Former Surgeon General Richard H. Carmona charged the Bush administration with unprecedented levels of political interference in his work as the nation's doctor, compromising his ability to deliver the best available public health science to Americans.1
Carmona described censorship of speeches, suppression of scientific reports, and restrictions on media and outreach opportunities. He was also encouraged to politicize his office by attending "political pep rallies" where partisan politics and elections were discussed. While he refused to name any of the appointees involved during the public hearing, Carmona agreed to do so in a closed session with the committee.2
"The reality is that the nation's doctor has been marginalized… with supervisors who are political appointees with partisan agendas," he said in sworn testimony before the House Committee on Oversight and Governmental Reform. "Anything that doesn't fit into the political appointee's ideological, theological, or political agenda is ignored, marginalized, or simply buried."3
The Surgeon General serves as the preeminent public health educator for the American public. Because the office speaks solely on the basis of science, landmark reports on HIV/AIDS prevention, the causal link between lung cancer and cigarettes, and the dangers of second hand smoke4 have alerted the nation and the world to the scientific consensus surrounding controversial topics, and paved the way for informed decisions about public health policy.
Vetting speeches
Carmona's term as surgeon general began in 2002 when the issues of embryonic stem cell research, emergency contraception, and the effectiveness of abstinence-only sex education were politically controversial topics. As he testified to Congress, Carmona wanted to use his position as surgeon general to "engender debate on these issues, so we make sure the American public, our elected officials, and our appointed officials are all knowledgeable of the science." The ultimate goal was a citizenry who could achieve "informed consent" on these complex issues.5
But political appointees blocked his attempts to include relevant scientific discussion in his speeches. These administration officials "were specifically there … to spin, if you will, my words in such a way that would be preferable to a political or ideologically preconceived notion," he said. He was told that "the decision had already been made" and to "stand down" on those issues; the information he attempted to include in his speeches was removed.6
Two speechwriters working for Carmona eventually resigned due to their "embattled position – people trying to get to the surgeon general through them," Carmona said. "I finally told the staff, let [the political appointees] put in whatever they want, I'm not going to say it anyways." He added that the appointees suggested that he should mention the president's name at least three times per page of his speech. He refused, saying "my job is not to sell politics."7
Suppressing reports
Carmona was only able to release three reports during his tenure.8 Carmona testified that one of these reports, an update on the health risk of second-hand smoke,9 was repeatedly delayed by appointees attempting to selectively weaken the science.
But administration officials went much further, completely suppressing three additional reports. When Carmona prepared a report on mental health care in the country, which he felt was timely due to the emotional stresses of war, 9/11, and the anthrax mail attacks, he was "admonished" and told "you don't write anything unless we approve it." The second report, on emergency health service's preparedness, was also denied publication; reasons cited included concern it might "incite" or "scare" the public, and that such reports were now the purview of the new Department of Homeland Security.10 Another report on the importance of improving the health care of the inmate population of the United States was also stalled.11
Carmona's unreleased report on global health12 made the case that health is a basic human right. The Washington Post has reported that this publication was blocked by William R. Steiger, a Bush administration political appointee with no scientific training who served as director of the Office of Global Health at Health and Human Services.13 In a letter to the Secretary of Health and Human Services, 14 Rep. Henry Waxman (D - CA) compares Carmona's draft to the edited version prepared by Steiger's office.15 The edited draft, which is a third shorter, removes discussion of reproductive rights for women, gender inequality and sexual violence, the entire section of poverty and health disparities, all discussion of global warming and obesity, and almost all mentions of tobacco as a health problem. In addition, it adds sections about US policy and initiatives in Iraq and Afghanistan, and increases the number of references to President Bush and his policies from two to ten.16
Politicizing meetings
The attempts to politicize the Office of the Surgeon General did not stop with censoring speeches and reports. Carmona testified that he was asked to attend what he called "political pep rallies." At these "mandatory" meetings, high level appointees would talk about partisan political issues and elections, in apparent violation of the Hatch Act,17 which prohibits the federal civil service from taking part in political campaigns. Carmona stopped attending these meetings by "making sure I was busy during those times."18
Political appointees also restricted Camona's travel requests based on partisan politics. In support of his call to action on children's disability,19 Carmona agreed to speak at the Special Olympics. His travel orders were cancelled and he was told he would be aiding the Kennedy family, who are substantial donors to the organization. Carmona was asked "why would you want to help those people?" to which he replied "This is about sick kids. It has nothing to do with who's moving the project." In order to fulfill his commitment, Carmona took a weekend holiday and paid for the trip himself.20
However these same appointees were eager to direct Carmona to attend political events supporting Republican candidates up for re-election, where he was expected to talk about the programs the party was moving forward. Carmona declined these invitations, feeling they were an ethical violation. 21
Escalating interference
Interference with the surgeon general is not new. Two other former Surgeons General also testified at the hearing: C. Everett Koop (1982-1989, Reagan Administration) and David Satcher (1998-2002, Clinton Administration). Koop described how he went to extreme measures of secrecy to protect his outreach campaign about the threat of HIV and AIDS from being suppressed; Satcher described how his report on sexual health and responsible sexual behavior was delayed while the Clinton Administration battled the Lewkinsky scandal. But they both agreed that "never had they seen Washington, D.C. so partisan or a new Surgeon General so politically challenged and marginalized" as Carmona.22
The independence of the Surgeon General is vital so that Americans can act on the best available information regarding the risks to their health. "You don't want Republican or Democratic scientific information," said Carmona. "You want real scientific information, and that's our job, to bring it forward." 23
1. Carmona, Richard. Oral testimony (video) before the House Committee on Oversight and Governmental Reform. Hearing entitled "The Surgeon General's vital mission: Challenges for the future." July 10, 2007. Accessed July 31, 2007.
2. Carmona. Oral testimony.
3. Carmona, Richard. Written testimony submitted to the House Committee on Oversight and Governmental Reform hearing. July 10, 2007.
4. Reports of the Surgeon General. Accessed July 31, 2007.
5. Carmona. Oral testimony.
6. Carmona. Oral testimony.
7. Carmona. Oral testimony.
8. Reports of the Surgeon General.
9. Office of the Surgeon General. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. June 27, 2006.
10. Carmona. Oral testimony.
11. Lee, Christopher and Kaufman, Mark. Bush aide blocked report; Global Health draft in 2006 rejected for not being political. The Washington Post. July 29, 2007.
12. Carmona. Draft of the Surgeon General's Call to Action on Global Health, 2006. May 19, 2006. Accessed July 31, 2007.
13. Lee and Kaufman. Bush aide blocked report.
14. Waxman, Henry A. Letter to Michael O. Leavitt, Secretary of the Department of Health and Human Services. July 30, 2007.
15. Edited version of the global health call to action from the Office of Global Health. Obtained by the House Committee on Oversight and Governmental Reform. Accessed July 31, 2007.
16. Waxman, Henry A. Letter to Michael O. Leavitt.
17. The Hatch Act.
18. Carmona. Oral testimony.
19. Surgeon General. The Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities. July 26, 2005. Accessed July 31, 2007.
20. Carmona. Oral testimony.
21. Carmona. Oral testimony.
22. Carmona. Written testimony.
23. Carmona. Oral testimony.