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The Death of Public Health

July 11, 2007

June 10 – Washington, D.C.

Public health is dead. In shocking testimony given to the House Oversight Committee, former Surgeon General Dr. Richard Carmona let it be known that public health has, after a torturous fade into the background of American life, finally been shunted out of the public sphere in totality. His prepared remarks show the lengths to which the current Administration went to suppress and degrade the science that is the linchpin of a successful public health strategy:

I turned to my fellow Surgeons General, the men and women who came before me and had made tremendous positive contributions to the science and practice of public health, who had saved and improved millions of lives through their work and dedication. They became my mentors. They said that they had all been challenged and had to fight political battles in order to do their job as “the doctor of the nation.” But each agreed that never had they seen Washington, D.C. so partisan or a new Surgeon General so
politically challenged and marginalized as during my tenure.

They told me that although most Americans believe that their Surgeon General has the ability to impact the course of public health as “the nation’s doctor,” 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. Anything that doesn’t fit into the political appointees’ ideological, theological, or political agenda is ignored, marginalized, or simply buried.

His unprepared remarks show that daily interactions muzzled the Surgeon General in a way that, given the matter of his specialty, should be criminal:

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 name.

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

On a personal note, having come from public health into preparedness, this truly upsets me. I have seen too many good people leave the field in frustration due to what was a perceived feeling that those in government would do nothing to help grow public health or use accepted science to better the lives of Americans. I say perceived because that’s how we all felt. We now know that this perception was only partially correct. While we weren’t being actively rebuked or targeted; we were being ignored, which is infinitely worse.

Having spoken with my colleagues during Dr. Carmona’s tenure, we were appalled by his unwillingness to take a stand – to actually advocate for the public’s health – instead of continually offering platitudes about the Bush Administration’s half-hearted or two-faced public health efforts. My initial reaction after hearing his testimony was that he was muzzled, that there was nothing he could have done. But then I look at the things that former Surgeon General C. Everett Koop was able to accomplish during his tenure in the Reagan Administration. He was warned to stay away from speaking about AIDS, and ignored that warning and probably saved millions of lives. Dr. Jocelyn Elders was sacked for saying things that the Administration and public didn’t want to hear, but still represented good science. Dr. Carmona, however, cowed to the pressure of the Administration and, while standing in the bully pulpit, shied away. Only now, when he is removed from the spotlight and all of his power to do good has been taken away, will he speak. I don’t doubt that Dr. Carmona is an excellent doctor and a good man – but he failed his country when we needed him most.

Video of the testimony can be found here. Direct quotes taken from the New York Times and Dr. Carmona’s prepared remarks (pdf).

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