TCS Daily


Doctor Know?

By Henry I. Miller - July 19, 2007 12:00 AM

Stanford, California- The Washington political game has two modes: claiming undeserved credit, and shifting blame for your own shortcomings to others. The latest egregious example of the latter occurred this week [July 10] when former U.S. Surgeon General Richard H. Carmona testified before the House Oversight and Government Reform Committee chaired by Representative Henry A. Waxman (D-Calif.). The subject of the hearing was how to strengthen the office of the surgeon general.

The office of the surgeon general is problematic, in that it lacks virtually any budget or staff or programs of its own. Whatever the incumbent achieves is the result of moral suasion - and in the case of some incumbents, courage. Dr. C. Everett Koop, surgeon general in the Reagan administration, and Dr. David Satcher, surgeon general during the Clinton administration, also testified at the Waxman hearing. Both of them complained about political pressure and interference during their respective tenures.

Dr. Satcher said that the Clinton administration tried to interfere with his issuing a report demonstrating that needle-exchange programs were effective in reducing disease. He released the report anyway. Dr. Koop, perhaps the best known surgeon general in modern times, said he had been discouraged by senior officials in the Reagan administration from discussing the accelerating AIDS crisis. He ignored the pressure and became known as a champion of AIDS funding and research.

In contrast to these profiles in courage, Dr. Carmona, who served as surgeon general from 2002 to 2006, went along to get along. He testified before the Waxman committee that he had been muzzled and subjected to "partisanship and political manipulation" by Bush Administration "political appointees" in his "chain of command," whom he refused to name. (He, too, was a political appointee, by the way.)

Dr. Carmona was virtually invisible during his entire tenure. Toward the end of his four-year stint as surgeon general, in an informal poll that I conducted, only five of 60 experts in public health and public policy could identify the current surgeon general, even when offered a multiple-choice format. Many thought the post had been abolished. When I mentioned to former Surgeon General Koop that I was conducting an informal poll of how many physicians and public health experts could identify the current surgeon general, he quipped, "Have you found one?"

Dr. Carmona often got the science wrong. In 2003, he testified before the House Energy and Commerce Committee, "No matter what you may hear today or read in press reports later, I cannot conclude that the use of any tobacco product is a safer alternative to smoking." That statement is manifestly untrue. It had been known for almost a decade that switching from smoking to smokeless tobacco is a lifesaver: All forms of tobacco are not equally risky; smokeless tobacco causes neither lung cancer nor other pulmonary diseases; nor do its users experience an enhanced risk of heart attacks. Oral cancers are the only important adverse health effect of smokeless tobacco, and they are relatively infrequent (about half as great as in smokers).

Several years ago, Dr. Carmona spoke to an audience of scholars here at Stanford University's Hoover Institution. Thirty-five of his forty minutes were devoted to self-serving autobiography; the remaining five minutes offered no specifics but merely a promise to "implement the public health policies of the president."

Dr. Carmona said on PBS's The News Hour that the U.S. surgeon general is regarded as "a shining example of a great America." Certainly not on his watch. Even with capable incumbents - a rare occurrence in recent decades - the position is arguably an anachronism, like the human appendix. And as Dr. Carmona demonstrated unwittingly, like the appendix, we can do fine without it.

Perhaps the most revealing insight into Dr. Carmona's tell-all testimony is that after enduring the alleged muzzling, political interference and manipulation for four years, he asked to continue in the job. He was turned down.

Physician, heal thyself.

Henry Miller, a physician, is a fellow at the Hoover Institution. He was an official at the NIH and FDA from 1977 to 1994.


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41 Comments

The trouble is, when a President forces
The Surgeon General to promote policy that actual ARE unscientific. I think the office should be left alone to speak what they want, or dissolved completely.

Anyone...
who takes scientific advice solely from political appointees (a la NAS(!)) gets the ignorance they deserve.

blame the victim!!! it always works!
So you have an administration deliberately suppressing science in all kinds of ways, including censorship of the Surgeon General, but that's not a problem at all, and involves no issues. The justification? Nobody should be listening to the Surgeon General at all, because (like the FBI director, Homeland Security Secretary and chair of the Joint Chiefs, he's a political appointee, and anyone who does gets what they deserve.

Surgeon General required to mention Bush glowingly 3 times a page in speeches
So Dr. Carmona testified, a statement that stands unrebutted, a symbol of the heavy handed politization that has been characteristic of the Bush administration across the board.

Instead of dealing wtih the out-of-control Republican ideological trashing of science, Dr. Miller instead blames the institution of the Surgeon Generalship for the problems. He probably blames his own patients for their diseases.

It looks like Dr. Miller is just totally used to requirements that he enthusiastically mention his ideological program 3 times per page in all fo his communications, and can't imagine a Doctor who doesn't.

more paranoid fantasies from the master of paranoid fantasies
...

Still another empty blast of no-content namecalling from MarkHotAir
Why are you wasting everyone's time??

What victim?
Political appointees are put in place by politicians to get their policies and agendas implemented. How exactly does this make this person a "victim"?

Their was no supression of science, just the push for policies that the Bush administration wishes to push. Was there a suppression of science when Clinton sacked Elders? Some would say he was suppressing the scientific validity of teaching children to **********. What would LeMule say?

BTW dummy, I said "anyone who takes scientific advice SOLELY from political appointees". The word "solely" is there for a reason in that implies that one would fact check or research the advice that was coming from political appointees. Now I know you are not familiar with that concept considering your absence of intellectual curiousity.

For instance, you seem to have no problem with the NAS(!) pushing AGW when there is no concrete evidence of its existence. Nor do you have any issue with the suppression of AGW skeptics and their work.

I believe your beef with all this is that it involves Bush. Period. Your view of reality changes as you view it through the lens of Bush Hate.

Thank you.
For the liberal talking points. I see you are now very adverse to added sources to your posts.

when you post something substantive, I will rebut it. When you post paranoid fantasies
I will point that out as well.

for those who won't look, it's easy to claim that nothing exists
eric is the master of not seeing anything he doesn't want to see.

The 'victim' you designated. Not that we expect consistency, but c'mon
What you said was, "anyone who takes scientific advice solely from political appointees (a la NAS(!)) gets the ignorance they deserve."

So what you were saying was anyone stupid enough to listen to a Bush appointee deserved no sympathy. Regarding "soley" = what this ignores is that the Surgeon General is a substantive office whose decisions have impact in people's lives - that is, a substantial bureaucracy works "solely" on those decisions, and what they do affects people. If the decisions are based on politics, not science, there will be victims. And have been - as there were when Reagan tried to muzzle Koop on AIDS.

You seem completely unaware of how much political interference there was under Bush - it was orders of magnitude more than in any previous presidency, includng the order that Bush be mentioned 3 times on every page of every speech the SG gave.

>or instance, you seem to have no problem with the NAS(!) pushing AGW when there is no concrete evidence of its existence.

Thank you for completely discrediting yourself with regard to scientific judgement. IN your little shared crank reactionary pigpen, you may not have heard of the evidence. In the real world, among scientists, that's not the way the cookie is crumbling

You haven't 'pointed out' anything. You've posted your cheap, no backup names
Stop wasting everyone's time.

He was required to put three glowing references to Bush on every page of every speech
I didn't make that up.

"he 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."

That's from the NY Times report:
http://www.nytimes.com/2007/07/11/washington/11surgeon.html?ex=1185076800&en=11f69a07bd2d78ba&ei=5070
Do you think they made it up?

What does exist: Carmona's sworn testimony he had to mention Bush 3x every page every speech
http://www.nytimes.com/2007/07/11/washington/11surgeon.html?ex=1185076800&en=11f69a07bd2d78ba&ei=5070

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.

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 nam

I pointed out the fact that your paranoid fantasies are nothing more than paranoid fantasies
I can understand why the truth would make you so nervous.

eric's reading comprehension still fails him
I don't know why I bother, eric doesn't want to deal with reality.

Try looking up what solely means, and it has nothing to do whether the particular surgeon general is a Rep or Dem.

If you think the political interference was greater under Bush, then explain why Bush relaxed the Clinton executive order on Stem Cell research.

Wow!
It sounds like this guy was some kind of political appointee! I think you're on to something!

Keep us posted.

F in English!
>"So what you were saying was anyone stupid enough to listen to a Bush appointee deserved no sympathy."

No. What I said was that anyone who takes their scientific advice solely from a political appointee gets the ignorance they deserve. Twist it as you will but I never said you couldn't listen to a Clinton appointee or a Bush appointee. I just said that their words should be viewed as suspect considering the political nature of their post.

If you can't understand that then you don't understand much.

>"Regarding "soley" = what this ignores is that the Surgeon General is a substantive office whose decisions have impact in people's lives - that is, a substantial bureaucracy works "solely" on those decisions, and what they do affects people."

The Surgeon General is a promotional office. They promote the Administration's health policies. The Surgeon General reports to the Assistant Secretary for Health, who is the principal advisor to the Secretary on public health and scientific issues.

Hard to imagine that the Surgeon General, who's job it is to promote the health policies of the Administration, would promote the policies of the Administration.

>"Thank you for completely discrediting yourself with regard to scientific judgement. IN your little shared crank reactionary pigpen, you may not have heard of the evidence. In the real world, among scientists, that's not the way the cookie is crumbling"

Actually, the cookie is crumbling in my direction and the direction of others who won't buy into the AGW hoax. True scientific thought will triumph, as it always does, over the political hacks who see profit and power in repressing it.

So you don't think the Surgeon General's office goes solely on what the Surgeon General says??
And you don't think that has real world consequences?

But wait; I forget: you never think.

No, you don't get it
>o. What I said was that anyone who takes their scientific advice solely from a political appointee gets the ignorance they deserve.

You're talking here about the people in the office of the Surgeon General of the United States, whose actios affect many people. YOu're saying that the affected peolple are getting the ignorance they deserve from people they are paying?

>The Surgeon General is a promotional office.

So it should be promoting bogus science???

>Hard to imagine that the Surgeon General, who's job it is to promote the health policies of the Administration, would promote the policies of the Administration.

And mention George Bush three times on every page of every speech, but not mention (say) contraception as opposed to abstinence??

>Actually, the cookie is crumbling in my direction and the direction of others who won't buy into the AGW hoax

Sure it is! and we will soon get proof that the moon is made of green cheese.

It's not paranoia that Carmona was ordered to put 3 Bush refs on every page of every speech
Do you have contrary information?? Please document it.

So you think that every Surgeon General had to praise the President 3 times on every page of every s
Funny, but none of the others have ever had to do that. I wonder why.

And if Clinton had required that, would you be saying no big deal???

And your point is?
That the office is useless, or that he was just a tool of the evil Bush administration? If the former, then why was Koop effective? If the latter, why was he fired? I mean, come on. Write with a purpose, or don't bother.

The office has existed for more than a century. No previous adminstration has made it a joke
Is that too sharp a point for you to understand?

Of course it does dummy!
>"And you don't think that has real world consequences?"

No. I don't.

What are some of the amazing accomplishments of the Surgeon General? What would the world be like if we eliminated that office?

Answers: None. No different.

As I said: political appointee in charge of promoting the President's agenda. Pretty amazing that anyone would be angry that the Surgeon General was doing exactly that.

>"But wait; I forget: you never think."

Ouch. That hurt. I will take that for what it's worth considering the source.

Political appointees let LeMule down...
and we have to suffer for it.

>"You're talking here about the people in the office of the Surgeon General of the United States, whose actios affect many people. YOu're saying that the affected peolple are getting the ignorance they deserve from people they are paying?"

What actions? Who was affected? What hideous price has been paid? Before you utter your shrill cry for "the people" you should at least be able to show who has been damaged by the policies of the President and, through his political offices, the Surgeon General.

>"So it should be promoting bogus science???"

AGW is bogus yet you have no problem with the promotion of that. However, the political arena is full of bogus scientific policies that have no bearing on science. Like AGW, second-hand smoke, trans-fats, DDT, and flouride (which is a nutrient according to the NAS).

It is always sad and frustrating that science is so poorly represented in governmental policy but blaming one political party or one politician is idiotic.

Instead, you should know that scientific facts do not come from political appointees. And if they do then there should be other sources that confirm it.

So, once again, if you rely solely on political appointees for scientific fact then you deserve the ignorance you receive.

>"And mention George Bush three times on every page of every speech, but not mention (say) contraception as opposed to abstinence??"

Who cares about mentioning GWB on every page? What does that have to do with anything?

On the topic of contraception vs. abstinence the argument can be made that abstinence provides 100% protection from STDs and unwanted pregnancy. I always find it amazing that liberals are willing to banish food products and smoking with a 0% tolerance yet take an issue with applying 0% tolerance against underage sex or sex outside a responsible relationship.

Just so you know: I believe in contraception and will teach it to my children, as it should be, instead of leaving it to forces driven by politics.

I know you believe the government can raise you better than your own parents but I do not. This is part of that ignorance I was talking about. And you deserve it.

>"Sure it is! and we will soon get proof that the moon is made of green cheese."

Yep. The fact that climate change is driven by far more important factors than humans generating CO2 is akin to believe the moon is made out of green cheese.

Thank you for demonstrating the logical capacity of the average AGW alarmist. Bravo!

Very, very funny!
Because it has nothing to do with anything. In fact, you should be happy that GWB attaches his name to what you consider bogus science. It would be hard for him to deny his hand in the surgeon general's policies.

>"And if Clinton had required that, would you be saying no big deal???"

Absolutely. Of course Clinton had a policy of being able to deny anything at any time so it is of no surprise that even the Surgeon General was not required to use his name.

Considering Elders, was was a pretty shrewd political policy on his part. I may hate what Clinton did to our country but I can't say he wasn't a very intelligent manipulator.

that's PR, it's not suppression of science, which is what you claimed
I'm still waiting for you to show something to justify your hysterical rants.

Not that any cares or pays attention to the Surgeon General, or his office.
...

now you are attempting to change the subject
He stated quite clearly, that those people who get their information for the office of the SG, and that office only, deserve their ignorance. He said nothing about people who depend on the office of the SG. Not that there are any such people.

There's no evidence that the SG is promoting bogus science.
That's your hysterical, paranoid claim, but to date the only evidence you have offered up to support it is an alleged requirement that the SG frequently mention Bush.

Did the NYT make it up??? Quite probably.
They do have a habit of making things up.

Who cares? it's not like the SG matters to anyone or anything.
...

It's not like the SG does science
So what if the SG's office couldn't issue reports on various topics. They don't do original science, nor do they do a good job of analyzing the science that real scientists do.

You seem to have a big problem with a political appointee being ordered to go along with the program and to make his boss look good.

neither has this one, that's your paranoid fantasies getting the better of you again
...

He was ordered not to talk about stem cell research, contraception and all kinds of other issues
... but he still had to put in the plugs for Bush, three per page on every page of every speech. Why not read his testimony???

Two words: Everett Koop
When Reagan refused to acknowledge that AIDS was a threat, he spoke out, which drastically changed the debate. The Surgeon General's post is a bully pulpit to focus attention on issues. Except when the SG is ordered to do nothing but PR for Bush.

And, again, tell me you'd be calm and no-big-deal about this if it were the Clinton adminisntartation that ordered the 3-cheers for Bill per page thing. Sure you would.

Not that you can pay attention to anything but your own colon with your head buried up your rectum
Why do you waste everyone's time?

Non statement about non-issues
Your only problem in talking about science is you are and remsolutely insist onf remaining grossly ignorant of it. You go on about global warming as nonsense, even though you don't even know high school chemistry. You talk about abstinence v. contraception when the debate is about teaching abstinence plus contraception. Regardng government raising people, government doesn't raise people but it can help parents to do so. Stop your ideological posturing and look at the world.

Sure: the Times makes up quotations about congressional testimony, but Mark is never wrong
Credibility: on one side, the NY Times, going by the verbatim transcipt of a congressional hearing. On the other side, Mark. No contest.

Two words: So what
>"When Reagan refused to acknowledge that AIDS was a threat, he spoke out, which drastically changed the debate. The Surgeon General's post is a bully pulpit to focus attention on issues. Except when the SG is ordered to do nothing but PR for Bush."

Ah, the ol' "Reagan was the reason for the spread of AIDS" canard. An oldie but a goodie. What is funny is that you make Koop out to be a hero when most gay-activists believe him to be a villan. One who wanted homosexuals to modify their behaviour to halt the spread.

So first, detail for me the impact of Koop's "speaking out". What did it accomplish? Who was saved?

Reagan's attempt to deal with the AIDS outbreak would have been effective. When the various departments of health attempted to shut down bathhouses and suggest a modification of behaviour what happened? Protests, a declaration of homophobia, and the labeling of Reagan as someone who wanted to wipe out homosexuals or deny them their rights.

None of which is true. In fact, the standard procedure for an outbreak of a new disease was to isolate those infected. Could Reagan have done this? No way.

So blame Reagan for the AIDS "epidemic" but I would rather blame those responsible: the Gay activist community that fought for free, frequent, and unprotected sodomy while villifying a man who had several gay friends and who employed known homosexuals.

Here is the transcript of Marc Christian's letter (he was Rock Hudson’s last partner) to Les Moonves (head of CBS entertainment) making clear his disgust at the portrayal of the President, especially the assertion that Reagan was a cruel homophobe.

"The notion that President Reagan was a homophobe strikes me as silly beyond belief. Not only did he have several gay men on his staff when he was Governor of California, he called my lover, Rock Hudson when he was on his deathbed just weeks before he died of AIDS and wished him well and voiced his and Nancy's concern and prayers. The Reagans had known Rock for years and knew he was gay (as did most in Hollywood). The point is Reagan could have ignored Rock's illness and didn't. He could have just issued a public statement concerning his "official sorrow" but made a personal phone call instead. CBS used to be the network of class, now its the official arm of the Democrat party and its sources for information regarding truth below that of The National Enquirer. I bet President Reagan's phone call to Rock Hudson isn't in the screenplay or should I say smearplay, is it?"

Pretty compelling stuff don't you think?

Also here is a source from some responsible homosexual advocates:

http://www.homohealth.org/taskforce/manifesto.htm

If this manifesto had been put out during the time of Reagan it would have been labeled homophobic. When AIDS first came out you could not tie it to the Gay community nor could you target homosexual behaviour. Try as you might to pin this on Reagan the gay advocate community of the 80's bears the brunt of the responsibility.

Not to mention that I doubt you were even born during the Reagan years.

>"And, again, tell me you'd be calm and no-big-deal about this if it were the Clinton adminisntartation that ordered the 3-cheers for Bill per page thing. Sure you would."

Sure would. The 3 mentions/page is a non-issue. Why does this mean anything about anything? Of what importance does requiring a political appointee to mention his boss's name make?

You love the non-issues but this one is just stupid.

A perfect description for any LeMule post
>"Your only problem in talking about science is you are and remsolutely insist onf remaining grossly ignorant of it."

Okay, if you are going to chide me for ignorance please do a spell check. It will help the irony.

>"You go on about global warming as nonsense, even though you don't even know high school chemistry."

It is nonsense and one does not even have to crack open a chemistry book to figure it out. Your main contention, that AGW is "settled" science, is patently false. Your secondary contention, that Consensus has scientific value, is equally false. See? No chemistry required.

>"You talk about abstinence v. contraception when the debate is about teaching abstinence plus contraception."

Many believe that promoting contraception creates tolerance for dangerous behavior. Holding that position is not a scientific theory but a philosophical and political one. What has prevention done to curb unwanted teen pregnancy? Not a whole lot.

Considering that the Surgeon General is appointed by a President that holds that position I am not surprised that the Surgeon General promotes it.

I am quite silly as I hold that it is the parents responsibility to talk to their children about such issues and none of the government's responsibility. So I could care less what the Surgeon General says.

>"Regardng government raising people, government doesn't raise people but it can help parents to do so."

Sure it can, let us keep more of our money so the parents can work more on raising our children and less on paying for government. In particular an office that thought teaching pre-schoolers to ********** was a good idea.

>"Stop your ideological posturing and look at the world."

One has to wonder if you understand the irony of that statement as you write it. You are nothing if not entertaining.

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