Whereas the Bush administration makes a mess out of everything that it touches, its toxic effects on the science and profession of public health is of special concern to me because I have worked all of my 30 year career in public health and it is the only activity at which I know how to make a living.
The purpose of public health, as I discuss in my (unfortunately grossly over-priced) 1997
book, is to preserve and protect the health of human populations. Based on the science of epidemiology, which illuminates the causes of human health, disease and death, public health achievements have contributed to marked increases in human life expectancy in the United States and elsewhere. These achievements have included such wide-ranging activities as the development of
pure drinking water supplies, the
investigation of epidemics, infectious disease prevention with
vaccines, discovery of the effects of
smoking, the use of
seat belts, life style education on the
prevention of coronary heart disease, government agencies and regulations that address the safety of consumer products, and (dare I mention it)
family planning clinics.
Almost all public health professionals are liberals (I have never known one who admitted to being conservative or a Republican or to having any racist tendencies.) The reason for that is that the very existence of the profession of Public Health implies the belief that an important function of government is to protect and improve the health of its citizens. And as such, Public Health is seldom practiced outside of government.
Intrinsic conflicts between Public Health and the George W. Bush administrationPublic health is against everything that the Bush administration and its Republican fellow travelers stand for – especially with regard to two fundamental issues:
First, public health uses science rather than ideology to ascertain its strategies for protecting people. For example, the prevention of sexually transmitted diseases, including AIDS, relies to a very large extent on condoms. The fact that some people consider it immoral to discuss with teenagers the potential life saving effects of condoms is of little concern to the vast majority of public health professionals. To them, the fact that condoms save lives is the bottom line consideration in deciding whether or not to discuss or advocate them.
Secondly, the field of public health is concerned with human disease, death, and quality of life, and
not the accumulation of short term profits by corporations. This is a crucial point because the concern for corporate profits often sharply conflict with the goals of public health. For example, allowing a corporation to pollute our water or atmosphere may provide great economic benefits to that corporation, but at the expense of the health of the people who have to breathe the air or drink the water.
Examples of how the Bush administration neglects and even wars against public healthInfant mortality rateInfant mortality rate is often cited as an
excellent indicator of the state of public health of a nation or community, because public health activities have been shown to exert a pronounced effect on it. Prior to George Bush being selected as president in 2000 the United States had experienced tremendous declines in infant mortality, with a continuing steady decline since 1958 and a
three-fold decrease since 1970.
Then, in 2002 the United States experienced its
first increase in infant mortality since 1958. The close timing of this unfortunate occurrence with the presidency of George W. Bush was no accident. As
explained by Georges Benjamin, executive director of the American Public Health Association (APHA), potential reasons for the surprising turnaround in infant mortality in this country include: “women receiving less prenatal care or losing their jobs, cuts to nutrition programs, and climbing poverty rates”.
The politicization of public health decisions at the Food and Drug Administration (FDA)The FDA was created as a science based organization committed to evaluating foods, drugs, biological products, and now medical devices, for their safety and/or effectiveness, so as to protect potential consumers against dangerous or ineffective products. They make a big deal out of their claim to be a “science based” organization.
My experience in working for the FDA since George Bush got hold of it says otherwise, as does a recent poll conducted on FDA scientists by the “Union of Concerned Scientists”, described in a
Reuters article. The results of that poll, based on 997 anonymous respondents (including myself), included 15% of FDA scientists saying that they had been “asked, for non-scientific reasons, to inappropriately exclude or alter technical information or my conclusions in an FDA scientific document”, 17% saying that they had been asked “to provide incomplete, inaccurate or misleading information to the public, regulated industry, media or elected/senior government officials”, and 40% saying that they feared retaliation if they voiced concerns about product safety in public.
The article goes on to state that (surprise, surprise!) an FDA spokeswoman dismissed the findings, saying that they were “based on leading questions and innuendo.” Well, I never heard poll results referred to as “innuendo” before. And if “
Have you been asked, for non-scientific reasons, to inappropriately exclude or alter technical information or your conclusions in an FDA scientific document?” is a leading question, I wouldn’t know how else to ask it. It is also interesting that Reuters refers to the Union of Concerned Scientists (UCS) as “left-leaning” – I guess because believing that science is a more reliable tool than ideology for ascertaining reality automatically qualifies one as “left-leaning” these days.
My own FDA experiences have been no better than those suggested by the UCS poll. I have talked with colleagues about groups of FDA scientists who spent months reviewing a product and decided it was too dangerous to be approved, only to be over-ruled by higher level FDA managers with little familiarity with the product, for no stated reason. My own manuscript which described research involving ruptured aortic aneurysms associated with a medical device used to prevent those occurrences
was pulled by the FDA Commissioner just prior to being published, following conversations with the manufacturer. The FDA, against
opposition from consumer groups such as NOW, continues to push
silicone breast implants, a product with a rupture rate estimated at 30% to 70%, which frequently requires repeat surgery to address the resulting clinical problems. And then there was the
scandal where the FDA ignored the warnings of Dr. David Graham about the lethal effects of the drug Vioxx, until publicity on the matter forced it to stop ignoring the situation.
Hurricane KatrinaProbably the most obvious failure of public health by the Bush administration concerns its lack of preparation for and response to Hurricane Katrina. Despite recommendations from its own Army Core of Engineers that the New Orleans levees could not withstand a major hurricane, the Bush administration
decided not to repair them. Then, despite adequate warnings, George Bush sat around and
partied rather than initiate an evacuation or rescue plan for the people of New Orleans, while hundreds or thousands of potentially preventable deaths were occurring. And when he finally got around to coming to New Orleans he ordered rescue workers to pose with him for a
photo-op rather than commence with the urgently needed rescue of hurricane victims.
Other major obstructions of public health initiatives by the Bush administrationPerhaps the natural phenomenon with the greatest potential for catastrophic public health consequences is global warming. An
Intergovernmental Panel on Climate Change found that of 928 scientific peer reviewed articles on climate change, not a single one disagreed with the scientific consensus view that global warming is produced by greenhouse gases due to industrial activities, is highly likely to have catastrophic effects on the world population, and can be mitigated only by changing the industrial causes of the production of greenhouse gases. Yet George Bush has responded to this threat by denying that it is a major problem, making the United States one of two countries in the world that has
refused to participate in the Kyoto protocol for reducing the greenhouse gases that cause global warming, and by
silencing the top climate expert at NASA, Dr. Jim Hansen, who has called for “prompt reductions in emissions of greenhouse gases linked to global warming”.
AIDS is likely to be the worst epidemic in the history of the world, predicted to reach 100 million world-wide
deaths by 2020. Probably the best public health measure to prevent AIDS is education on the use of condoms. The Bush administration has not only refused to promote this, but it has actually
actively obstructed its own scientists at the Centers for Disease Control and Prevention (CDC) from continuing this crucial preventive measure.
Research using
embryonic stem cells has the potential to produce major advancements on a number of public health fronts. Yet, in order to pander to his religious base, George Bush has refused to fund this research, even going so far as to use his first and only
presidential veto (Note the typical hypocrisy of opponents of embryonic stem cell research on display in the photo accompanying this article. Bush is holding a baby who was adopted as an embryo, the implication being that funding of embryonic stem cell research may have resulted in the baby’s sacrifice to research – an implication that is about as reality based as Bush’s contention that he invaded Iraq in order to prevent Saddam Hussein from attacking the United States with weapons of mass destruction.)
The future of public health in a Republican controlled nationAs Bush’s defenders like to say, “at least he’s consistent” – and I’ll agree with them on that score. His attitude towards public health is no different than his attitude towards government in general.
In the world of the George W. Bush and all his Republican followers, government either has no useful purpose at all, or else its only purpose is to fight imperialistic wars and to eliminate restrictions on powerful corporations so that the rich get richer at the expense of everyone else. Public Health has no place in that world, unless it is contracted out to private corporations, in which case their ability to roll up profits will inevitably conflict with and take priority over public health concerns.
The practice of Public Health is based on science rather than on ideology, and since that science often conflicts with Republican ideology, Public Health must be sacrificed so that the Republicans can pander to their ideological base. And since public health costs money it must be abandoned so that Republicans can lavish more tax relief on their rich benefactors.
Republicans have made it perfectly clear that neither Public Health nor any other government function that helps people in general, as opposed to their wealthy supporters, has any place in their system of government. Whether the issue be
veterans’ health benefits, the availability of
adequate health care to
all Americans, or the promotion of public health policies to
protect the health of the current and future generations of Americans, Republicans have made it quite clear where they stand. Only a fool would believe that any of that is going to change if another Republican Congress is voted in this fall.
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