Surgeon General Nominee to Face Questions

Confirmation hearings are scheduled Thursday for Dr. James Holsinger Jr., the Kentucky cardiologist nominated by President Bush to be the nation's 18th surgeon general. Holsinger is likely to face tough questioning — not only about his own qualifications, but about whether he can stand up to the political meddling that his predecessor, Richard Carmona, says hampered his ability to do the job.

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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

Tomorrow, a Senate committee will consider the nomination of James Holsinger Jr. to become the nation's 18th surgeon general. Today, however, the Capitol was buzzing over charges leveled yesterday by the most recent occupant of the post, Richard Carmona. Carmona and two other former surgeons general told the House committee that the Bush administration has politicized the position.

But as NPR's Julie Rovner reports, it's unclear how politically independent any surgeon general is supposed to be.

JULIE ROVNER: At today's White House briefing, presidential spokesman Tony Snow seems surprised by all the attention paid to Carmona's charges that he'd been told what to say and what not to.

Mr. TONY SNOW (White House Press Secretary): There is certainly nothing scandalous about saying to somebody who was a presidential appointee, you should advocate the president's policies.

ROVNER: Carmona did cite several specific complaints including attempts to water down a report on the dangers of second-hand smoke. And he said he was warned against talking about stem cell research, sex education and other sensitive topics. But the former surgeon general also told the House Oversight and Government Reform Committee that there was something bigger at stake - the credibility of the job itself.

Dr. CARMONA: When you go to a doctor, do you pick your doctor based on what political party they belong to? No. And that's what's happening here. I mean, you don't want Republican or Democratic scientific information, you want real scientific information, and that's our job to bring it forward.

ROVNER: Former Surgeon General C. Everett Koop, who served under Presidents Ronald Reagan and the first President Bush, cited a long a list of things that might never have happened if he'd been subject to the same kinds of political interference as Carmona.

Dr. C. EVERETT KOOP (Former Surgeon General): Eight reports to Congress on smoking and health might not have been published. The knowledge of the addiction of tobacco because of its nicotine content might have been suppressed. We might have still had smoking on airplanes.

ROVNER: And David Satcher, who served under President Bill Clinton, said that public disagreement between a surgeon general and his administration are to be expected.

Dr. DAVID SATCHER (Former Surgeon General): I think it's okay for the White House or the Congress to disagree with the surgeon general on issues because American people look to the surgeon general for the best available science. I don't think it's okay for the White House or the Congress to dictate the messages of the surgeon general.

ROVNER: But while most people think that the surgeon general is a fairly powerful person in the federal health care bureaucracy, that power doesn't come automatically with the job. Fitzhugh Mullen is a professor of public health at George Washington University.

Dr. FITZHUGH MULLEN (Public Health, George Washington University): The surgeon general enjoys no specified budget, the surgeon general has no specified staff, and the surgeon general has no specified arm's length relationship to the White House or the administration.

ROVNER: In fact, the surgeon general was once very powerful. From 1871 until mid 1960s, he headed the entire Public Health Service. But by the mid 1960s, with the creation of Medicare and Medicaid and the addition of a raft of new public health programs as part of Lyndon Johnson's war on poverty, the White House didn't really want a career doctor in charge of so much. Mullen says…

Dr. MULLEN: And the result was the decision to appoint an assistant secretary of more traditional form of political management of major federal programs.

ROVNER: That left the surgeon general with less and less to do, says John Parascandola, recently retired historian for the U.S. Public Health Service. Over time, the role of the job simply changed.

Dr. JOHN PARASCANDOLA (Retired Historian, U.S. Public Health Service): What happened then is that after the '60s, the role of the surgeon general became more informational putting out surgeon general's reports, speaking, you know, out to the public.

ROVNER: And that's why they have to remain above partisan politics, Carmona, Koop and Satcher said. Mullen agrees. The office has power because the public mostly trusts what surgeons general say about smoking or obesity or mental health.

Dr. CARMONA: But that - they have to be confident that the positions and the views of the surgeon general are going to be allowed to be expressed that are going to be science based and independent not politically driven.

ROVNER: The former surgeons general want Congress to write more independence for the office into law so Carmona's successors won't be subjected to the same treatment he got.

Julie Rovner, NPR News, Washington.

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Ex-Surgeon General Says Administration Interfered

Former U.S. Surgeon General Richard Carmona

Former U.S. Surgeon General Richard Carmona, speaks at the 2006 Pandemic Flu Summit in Honolulu. Marco Garcia/Getty Images hide caption

itoggle caption Marco Garcia/Getty Images

Accusations that the Bush administration is playing politics with science are nothing new. But Tuesday, those charges came from one of the administration's own appointees — former Surgeon General Dr. Richard Carmona.

The hearing before the House Government Reform Committee actually featured three former surgeons general; Carmona, Dr. David Satcher, who served under President Bill Clinton, and Dr. C. Everett Koop, who served under President Ronald Reagan and the first President Bush.

Koop and Satcher each faced challenges: Koop fought the Reagan administration over his work on the AIDS epidemic, while Satcher fought the Clinton administration over his support for needle-exchange programs to prevent the spread of HIV.

But all three agreed that none faced the sorts of political challenges that confronted Carmona, who finished his four-year term last year. He testified that the very position of surgeon general is in grave danger.

"The reality is that the nation's doctor has been marginalized and relegated to a position with no independent budget and with supervisors who are political appointees with partisan agendas," Carmona said. "Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried."

Carmona said when he first came to Washington in 2002, he was somewhat naïve.

He recalled a meeting where senior White House officials talked about global warming as a liberal cause with no merit.

"I remember thinking, 'I know why they want me here, they want me to discuss the science; they don't understand the science.' So I had this scientific discussion for about a half an hour, and I was never invited back to the meeting."

Carmona soon realized what he had gotten himself into, however. When he wanted to launch a public education campaign on the science of stem-cell research, he was told he couldn't.

"I was blocked at every turn, told the decision had already been made. Stand down, don't talk about it," he said.

Carmona said that throughout his term, his speeches were edited and talking points were provided by political appointees. President Bush was to be mentioned at least three times per page for example.

Carmona said his travel was also carefully monitored. After he issued a report on the health of those with disabilities, he was invited to speak to a group affiliated with the Special Olympics.

"I put in my paperwork to go to this meeting where I was going to give the keynote addresses ... and I was admonished for doing that," Carmona said. "And the reason I was admonished for doing this is, unfortunately, I was told I would be helping a politically prominent family.... I said, 'This is about sick kids. It has nothing to do with who is moving the project.'"

The politically prominent family was the Kennedys.

Carmona spent most of his last year unsuccessfully trying to issue a report that he and his staff had written on global health.

"And there was no nebulousness," Carmona said. "I was told, 'This will be a political document or you are not going to release it.' And I refused to release it because I would not put the political rhetoric into that document that they wanted, because it would tarnish the office of the surgeon general when our colleagues saw us taking a political stand."

Virginia Congressman Tom Davis, the committee's senior Republican, said he was sympathetic to Carmona's complaints, but only to a point.

"I'm not sure what the boundaries are for appointed political officials who sometimes have opinions different from the elected administration," Davis said. "It's tough trying to define where you be a team player and where you speak out, and you try to balance that every day. But we have politicians who run the government, and not scientists."

The Department of Health and Human Services issued a written statement disagreeing with Carmona's testimony. It said he was "given ample opportunity to communicate his views to the American people, and he routinely did so in hundreds of appearances before the public, the media and Congress."

President Bush's nominee to replace Carmona, James Holsinger, goes before a Senate committee for his confirmation hearing on Thursday.

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