Sharfstein has made his mark

When he took over as Baltimore health commissioner, Dr. Joshua M. Sharfstein says, he was unsure whether he would last three days.

Recalling that beginning in a letter to friends and colleagues this month, he described the public health challenges facing the city as "awesome" and named a few: young mothers unable to get needed support before, during and after pregnancy; thousands of residents who can't access drug treatment; tens of thousands shut out of preventive health care.


Sharfstein made it three years as health commissioner. Now he leaves to become principal deputy commissioner of the federal Food and Drug Administration. While Baltimore didn't unravel what he described as a "tangled web of problems" during his tenure, it did achieve some measurable change: a citywide ban on lead in children's jewelry and the nationwide withdrawal of over-the-counter cough and cold medicines linked to the deaths of four city children; declines in drug overdose deaths and increases in immunizations.

His department enlisted hundreds of local college students to help the poor get access to health services, worked with pediatricians to distribute tens of thousands of books to children, and partnered with police to take on violence as a public health issue. Governing magazine named him a 2008 Public Official of the Year; Mayor Sheila Dixon calls him a "superstar."


Now the city must find a way to replace him. Dixon has named Olivia Farrow, the city's assistant commissioner for environmental health, to head the department pending a national search for a new commissioner.

Dr. Peter L. Beilenson, who preceded Sharfstein as health commissioner, says the city should look for "passion" in choosing a successor; Police Commissioner Frederick H. Bealefeld III wants "a Josh Sharfstein clone."

Ask Sharfstein whom he would want as a successor, or the public health priorities Baltimore should pursue, and he demurs. Beilenson didn't burden him with public comments about the job when leaving, he notes. Sharfstein wants to extend the same courtesy to the next commissioner.

He is similarly reluctant to discuss his achievements in the city. To a degree unusual for a public official - and particularly one so widely lauded - the Harvard-trained pediatrician deflects the credit to others: To Mayors Martin O'Malley and Dixon, for what he says was their insight and support; to Beilenson, for broadening local perceptions of what public health can encompass; to the officials and academics and volunteers who make the programs work.

"I think that we have engaged so many different partners in a wide range of positive efforts, and I can see that they will continue to pay dividends for the city in the future," says Sharfstein, 39. "I mean, there are enormous challenges still, but I do think that things are improving."

Sharfstein had already affected national policy when he arrived in Baltimore. As a volunteer with the FDA, he wrote and edited portions of the agency's legal argument to regulate tobacco as an addictive drug. As a policy adviser to Rep. Henry A. Waxman, he initiated and helped to write legislation requiring the FDA to regulate colored contact lenses not as cosmetics but medical devices.

As health commissioner, Sharfstein led a succession of high-profile campaigns. In 2006, after the deaths of four city children under the age of 4 in the previous six years, he led a group of prominent state pediatricians in warning parents away from over-the-counter cough and cold medicines and asked the FDA to take action. "The bottom line is that there is no evidence that the products are effective, and we know they've harmed children," he said at the time.

Last year, the FDA issued a public health advisory urging parents to stop giving the products to children under 2, warning of serious and potentially life-threatening side effects, and the agency announced a broad review of related regulations, a process likely to take years. The makers of the remedies, meanwhile, agreed to stop marketing them for children under 4.


Children's health has occupied much of Sharfstein's attention. Also in 2006, the Health Department tested jewelry for children from six city merchants and found 17 products with unacceptably high levels of lead content. Young children who mouth or swallow products containing the heavy metal can suffer brain damage or death. Declaring that the federal government had failed to protect children from the hazard, he initiated a citywide ban on the sale of the products.

Such efforts won the praise of Ruth Ann Norton, executive director for the Coalition to End Childhood Lead Poisoning.

"Sharfstein really has taken the Health Department to another level," she says. "He has done a lot of the groundwork that hadn't been done before. It had been a neglected department in terms of infrastructure."

Sharfstein's training had suggested a future at the intersection of public health and health policy. He was a student at Harvard Medical School when he published his first article in the New England Journal of Medicine, an analysis of political contributions made by the American Medical Association he co-wrote with his father, the psychiatrist Steven S. Sharfstein. At the time, he was also rallying classmates to reject the free books offered by pharmaceutical companies.

As a postgraduate, he visited poor neighborhoods in Boston to produce reports documenting how unsafe housing was threatening children's health. He also showed that mentally ill youngsters were languishing in emergency rooms for days because there were no beds available in psychiatric hospitals, prompting Massachusetts to act.

In Baltimore, Sharfstein has seen his role in part as coordinating local resources - hospitals, universities, nonprofit and advocacy groups, other city agencies - to tackle public health challenges. Examples include Project Health, which has sent hundreds of college students into the community to help connect low-income adults with medical care, housing and education; and Operation Safe Streets, which has enlisted ex-offenders in canvassing troubled neighborhoods, mediating conflicts and mentoring young men at risk of succumbing to violence.


"One strategy that we've been pursuing is to support community institutions to really do frontline work in their communities on public health problems," Sharfstein says. "Oftentimes, it's not the public health department that needs to do the work. We're moving in the direction of supporting community institutions, and that has all sorts of extra positive effects for those communities."

Sharfstein, who is married with two young sons, plans to continue living in Baltimore while working at FDA headquarters in Silver Spring. As he turns to national issues, he says he will remain available to the city.

"I just have really grown to love the city," he says. "I'm going to think about this time as a time where I tried to put everything I had into a really challenging job to move the city - to move my city - forward."

Baltimore Sun reporter Kelly Brewington contributed to this article.