Wednesday, July 11, 2007

Censored Surgeons General

Several major newspapers (including the Los Angeles Times, New York Times, and Washington Post) just reported on testimony of three former US Surgeons General about politically based attempts to censor them. Most of the emphasis was on the testimony of Dr Richard H Carmona, former Surgeon General under President George W Bush. To quote the Washington Post's story,

Former surgeon general Richard H. Carmona yesterday accused the Bush administration of muzzling him on sensitive public health issues....

Political appointees in the administration routinely scrubbed his speeches for politically sensitive content and blocked him from speaking out on public health matters....

'Anything that doesn't fit into the political appointees' ideological, theological or political agenda is often ignored, marginalized or simply buried,' he said. '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.'

Particular issues about which Carmona charged he was censored included stem cell research,

He was told not to speak out during the national debate over whether the federal government should fund embryonic stem cell research, which President Bush opposes.

'Much of the discussion was being driven by theology, ideology, [and] preconceived beliefs that were scientifically incorrect,' said Carmona, one of three former surgeons general who testified at yesterday's hearing. 'I thought, 'This is a perfect example of the surgeon general being able to step forward, educate the American public.' . . . I was blocked at every turn. I was told the decision had already been made -- 'Stand down. Don't talk about it.' That information was removed from my speeches.'

Also, there was sex education,

Carmona said that when the administration touted funding for abstinence-only education, he was prevented from discussing research on the effectiveness of teaching about condoms as well as abstinence. 'There was already a policy in place that did not want to hear the science but wanted to just preach abstinence, which I felt was scientifically incorrect,' Carmona said.

And second hand smoke, according to the New York Times,

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.

Carmona was even warned about attending the Special Olympics,

And administration officials even discouraged him from attending the Special Olympics because, he said, of that charitable organization’s longtime ties to a 'prominent family' that he refused to name.

'I was specifically told by a senior person, ‘Why would you want to help those people?’ ' Dr. Carmona said.

The Special Olympics is one of the nation’s premier charitable organizations to benefit disabled people, and the Kennedys have long been deeply involved in it.

When asked after the hearing if that 'prominent family' was the Kennedys, Dr. Carmona responded, 'You said it. I didn’t.'

And some reports are still on ice, according to the New York Times,

Dr. Carmona said drafts of surgeon general reports on global health and prison health were still being debated by the administration. The global health report was never approved, Dr. Carmona said, because he refused to sprinkle the report with glowing references to the efforts of the Bush administration.

Two other Surgeons General testified. They were Dr David Satcher, who served under President Bill Clinton, and briefly under President George H W Bush and Dr C Everett Koop, who served under Ronald Reagan. Both also cited politically driven attempts to censor them. As the Post put it,
Two other former surgeons general, David Satcher and C. Everett Koop, said at the hearing that political interference appears to have grown worse under Bush, although they noted that this administration has not been the only one to take a political approach toward the office.
Under Clinton, Satcher was censored about health and sexuality,

Satcher, Carmona's predecessor, who served from 1998 to 2002, said that under President Bill Clinton he could not release a report on sexuality and public health, in part because of sensitivities triggered by the Monica Lewinsky scandal.[WaPo]

The Washington Post article also noted,

Clinton also forced out Joycelyn Elders as surgeon general in 1994 after her controversial remarks that public schools should consider teaching about masturbation.

Satcher also was censored about substance abuse,

Dr. Satcher said that the Clinton administration discouraged him from issuing a report showing that needle-exchange programs were effective in reducing disease. He released the report anyway.

Under Reagan, Koop was told of political pressures on Reagan, but apparently was shielded from them by the President,

Koop, who served as surgeon general under President Ronald Reagan, spoke out on AIDS, despite political pressure not to do so. He said Reagan was pressured to fire him every day -- but he did not.

'If he had not been the kind of person he was, I would not be here today,' Koop said [WaPo]

On Health Care Renewal, we often discuss cases in which research results have been suppressed, or discussion of various health care issues has been discouraged. Often those doing the censoring in these cases appeared to have been acting out of economic self-interest.

These new and not so new stories remind us that people with political vested interests may also be eager to shape the debate about health care issues, and even try to completely shut up people whose positions offend them.

On the other hand, as we have said many times, for patients and doctors to make the best possible clinical decisions, they need access to the best possible evidence about tests and treatments. Furthermore, to make the best possible health policy decisions, people and policy-makers need access to all relevant evidence and view-points.

Stifling dissemination of information or debate to serve vested interests, whether these interests are primarily economic or political, is bad for patients and bad for people in general.

No comments: