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The Surgeon General's Commissars | The Nation

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The Surgeon General's Commissars

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The Constitution's Framers, who naïvely believed their grand experiment would eschew partisan politics--they did not even anticipate the formation of parties--might have had their checks and balances unhinged had they heard the Congressional testimony of former Surgeon General Richard Carmona, who served in George W. Bush's Administration for one term, from 2002 to 2006. After his testimony, we know why he was not asked to return.

About the Author

Stanley I. Kutler
Stanley I. Kutler is the author of The Wars of Watergate (Norton).

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Partisan politics pervades our national bureaucracy, enforced and supervised with what smacks of a full-blown political commissar system. The White House has deployed a far-flung raft of apparatchiks, apparently reporting to Karl Rove at Political Central. Carmona revealed their shadowy workings. They appear in the organization charts as "chiefs of staff" or simply "aides," situated to ensure that the White House's political needs trump policy considerations.

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Carmona offered a carefully calibrated account of the Administration's insistence that politics trumps science and wise social policies--but without publicly naming names. He testified that Bush officials weakened or suppressed public health reports to suit their political agenda. He was prohibited from making any speeches or reports about stem cells, emergency contraception, sex education, global health, public health of the prison population or mental health issues. The Surgeon General's report on the dangers of secondhand smoke was delayed for years. Dr. Carmona was expected to support Republican candidates and to attend political briefings. When the stem cells issue emerged, he said that "I was told to stand down and not speak about it." And he had to submit his speeches to vetting and--call it by the right name--censorship; specifically, any remarks on stem cell issues were removed from his speeches.

Carmona asserted that the apparatchiks insisted he mention the President three times on every page of his speeches--what substantive information could he offer with such a requirement? The Stalinist Romanian dictator Nicolae Ceausescu required his scientists to mention his name and his wife, Elena, in their speeches or papers. So far, we have no known requirement that Laura Bush receive equal time.

The New York Times dutifully carried the Administration's rejoinders. A Department of Health and Human Services spokesman disagreed with Carmona, predictably noting that the Administration believed "public health policy should be rooted in sound science." A White House spokeswoman turned the doctor's testimony on its head when she bemoaned his failure "to use his position to the fullest extent" to advocate policies he thought served the nation's best interests. Carmona probably has been in the Administration's gun sights since he was forced out.

The White House controls a powerful microphone--so powerful that we might be at the end of the story as far as the media is concerned. The New York Times followed the story with an editorial pleading for more independence for the Surgeon General, ignoring the pervasiveness of political surveillance.

Regimes everywhere naturally are inclined to audit their inner workings, check independent judgments and enforce conformity. Bureaucratic independence is usually rare and precious. If only Carmona (and others) had resigned and publicly protested the damage he had witnessed. He is a brave man who served in the Army Special Forces and earned two Purple Hearts in Vietnam. (We can hear the Swift Boat folks revving their engines.) But he stayed the course for his term and tolerated the abuses he recently reported. Alas, in the American system, high-level officials do not resign on principle; they soldier on, no matter how humiliated they have been (see Colin Powell).

Make no mistake: This phenomenon is not the exclusive province of the present Administration. Two of Carmona's predecessors testified to political interference by the Reagan and Clinton administrations. Dr. C. Everett Koop, a feisty figure in the Reagan years, said that officials tried to prevent him from discussing AIDS, but he did so nevertheless. Clinton's Surgeon General, Dr. David Satcher, complained that the Clinton White House discouraged him from issuing a report on the effectiveness of needle-exchange programs, but he, too, released it. The Bush Administration is nearing its end, but it would be foolish to think that imposing political discipline and correctness will wind down. The practice is not new--only the scale and scope are new. Will it be expanded and refined by Bush--as well as his successors?

Our President's Political Central demands its scientific people (and others, of course) be nothing less than shills for political dogma that most of this country does not share. We have this Administration for eighteen more months. Congress must reassert its proper role, now and beyond. This does not mean perfunctory two-hour hearings but rather carefully prepared and executed inquiries--followed by actions. For the past decade, Congress has forsaken its equal role in the government; instead, it has passively accepted Bush's designation of it as merely his advisory body.

Perhaps we have a supersecret agency tucked away in the Executive Office Buildings--directed by Rove or maybe Vice President Cheney and his dubious staffers--tasked to review or suppress policies, or to add laudatory remarks about the President in officials' speeches. The primary mission of Political Central--wherever it is located--is to enforce political conformity, no matter how compelling the requirements and needs of public policy may be. The Soviets did it better, but that was the Soviet system, not ours.

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