Is the CDC Ignoring Science When it Interferes with a Cozy Relationship?

When does collaboration cross the line into research misconduct? And why is it bad for public policy, cats, and people care about both of them?

Back in August of 2013, I wrote a post asking whether the Centers for Disease Control and Prevention was doing the American Bird Conservancy’s bidding. As should be obvious, the question was intended to be provocative. As it turns out, though, it was also more than a little prescient.

Documents obtained through Freedom of Information Act requests reveal a pattern of questionable behavior from CDC epidemiologist Jesse Blanton, whose cozy relationship with various ABC staff resulted in the publication—and extensive promotion—of a paper that’s become one of the go-to tools in TNR opponents’ arsenal (see Note 1).

And yet, despite its glaring flaws and dubious origins—which together raise serious questions about research misconduct—both the CDC and John Wiley & Sons (publisher of Zoonoses and Public Health, the journal in which the paper appeared) have been eager to dismiss concerns over this poster-child for publicly funded junk science.

(O)mission(s) Accomplished

Section 93.103 (Research misconduct) of the Public Health Service Policies On Research Misconduct, with which CDC staff must comply, defines falsification as “manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record” (emphasis mine). E-mail exchanges between Blanton and his co-authors reveal a number of instances of such behavior over the course of writing “Rabies Prevention and Management of Cats in the Context of Trap-Neuter-Vaccinate-Release Programmes.”

Although the authors argue that “TNVR has not been shown to reliably reduce feral cat colony populations,” [1] for example, it’s difficult to ignore the implication that they simply disregarded much of the available evidence. In fact, Allison Roebling (listed as the paper’s lead author although it’s clear Blanton was in charge) acknowledged, in an e-mail to Blanton, that one of the studies to be included [2] was “technically a success,” documenting “an overall decline in the populations of 103 colonies of 16–32 percent” (see Note 2). In the published version of the paper, however, these impressive results were obscured entirely by the authors, likely giving readers the impression that such large-scale sterilization efforts are in vain:

“A study of 103 local colonies in Rome, Italy, found that while half of the colonies reported population decreases, virtually the same number were stable or showed increases (Natoli et al., 2006) in spite of an active sterilization campaign and the adoption of most of the kittens being born in colonies.” [1]

Although technically correct, this characterization is so misleading it’s difficult not to believe it was deliberate. What Roebling identified (correctly) as a success, readers were likely to interpret as a notable failure.

And Roebling herself omitted two additional favorable studies, one because the study’s “numbers only make sense with considerable adoptions and emigrations,” [3] and the other because of its “very short observation time (two years)” and failure to estimate “the change in population size.” [4] (As Roebling herself admits, however, “there were no kitten litters observed the second year of [this] campus TNR program,” an obvious measure of success.) A fourth study, [5] which, as Roebling explains to Blanton “showed a significant success with feral cat sterilization” and could be included “if we want to add a paper that showed positive results” was also left out of the final paper.

Also curious is the authors’ reference to Felicia Nutter’s PhD work in Randolph County, North Carolina, one of four citations supporting their claim that “many other potential zoonotic and cat-specific diseases are harboured in feral cat populations in addition to rabies.” [1] In fact, as Nutter explained in a paper summarizing her PhD research, the colony cats studied “had similar baseline health status to pet cats.” [6]

Again, readers were likely to come away with a very different impression.

Moreover, Blanton and his co-authors either overlooked or ignored what Nutter had documented in terms of TNR success: a 36 percent average decrease among six sterilized colonies in the first two years while three unsterilized colonies experienced an average 47 percent increase over the same period. [6] And during her four-year follow-up census, one colony had been reduced from 10 cats to none; at seven years, another colony originally containing 10 cats had been reduced to one cat. [7]

All of this raises some serious questions for public health professionals claiming publicly that “TNVR has not been shown to reliably reduce feral cat colony populations.” [1] Indeed, one of the paper’s two anonymous reviewers noted as much: “You have cherry-picked the TVNR references that support your position and this fact will be used as an argument against your position.”

Well, sort of. Unfortunately, not enough of the right people argued against the paper’s publication.

The specter of falsification wasn’t limited to research related to TNVR, either. Blanton and his co-authors note, correctly, that “exposures to rabid cats resulted in human fatalities in 1960 and 1975,” [1] but fail to acknowledge that one of those two cases involved a woman who was bitten while traveling in Guatemala and then treated in the U.S. [8] Actually, Roebling pointed this out in an e-mail to Blanton: “The 1960 case was acquired in Guatemala. Still want to include it?”

His reply, just one minute later?

“Sure, why not it was a case that was imported into U.S. and due to a cat.”

Curiously, Blanton was far less enthusiastic about the topic of rabies and cats just one year earlier. Indeed, a comment he made prior to undertaking the publication of “Rabies Prevention and Management of Cats” undermines the entire premise of the paper. In an e-mail to Rick Gerhold (who’s co-authored at least two articles attacking TNVR as a public health threat, [9, 10] including another badly flawed article in Zoonoses and Public Health), Blanton seemed to dismiss the very idea that domestic cats pose a threat of transmitting rabies: “Rabid cats appear to be dead end hosts, with data rare or non-existent that indicates further transmission from these rabid felines to other mammals, including humans.”

Now, given Blanton’s role with the CDC—which includes being lead author for the agency’s annual rabies surveillance reports from 2004 to 2011, co-author for 2012–2014, and the agency’s consultant for the latest edition of the Compendium of Animal Rabies Prevention—it seems highly unlikely that his assessment of these risks would have changed so dramatically over such a short period of time.

So what did change? I’m getting to that.

Nothing Personal, It’s Just Business

In the Acknowledgments section of “Rabies Prevention and Management of Cats” (conveniently hidden behind a paywall), the authors provide the following disclaimer: “The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.” [1] Documents obtained via FOIA requests, however, suggest otherwise. To begin with, the American Bird Conservancy’s press release—which was cleared by CDC and its parent agency, Health and Human Services—claimed that the paper’s “authors represented the American Bird Conservancy, the Centers for Disease Control and Prevention, and the U.S. Department of Agriculture” (emphasis mine).

And when Arun Prasath Kanagarajan, production editor for Wiley, e-mailed Blanton to confirm that he’d received his “copyright agreement indicating U.S. Government work,” and requesting additional confirmation “that all authors are U.S. Government employees,” Blanton merely noted that “Dr. Fenwick with the American Bird Conservancy is the only non-government employee author.” That the work done researching, writing, and revising the paper was “government work” is indicated by the fact that e-mail correspondences from CDC (other than a handful from Roebling and co-author Dana Johnson, who, like Roebling, was working at CDC on an unpaid fellowship) were only very rarely engaged in outside of typical work hours.

The CDC effort associated with “Rabies Prevention and Management of Cats” was, in other words, done almost entirely “on the clock.”

Assume the Position

In April 2013, Tampa Tribune reporter Mike Salinero contacted CDC regarding a story he was working on. His only question: Does CDC have a position on TNVR?

Although it appears the CDC didn’t respond to Salinero’s request before his deadline, the response crafted by CDC staff (as evidenced by a string of e-mail in which Blanton was included) began as follows: “CDC does not currently have an official position on trap-neuter/vaccinate-release programs.”

CDC e-mail communications obtained via FOIA requests, however, reveal both internal and external communications stating that CDC does have a position opposing TNVR—and that it’s articulated in “Rabies Prevention and Management of Cats.”

In a May 15, 2012, e-mail to his boss, Charles Rupprecht (see Note 3), for example, Blanton refers to “the most recent version of the TNVR position paper” (emphasis added). In fact, the term position paper was used frequently in Blanton’s correspondences with his co-authors, and in a June 12, 2012, e-mail in which he first sought ABC’s collaboration in writing and publishing “Rabies Prevention and Management of Cats” (more on this below). And in a December 4, 2012, e-mail responding to an inquiry from the American Public Health Association’s Veterinary Public Health Special Primary Interest Group (which endorsed TNVR a year later), Blanton writes: “We are not in agreement with recommending TNVR as a preferred management practice. I’ve attached a perspective piece which we prepared along these lines” (emphasis added).

CDC Doing ABC’s Bidding? Check.

Although the origins of “Rabies Prevention and Management of Cats” are not entirely clear, ABC’s involvement can be traced back to a June 2012 e-mail from Blanton to ABC’s Senior Policy Advisor, Steve Holmer (see Note 4), which reads:

“Dr. Holmer, we are currently working on a position paper regarding trap-neuter-vaccinate-release programs for feral cat colonies. The focus is largely on claims around public health impacts of these programs (particularly rabies), but we also hope to address the relative efficacy of the programs, impact on local ecology, and other zoonotic diseases. We have been working on a draft and based on the information you presented during last year’s World Rabies Day webinar were interested if you might be willing to provide input on the draft and be considered as a co-author? If you are interested I would be happy to provide a current copy of the manuscript for your review and input.”

Why would a CDC epidemiologist, who’s been focused on rabies for at least five years, reach out to anybody at ABC, an advocacy group whose stated mission was, at the time, “to conserve native birds and their habitats throughout the Americas”—and whose track record representing the science relevant to managing outdoor cats is nothing short of abysmal—for input regarding CDC’s apparent position on TNVR? After all, if the press release (no longer available on the ABC website) promoting Holmer’s World Rabies Day webinar (see Note 5) is any indication, ABC’s longtime opposition to TNR/TNVR (and outdoor cats more generally) would have been immediately clear to Blanton.

It’s difficult not to conclude, from this one e-mail alone, that Blanton (and some of his CDC colleagues) share ABC’s agenda—which might help explain the unsettling degree of assistance CDC staff provided in ABC’s promotion of “Rabies Prevention and Management of Cats.”

On July 15, 2013—just two days before the online publication of the paper—Grant Sizemore, then ABC’s Cats Indoors Program Officer (now Director of Invasive Species Programs), e-mailed Blanton:

“Hello, Jesse—I am looking forward to the release of the Roebling et al. paper and appreciate you keeping me in the loop. I was wondering if the CDC has any plans to work with the press on the paper’s release. ABC believes that this paper is extremely important in identifying the public health threat posed by feral cat colonies, and we want to make sure people hear about it. Does the CDC have any interest in a press release or press conference when the paper is published? Would the CDC like to take the lead on these activities, or would they prefer if ABC did? Also, do you have any interest in an Op-Ed piece to be sent to some major papers in key locations (e.g., Florida)? ABC is trying to prepare ourselves for the publication’s release, and these are some important questions that will determine how we proceed. I appreciate any information that you can provide and hope that you and other authors, the CDC, and ABC can work together to bring awareness to this important issue.”

Two days later, Christopher Cox, whom Blanton refers to as “our division communications officer,” informed Sizemore (with a copy to Blanton) that “this particular study is not one that CDC has slated for proactive press engagement, but if ABC engages the media we’ll be happy to help facilitate interaction with Jesse and help ensure consistency of messaging.”

ABC jumped at the opportunity, not even waiting for Blanton to provide his own quotes.

On July 23, Robert Johns, ABC’s Director of Public Relations, sent Blanton a draft press release—astonishing in both its contents and tone, even in the incomplete form I was provided—requesting his feedback (PDF). This was followed by a flurry of internal CDC communications documenting the clearance of the press release, along with talking points provided by CDC (PDF), up through CDC administration and finally receiving approval from Health and Human Services, the agency that oversees CDC, on August 5.

All of which seems like a remarkable amount of work (again, virtually all of it on the clock) to help ABC (whose mission was, don’t forget, “to conserve native birds and their habitats throughout the Americas”) promote “Rabies Prevention and Management of Cats”—the findings and conclusions of which “are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.”

•     •     •

Although it’s not entirely clear from the documents received, Blanton and the ABC staff with whom he collaborated appear to have recognized, and capitalized on, the advantages of a partnership: the CDC has enormous credibility, obviously, while ABC has a very effective PR department. Together, the two could do far more to advance a common agenda opposing TNVR that either could do alone. Of course, it’s one thing for ABC to promote its opposition to the non-lethal management of outdoor cats—however misguided and self-defeating—but for CDC to collaborate in such efforts is a blatant misuse of precious tax dollars and an indefensible betrayal of the public’s trust.

Unfortunately, the CDC sees things differently, arguing via e-mail that my concerns “do not meet the definition of ‘research misconduct.’” Although I was assured that the agency takes these concerns “seriously” and that “further evaluation outside of the scope of [the Public Health Service Policies On Research Misconduct]” would be conducted, that was last October and I’ve heard nothing more.

The response from Wiley was similar—both puzzling and frustrating:

“We have followed the procedures as outlined by the Committee on Publication Ethics (COPE) and have received a response to the concerns you have raised from the corresponding author—the corresponding author’s institution has also reviewed the concerns and found the issues raised not to be in conflict with their guidelines for research integrity. Upon reviewing all of the information provided, we have found no evidence of research misconduct and have no further concerns with this article.”

I find it truly incomprehensible that the behavior documented here is considered acceptable by both the CDC (which pledges to “base all public health decisions on the highest quality scientific data that is derived openly and objectively”) and Wiley (“one of the world’s most respected publishing and information services companies”). After all, research papers have been retracted for far less.

Postscript

Three months after the publication of “Rabies Prevention and Management of Cats” and the media circus that followed—triggered in part by an article in USA Today (see Note 6) in which the paper is attributed (incorrectly) to the CDC and its contents mischaracterized as a “study”—Blanton was visiting the University of Georgia for a symposium called Rabies: An Old Disease with New Tricks. Over the course of his 36-minute presentation, Few Poisons More Deadly than a Mad Dog’s Tooth: Rabies in the U.S. and Abroad, Blanton never brought up TNVR once—and rarely mentioned cats at all.

How is that even possible?

Just a few months early he and his co-authors had argued that “rabies transmission via feral cats is a particular concern as demonstrated by the significant proportion of rabies post-exposure prophylaxis associated with exposures involving cats.” [1] And Blanton was quoted at some length in ABC’s press release (which, remember, he and a number of his CDC colleagues approved), complaining that “allowing populations of feral cats to persist in communities does not reduce public health problems related to feral cats.”

Just a few months later, though, the only threats he acknowledged to the UGA audience were dogs and wildlife.

The following month (November 2013), I e-mailed Blanton (the paper’s corresponding author), with some very specific questions about the scientific rationale for some of the claims he and his co-authors made. His response was more than a little disappointing, and Blanton made it clear that he wasn’t about to be as generous, time-wise, with me as he was with the ABC staff:

“As you can probably imagine, we’re very busy with multiple rabies projects both domestic and international and we likely won’t soon have time to engage in a more rigorous exchange regarding the specifics of the data and evidence cited.”

Indeed, my follow-up e-mail to Blanton went unanswered.

And it become clear only earlier this year, with the publication of the 2016 Compendium of Animal Rabies Prevention and Control (PDF), what might have been keeping him “very busy.” In it, the authors refer to “Rabies Prevention and Management of Cats” as the sole source to support their claim, “Stray and feral cats serve as a significant source of rabies exposure risk.” [11] Even setting aside the damning evidence outlined above, it’s a real stretch to suggest that this paper—and this paper alone—can support any such claim.

Note 1: For the purposes of this post, I will use the term TNR to refer generally to trap-neuter-return, whether or not vaccines are administered (a component that’s considered best practice). The term TNVR will be used to refer specifically to the practice described in the paper “Rabies Prevention and Management of Cats in the Context of Trap-Neuter-Vaccinate-Release Programmes” and any references to that paper.

Note 2: In the interest of full disclosure: in the same e-mail, Roebling goes on to describe the 16–32 percent decline as “modest compared to the time spent on the program (2–6 years).” Curiously, none of the co-authors, reviewers, or editors seemed troubled by the comparative baseline implied in Roebling’s comment—that “removal of strays” (as prescribed by the authors) has demonstrated superior real-world results as compared to TNVR. In fact, no such evidence exists; even on small oceanic islands, eradication efforts typically take many years.

Note 3: Rupprecht, who headed up CDC’s rabies program since 1993, left in 2012 amidst allegations that he’d injected primates with unapproved viruses and failed to inform his staff.

Note 4: Holmer would eventually have to settle for being thanked in the Acknowledgments section of the paper, while ABC President George Fenwick received co-author credit.

Note 5: Incredibly, the ABC press release that attracted Blanton’s attention badly misrepresented CDC’s own rabies surveillance data.

Note 6: It’s not clear who’s to blame for the story’s inaccuracies, but documents obtained via FOIA request show that reporter Elizabeth Weise contacted the CDC with questions three days before the story was published. How she learned of the paper’s publication remains a mystery; ABC’s press release wasn’t published until five days after the USA Today piece, on July 23rd.

Literature Cited

1. Roebling, A.D., et al., Rabies Prevention and Management of Cats in the Context of Trap-Neuter-Vaccinate-Release Programmes. Zoonoses and Public Health, 2013. 61(4): p. 290–296.

2. Natoli, E., et al., Management of feral domestic cats in the urban environment of Rome (Italy). Preventive Veterinary Medicine, 2006. 77(3-4): p. 180–185.

3. Centonze, L.A. and J.K. Levy, Characteristics of free-roaming cats and their caretakers. Journal of the American Veterinary Medical Association, 2002. 220(11): p. 1627-1633.

4. Hughes, K.L. and M.R. Slater, Implementation of a Feral Cat Management Program on a University Campus. Journal of Applied Animal Welfare Science, 2002. 5(1): p. 15–28.

5. Mendes-de-Almeida, F., et al., Reduction of feral cat (Felis catus Linnaeus 1758) colony size following hysterectomy of adult female cats. Journal of Feline Medicine & Surgery, 2011

6. Stoskopf, M.K. and F.B. Nutter, Analyzing approaches to feral cat management—one size does not fit all. Journal of the American Veterinary Medical Association, 2004. 225(9): p. 1361–1364.

7. Nutter, F.B., Evaluation of a Trap-Neuter-Return Management Program for Feral Cat Colonies: Population Dynamics, Home Ranges, and Potentially Zoonotic Diseases, in Comparative Biomedical Department2005, North Carolina State University: Raleigh, NC. p. 224.

8. Ross, E. and S.A. Armentrout, Myocarditis Associated with Rabies—Report of a Case. New England Journal of Medicine, 1962. 266(21): p. 1087–1089.

9. Gerhold, R.W. and D.A. Jessup, Zoonotic Diseases Associated with Free-Roaming Cats. Zoonoses and Public Health, 2012. 60(3): p. 189–195.

10. Gerhold, R., Cats as Carriers of Disease. The Wildlife Professional, 2011. 5(1): p. 58–61.

11. Brown, C.M., et al., Compendium of Animal Rabies Prevention and Control, 2016. Journal of the American Veterinary Medical Association, 2016. 248(5): p. 505–517.

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2 Comments

  1. Peter, as always, your analysis and research is amazingly thorough and leave no stone unturned. My question … what can we do about this? Is there a vehicle for escalating these issues?

  2. Thank you for the kind words. Honestly, I expected a different response from both CDC and Wiley. I’m not sure what other options are available—other than getting the media interested in the story.

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