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Surgeon General Nominee to Face Questions

MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris.

Tomorrow, a Senate committee will consider the nomination of James Holsinger Jr. to become the nation's 18th surgeon general. Today, however, the Capitol was buzzing over charges leveled yesterday by the most recent occupant of the post, Richard Carmona. Carmona and two other former surgeons general told the House committee that the Bush administration has politicized the position.

But as NPR's Julie Rovner reports, it's unclear how politically independent any surgeon general is supposed to be.

JULIE ROVNER: At today's White House briefing, presidential spokesman Tony Snow seems surprised by all the attention paid to Carmona's charges that he'd been told what to say and what not to.

Mr. TONY SNOW (White House Press Secretary): There is certainly nothing scandalous about saying to somebody who was a presidential appointee, you should advocate the president's policies.

ROVNER: Carmona did cite several specific complaints including attempts to water down a report on the dangers of second-hand smoke. And he said he was warned against talking about stem cell research, sex education and other sensitive topics. But the former surgeon general also told the House Oversight and Government Reform Committee that there was something bigger at stake - the credibility of the job itself.

Dr. CARMONA: When you go to a doctor, do you pick your doctor based on what political party they belong to? No. And that's what's happening here. I mean, you don't want Republican or Democratic scientific information, you want real scientific information, and that's our job to bring it forward.

ROVNER: Former Surgeon General C. Everett Koop, who served under Presidents Ronald Reagan and the first President Bush, cited a long a list of things that might never have happened if he'd been subject to the same kinds of political interference as Carmona.

Dr. C. EVERETT KOOP (Former Surgeon General): Eight reports to Congress on smoking and health might not have been published. The knowledge of the addiction of tobacco because of its nicotine content might have been suppressed. We might have still had smoking on airplanes.

ROVNER: And David Satcher, who served under President Bill Clinton, said that public disagreement between a surgeon general and his administration are to be expected.

Dr. DAVID SATCHER (Former Surgeon General): I think it's okay for the White House or the Congress to disagree with the surgeon general on issues because American people look to the surgeon general for the best available science. I don't think it's okay for the White House or the Congress to dictate the messages of the surgeon general.

ROVNER: But while most people think that the surgeon general is a fairly powerful person in the federal health care bureaucracy, that power doesn't come automatically with the job. Fitzhugh Mullen is a professor of public health at George Washington University.

Dr. FITZHUGH MULLEN (Public Health, George Washington University): The surgeon general enjoys no specified budget, the surgeon general has no specified staff, and the surgeon general has no specified arm's length relationship to the White House or the administration.

ROVNER: In fact, the surgeon general was once very powerful. From 1871 until mid 1960s, he headed the entire Public Health Service. But by the mid 1960s, with the creation of Medicare and Medicaid and the addition of a raft of new public health programs as part of Lyndon Johnson's war on poverty, the White House didn't really want a career doctor in charge of so much. Mullen says…

Dr. MULLEN: And the result was the decision to appoint an assistant secretary of more traditional form of political management of major federal programs.

ROVNER: That left the surgeon general with less and less to do, says John Parascandola, recently retired historian for the U.S. Public Health Service. Over time, the role of the job simply changed.

Dr. JOHN PARASCANDOLA (Retired Historian, U.S. Public Health Service): What happened then is that after the '60s, the role of the surgeon general became more informational putting out surgeon general's reports, speaking, you know, out to the public.

ROVNER: And that's why they have to remain above partisan politics, Carmona, Koop and Satcher said. Mullen agrees. The office has power because the public mostly trusts what surgeons general say about smoking or obesity or mental health.

Dr. CARMONA: But that - they have to be confident that the positions and the views of the surgeon general are going to be allowed to be expressed that are going to be science based and independent not politically driven.

ROVNER: The former surgeons general want Congress to write more independence for the office into law so Carmona's successors won't be subjected to the same treatment he got.

Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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