The Medical CIA
(Published in drastically rewritten, condensed form as
This is the epidemic of the century, and every qualified person should want to have a piece of the action.
Donald Francis was not known for his subtlety. When he wanted something, he would make demands while pounding the table with his fist. This time he was giving a speech to his fellow officers of the Centers for Disease Control (CDC), the Federal agency charged with handling public health issues. Speaking at CDC headquarters in Atlanta, Georgia, he was revealing a hidden agenda one that would shock an uninitiated visitor.
Francis saw the AIDS epidemic as a golden opportunity, a crisis that could force Congress to grant the CDC more money and expanded authority. The United States needs to establish a separate line of public health authority, he declared, and restructure the CDC to make it less accountable to the President and Congress. Having given the CDC a new mandate to manage the epidemic, the government would then guarantee medical coverage to all HIV-infected Americans, a program that would lure people in to be tested for the virus. Third, he proposed a program of safe injection, in which heroin and other drugs would be prescribed to addicts who might otherwise use drugs without government supervision. Fourth, the government would also begin taking over vaccine production, not only for AIDS but for all diseases. Then Francis turned to his ultimate objective. CDC needs to reestablish its leadership role in HIV prevention, he emphasized. Prevention requires close coordination, training, and financial support of state and local health departments. In other words, the CDC should seize control over all public health functions in the country.
This ambitious plan had originally begun as Operation AIDS Control in 1984. Francis had been asked to write the proposal because of his experience using heavy-handed measures in dealing with disease epidemics. Working for the CDC, he had spent years in such Third World countries as India, Bangladesh, and several African nations. He had responded to unexplained epidemics by quarantining the victims and suppressing local customs. Whenever such epidemics coincidentally disappeared, Francis would take full credit. Now he wanted to bring similar methods to bear against AIDS. According to the CDCs own estimates, a constant one million Americans have been carrying HIV, the so-called AIDS virus, since 1985. Of those, only one-fifth have developed AIDS. All these people would fall under CDC control, sick or healthy.
Francis continued his speech by outlining his plan for managing AIDS, starting with techniques to find all the HIV-positives. The concept of routine voluntary testing for everyone should be aggressively promulgated as the standard of medical practice, he said. Then the CDC would trace all the sexual partners of these infected people, testing them as well. Having been registered in a database, the HIV-positives would be linked to lifelong medical and preventive services under CDC control. Any vaccine or drug favored by the agency could be distributed almost instantaneously to the helpless individuals.
According to Francis, the plan would become permanent. This new system of public health would reach far beyond AIDS, extending to issues ranging from the food we eat to accidental injuries, from population control to criminal violence. The CDC would have the power to force lifestyle changes on virtually everyone, guilty or innocent, all in the name of prevention.
This Orwellian-sounding scenario jars with the image most outsiders have of the CDC a simple statistics-gathering operation that keeps track of diseases. If the agency were actually that harmless, Donald Francis notions would amount to personal opinions with no serious impact. But the truth is surprisingly different. The CDC has long aimed to become this nations centrally powerful public health agency, regulating every aspect of our individual lives. Francis himself belongs to a special group of insiders working to make this vision reality. Since 1971, he has been a member of a semi-secret, elite unit of the CDC known as the Epidemic Intelligence Service (EIS).
Often called the medical CIA by scientists who know of its existence, the EIS was the brainchild of public health VIP Alexander Langmuir. The CDC had been itching to expand beyond its mandate for malaria control, but needed some justification. In 1949 it tapped Langmuir from his teaching position at the Johns Hopkins University School of Hygiene and Public Health. Langmuirs arrival was a coup for the CDC he had a security clearance as one of the few scientific advisors to the Defense Departments biological and chemical warfare program. The Cold War was raging at that time, and civil defense ranked high in government priorities. So officials of the Public Health Service listened to Langmuir when he proposed that the CDC build a comprehensive disease surveillance system to detect the earliest signs of a biological warfare attack. Besides, noted Langmuir, the same infrastructure could also be used to control any natural epidemic, using quarantine measures, mass immunizations, and other emergency techniques.
Federal officials soon agreed, and gave Langmuir millions of dollars to create a special new division of the CDC. In July of 1951, he assembled some twenty-three young medical or public health graduates for the first class of the EIS. Langmuir put them through six weeks of intensive epidemiological training, and assigned the new EIS officers for two years to hospitals or to state and local health departments around the country. Upon completing their field experience, EIS alumni were free to pursue any career they desired. But they all understood the implicit agreement that they would function as a permanent reserve for the CDC. Their loyalties would remain with the agency for life, and they would act as its eyes and ears. The symbol of the EIS reflected its focus on activism instead of scientific research a pair of shoe soles worn through with holes.
Every summer since 1951, a new class of carefully-chosen EIS recruits has been trained, some classes exceeding one hundred people. Until a few months ago, the EIS had released an annual directory of its membership, but now it has made the list secret after receiving several outside requests for copies. Members rarely advertise their affiliation, and the CDC has quietly placed nearly 2000 EIS trainees in key positions throughout this country and the world. Many work in the CDC itself, others in various agencies of the Federal government. One EIS graduate became a Surgeon General of the United States, and two others became assistant Surgeons General. Some have staffed the World Health Organization, including Jonathan Mann and Michael Merson, the past and present heads of its Global AIDS Program. Fellow agents can be found in the health departments of foreign nations. Several dozen have entered university public health programs as teachers and researchers. Roughly 150 have taken jobs in state or local health departments, closely watching every little outbreak of disease. Hundreds have become private practice doctors, dentists, or even veterinarians, while others work in hospitals. Some have joined biotechnology or pharmaceutical companies, or have even risen in the ranks of major insurance corporations. Some reside within tax-exempt foundations, helping direct the spending of trust funds on medical projects.
Several have even infiltrated prominent positions in the communications media. Lawrence Altman joined the New York Times as a medical journalist in 1969, since rising to become its head medical writer. Bruce Dan was hired by ABC News as its Chicago medical editor for six years beginning in 1984, the same year he became a senior editor of the prestigious Journal of the American Medical Association, a position he still holds today. Marvin Turck has held the title of editor at the University of Washingtons Journal of Infectious Diseases since 1988. These three men were recruited into the EIS in 1963, 1979, and 1960, respectively each one years before he entered the media.
Regardless of which career paths EIS alumni take, the vast majority retain their contacts with the CDC. Not only do they constitute an informal surveillance network, but they can even act as unrecognized advocates for the CDC viewpoint, whether as media journalists or as prominent physicians. And they serve as a reservoir of trained personnel for any CDC-defined emergency. As Langmuir himself described it in 1952, One of the primary purposes of the Epidemic Intelligence Services of CDC is to recruit and train such a corps of epidemiologists. As a result of their experience, many of these officers may well remain in full-time epidemiology or other public health pursuits at federal, state, or local levels. Some, no doubt, will return to civilian, academic, or clinical practice, but in the event of war they could be returned to active duty with the Public Health Service and assigned to strategic areas to fulfil the functions for which they were trained.
Biological warfare, of course, never struck. Nor would it have been a disaster anyway, for even the deadliest germs can only kill a fraction of infected people, those who are least healthy. But the CDC did turn to declaring wars on natural diseases, which gave the agency plenty of material to work with. Most people do not know that this country alone experiences more than one thousand clustered outbreaks of disease each year roughly one every eight hours including colds, flus, hepatitis, and numerous noninfectious conditions, all running their course and disappearing often despite remaining unexplained by scientists. The EIS could detect most of those clusters as soon as they popped up, and in its military style, would treat selected outbreaks as emergencies on the assumption they were contagious.
The flu proved to be one of their perennial favorites for exploitation. At the end of World War I, a flu epidemic had swept through the nation as troops returned home from Europe, and had taken hundreds of thousands of lives. Because of healthier conditions, no flue has since been as deadly. The CDC, however, has always itched to revive that old flu scare.
Its first major opportunity surfaced in the spring of 1957 with news of a flu sweeping nations of the Far East. The CDC rang the alarm of an imminent and devastating epidemic heading for the United States, and Congress responded by providing money. Langmuir dipped into the new funds to expand the EIS, and the CDC crash-produced a vaccine that nevertheless arrived too late. But in the end, the mild flu disappeared quite spontaneously, leaving behind none of the predicted destruction. Some public health experts even questioned whether the hyped-up scare may have only stimulated vaccine sales.
The CDC tried again in 1976. By that time the EIS network had become so widespread that it could detect even the tiniest outbreaks. When five soldiers caught a flu that January, the alarm bells broke out again. This time the disease was nicknamed the swine flu, based on the speculation that pigs served as the reservoir for the virus. The CDC predicted another fatal pandemic like that of 1918. President Ford and Congress panicked, throwing vast new sums of money into another flu vaccine. Then came an unexpected wrinkle: the program stalled when insurers discovered that the vaccine itself had lethal side effects. This jeopardized the CDCs mass immunization crusade.
Now the EIS network sprang into action. Except for the five soldiers, no flu epidemic could be found, and the EIS was placed on full alert to detect any outbreak. Unless Congress could be convinced the danger was real, the vaccine program would end. As described by Gordon Thomas and Max Morgan-Witts in their book, Anatomy of an Epidemic, the large Auditorium A, located in CDC headquarters in Atlanta, became the command center called the War Room. Set up especially for this occasion, it contained banks of telephones, teleprinters, and computers, the hardware for an unprecedented monitoring system which, to work, also required a typing pool, photocopy machines, and doctors sitting at rows of desks in the center of the room. Experts worked around the clock, week after week, chasing down every rumor of flu outbreaks.
A cluster of pneumonia cases suddenly appeared in Philadelphia, days after American Legion members had returned home from their July convention. On Monday morning, August 2nd, after receiving word of this outbreak, personnel in the CDCs swine flu War Room established contact with Jim Beecham, a brand new EIS officer on assignment in the Philadelphia health department. The CDC could not directly intervene in the situation without an invitation, and Beecham helped arrange one immediately. Within hours three EIS officers flew down to Philadelphia. They were joined within days by a team of dozens of CDC experts.
When the CDC personnel arrived, pre-positioned EIS members such as Beecham and top health advisor Robert Sharrar stopped obeying local authorities and began following orders from the incoming CDC team. Local officials became helpless to stop the tide of events. The CDC seized the initiative, fomenting wild rumors that this Legionnaires disease was the beginning of the swine flu epidemic. The media proved cooperative; the New York Times assigned none other than Lawrence Altman, an EIS alumnus, to cover the story.
With nationwide hysteria rapidly developing, Congress suddenly changed its mind and approved the swine flu vaccine. Days later, the EIS team finally admitted the pneumonia was not related to swine flu, but the announcement deliberately came too late. Some 50 million Americans were inoculated with the dangerous vaccine, resulting in at least a thousand cases of severe nerve damage and paralysis, dozens of deaths, and nearly $100 million in damages. Swine flu, on the other hand, never showed up.
The swine flu fiasco nearly destroyed the CDCs reputation, but the EIS performed some damage control by blaming Legionnaires disease on a newly isolated bacterium. In reality, the stricken legionnaires had been elderly men, often with kidney transplants, who had become extraordinarily drunk at the convention all classical risk factors for pneumonia. Such minor disease outbreaks can be relatively common, though rarely falling into the public spotlight. But the CDC did succeed in scaring the nation about a harmless bacterium, one found in the plumbing of almost any building.
Still, the CDC needed another crisis epidemic to revive its heroic image and expand its mandate. Thus AIDS appeared not a moment too soon, in 1981. Naturally, the agency jumped at the opportunity and assumed AIDS to be infectious from the very start. Such EIS members as Donald Francis were poised to convince the biomedical establishment, and the public, that AIDS was caused by a virus.