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Bush Appointees Blocked Health Report Release:

Today's Washington Post reports that political appointees in the Bush Administration blocked the publication of a 2006 Surgeon General's report on global health. As the Post reports, in recent Congressional testimony Carmona cited the report's "suppression as an example of the Bush administration's frequent efforts during his tenure to give scientific documents a political twist." This episode is part of a broader narrative that the Bush Administration systematically distorts and politicizes science for ideological reasons. The problem is that the facts of this episode do not support Carmona's charge nor the larger narrative.

The draft report at issue here was not a purely scientific or medical document — not even close. The report, The Surgeon's General Call to Action on Global Health, is as much a policy document as anything else, complete with specific policy recommendations on a range of issues. Among other things, the report calls for ratification of the Framework Convention on Tobacco Control, and the acceptance of certain international health regulations. Whether or not these are sensible health policy prescriptions or not, they reflect normative value judgments, not scientific judgments.

My point here is not to defend the Bush Administration, nor is it to suggest that the report should have been withheld. Rather it is that many cases of "science politicization" are in fact policy disputes. The Post's subhead reads "Global Health Draft In 2006 Rejected for Not Being Political," yet the report itself was an inherently political document. The dispute between Carmona and Bush officials was about the extent to which a policy report should reflect, endorse, or promote Bush Administration policy. It was not an instance of politics or ideology trumping science. If the Administration is to be criticized for blocking the release of The Surgeon's General Call to Action on Global Health, it should be criticized on policy grounds — for opposing particular public health measures and refusing to support others — rather than for allegedly censoring scientific expertise.

UPDATE: Here is a good example of how this story is (wrongly) placed in the traditional narrative of science politicization. Contrary to Mark Hoofnagle's claim, this episode has little to do with "scientific integrity." Nonetheless, he terms it "despicable."

Related Posts (on one page):

  1. Bush Appointees Blocked Health Report Release:
  2. Richard Carmona's Political Science:
  3. Did White House Censor Surgeons General?
agesilaus:
We seem to have entered an era where political appointees, like this Surgeon General, forget that they are politically appointed and are bound to support the political stance of the administration that appointed them. Or if they cannot, they should have refused the appointment in the first place. These people were not appointed to independant satrapies free to carry out their own independant policies.
7.29.2007 6:39pm
Minnesota Reader:
While I agree with agesiaus that, to some extent, political appointees "are bound to support the political stance of the administration that appointed," the support should not (perhaps, even, cannot) be unconditional. Even political appointees have obligations to uphold the duties of their office for the benefit of all citizens. There are certain points where facts dictate a course of action that may not be in accordance with an administration's policy. This is basically another side of the same issue that came up in the U.S. Attorney firings.

I'm not saying that this is the case in this instance. I haven't read the report. However, absolute fealty should not be requirement for political appointment.
7.29.2007 7:15pm
ifoughtthelaw (mail) (www):

My point here is not to defend the Bush Administration.


Boy, has that become a familiar refrain on this blog.

Anyway, the guy quoted in the article who is defending the Bush administration and who is suggesting the report should have been withheld justifies the suppression on purely scientific grounds:


Steiger said that "political considerations" did not delay the report; "sloppy work, poor analysis, and lack of scientific rigor did."


The report was a hybrid scientific/policy document, and the scientifically untrained, political appointee who suppressed it is attacking the science of the report, not the policy. I think JHA might be slicing things too thin in his efforts to not defend the Bush administration.
7.29.2007 7:53pm
Jonathan H. Adler (mail) (www):
Ifoughtthelaw --

I agree that both the Bush Administration and Carmona have unjustifiably sought to justify their positions and actions by appealing to scientific authority. I also believe that both are wrong to do so. I further think it fair to accuse the Bush official of dissembling on this point as the e-mails quoted in the story make clear that the appointee's objections to the report were political, not scientific, in nature.

JHA
7.29.2007 8:08pm
neurodoc:
I fully expect and accept that a Republican president will appoint a very different sort for a position like Secretary of Labor from the sort a Democratic president will. And those on a Republican prez's list of possible Supreme Court appointees will not overlap with a Democratic prez's. Is it unreasonable of me, though, to hope that for positions like Surgeon General (of the USPHS) and director of NIH presidents will place far greater weight on candidates' qualifications and demonstrated competence than on their political pedigrees? Should "Republican" and "Democrat" mean much when speaking of SGs and NIH directors?

(Cristina Beato, to whom Carmona reported, falsified her CV. She should have been swiftly fired, but she was a loyal Bushie, so stayed.)

How many think the current Administation hasn't been less heedful of "inconvenient" science, if not frankly hostile to such, than any of its predecessors? Why not call someone like Steiger what they really are, which is "political commissars"?
7.29.2007 9:39pm
Cecilius:
Well, claims of suppressing or re-writing scientific findings (i.e., acting as "political commissars") have become quite popular, but this leads me to a question. What is one to do, as a good natured, paper-shuffling bureaucrat, when confronted with a scientific report that truly suffers from "sloppy work, poor analysis, and lack of scientific rigor...."? Perhaps a political appointee receives a draft report from a government scientist with an activist streak; one that pushes for drastic policy changes based on little data and lots of dogmatic assumptions? Is there anything to do, aside from publishing the report and giving an "atta boy" to our hypothetical activist scientist, that avoids accusations of being a ruthless, anti-science political commissar? Editing of the report to remove poorly drafted or unsupported conclusions will certainly be characterized as the improper repression of science by a know-nothing partisan on purely political grounds; deep-sixing the draft as hopelessly flawed will have our hypothetical activist scientist crying "censorship!", "cover-up!" and "oppression!" during their exclusive 60 Minutes interview. I only bring this up because I have a lot of trouble independently evaluating these now common claims of supposedly evil Bush Administration stormtroopers destroying the purportedly unquestionable scientific conclusions of our many noble government scientists without actually comparing the original draft to the subsequent revisions. I'm of the mind that scientists do sometimes stretch their conclusions beyond the bounds justified by their research or that they do sometimes improperly cross over into policy or economic analysis, where their scientific training and education is no more useful than a correspondence school degree in gun repair. Of course, I don't doubt that some policy makers confront legitimate scientific conclusions that they wish would simply go away and may actually do things to make them go away. How are we to know which is happening?
7.29.2007 10:27pm
Jim Satterfield (mail) (www):
Cecilius says

What is one to do, as a good natured, paper-shuffling bureaucrat, when confronted with a scientific report that truly suffers from "sloppy work, poor analysis, and lack of scientific rigor...."?

The point is that the good natured bureaucrat has absolutely no basis on which to judge these things. He is a bureaucrat, not a scientist. What expertise does he possess to determine this? None. Is he there to judge on scientific criteria? No. He is there solely to make a determination on political grounds.
7.29.2007 10:39pm
Jim Satterfield (mail) (www):
"My point here is not to defend the Bush Administration,..."

Of course it is. Please be honest enough to stop pretending otherwise.
7.29.2007 10:42pm
Justin (mail):
Shorter Jonathan Adler:

The White House has defended the repression of the report on non-political grounds. Irrespective of their actual motive, I think they would have been on better grounds to have argued their motive was acceptable political grounds. So, if I were defending the White House, I could make an argument that would make this all go away. Thus, this should all go away - not that I'm defending the White House, mind you.
7.29.2007 11:23pm
Jonathan H. Adler (mail) (www):
Justin --

I accept the first two sentences of your synopsis. I am not convinced that this story would, or should, go away if it were properly framed. I doubt it would make the front page of the Washington Post, but it might still be a controversial decision. The big difference is that the public debate would focus on the actual relevant policy questions.

The larger point is that this episode is quite different from the Julie MacDonald-ESA listings episode (see, e.g. here), in which it appears there was political interference with scientific determinations.

JHA
7.29.2007 11:42pm
Dave N (mail):
Neurodoc asked, "Should 'Republican' and 'Democrat' mean much when speaking of SGs and NIH directors?"

I am not sure, but I suspect Howard Dean as Surgeon General would be a different sort than Bill Frist, and both would be different from Ron Paul--all of whom are medical doctors.
7.30.2007 12:28am
Justin (mail):
JHA,

If you were serious about wanting to discuss the actual policy issues, wouldn't the more obvious way to go about doing that be - posting on the actual policy issues?
7.30.2007 1:35am
Cecilius:
Jim Satterfield said:

"The point is that the good natured bureaucrat has absolutely no basis on which to judge these things. He is a bureaucrat, not a scientist. What expertise does he possess to determine this? None. Is he there to judge on scientific criteria? No. He is there solely to make a determination on political grounds."

Well, this is absolutely false. Surely, the good natured bureaucrat, like all other members of the general public, is perfectly capable of determining to some degree whether a scientific conclusion is supported by the scientist's data. Small data sets, conclusions that a consistent result occurred despite underlying data showing that inconsistent results occurred, the reliance on several assumptions of fact without explanation or justification and the existence of contradictory data that receives no treatment or explanation by the scientist are issues that can be easily identified by any 10th grader. The notion that non-scientists should or must accept anything and everything that a scientist says is patently absurd. The scientists have the burden of convincing the policy makers (be they bureaucrats or voters) that their research is accurate and meaningful. Otherwise, taking Mr. Satterfield's beliefs seriously, we need to dump our representative democracy and simply acquiesce to be governed by the scientists (assuming they all agree on what needs to be done).
7.30.2007 10:37am
byomtov (mail):
I further think it fair to accuse the Bush official of dissembling on this point as the e-mails quoted in the story make clear that the appointee's objections to the report were political, not scientific, in nature.

By "dissembling" you mean "lying?"
7.30.2007 11:17am
Elliot123 (mail):
"The point is that the good natured bureaucrat has absolutely no basis on which to judge these things. He is a bureaucrat, not a scientist. What expertise does he possess to determine this? None. Is he there to judge on scientific criteria? No. He is there solely to make a determination on political grounds."

The bureaucrat may not be a scientist, but one does not have to be a scientist to recognize policy recommendations. Policy recommendations are not science, nor should we allow them to masquerade as science.
7.30.2007 11:59am
Andy Freeman (mail):
> The point is that the good natured bureaucrat has absolutely no basis on which to judge these things. He is a bureaucrat, not a scientist.

We let journalists judge science. We let random blog commentors judge science. Heck, we even let lawyers and law professors judge science.

Why are bureaucrats different?
7.30.2007 12:20pm
Thorley Winston (mail) (www):
We seem to have entered an era where political appointees, like this Surgeon General, forget that they are politically appointed and are bound to support the political stance of the administration that appointed them. Or if they cannot, they should have refused the appointment in the first place. These people were not appointed to independant satrapies free to carry out their own independant policies.

Personally I'm in favor of just abolishing the position of Surgeon General (as was suggested after Jocelyn Elders resigned in disgrace) and being done with it. Barring that then yes, I'd agree that the President has the right to appoint people who support or will support his policy preferences and if they find them so disagreeable they cannot carry them out, then they should either quit or decline the offer in the first place.
7.30.2007 1:06pm
courtwatcher:
The point Prof Adler makes, that policy disagreements are different from suppresion of science, is a reasonable one as far as it goes. But ironically, it was the libertarian and "conservative" political consultants, think tanks, and others that first framed these debates as about "science" --"junk science," "sound science" and other buzz-phrases have been used in a calculated fashion to mischaracterize progressive policies as not grounded in science rather than as policy debates. It is not an anomaly that the White House is attacking the "science" in this or other reports, but rather it is a strategy. Given the political reality that admitting their real policy preferences will reveal those preferences to be unpalatable to many mainstream voters, they framed the debate as about science.
Personally, I think progressives would do better to reframe the debate as about policy. But given how the "sound science/junk science" frame was created, and by whom, it is ironic that it turns out that the Bush administration (and allies such as the Competitive Enterprise Institute) have been substantially worse than liberals in simply getting the science wrong, or intentionally mangling it.
7.30.2007 3:28pm
Randy R. (mail):
There is a bit of confusion here between policy and science. A report such as the one in question could be boiled down to two parts.

First, you have the science part, which states the nature of the problem, it's extent, who is hurt or benefits, and so on. it's a kin to saying,
"The Potomac river, in it's natural state, contained no pollutants, but had a lot of sediment. Today, the river contains PCBs, mercury, and other toxic elements. The amounts of these toxic elements exceed EPA standards."

The policy part of the study should state what the gov't should or should not do about the problem, the projected costs, who benefits and who is hurt, and so on. In other words,
"The federal gov't should coordinate with the bordering states of Virginia, DC, and Maryland to take steps to identify the sources of the pollution and bring it all down to meet or exceed EPA limits."

The problem we have seen with the Bush Administration is that they don't like the science part. So what they write is that the Potomac River is not polluted, so nothing needs to be done. The scientists who write the science are told that they are wrong, the reseach is sloppy, the reasoning poor, and so on. By framing it this way, they never actually get to the policy part.

They have done this with global warming and others, so I'm not surprised to find that the Bush Ad.finds no health care problems in these united states.
7.30.2007 7:41pm
Randy R. (mail):
"We seem to have entered an era where political appointees, like this Surgeon General, forget that they are politically appointed and are bound to support the political stance of the administration that appointed them. "

Yes. And how foolish of us, as the American public, to think that government might actually work to make life better for everyone, instead of just playing politics.

What next? Can we expect the weather service to bend the weather reports to make Bush look good?
7.30.2007 10:26pm
Montie (mail):

And how foolish of us, as the American public, to think that government might actually work to make life better for everyone, instead of just playing politics.


But doesn't that prove the original point. Virtually every politician and bureaucrats thinks (often misguidedly) that they are acting in the public's best interest. So, who should be the final judge of what the public's best interest is? Bureaucrats or elected officials?
7.31.2007 11:10am
neurodoc:
Neurodoc asked, "Should 'Republican' and 'Democrat' mean much when speaking of SGs and NIH directors?"

I am not sure, but I suspect Howard Dean as Surgeon General would be a different sort than Bill Frist, and both would be different from Ron Paul--all of whom are medical doctors.
Dave N
I used scare quotes for a reason. I don't think we have ever had any SG nearly so clearly partisan as those physician/politicians you have named, nor do I think we should. It seems to me that the pool of eligibles for those positions should be little different, if not the same, whether a Republican or a Democratic president is making the decision. Should we get a different Chair of the Joint Chiefs of Staff according to whether we have a Republican administration or a Democratic one?

(BTW, I don't anything about Ron Paul's credentials as a physician. I will tell you that as a physician Frist qualified as an outstanding major leaguer, while Dean would be counted no more than a mediocre minor leaguer. Putting aside political, if that were possible where Frist and Dean were concerned, I think Frist would be much better qualified to serve as SG than would Dean. I don't think Paul would be at all qualified to serve in that position.)
7.31.2007 3:23pm