by Frank James

White House Press Secretary Tony Snow today rejected charges made by former Surgeon General Anthony Carmona yesterday in testimony before a House committee that Bush Administration officials repeatedly put politics over science, making Carmona toe the ideological line.

The main White House talking point on Carmona is that they're "disappointed" Carmona didn't speak his mind. For instance, today Snow said:

It's disappointing if he did not use his position to do what -- to advocate what he thought were the proper policies. But on the other hand, he is somebody who worked for administration."

Yesterday, White House's deputy press secretary Tony Fratto said:

"It's disappointing to us if he failed to use his position to the fullest extent in advocating for policies he thought were in the best interests of the nation."

It's probably just as true that the White House is disappointed Carmona is speaking his mind now.

Here's the complete exchange Snow had with a reporter about Carmona:

REPORTER: If my colleagues will permit me to change the subject, yesterday, the former surgeon general, Dr. Carmona, gave very damning testimony on Capitol Hill in which he said the administration would not allow him to speak or issue reports about stem cells, emergency contraception, sex education or prison and mental health and global health issues. He was instructed to mention President Bush three times on every page of his speeches, et cetera.

Why was he given these instructions? Who gave them?

MR. SNOW: I'm not sure.

REPORTER: And is there an attempt on the part of the administration to muzzle the nation's public health spokesman?

MR. SNOW: Yeah. Well, number one, if you're -- if you in fact serve at the pleasure of the president, you have some obligation to share his policies.

But on the other hand, there have been some of these that are sort of head-scratchers -- for instance, stem cell. Nobody at the White House can recall ever having had any conversation with him about stem cell. Special Olympics -- there was some notion that he wasn't to participate. That -- the president and first lady are active in Special Olympics. We're talking about having the torch come through here. We've had the special ceremony for Eunice Shriver. We've had the Kennedy family over here.

But I think on the particulars -- here's the way it works. Dr. Carmona, as surgeon general, surely was free to speak his mind. Apparently he thinks he didn't. It's disappointing if he did not use his position to do what -- to advocate what he thought were the proper policies. But on the other hand, he is somebody who worked for administration. I don't know anything -- I don't know --

REPORTER: He's saying -- (off mike) -- prevented him from using his position to advocate for the proper policies. Is that true?

MR. SNOW: Just not aware of that.

The other thing is, he was very eager to get reappointed. So I just -- I don't know. I know that members on the Hill -- I know that he was asked questions about who said this and so on. And a lot of this is going to have to wash out. I cannot give you specific information. But nobody, as far as I could tell, was, quote, "muzzling" him. But on the other hand, there is certainly nothing scandalous about saying to somebody who is a presidential appointee, "You should advocate the president's policies."

For the record, Carmona's testimony was eye-popping even for some reporters who've been around Washington long enough to be jaded.

In the section of his testimony below, he says when he tried to address the science of stem cells or other medical and health-related issues in his speeches, if the science didn't agree with the administration policies, those parts of his speeches were excised by higher ups in the administration.

REP. WAXMAN: Well, you tried to fill the role and did a responsible job of trying to provide accurate science-based information, but you indicate the times you were marginalized or simply had your reports or ideas buried. You came in as Surgeon General in 2002 and at that time there was a great national debate about the role of stem cells in medical research. I understand you thought the surgeon general could play a constructive role in explaining this issue, just the science of it, to the American public. Could you tell us what you tried to do and what the result was?

DR. CARMONA: Yes, Mr. Chairman, I'd be happy to. I recognize that notwithstanding stem cell issues, the nation suffers from health illiteracy. The literature is clear. About a third of the nation really doesn't understand the science we have to deal with everyday, doesn't understand the relationship of their behaviors to ultimate health outcomes. I saw this debate going around, not only as a new Surgeon General, but I'd witnessed it as a professor.

I saw that much of the discussion was being moved forward devoid of science and so I approached leadership to say the surgeon general should be leaning forward on this, we should be in fact engendering debate on this issue so that we make sure the American public, our elected officials, our appointed officials are all knowledgeable of the science. Much of the discussion was being driven by theology, ideology, preconceived beliefs that were scientifically incorrect. So I thought this is a perfect example of the surgeon general being able to step forward, educate the American public as well as elected and appointed officials so that we can have, if you will, informed consent on an issue to the American public to make better decisions.

I was blocked at every turn. I was told the decision had already been made. Stand down. Don't talk about it. In speeches initially where that information was put in speeches, it was removed from my speeches.

REP. WAXMAN: Who would remove a portion of your speech?

DR. CARMONA: Well, there were people that actually were assigned in the Department to vet my speeches through speechwriters who were helping me put together talking points and things like that. Unfortunately, I was naive enough during my first year that I didn't recognize this was happening. Many of the staff in trying to protect me didn't tell me the embattled problems and positions that they were in trying to help me bring the best science forward. But constantly being vetted and politically vetted, I should say, not scientifically vetted. It was awhile before I figured out that this was happening behind the scenes.

REP. WAXMAN: Did you have any of your other speeches vetted and censored?

DR. CARMONA: Repeatedly.

REP. WAXMAN: On other topics?

DR. CARMONA: Repeatedly.

REP. WAXMAN: Repeatedly?

DR. CARMONA: Yes.

REP. WAXMAN: And were these scientist or physicians that were doing it, or political people?

DR. CARMONA: No, in fact I welcomed input from my colleagues in science. I often called my NIH colleagues, and CDC, my officers in other departments to say, what do you think about this? Get me the best science. I would bring groups together to achieve consensus on a scientific issue. The vetting was done by political appointees who were specifically there to be able to spin, if you will, my words in such a way that would be preferable to a political or an ideologically preconceived notion that had nothing to do with science.

REP. WAXMAN: Were you allowed to speak freely to reporters?

DR. CARMONA: No. I was often instructed what to say or what not to say. I did the best I could to speak out on issues. Honestly, I never lied, I never covered the truth, but it was a fine line that I walked all the time because often the particular issue already had a preconceived political solution, and I had nothing to do with it. What I found during my first year was that I would see policy moving forward and I would scratch my head and think, shouldn't the surgeon general have been involved in this discussion? Yet, I'd have nothing to do with it, but yet be expected to support these notions that were released to the press, through policy, legislation and such, yet I've had no input into them prospectively.

REP. WAXMAN: The President made a decision on stopping research using embryonic stem cells. He claimed he had a certain number of lines of cells that were already in existence and he would allow that research to go forward. It may not have been a decision you agreed with, but it was his decision.

What do you think your role should be after the President decides for the Administration what that Administration's policy would do?

DR. CARMONA: Mr. Chairman, I think clearly the President of the United States, as the senior elected official, has the authority to do what he sees fit, as does Congress as the elected officials representing our citizens. However, I think as part of the due diligence, the surgeon general should be at the table representing our colleagues in science as it relates to the issue. Make no mistake, I think I speak with my fellow Surgeons General on this as well, we recognize that ultimately the authority rests with those elected officials. The danger is when the science is not heard, when the ideas are promulgated forward in front of the American public devoid of scientific discussion, where the surgeon general is marginalized; that's the danger.

At another point, he discussed how when he tried to explain the science behind sex ed or global warming at a meeting of administration officials, he'd get the skunk-at-the-picnic treatment.

DR. CARMONA: There were times when I was invited to meetings or had discussions where I guess I would say people were testing the waters. On abstinence -- the abstinence only -- and I remember that in all of my presentations, I never wavered based on -- you know, the best science that Surgeon General Koop and Surgeon General Satcher had spoken about. It was clear that we needed a broad comprehensive program of sexual education in the United States that would include abstinence, but not be exclusively abstinence. People weren't happy about that. So, you know, I think that powers-that-be saw that I was going to be true to the science and not to a political agenda, so that was challenging.

The issue of global warming came up once at some meetings and it was my first year, and I was actually naive enough listening to the discussion at the office with senior officials, where they were heralding global warming to be nothing more than -- you know, a liberal cause and had no merit, and they were kind of dismissing it. And then I -- and I remember thinking -- I said, "Well, I understand why they want me here now. They want me to discuss the science because obviously they don't understand the science." And I had this scientific discussion for about a half an hour, and I was never invited back to the meeting.

And so there were a number of little anecdotes and vignettes like that that I can cite for you over the years where the water was tested, where I was asked to say certain things at meetings, things were put into my speeches -- in fact, I had two speechwriters that ultimately quit because they were so intimidated and browbeat by appointed officials who would vet my stuff and write so that it would be rewritten politically, and we'd play this game the day or two before taking things out, putting things in. And finally, I told the staff, "Let them put in whatever they want. I'm not going to say it anyway." And eventually these people left the employ there because they were -- you know, they really were in an embattled position in people trying to get to the surgeon general through them.

DR. CARMONA: In fact, in my first year, clearly I was told a number of times that the president's name wasn't mentioned in the speech and I was told it should be mentioned -- at one point, at least three times on every page. And I said, "I'm not going to do that." I said, "I'll mention any politician when appropriate if they're involved in a particular scientific endeavor, but my job is not to sell politics." And in fact, the speechwriters will tell you they fought that battle every day because they -- I would tell them what I wanted in the speech, they'd provide it back to me, it would be vetted politically unbeknownst to me -- the first few months, I didn't know this was happening -- and they were being admonished for not putting certain politicians' names in or political phrases in that I took out because I said, "It has nothing to do with public health science and I will not say those things."

One of Carmona's most amazing stories was of how he was told the administration wouldn't pay for him to attend a Special Olympics event in Japan. First he was told it was because of the expense. Later, he learned the real reason was the group was linked to Kennedys (Eunice Shriver, President Kennedy's sister, founded the group.) Carmona wound up paying for the Japan trip it out of his own pocket.

The former surgeon general also told of attending meetings of administration officials that were more like pep rallies where the stated goal was to help Republican lawmakers gain and hold onto seats.

DR. CARMONA: There were a couple of issues, and I can give you some examples. There was a -- as you know, I issued a surgeon general's call to action the first -- on the health of people with disabilities. And I was looking at gap analysis across the country to see where I could add to the great body of evidence that my predecessors had provided. And I saw this issue of disability and children's health, and so we started to have some conversations with Special Olympics and Best Buddies and a number of national organizations that deal with health and disabled children. And the Special Olympics was coming up and I was asked if I would come to Japan and give the opening keynote address and discuss the health of disabled athletes, which had been marginalized. I thought this was a perfect forum globally. I was told I couldn't go. There was no reasons given except, you know, "Well, it's kind of expensive to go over there," but -- you know, there were times when I was asked to go speak at groups that I wasn't sure I should be at where budget was never an issue. But in this case --

REP. WAXMAN: Well, give me an example of that.

DR. CARMONA: Group political gatherings, political gatherings where they wanted to have the surgeon general there to say some things about programs that -- parties who were moving forward and, you know --

REP. WAXMAN: Were these a district of vulnerable Republican members?

DR. CARMONA: Sometimes that was -- sometimes that was the case. Yes, sometimes that was the case. Asked to go talk about our programs and this particular issue and, you know, for the benefit of some elected official. Yes, that happened.

REP. WAXMAN: So you were told you couldn't make a decision to go speak to the Special Olympics and you never were given a reason why you couldn't, but then you were told there was money to go and speak to -- somewhat politicalized groups?

DR. CARMONA: There were often conflicting messages like that. Those are two examples. The Special Olympics one I think was an egregious one, because ultimately another group that was part of the Special Olympics, the Best Buddies program, which deals with physical activity for disabled children, intellectually disabled children, and I thought that's some place we should be speaking out on to prevent the marginalization, and it really addresses health disparities as well. So I put in my paperwork to go to this meeting where I was going to give the keynote address and actually ride a bike with a disabled child and -- and help to bring some light to this problem in our nation, and I was admonished for doing that. And the reason I was admonished for doing that was that, unfortunately, I was told that I would be helping a politically prominent family who is -- this is one of their endeavors, and why would I want to help those people? And I said, I -- I don't even know -- I mean, I'm not going to mention names now, but I remember responding. I said, "This is about sick kids. It has nothing to do with who's moving the project." So in effect, I was told, "You can't travel." My travel orders were cancelled. I took a weekend vacation, I paid for it myself, and I went up there, because I had made the commitment to the group.

REP. WAXMAN: At what level were you told you couldn't go to the Special Olympics --

DR. CARMONA: These were, you know, high, politically appointed officials.

REP. WAXMAN: In the Department or the White House?

DR. CARMONA: In the Department. In the Department, yes.

REP. WAXMAN: In the Department. And then you were told, on the other hand, that they wanted you to act as a surrogate to go and speak in districts where you could act on behalf of the Republican cause, isn't that correct?

DR. CARMONA: That happened at times, yes.

REP. WAXMAN: Yeah. And there they didn't have a problem of money?

DR. CARMONA: Didn't -- didn't seem so.

REP. WAXMAN: Well, I just have to say, Dr. Carmona, I really find the political interference with you doing your job astonishing. It was difficult enough for Dr. Koop or Dr. Satcher, but it really is distressing that you had so much more interference in what you were trying to do. You've testified you were prevented from speaking out on stem cells, abstinence education and Plan B emergency contraception, is that correct?

DR. CARMONA: That's correct.

REP. WAXMAN: You testified you were prohibited from preparing reports on mental health preparedness and emergency preparedness, is that correct?

DR. CARMONA: And global health.

REP. WAXMAN: You testified that you couldn't release the report on global health.

DR. CARMONA: Correct.

REP. WAXMAN: Correct. You testified that your report on the dangers of secondhand smoke was delayed for years while you fought efforts to weaken your science-based findings. Is that correct?

DR. CARMONA: That's correct, and I was not aware of it at the time. I didn't find out about the scientific assault until later on, because the staff was trying to protect me. And it wasn't until very late in the game that I found out that they were fighting the re- wording of certain paragraphs and things like that, and -- you know, fighting their own battles, if you will, for scientific integrity.

REP. WAXMAN: And you testified you were even directed to attend White House political briefings about the best interests of the Republican Party and its candidates, is that correct?

DR. CARMONA: Well, I'm not -- let me -- let me clarify, and that's -- I can't say they were White House, but there were memos from senior political officials who brought people together to discuss things. And I said -- the couple I went to, clearly they were discussing political issues and elections and, you know, getting people out and, you know -- pep rallies, I would call them. Political pep rallies.

REP. WAXMAN: But this wasn't from the Department; it was beyond the Department --

DR. CARMONA: Yes. Yes, but sometimes the meetings took place at the Department. Sometimes they were off in other buildings.

REP. WAXMAN: Really? And people would come and talk about -- give a list of the key races for the Republicans?

DR. CARMONA: You know, I can't say "key races," but certainly would talk about candidates or getting out -- you know, getting "our word out" -- you know, political agendas, things like that which, really, the surgeon general should have nothing to do with because it undermines the credibility of the office. It undermines the integrity and the dignity of the Office of the Surgeon General to be involved in day-to-day politics. That's not our job.

REP. WAXMAN: Did Karl Rove attend any of those meetings?

DR. CARMONA: I can only remember one where I saw him. There were other staffers up and down, you know, at different levels of government that would -- come and speak at so-called "brown bag" lunches and meetings, things like that. But to be honest with you, I didn't pay much attention to them. After the first few, I recognized that it was really something that the surgeon general shouldn't be at or involved in.

REP. WAXMAN: And you didn't take any grief for not going to future meetings, did you?

DR. CARMONA: No, not grief. People, you know, I -- in fact, I made sure I was busy during those times. (Chuckles.)

REP. WAXMAN: Well, I thank you for your being forthright in talking to our committee and the American public about this issue, and I hope the testimony of you and Dr. Koop and Dr. Satcher will help us clarify that this is an important position that we shouldn't allow to be marginalized; we shouldn't allow the surgeon general to be politicized. It is the doctor to the nation. That person needs to have credibility, independence and to speak about science.

DR. CARMONA: Yes.

REP. WAXMAN: And I think that's so important. I thank you all very much for your testimony today. That concludes our hearing, and the committee stands adjourned. (Raps gavel.)

DR. SATCHER: Thank you.

DR. CARMONA: Thank you, Mr. Chairman. Thank you very much.