October 29, 2018

When politics squashed science: Former surgeons general share their 'I told you so' moments

Daily Briefing

    The U.S. Surgeon General is supposed to be one of the federal government's primary authorities on medical science, but former surgeons general recently described being silenced or reprimanded when their evidence-based views conflicted with an administration's politics, Donald McNeil Jr. reports for the New York Times.

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    Earlier this month, four former surgeons general who served from 1990 to 2006 sat down at the New York Academy of Medicine to discuss the political opposition they faced when discussing issues such as HIV/AIDS, drug misuse, teenage pregnancy, and smoking.

    The former surgeons general were:

    • Richard Carmona, who served during former President George W. Bush's administration;
    • David Satcher, who served during former President Bill Clinton's administration;
    • Joycelyn Elders, the United States' first black surgeon general, who also served under Clinton,
    • Antonia Novello, who served during former President George H.W. Bush's administration.

    Surgeons general reflect on 'I told you so' moments

    Each of the former surgeons general had at least one "I told you so" moment—a time when they pushed science-based policies and faced condemnation by their administrations, even though time eventually proved their views right, McNeil reports.

    For example, Satcher recalled being admonished by conservatives and the Clinton administration in 1998 for supporting the distribution of clean needles to intravenous drug users to stop the spread of HIV and hepatitis. The administration said his stance encouraged drug misuse, but today, clean-needle programs are popular across the country, with some states considering establishing safe injection sites.

    But Satcher said the political pushback had consequences. "If we had responded to the crack cocaine epidemic as we should have, we wouldn't have had the opioid epidemic," Satcher said.

    Novello said he was condemned by the Bush administration in 1992 for speaking out against Camel's cigarette marketing practices. Novello argued that the company's Joe Camel character appealed to children. The character was ultimately shelved in 1997 in the face of a growing outcry.

    Elders may have received the harshest punishment out of the four, McNeil reports. Elders was an outspoken advocate of birth control, sex education, and expanded use of the RU-486 abortion pill. In the 1990s, Elders called teenage pregnancy a "form of slavery" for black women and argued that drug legalization could reduce crime and overcrowding in the prison system, McNeil reports.

    The White House criticized, and eventually dismissed, Elders for her remarks—particularly a suggestion that schools should teach that masturbation is a normal human sexual activity—and conservatives said her stances encouraged drug misuse and premarital sex. But according to McNeil, some of the strategies Elders backed eventually helped lower teenage pregnancy rates and led to marijuana decriminalization in numerous states.

    Elders told the audience, "I have no regrets. If I had to do it all over again, I'd do it the same way. I thought I did it right the first time."

    Political pressure is getting 'worse' for surgeons general

    During the discussion, the surgeons generals said political pressure they endured signaled a stark break from how the role was originally envisioned.

    Between 1871 and 1968, the surgeon general acted as chief medical officer of the United States and led the Public Health Service Corps, McNeil reports. But today, McNeil writes, the director of CDC is the "most visible health official," and the surgeon general operates through HHS on a much smaller budget.

    Carmona said he noticed the downsizing of his role when he was asked to make an appearance on Sesame Street to talk about health, including the benefits of eating broccoli. But HHS objected, saying that then-Secretary Tommy Thompson would be the only official allowed to make an appearance on the show.

    "Once you put on the uniform, there's supposed to be no room for politics," Carmona said. "But we aren't stupid—Washington is a combat zone. And you don't always know where the shooting is coming from" (McNeil, New York Times, 10/24).

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