Assistant Secretary For Health Nominee Koh Reinforces Tobacco Theme For HHS

Harvard Public Health School’s Howard Koh also continues alignment of key public health roles with White House and Capitol Hill, rather than HHS Secretary-nominee Sebelius.

The nomination of Howard Koh to serve as assistant secretary for health continues the Obama administration's theme of aligning key public health positions of HHS around prevention, preparedness, cancer treatment - and with the new White House team.

Koh currently is associate dean for public health practice at the Harvard School of Public Health. He was nominated for the HHS post March 25.

As assistant secretary, Koh would oversee FDA, the National Institutes of Health, the Centers for Medicare & Medicaid Services, the Centers for Disease Control & Prevention, the Agency for Healthcare Research and Quality and other health-related activities of HHS. He also would advise the secretary on a range of public health issues.

Koh's background fits well with other incoming top officials at HHS, including deputy secretary-nominee Bill Corr, commissioner-nominee Margaret Hamburg and deputy commissioner-designate Joshua Sharfstein.

Like Corr, who most recently led the Campaign for Tobacco Free Kids, Koh has devoted a significant portion of his career to fighting to reduce smoking and its adverse health consequences (¹ (Also see "HHS Deputy Corr May Reignite FDA Tobacco Oversight; PhRMA Sees Upside" - Pink Sheet, 19 Jan, 2009.), p. 8). As commissioner for Public Health for the state of Massachusetts from 1997-2003, he oversaw an aggressive state-wide anti-smoking campaign - and also what he characterized as its dismantling, which he lamented in a recent Boston Globe ² editorial.

Koh has continued to advocate for tobacco-control polices at Harvard, for example, in this ³ presentation as part of the Great American Smokeout in December.

His selection would help position HHS to respond to whatever approach, if any, Congress enacts to add tobacco regulation to the department's policy portfolio. While House Energy and Commerce Committee Chairman Henry Waxman, D-Calif., is proposing to house tobacco regulation in FDA, for example, Rep. Steve Buyer, R-Ind., advocates a new separate tobacco agency within HHS.

Balancing the staff

The selection of Koh also suggests a continuing effort to balance key health appointments with the interests of two of the Obama administration's key allies on Capitol Hill: Sen. Edward Kennedy (D-Mass.) and Waxman.

That goal is most evident in the simultaneous appointments of Hamburg and Sharfstein, with the former supported for the commissioner post most vigorously by Kennedy and the latter by Waxman.

The chief deputy at HHS - Corr - is a former Waxman aide. Koh's Massachusetts background gives him closer ties to Kennedy. Indeed, Kennedy issued a statement complimenting Koh when he left the state government post to join Harvard.

Koh's background as a former public health commissioner also gives him a lot in common with both Hamburg (former public health commissioner of New York City) and Sharfstein (Baltimore).

He and Hamburg share in interest in preparedness. Koh directs the Harvard Public Health School's Center for Public Health Preparedness. He chairs the CDC Board of Scientific Counselors on Emergency Preparedness and Response, which includes Hamburg as a member.

Koh and Sharfstein were both co-authors on a 2001 paper analyzing Massachusetts' 1997 decision to expand newborn screening for rare metabolic disorders. The paper analyzes the experience as a model for the challenges inherent in adapting public policy to scientific advances, especially in the field of genomics.

Not Sebelius' HHS?

All of the top HHS appointees so far share one other thing in common: they are the White House choice for their posts, since Secretary-nominee Kathleen Sebelius is not yet confirmed for the post (see ⁴ (Also see "HHS Secretary-Nominee Sebelius Hearings Set Before Senate Health, Finance Committees" - Pink Sheet, 26 Mar, 2009.)).

Corr, Hamburg and Sharfstein all served on the HHS transition team for Obama. Koh was not on the transition team, but has worked with transition team member Nicole Lurie (currently with RAND) on issues related to health care disparities and preparedness. Lurie herself was considered a candidate for the ASH post.

And Koh was hired at Harvard by Larry Summers, who now chairs Obama's counsel of economic advisors.

Unlike the other HHS appointees, Koh did not previously serve in the Clinton administration, although he was appointed by the president to the National Cancer Advisory Board in 2000. Indeed, much of Koh's early research focused on different prevention strategies for cancer, including the importance of sunscreens to prevent melanoma.

Koh authored the first large-scale survey of sunscreen use a decade ago ⁵ (Also see "Sunscreens routinely used by 47% of sunbathers in first large-scale U.S. survey." - Pink Sheet, 18 Aug, 1997.), p. 8). His appointment could lead to a revisiting of FDA's sunscreen-labeling rule, which has been stayed due in part to industry opposition.

Koh recently has had the opportunity to take an in-depth look at the department he is slated to join, serving as an independent reviewer on the Institute of Medicine's just-published report "⁶ HHS in the 21 Century."

-Michael McCaughan ([email protected]) and Katie Stevenson ([email protected])