Draft Reflects Tensions At HHS

Democrat Releases Outline Opposed by Surgeon General

A draft outline of a surgeon general's report on global health overseen by a Bush administration political appointee in 2005 extolled the administration's efforts to improve health care in Iraq and Afghanistan and promoted an initiative to detect terrorism-related health threats on the U.S.-Mexico border.

The outline prepared under the direction of William R. Steiger, head of the Office of Global Health Affairs, differed substantially from a draft compiled by then-Surgeon General Richard H. Carmona, who has said he refused to incorporate Steiger's ideas for fear of turning a scientific document into a political one.

The 22-page Steiger draft, released yesterday by Rep. Henry A. Waxman (D-Calif.), chairman of the House Committee on Oversight and Government Reform, helps illustrate why Carmona and Steiger fought for more than year over what the report should say and whether it should be released. It also illustrates how the administration has sought to deal with scientific matters that are politically sensitive -- a subject under investigation by Waxman's committee.

Steiger, whose office provided funding and staff for the report, said in a statement last week that he blocked Carmona's draft from public release not for political reasons but because it "was often inaccurate or out of date and it lacked analysis and focus."

But in a letter yesterday to Health and Human Services Secretary Mike Leavitt, Waxman said Steiger's critique is unreasonable.

"Dr. Carmona's draft thoughtfully covers a wide range of global health topics," Waxman wrote. "Mr. Steiger's draft ignores or glosses over serious global health problems and emphasizes the achievements and policies of the Bush administration. The differences between the two drafts are further evidence that Dr. Carmona's report was blocked for political, not scientific reasons."

Steiger's draft devotes three pages to administration-sponsored efforts to help hospitals and health-care professionals in Iraq and Afghanistan and to U.S. relief activities after the December 2004 Indian Ocean tsunami.

"During the liberation of Iraq, the United States readily committed HHS resources [to] helping the Iraqis rebuilt their health care system," the draft says. "The Department of Health and Human Services sent some of its finest to join the Coalition Provisional Authority's health team, which directly assisted the dedicated Iraqi doctors to reopen hospitals and clinics across the country and plan for a future health care system to meet the needs of the Iraqi people."

Carmona's draft contains no specific mention of Iraq and a single reference to efforts in Afghanistan.

Steiger's outline also discusses a joint initiative with Mexico and Canada that focuses on early detection and "prompt reporting of infectious disease outbreaks associated with potential bioterrorism agents or other major threats to public health." The program is not mentioned in Carmona's report.

Carmona's report also discusses the health consequences of obesity and air pollution. Neither subject is addressed in Steiger's outline.

Bill Hall, an HHS spokesman, said that Steiger's outline was merely guidance for the surgeon general during the development of the draft. He said Carmona's report fell short in some scientific reviews. "It was the scientific review process, not politics, that stalled the Call to Action on Global Health," he said.