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.