Wednesday, July 11, 2007

Political Pressure and the Surgeon General

The New York Times reports on the discouraging tale the nation’s most recent surgeon general presented to a congressional committee yesterday:
WASHINGTON, July 10 — Former Surgeon General Richard H. Carmona told a Congressional panel Tuesday that top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations.
The administration, Dr. Carmona said, would not allow him to speak or issue reports about stem cells, emergency contraception, sex education, or prison, mental and global health issues. Top officials delayed for years and tried to “water down” a landmark report on secondhand smoke, he said. Released last year, the report concluded that even brief exposure to cigarette smoke could cause immediate harm.
Dr. Carmona said he was ordered to mention President Bush three times on every page of his speeches. He also said he was asked to make speeches to support Republican political candidates and to attend political briefings.
Dr. Carmona went before the committee with his predecessors, C. Everett Koop (appointed by Ronald Reagan) and David Satcher (appointed by Bill Clinton). All described instances the political pressures they faced. In his testimony, Dr. Carmona described consulting with his peers about the political pressures of the job:
I turned to my fellow Surgeons General, the men and women who came before me and had made tremendous positive contributions to the science and practice of public health, who had saved and improved millions of lives through their work and dedication. They became my mentors. They said that they had all been challenged and had to fight political battles in order to do their job as “the doctor of the nation.” But each agreed that never had they seen Washington, D.C. so partisan or a new Surgeon General so politically challenged and marginalized as during my tenure.
They told me that although most Americans believe that their Surgeon General has the ability to impact the course of public health as “the nation’s doctor,” the reality is that the nation’s doctor has been marginalized and relegated to a position with no independent budget, and with supervisors who are political appointees with partisan agendas.
Anything that doesn’t fit into the political appointees’ ideological, theological, or political agenda is ignored, marginalized, or simply buried. The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science, or marginalizing the voice of science for reasons driven by changing political winds. The job of Surgeon General is to be “the doctor of the nation”— not “the doctor of a political party.”
Dr. Carmona’s testimony yesterday reminds us of how much work there will be to do to restore rationality to our national government when our current president leaves office. Perhaps Abba Eban was right:
When all else fails, men turn to reason.
Given the systemic failures of George W. Bush and those he put in power, we can hope that people of the U.S. are ready to turn to reason.

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