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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 21; 335(7611): 114.
PMCID: PMC1925215

Former US surgeon general reveals extent of political pressure he was under

A former US surgeon general told a Congressional committee last week that while he was in office he had been forbidden by the Bush administration to speak on topics such as stem cell research, emergency contraception, sex education, health of prisoners, mental health, secondhand smoking, and global health issues.

Richard Carmona, the last surgeon general, told the House of Representatives Committee on Oversight and Government Reform that he had been instructed to mention President Bush three times on each page of his speeches, which were vetted by officials at the parent agency, the Department of Health and Human Services. Travel to conferences was prevented, and he was told not to attend the special Olympic games for disabled athletes, which were supported by the Kennedy family.

When he wanted to issue information about mental health after the 11 September 2001 terrorist attacks on the United States he was told by his bosses at the Department of Health and Human Services: “You don't write anything unless we approve it.”

Six previous surgeons general told him they'd also faced political pressure, but not to the extent that Dr Carmona had.

The office of the surgeon general dates from 1798. Nowadays the holder has little power and no budget but is considered “the nation's doctor,” charged with giving truthful scientific information to the public. Previous surgeons general have warned about smoking, HIV and AIDS, obesity, sexual behaviour, drink driving, among other issues, and have recommended needle exchange to prevent HIV transmission.

Dr Carmona's testimony was the lead story in the New York Times on 11 July (, “Surgeon general sees 4-year term as compromised”).

Dr Carmona said he was naive when he came to Washington, although he had served as a US army special forces doctor and weapons specialist, a registered nurse, and a police officer before becoming a doctor and trauma surgeon, chief executive officer of a public hospital and health system, and a university professor.

Edward Kennedy (Democrat, Massachusetts), chairman of the Senate Committee on Health, Education, Labor, and Pensions, and Henry Waxman (Democrat, California), who chairs the House of Representatives oversight committee, asked the secretary of health and human services, Mike Leavitt, to provide documents related to Dr Carmona's silencing. They both said they would introduce legislation giving the surgeon general's office independence and funding. Senator Kennedy said that nominations for surgeon general should be made by the independent Institute of Medicine.

Two days after Dr Carmona testified to the House committee, James Holsinger Jr, nominated by President Bush to fill the vacant position of surgeon general, was intensively questioned at confirmation hearings conducted by the Senate health committee, chaired by Senator Kennedy.

Dr Holsinger must be approved by the Senate, but because of an August recess it may be September before a vote takes place.

He is a Kentucky cardiologist. He was a senior official at the Veterans Administration, chancellor of the University of Kentucky medical centre, and head of Kentucky's state office for health and family services.

The Senate committee grilled him about a report he wrote for United Methodist church officials in 1991 saying that homosexuality was unnatural and physically injurious; his approach to women's health issues; sexual harassment at an Atlanta Veterans Administration hospital; and sex education for teenagers.

The committee asked whether he would stand up to pressure from the Bush administration.

Dr Holsinger defended his report on homosexuality, saying it was intended for church officials and was not a scientific paper. It did not reflect his current thinking, he said.

He said that if science conflicted with administration opinions he would try to persuade officials and would resign if science was ignored.

He said that sex education should include information about condoms and contraception as well as abstinence, a position that conflicts with President Bush's abstinence only policy. Dr Holsinger said that advertising of prescription drugs directly to the public should be banned, and he favoured restricting the availability of fast food and snacks in school vending machines.


A video of the Senate hearing at which Dr Holsinger spoke is available at (click on “Hearings” at the top of the page). Testimony by former surgeons general David Satcher, Everett Koop, and Dr Carmona, as well as a videotape of the House hearing, is available at

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