One world, 2 distinct diagnoses

Times Staff Writer

As then-Surgeon General Richard 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 William 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

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.