TheMillerCircle.org

Perhaps because of my training, and the fact that I have an MD, I have always believed that a high calling of government is to disseminate health information to the public in a timely, accurate manner. Seems very simple doesn’t it? Well, it is, or it should be. The surgeon general of the United States is supposed to be the pinnacle of the government’s responsibility for objective reports on health. A position that was created in the 19th century, the surgeon general sits at the head of the nation’s health table, as a symbolic figure for dealing with issues of public health. He or she is someone we look to for expressing good, unbiased opinions on matters of health and public health policy: they are commissioned officers in the Public Health Service, a uniformed branch of the armed services classified as "non-combatants": we pay their salary to serve the the health interests of the general public. The failure of this symbolic figure to be unimpeded in their pursuit of rational, objective, scientifically valid information and keep the public informed based on those criteria represents a high-level failure of our government and a fatal flaw in its integrity. Welcome to America! Today, the surgeon general is a badly flawed position. The downgrading of this position started in the Reagan administration and, as we have been learning recently, has been so pitifully undermined by the Bush administration that we should think seriously about abolishing the position as a hopelessly dysfunctional, anti-health position with virtually no independent authority.

There was a time when things were different. In 1964, the surgeon general Luther Terry, MD published the first government report on Smoking and Health during the Johnson administration. This was the first report that indicated a causal relationship between smoking and lung cancer and you can imagine how reactionary the tobacco companies were against this report, unless you were old enough to remember this sordid history of government vs corporate bantering that went on for many years. But the surgeon general had the full weight and support of the Federal Government behind him and a panel of well known doctors who served on a committee to evaluate the information and make recommendations and a growing array of research institutions that provided increasingly weighty studies on the subject. Eventually the tobacco companies had to give way and accept the conclusions, which today, are not seriously in doubt. But no surgeon general of today would find his/her job conditions anything like those under which Luther Terry operated. Under the Bush administration, the tobacco companies didn’t want the surgeon general making a case about the dangers of second hand smoke and so, a report on this issue that should have been released years ago, has only recently been issued and was forced into being more watered down. Business has triumphed over public health under Republican administrations.

The first major hint of a deep flaw in the objectivity of our government on issues of health took place with the AIDS epidemic during the Reagan administration. When the early information began coming in about the disease, in the early 1980s, the under secretary of HHS refused to get information out to the public because advisers to Reagan and Reagan-appointed officials thought that AIDS was God’s punishment for homosexuals and that it should be allowed to run its course to weed out the evil-doers among us. The Moral Majority political action committee with Jerry Falwell as its leader and Pat Buchanen as the communications advisor to the president encouraged Reagan to adopt a policy of indifference towards AIDS. The surgeon general at the time, C. Everett Koop, was specifically told not to mention AIDS in his reports and was not free to do so until 1986, years after the AIDS epidemic first broke out. He cleared his conscience in 1988 by sending out a mailing on AIDS to every household in America. Ronald Reagan himself never mentioned "AIDS" in a speech or a press conference until late in his administration after his friend Rock Hudson had died of AIDS, which for some strange reason, broke the ice for Reagan. The policies of the Reagan administration led to thousands of American deaths that could have been avoided with a more aggressive, early educational effort, encouraging and distributing clean needles, closing the bath houses much earlier, using condoms and pursuing policies free of ideological interpretations of homosexuality. Had a policy of greater scientific objectivity been pursued, the US could have played a much stronger role in dealing with the looming AIDS epidemic in Africa, the magnitude of which was first appreciated among workers in the CDC and NIH. The scourge of AIDS in Africa will haunt all Western nations for decades to come, because a more sensible policy, particularly by the Reagan administration, would have made a big difference. But, as Africa began to appear on the radar screen for its huge AIDS epidemic, it was understood that AIDS transmission in Africa was not an issue of homosexual behavior but heterosexual transmission was the rule and therefore, the Reagan administration did not want to acknowledge the African AIDS problem because it would mean admitting that AIDS was not just a homosexual contagion……on and on into the valley of death rode the American Government . Until Ronald Reagan, most Americans viewed the surgeon general as the "Nation’s Doctor." It would be foolish for any American citizen to believe that the surgeon general under the Bush administration is free to advocate health policies based on scientific information. If you want this kind of information that is developed in an unbiased way, consult the World Health Organization (WHO) and never be foolish enough to consult with the surgeon general’s office or website. With this administration, it’s all about ideology and whatever the corporate needs are that must be served. The surgeon general, like so many other components of our government, has in fact become a dysfunctional position. If it were removed we would never know the difference. In fact our health might actually be improved.

The Bush Administration has demonstrated that there is yet a lower depth of performance for our health advocates and a further lowering of our surgeon general’s integrity and hence the integrity of our government. Everything in this government is politicized and nothing is left in which independent policies can be developed and expressed on the basis of objective observation and analysis. With this administration the scientific method is persona non grata . A few days ago, a former surgeon general Richard Carmona testified before Waxman’s congressional oversight committee on the policies he was forced to deal with while in the Bush administration. Carmona served as the surgeon general from 2002 and served one term until 2006 and was not invited to fill a second term. I’ll bet you can’t remember hearing anything he ever said? As he described his own experience in the Bush administration, he revealed how naive he had been about the position and eventually began consulting with former surgeon generals, which led him to believe that he had been forced to politicize the institution far more than any of those that preceded him. His testimony made you feel that the position should be abolished because it is now used for politicizing health care issues and elevating the image of king Bush. According to the NYT report, "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." If you go to the section on the surgeon general’s website about smoking , you will find that several links to pdfs on smoking and health will not lead to the file, but rather give a message saying that the file is not available. What’s more, Carmona was prevented from attending the Special Olympics and when asked why, he was told that because the Special Olympics is supported by the Kennedys, who were the mortal political enemies of Bush, it would not look good for Bush’s appointee to attend. Carmona also reported that he was forced to write George Bush’s name three times on each page of his prepared speeches. The Republican presidents, from Ronald Reagan to George Bush have made the surgeon general’s position not only irrelevant for accurate and timely knowledge on public health, but in fact, it is a dangerous position, because of the misinformation it conveys, either by watered down reports or the failure to talk about the most critical health issues of our time. The surgeon general’s office is but one glaring example of how the Republican mantra of making government dysfunctional has operated to perfection. My personal top two go like this: an example of the Republican dysfuncitonalization of a Federal Agency would have to be awarded to FEMA (Federal Emergency Management Agency) , as exemplified during Katrina, while the top award for a dysfunctional position would be that of the surgeon general. It is a position that is so traumatized and gutted of integrity, that, like the CIA, we would be better off closing it and starting anew, after we impeach George Bush and Dick Cheney.