Deconstructing NIH, CDC and FDA: Culture Matters

Current NIH, CDC and FDA leadership and scientific culture traces to Vietnam Draft Dodging, Socialism, and Corporatism. Time for a change.

The Yellow Berets, also known as Public Health Service trainees, were a group of physicians who participated in the National Institutes of Health (NIH) Associate Training Program during the Vietnam War era. They were often derogatorily referred to as "Yellow Berets" by supporters of the war who viewed them as avoiding military service. However, this term eventually became a badge of honor among the participants, many of whom formed a network of influential scientists and medical leaders that continue to dominate the public health enterprise, particularly at NIH. While most of these are now retiring out of the USPHS, they have fostered a culture and mentored others that continue to enforce that culture and support the informal networks, alliances and power relationships that dominate the USPHS and the overall US medical research enterprise.

Physicians who served in the U.S. Public Health Service (USPHS) during the Vietnam War primarily worked at the NIH or other federal health institutions, including the CDC and FDA. For example, during the Vietnam War, physicians could serve their draft requirement by joining the USPHS, which allowed them to work at places like the CDC. Their common experience, background, and cultural biases fostered natural affiliations that eventually developed into a loose network of influence that came to dominate both the NIH and the USPHS. Dr. Anthony Fauci is one example of a successful “Yellow Beret”.

For more than 200 years, men and women have served US public health in what is today called the Commissioned Corps of the U.S. Public Health Service. These commissioned officers wear uniforms and have ranks similar to those of US Navy officers. For example, Dr. Rachel Levine holds a commission as a USPHS Admiral. These military titles, uniforms, and trappings of authority confer unwarranted legitimacy to these career PHS bureaucrats.

Given this background, conservatives and libertarians should not be surprised that “Public Health,” as currently practiced in the United States and its Western allies, is based on utilitarian and socialist political and economic philosophy. “Public Health” seeks to obtain the greatest good for the greatest number, and focuses on optimizing and standardizing health outcomes rather than opportunities and information that will enable individuals to optimize their own personal health and that of their children.

This represents yet another example of blowback. The male young adult children of the wealthy and upper middle class, having been provided with the benefits of the best educational opportunities, were then provided a pathway to avoid the selective service sacrifices required of most of their age cohort. They did not need to debase themselves on an “Alice’s Restaurant” group W bench strategy or even contrived claims of bone spurs to avoid the draft. They just had to apply to serve in the pseudo-military public health service, and would be given a cushy job for the duration in DC or Atlanta. And so they did, with the consequence being that these “public health enterprise” agencies became captured by pseudo-hippies that viewed public service not as a responsibility and calling, but rather as yet another entitlement. And no surprise that they jumped right into bed with corporate America and Big Pharma, for this was the caste from whence they whelped.

When MAHA speaks of trying to re-orient the USG public health enterprise and NIH from the current focus on disease treatment towards a focus on health promotion, this is perceived as a threat to the current Socialist/Corporatist order that has been developed under the leadership of the Yellow Berets. A very overt example that illustrates this point involves the positions taken by the far left/socialist advocates for big government, Senators Bernie Sanders and Elizabeth Warren, during the RFK Jr. confirmation hearings.

This is neither unprecedented nor unusual; there is a long history of political alliance between socialists and corporatists. Examples include current Eurosocialism as practiced at the European Council and European Parliament of the European Union, the “Stakeholder Capitalism” model espoused by Klaus Schwab and his World Economic Forum, and of course the WW II era socialist/corporatist governments of Germany and Italy. In his 1923 pamphlet “The Doctrine of Fascism,” Benito Mussolini wrote “If classical liberalism spells individualism, Fascism spells government.” Mussolini’s Fascism was not about individual freedom or laissez-faire economics but rather about the state’s control over the economy and society, with corporations playing a key role.

“Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power.”

―Benito Mussolini

Today’s NIH, CDC, and FDA Cultures are Fundamentally Socialist and Pro-Corporatist

Given this background, it should surprise absolutely no one that the underlying cultures of NIH, CDC, and FDA are Socialist/Corporatist. Whether by intent or circumstance, these organizations are led by the children of privilege, typically graduates of elite East Coast “Ivy League” prep and finishing schools, and have been for decades. Federal policies have consequences, and those consequences often persist for a very long time.

It will be extremely difficult to shift current USPHS culture, and extremely difficult to shift the underlying cultures of NIH, CDC and FDA. But without cultural change, any structural changes implemented by MAHA leadership will rapidly revert back to current norms as soon as the focus shifts to other areas, or a left-wing administration assumes power. It is important to understand that these agencies see Congress rather than either the President or the voters as their customers. We have a midterm election coming at us like a freight train, and Congress has long abused the USPHS, and in particular the NIH as a pork barrel opportunity. Upon confirmation, the new overall director of NIH will find that he or she is hamstrung, and the various NIH institute directors are focused on servicing their Congressional benefactors (and in turn their client corporations) rather than responding to any direction coming from the overall NIH Director.

This was NOT the Original Culture of the USG Research and Development Enterprise

The current version of the USG research and development enterprise traces its origins back the (highly entrepreneurial) Manhattan Project, and in particular to the contributions of Vannevar Bush.

Quoting from Wikipedia.

Vannevar Bush (March 11, 1890 – June 28, 1974) was an American engineer, inventor and science administrator, who during World War II headed the U.S. Office of Scientific Research and Development (OSRD), through which almost all wartime military R&D was carried out, including important developments in radar and the initiation and early administration of the Manhattan Project. He emphasized the importance of scientific research to national security and economic well-being, and was chiefly responsible for the movement that led to the creation of the National Science Foundation.

On June 28, 1941, Roosevelt established the Office of Scientific Research and Development (OSRD) with the signing of Executive Order 8807. Bush became director of the OSRD. The OSRD had the resources and the authority to develop weapons and technologies with or without the military. Furthermore, the OSRD had a broad mandate, moving into additional areas such as medical research and the mass production of penicillin and sulfa drugs. The organization grew to 850 full-time employees, and produced between 30,000 and 35,000 reports. The OSRD was involved in some 2,500 contracts,^] worth in excess of $536 million.

Bush's method of management at the OSRD was to direct overall policy, while delegating supervision of divisions to qualified colleagues and letting them do their jobs without interference. He attempted to interpret the mandate of the OSRD as narrowly as possible to avoid overtaxing his office and to prevent duplicating the efforts of other agencies. Bush would often ask: "Will it help to win a war; this war?" Other challenges involved obtaining adequate funds from the president and Congress and determining apportionment of research among government, academic, and industrial facilities. His most difficult problems, and also greatest successes, were keeping the confidence of the military, which distrusted the ability of civilians to observe security regulations and devise practical solutions, and opposing conscription of young scientists into the armed forces. This became especially difficult as the army's manpower crisis really began to bite in 1944. In all, the OSRD requested deferments for some 9,725 employees of OSRD contractors, of which all but 63 were granted. In his obituary, The New York Times described Bush as "a master craftsman at steering around obstacles, whether they were technical or political or bull-headed generals and admirals."

How Can USPHS, NIH, CDC and FDA Culture be Changed?

MAHA must begin by recognizing that they are not just dealing with organizational charts and a massive siloed bureaucracy that is structurally biased towards a disease treatment model rather than a health promotion model. They are faced with transforming a deeply entrenched socialist/corporatist bureaucratic culture. This is a culture for which the idea of entrepreneurship is not only foreign, but is seen as a threat. For which libertarian and conservative beliefs in the primacy of the individual and right to choose are alien. This is a culture that firmly believes in utilitarian outcomes-based socialism while fiercely defending their own privileges. For which risk-taking is a threat to be strictly avoided, suppressed, and never rewarded. Team players are what is selected for.

The only way this can be changed will be to actively recruit, incentivize and promote a new generation of leaders, and help them to work up the ladder to replace the Yellow Berets and their bureaucratic offspring.

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