Former Surgeon General Richard H. Carmona claims that Bush suppressed vital health information during his presidency

Disagree

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by Gary Charles Berliner

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Upon reflection on the health topics and the actual testimony covered by Dr. Carmona in his appearance before Congress, I would conclude that Dr. Carmona's report actually reflects his own personal political agenda, rather than any objective evaluation of the overall health directives delivered to the Surgeon General's office during the past 8 years. His claims of "suppression of vital health information" is simple hyperbole designed to demonize the former Bush administration's legitimate disagreement with Dr. Carmona's personal views on the science and medicine priorities in their previous Public Health programs.

The first fallacy embodied within Dr. Carmona's testimony is his promulgating the assumption that the office of Surgeon General is an apolitical appointment designed to further the general health and welfare of US citizens at the behest of the appointee. Nothing could be further from the truth. The office of Surgeon General was designed, from the beginning, for the office holder to be a spokes-piece for their administration's showcased Public Health policies, with the intent that implementation of these policies were not simply for the benefit of the public at large, but also served to promote that particular administration's own civil agenda. Toward that end, the Surgeon General has never necessarily represented his own, or some larger objective view of medicine and science, but rather has always served at the bidding of the President, and by that token should reflect the President's views, or recuse themselves from their post.

Past Surgeon Generals have been roundly critiqued and even removed from their appointments for failing to represent their administration's views on Public Health Policy. Most notorious was Dr. Jocelyn Elders during the Clinton administration, who famously advocated masturbation as an alternative to sexual intercourse for a means to reduce unwanted pregnancy, and sexually transmitted disease. While her's was not a true advocacy of abstinence, the approach she took none the less provoked the ire of the Clinton White House and resulted in Dr. Elders' dismissal, not for the illegitimacy of her ideas, but for their variance with implementation of President Clinton's desired Public policies on birth control and family planning.

Other Surgeon Generals have been equally stymied in their attempts to implement science and medicine into Public Policy. For example we see the graduated warnings successively placed on cigarette packages and tobacco products during the 60's, 70's, and 80's even though the medical evidence of the dangers inherent in smoking cigarettes has been known since the 50's. The pressure which various Surgeon Generals brought to bear on their own administrations to attach increasingly strident warnings and public restrictions on smoking, reflected the tolerances of their individual era's Political climate rather than any increase in the data on the dangers of cigarette smoke. Similarly, despite vociferous support for 3 decades, from Public Health and the medical community, mandatory motorcycle and bicycle helmet laws have been slow in coming to all states, even though ample data exists that they decrease morbidity and mortality in cycle accidents. Eventually most state legislatures were pressured into drafting some form of mandatory helmet law, yet as the Political climate has again shifted, and despite the objections of successive Surgeon Generals, many states repealed these laws (for adults), in favor of personal responsibility and individual choice.

Examining Dr. Carmona's positions individually one can see that he is often at odds with his Bush administration benefactors in point of style and political implication but rarely as to point of fact. Dr. Carmona's issues seem to be : 1) which public policy steps should be taken to address a particular problem, 2) how swiftly one implements a program of change, 3) how draconian should the enforcement of public policy be. A synopsis of Dr. Carmona's discordancy with the Bush administration's policies follows:

Tobacco as a health problem & Effects of second hand smoke :

Second hand smoke is a known and quantifiable health risk. Dr. Carmona may even be medically correct in wishing to address and further restrict public exposure to and unnecessary risk from side stream smoke. Still, the political climate and the public will is not yet ready to sustain further government suborning of smoker's rights for access to tobacco in non-enclosed public venues. Advocacy of a restrictive government position has put Dr. Carmona at odds with many who feel that it is a further infringement of their personal liberties. Further, while negative consequences from exposure to side-stream or second-hand smoke are demonstrable in confined quarters, such deleterious effects are controversial when random controlled trials are performed in open settings. Smoking may be a noxious habit, but it is not provably assaulting bystanders out of doors. Dr. Carmona's desire to regulate smoking in one's own home, as well as open public venues simply smacks of fascism. It is not appropriate to regulate people's behaviors based on one's own ideological prejudices, especially when those adopting said behaviors are not demonstrably threatening the well being of others. Additionally, such wholesale restrictions by regulatory fiat stifle a multi-billion dollar industry and long tern labor pool, which supports a long tradition of economic prosperity.

Sex education :

Dr. Carmona might be perfectly correct from a systems management position in saying that abstinence should not be the sole method emphasized in the struggle to stem unwanted pregnancy and sexually transmitted disease. After all, not everyone is of a mind to abstain from sex, and for those who will not, it becomes necessary to present an alternative, or to risk undesirable results. Regardless, the Bush administration had to deal with a large portion of their base and a large proportion of Americans, who personally feel that such alternatives to abstinence, like sex education and distribution of condoms, are immoral and repugnant, to a degree that they wish none of their tax dollars or public funds to be expended on such (subjectively) heinous acts. This is an issue that inflames passions and has the potential to actually create civil unrest should a much broader implementation be forced upon an unwilling section of the public. It is unfortunate that Dr. Carmona felt this policy should be implemented despite the potential for vociferous and violent objection. In a Republic the rights of minorities (even minorities of unpopular faith and opinions) should be free from the tyranny of majorities. The Bush administration obviously felt their larger societal considerations to be more urgent, and of a higher priority than those Dr. Carmona advocated.

Speaking at the Special Olympics :

The Special Olympics is a good will games for the cognitively impaired, where everyone wins, and the spirit of the Games is of more importance than their competitive outcomes. The Kennedy family helped found the events, and they are featured during the opening and closing ceremonies. Dr. Carmona's desire to address the Games had much more to do with his own perception of public relations and good will than any pressing Public Health urgency. The Bush administration's desire for Dr. Carmona to NOT do so was apparently a political gambit to deny association with Senator Ted Kennedy, whose support for government sponsored embryonic stem cell research, and Socialist Health Care initiatives were often diametrically opposed to Bush's. This might seem petty motivation to avoid publicizing a worthy event. However, the politics embraced by Senator Kennedy and his stark differences with President Bush on Public policy in areas from abortion to "universal" health care are perceived in some quarters as being equivalent.

Global health as a "basic human right":

What kind of health? What level of care? Clean water, safe food, freedom from parasitic & infectious disease, global vaccines, anti-retro-viral drugs, child deliveries, heart transplants? How funded? Who will pay? Who provides the care? This is a buzz phrase for socialized medicine on a global scale, but at what baseline?. Neither the US, nor any other country has the resources to provide unlimited universal health care for their own people, much less for the world, not even with a combination of all monies from all countries in the world. Every country that provides government funded medical care to its population, ultimately rations that care to its populace, while providing comprehensive medical care only to its political elites. Each of these global health care countries then sets a different baseline for minimalist care based on their economic resources, available medical personnel, equipment, and drugs. The defining elements of that minimalist baseline often shift with changes in their societies' financial solvency. Dr. Carmona's philosophical and humanist desire to ensure the provision of modern medicine to the entire world, while laudable, falls far short of definable, much less practical. The Bush administration's desire to allow the free market, and personal choice to dictate how individuals wish to access medical care, continued to sustain the most effective health care system in the world, at the lowest cost to participants. Medical insurance company reimbursements are the lowest they have been in history, premiums are highest, and the insurance industry has recorded record profits. Dr. Carmona's disputation with the Bush administration comes down to his ideology vs the effectiveness of the current system.

Stem Cell research :

Despite President Obama's currently lifting restrictions on EMBRYONIC stem cell research, the topic is still controversial. It is like using Nazi human bio-physiology data to further modern science and medicine. The question becomes should we as a society rely on data collected in a fashion seen as immoral & repugnant to some? What are the implications to our culture of supporting the publication of bio-physiology data garnered from unethical human trials during World War II? Is embryonic stem cell research equally unethical as some people believe? Moreover, is embryonic stem cell research necessary, since there NOW exist morally palatable alternatives to Embryonic stem cells, that are much more useful and biologically appropriate from a utilitarian standpoint. We are now able to extract, cultivate, & reproduce viable Adult same-cell haplotype stem cells from the individual at need, that are a perfect match to his own cell's antigens. These are discoveries that were made precisely because the Bush Administration requested and funded such research which led to this superior methodology and outcome, specifically in order to circumvent the use of sacrificed embryos in garnering their stem cells. Should Dr. Carmona have had his way, then like the demand for African Ivory which drives elephant poaching, would not the demand for sacrificed embryos continue to drive its own market, and foster an industry encouraging young women to undergo abortion in order to fuel that demand? Regardless of where you fall on the abortion issue, the nature of turning human fetuses into commodities, and bartering them to the medical establishment is repugnant. Especially, in light of the more useful technologies available to us for acquiring adult stem cells, that cost less money, have more efficacy, and provoke minimal moral repugnance, the harvesting of embryonic stem cells becomes a significantly inappropriate method to achieve a laudable goal.

Reproductive rights for women :

In most of the world, for cultural and religious reasons, women have a very limited ability for determining whether or not they become pregnant or whether they carry a child to term. In the Western world this has changed due to technology and education, and the secularization of male/female relationships. Dr. Carmona's stance appears in favor of females having sole determinism over their reproductive potential, but seems to count a woman's right to say yes to birth control & abortion no matter where or how, while discounting her right to say NO to terminating an ongoing pregnancy and instead accessing social services. Choice should mean choice whether yes or NO. The Bush administration had to answer its religious constituency which radically opposed abortion and in some instances birth control methods (like plan-B or IUD's), which do not prevent conception but rather prevent implantation of a fertilized egg. Accordingly, while in no wise attempting to overturn Roe vs. Wade, President Bush did advocate balanced counciling and alternatives to abortion. Dr. Carmona's opposition to this position set him at odds with an administration that primarily desired his cognition and cooperation in appeasing an otherwise outraged portion of their voter base.

Gender inequality :

Dr. Carmona advocates an affirmative action program for distribution of public health care dollars between the genders, a title nine decree for engineering female specific health outcomes. Under Dr. Carmona's directives more money might be allocated to investigating and treating female gender specific disorders in order to more equally distribute those funds between the sexes. While laudable and timely especially when considering gender driven efficacy of treatments and outcomes for myocardial infarction and malignant hypertension, this may not always be necessary or advisable since incidence of many other gender specific illnesses such as screening for Polymyalgia Rheumatica and related inflammatory illnesses with a 2:1 female to male ratio, are often quite low in the general population. President Bush on the other hand advocated an intense practicum application of health care dollars for determining answers to and affecting treatments for some of the most pressing in a hierarchy of common medical issues, regardless of gender, such as annual influenza vaccination, colon cancer and hypertension screening which effects far more individuals of both genders, yet coincidentally also has a disproportionately higher male to female ratio. Job or health equivalency is not the same as job or health equality. Equal pay for equal work is social justice, but equal pay for equivalent work, is a brand of socialism that discounts the supply & demand side of the job market, and obviates disparate requirements in effort, expertise, training, work difficulty, production, and outcome between types of labor. Cosmetically adjusting numbers of male:female ratios in salaries, jobs, professions, earned income, and overall at work, creates is own brand of injustice where productive, motivated individuals are disenfranchised by fiat, and quotas, not performance become the measures of job retention. So too in Health Care where the most pressing of acute medical issues, such as distribution of vaccinations for influenza, can often mean differences in morbidity, life, and death for large numbers of people regardless of gender (22 to 45 thousand people die of influenza in the US each year - a small city). Whereas, in less common more female gender specific illnesses, such as Fibromyalgia where diagnosis and treatment is often delayed and morbidity and productivity loss is high, while these may be no less pressing for the individuals they are often more difficult, time consuming affairs to solve, and draw vital resources in seeking answers for a limited few persons, while those same resources might be better spent providing treatments & cures to the vastly larger numbers of people affected by more common illnesses. The Bush administration was loathe to shift their Public Health policy interests from general population-specific medical issues, to the narrower gender focuses envisaged by Dr. Carmona.

Sexual violence :

Women are not Cattle, nor objects for barter, trade, or commodius usage. Women do not exist to be controlled, humiliated, degraded, suppressed, or denied equal rights under the law. We must face the reality of female genital mutilation and sexual violence in this world. To do so one has to admit that there is still a cultural imperative to keep women in an underclass throughout many third world countries. If China can own up to and cease binding woman's feet, then the African & Muslim world can renounce infibulation and the performance of clitorectomies on its female children, the sequestration and restriction of their wives and daughters, the judicial inequities meted out to women over men, and rape used as a tool for government or religious oppression of ethnic and religious minorities. We all know the fate of far too many women in Darfur. So too can Eastern Europe and Central Asia renounce rampant sexual and financial enslavement of women by unscrupulous criminal and government sponsored or condoned agencies. Naturally, in light of the current global political climate, it is controversial to state this position, much less support constructive efforts to increase awareness and effect change while at the same time trying to engage, or engender a political rapproachment with the very same countries whose governments and their agencies are committing these atrocities against women.

Poverty and health disparities :

It is axiomatic that the poor will be "less" healthy; by mere dent of their poverty the poor have greater risk and exposure to injury and disease, with less immediate access to remedies. However, this is not the same as being "unhealthy", or "without access" to health care services. Years of social welfare programs and entitlements spending trillions of dollars have not changed poverty and health disparities. Education and economic mobility has. If you teach a person to fish, they feed themselves. It is no solution to pour money into health programs that maintain the impoverished status of the recipient, thus maintain their risk, and limit their access, when simply advocating education and upward social mobility solves both problems.

Global Warming :

Many scientists feel the current emphasis on human contribution to climate change is incorrect. The modest global warming trend of the past 22 years has stopped, even reversed itself. Record low temperatures were experienced in much of the world this winter as global temperatures have been falling the past 5 years, according to tracking performed by former NASA climatologist Roy Spencer. "Global warming" was going to bring more and more horrific hurricanes, climate change scientists and the politicians who subscribed to their theories said. But since 2005, only one major hurricane has struck North America. A new study by Florida State University researcher Ryan Maue shows worldwide cyclone activity typhoons, as well as hurricanes has reached a 30-year low. Two more studies one by the Leibniz Institute of Marine Science and the Max Planck Institute of Meteorology in Germany and another by the University of Wisconsin, show a slowing, and reversal of warming, for the next 10 to 20 years. The Arctic sea ice has grown more on a percentage basis this winter than it has since 1979. The number of polar bears has risen 25 percent in the past decade. There are 15,000 of them in the Arctic now, where 10 years ago there were 12,000. "The recent global warming cycle that began in 1977 is over, and the Earth has entered a new phase of global cooling," says Don Easterbrook, professor of geology at Western Washington University in Bellingham. He maintains the 19 -22 year cyclic switch in Pacific Ocean currents "assures about three decades of global cooling. New solar data showing unusual absence of sun spots and changes in the sun's magnetic field suggest ... the present episode of global cooling may be more severe than the 22 year cooling period of 1945 to 1977." Climatologist Joe D'Aleo of the International Climate and Environmental Change Assessment Project, says new data "show that in five of the last seven decades since World War II, including this one, global temperatures have cooled while carbon dioxide has continued to rise." "These data suggest cooling not warming in Earth's future." The eco-socialist paradigm that insists on "global warming" as a uni-directional man-made imminent catastrophe which can only be reversed through co-opting Earth's resources and restricting the economies of Western industrialized nations through controls on individuals and natural resources is flawed. Dr. Carmona's ascribing the need for overall long term changes in social, economic, and Public Health policy as a necessity based on this flawed "warming" paradigm puts him at odds with Bush administration beliefs. The Administration's view discounts the impact of a "warming" climate on social migration, hurricane incidence, or coastal flooding, as mere situational incidents in a larger concept of climate variability, which may need short term solutions to a variety of specific events such as last Summer's spate of heat related deaths, Hurricane Katrina, or the Outer Banks beach erosion and its impact on Eastern seaboard fishing yields, but do not require suborning our economy to draconian implementation of restrictions on industrial or auto emissions, farming methods and crop rotations, rebuilding coastal infra-structure, or giving up National rights to utilization of natural resources like coal and nuclear power. Regardless of where one's beliefs fall on the issue of global warming, Dr. Carmona instead of social engineering, should have been addressing the very real United States Public Health consequences of climatological variation. These concerns more appropriately encompass dealing with regional patterns of emerging infectious diseases, coastal inundation, food contamination, and availability of potable water. Illustrating these concerns, in recent years the US has seen increases in reproductive habitat for mosquitoes, resurgences of Malaria, Dengue, and Yellow Fever, the spread of arthropod borne encephalopathies like West Nile and SLE, northward migrations of Africanized bee strains and fire ants, increased ranges of arthropod borne illness such as Lyme's disease, RMSF, and Ehrlichosis, increased ranges of brown recluse spider and pit viper habitat, survivability of escaped tropical species, venom variation and cross breeding in poisonous snake species like that between the Southern Pacific and Mohave Green Rattlesnakes, or increased occurance of food borne epidemics such as Salmonella, Cholera, and E. Coli. The list goes on. These issues have directly impacted and changed regional Public Health concerns and the allocation of limited resources such as anti-venom, screening for food borne illness, or the commonality of Lyme's disease testing outside of traditional ranges. It is this regional approach to the more limited immediate and numerous Public Health oriented problems associated with climate variation that the Bush administration has preferred to address, rather than Dr. Carmona's insistence on addressing the more controversial and unproved issue of "global warming".

Obesity :

It is true that Obesity is a co-morbid factor in many illnesses such as Diabetes, Hypertension, Atherosclerosis, Coronary Artery Disease, or Cancer that consume much of our health care resources. However, despite Dr. Carmona's hinting at civil intervention, most legislatures feel the absolute weight of Americans should not be criminalized or stigmatized, and that the food police should not be a realistic answer to the US Obesity crisis where 63% of Americans are greater than 30 BMI and 33% are greater than 33 BMI. Suing McDonald's and other fast food franchises was not the Bush administration's answer to the free choice which enabled the partakers of these fast food franchises to overindulge in calories to their own health detriment. The purveyors of fast food are not forcing people to eat too much, rather they are simply providing a commodity that people choose to consume. Educating the public in healthy choices, and regulating the content of foods is much more in line with traditional public health policy, than is trying to capitalize by criminalizing the providers of a free market commodity.

Dr. Carmona's testimony :

These topical highlights illustrate the discrepancies between Public Health policy positions Dr. Carmona has assumed, and those exact same policy views with an added layer of competing concerns, as seen by his bosses in the Bush administration. Dr. Carmona's claims of "suppression of vital health information" ultimately can be seen as his own personal disagreement with the Bush administration's priorities on Public Health policy regarding Science and Medicine. In the final analysis perhaps the only "vital" thing 'suppressed' was Dr. Carmona.

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