnership for Prevention, Prevent Blindness

America, Society for Public Health Education, and The Scripps

Research Institute. The CDC official also

noted in the e-mail: " … that since no single source captures all of

this information in a simple way … CDC

is fairly confident in the information conveyed, but can't be 100%

certain that it's captured every award. "

5 The Campaign for Public Health's Washington, D.C. advertisement,

http://www.fundcdc.org/documents/CPH_HillAd_Final_000.pdf, accessed

March 2007.

6 Ibid. The 12 of the 21 groups that signed the DC ad and also

receive CDC funding are the: American

Medical Association, American Public Health Association, American

Red Cross, Association of State and

Territorial Health Officials (only two of five fiscal years

available), Home Safety Council, Infectious

Diseases Society of America, March of Dimes, National Association of

County and City Health Officials

(only two of five fiscal years available), Parent Project,

Partnership for Prevention, Prevent Blindness

America, and the Society for Public Health Education.

114

IV. CONCLUSION

The Centers for Disease Control is one of the few government

agencies that has been

demonstrated to engender trust and confidence among the American

public. People are

content to believe that those employed at the CDC are watching out

for American

citizens, whether or not it is responding to and tracking down the

causes of E. coli

outbreaks, preparing for bioterrorism attacks, or working to fight

and prevent disease in

America.

" CDC Off Center " is not an effort to discredit the good work that

the CDC and those who

work for it have carried out and the good work that will continue in

the future. The

report will hopefully be seen for what it is: an effort to shine

some light on prevention

efforts and funding decisions that may be holding the agency back

from fulfilling its

central mission of fighting and controlling disease.

In 2007, the CDC has an estimated budget of $10 billion and a

mission " To promote health and

quality of life by preventing and controlling disease, injury, and

disability. " The funding level

and the mission are, by most standards, substantial.

This review of recent CDC expenditures demonstrates that a

reprioritization of CDC

funding and a review of the approach to certain types of disease

prevention are in order.

The CDC says it " pledges to the American people: To be a diligent

steward of the funds

entrusted to it […and to] place the benefits to society above the

benefits to the institution. " 1 If

this pledge is to be more than mere sentiment, the CDC should

commence a bottom-up and

top-down review of how the agency is spending the taxpayers' hard-

earned money and should

institute agency-wide and programmatic reforms where needed.

It is hoped that this report and the recommendations contained

within it will assist CDC in

identifying areas to look first for that reform.

1CDC website, http://www.cdc.gov/about/mission.htm,

http://www.cdc.gov/fmo/PDFs/FY06AppropFactsheet.pdf, accessed

October 2006.

115

APPENDIX

CENTERS FOR DISEASE CONTROL AND PREVENTION

CDC HIV/AIDS PREVENTION1

FY 2001-2008

(Dollars in Thousands)

Budget Activity FY 2001

Actual

FY 2002

Actual

FY 2003

Actual

FY 2004

Actual

FY 2005

Actual

FY 2006

Actual

FY 2007

Enacted11

FY 2008

Budget

HIV, Viral Hepatitis, STD, and TB

Prevention2

--State and Local Health Departments $394,629 $429,152 $424,806

$415,544 $412,016 $405,944 $451,811 $499,224

--Directly Funded Community,

National, Regional and Other

Organizations $166,350 $175,491 $190,745 $179,424 $177,901 $170,449

$170,814 $170,567

--CDC Research, Surveillance

Analysis, Technical Assistance,

and Program Support $92,483 $84,526 $84,069 $72,972 $72,350 $75,264

$75,425 $75,316

Management and Administration

costs (assumes FY06-FY08)3: $68,000 $74,000 $74,000 $74,000 $74,000

Subtotal HIV/AIDS Prevention4 $653,462 $689,169 $699,620 $735,940

$736,267 $725,657 $772,050 $819,107

Infectious Diseases Control5 $41,644 $43,844 $40,160 $4,130 $4,095 --

-- --

Chronic Disease Prevention, Health

Promotion, and Genomics6 $54,433 $54,394 $53,817 $48,050 $47,642

$46,717 $46,795 $46,749

Birth Defects, Developmental

Disabilities, Disability and Health2 -- -- -- $17,852 $17,701

$17,291 $17,321 $17,304

Subtotal CDC Domestic HIV/AIDS7 $749,539 $787,407 $793,597 $805,972

$805,705 $789,665 $836,166 $883,160

Global AIDS Program8 $104,527 $143,700 $142,600 $142,700 $123,830

$122,560 $122,769 $121,223

International Mother and Child

Prevention Initiative9 [$40,000] [$150,000]

Office of Global AIDS Coordinator

transferred funds10 $230,600 $439,600 $578,200 $815,000+ ?

Subtotal prior to OGAC transfer $1,004,383

Total CDC HIV/AIDS Prevention: $854,066 $931,107 $936,127a

$1,179,272a $1,369,135 $1,490,425 $1,773,935

1Funding figures provided by CDC and the Congressional Research

Service (CRS), except where noted.

2According to CDC, from FY2003 to FY2004, funding for the Division

of AIDS, STD, and TB Laboratory Research was reallocated to various

other areas within the CDC budget from the Infectious Diseases

Control budget activity. Funding for this activity is now reflected

in the Birth

Defects, Developmental Disabilities, Disability and Health and

HIV/AIDS, Viral Hepatitis, STD, and TB Prevention budget lines.

3In FY2004 and beyond, CDC's new budget structure removed the

management and administrative costs from the program lines. For FY04

and

FY05, the CRS published the management and administrative costs

based on CDC's internal figures. Subsequently, CDC stopped

calculating

these costs separately. For purposes of comparative analysis, this

chart estimates that the management and administrative costs for

these HIV

programs have remained constant. CRS source: " AIDS Funding for

Federal Government Programs: FY1981-FY2008, " updated March 8, 2007.

4This subtotal for prevention funding is the basis for the funding

totals used in Figure 2: CDC's Domestic HIV/AIDS Funding by Fiscal

Year.

5According to CDC, beginning in FY2007, Infectious Diseases Control

HIV/AIDS-related funding was reallocated to the CDC Research,

Surveillance Analysis, Technical Assistance, and Program Support

line within the HIV/AIDS, Viral Hepatitis, STD, and TB budget as

part of the

reorganization of the Coordinating Center for Infectious Diseases.

Funding in FY2006 is shown comparably.

6 Includes funds for School Health – HIV/AIDS, Safe Motherhood –

HIV/AIDS, Oral Health – HIV/AIDS, and BRFSS – HIV/AIDS.

7 Because funding for the Birth Defects, Developmental Disabilities,

Disability and Health accounts and the Infectious Disease Control

account

were reallocated within the CDC budget during the time period shown

(as indicated by the dashes), this subtotal does not provide a true

reflection

of the CDC's HIV/AIDS budget.

8These figures are taken from " Trends in U.S. Global AIDS Spending:

FY2000-FY2007, " CRS, December 26, 2006, RL33771.

9Funding shown for the President's International Mother and Child

HIV Prevention Initiative in FY2003 and 2004 is not counted in the

subtotals

or totals because PMTCT was transferred from CDC to the Department

of State's Office of the Global AIDS Coordinator (OGAC) in FY 2005.

Funding figures from Public Laws 108-7 and 108-199.

10CDC does not " count " in its HIV/AIDS budget those funds received

from the OGAC, yet amounts shown are spent by CDC on HIV/AIDS

prevention. According to CDC, additional funds are " likely to be

transferred " in FY07 from OGAC (though the amount is not yet known),

and an

estimate for the FY08 transfer is not yet available.

aThese totals do not include PMTCT funds because they were only

temporarily counted in CDC's budget.

11 " FY2007 Joint Resolution [CDC] Detail Table, "

http://www.cdc.gov/fmo/PDFs/FY_2007_JR_Detail_Table.pdf, accessed

May 2007.

--- In , " tigerpaw2c " <tigerpaw2c@...>

wrote:

>

> According to the local news this evening, it was also mentioned

that

> 45 million was spent on " beach parties, drag queen contests,

hiring

> prostitutes for various parties. " $250,000 to boost the morale of

2

> employees.

>

> Link to Senators full report:

>

http://coburn.senate.gov/ffm/index.cfmFuseAction=Files.View & FileStore

> _id=0e72b780-363a-4777-b841-20925a304d20

>

>

>

> Report: CDC wastes millions

> Agency with big budget 'can veer off track,' senator says

>

> By Alison Young

> The Atlanta Journal-Constitution

>

> Published on: 06/12/07

>

>

http://www.ajc.com/search/content/metro/stories/2007/06/12/meshcdc061

> 2a.html

>

> While the Centers for Disease Control and Prevention tells

Congress

> it needs more money, a new report contends that the agency has

> wasted millions of dollars, including on lavish new buildings in

> Atlanta.

>

:

>

> > Spending $1.7 million, including some antiterrorism funds, on a

> Hollywood liaison program to get health messages into TV shows and

> movies.

>

>

[Guest guest]

KC and Sharon,

Sharon K beat me to it! Great find!

Carl Grimes

Healthy Habitats LLC

-----

> Hey KC and Sharon,

>

> Oh my gosh! What a great find regarding the deceit in medicine in the US.

> You guys are awesome. I got the link to work.

>

> _http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e7

> 2b780-363a-4777-b841-20925a304d20_

>

(http://coburn.senate.gov/ffm/index.cfm?FuseAction=Files.View & FileStore_id=0e72b\

780-363a-4777-b841-20925a304d20)

>

>

>

> ************************************** See what's free at http://www.aol.com.

>

>

>

[Guest guest]

I CAN'T EVEN FIND THE WORDS. WTF, HAS OUR WORLD GONE INSANE?

>

> Have just skimmed that Senate doc on the CDC. Pulled out a few

choice

> quotes. There are MANY more.

>

>

> _http://coburn.senate.gov/ffm/index.cfm?

FuseAction=Files.View & FileStore_id=0e7

> 2b780-363a-4777-b841-20925a304d20_

> (http://coburn.senate.gov/ffm/index.cfm?

FuseAction=Files.View & FileStore_id=0e72b780-363a-4777-b841-

20925a304d20)

>

> DRUG LEGALIZATION CONFERENCE:

> HHS and CDC sponsored an August 19-20, 2005, Utah conference

hosted by the

> Harm

> Reduction Project and the Harm Reduction Coalition †"

organizations that

> support tacit

> legalization of drugs, including methamphetamine. Several sessions

planned

> for the conference

> appear to promote illegal drug use and risky sexual behavior such

as, “We Don

> ’t Need a ‘War’

> on Methamphetamine,†and “You Don’t Have to Be Clean & Sober.

Or Even Want

> to Be!â€

>

> One of the presenters had earlier been quoted as saying, “For a

lot of

> people, meth use is a rite of

> passage and it really does increase sexual pleasure.†He also

criticized

> current so-called safer

> sex messages promoting condom use every time as no longer

effective and

> instead encouraged

> “harm reduction techniques†during risky sexual behavior.14

>

> PORN STARS HEADLINE CDC-FUNDED SAFE-SEX EVENT:

> In July 2002, a CDC-funded group in Missouri called Blacks

Assisting Blacks

> Against AIDS

> (BABAA) hired Memphis gay porn star Edgar Gaines, whose movie name

is Bobby

> Blake, to

> attend a “safe-sex†event at the BABAA’s Executive

Director’s downtown

> loft. Gains was paid

> $500 from a syphilis elimination grant.20 The porn star appeared

at the

> event in a towel and

> cowboy boots.

>

> One CDC auditor who was in California to review the STOP AIDS

workshops,

> such as “Booty

> Call†and “Men for Hire,†is reported to have told another

CDC employee, “

> I would take my

> mother to this.â€

>

> AUDIT FINDS GROUP’S ACTIVITIES ENCOURAGE SEXUAL ACTIVITY AND ARE

OBSCENE …

> YET

> CDC CONTINUED TO FUND GROUP:

>

> In April 2003, the CDC-funded Stop AIDS Project of San Francisco

hosted a

> four-part “erotic

> writing workshop†where participants were to “Start by

exploring your

> fantasies and get support

> for you [sic] creative writing process.â€8

>

> In response to congressional inquiry, it was reported that in 2000,

the Stop

> AIDS Project of San

> Francisco received $698,000 in federal funds, including CDC HIV

prevention

> grants and that

> these funds were used to fund the activities listed above.9

>

> In 2001, HHS’s Inspector General (IG) noted that two other CDC-

funded STOP

> AIDS Project

> HIV prevention workshops, entitled “Booty Call†and “Great

Sex,†“could be

> viewed as

> ‘encourag[ing], directly … sexual activity’ in violation of

CDC’s guidance

> … and as ‘obscene,’

>

>

> Despite receiving millions of dollars from the federal government

in the

> past few years,

> according to the Asian & Pacific Islander Wellness Center’s

website, in the

> last 17 years the

> organization only has “served over 600 HIV-positive A & PIs.â€

>

>

>

>

>

>

> ************************************** See what's free at

http://www.aol.com.

>

>

>

[Guest guest]

Is this surprising? No. Why?

*Bear in mind all of you that MANY in the GOP feel VERY strongly that the

government should not AT ALL be in the business of protecting people's

health, funding education, etc. AT ALL *

In private, many will tell you LOUDLY that they would like to ELIMINATE

agencies like the CDC, EPA, NIOSH, OSHA, Dept. of Education, HUD etc. as

standing in the way of the free market.

(Hell, many would also like to eliminate all public education, national

parks, and just about anything that helps level the playing field for

people.)

So, IF *THEY* HELP contribute to a chain of events that leads to the CDC,

EPA, NIOSH, OSHA, Dept. of Education, HUD, etc, being ELIMINATED or

privatized then they will be VERY happy.

That means more tax money goes to the things they want, less goes to health

and safety and education, etc.

That would mean that everyone was on their own.

There would be no regulations concerning health, mold, toxics, medicine, job

safety, discrimination, hours, or anything else.

Just like it was 100 years ago.

[Guest guest]

They are ego-centric group.

--- In , LiveSimply <quackadillian@...>

wrote:

>

> Is this surprising? No. Why?

>

[Guest guest]

Thanks for posting, I haven't read it all yet.

>

> Is this surprising? No. Why?

>

> *Bear in mind all of you that MANY in the GOP feel VERY strongly that

the

> government should not AT ALL be in the business of protecting people's

> health, funding education, etc. AT ALL *

[Guest guest]

Did any of the buidling material come from Home Depot?

>

>

http://www.ajc.com/search/content/metro/stories/2007/06/12/meshcdc0612a.html

>

> Report: CDC wastes millions

> Agency with big budget 'can veer off track,' senator

> says

>

> By Alison Young

> The Atlanta Journal-Constitution

>

> Published on: 06/12/07

>

> While the Centers for Disease Control and Prevention

> tells Congress it needs more money, a new report

> contends that the agency has wasted millions of

> dollars, including on lavish new buildings in Atlanta.

>

> U.S. Sen. Tom Coburn (R-Okla.) says the CDC has used

> taxpayer money in questionable ways, including:

>

> > Spending $1.7 million, including some antiterrorism

> funds, on a Hollywood liaison program to get health

> messages into TV shows and movies.

>

> > Equipping new buildings on Clifton Road with

> extravagant finishes, including a $200,000 fitness

> center, a giant wall of plasma screen TVs in the

> visitor center and a sculpture of a woman made out of

> vegetables.

>

> > Spending tens of millions of dollars on programs

> ranging from HIV/AIDS prevention to bioterrorism

> preparation without adequate oversight.

>

> CDC does important work, Coburn said Monday in a

> statement. " Yet, like most agencies, it offers many

> examples of how an agency with a large budget can veer

> off track in prioritizing its funds. "

>

> CDC spokesman Tom Skinner said the agency has received

> a copy.

>

> " We share Sen. Coburn's commitment to accountability,

> and we strive day in and day out to fulfill our

> commitment to the American taxpayer and to be diligent

> stewards, " he said. The CDC has an annual budget of

> more than $8 billion. Skinner said CDC officials have

> provided " exhaustive " information to Coburn.

>

> Coburn, a medical doctor, is the ranking Republican on

> a Senate financial management subcommittee.. He

> recently was in the news for blocking bills to honor

> Carson, author of " Silent Spring. "

>

> Coburn's report includes many items that have been

> previously reported in news articles, including the

> use of CDC grant money in 2002 to hire a porn star to

> appear at a safe-sex conference.

>

> But the report provides new details about the $1

> billion in ongoing construction at the CDC's Clifton

> Road headquarters. The Atlanta Journal-Constitution

> sought information about construction costs under the

> Freedom of Information Act in October and January, but

> the CDC has not yet released it.

>

> According to Coburn's report, the CDC spent $106

> million on its new Tom Harkin Global Communications

> Center on the Clifton Road campus, which includes a

> visitor center with a video wall that is 70 feet tall

> by 25 feet wide. It houses a new $20 million

> communications studio.

>

> The new headquarters cost $109.8 million, and includes

> nearly $10 million in furniture and $6 million in

> audio/visual systems, monitors and teleconferencing

> equipment, the report says. A fitness center has more

> than $200,000 in equipment, including zero-gravity

> chairs in a light-therapy room, a 12-bike cycling room

> with images of the Tour de France flashing on the

> walls, two dry-heat saunas and a $70,000 sound system.

>

> To read the full Coburn report, go to

> coburn.senate.gov/ffm/. Contact staff writer Alison

> Young at 404-526-7372.

>

>

>

>

>

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