A day after Mayor Michael R. Bloomberg said he would seek a significant increase in the cigarette tax but dismantle the City Health Department's smoking cessation program, Dr. Thomas R. Frieden, the health commissioner, said yesterday that his main priori

Dr. Frieden, who led a successful fight against drug-resistant tuberculosis in New York in the early 1990's as an assistant health commissioner, said he would devote similar attention to reducing smoking-related illnesses, which he said accounted for 30 percent of all preventable deaths in the city. Dr. Frieden, who led a successful fight against drug-resistant tuberculosis in New York in the early 1990's as an assistant health commissioner, said he would devote similar attention to reducing smoking-related illnesses, which he said accounted for 30 percent of all preventable deaths in the city. "When I first talked to the mayor's office about this job, I said smoking would be my No. 1 concern," said Dr. Frieden, who spent the last five years working in India to control tuberculosis with the World Health Organization. "And if he didn't care about that, I wasn't interested." In his interview with Mr. Bloomberg, Dr. Frieden said, the mayor brought up the subject of smoking and spoke about it at some length. He declined to say whether he had helped Mr. Bloomberg formulate his cigarette tax proposal, but said he had discussed it with the mayor in detail before it was announced. Because the city is short on money, Dr. Frieden said, he will focus on prevention programs that have proved most effective and will seek financial help from the private sector, especially drug companies that manufacture nicotine replacement products and antidepressants known to help smokers quit. "For the last five years, my enemy has been microbacterial tuberculosis," said Dr. Frieden. "Now, it is tobacco executives." Dr. Frieden defended Mr. Bloomberg's desire to gut the department's smoking cessation program, which includes an advertising campaign urging New Yorkers to quit smoking and a prevention program based in city schools. The American Cancer Society swiftly attacked the mayor's proposal to cut the smoking cessation program, which would save the city about $13 million in the fiscal year beginning July 1. The group applauded his proposal to raise the cigarette tax, which it promised to help promote, but said it expected some of the money to be restored for anti smoking programs. "You have to pick the programs that work the best, and often those are lower-budget ways," Dr. Frieden said. "School-based programs are wonderful things and people spent a lot of time working on them, but 10 years later when you look at the data they have made no difference." Most effective, he said, are combinations of counseling and nicotine replacement products like patches, chewing gum, nasal sprays and bupropion, an antidepressant that has been shown to be effective in curbing the addiction. "You have to keep pace with tobacco companies," he said. "They are smart. We've got to be smarter." Dr. Frieden said he had found $3 million in his department's budget that now goes toward the smoking cessation program and would look to other sources to pay for his efforts, including increasing the fines levied against merchants who sell cigarettes to minors and establishing partnerships with the companies that make antismoking products. The companies could help cover the cost of educating doctors who serve communities where smoking rates are high to press their patients to quit smoking, and in turn push the drug companies' products, he said. Research shows that 70 percent of people who smoke say they would like to quit, Dr. Frieden said, but that only 5 percent do it on their own. Holly Russell, a spokeswoman for GlaxoSmithKline — which makes Wellbutrin and Zyban, two popular smoking cessation drugs, and a nicotine patch — said she did not believe that the company had previously formed a partnership with a city, but added that it would consider such a request. "I am sure we would be open to it," said Brian Jones, a spokesman for the company. Dr. Frieden, who exhibits an unusual combination of passion and practicality, said he would focus directly on health care problems that the city had a shot at tackling through increased surveillance and community-specific attacks. He applied that technique from 1992 to 1996, when he was an assistant health commissioner and director of the city's Bureau of Tuberculosis Control. During that time, the city reduced cases of multidrug-resistant TB by 80 percent, largely by creating a treatment program in which those infected with TB were required to take their drugs in front of health care workers or risk quarantine. Now, he takes control of a department whose mission includes managing bioterror attacks, strange new viruses like West Nile, and bread- and-butter public health problems like flu and infant mortality. And when the agency formally merges with the Department of Mental Health, Mental Retardation and Alcoholism Services, it will take on the complex problems of the mentally ill. "You prioritize by looking at the data, deciding how important a problem is and how amenable it is to treatment," said Dr. Frieden, whose passion for obscure medical studies is like a home cook's lust for rare spatulas, and who peppers his conversation with references to India. "I love this department. This is the only job in the United States that I would have come back for." "When I first talked to the mayor's office about this job, I said smoking would be my No. 1 concern," said Dr. Frieden, who spent the last five years working in India to control tuberculosis with the World Health Organization. "And if he didn't care about that, I wasn't interested." In his interview with Mr. Bloomberg, Dr. Frieden said, the mayor brought up the subject of smoking and spoke about it at some length. He declined to say whether he had helped Mr. Bloomberg formulate his cigarette tax proposal, but said he had discussed it with the mayor in detail before it was announced. Because the city is short on money, Dr. Frieden said, he will focus on prevention programs that have proved most effective and will seek financial help from the private sector, especially drug companies that manufacture nicotine replacement products and antidepressants known to help smokers quit. "For the last five years, my enemy has been microbacterial tuberculosis," said Dr. Frieden. "Now, it is tobacco executives." Dr. Frieden defended Mr. Bloomberg's desire to gut the department's smoking cessation program, which includes an advertising campaign urging New Yorkers to quit smoking and a prevention program based in city schools. The American Cancer Society swiftly attacked the mayor's proposal to cut the smoking cessation program, which would save the city about $13 million in the fiscal year beginning July 1. The group applauded his proposal to raise the cigarette tax, which it promised to help promote, but said it expected some of the money to be restored for anti smoking programs. "You have to pick the programs that work the best, and often those are lower-budget ways," Dr. Frieden said. "School-based programs are wonderful things and people spent a lot of time working on them, but 10 years later when you look at the data they have made no difference." Most effective, he said, are combinations of counseling and nicotine replacement products like patches, chewing gum, nasal sprays and bupropion, an antidepressant that has been shown to be effective in curbing the addiction. "You have to keep pace with tobacco companies," he said. "They are smart. We've got to be smarter." Dr. Frieden said he had found $3 million in his department's budget that now goes toward the smoking cessation program and would look to other sources to pay for his efforts, including increasing the fines levied against merchants who sell cigarettes to minors and establishing partnerships with the companies that make antismoking products. The companies could help cover the cost of educating doctors who serve communities where smoking rates are high to press their patients to quit smoking, and in turn push the drug companies' products, he said. Research shows that 70 percent of people who smoke say they would like to quit, Dr. Frieden said, but that only 5 percent do it on their own. Holly Russell, a spokeswoman for GlaxoSmithKline — which makes Wellbutrin and Zyban, two popular smoking cessation drugs, and a nicotine patch — said she did not believe that the company had previously formed a partnership with a city, but added that it would consider such a request. "I am sure we would be open to it," said Brian Jones, a spokesman for the company. Dr. Frieden, who exhibits an unusual combination of passion and practicality, said he would focus directly on health care problems that the city had a shot at tackling through increased surveillance and community-specific attacks. He applied that technique from 1992 to 1996, when he was an assistant health commissioner and director of the city's Bureau of Tuberculosis Control. During that time, the city reduced cases of multidrug-resistant TB by 80 percent, largely by creating a treatment program in which those infected with TB were required to take their drugs in front of health care workers or risk quarantine. Now, he takes control of a department whose mission includes managing bioterror attacks, strange new viruses like West Nile, and bread- and-butter public health problems like flu and infant mortality. And when the agency formally merges with the Department of Mental Health, Mental Retardation and Alcoholism Services, it will take on the complex problems of the mentally ill. "You prioritize by looking at the data, deciding how important a problem is and how amenable it is to treatment," said Dr. Frieden, whose passion for obscure medical studies is like a home cook's lust for rare spatulas, and who peppers his conversation with references to India. "I love this department. This is the only job in the United States that I would have come back for."

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