Monday, July 16, 2007


The Washington political game has two modes: claiming undeserved credit and shifting blame for your own shortcomings to others. The latest egregious example of the latter occurred July 10, when former U.S. Surgeon General Richard H. Carmona testified before the House Oversight and Government Reform Committee chaired by Rep. Henry A. Waxman, California Democrat. The subject was how to strengthen the office of the surgeon general.

The office of the surgeon general is problematic, in that it lacks virtually any budget or staff or programs of its own. Whatever the incumbent achieves is the result of moral suasion — and in the case of some incumbents, courage. Dr. C. Everett Koop, surgeon general in the Reagan administration, and Dr. David Satcher, surgeon general during the Clinton administration, also testified at the Waxman hearing. Both complained about political pressure and interference during their respective tenures.

Dr. Satcher said the Clinton administration tried to interfere with his issuing a report demonstrating that needle-exchange programs were effective in reducing disease. He released the report anyway. Dr. Koop, perhaps the best-known surgeon general in modern times, said he had been discouraged by senior officials in the Reagan administration from discussing the accelerating AIDS crisis. He ignored the pressure and became known as a champion of AIDS funding and research.

In contrast to these profiles in courage, Dr. Carmona, who was surgeon general from 2002 to 2006, went along to get along. He testified before the Waxman committee that he had been muzzled and subjected to “partisanship and political manipulation” by Bush administration “political appointees” in his “chain of command,” whom he refused to name. (He, too, was a political appointee, by the way.)

Dr. Carmona was virtually invisible during his entire tenure. Toward the end of his four-year stint as surgeon general, in an informal poll I conducted, only five of 60 experts in public health and public policy could identify the current surgeon general, even when offered a multiple-choice format. Many thought the post had been abolished. When I mentioned to former Surgeon General Koop that I was conducting an informal poll of how many physicians and public health experts could identify the current surgeon general, he quipped, “Have you found one?”

Dr. Carmona often got the science wrong. In 2003, he testified before the House Energy and Commerce Committee, “No matter what you may hear today or read in press reports later, I cannot conclude that the use of any tobacco product is a safer alternative to smoking.” That statement is manifestly untrue. It had been known for almost a decade that switching from smoking to smokeless tobacco is a lifesaver: All forms of tobacco are not equally risky; smokeless tobacco causes neither lung cancer nor other pulmonary diseases; nor do its users experience an enhanced risk of heart attacks. Oral cancers are the only important adverse health effect of smokeless tobacco, and they are relatively infrequent (about half as great as in smokers).

Several years ago, Dr. Carmona spoke to an audience of scholars here at Stanford University’s Hoover Institution. Thirty-five of his 40 minutes were devoted to self-serving autobiography; the remaining five minutes offered no specifics but merely a promise to “implement the public health policies of the president.” That’s not what policy wonks came to hear.

Dr. Carmona said on PBS’ “The News Hour” that the U.S. surgeon general is regarded as “a shining example of a great America.” Certainly not on his watch. Even with capable incumbents — a rare occurrence in recent decades — the position is arguably an anachronism, like the human appendix. And as Dr. Carmona demonstrated unwittingly, like the appendix, we can do fine without it.

Perhaps the most revealing insight into Dr. Carmona’s tell-all testimony is that after enduring the alleged muzzling, political interference and manipulation for four years, he asked to continue in the job. He was turned down.

Physician, heal thyself.

Henry Miller, a physician, is a fellow at the Hoover Institution. He was an official at the National Institutes of Health and the Food and Drug Administration from 1977 to 1994.

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