The politics of scientific policy

October 2004

King Holmes, MD, gave a spectacular presentation at the Infectious Diseases Society of America’s 42nd Annual Meeting in Boston earlier this month, in which he reviewed some of the recent findings in sexually transmitted diseases (STDs), including the data on the efficacy of condoms in preventing STDs (click here to read related story). This has become a contentious issue both domestically and globally.

One-third of the AIDS prevention program’s funds have been used for abstinence, and the role of condoms has been misrepresented. Randall Tobias, the spokesman for the administration, has denied the effectiveness of condoms in the prevention of HIV and has quoted studies from the London School of Hygiene and Tropical Medicine to support his contention. However, the dean of the school denied that the London School had produced such research. In addition, some information on condom use and references on their effectiveness have been removed from the CDC Web site (The New York Times, May 18, 2004). Dr. Holmes in his presentation cited data for the efficacy of condoms and other evidence rejecting the efficacy of abstinence-only educational programs, which are preferentially promoted by the Bush administration.

Questionable appointments

The interference with appointment of members of advisory panels has been another sore point. Gerald Keusch, MD, who resigned last December after five years as director of the Fogarty International Center at the NIH, is quoted in Science (July 16, 2004) as saying that 19 of his 26 proposed appointments were rejected — including Nobel laureate Torsten Wiesel, MD, PhD. He was given names suggested by political appointees, but “for the most part, I’d never heard of them,” Dr. Keusch stated in the article. Many nominees had indicated that they were asked questions on their political leanings, and a spokesperson for the Department of Health and Human Services did not dispute that certain employees did have a list of questions about political views. However, he said, “there was no one question on any subject that would qualify or disqualify someone.”

Another interesting nomination is that of W. David Hager, MD, to the FDA Reproductive Health Drugs Advisory Committee. He is the author of “As Jesus Cared for Women: Restoring Women Then and Now.” This is reported in the Oct. 5, 2002 issue of Time. He and his wife also authored a book called “Stress and the Woman’s Body,” which recommends Scripture readings and prayers for such ailments as headaches and premenstrual syndrome. He is said to refuse to prescribe contraceptives for unmarried women. He assisted the Christian Medical Association in a “citizens’ petition” demanding that the FDA reverse itself on RU-486, claiming that it “endangered the lives and health of women.” Dr. Hager, who has a teaching appointment at a hospital affiliated with the University of Kentucky, was chosen over the former dean of the University of Pittsburgh and the director of maternal and child health at Massachusetts General.

Stem-cell research

The reluctance to make more liberal use of discarded human embryos for stem-cell research has received much notoriety. Expanded use is being promoted for cures of diseases that have become popular causes, eg Parkinson’s disease. This may be true and this is the way, unfortunately, this has been presented to the public, but the contributions of expanded research using this material could rival the information explosions of DNA of the last century. What is more, it is likely that this research will go forward, but in foreign countries. This is already the case. Here, I think the damage already has been done. Would you advise a young person to choose this as a field of research if he or she wants to remain in the United States? I think not! The failure to aggressively pursue stem-cell research could have a profound effect on the biotech industry in this country in years to come as other countries compete in this area.

There are many people on both sides of these issues. Either way, one should have this information as one goes forth to choose our leadership in the next few weeks.

Editor’s note: It is worth noting also, for the record, that last February the Union of Concerned Scientists, a nonprofit advocacy group based in Cambridge, Mass., issued a statement signed by over 60 well-known scientists, including 20 Nobel laureates, that was highly critical of the current administration for “suppression and distortion of scientific findings,” and called for “regulatory and legislative action to restore scientific integrity to federal policy-making.”

We have generally avoided being overtly political in these pages, but as pointed out by Dr. Brunell, infectious disease physicians should be aware of these issues as we prepare to vote in this election. — Theodore C. Eickhoff, MD