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US public health chief resigns over tobacco investments

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k556 (Published 02 February 2018) Cite this as: BMJ 2018;360:k556
  1. Owen Dyer

Brenda Fitzgerald, President Trump’s appointment to lead the US Centers for Disease Control and Prevention (CDC), has resigned after just six months in the role, after revelations of a tobacco stock purchase early in her tenure.

Many observers said that news of the tobacco investment, revealed by the Politico news website, was the last straw for an administrator who had already officially recused herself from much of a CDC director’s normal role because of financial conflicts of interest.

An ethics agreement Fitzgerald signed soon after taking up the post last July noted that, for contractual reasons, she could not divest from holdings in cancer detection technology and prescription tracking services designed to identify opioid abusers, and she was therefore obliged to avoid working in those areas. She consequently missed her first appointment to discuss the opioid crisis with Congress and sent a deputy to the next three appointments.

A health department spokesman said that, after a review by the ethics office, “she was instructed to divest of certain holdings that may pose a conflict of interest. During the divestiture process, her financial account manager purchased some potentially conflicting stock holdings. These additional purchases did not change the scope of Dr Fitzgerald’s recusal obligations, and Dr Fitzgerald has since also divested of these newly acquired potentially conflicting publicly traded stock holdings.”

Fitzgerald bought shares in at least a dozen companies in the three months after becoming director, including purchases valued from $1000 (£700; €800) to $15 000 (£10 550; €12 000) in the drug manufacturers Merck & Co and Bayer, the health insurer Humana, and Japan Tobacco—one of the world’s largest tobacco companies, which has four brands on the US market.

Before becoming the CDC director Fitzgerald, 71, an obstetrician-gynaecologist, was commissioner of Georgia’s Department of Public Health, where she listed tobacco cessation among her top priorities. But freedom of information requests have shown that she then held stock in five other tobacco companies: Reynolds American, British American Tobacco, Imperial Brands, Philip Morris International, and Altria Group.

Even before the tobacco revelations, widespread speculation arose within the health department that Fitzgerald’s conflicts and recusals would not sit well with the new health secretary, Alex Azar. In the event, Azar accepted Fitzgerald’s resignation within 48 hours of his own swearing in.

Azar himself replaces Trump’s first pick, Tom Price, who as a congressman was frequently criticised for dealing in shares whose price depended on legislation he worked on.1 Price eventually resigned over his use of taxpayer money to charter private jets.

Fitzgerald, who has not publicly commented on her resignation, will be replaced as acting director by a well regarded agency insider, Anne Schuchat. The change comes as the CDC faces an unusually bad flu season and massive budget cuts. Many of the cuts proposed by the Trump administration for this year were restored by Congress, but the agency will see its resources for disease detection abroad cut by 80% over the next two years.

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