Frederic E. Shaw, M.D., J.D.
Title: Senior Advisor for Health Reform, Office of Health System Collaboration, Office of the Associate Director for Policy, CDC
Organization: National Indian Health Board
Education:
B.A., 1973, University of New Hampshire
M.D., 1977, University of Vermont College of Medicine
J.D., 1992, Columbia Law School
PHLN: What sparked your interest in public health?
Shaw: In 1980, I was working as an internal medicine resident at the University of Vermont when I learned of an opportunity to go to Thailand to provide care to Cambodian refugees. The Vietnamese had just invaded Cambodia, forcing thousands of these refugees into makeshift camps near the Thai border, and mortality was high. Within a few weeks, I was treating patients in a tent six kilometers inside Cambodia. I worked in the camp for three months, seeing patients with typhoid fever, malaria, dysentery, and other illnesses. We soon realized that many of these illnesses could be prevented, and we began a basic public health and hygiene program in the camp. That's when I first thought of working in public health. While working in the camp, I met several people from CDC. They told me about the Epidemic Intelligence Service (EIS). Three years later, when I finished my service in the National Health Service Corps, I applied to EIS.
PHLN: Few people have earned both doctor of medicine and juris doctorate degrees. Please describe your educational path and what inspired you to earn both degrees?
Shaw: I had been interested in medicine since I was about twelve years old. In the late 1980s, I was working as the state epidemiologist in New Hampshire when I became interested in the legal issues around the AIDS epidemic. I deferred going to law school for a couple of years, then entered Columbia Law School in 1989.
PHLN: How have you used your law degree in your public health law career?
Shaw: The legal training has allowed me to have a perspective that I would not have had otherwise. Law underpins almost everything we do in public health. My legal training has come in handy at many points in my career, for example when I worked in the U.S. Senate as a legislative assistant, and in my current position as CDC's Senior Advisor for Health Reform.
PHLN: What was your career path to the position of Senior Advisor for Health Reform?
Shaw: I worked for a couple of years as the Associate Director for Science in the Division of Health Informatics and Surveillance. In October 2012, the health reform position became vacant unexpectedly when the previous advisor left CDC. I had to climb a steep learning curve on the Affordable Care Act (ACA), a very complex law, but I had some experience in health insurance and regulation from my days on Capitol Hill. Training in health law also helped.
PHLN: Your diverse background working in public health law, both within and without CDC, gives you a unique perspective on public health law. What are your thoughts on how public health law has evolved during your career?
Shaw: The study of public health law goes back a very long time, but it went through a modern renaissance in the last century through the work of James Tobey, and later, Frank Grad, Lawrence Gostin, Scott Burris, and many others. At CDC, public health law got more attention beginning with CDC-sponsored workshops in 1999–2000. The CDC Public Health Law Program was established in 2000. I first became associated with the program by attending weekly CDC law team meetings convened by Richard Goodman, Gene Matthews, and Tony Moulton. In 2003, I joined the program on a temporary detail, and then later took a permanent position there. Public health law was a "natural" for me because I was dually trained and I had experienced firsthand the crucial role of law in daily public health practice in the field.
The CDC program grew during the mid-2000s, gained more staff, published important works in the literature, expanded its technical and educational reach, held yearly national conferences, and had a big role in putting public health law more firmly on the map. Now, under the leadership of Matthew Penn, the program has expanded further. A couple of years ago, public health law expanded again at CDC with the establishment of the Law and Science Advisory Group, which has over 120 members across the agency.
In the last several years, support through the Robert Wood Johnson Foundation has had a big effect on public health law through its funding of programs such as the Network for Public Health Law, and Public Health Law Research. Other entities, such as the American Society of Law, Medicine & Ethics, also have made big contributions.
PHLN: You founded the Public Health Law News in July 2003. What was your inspiration for the PHLN?
Shaw: My work at the CDC Public Health Law Program involved setting up a clearinghouse of information on public health legal preparedness. The PHLN was part of that. It began as a simple daily email to a few dozen people within CDC to help keep them informed about news, journal articles, and court cases in the field. After a while, it began circulating outside CDC and the number of subscribers skyrocketed. Later it became a weekly, and then a monthly publication. We never imagined the circulation would rise to what it is today, around 119,000.
PHLN: How has the PHLN changed in the past decade?
Shaw: Initially it was a very simple publication. When a newsletter comes out every day, you don't need a huge amount of content in each issue. Then, as it became a weekly, and then a monthly, it became longer and more elaborate. It's a great publication with a very important function.
PHLN: What kind of stories are important for the PHLN to cover and why?
Shaw: Somebody once told me that the News was needed to help create an "intentional community" of people interested in public health law. Yes, the purpose was partly to inform—to spread news and developments in the field—and to transmit information from CDC. But it also served to knit together like-minded people into a community built around public health law. It's important for the PHLN to continue doing that.
PHLN: What have been some of the most exciting public health law events you have observed and how have those events shaped your career?
Shaw: At the top of my list would be the enactment of the Affordable Care Act and the Supreme Court's decision in National Federation of Independent Business v. Sebelius. Those were major landmarks in the law and they are having far-reaching effects on public health. In addition, I would list some of the early public health law conferences put on by the CDC Public Health Law Program. They were very exciting, almost exuberant, because people were coming together for the first time in years to trade ideas and celebrate the huge potential of the subject.
PHLN: The influenza A (H1N1) pandemic in 2009 was a catalyst for public health law preparedness. What were your observations and what role did you play in addressing the pandemic?
Shaw: I was very involved because, at the time, I was editor of the MMWR. We published the first two cases of pandemic influenza A (H1N1) on April 21, 2009. In the next year or so, we published over forty-five articles on various aspects of the pandemic. Yes, the H1N1 pandemic was a catalyst for public health legal preparedness, but that had begun earlier with the SARS epidemic in 2003, in which the CDC Public Health Law Program played an important role.
PHLN: For the past six years you have taught public health law to students at Emory's Rollins School of Public Health. Can you describe your experience teaching public health law?
Shaw: It's been a great experience, as much for me as for the students. You never learn a subject so well as when you have to teach it. The vast majority of my students are masters-level students in health policy. Teaching law to masters-level public health students is much different from teaching to law students. Most of my students have no knowledge or background in law, the U.S. Constitution, or legal thinking. Many are from foreign countries. So, in my class we start with the basics: what law is, what it does, and how it is interpreted. I love it when students have an Aha! moment about the role of law in public health.
PHLN: Of the valuable public health law principles you teach, which do you consider to be the most important?
Shaw: Federalism is the most important concept for masters-level students to understand, because it is so important to how public health works in the United States. In our country, legal power is divided, and often shared, between the federal government and the states. This makes public health practice much different in the United States than in many other countries.
PHLN: What are your current projects?
Shaw: For the past fourteen months, I've served as the Senior Advisor for Health Reform in the Office of Health System Collaboration, Office of the Associate Director for Policy, CDC. I have truly enjoyed the work. My job is to understand the Affordable Care Act and its implications for CDC and for public health, to help translate the technicalities of the law, to provide technical assistance to public health professionals about the law and its likely effects, and to review ACA-related regulations on behalf of CDC. I work a lot with the Office for State, Tribal, Local and Territorial Support (OSTLTS) and other CDC programs, the Department of Health and Human Services, and CDC partner organizations. I also serve as Chair of CDC's Law and Science Advisory Group.
PHLN: What public health law projects would you be interested in working on in the future?
Shaw: In my current work in health reform, I've gotten very interested in how the insurance expansions of the ACA and the big transformation we are now seeing in health care delivery will affect local health departments. I have been working on this with OSTLTS and key CDC partners, and I plan to stay involved in that work. Another area of interest for me is the law of disease reporting. Over the past few years I had an opportunity to work on this subject with CDC and the Council of State and Territorial Epidemiologists, and I have found it to be a fascinating subject of study. There is a lot to learn about how these laws are constructed and how they operate.
PHLN: Have you read any good books lately?
Shaw: I just finished reading three good books by Nathaniel Philbrick: Mayflower: A Story of Courage, Community, and War; In the Heart of the Sea: The Tragedy of the Whaleship Essex; and Bunker Hill: A City, a Siege, a Revolution. All three are about the history of New England, my native land.