The president's pick to be the nation's top doctor faces a day of tough questions about his views on sex and science.
President Bush had hoped Dr. James Holsinger, nominated in May to become surgeon general, could focus his efforts on childhood obesity. But before he can take office, Holsinger faces a gantlet of liberal Democrats who are eager to poke and prod and criticize his views on homosexuality, birth control and sex education.
Last month, gay rights groups attacked Holsinger's nomination after unearthing a paper he wrote 16 years ago titled "The Pathophysiology of Male Homosexuality" in which he argued homosexuality is unnatural and unhealthy.
Those views don't sit well with many Democrats serving on the Senate Health, Education, Labor and Pension Committee, which will hold Holsinger's nomination hearing Thursday morning, particularly not the committee's chairman, Sen. Edward Kennedy, D-Mass., a longtime advocate for gay and lesbian rights.
Senate Liberals Express Reservations
Membership on the committee reads like a who's who of liberals in the Senate -- including three presidential candidates eager to befriend the gay and lesbian community during this primary season: Sens. Christopher Dodd of Connecticut, Hillary Rodham Clinton of New York and Barack Obama of Illinois.
Last month, Obama said he would at least listen to Holsinger's testimony but expressed "serious reservations about nominating someone who would inject his own anti-gay ideology into critical decisions about the health and well-being of our nation."
Medical Groups Declare Opposition
Some medical groups have also sounded alarms.
Wednesday, the American Public Health Association formally declared its opposition to Holsinger's nomination for only the second time in the groups 135-year history and the first time since 1981.The APHA declared its opposition Wednesday in separate letters to Kennedy and Mike Enzi, R-Wyo, the ranking Republican on the committee.
Dr. Georges Benjamin, executive director of the 50,000-member APHA. wrote that "As our nation's most trusted adviser and leading educator on health, the surgeon general plays a vital role in promoting health, preventing disease and protecting the public. Scientific objectivity must be the standard for any nominee."
Continued Benjamin, "We cannot support a nominee with discredited and non-evidence-based views on sexuality," wrote Benjamin. "While we have no doubt that Dr. Holsinger has made positive contributions throughout his medical and public health career, we believe his previously expressed views on sexuality are inconsistent with mainstream medicine and public health practice."
Holsinger's Controversial Paper
Holsinger, a professor of preventive medicine at the University of Kentucky College of Public Health, did not return a call for comment. The administration has said it wants Holsinger, a former secretary of the Kentucky Cabinet for Health and Family Services, to focus on childhood obesity.
His controversial 1991 paper argues that "[a]natomically the vagina is designed to receive the penis" while the anus and rectum -- which "contain no natural lubricating function" -- are not. "The rectum is incapable of mechanical protection against abrasion and severe damage ... can result if objects that are large, sharp or pointed are inserted into the rectum," Holsinger wrote.
Doctors who reviewed the paper -- written for a United Methodist Church's committee to study homosexuality -- derided it as prioritizing political ideology over science.
Kennedy previously said in a statement, "I am disappointed that the administration looked past the many talented physicians who have a record of bringing people together and instead chose an individual whose record appears to guarantee a polarizing and divisive nomination process. Our committee has the responsibility to assess whether Dr. Holsinger can serve effectively as surgeon general for all Americans."
House Democrats set the stage for the hearing, which is expected to be contentious, by publicly interviewing Dr. Richard Carmona, the surgeon general from 2002 to 2006, who claimed that the Bush administration suppressed public health information because of the administration's conservative ideology.
"The vetting was done by political appointees who were specifically there to be able to spin, if you will, my words that would be preferable to a political or ideological preconceived notion that had nothing to do with science," Carmona testified.
White House spokesman Tony Snow Wednesday told reporters that "nobody, as far as I could tell, was 'muzzling' him. But on the other hand, there is certainly nothing scandalous about saying to somebody who was a presidential appointee, you should advocate the President's policies."
Former Surgeon Generals Cry Political Interference
Other surgeons general -- Dr. David Satcher, who served in that role under President Clinton, and C. Everett Koop, who served under President Reagan, also told stories about political interference.
"Mr. Reagan was pressed to fire me every day, largely because of my work on AIDS, but he would not interfere," Koop testified. "Over the years since I left office I've observed a worrisome trend of less than ideal treatment of the surgeon general, including undermining his authority at times when his role and function seemed abundantly clear. Clearly, the surgeon general must be free to serve the American people without political interference."
What Democrats seem to fear is that Holsinger is precisely the kind of doctor who wouldn't need any political interference since he already is guided more by political considerations and theology than science. Some conservative groups, however, are also opposed to Holsinger's nomination, because in 2002 he spoke in favor of embryonic stem cell research. A White House spokeswoman said that Holsinger no longer feels the same way because of advances in stem cell research that does not involve human embryos.
White House Stays Mum
Beyond that, the White House has generally not addressed the controversy.
Holly Babin, a spokeswoman for the Department of Heath and Human Services -- the agency that will take the lead on trying to achieve Holsinger's confirmation -- insisted that the paper was by no means reflective of Holsinger's thinking.
"That paper was a survey of scientific peer-reviewed studies that he was asked to compile by the United Methodist Church, it's not that he was saying 'this is what I believe,'" Babin said. "It's a reflection of the available scientific data from the 1980s. It should be noted that in 1991, homosexuals were banned from the military and several years before that, homosexuality and Haitian nationality were considered risk factors for HIV/AIDS. Over the last 20 years, a clearer understanding of these issues has been achieved.
Asked about medical experts who disputed that Holsinger's paper expressed opinions timely in 1991 and pressed to explain what Holsinger's views on homosexuality are currently, Babin said, "We look forward to the confirmation process, where we can share Dr. Holsinger's qualifications and views."