CDC History of Tuberculosis Control - Medical and Public Health ...

working as a team with state and local TB
Controllers and their staff. These assignees
were in effect “on loan” to the health departments
and operated as state or local employees,
although they were subject to frequent
transfer by CDC among the health departments.
By the mid-1960s, almost every state
plus Guam and Puerto Rico had a TB project
grant (Wyoming did not).
The number of TB Medical Officers began to
decline after 1967 as recruitment became more
difficult and the categorical grants were phased
out. However, Public Health Advisors continued
to be requested and effectively work in
health department TB programs where they
were supported by Partnership for Health and
later prevention block grants. The Advisors
and TB Medical Officers had a major impact
on TB control in the areas where they were
assigned and afterwards. After serving in the
field, many of the TB Medical Officers continued
on in public health and national TB
leadership. Larry Farer and Dixie Snider
started as TB Medical Officers in Utah and
Oklahoma, respectively, and both later went
on to become directors of the TB Division.
There is a long list of other former TB Medical
Officers who continued in leadership roles in
TB including current ATS president Jeff
Glassroth, John Sbarbaro, Phil Hopewell,
Tony Catanzaro, and others. The last of the
original TB Medical Officer field group was
Eric Brenner. (The concept of field Medical
Officers was revived on a smaller scale in the
early 1990s and continues today.) The TB
Branch in the late 1960s and early 1970s also
supported a number of “Clinical Associates”
who were not PHS medical officers but
worked like “TB fellows” in pulmonary
training and were assigned to key institutions.
For example, Mike Iseman was assigned to
Harlem Hospital under Julia Jones. These
clinical associates were basically pulmonary
fellows working in pulmonary clinics who
concentrated on TB and worked in the TB
clinics. Lee Reichman was also a TB Branch
Clinical Associate, as was Ray McDonald,
TB Control at the Millennium
44
who works in New Jersey with Dr.
Reichman.
No early history of the TB Division would be
complete without a mention of the “TB
Today!” course, which was conducted by the
TB Division from the late 1960s until the early
1990s. The course evolved from courses taught
at National Jewish Hospital in Denver and
Battey Hospital in Rome, Georgia. Seth
Leibler directed the development of this
course, working closely with the Director, Al
Holguin, and Don Kopanoff, who later served
as the TB Division’s Associate Director for
External Affairs. Later the course was implemented
by Ginny Bales, now CDC Deputy
Director for Program Management, and Kathy
Rufo, now Deputy Director of the Diabetes
Translation Division; they were all essential to
the design and early conduct of this course.
Later, Barbara Holloway (currently Deputy
Director of the CDC Epidemiology Program
Office) directed the course. It was designed for
key TB program managers including physicians,
TB Controllers, TB nurses who had
management responsibilities, and other TB
program managers. The course was presented
in a workshop format with heavy emphasis on
program evaluation and management by
objectives. The attendees worked through the
course using their own program’s TB morbidity
and program evaluation data. They developed
objectives for their program based on
their unique problems, and developed strategies
for achieving the objectives. They went
back to their programs and began to implement
the plans and achieve the objectives.
Many of the TB Controllers from that era will
testify the course changed their whole approach
to TB from a perspective of clinical
management of TB patients to one of managing
programs and effectively supervising
people. Since the late 1960s, nearly every state
and major city TB Controller and head TB
nurse has attended the course, which has been
revised over time.
The 1970s were belt-tightening times for TB