Politics and public health.

Byline: The Register-Guard

A doctor who will tell patients only what they want to hear is of no use to anyone. Yet that's the kind of doctor the Bush administration wanted as surgeon general, the nation's top public health official. Richard Carmona, surgeon general during President Bush's first term, testified in Congress Tuesday about the relentless pressure he endured, and only sometimes resisted, to tailor his medical pronouncements to fit the administration's political agenda.

The potential medical benefits of stem cell research? Keep quiet about the issue, Carmona was ordered.

Emergency contraception? Avoid the topic.

The Special Olympics? Stay away, because the organization for disabled athletes is associated with the Kennedy family.

The hazards of second-hand tobacco smoke? When Carmona prepared a report finding that even brief exposure to second-hand smoke was unhealthful, administration officials asked him to soften its conclusions, and delayed its release by two years.

Surgeons general have found themselves in political conflicts before - C. Everett Koop under President Reagan and Joycelyn Elders under President Clinton come to mind - but Carmona's testimony before the House Oversight and Government Reform Committee is disturbing. This was not a case of an outspoken official who found himself out of step with the administration on a single controversial issue. What Carmona described was a comprehensive expectation that medical science conform to political ideology, often at the expense of public health.

The surgeon general occupies a position whose visibility far exceeds his powers. He's the head of the U.S. Public Health Service Commissioned Corps, one of the seven uniformed services, and holds the rank of vice-admiral. He answers to an undersecretary of the Department of Health and Human Resources. But as the nation's top public health official, the surgeon general's pronouncements carry great weight. On issues ranging from smoking to AIDS, the surgeon general has been a credible and powerful voice for evidence-based public health policies.

Carmona was new to Washington, D.C., when he was first appointed, and wasn't sure that the pressure he felt was anything out of the ordinary. After consulting with six former surgeons general who had served under both Democratic and Republican presidents, he realized that the degree of interference was beyond anything in their experience. But Carmona's testimony is consistent with complaints by other scientific advisers who tell of the Bush administration's demands for ideological conformity or silence in fields ranging from global warming to fisheries.

Carmona's testimony points toward a deeper problem than an administration that views every issue through a political lens, a habit common to partisans of all stripes. The Bush White House goes further, rejecting facts that fail to fit its conceptions. The result is rigidity - an unwillingness to adapt ideas to accommodate fresh information, or adjust policies in light of new findings. This impermeability to facts has been on display in many of the Bush administration's undertakings, notably in Iraq, with tragic results.

The hearings were called to explore the possibility of strengthening the surgeon general's office. Given the prominence of public health issues and the controversy that often surrounds them, a more powerful or independent surgeon general might be a good idea. What's really needed, however, is leaders who are not so blinded by certitude that they refuse to hear what the surgeon general and others are saying.