2 distinct diagnoses on world health

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2 distinct diagnoses on world health

Differences between a surgeon general's report and one by a political

aide fuel criticism that White House is politicizing science.

By Alonso-Zaldivar, LA Times Staff Writer July 31, 2007

WASHINGTON — As then-Surgeon General H. Carmona was preparing

a report on world health problems, he received a detailed outline from

officials at the Department of Health and Human Services. It suggested

that he praise President Bush's initiative against AIDS in poor

countries, and highlight American efforts to rebuild public health

infrastructure in Iraq and Afghanistan. Instead, his report decried

global pollution and violence against women.

Carmona's 2006 draft described condoms as an effective way to prevent

AIDS, omitted U.S. efforts on public health in Iraq and Afghanistan

and made only passing references to Bush. The report was subsequently

pigeon-holed and never released by the health department.

The difference between the drafts, released Monday in Congress, added

fuel to the controversy over whether the Bush administration has

politicized science and medicine — putting political and ideological

messages ahead of scientific information.

Carmona recently testified before Congress that his report was killed

because it did not conform to administration doctrine, a charge the

administration disputes.

Health and Human Services spokesman Bill Hall said it was not released

because a scientific review raised " strong concerns [from] multiple

agencies " within the department, not because of politics.

But Rep. Henry A. Waxman (D-Los Angeles), who Monday released both the

departmental outline and Carmona's report, charged that the incident

reflected the determination of Bush administration officials to

politicize government agencies that were supposed to be insulated from

partisan influence.

" Dr. Carmona's draft thoughtfully covers a wide range of global health

topics, " Waxman said in a letter to HHS demanding more information on

the dispute. The department's draft, he said, " ignores or glosses over

serious global health problems and emphasizes the achievements and

policies of the Bush administration. "

Carmona declined to comment on the controversy Monday, but said he

would be ready to return to Congress and testify in greater detail, if

asked. Other former surgeons general who testified alongside Carmona

this month said political pressure had been a problem under Republican

and Democratic administrations. They urged that Congress act to make

the office of the surgeon general more independent.

The memo to Carmona was drafted by officials in an HHS office that

deals with global health, headed by R. Steiger, a political

appointee first identified by the Washington Post as responsible for

having bottled up the surgeon general's report.

In an earlier statement, Steiger called Carmona's draft " a poorly

written, general recitation of every disease problem in the world, "

adding that " the information it provided was often inaccurate or

out-of-date, and it lacked analysis and focus. "

Hall added Monday: " It was not just Bill Steiger and the office of

global health — a number of other agencies … had strong concerns. " The

National Institutes of Health and the Food and Drug Administration

were among the agencies that objected to the release of the report as

presented by Carmona, he said.

Waxman said it was the information in the memo from Steiger's office

that was inaccurate.

For example, while omitting any mention that condom use can prevent

AIDS infection, the HHS draft called attention to antimicrobial

ointments " near final development " that women could use to protect

themselves.

Waxman called that misleading. " No microbicide has been approved for

reducing HIV infection, and an international microbicide development

organization predicts five to seven years until a product is

available, " Waxman said in his letter to HHS.

The two documents are posted on the Internet at oversight.house.gov.

Broadly speaking, Carmona's draft blames social problems such as

poverty and man-made conditions such as pollution for much of the

burden of disease in the world.

The HHS memo tends to focus on pathogens, such as the H5N1 bird flu virus.

Even on the ill effects of tobacco, a standard theme of public health

reports, there are striking differences. Carmona's report mentioned

tobacco 16 times, calling it the second major cause of death

worldwide, and describing tobacco use as an " epidemic. " The HHS memo

only mentions it twice, acknowledging that reduced tobacco use

promotes better health but hardly calling for a crusade.

Carmona said he wanted to issue a report on worldwide health, because

in an era of globalization, health problems are no longer localized.

" The hunger, disease and death resulting from poor food and nutrition

create social and political instability in many nations, and that

instability may spread to other nations as people migrate to survive, "

his draft report said. " Failing to address global health issues

outside of our national border will only make problems much more

challenging when they enter our country. "

Besides, he wrote, the U. S. could win friends and allies overseas by

helping other countries confront their health problems.

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