Like several of President Trump’s cabinet picks, Dr. Brenda Fitzgerald comes to Washington with some baggage.
Fitzgerald, who Trump tapped in early July to oversee the Centers for Disease Control and Prevention (CDC), has some impressive health credentials.
She’s a board-certified OB-GYN who had a private practice for 30 years in Carrollton, Ga.
Fitzgerald also served as health adviser to Republican Newt Gingrich, the former speaker of the House of Representatives.
And since 2011, she’s been the public health commissioner in Georgia, where she led the state’s response to the Zika virus and the opioid addiction epidemic.
Fitzgerald, a two-time Republican congressional candidate and major in the Air Force, faces a daunting task of leading an agency that faces a proposed $1.2 billion budget cut.
It’s the largest reduction in two decades to the federal agency, which supports health promotion, prevention, and preparedness, and protects the United States from health, safety, and security threats.
When Fitzgerald accepted the cabinet position, Tom Price, secretary of Health and Human Services, said, “She has a deep appreciation and understanding of medicine, public health, policy, and leadership — all qualities that will prove vital as she leads the CDC.”
But numerous public health experts interviewed by Healthline said that her comments about public health are ill-informed, and that some of her actions as a public health official have been ethically questionable.
Water and Ebola
When the Ebola crisis hit in 2014, Georgia Gov. Nathan Deal, who appointed Fitzgerald to run the state agency, said water destroys the Ebola virus.
And he noted it was Fitzgerald who told him this.
Deal told the editorial board of the Marietta [Georgia] Daily Journal that he met with Fitzgerald and other medical officials to discuss how to respond to the virus.
“The most comforting thing that I heard from [Fitzgerald] was that water kills the Ebola virus,” he said. “I’ve never heard that before. I thought it was something that was so contagious there wasn’t much you could do to prevent it or anything else, so her advice was ‘wash your hands.’”
After Deal made the comment, Fitzgerald cited the World Health Organization (WHO) guidelines that said washing hands with soap and water can help prevent contamination.
She said that according to news reports, Ebola can only survive for a short period of time in water.
“Does water kill it? Yes,” she said, according to the Atlanta Journal-Constitution. “But once it gets in your body, it’s mean.”
Dr. Ford Vox, a physician at Atlanta’s Shepherd Center, which is ranked by U.S. News & World Report as among the top 10 rehabilitation hospitals in the country, disputed that.
He told the Atlanta Journal-Constitution that Fitzgerald’s claim about water killing Ebola “didn’t hold water.”
“While water can kill Ebola in a petri dish, that’s not practically relevant in health cases,” Vox said.
The Coca-Cola problem
However, the biggest public health controversy involving Fitzgerald might be her work with childhood obesity.
As Georgia’s public health leader, she took on the childhood obesity crisis and the accompanying childhood diabetes epidemic with a surprising partner.
Fitzgerald accepted $1 million from Coca-Cola, which is based in Atlanta, to fund the program aimed at cutting the state’s high childhood obesity rate.
This was despite the fact that Coca-Cola’s sugar-filled soft drinks are known as major contributors to childhood obesity.
In fact, the CDC cut ties with Coca Cola in 2013.
After receiving the soft drink company’s donation, Fitzgerald was subsequently accused by many public health experts of downplaying the relationship between soda drinks and obesity, and instead focusing on promoting exercise.
While she has emphatically denied that she ever downplayed nutrition in favor of exercise after Coke’s $1 million gift, Fitzgerald did not directly address the issue when commenting to Healthline.
Fitzgerald did address the general issue of nutrition’s role in preventing disease, including her state’s Georgia Shape program. Its goal over the next decade is to increase the number of students in the “Healthy Fitness Zone for Body Mass Index” by 10 percent.
“Healthy nutrition is an essential component of wellness, and the Georgia Shape program promotes both healthy nutrition and physical activity,” Fitzgerald told Healthline. “Nutrition has been a critical part of the program since the beginning and includes innovative strategies for all stages of childhood.”
Those strategies, she said, include “supporting the Five Star Baby Friendly Hospital Initiative, which recognizes hospitals that promote, protect, and support breastfeeding,” as well as “working with Georgia’s Quality Care for Children program to ensure healthy nutrition is required as part of the quality rating for all centers serving infants and young children.”
The strategies also include, she said, the Strong4Life cafeteria program “that teaches school and cafeteria staff how to encourage healthy choices.”
She said she also worked with Georgia’s Department of Agriculture “to increase schools’ access to local, organic fruits and vegetables.”
The CDC also sent Healthline a statement by Fitzgerald addressing, in broad terms, whether she would accept future funding from Coca-Cola or other corporations for any CDC program.
“Where there’s science to support public health measures, I am a champion for those efforts. For public-private partnerships, I believe that finding common ground and voluntarily working together has been successful and sustainable,” she said in the statement.
As CDC director, she continued, “I am committed to evidence-based recommendations and education, including those that support healthy nutrition.”
Two weeks ago, Fitzgerald told The New York Times she would consider allowing Coca-Cola to fund the federal agency’s programs.
“I will continue the review process in place at CDC,” Fitzgerald wrote to the newspaper, “and any offers of support would be considered through this process before moving forward.”
Based on studies from the Institute of Medicine, the Department of Agriculture, and several other agencies, Harvard’s School of Public Health recently concluded that sugar-filled soda drinks are a major contributor to adult and childhood obesity.
In defiance of these studies, Coca-Cola has, in the recent past, contended that the best way to lose weight is to exercise, and that people should not worry as much about cutting calories.
In August 2015, U.S. News & World Report reported that a nonprofit organization founded to fight obesity was given $1.5 million from Coca-Cola.
The nonprofit, dubbed the Global Energy Balance Network, was reportedly led by a professor at the University of Colorado School of Medicine.
Coca-Cola insisted it had no influence on the organization.
But the Associated Press reported in November 2015 that Coca-Cola helped pick the group’s leaders, edited its mission statement, and suggested articles and videos for its website.
In an email in 2014, the group's president told a high-ranking Coca-Cola executive:
“I want to help your company avoid the image of being a problem in peoples’ lives and back to being a company that brings important and fun things to them.”
When reached for comment by Healthline, Ben Sheidler, a spokesperson for Coca-Cola, declined to answer specific questions about Coca-Cola’s relationship with Fitzgerald — past or future.
Instead, he sent Healthline a statement that read, “As a Georgia-based company that’s been operating for more than 130 years, we have a long history of supporting local programs and initiatives that are important to our home state and hometown of Atlanta. In keeping with that tradition, our company’s foundation provided multi-year grants to support programs aimed at addressing childhood obesity in Georgia.”
The statement went on to note that Coca-Cola understands it has a role to play in helping people reduce their sugar consumption.
“That’s why we support the recommendation of the World Health Organization that people should limit their intake of added sugar to no more than 10 percent of their total daily calorie intake,” the statement read. “We have begun a journey toward that goal.”
The statement explained that the company is “taking action to offer people more drinks in smaller, more convenient sizes, reducing sugar in many of our existing beverages, and making more low and no-sugar beverage choices available and easier to find at local stores.”
The statement concluded, “We’ll also continue making calorie and nutrition information clear and accessible so people can make more informed choices for themselves and their families without the guesswork.”
Corporate influence on public health
Multiple studies, including several conducted by the CDC, have concluded that sugar-filled beverages such as Coke are a significant contributor to childhood obesity, heart disease, and type 2 diabetes.
The CDC's website says, “Frequently drinking sugar-sweetened beverages is associated with weight gain/obesity, type 2 diabetes, heart disease, kidney diseases, nonalcoholic liver disease, tooth decay and cavities, and gout, a type of arthritis”
Multiple public health experts interviewed for this story insisted that mixing corporate interests with public health interests the way Fitzgerald has is problematic.
Susan Levin, MS, RD, CSSD, is a dietitian and director of nutrition education for the Physicians Committee for Responsible Medicine, a nonprofit with a staff of more than 12,000 physicians, dietitians, and scientists, works to bring nutrition into medical education and practice.
Levin said the debate over nutrition vs. exercise in the proliferation of obesity has already been settled.
“It’s long been debunked that exercise is going to have a dent in the obesity epidemic,” she told Healthline. “We know it is the nutrition that has contributed to the horrific statistics.”
Levin noted that two-thirds of Americans are overweight, including one-third who are obese, that 50 percent of Americans have diabetes or pre-diabetes, and that 50 percent of Americans will die of heart disease.
“I have respect for the CDC, and I am disappointed that industry is now so blatantly represented,” Levin said. “She [Fitzgerald] has a track record.”
Levin said America’s food industry is primed to take full advantage of Trump’s deregulation charge and is working to reverse recent nutrition mandates.
Reversing progress on nutrition
Levin said Coca-Cola’s funding of Fitzgerald’s public health initiatives is just one example of part of a “growing national problem” in which industry has taken on a big a role in the dissemination of health information.
During her eight years as first lady, Michelle Obama focused much of her work on improving nutrition for kids and reducing childhood obesity. The Let’s Move campaign focused largely on improving the nutritional quality of school lunches.
There was intense pressure from the food industry during the Obama years, too.
Nevertheless, the first lady’s programs led to “significant improvement” in the nutritional quality of foods chosen by students, according to a 2016 Washington state school district study.
She also successfully pushed for the nation’s first update to nutrition labels in more than two decades.
As Reuters reported last year, the new Nutrition Facts label, which was to take effect next year, would have for the first time required food companies to list how much sugar they add to their products.
But the Trump administration announced in May that it will be rolling back much of the former first lady’s work.
As Vox reported, school lunch standards are just one victim of the increased corporatization of public health under the current administration.
The Healthy, Hunger-Free Kids Act of 2010, which was a big part of the previous administration’s campaign to fight childhood obesity, could be among the many healthy initiatives on the Trump chopping block.
Trump’s Department of Agriculture director, Sonny Perdue, said in May that the department will be giving schools more flexibility in meeting federal nutrition standards for school lunches.
As NPR reported in May, the Trump administration also announced it was delaying the Obama-era requirement that chain restaurants and other food retailers post calorie information, and allowing schools to serve some grains that aren’t whole-grain rich.
Ken Cook, president of the Environmental Working Group, said in a statement in May, “The president’s fondness for Big Macs and KFC is well known, but we shouldn’t let Colonel Sanders and McDonald's run the school cafeteria.”
Levin said that for next three years under Trump, expect to see much more blurring of the lines between corporations and public health initiatives.
“Go to a medical conference and it’s all sponsored by drug companies, go to a nutrition conference and it’s all sponsored by Coca-Cola or the Beef Council,” Levin said. “You really have to question the information you are getting.”