Wednesday, 24 October 2018

Former Surgeons General Recount

Former Surgeons

Former Surgeons General Recount Political Pressure on the work

It made an arresting tableau: four former surgeons general, aged 68 to 85, beat their blue admirals’ uniforms, together on stage like four grizzled war veterans rehashing their biggest battles, and the way they were treated afterward by the President and Congress.

But this was no re-enactment of Bull Run or Shiloh. it had been an after-action report on America’s medical wars and it happened this month on the stage of the NY Academy of drugs.

“In this current climate of incivility, I feel it’s important that medical students see models of integrity, compassion, camaraderie, and wit,” said Dr. Judith A.

Salerno, the academy’s president, who invited Dr. Antonia C. Novello, Dr. M. Joycelyn Elders, Dr. David Satcher and Dr. Richard Carmona to talk.

The underlying theme was how badly the country needs independent public health leadership and the way often partisan politics obstruct that.

There were quite a couple of “I told you so” moments.

Since the late 1990s, retired surgeons general became the off-the-cuff club, appearing together every few years when someone asks them to talk out.

They need to be discussed transplant medicine at a surgeons’ conference, cancer treatment at Lance Armstrong’s Livestrong Foundation, maternal care during Women’s Health Month, and so on.

The four at this meeting were in office from 1990 to 2006 during the administrations of George H.W. Bush, Clinton, and George W. Bush.

That was an era when — not unlike today — scientists felt they were under fire by the White House, Congressional conservatives and armies of industry lobbyists.

Then, however, the fights were even more blatantly over medical issues instead of global warming.

The four described battles over AIDS, smoking, teenage pregnancy and medicines.

They lost most of them — but time usually proved them right.

For example, in 1998, Dr. Satcher backed giving clean needles to drug users to prevent H.I.V. and hepatitis.

Conservatives accused him of encouraging drug use, and therefore the Clinton White House publicly repudiated him.

Now that the opioid epidemic has caused H.I.V. outbreaks even in rural America, clean-needle programs are common.

“If we had skilled the crack cocaine epidemic as we should always have, we wouldn’t have had the opioid epidemic,” Dr. Satcher said.

In 1992, Dr. Novello said, the primary Bush White House ordered her to prevent condemning Joe
Camel cartoons for marketing cigarettes to children.

Five years later, under increasing pressure, R.J. Reynolds Tobacco retired the character.

In 1994, from behind a desk bouquet of faux roses made from condom wrappers, Dr. Elders, the primary black Surgeon General, called teen pregnancy “a sort of slavery” for young black women and vigorously backed sex education, contraception, and wider use of the RU-486 RU 486.

She also suggested legalizing drugs as how to chop crime and jail crowding. In response, she was pilloried.

Conservatives accused her of promoting premarital sex and white plague, black leftists accused her of promoting black genocide.

Mr. Clinton first rebuked her then later dismissed her over an offhand answer she gave at an AIDS conference.

Asked if she thought teaching children about masturbation could reduce unsafe sex, she answered
that it had been a part of human sexuality and “perhaps should be taught.”

(She later explained that she meant children should be told it had been normal, not tend how-to instructions.)

“I haven't any regrets,” Dr. Elders said at the academy. “If I had to try to to it everywhere again, I’d roll in the hay the same way. I assumed I did it right the primary time.”

After she was forced out, Mr. Clinton admitted to an extramarital affair. Since those days, thanks largely to measures she backed, birthrates have plummeted among both black and white teenage girls.

Marijuana is now legal in many nations. And masturbation is more often a problem for adult men caught by the #MeToo movement.

After he left office, Dr. Carmona testified before Congress that the second Bush White House had prevented him from speaking out on many issues, including the risks of secondhand smoke, embryonic somatic cell research, global climate change, emergency contraception, and abstinence-only sex education.

Their complaints echo similar ones from other federal health officers.

Privately, top officials at the Centers for Disease Control and Prevention in Atlanta have complained for years about demands that they clear public statements and even medical advice through the Department of Health and Human Services, which is taken into account by some to be heavily politicized.

The depth of that interference became public last year when the Washington Post revealed that H.H.S. had forbidden the C.D.C. to use certain words, including “fetus” and “transgender” in its budget requests.

The surgeons general described moments of equal absurdity.

In Dr. Carmona’s case, it involved Sesame Street.

A former policeman and Special Forces medic who grew up in Harlem, he was asked by the producers of the children’s show to form occasional appearances, sitting on a stoop in his uniform, chatting about health.

(One tentative plotline involved him to speak Cookie Monster into trying broccoli.)

But the department, he said, decreed that the role had to travel to H.H.S. Secretary Tommy G. Thompson. Sesame Street dropped the thought.

In 1991, Dr. Novello said, when the basketball star Magic Johnson shocked the planet by revealing that he had H.I.V., she was told that her role within the announcement had to be handed over to the H.H.S. secretary.

All four lamented that the surgeon general’s job has faded in stature. From 1871 to 1968, its holder was the nation’s chief medic and commanded the general public Health Service Corps, a uniformed rapid-reaction force for health crises.

But the office was subsumed under H.H.S. and its budget was cut. Nowadays, the director of the C.D.C., which was created in 1942, is typically the foremost visible health official, especially during epidemics.

The exception was Surgeon General C. Everett Koop, a renowned pediatric surgeon in office from 1982 to 1989. He was chosen by Reagan due to his conservative politics and opposition to abortion, but he became famous for defying White House pressure.

He condemned nicotine as addictive and endorsed warnings on cigarette packs.

At a time when many politicians said AIDS was divine punishment for homosexuality, he sent
every American household a pamphlet explaining how it had been transmitted.

And he refused to issue a report saying that abortions harmed the psychological state of girls who
had them.

In testimony before Congress in 2007, Dr. Koop — who died in 2013 — said efforts to suppress sound medicine seemed to be getting worse.

Even he had not faced the maximum amount of pressure as Dr. Carmona did, he testified. Dr. Carmona recalled that moment.

“Once you set on the uniform, there’s alleged to be no room for politics,” he said.

“But we aren’t stupid — Washington may be a combat zone. And you don’t always know where the
shooting is coming from.”

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