The Doctor Who Didn't Know When to Quit

Richard Carmona, the former U.S. surgeon general, is a brave man. He is a decorated combat veteran of the Vietnam War who once dropped out of a helicopter in a rescue operation. He bootstrapped his way out of the New York Puerto Rican barrio to become a registered nurse, then a trauma surgeon and finally a high government official. Yet when the time came for a different kind of guts, Carmona's courage failed him. He should have quit the Bush administration with a bang. Instead, he left with a whimper.

That meow was heard by no one. He simply departed from the administration when his four-year term was up and said nothing about how he had been maneuvered and micromanaged -- until last week, when he told (almost) all to a congressional committee. Only then did we learn that it was suggested that whenever Carmona gave an official speech, he should mention the president at least three times a page. He declined. He was also ordered not to talk about controversial matters -- stem cell research, sexual abstinence, contraception, etc. He complied. A report on global health was withheld for political reasons.

"The reality is that the 'nation's doctor' has been marginalized and relegated to a position with no independent budget and with supervisors who are political appointees with partisan agendas," he testified. As for those "political appointees," anything that didn't fit their agenda was "ignored, marginalized or simply buried."

As shocking as this may be, it is not news. It has long been known that the Bush administration subordinated science to faith and ordered a bunch of compliant officials to remain ideologically pure. The Food and Drug Administration, for instance, heroically tried to keep the emergency contraceptive Plan B off the market, even though a preponderance of experts attested to its safety. The administration has wasted huge sums on dubious abstinence programs and cut funding for other methods of family planning, including condoms and abortion. It is not too much to say that this administration is hung up over sex. The father of many a child is ideology.

What remains a mystery, though, is why people such as Carmona, being "marginalized" in their own offices and almost certainly aware of what was happening in related government agencies, proved incapable of quitting -- and telling the world why. And what is even more of a mystery is how, later, they come before Congress thinking they are about to say something heroic, when all they are testifying to is their own lack of courage or, perhaps, a touching concern for their careers. Carmona refused to openly name the administration officials who gave him his ridiculous marching orders.

Another president -- ah, what a felicitous phrase -- might have read Carmona's testimony and felt the blood rush to his face, a combination of shame and fury. Another president -- such fun just to write the phrase -- might have demanded to know which officials had given such orders. Who had insisted that the president's name be invoked over and over? Who prevented the surgeon general from offering his best medical opinion? Who were these people?

But Bush, the only president with a master's degree in business administration -- the eternal shame of Harvard -- is passive to the point of being inert when it comes to these matters. Another president would wonder whether the same process that smothered Carmona's attempt to tell the scientific truth played a role in the smothering of truth about Iraq. There, too, ideology triumphed over reason: Iraq would compliantly fall within a month or so and then emerge as a Middle East version of Switzerland -- with a Sunni canton and a Shiite canton and a Kurdish canton. You could just hear them yodeling.

In his own way, Carmona is the poster boy for the Bush administration -- a low-level Colin Powell, another non-quitter, a saluter who went along with the program and now talks more in defense of his own reputation than he ever spoke as an internal critic or, more likely, secret doubter. Such loyalty -- not to principle, conscience or integrity but to the boss -- is as much an essential ingredient for failure as are incorrect intelligence reports or fervid ideology. What Carmona and others like him too often forget is that when it comes to loyalty, they owe it not to the president but to you and me. Last time I looked, we were still the boss.

cohenr@washpost.com