On Thursday, President Bush's nominee for surgeon general, Dr. James Holsinger, faced blunt questioning at his Senate confirmation hearing about how he would react if he were pressured to put politics before science. "I would resign," Holsinger said.
If history is any indication, he's likely to be tested on that promise. Earlier in the week, three former surgeons general—including Dr. Richard Carmona, the most recent occupant of that august office—testified before Congress that he felt intense political pressure. Carmona, who left office in July, said that the Bush administration had delayed his reports and changed his speeches on controversial issues such as smoking and stem cells. "Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried," he testified. That came as no surprise to Joycelyn Elders, who served as surgeon general from 1993 to 1994 under President Bill Clinton; she was asked to step down after her comments about masturbation—she called it “a part of human sexuality, and is part of something that perhaps should be taught”—stirred up a political controversy of their own. She spoke with NEWSWEEK's Mary Carmichael about the new revelations. Excerpts:
NEWSWEEK: What was your reaction to the testimony of the three former surgeons general?
Joycelyn Elders: What they were saying was true. I think each surgeon general has a different set of problems. But when they're suppressed—when they can't put the science out there for people to make good decisions about—then our ideas and our morality and ideologies and mythologies get in the way of good science. When I was the surgeon general, I did not feel that we should let politics invade science and marginalize it. And I think we’ve been seeing some of that. Of course, it didn’t start with [George W.] Bush. Look at Dr. [C. Everett] Koop, who stood up for AIDS when heaven knows the president [Ronald Reagan] didn’t want to even mention the word. And [the surgeon general under George H.W. Bush, Dr. Antonia Novello] was more muzzled than anybody ... When tobacco smoking was an issue, she only spoke about it after the state attorneys general were already suing the tobacco companies. But I do think the suppression has been going on more and more lately. And we just can't let that happen.
What does it mean for the office of the surgeon general when political pressure is brought to bear?
It destroys the office. And I think it's a very important office; it has a very important role. We're setting a dangerous precedent. We need to find a way to make that office more independent. We've got to be able to build a support system around the surgeon general such that he is not being constantly bombarded and afraid of losing his job because he's taken a position that's different from the president's. If all he's going to do is be the president's mouthpiece, what does the country need with a surgeon general?
Surgeons general are political appointees, however.
They're nominated by the president and confirmed by the Senate, but it's a statutory appointment. What that means is that you do not serve at the wishes of the president. You're not a Democratic surgeon general, you're not a Republican surgeon general. You are the surgeon general for all of the people. I think the president always hopes that his surgeon general will have similar ideas to his. And that may or may not be the case. But when it comes down to it, the surgeon general must stick to the science.
Do you see echoes of what happened to you, when you were asked to step down, in what's happening now?
When I was removed from office, I felt that was a very political thing. But I'm not sure it was President Clinton’s idea. I felt that some of the political people who influenced the president probably had more influence than I had, and they influenced that decision. The difference with my situation was, Clinton knew when he asked me to be surgeon general that I was going to speak my mind. When he was governor of Arkansas, I was his health director, and I said, "Mr. President, you know what you're getting." And he said, "I understand, I know, but I want you to do it." Of course, by the time I started, everybody else had already decided that I wasn't going to be there very long.
Were you ever pressured in some of the ways Dr. Carmona talks about—told you couldn't release a report, for instance?
There were two or three things that happened when I was office. We had a report on needle exchange proving that clean needles did not increase drug use and did decrease the transmission of HIV. The report was done, finished, I had it and I was going to sign the papers to release it. And then I went on the road, and my secretary told me they came to my office—I don’t know who it was that came—and picked up the report. And then I was told that we weren't going to release the report because the timing wasn't right. It took two and a half more years before [the next surgeon general, Dr. David Satcher] was able to release the report. That was the only thing I really regretted, that I did not hunt it down and sign it anyway. The other thing, of course, was my speech at the U.N. about AIDS, where I was asked about masturbation. I said masturbation was a normal part of human sexuality, that it doesn't cause hair to grow on people's hands or make them go blind. I didn't think a thing in the world about it. It never occurred to me that Bill Clinton would ask me to resign over it. But there was, I think, a news reporter interviewing me on the plane that night, and he said he thought I was going to be a problem for the Democrats, in that any time I was asked a question I answered it openly.
Were you asked to sprinkle your speeches with references to the president's policies, the way Dr. Carmona says he was?
Well, nobody ever had to ask me to say anything about Bill Clinton, because everybody knew how I felt about him. But as for vetting the speeches, I didn't care if they tried. I never read the speech that was written on the paper anyway. The only time I was asked not to do something was when I was supposed to go to Kentucky to give a talk at the Planned Parenthood annual awards dinner. It was about a week or two before the election. The senator from Kentucky was up for re-election, and he called and asked the president to get me not to go. So an assistant secretary of Health [and Human Services] asked me not to. I was going to go anyway. But eventually they said they could send somebody else instead.
And did they?
Was there anything that was off-limits, anything you were ever specifically told not to say?
I don't think even Bill Clinton felt that he could tell me something like that. I don't think he thought it would work. If there was something specific he thought was important, that he felt that I supported and believed in, he might discuss that issue with me.
When the surgeon general is muzzled in some way, does that have an effect on medical science?
Well, the surgeon general does not make the science. He or she tries to take the science and interpret it with other people and use that to find what is in the best interest of the American people. With the surgeon general’s reports, the science has been done already. An administration may not want to release a report about the science that's out there, but it can't change what the science says.