Surgeon general nominee on hold

"Dead in the water"

By Justin Thompson

Scripps Howard News Service

October 15, 2007

WASHINGTON - Three months after Dr. James Holsinger answered some sharp questions from senators, his nomination to be the next surgeon general appears to be on life support.

The 68-year-old Kentuckian, whose critics cried foul about a paper he wrote years ago condemning homosexual sex, needs Senate confirmation to become the nation's 18th surgeon general.

Melissa Wagoner, a spokeswoman for Sen. Edward M. Kennedy, D-Mass., who chairs the Health, Education, Labor and Pensions Committee, said members are waiting for the nominee to answer follow-up questions. Wagoner said she could not release the questions while Holsinger continues to work on them.

Craig Orfield, the committee's communications director, said he knows of no date for a vote.

A spokeswoman for the White House said Holsinger is working on the questions but could not say when he would respond.

The questions are related to his views on homosexuality, his record at the Department of Veterans Affairs and his plans to deal with childhood obesity, which he said would be his highest priority as surgeon general, speculated Rebecca Fox, director of the National Coalition for LGBT Health, which works on lesbian, gay and bisexual health issues.

Jerry Farrell, executive director of the Commissioned Officers Association of the U.S. Public Health Services, said that Holsinger's prospects for confirmation appear dim, despite the nominee's "tremendous service" to public health.

"From the tea leaves that I am reading, there is not a lot of interest in getting a vote," he said.

His organization has neither opposed nor endorsed Holsinger's nomination, Farrell said.

He would not speculate on whether Holsinger might remove his name from consideration or if the administration might ask him to do so.

He said he expected that Dr. Steven Galson, who has served as acting surgeon general for the last three months, would continue in that role through the end of the year.

The president has the option of appointing Holsinger after Congress adjourns later in the fall; the White House would not comment on that possibility.

Fox, an outspoken critic of Holsinger's nomination, said she hopes the president will refrain from using that power, as he did in August, and wait for Holsinger to respond to the committee's questions.

Some of Holsinger's opponents said the White House might support him in theory, but in practice, has done little to move him closer to becoming surgeon general.

"They're not pushing to get this through," said Becky Dansky, federal legislative director for the National Gay and Lesbian Task Force.

"It's kind of dead in the water at this point."

But the Bush administration said it has not reconsidered its endorsement of Holsinger.

"The White House certainly still supports him," said Emily Lawrimore, a White House spokeswoman.

Senate Minority Leader Mitch McConnell, R-Ky., of Louisville, who introduced Holsinger to the committee in July, said then that the nomination is "the right prescription to help America confront today's health challenge." This week, a McConnell spokesman said that the Louisville Republican continues to support Holsinger.

McConnell's fellow Kentucky Republican, Sen. Jim Bunning of Southgate, also championed Holsinger at the hearing, but has since remained silent. A spokesman for Bunning said the senator remains steadfast in his support.

Unfortunately for Holsinger, neither McConnell nor Bunning is a member of Kennedy's committee, and Sen. Michael Enzi, R-Wyo., the committee's ranking Republican, has not said how he would vote.

Holsinger has served in government medical positions before, as Kentucky health secretary and as chief medical director of the U.S. Department of Veterans Affairs.

The president tapped Holsinger in May to replace former surgeon general Dr. Richard Carmona, who resigned in August 2006 after complaining that the White House stymied his attempts to speak about stem-cell research and the psychological trauma faced by 9-11 responders.

When Holsinger appeared before the Senate committee, he tried to allay concerns about the controversial paper he wrote in 1991 for the United Methodist Church's committee to study homosexuality.

In "Pathophysiology of Male Homosexuality," Holsinger contended that homosexual sex was neither natural nor healthy.

At the hearing, Holsinger portrayed the report as a literature review of previous reports. Some of the authors of those reports accused Holsinger of misconstruing facts.

The Human Rights Campaign, a gay-rights advocacy group, the AIDS Healthcare Foundation, People for the American Way, the National Coalition for LGBT Health and the National Gay and Lesbian Task Force denounced his nomination because of the paper.

Holsinger, who declined to comment outside of the hearings, has spent the time since his nomination 500 miles from the political battle, at the University of Kentucky's College of Public Health in Lexington. There, he teaches classes on health care ethics, health services leadership and health care management.

Stephen Wyatt, the College of Public Health dean, described the surgeon general nominee as "very active" outside the classroom, mentoring junior faculty, consulting and chairing committees.

Wyatt has worked with surgeons general before. From 1980 to 2000, he held several positions in the Centers for Disease Control and Prevention, including deputy center director.

"None of the folks I worked with would be stronger than Dr. Holsinger," he said.

Wyatt has prepared for a replacement professor in case the Senate confirms Holsinger, but he said he has no idea if or when that might happen.

Dansky puts those chances at "slim to none." Three of the Democrats on the committee - Democrats Barack Obama of Illinois, Hillary Clinton of New York and Chris Dodd of Connecticut - seem unlikely to vote to confirm Holsinger and risk a backlash from gay and lesbian voters against their presidential campaigns, she said. And Kennedy has a record of voting for gay and lesbian rights.

Other committee members, including Sens. Sherrod Brown, D-Ohio, and Barbara Mikulski, D-Md., have not publicly announced how they would vote, though Brown and Mikulski questioned Holsinger aggressively during the hearing.

Mikulski clashed with him when he was the VA's chief medical director, accusing him of being apathetic toward what she called the system's mistreatment of women.

"There is no reason to think he is going to make it out of committee," Dansky said.

"The votes just aren't there."

See other LifeLube posts on this topic.

Clinton, Obama to vote against Holsinger for post

Read the whole Washington Blade story here.

“Because of the questions that have been raised about Dr. Holsinger’s qualifications and ability to fulfill the duties of the job, I do not believe that he will be able to provide adequate leadership in the public health field as Surgeon General, and I must go on record as opposing his nomination,” Clinton said in a statement.

In a statement released on June 7, Obama said, “America’s top doctor should be a doctor for all Americans, and so I have 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.”

Dr. Dodgy

Editorial via the Washington Post

A surgeon general nominee does little to quell concern about a paper on gay men.

DR. JAMES W. Holsinger Jr. wants to be the next surgeon general of the United States. On paper, he's nearly perfect. His distinguished career spans nearly 40 years in Kentucky and Washington, D.C. If confirmed, Dr. Holsinger said, his three priorities would be combating smoking and childhood obesity and improving how the public health system responds to emergencies -- excellent goals. But his prurient 1991 paper for the Methodist Church on what he imagined to be the sex lives of gay men has gummed up his effort to become the nation's top doc.



The hope was that his confirmation hearing last week would bring some clarity to Dr. Holsinger's views on homosexuality. No such luck. Instead, he expressed his "deep appreciation for the humanity of everyone, regardless of their personal circumstances or their sexual orientation." That's excellent, but it doesn't answer the question.



"Pathophysiology of Male Homosexuality" is a six-page romp through sexual practices that would be extreme for anyone regardless of sexual orientation. Yet Dr. Holsinger ascribed these practices to all gay men and decreed that the practices marked all homosexuals as promiscuous and diseased. The idea that two people of the same sex could establish a relationship based on love was never broached. Instead, he concluded his NC-17 report by saying the hardware store popularity of male and female pipe fittings proves the primacy of heterosexuality.



Sen. Edward M. Kennedy (D-Mass.) did his best to show that the scientific underpinnings of Dr. Holsinger's report were beyond weak. He pointed out that one physician whose work was featured wrote him to complain of the paper's "unscientific, biased, and incredibly poor scholarship." Mr. Kennedy said it "cherry-picks and misuses data"; for instance, much of the information was culled from "emergency room and trauma studies" -- hardly a representative sample of gay men.



Dr. Holsinger struck a that-was-then-this-is-now pose. "The paper does not represent where I am today," he said. Fine. But the question remains: Does Dr. Holsinger still believe that homosexuality is unnatural and unhealthy? If the answer is yes, he should not be confirmed.


Read the infamous 1991 paper here.


Link to other LifeLube posts on this topic here.

Pathophysiology of Male Homosexuality, i.e. Gay Sex is EWWWWWWW

by Curt Hicks (thanks for this Curt!!)

Here is Holsinger's infamous paper. In it, he displays a rather obsessive focus on gay men who engage in anal sex. Despite the theological concern he is addressing for a United Methodist Church committee being equally applicable to lesbian women, he oddly limits his paper solely to male homosexuality.

Holsinger's pathologizing of homosexuality relies heavily on the distinctness of the human alimentary and reproductive systems. "There is absolute consensus in the scientific community concerning the structure and function of the human alimentary and reproductive systems. These two systems are absolutely separate since the human does not possess a cloaca." And yet, oral sex--which also connects those two systems for sexual pleasure--somehow fails to rate even a mention.

Holsinger demonstrates remarkably selective attention in detailing maladies that can befall MSM, citing research conducted in the early and mid-eighties when MSM condom use and access to gay-friendly STD treatment were both rare. Though not one of the conditions he mentions are unique to homosexuals, he cites each as evidence of homosexuality's pathogenicity, failing to consider that his own arguments condemn heterosexuality too. "From the perspective of pathology and pathophysiology, the varied sexual practices of homosexual men have resulted in a diverse and expanded concept of sexually transmitted disease and associated trauma. Four general groups of conditions may be encountered in homosexually active men: classical sexually transmitted diseases (gonorrhea, infections with chlamydia trachomatis, syphilis, herpes simplex infections, genital warts, pubic lice, scabies); enteric diseases (infections with shiggella species, Campylobacter jejuni, Entamoeba histolytica, Giardia lamblia, hepatitis A, hepatitis B, hepatitis non-A, non-B, and cytomegalovirus); trauma (fecal incontinence, hemorrhoids, anal fissure, foreign bodies, rectosigmoid tears, allergic proctitis, penile edema, chemical sinusitis, inhaled nitrite burns, and sexual assault of the male patient); and the acquired immunodeficiency syndrome (AIDS, Owen, 1985) ."

Holsinger closes by citing plumber slang as evidence of the clear and distinct superiority of heterosexuality. "In fact, the logical complementarity of the human sexes has been so recognized in our culture that it has entered our vocabulary in the form of naming various pipe fittings either the male fitting or the female fitting depending upon which one interlocks within the other. When the complementarity of the sexes is breached, injuries and diseases may occur as noted above."

Our myopic nominee seems to be assuring those who strictly observe the complementarity of the sexes that they can count themselves safe from STD's, enteric infections, sexual or drug-related trauma, rape, and AIDS.

What a relief!

Former Surgeon General Says He Was Muzzled

By REUTERS Filed July 10, 2007 at 4:25 p.m. ET WASHINGTON (Reuters) - The first U.S. surgeon general appointed by President George W. Bush accused the administration on Tuesday of political interference and muzzling him on key issues like embryonic stem cell research.

"Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried," Dr. Richard Carmona, who served as the nation's top doctor from 2002 until 2006, told a House of Representatives committee.

"The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science, or marginalizing the voice of science for reasons driven by changing political winds. The job of surgeon general is to be the doctor of the nation, not the doctor of a political party," Carmona added.

Carmona said Bush administration political appointees censored his speeches and kept him from talking out publicly about certain issues, including the science on embryonic stem cell research, contraceptives and his misgivings about the administration's embrace of "abstinence-only" sex education.

Carmona's comments came two days before a Senate committee is due to hold a hearing on Bush's nomination of Dr. James Holsinger as his successor. The administration allowed Carmona to finish his term as surgeon general last year without a replacement in place.

Gay rights activists and several leading Democrats have criticized Holsinger for what they see as "anti-gay" writings, but the White House has defended him as well qualified.

U.S. surgeons general in the past have issued influential reports on subjects including smoking, AIDS and mental health.

"Political interference with the work of the surgeon general appears to have reached a new level in this administration," said Rep. Henry Waxman, a California Democrat who chairs the House Oversight and Government Reform Committee to which Carmona testified.

"The public expects that a surgeon general will be immune from political pressure and be allowed to express his or her professional views based on the best available science," he said.

Carmona said he was politically naive when he took the job, but became astounded at the partisanship and manipulation he witnessed as administration political appointees hemmed him in.

Bush in 2001 allowed federal funding for human embryonic stem cell research, but only with heavy restrictions that many scientists condemn as stifling.

Carmona said the administration prevented him from voicing views on stem cell research. Many scientists see it as a promising avenue for curing many diseases. But because it involves destroying human embryos, opponents call it immoral.

Carmona said he was prevented from talking publicly even about the science underpinning the research to enable the U.S. public to have a better understanding of a complicated issue. He said most of the public debate over the matter has been driven by political, ideological or theological motivations.

"I was blocked at every turn. I was told the decision had already been made -- stand down, don't talk about it," he said.

Carmona testified with two predecessors, Dr. C. Everett Koop, who served under President Ronald Reagan, and Dr. David Satcher, named by Clinton but whose term ended under Bush.

Carmona said some of his predecessors told him, "We have never seen it as partisan, as malicious, as vindictive, as mean-spirited as it is today, and you clearly have worse than anyone's had."

A Nominee’s Abnormal Views

A Nominee’s Abnormal Views

Editorial in the The New York Times
Published: July 10, 2007

The Senate Health Committee will have to dig beneath the surface on Thursday to consider the nomination of Dr. James Holsinger to be surgeon general. Dr. Holsinger has high-level experience as a health administrator, but there are disturbing indications that he is prejudiced against homosexuals.

Though routinely called “the nation’s top doctor,” the surgeon general is a midlevel official who oversees the 6,000 uniformed professionals in the Public Health Service. His main mission is to serve as “America’s chief health educator,” with potentially enormous capacity to shape public opinion.

Dr. Holsinger served for 26 years in the Department of Veterans Affairs, where he rose to be chief medical director and under secretary for health. After retiring, he became chancellor of the University of Kentucky Medical Center and, briefly, secretary for health and family services in Kentucky.

Although he is a Christian conservative, he is difficult to pigeonhole ideologically. He testified against an anti-cloning bill in Kentucky that he felt would impede research, a position at odds with that of the president. He backed a session on lesbian health issues at a state health conference despite protests from angry legislators, favored raising cigarette taxes in a tobacco-growing state and worked to limit junk food in schools.

What’s troubling is the view he once expressed — and may still hold — on homosexuality, through his activities as a lay leader in the United Methodist Church. On the church’s judicial council, he supported a minister who refused to allow a gay man to join his congregation and argued that a lesbian minister should be removed because church doctrine deems the practice of homosexuality to be “incompatible with Christian teaching.” His supporters say these rulings should not be read as his personal views because the council can’t change church doctrine. However, some council members opposed his views, and the bishops later rejected one decision.

His strongest statement on homosexuality can be found in a murky, loosely reasoned paper that he wrote for a church committee in 1991. Titled “Pathophysiology of Male Homosexuality,” the paper purported to be a scientific and medical review. It argued that gay sex was abnormal on anatomical and physiological grounds and unhealthy, in that anal sex can lead to rectal injuries and sexually transmitted diseases. Dr. Holsinger did not brand the large number of heterosexual women who engage in anal sex as abnormal, failed to acknowledge the huge burden of disease spread heterosexually and implied that women are more likely than men to avoid injuries with generous lubrication.

The Bush administration says the white paper reflected the scientific understanding of the time, but it reads like a veneer of science cloaking an aversion to homosexuality. The committee should examine whether Dr. Holsinger cherry-picked the literature or represented it objectively. Most important, it must determine whether Dr. Holsinger holds these benighted views today. The Senate should not confirm a surgeon general who considers practicing homosexuals abnormal and diseased.

Other posts on this topic are here.