We already knew from former Surgeon General Carmona’s testimony that this was happening, but now the WaPo brings us
a specific example of science being squelched by a political appointee. It’s not only inappropriate, but just despicable.

A surgeon general’s report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration’s policy accomplishments, according to current and former public health officials.

The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate.

Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services.

Carmona told lawmakers that, as he fought to release the document, he was “called in and again admonished . . . via a senior official who said, ‘You don’t get it.’ ” He said a senior official told him that “this will be a political document, or it will not be released.”

The draft report itself, in language linking public health problems with violence and other social ills, says “we cannot overstate . . . that problems in remote parts of the globe can no longer be ignored. Diseases that Americans once read about as affecting people in regions . . . most of us would never visit are now capable of reaching us directly. The hunger, disease, and death resulting from poor food and nutrition create social and political instability . . . and that instability may spread to other nations as people migrate to survive.”

Heckuva job their Steiger. And is it an isolated incident? Of course not:

Public health advocates have accused Steiger of political meddling before. He briefly attained notoriety in 2004 by demanding changes in the language of an international report on obesity. The report was opposed by some U.S. food manufacturers and the sugar industry.

The global health document was one of several reports initiated by Carmona that top HHS officials suppressed because they disliked the reports’ conclusions, according to a former administration official. Another was a “Call to Action on Corrections and Community Health.” It says — according to draft language obtained by The Post — that the public has a large stake in the health of the 2 million men and women who are behind bars, and in the health care available to them in their communities after their release.

The report recommends enhanced health screenings for those arrested and their victims; better disease surveillance in prisons; and ready access to medical, mental health and substance abuse prevention services for those released.

But the report has been bottled up at HHS, said three public health experts who worked on it. John Miles, a consultant and former Centers for Disease Control and Prevention official who helped draft it, said he suspects that the proposed health screenings and other recommendations are seen as a potentially burdensome cost. “Maybe they just don’t feel it’s a priority,” Miles said.

What can we do about this? Scientific integrity is at stake here when political appointees with no expertise and no respect for science can suppress information of value to the public. I encourage everyone to sign the Union of Concerned Scientists petition to restore scientific integrity to government agencies.

Comments

  1. #1 Ted
    July 29, 2007

    . It’s not only inappropriate, but just despicable.

    When, you say “despicable”, do you pronounce it like Daffy Duck for effect? :-)

    Sorry, cartoons have ruined some words. But then political discourse has ruined “appeasement” as well.

  2. #2 Jonathan H. Adler
    July 29, 2007

    I have a hard time seeing why this story has much of anything to do with “scientific integrity.” The report in question was a policy document — a self-described “Call to Action” — not a scientific report. If the Bush Administration’s actions were wrong here, it is because they adopted the wrong policy positions, not because they overrode the policy positions of the Surgeon General.

    I have more on this here:
    http://volokh.com/archives/archive_2007_07_29-2007_08_04.shtml#1185724235

    JHA

  3. #3 minimalist
    July 29, 2007

    Darn tootin’ there, Jonathan. Why, just look at this lefty-muckraking propaganda:

    In 65 pages, the report charts trends in infectious and chronic disease; reviews efforts to curb AIDS, tuberculosis and malaria; calls for the careful monitoring of public health to safeguard against bioterrorism; and explains the importance of proper nutrition, childhood immunizations and clean air and water, among other topics. Its underlying message is that disease and suffering do not respect political boundaries in an era of globalization and mass population movements.

    Silly moonbats like MarkH just don’t understand that that is EXACTLY equivalent to

    chiefly because the report did not promote the administration’s policy accomplishments

    .

    And furthermore, the careless reader might even be led to believe that

    He said a senior official told him that “this will be a political document, or it will not be released.”

    or

    On June 30, 2006, a Steiger aide sent an e-mail saying that the report should not be cleared for public distribution: “While we believe the subject matter of the draft is important, we disagree with the style, tone and messaging,” wrote the aide, Mark A. Abdoo, according to a copy of the e-mail. “We believe this document should be focused tightly on the Administration’s major priorities in global health so the American public can understand better why these issues should be important to them. As such, the draft should be a policy statement, albeit one that is evidence based and draws on the best available science.”

    imply that it was not a policy statement before, or that its broad base of support from global health experts and scientists both inside and outside the government suggests very little that was controversial about it, at least among people who know what they’re talking about.

    But more enlightened souls know that the facts have a known liberal bias, and there’s always another side to the story, right?

    And if that other side is based on highly selective reading and willful blindness? No skin of your nose, you’re “not defending the Bush administration”, right?

  4. #4 Jonathan H. Adler
    July 30, 2007

    Minimalist –

    Why don’t you try reading the actual document instead of the Post summary? If you do, you will see that it is a policy document — titled a “Call to Action” — that makes specific policy recommendations. Whether “global health experts” liked the report or not does not make it any more “scientific.” Most of the reports may have been completely unobjectionable — and most are — but they are anything but value-free scientific judgments.

    JHA

  5. #5 minimalist
    July 30, 2007

    Hey, thanks, I did read it. Even better, I understood it. As with all Calls to Action, it details the cause and effect of certain health problems, as documented in the scientific literature, and lists strategies that have met with success in alleviating them, but it does not make specific policy recommendations. The closest it comes is to detail specific, successful existing policies in various sidebars, but that is still a far cry from crafting “policy.”

    In short, that you might consider statements like “The public health community has embraced the concept that violence and injuries are predictable and preventable” (p. 44) as anything close to a specific policy statement, let alone potentially “controversial”, is laughable.

    “Hey, I think ‘babies are cute’ is too specific and may not play well in the baby-hating demographic — can we tone it down?”

    I mean, I can see how certain interests might see “Tobacco control measures can have a significant impact on reducing tobacco consumption, hence decreasing the burden of disease and death due to tobacco use” (p. 25) as a “political” statement… but only for the same reasons creationists call evolution a “religion”.

    In short, nothing about this report indicates Carmona stepped outside his bounds or broke precedent (and past Surgeons General agree — oh, but you don’t truck with “experts”), and you are implicitly supporting an unprecedented level of interference for little reason other than you don’t like the implications.

    And I can see where the Bush administration might want the SG to tout their policies in one of those sidebars, but seriously, what was Carmona going to put there — the failed “abstinence” program? Pulled funding to foreign family-planning clinics? To call those “successes” of Bush health policy would most definitely be to lie about the scientific data.

  6. #6 MarkH
    July 30, 2007

    I’ve re-written this response like a dozen times now and still don’t know quite what to say to Adler. His statement made my brain kind of lock up.

    The SG’s office does not publish original scientific research. It studies the available science, makes recommendations, and points out effective and ineffective policies based upon what the literature shows.

    Adler’s comment is almost like an admission from the Bushies that they no longer hold onto an objective reality, in which science can be stated by someone like the SG, without being a “political” document. Even if it did craft specific policies, is it impossible to consider that science can inform policy without being political? Are they so far gone that science and reality represents a political view?

    Am I reading this right? Have I gone insane?

  7. #7 MarkH
    July 30, 2007

    I can’t help myself. This is just too funny.

    So, saying something is effective is a policy recommendation (ok), and is therefore political (uh, wait a minute), and therefor can be suppressed or ignored by the Bush administration (wait, what?).

    No wonder why the Bush administration can never do anything effective. Reality is politically opposed to them. It explains a lot actually.

  8. #8 Ben
    July 30, 2007

    BDS at work, as usual. It becomes almost comical when MiniMouse posts this quote from the report as some sort of proof that it was strictly scientific: “The public health community has embraced the concept that violence and injuries are predictable and preventable.” Since when is mere assertion considered “science”?

    If you want to hate Bush, that’s fine. But please don’t pretend that your whining is anything other than politics as usual.

  9. #9 llewelly
    July 30, 2007

    Are they so far gone that science and reality represents a political view?

    That’s why they won in 2000, and again in 2004. They make their own reality – and frankly, Americans overwhelmingly prefer it.
    Things didn’t get sour for them until hurricane Katrina blew apart the smoke and mirrors, the failed Iraq invasion crash-landed in the paper-mache, and their illusions became impossible to believe for all but the most dedicated denialists.

  10. #10 Jonathan H. Adler
    July 30, 2007

    The Call to Action does much more than say certain measures are or not effective, and it most certainly does make specific policy recommendations – pages 57-60 are nothing but recommendations for policy and priority-setting. Some of the recommendations are innocuous, others are potentially controversial and anything but scientific, such as calling for the U.S. to follow certain international regulations and advocating ratification of an international treaty. Whether or not such policy recommendations are wise, they are not scientific determinations. They can (and should) be informed by science, but they are not determined by science, and it is not suppression or manipulation of science to have different policy priorities. To say policy A can be effective at achieving X is not a “policy statement” — but to recommend that policy A be made a priority (and, by implications policies B through G should not) is a policy statement, and this report certainly went that far.

    It should also be remembered that the SG is a political appointee who that political appointees are expected to support the Administration’s policies. I would not expect a Clinton or Obama SG to devote government resources to the same sorts of things as a Bush SG. Of course all SGs should take pains to ensure their reports are accurate, but they should also expect that the administration’s priorities will trump when they cross the line from science to policy, as this report did.

    My point is not to defend the Bush Administration, but to criticize the repeated mischaracterization of policy disputes as science politicization. This is done by both right and left — by both the Bush Administration and its critics — and it is bad for science and policy alike.

    JHA

    P.S. As I noted in a separate post, it is also ironic that Carmona complains about twisting science when he — like some in the Bush Administration — has himself misrepresented scientific findings for political purposes when he saw fir to do so.

  11. #11 MarkH
    July 30, 2007

    Woah, hold up there CEI guy. Not all political appointees are supposed to behave in a political manner. For instance, look at all the trouble the AG is currently in. There are lots of political appointments that don’t entail carrying water for whoever is in power. Science is one of those fields in which this is completely inappropriate, and unethical, to shape the message to achieve a political goal. Hell, SG Koop got in trouble for just such behavior with regards to repressing the science about abortion safety. It is also against the law to use government funds for political reasons – take Monica Goodling.

    Further, it was not an isolated instance. He appeared to be blocking information that would have been damaging to the sugar lobby for political reasons – a direct ethical breach if you ask me. He also suppressed coverage on topics of public health that weren’t political expedient – the prisons issue.

    Then you look at what they wanted him to add – three mentions of George Bush per page!

    Your position is laughable – all political appointees are not supposed to, or allowed to make political considerations in the course of their duties etc. Surgeon General is essentially chief medical science educator of the US. It isn’t chief Bush cheerleader. It isn’t chief liar about contraception, and ES cell research, and public health to help your boss. No. He has duties which require a stance of political independence.

    Hell, they said he couldn’t go to a Special Olympics event because of the Kennedy’s role in setting it up. How can you defend this stuff?

  12. #12 Ben
    July 30, 2007

    Carmona’s unsubstantiated charges (and there are several) should be taken with a huge grain of salt. The Special Olympics thing is especially questionable given the Bush family’s huge support of it over the years. Funny how libs who are now willing to believe anything Carmona says were utterly dismissive of Louis Freeh’s much better substantiated (and much more important) complaints of life under the Clinton presidency.

  13. #13 Boris
    July 30, 2007

    What’s the point of commissioning a report if an unqualified political appointee is just going to rewrite the conclusions? Couldn’t we save a lot of money and time by having the appointees write the report themselves?

    Oh, but then the reports would lose their bopgus sense of authority. And that would be a real shame.

  14. #14 minimalist
    July 30, 2007

    Boris hit the nail on the head. The office of the SG was created in an advisory capacity for the Executive. They have no control over setting policy, and governments are perfectly free to ignore reports and calls to action as they wish. Soliciting advice and then demanding rewrites if the answers are not what they wish rather undermines the whole point of the office.

    I’m not saying science isn’t political, but when the global health community is all but unanimous in a position, and it is undermined for solely political reasons by a non-expert, then yes, that is clearly interference and clearly inappropriate.

    But I suppose an administration that wants to appoint Homobigot Holsinger as the next SG can’t fairly be accused of politicizing the office, or the science.

  15. #15 minimalist
    July 30, 2007

    In closing, it appears that independent, unvarnished advice should only be protected when it comes from industry — under the cover of secrecy and super executive privilege — and not when it comes from scientists and health workers. You just can’t trust a guy who wants people to be healthy and doesn’t stand to profit from it.

  16. #16 Ben
    July 30, 2007

    So according to MiniMouse, political appointees should be free to issue any report they desire and the administration they work for shouldn’t be allowed to say boo. Riiiight. Somehow I think his opinion would turn a full 180 if a Dem president’s SG started advocating for positions conservatives support.

    But of course, Mini gives the game away with his dismissive remark about “Homobigot Holsinger”. Oh yeah, Mini is all about dispassionate science.

  17. #17 MarkH
    July 30, 2007

    Wow Ben. You know pretty much nothing about how science or our government works do you? And Holsinger did write a complete piece of idiotic psuedoscientific bigotry for his church – an action that deserved to be questioned and examined.

    Yes! Political appointees should be free to issue any report they like, and usually are. It’s against the law to spend government money for political gain. Even political appointees are subject to this, and the current problems with the AGs should make it quite clear that yes, political appointees have to obey the law and do their jobs. In justice, and science agencies in particular this has been the case.

    Have you ever heard of the midnight massacre? Are you paying attention to what is happening with Gonzalez? Or what previously happened with SG Koop? Koop did the opposite of Carmona, he suppressed data himself that was not politically expedient for his bosses, and he got punished and exposed and rebuked for acting politically.

    Just because the Bush administration does this does not mean it has always been so. You’re ignorant of science and history. This behavior is exceptional, and that you people don’t think it’s wrong is just sad, sad, sad.

  18. #18 Cwags
    July 30, 2007

    I’m sorry, but if you are going to shovel our nations culture of cartoons under the rug (or worse) at least get it right.

    That was Sylvester, NOT Daffy Duck. Daffy picked that up After the cat.

    loser.

  19. #19 Ben
    July 30, 2007

    Mark,

    Your biases blind you to your own ignorance. It is the job of U.S. attorneys to follow the law. But it is the Administration’s job to set policy priorities. If the White House tells the U.S. attorneys to go after illegal immigrants or sexual discrimination cases, that’s what they have to do. It is not in the attorneys’ discretion to start issuing “calls to action” on other issues or publicly disagreeing with administration policy. Any attorney who does so deserves to be fired, no matter which president he works for.

    Same goes for other political appointees. And by the way, if you think that the Bush administration invented the art of influencing the actions of appointees, you really are a hopeless case.

  20. #20 Jonathan H. Adler
    July 30, 2007

    Minimalist –

    I’m glad to see you are no longer trying to argue that the “Call to Action” was not a policy document that made policy recommendations. If the global health community supports a given policy measure, such as the ratification of a treaty, that does not make the position any more “scientific.” (In contrast to descriptive claims about the likely effects of a given policy measure, which may well be scientific.)

    MarkH –

    It’s nice to see that instead of responding to my points you instead talk about other things — such as the Bush Administration’s insane insistence of repeated mentions of Bush policies in SG speeches (something I’ve already criticized in my Volokh posts) or Steiger’s alleged efforts to cater to the sugar lobby (something that, if true, is far more worthy of criticism that the episode that prompted your initial post), or the silly Special Olympics flap. I’m not defending this stuff, but you’re also not defending the substance of your initial post.

    I challenged your claim that the refusal to release this specific policy report was “despicable” and an example of the suppression of science. You’ve offered nothing to substantiate this charge. That the Bush Administration has politicized or suppressed science in other instances — and should be criticized for doing so — does not vindicate your claims about the suppression of this report.

    As for the obligations of political appointees, they are generally expected to conform their policy-related actions to the policy preferences of the administration of which they are a part, insofar as this is permitted by law. Insofar as this episode involved an intra-administration dispute about the content of a policy document — and did not involve any effort to misrepresent scientific evidence — it is nothing new, and hardly scandalous.

    JHA

    P.S. I haven’t been a “CEI guy” for seven years now, and I don’t hold all of the positions I did back then.

  21. #21 MarkH
    July 30, 2007

    Influence, sure. Set priorities, fine. Shamelessly promote the president using science reports and government money? Hmmm, that seems a bit illegal to me. Not that this is the first instance of this kind of crap. The office of faith-based initiatives being the most egregious example.

    I’m glad to see you are no longer trying to argue that the “Call to Action” was not a policy document that made policy recommendations. If the global health community supports a given policy measure, such as the ratification of a treaty, that does not make the position any more “scientific.” (In contrast to descriptive claims about the likely effects of a given policy measure, which may well be scientific.)

    Hmmm? The suggestions of experts in the field is not relevant scientific information?

    It’s nice to see that instead of responding to my points you instead talk about other things — such as the Bush Administration’s insane insistence of repeated mentions of Bush policies in SG speeches (something I’ve already criticized in my Volokh posts) or Steiger’s alleged efforts to cater to the sugar lobby (something that, if true, is far more worthy of criticism that the episode that prompted your initial post), or the silly Special Olympics flap. I’m not defending this stuff, but you’re also not defending the substance of your initial post.

    This post is about the political interference by the Bush administration in the SG’s office. There were three specific examples listed in the article, on global health, obesity and prisons, all are relevant. Further, I didn’t feel the need to respond individually to every single poster here. I thought Boris and Minimalist did an adequate job describing the problem with your position.

    I challenged your claim that the refusal to release this specific policy report was “despicable” and an example of the suppression of science. You’ve offered nothing to substantiate this charge.

    A scientific officer in the federal government is commissioned to study public health. He does and writes a report. He can not publish it because it does not laud Bush enough in the opinion of a non-expert supervisor. Where is the confusion?

    That the Bush Administration has politicized or suppressed science in other instances — and should be criticized for doing so — does not vindicate your claims about the suppression of this report.

    Except that it is evidence of a pattern of behavior from a specific employee.

    As for the obligations of political appointees, they are generally expected to conform their policy-related actions to the policy preferences of the administration of which they are a part, insofar as this is permitted by law. Insofar as this episode involved an intra-administration dispute about the content of a policy document — and did not involve any effort to misrepresent scientific evidence — it is nothing new, and hardly scandalous.

    Wait, so now making the SG write paeans to Bush is in his job description? It’s not suppression of science to make science officers write reports about how Bush is our dear leader rather than focus on global health? And where did this idea come from that the Surgeon General is a pure science drone and can’t suggest policy based on the science? Koop got in trouble almost 20 years ago for just this kind of malarkey – politicization of his office. Why don’t you address that episode?

    It is perfectly acceptable for a science officer to write something that conflicts with the administration in charge. It is not acceptable to make science officers use their reports – policy or pure science, whatever that means – to laud a politician. It is not acceptable to tell them they can’t publish on an issue as important as global health until they do so. Like Minimalist said, it would have been perfectly appropriate for them to let the SG publish the report, and then ignore it. It is not appropriate to have non-expert political operatives try to modify it so it becomes a propaganda device for the president.

    There is a reason scientists are offended by this stuff. It isn’t liberal bias, it’s despicable politics.

  22. #22 Ben
    July 30, 2007

    Mark,

    Reading your contortions and ramblings is becoming increasingly painful. Call yourself what you want, but you are no scientist, nor do you really care about science. You are a political ideologue hiding behind the skirts of science. The rest is all horse crap.

    But all of this reminds me of a certain story I once heard about the senselessness of mud-wrestling with a pig, so I’ll waste no more of my time in this pointless exercise.

  23. #23 MarkH
    July 30, 2007

    Eh,
    I get accused of being a Republican operative, or a Democratic operative, or a drug company shill, or a member of the global medical conspiracy every day. My feelings aren’t hurt by pointless ad hominems. I accept your retreat and my victory.

  24. #24 minimalist
    July 30, 2007

    Anyone still confused by the purpose of the office of Surgeon General — who at this point I would put in the same class of people who are confused by their own feet — might wish to peruse this page.

    “Kissing the President’s butt at every opportunity” is curiously absent from the job description.

    It’s rather depressing at this point to see Adler’s continuing refusal to admit that the wholesale suppression of a report for inadequate butt-kissing is not politically-motivated interference with science, and with the duties of the SG in specific. Luckily we had Ben’s hilarious pants-pooping temper tantrum to leaven the mood a bit. Just a bit.

  25. #25 G Felis
    July 30, 2007

    Reading the comments from Ben, it occurs to me that virtually every troll I’ve ever encountered is simply the subspecies of denialist who spends a lot of time and energy making (un-)contributions to online forums.

    This whole denialism frame of reference keeps proving useful. Keep up the good work, Brothers Hoofnagle!

  26. #26 minimalist
    July 30, 2007

    Whoops, strike the “not” from my above post. Should read:

    It’s rather depressing at this point to see Adler’s continuing refusal to admit that the wholesale suppression of a report for inadequate butt-kissing IS politically-motivated interference with science, and with the duties of the SG in specific.

  27. #27 Thomas Robey
    July 31, 2007

    There is another thing you can do about this situation. Email your senators and ask them not to support William Steiger’s nomination as ambassador to Mozambique.