By Bob Roehr
The nomination of James Holsinger to be Surgeon General of the United States appears to be in limbo after his July 12 appearance before the US Senate Committee on Health, Education, Labor and Pensions. A growing number of organizations have come to oppose his confirmation, based in large part on his views on gays, as expressed in a 1991 paper.
"The office of Surgeon General has become a morass of shameful political manipulation and distortion of science," said chairman Ted Kennedy (D-Massachusetts) in opening the hearing.
He cited testimony earlier in the week by former Surgeon General Richard Carmona on how the White House sought to suppress or change the content of reports, as well as experience with the Bush administration hiding or warping scientific findings in areas ranging from global warming, to stem cell research, to abstinence only programs, to condoms and birth control.
Kennedy announced introduction of the Surgeon General Integrity Restoration Act, which would radically reshape the office and protect it from political influence, should it be enacted. The bill would establish budgetary and administrative independence from the Department of Health and Human Services and the White House. It would require that the President select a nominee from a list of candidates drawn up by the Institute of Medicine.
He said this hearing was to determine if Holsinger was the right person to fill that role; "To see that the new Surgeon General has the independence needed to provide objective, reliable scientific advice to the nation."
Sen. Sherrod Brown (D-Ohio) asked Holsinger, "To what extent do you think that scientific evidence versus political/religious ideology should influence the Surgeon General's recommendations?
Holsinger affirmed his commitment to science. "I believe that is the position of any Surgeon General."
HOMOSEXUALITY
Kennedy focused on the 1991 paper on homosexuality that Holsinger had written for a committee of the United Methodist Church, which was considering those issues within the church.
"So many say that you did not look at the real science, you were controlled by ethics and religion – all of which are admirable elements and all of which have value in terms of politics and making judgments and decisions. But the issue is, did you avoid available science in terms of your document?"
Kennedy pointed out that the nation's and world's premier medical and psychological groups had written extensively on the subject, "But as I understand in reading the notes from the meetings when you were tasked to do this study…all of that scientific information was effectively ignored." Other sources have written to Kennedy saying their research was misused by Holsinger.
"This raises serious questions about your willingness to use the best in terms of science."
Holsinger claimed that the report was for laymen and was not meant to be a comprehensive scientific paper. "Other issues had already been covered in other papers that had been presented. I was asked to do a literature review of the health issues surrounding the issue of homosexuality."
But Kennedy didn't buy it. "If it is a literature review, why not reference the most prominent medical and scientific journals?" He accused Holsinger of "cherry picking" his data.
Holsinger said, "I am deeply troubled by these allegations [concerning his views on sexual orientation] because, I do not feel that they represent who I am, what I believe, or how I have practiced medicine. I pledge to you today that I will continue to serve all Americans, regardless of sexual orientation or any other personal characteristic."
Under prodding from ranking Republican Mike Enzi (Wyoming), Holsinger spoke of how he had helped gay and lesbian patients and how he had "fought fiercely" to defend presentation of lesbian health issues at a conference on women's health in 2002 at the University of Kentucky.
VA EXPERIENCE
Senator Barbara Mikulski (D-Maryland) recounted that the two had crossed swords when Holsinger was a senior official with what is now the Department of Veterans' Affairs (VA). She said, "We did not have a good time together."
"You resisted change in the area of quality control. You were often indifferent or dismissive of oversight when it came to the healthcare of women veterans, and sexual harassment at VA medical facilities."
Holsinger seemed to acknowledge the futility of trying to change Mikulski's opinion of him.
Sen. Patty Murray (D-Washington) grilled Holsinger on how he might respond to White House pressure to change language or suppress reports. He stressed the need for dialog and context, reserving the right to resign in protest, without detailing what type of pressure might trigger his resignation.
She pressed on how he would respond to a question from a high school student on the use of condoms. Holsinger said, "That is one of a number of appropriate means of birth control and prevention of STDs…and I would encourage them to consider abstinence as a possibility."
OTHER VOICES
The hearing was unusual in that no other persons testified on behalf of or in opposition to the nominee. Nonetheless, many groups had made their feelings know beforehand.
AIDS Action opposed Holsinger based on his "long documented history of prejudice towards lesbians and gay men," and 76 local and national organizations joined in signing that letter.
The HIV Medicine Association said, "A man who believes homosexuality is a condition to be "cured" is not fit to be the nation's First Physician."
And to the surprise of many, the American Public Health Association joined the call to reject the nomination on July 11. "At a time when one of our association's top priorities is to eliminate disparities in health, including disparities in the gay and lesbian community, we cannot support a nominee with discredited and non-evidence-based views on sexuality."
The Association has more than 50,000 members working in the field of public health, the principle area of responsibility of the Surgeon General. This is only the second time in its history that it has opposed a nominee.
More than half of the health committee members did not attend the hearing. Among them was right wing firebrand Tom Coburn (R-Oklahoma), who would be expected to support the nominee if he had the blessings of the far right.
Three democratic presidential aspirants–Hillary Clinton, Christopher Dodd, and Barack Obama–sit on the committee. All previously had issued statements expressing concern with the nominee, but none attended the session; they reportedly were at the NAACP convention in Detroit.
Speaking after the hearing, AIDS Action deputy director Ronald Johnson said, "The 1991 paper was very specific on his views of the abnormality of male homosexuality. I did not see a clear refutation of that" fro Holsinger
The AIDS Institute's Carl Schmid was surprised by the intensity of Sen. Mikulski's opposition to Holsinger based on her earlier experience with him. Schmid would not be surprised if Mikulski put a hold on the nomination if it ever reaches the floor of the Senate.
The right wing has been largely silent on the nomination. Only Concerned Women for America (CWA) distributed a statement at the hearing, and its focus was gay-bashing (they're for it). They said Holsinger's nomination "has become unfairly politicized due to both his medical findings on homosexual behavior and his religious beliefs." This constitutes an "inappropriate and unconstitutional…religious litmus test," they asserted.
However, CWA was careful to note that it "takes no position" on Holsinger's nomination.
The Family Research Council (FRC) later told its supporters that Holsinger had "recanted his earlier statement" on homosexuality. It questioned his stance on stem cell research. FRC concluded, "Dr. Holsinger's confirmation should not fail because of his views, but because of his seeming lack of conviction on any of them."
Committee staff indicated that they do not anticipate an early vote on the nomination.
