The New York Times
Thursday 12 July 2007
Washington - A day after former Surgeon General Richard H. Carmona told Congress that top Bush administration officials had interfered with his public health mission for political reasons, the hunt for those suspected of undermining Dr. Carmona was in full swing on Capitol Hill.
Dr. Carmona refused on Tuesday to name those who he said had instructed him to put political considerations over scientific ones. He was traveling Wednesday and did not respond to phone messages seeking comment.
But more than a half-dozen former top health officials said in interviews that the official most likely to have interfered was Dr. Cristina V. Beato, a former deputy assistant secretary and acting assistant secretary for health who was Dr. Carmona's boss from 2003 to 2005 and is now deputy director of the Pan American Health Organization.
In an interview Wednesday, Dr. Beato rejected the suggestion that politics had ever trumped science in the Bush administration.
"That wasn't my experience," she said, adding that she was "really sad to hear that he talked that way."
All the former officials interviewed said Dr. Carmona and Dr. Beato had a difficult relationship.
"They clashed tremendously, both personally and professionally," said William A. Pierce, a spokesman for the Department of Health and Human Services from 2001 to 2005.
Some tension between the two offices is not uncommon, Mr. Pierce said, because "the surgeon general reports to the assistant secretary for health, but the surgeon general is much better known to the public." With Dr. Carmona and Dr. Beato, he added, the institutional conflict was compounded by a "personality clash." Dr. Beato was widely seen within the department as trying to advance conservative agendas, the former officials said.
"Dr. Beato was more ideological and more right-wing, less objective and more political" than Dr. Carmona, said Dr. Philip R. Lee, a former government health official and a founder of the Institute for Health Policy Studies at the University of California, San Francisco.
Dr. Lee said Dr. Carmona frequently consulted him "when he was particularly frustrated" as surgeon general, adding: "Rich is a straight shooter, but he was naïve about the ways of Washington."
On Wednesday, Senator Edward M. Kennedy, Democrat of Massachusetts and chairman of the Senate health committee, sent a letter to the Bush administration asking for records on the interactions of Dr. Carmona with several health officials, including Dr. Beato.
Dr. Beato was nominated as assistant secretary for health, but her nomination was derailed in 2004 after accusations surfaced that she had padded her résumé. In an interview, Dr. Beato said those accusations arose from several misunderstandings and what she described as mostly clerical errors.
She disputed Dr. Carmona's claim that the government had delayed by years a major report on secondhand smoke and tried to weaken it.
Dr. Beato also rejected Dr. Carmona's assertion that the department had suppressed his report on global health because he refused to sprinkle it with accolades to President Bush.
Tony Snow, the White House press secretary, said Wednesday of Dr. Carmona's testimony: "Nobody, as far as I could tell, was muzzling him. But on the other hand, there is certainly nothing scandalous about saying to somebody who was a presidential appointee, 'You should advocate the president's policies.' "
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Sheryl Gay Stolberg contributed reporting.
Unhealthy Interference
The New York Times | Editorial
Thursday 12 July 2007
Even those who have grown cynical over the Bush administration's relentless manipulation of scientific views to fit its political and ideological agenda must have been surprised at the sheer breadth of interference described by the former surgeon general, Dr. Richard Carmona.
The official job description calls for the surgeon general to serve as "America's chief health educator." But the Bush administration instead tried to turn Dr. Carmona into a propagandist and political cheerleader, and when he refused to go along, it stopped him from speaking at all on a host of essential health issues.
Dr. Carmona told a House committee that the administration would not allow him to speak on the scientific and medical aspects of stem cell research, emergency contraception, comprehensive sex education and prison or mental health issues. He said a surgeon general's report on global health issues was quashed because he refused to insert glowing references to the efforts of the Bush administration. His report on prisoners' health care was held up for fear it would lead to demands for costly reforms.
Other disturbing improprieties included an order that Dr. Carmona insert President Bush's name at least three times on every page of his speeches, requests that he make political speeches on behalf of Republican candidates and an admonition not to speak to a group affiliated with the Special Olympics because of the charity's longtime association with the Kennedy family.
It all sounds so ham-handedly partisan that it would be laughable if it weren't so damaging to the public's understanding of important public health issues. Dr. Carmona declined to name his tormentors but made it clear that they included assistant secretaries in the Department of Health and Human Services as well as other top political appointees.
What to do about such interference needs to be high on the agenda when the Senate health committee holds a confirmation hearing today on Dr. James Holsinger, the president's nominee to become the next surgeon general. The main subject to be probed, aside from Dr. Holsinger's professional qualifications, is whether he still holds the views he has expressed in the past that seem hostile to gay men and lesbians. Now, in the wake of Dr. Carmona's revelations, it will also be important to ask Dr. Holsinger what steps he would take to keep the office from being politicized.
Beyond that, oversight committees in the House and the Senate must look for ways to protect the position from future political interference. Dr. Carmona testified alongside two other former surgeons general who also met political resistance, but nothing close to what Dr. Carmona experienced during four years of service in the Bush administration.
A first step is to stop thinking of the surgeon general as an agent of any administration and instead view the job as a national ombudsman for public health. The post could be given its own specified staff and budget - it currently relies on the Department of Health and Human Services - freeing it to pursue topics without administration approval. Or the position could be made even more independent, much like the inspectors general who root out waste and corruption.
Congress could also ban any effort to censor or delay the surgeon general's reports and speeches. If this White House doesn't understand why that independence is so important to the nation's health, the American public certainly should.
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