Nation's top doctor criticized for low profile

By Laura Meckler ~ The Associated Press

WASHINGTON -- The nation's surgeon general is using the soapbox that comes with his crisp white uniform to promote healthy living. It's safe ground, and that's just the way Dr. Richard Carmona likes it.

"Everything I approach will be with the mantra of 'prevention first,"' Carmona said in an interview.

Since his confirmation last summer, he's traveled to about 20 states to give speeches on disease prevention, health disparities and terrorism preparedness. None of the issues is likely to rankle the Bush administration. Disease prevention, for instance, is also a favorite theme of Health and Human Services Secretary Tommy Thompson.

Carmona's low profile contrasts with a swashbuckling past -- once he rappelled from a helicopter to rescue a victim -- that brought media attention and inspired a made-for-TV movie.

Today, Carmona sees himself as a team player working on the inside to shape policy -- not an independent voice critiquing decisions after they are made.

The surgeon general is sometimes called "the nation's doctor," and many of Carmona's predecessors have effectively used the position to deliver health messages, some of them controversial.

Dr. C. Everett Koop railed against smoking and educated Americans on AIDS. Dr. David Satcher, Carmona's predecessor, sought to keep the nation calm during the 2001 anthrax attacks.

But at a time when public health issues like SARS and smallpox vaccinations are front and center, Carmona has barely registered with the public.

He was vaccinated against smallpox, but he has not been a leading voice urging health-care workers to do likewise, even as the federal vaccination program has fallen far short of expectations.

While Carmona's bioterrorism preparedness credentials were touted when he was nominated for the job, Carmona acknowledges he has had minimal involvement in HHS's work in this area. And he has said little publicly on SARS, the deadly new virus that has spread from China.

No stick

Koop, widely praised for his tenure as surgeon general, contends the White House is not letting Carmona speak independently and therefore Carmona will never be able to deliver truly straight talk.

"If you send somebody out to play a hockey game but you don't give him a stick, that's a problem," Koop said.

Carmona's low profile prompted a rant from one member of Congress. The surgeon general's job, after all, is to be the nation's leading spokesman on matters of public health.

"Most people don't know who he is," complained Rep. John Peterson, R-Pa. "Where is he?"

Carmona, 53, rose from high school dropout to Green Beret in Vietnam to nurse to doctor to university professor. Before his confirmation last summer, he combined duties as a doctor and sheriff's deputy in Tucson, Ariz. It was as a sheriff's deputy that he rappelled from a helicopter to make the dramatic rescue of someone stranded on a cliff that prompted the TV movie.

Coming upon an accident scene in 1999, Carmona confronted a man who would not step out of his car. The motorist shot at Carmona, and Carmona shot back. The suspect, who turned out to be a mentally ill murder suspect, was killed.

Carmona is now planning reports on disease prevention and global health and to follow up Satcher's work in racial health care disparities and mental health. He is also considering a report on the psychology of war.

But like his predecessors, Carmona may sometimes find it difficult to be loyal to both his boss and the scientific evidence.

Take smoking. An advisory committee Carmona heads concluded that fewer people will smoke if cigarettes cost more and recommended an increase in cigarette taxes. Thompson dismissed the advice, saying the Bush administration does not support tax increases of any stripe.

Asked about this, Carmona tried to balance the two positions. He said the science clearly shows smoking will drop if the price goes up. But he said that doesn't mean government should raise taxes.

"If Congress decided to enact taxes for that, it would probably cause decreased usage. But that would be up to Congress," he said, "That's not my responsibility."

On another issue, though, Carmona did break with conservatives. Many Republicans in and out of the administration argue that abstinence from sex is the only message government should be sending in its effort to prevent teen pregnancy and the spread of HIV and other diseases.

Abstinence is the only sure solution, Carmona said, but programs should include discussion of condoms and other forms of birth control.

"As part of comprehensive education," he said, "we should be talking about all of the issues."