Advancing Sexual and Reproductive Health and Rights
 
The Guttmacher Report on Public Policy
May 2003, Volume 6, Number 2
 
Issues and Implications

Critics Charge Bush Mix of Science and Politics Is Unprecedented and Dangerous

By Heather Boonstra

Americans expect that every presidential administration will seek to advance its agenda by filling positions within the government with people who share its values. Even so, appointments to the nation's scientific advisory panels, and the public health information conveyed by the Department of Health and Human Services (DHHS) through its National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA), traditionally have been regarded as insulated from politics.

To many observers, this tradition is in jeopardy under the Bush administration. Critics say that a number of recent moves—in which advisory committees have been shut down entirely or seen their composition stacked and candidates subjected to tests of political loyalty, and in which health information on government Web sites has been changed—suggest that scientific decision-making is being subverted by an over-zealous commitment to ideology.

Government officials insist that the administration is doing nothing out of the ordinary. Speaking on behalf of the White House, DHHS spokes-person William Pierce said in an interview last year with Science that it is disingenuous to criticize the Bush administration for installing like-minded individuals "when every administration does that." DHHS, said Pierce, is simply exercising its prerogative in taking a more hands-on approach to the management of the advisory committees.

Critics maintain, however, that the administration's actions threaten to undermine the government's—and the public's—ability to rely on the expertise and independence of the scientific community in shaping health information and policy. The administration, they say, is co-opting "science" and distorting its findings to further its policy and political goals—in the area of reproductive rights and in other areas as well.

"Fair Balance"

The national system of advisory committees was established in 1972 under the requirements of the Federal Advisory Committee Act (FACA) as a "means of furnishing expert advice, ideas, and diverse opinions to the federal government." There are approximately 1,000 committees, panels, commissions, councils and similar groups across the government, established either in law, by presidential directive or by agency action. Some have ongoing assignments, such as the various NIH advisory panels that evaluate the scientific merit of research proposals or the standing FDA advisory committees that review studies on the safety and efficacy of drugs and medical devices and recommend whether new drugs should be approved for marketing. Others are chartered to address specific challenging and often-contentious scientific issues, such as how to protect human research subjects or the implications of genetic testing.

FACA allows the president or relevant appointing agency considerable discretion in determining who serves on these committees, saying only that membership be "fairly balanced" and not "inappropriately influenced by the appointing authority or by any special interest." (Some additional guidance is provided by the General Services Administration, which overseas the national committee system.) In a resolution approved by its board of directors and council in March 2003, the American Association for the Advancement of Science (AAAS)—the world's largest general scientific organization—adds that "fair balance" pertains to "competence, disciplinary focus, and political and/or institutional allegiance among other criteria." Importantly, the resolution states that selection, removal or replacement of committee members "based on criteria extraneous either to the scientific, technical or medical issues...compromises the integrity of the process of receiving advice and is inappropriate."

A number of recent moves suggest that scientific decision-making is being subverted by an over-zealous commitment to ideology.

The AAAS resolution was prepared in response to reports in the popular press as well as in its journal, Science, that the Bush administration had begun to politicize the advisory committee selection process to an unprecedented degree. In October 2002, for example, the administration overhauled the composition of CDC's Advisory Committee on Childhood Lead Poisoning Prevention just as it began to look at evidence for setting stricter lead-exposure standards. Similarly, the administration replaced nearly all of the members of the advisory committee to the director of CDC's National Center for Environmental Health, without even consulting with the center's director. Rejecting the notion that this is "standard practice," Science Editor-in-Chief Donald Kennedy charged in a January 2003 editorial that an "epidemic of politics" cuts so deep that "it now invades areas once immune to this kind of manipulation."

An earlier Science editorial (October 2002), written by the former assistant secretary of energy for environment, safety and health, David Michaels, and a group of his colleagues, points out that scientific advisory committees "do not exist to tell the secretary what he wants to hear but to help the secretary, and the nation, address complex issues." As an example of the kind of "fair balance" that previous administrations have recognized as desirable and effective, the editorial cites the fact that dedicated scientists from such corporations as Exxon and General Motors "have long served on the Environmental Protection Agency's Science Advisory Board, along with others from the World Wildlife Fund and the American Lung Association. Although deliberations of environmental health advisory committees have not always reached consensus, the differences expressed make important contributions to the agencies' work."

The trend today is very different, administration critics say. Now, individuals far outside the scientific mainstream are being appointed to advisory committees—individuals who may even be at odds with the very nature of the committee's work. An example well-known in the reproductive rights community is the recent appointment of reproductive rights opponent W. David Hagar to the FDA's Reproductive Health Drugs Advisory Committee, which evaluates the safety and effectiveness of contraceptives and other drugs used in obstetrics and gynecology. A spokesperson for the Christian Medical Association, Hagar not only has called for the FDA to reverse its 2000 decision to approve the abortion-inducing drug, mifepristone, but also in his private practice reportedly has refused to prescribe contraceptives to unmarried women. In the fall of 2002, Hagar was floated as the administration's likely candidate to chair the committee; on Christmas Eve, however, he was named a regular member of the panel.

To promote abstinence outside of marriage, the administration and its political allies have been actively seeking to undermine public confidence in the effectiveness of contraception, and especially condoms.

"Hager's appointment is a distortion of what it means to have a diversity of viewpoints," says Amy Allina, program and policy director at the National Women's Health Network. "We at the Network know how important it is to have balanced advisory committee membership. We've worked long and hard to ensure that the viewpoint of the consumer, not just the industry, is heard in committee deliberations, for women's legitimate concerns over side effects to be taken seriously when a new drug's health benefits are being touted. But this is different. Dr. Hagar has a well-documented record of making medical choices influenced by personal religious beliefs rather than based on scientific research or clinical experience, and that calls into question his ability to effectively serve on a scientific advisory committee."

Manufacturing Uncertainty

Public health advocates are worried about the impact of the administration's actions. In their Science editorial, Michaels and his colleagues predict that "instead of grappling with scientific ambiguity and shaping public policy using the best available evidence (the fundamental principle underlying public health and environmental regulation), we can now expect these committees to emphasize the uncertainties of health and environmental risks, supporting the administration's...views."

Outside of the advisory committee structure, a good example of this strategy—which Michaels elsewhere has dubbed "manufacturing uncertainty"—may be the administration's recently unveiled plan for additional research on climate change, which was roundly criticized by a National Academy of Sciences panel for rehashing questions that have been largely settled in the scientific community. In a briefing book compiled for the November 2000 elections, obtained by the nonprofit Environmental Working Group, Republican political strategist Frank Luntz had warned party members that on global warming, "the scientific debate is closing [against us] but not yet closed." Luntz advised the party to be more aggressive in recruiting sympathetic experts who will encourage the public not to "rush to judgment before all the facts are in." "Should the public come to believe that the scientific issues are settled," he wrote, "their views about global warming will change accordingly. Therefore, you need to continue to make the lack of scientific certainty a primary issue."

This strategy may sound familiar to reproductive health advocates. In pursuit of its goal to promote abstinence outside of marriage, for example, the administration and its political allies have been actively seeking to undermine public confidence in the effectiveness of contraception, and especially condoms. As part of that campaign, CDC's long-standing fact sheet on condoms was removed from CDC's Web site and revised. The original advised the public, in accordance with the overwhelming weight of the evidence, that correct and consistent use of latex condoms can help reduce the risk of HIV and other STDs. The reposted version emphasizes that there is a lack of "proof" that condoms work effectively and warns that condom use "cannot guarantee absolute protection against any STD" ("Public Health Advocates Say Campaign to Disparage Condoms Threatens STD Prevention Efforts," TGR, March 2003, page 1).

Likewise, in pursuit of the administration's campaign against abortion, the National Cancer Institute's (NCI) fact sheet on the connection between abortion and breast cancer risk, which reassured women of the lack of an association, was withdrawn and reposted with a new message that the evidence is "inconclusive." NCI then convened a panel to reconsider the issue—one that scientists overwhelmingly considered settled. This time, however, the strategy failed to make a lasting impact. In March, a joint meeting of the NCI board of scientific advisors and board of scientific counselors unanimously approved the panel's conclusion that there is no link between abortion and breast cancer, saying that the evidence for that conclusion met the agency's highest standard, that of being "well established." As a result, the institute has updated its fact sheet once again, saying that abortion does not increase women's breast cancer risk.

"In the narrowest technical terms, both versions of the NCI fact sheet—and the CDC fact sheet on condoms for that matter—were accurate," says Wayne Shields, president and CEO of the Association of Reproductive Health Professionals (ARHP). "The truth is that science always has some degree of inconclusiveness. But what is at issue are the public health messages provided by the government, which must be based on the weight of the evidence. For the government to say that the research is not absolute, whether the subject is abortion and breast cancer or the effectiveness of condom use, is misleading."

Into the Open

In October 2002, more than a dozen members of Congress, led by Rep. Henry Waxman (D-CA), sent a letter to DHHS Secretary Tommy G. Thompson, raising concerns that scientific information discordant with the administration's political agenda was being suppressed, thereby "jeopardizing the trust that Americans now place in [the] decisions and actions [of our leading public health agencies]." In February 2003, nearly 80 research, public health and advocacy organizations signed an ARHP-initiated statement calling for the preservation of the "core values" in science, including the need for transparency, the value of peer-review and respect for the scientific process. And now, the General Accounting Office has agreed to a request from Rep. Eddie Bernice Johnson (D-TX), the ranking Democrat on the House Science Committee's Subcommittee on Research, to investigate the process by which the government's scientific advisory committees are constituted.

Clearly, what until recently had been something of a stealth campaign, allowing the administration and its allies to make in-roads pleasing to its core constituencies without attracting widespread attention, is coming increasingly into the open. What is less clear at this point is whether heightened public attention will be the first step toward a return to the day when the nation's scientific advisory committees, and the government's public health messages, were largely above politics.