Saturday, July 28, 2007

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate. A copy of the report was obtained by The Washington Post.

Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services.

Richard H. Carmona, who commissioned the "Call to Action on Global Health" while serving as surgeon general from 2002 to 2006, recently cited its suppression as an example of the Bush administration's frequent efforts during his tenure to give scientific documents a political twist. At a July 10 House committee hearing, Carmona did not cite Steiger by name or detail the report's contents and its implications for American public health.

Carmona told lawmakers that, as he fought to release the document, he was "called in and again admonished . . . via a senior official who said, 'You don't get it.' " He said a senior official told him that "this will be a political document, or it will not be released."

After a long struggle that pitted top scientific and medical experts inside and outside the government against Steiger and his political bosses, Carmona refused to make the requested changes, according to the officials. Carmona engaged in similar fights over other public health reports, including an unpublished report on prison health. A few days before the end of his term as the nation's senior medical officer, he was abruptly told he would not be reappointed.

In a leaked confidential letter to the Director-General of the World Health Organisation (WHO), Lee Jong-Wook, the US government has rejected decades of nutritional research and denied that there is any evidence of a link between junk food and obesity. The letter, from William R Steiger, special assistant at the Department of Health and Human Services and godson to George Bush Sr, is the United States' official response to an April 2003 report by the WHO and the UN Food and Agriculture Organisation (FAO). That report, entitled "Diet, Nutrition, and the Prevention of Chronic Diseases," argues that governments should take steps to limit children's exposure to junk-food advertising, and says that added sugar should comprise no more than 10% of a healthy diet.

The report was released last spring, prompting American food manufacturers' groups to begin frantic lobbying in Washington. The Sugar Association wrote to Gro Harlem Brundtland, then WHO director-general, threatening to "exercise every avenue available to expose the dubious nature" of the report. Congressmen recruited by the food industry urged the Secretary of Health, Tommy Thompson, to cut off the $406 million annual US contribution to the WHO.

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The leaked letter says the WHO/FAO report fails to meet the standards of the US Data Quality Act, lacks external peer review and mixes science and policymaking in the same exercise. "Whenever you hear the government or the industry talking about scientific rigour," says Professor Nestle, "it's code for self-interest. It reminds me of the obfuscating tactics of the tobacco industry."

Mr Steiger's letter questions the scientific basis for "the linking of fruit and vegetable consumption to decreased risk of obesity and diabetes." He adds: "There is an unsubstantiated focus on 'good' and 'bad' foods and a conclusion that specific foods are linked to non-communicable diseases and obesity... The assertion that heavy marketing of energy-dense foods or fast-food outlets increases the risk of obesity is supported by almost no data." The letter also criticises "the identification of adverse economic status, especially in women, as a causative factor in obesity," despite research that has consistently shown poor Americans are fatter than rich ones.

"Most of the WHO/FAO report is actually rather banal," says Professor Nestle. "The science is no different from dozens of previous reports by national governments. What annoys the industry is that it also contains concrete recommendations for actually doing something about the problem." Indeed, Mr Steiger's letter complains that "scientists should review and evaluate the available science without regard to policy decisions."

The letter provoked a robust response from Professor Kaare Norum, senior scientist of the WHO's obesity campaign. In a letter to US Health Secretary Tommy Thompson, he accused the US government of making the health of millions of young Americans "a hostage to fortune" as a result of its links to business, particularly the sugar lobby.