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Former Surgeon General Reports Political Pressure

July 10, 2007 at 6:30 PM EDT
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JUDY WOODRUFF: Has the role of the United States surgeon general become overly politicized? That was the focus of an Oversight and Government Reform Committee hearing in the House of Representatives today. Dr. Richard Carmona, surgeon general in the Bush administration until last year, testified that he dealt with political interference during his tenure.

And Dr. Carmona joins me now. Dr. Carmona, good to see you.

DR. RICHARD CARMONA, Former U.S. Surgeon General: Thanks, nice to see you again.

JUDY WOODRUFF: The job of the U.S. surgeon general is, broadly speaking, to be the chief public health educator for the United States. What does that really mean?

DR. RICHARD CARMONA: Well, it’s one of the job descriptions, but really the surgeon general’s job is to protect, promote and advance the health, safety and security of the nation.

JUDY WOODRUFF: As simple as that?

DR. RICHARD CARMONA: Simple as that, but very difficult to execute in a very partisan environment.

JUDY WOODRUFF: At this hearing today, it was not only you, but it was your Democratic and your predecessors of both Democratic and Republican administrations who spoke of conflicts with the administration. But you said your experience was worse under this administration. What did you mean?

DR. RICHARD CARMONA: Well, let me put it in context. It really wasn’t me. It was my predecessors who, after I was in office a few months, went to them for counsel, for mentoring, and mentioned to them the struggle I was having. And they recounted to me all the struggles that they had and said that is the way the surgeon general position has been for some time, but what we see is that you have it worse than any of us. And this is coming from several surgeon generals who preceded me.

JUDY WOODRUFF: And what were they basing that on? What was happening to you?

DR. RICHARD CARMONA: Their observations that the surgeon general was not allowed to speak out on health issues when needed, based on the best science, to deliver the best science, that often policy or spokespersons in government would be talking about given issues without appropriate scientific due diligence. And they were very concerned about that and had called me a number of times when I was in office.

Speaking out about stem cells

Dr. Richard Carmona
Former Surgeon General
I basically spoke, not of the politics of stem cells, but of the science, which I felt was information that the American public needed to know to be better informed to make good decisions.

JUDY WOODRUFF: Now, for example, when the subject of stem cell research came up, you did, you talked about trying to speak out about the science. What happened?

DR. RICHARD CARMONA: I did speak out about it, and I basically spoke, not of the politics of stem cells, but of the science, which I felt was information that the American public needed to know to be better informed to make good decisions and to hold their elected officials accountable for the policy that they brought forward. I was discouraged at times. People told me the policy was already made. I didn't need to speak about that, and it was contrary to what the administration wanted.

JUDY WOODRUFF: Who discouraged it?

DR. RICHARD CARMONA: People within the administration who were in my chain of command, who, you know, thought that it wasn't necessary for me to speak on that since there already was a policy.

JUDY WOODRUFF: I mean, what are some of the offices we're talking about?

DR. RICHARD CARMONA: These are political appointees.

JUDY WOODRUFF: Political appointees.

DR. RICHARD CARMONA: Yes, they're all political appointees in my chain of command.

JUDY WOODRUFF: How high up did it go?

DR. RICHARD CARMONA: It goes up right through the department to the White House.

JUDY WOODRUFF: So people in the White House were actually leaning on you not to say what you felt you needed to say?

DR. RICHARD CARMONA: I think it would be best described -- I think Surgeon General Koop described it this morning in his testimony, where he spoke about the "them" and the "they." Nobody steps out from the shadows and actually forces you, but there's a lot of forcing, there's a lot of coercion, there's a lot of moving a budget, not letting you speak, preventing you from traveling that doesn't allow you to get the scope of your message out on some issues.

JUDY WOODRUFF: And what was it about the stem cell message that didn't get out as a result of this?

DR. RICHARD CARMONA: Well, the science. The American public is still in a quandary as to, what's this whole thing about? The average person doesn't understand what a stem cell is. There's a lack of health literacy in our nation. So the public can't really get into this dialogue because they don't understand the complexity of stem cells, not the faith-based approach, not the ideological or political, but the science behind stem cells.

Opinions on sex education

Dr. Richard Carmona
Former Surgeon General
That policy flew in the face of prudent science, public health science, which said that we need a more comprehensive program in relation to sexual education and not just abstinence alone.

JUDY WOODRUFF: Another issue you talked about speaking out, sex education. Abstinence-only has been the preferred approach by many in the Bush administration when it comes to preventing teen pregnancy, preventing the spread of so-called sexually transmitted diseases, STDs. I think you said today, when you tried to talk about this, they didn't -- they, the administration -- didn't want to hear the science. What happened there?

DR. RICHARD CARMONA: Well, they didn't. I was discouraged. Again, the administration had already made a decision that abstinence was the way they wanted to go. And that really -- that policy flew in the face of prudent science, public health science, which said that we need a more comprehensive program in relation to sexual education and not just abstinence alone.

But I'll point out that it wasn't only me. My predecessor, David Satcher, wrote the first report on sexual health, and he ran into problems also in the liberal administration.

JUDY WOODRUFF: This was in the Clinton administration.

DR. RICHARD CARMONA: Yes, Joycelyn Elders was fired because she spoke out forcefully on sexual education. So these are things that should not happen to a surgeon general.

JUDY WOODRUFF: And was it worse under this administration or not?

DR. RICHARD CARMONA: Well, again, my reference point is solely this administration. It is my colleagues who came to me, several surgeon generals, Loop, Satcher, Novello, Julius Richmond, going back to the '70s, who all said, "We had to fight battles, but nobody has had it as bad in this partisan environment as Surgeon General Carmona."

JUDY WOODRUFF: Let me read to you, Dr. Carmona, what a White House spokesman said today commenting on your testimony. He said, "It's disappointing to us if he failed to use his position to the fullest extent in advocating for policies he thought were in the best interests of the nation."

DR. RICHARD CARMONA: Well, I did the best I could with the resources I had, which, as you may know, the surgeon general has no budget, has few staff. I'm sorry that they chose to make this comment, because, really, my surgeon general colleagues and I saw this as an opportunity to fix a broken system, not to place blame.

You'll notice that the surgeon generals who spoke with me came from different administrations. They all suffered the same problems. And what we wanted to do is come together with one voice and let the American public know that they should be outraged that their surgeons general of the United States have been marginalized and have been relegated to positions of relatively little importance, by political ideology, theology, and the appropriate discourse not coming out in society.

What Americans are missing

Dr. Richard Carmona
Former Surgeon General
But the overarching issue, really, is our surgeon general should be able to communicate transparently and honestly with the American public on all issues.

JUDY WOODRUFF: Sum it up for us again. What is it that the American people didn't get or didn't know because of this political interference?

DR. RICHARD CARMONA: Well, you have to look at the specific issues over time, whether it was Surgeon General Satcher, Surgeon General Koop, or myself.

JUDY WOODRUFF: Well, I'm asking in your circumstances.

DR. RICHARD CARMONA: Well, reports did not get out in a timely fashion. My secondhand smoking report took a lot longer because of political vetting. Global health reports that I wanted to get out because of the importance of emerging infections and global problems were stymied because people wanted it to be a political document and not a scientific document.

And there's many, many other examples. But the overarching issue, really, is our surgeon general should be able to communicate transparently and honestly with the American public on all issues.

JUDY WOODRUFF: And while you were in office, did you protest?

DR. RICHARD CARMONA: Oh, yes.

JUDY WOODRUFF: How high?

DR. RICHARD CARMONA: Well, I would go within my chain of command, and I tried, and I tried to work through various groups within the government to move these issues forward. And it depended on what the given issue was, but pretty much, on a lot of these very hot-button issues, because they were hot-button issues and a policy had already been established, they really didn't want to deal with scientific information.

Staying in the system

Dr. Richard Carmona
Former Surgeon General
We recognized that our responsibility as surgeon general was not to a political party; it was to the American public to be the doctor of the nation.

JUDY WOODRUFF: And yet you chose to stay the entire four-year term. Why? Some would say, if you were running into this kind of an adverse reaction, why did you stay?

DR. RICHARD CARMONA: Well, my -- let me put it this way, Judy. My experience wasn't a lot different than Surgeon General Koop and Surgeon General Satcher and the other surgeon generals who spoke today. The fact is, they all had their challenges.

And every one of us commiserating with one another said, "There were days that I wanted to quit. There were days I wanted to go home." But we recognized that our responsibility as surgeon general was not to a political party; it was to the American public to be the doctor of the nation.

And so we fought for that position, because the dignity and integrity of that office of the surgeon general is what we represented. And it has never been tarnished. It is one of the most shining examples of a great America globally when we travel, that people say, "Wow, surgeon general. Our country should have something like that."

So we recognize the importance, the preeminence of what we had. And we all decided to stay in spite of the challenges, because we felt we could move the agenda forward incrementally. And, you know, look at what happened with Surgeon General Koop and Surgeon General Satcher, even risking their own security and safety and their jobs, by Koop coming out on AIDS, for instance.

JUDY WOODRUFF: Dr. Richard Carmona, we're going to leave it there. We thank you very much for being with us.

DR. RICHARD CARMONA: Thank you so much. It was a pleasure to be with you again.