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Surgeons general testify to facing political pressure while in office.

Some of the nation's former U.S. surgeons general faced political pressure while in office to change the way they presented health information to the public, regardless of science, past officeholders told members of Congress in July.

During a hearing before the House Committee on Oversight and Government Reform, former Surgeons General C. Everett Koop, MD, ScD; David Satcher, MD, PhD; and Richard Carmona, MD, MPH, FACS, cited instances of administration officials limiting their abilities to accurately communicate scientific knowledge to the public.

Carmona, who served as surgeon general from 2002-2006, said his speeches dealing with scientific data about stem cell research and abstinence-only education programs were altered or cut to fit within the policies of the Bush administration. Additionally, after compiling a U.S. call to action regarding global health, which he said was based on comprehensive information from a range of scientific experts, Carmona said he was blocked from releasing the report and admonished for not "reflecting American policy."

"Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried," Carmona said.

Koop, who was surgeon general from 1981-1989, said he was told not to speak about AIDS, erroneously thought of at that time as a disease only affecting gay men. Satcher, who served from 19982002, discussed political intervention into his report on the benefits of needle exchange programs and a report on responsible sexual behaviors.

Rep. Henry A. Waxman, D-Calif., chair of the committee that held the House hearing, lauded the ability of the surgeon general's office to improve the nation's health, but said that ability has been increasingly challenged by political interference.

"On key public health issues, the surgeon general has been muzzled," Waxman said.

To address concerns, the three surgeons general recommended altering the selection process for the position and ensuring that the Office of the Surgeon General be provided with adequate staffing and funding. Koop recommended that the surgeon general not be a political appointment by the president, but should rather be named by the president via a panel selected by a committee of the U.S. Commissioned Corps.

Two days after the House hearing, Senate legislators raised the issue of scientific independence with the current surgeon general nominee, James W. Holsinger Jr., MD, PhD. Holsinger said that he would keep science and ideology separate and that if politics interfered with his position as surgeon general, he would step down.

"If I were faced with a situation that I felt I could not in good conscience do, I think I have a clear response to that: I would resign," Holsinger told the committee.

In response to the testimony from the past surgeons general, legislators in both chambers of Congress introduced new bills on the issue. On the House side in August, Waxman introduced H.R. 3447, the Surgeon General Independence Act, which would put into law that the surgeon general's office be guided by the best available public health science. In the Senate in July, Sen. Edward Kennedy, D-Mass., introduced the Surgeon General Integrity Restoration Act, S. 1777, which would require surgeon general nominees to be drawn from a list of top physicians prepared by the Institute of Medicine, and would provide the surgeon general with greater budgetary and managerial independence.

Under its policies, APHA supports public health decisions and appointments that are based on the best available science.

For more information on the surgeons general hearing, visit For more on the Office of the Surgeon General, visit
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Title Annotation:The NATION: Health news at the national and federal levels
Author:Bindman, Alyssa
Publication:The Nation's Health
Geographic Code:1USA
Date:Sep 1, 2007
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