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OPINION
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Why Bush is Bad for Public Health
By Lili Beit
Considering a career in public health? Take my advice and wait until President Bush is out of office. The practice of public health depends on the dissemination of accurate and politically unbiased scientific data, something that has been severely inhibited by the Bush administration.
It was Sue Addiss who first alerted me to the danger that Bush now encourages bad science to pose for public health research. Addiss, a graduate of the Yale School of Epidemiology and Public Health, served as the Connecticut Commissioner of Health from 1991 to 1995, as well as president of the American Public Health Association. In her current role as a member of the Yale Bioethics Project's working group on Distributive Justice in Health Care, she has actively decried instances of the misuse and distortion of scientific data by the Bush administration.
Addiss wrote an unpublished letter to the New York Times articulating why public health workers should be so concerned by the lack of respect for scientific integrity that has been evident throughout Bush's tenure. Sound research data is the primary tool of public health workers. Health directors are responsible for keeping abreast of new biomedical, psychological, sociological, and statistical findings. They are responsible for using these findings to generate effective policy and implement programs. When government departments distort or ignore such findings, they rob public health workers of the information on which their work depends.
The administration's policies on climate change and environmental pollutants have left environmentalists gasping for breath. Bush chose not to ratify the Kyoto Protocol on climate change, a document supported by most environmental scientists. His administration proposed the Clear Skies Act to replace the Clean Air Act, though scientists insisted that Clear Skies would actually be less effective in improving air quality and reducing mercury levels in fish. In 2002, Secretary of Health and Human Services Tommy G. Thompson declined to renew the tenure of several scientists on the Centers for Disease Control's Advisory Committee on Childhood Lead Poisoning, replacing them with appointees more friendly to the lead industry than to children's health.
The Bush administration has often defended its environmental policies by claiming that more research is needed to determine whether human activity is actually the cause of undisputed climate changes and health hazards. Bush often says in defense of the Iraq invasion that sometimes a speedy, bold decision based on limited available information is necessary. With respected scientists armed with years of overpowering evidence clamoring for stricter environmental protections, the response of a decisive leader should not be to wait for the result of further research - particularly when the environmental consequences of inaction could be extremely difficult, if not impossible, to undo.
You don't need advanced education in public health to see through some of the administration's bad policies. Common sense tells most people that young couples do not stop having sex when the government promotes abstinence. Yet the Bush administration has significantly increased funding for abstinence-only sex education programs, while cutting funds from programs that also promote condoms,
In 2000, under the Clinton administration, the Department of Health and Human Services (DHHS) developed scientifically sound measures to track the success of abstinence-only education programs. But in 2001, Bush's DHHS replaced these with vague measures that tracked only the "intentions" of teenage participants, rather than their actual sexual practices. Needless to say, the Bush administration's ill-defined method of measuring success showed abstinence-only education to be far more effective than previous studies had shown, and has used this to defend its abstinence-only policy.
One of the starkest examples of data manipulation in the Bush administration emerged last winter. A few days before Christmas 2003, DHHS issued a detailed report on the disparities in access to health care among racial and ethnic groups. Word got out that the report had been altered from a June 2003 draft version, and when concerned members of Congress pushed to see the draft, they found that many passages underscoring the extent of the disparities had been deleted from the final version. Stark statements and key statistics showing that minority groups had less access to quality health care than whites were present in the draft but missing from the final report. In late February, Secretary Thompson offered an apology for the deletions and released the original version of the document.
What are public health workers to do in this climate of politicized science? The trend of altered and suppressed data strains the trust between researchers, the federal government, and local health directors, whose work depends on the unfettered transmission of research data. As with the report on race and health care, whistle-blowers have sometimes managed to uncover misuses of data - but how many times have distortions remained?
Fortunately, some politicians believe that the situation is unacceptable. Representative Henry Waxman of California, ranking Democrat on the Committee on Government Reform, issued a statement last December cataloguing the complaints of scientists about Bush's policies. His statement was echoed in February 2004 by an open letter to the President signed by sixty-two prominent scientists, including more than twenty Nobel laureates. The letter and an accompanying report, issued by the Union of Concerned Scientists, criticized the administration's misuse of scientific data on everything from lead poisoning to reproductive health to endangered species to the aluminum tubes now known to have been incorrectly ascribed to Iraq's nuclear weapons program. The administration issued a rebuttal of the letter, which pointed out some errors in the claims while evading most of the accusations.
For public health workers, distortion of data has practical and direct consequences. They are stripped of the ability to make the informed decisions that are the backbone of public health practice, seriously endangering the health and welfare of the American public. Whichever candidate is elected, the new White House needs to work hard to restore scientific integrity in federal agencies by rebuilding trust in government data among scientists and public health workers.
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