Department of Health and Human

Department of Health and Human Services: A department of controversy

Ideally, medical science and health policy should be objective disciplines. They should attempt, in the words of the mission statement articulated on the website of the Department of Health and Human Services to improve the health, safety, and well-being of Americans everywhere. However, health policy has been rife with controversy, as it touches upon some of the most intimate aspects of human life, from diet, to drug use, to sexuality. But as the HHS department functions as a cabinet-level office with a secretary chosen by the sitting U.S. President, HHS has often found itself embroiled in controversy. The history of this bureaucratic department highlights how politics and health can never be severed. Although theoretically less directly politically influenced than the presidentially-appointed HHS Secretary, even the Center for Disease Control (CDC) and the Food and Drug Administration (FDA) have been far from immune from controversy.

The complex breakdown of the department manifests the diverse interests that exist within its framework, some of which are more directly answerable to elected officials than other aspects. Basically, the U.S. Department of Health and Human Services has two types of operating divisions: the Human Services and the Public Health Service Operating Divisions. The Public Health Service Operating Divisions includes the National Institutes of Health (NIH), which is widely respected as "the world's premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer's, diabetes, arthritis heart ailments and AIDS"(Definition of HHS, 2008, Medicine Net).

However, the agencies under the umbrella of the HHS also include the Food and Drug Administration (FDA) which monitors the safety of foods and cosmetics, as well as safety and efficacy of pharmaceuticals, biological products and medical devices. The FDA remains one of the most controversial agencies administered under HHS, as it has been alternatively accused of 'foot-dragging' in terms of approving medication for certain diseases, such as AIDS, but also of being overly beholden to the interests of large drug companies (Definition of HHS, 2008, Medicine Net). Recently many have criticized the FDA as being overly hasty in approving certain psychotropic drugs for adolescents and children. In 2004, FDA was accused of 'back-peddling' when it asked drug makers like Pfizer and Eli Lilly to include detailed warnings alerting doctors and consumers to watch for suicidal tendencies, agitation and hostility in patients using antidepressant medications. "The new warnings cover[ed] Prozac, Paxil, Zoloft, Effexor, Celexa, Lexapro and Luvox -- known as serotonin reuptake inhibitors (SSRIs) - as well as Wellbutrin, Serzone and Remeron, which are a different class of drugs" (Metrick 2004). But patient advocacy groups, such as the Alliance for Human Research, said the new labeling was overly "equivocating and ambiguous," and noted the FDA had possessed the data it used for drawing up the new warnings its files for years meaning either it "didn't warn the public in order to shield the industry" or it was "incompetent"(Metrick 2004).

In 2006, the Union of Concerned Scientists (UCS) released the results of a survey that demonstrated what it called "the pervasive political influence on science at the FDA" (FDA under fire for corporate links that compromise science, 2006, ISIS). The results indicated "almost one fifth of scientists (18.4%)" said that they had been asked or pressured "for non-scientific reasons to inappropriately exclude, or alter technical information or their conclusions in FDA scientific documents....This response echoes previous public complaints made by FDA scientists who said that their findings on the painkiller Vioxx produced by Merck & Co were dismissed," although later research indicated Vioxx was linked to a doubling of heart risk to the users and that the drug was no more effective than over-the-counter medications such as Advil, which has no such risk (FDA Under Fire for Corporate Links that Compromise Science, 2006, ISIS).

There are also many conflicts of interest in terms of issuing dietary recommendations for Americans, which also falls under the FDA's sphere of influence in advising Americans about how to preserve their health. For example, another cabinet-level, politically appointed secretary, of the Department of Agriculture, advocated the continued subsidization of corn during the current and previous administrations, but high-fructose corn syrup (HFC) has been linked to an increase in obesity. This placed the Department of Health and Human Services and the FDA in a difficult position of potentially contradicting the policies of the Department of Agriculture if it advised Americans to eat less HFC. Also, the Department of Agriculture has indirectly subsidized cattle farmers by helping them "buy grain for less than it costs to grow it," and F.D.A. approved the routine use of antibiotics in feed, enabling calves to eat corn earlier than they might normally, and grow fatter quickly -- and to be shipped more quickly to market (Pollan 2008, p.5). But corn-fed beef is more likely to develop e.coli, and put human health at risk, even while people are able to eat cheaper beef.

Additionally, in regards to the obesity crisis, the new 2005 FDA food pyramid, because of political pressures, has no 'eat less' messages, only to 'eat more' health foods -- as in eat more low-fat dairy foods, low-fat beef, and whole grains. To suggest calorie restriction, which is a necessary component of weight loss and maintaining a healthy weight, would offend the political lobbying efforts of many farmers, as well as the meat and dairy industries which fear such advice would hurt their bottom line. All of these interest groups wield considerable financial and political influence in all levels of government. "Today most federal messages about food, from nutrition labeling to the food pyramid, are negotiated with the food industry" (Pollan 2008, p.8). The only way to buffet the FDA against industry pressures would be for the surgeon general to entirely take over from the Department of Agriculture the job of communicating with Americans about their diet rather than to issue guidelines in consort with other politically-appointed and influenced departments in the administration's cabinet (Pollan 2008, p.8) Although "the Centers for Disease Control estimates that one in three American children born in 2000 will develop Type 2 diabetes," the government does not favor any types of foods or other foods because of political pressures (Pollan 2008, p.8).

This statistic brings to light another branch of the HHS often embroiled in controversy, namely the Center for Disease Control and Prevention. The CDC attempts to monitor and prevent the outbreak of diseases, and maintains national health statistics. Its mission includes both life-threatening as well as routine diseases: curtailing a potential avian flu pandemic as well as the usual winter spikes in the influenza virus are both part of its mission, as are issuing recommendations for who and when individuals should be immunized for common preventable diseases in childhood and later in life. This aspect of the CDC's mission has come under fire. There are reported links between autism and the commonly given childhood vaccinations for measles, mumps, and rubella although mainstream medical literature says such studies are unsubstantiated testimony. Fears have caused a resurgence of these ailments, which were once thought to be virtually extinct in America. "The Centers for Disease Control and Prevention (CDC) says 131 people were infected with measles (also called rubeola) in 15 states from January to July this year alone -- and 2008 isn't even over. That's more than twice the number of cases (63, on average, each year) from 2000 to 2007....A concern weighing on many parents' minds when it comes to vaccines is autism and the MMR vaccine that protects against measles, mumps, and rubella (German measles). But study after study has found no scientific evidence that autism is caused by any single vaccine, combination vaccines (like the MMR vaccine), or the mercury-containing preservative thimerosal, which was once widely used in many childhood vaccines (including MMR) but has since been eliminated...The controversial 1998 study that originally started the debate by suggesting a link between the MMR vaccine and autism was retracted -- or thrown out -- in 2004, long after it had been rejected by many major health organizations. But the study and the attention it received influenced parents worldwide and contributed to a decrease in immunization rates" (Dowshen 2008). The CDC has been striving to educate parents about the safety of vaccinations to reduce the spread of dangerous but preventable childhood illnesses, but many parents still ignore its advice.

The CDC's mission has become international in scope. "Recognizing the cross border nature of some communicable diseases and in light of this nation's constitutional structure, section 361 of the Public Health Service Act (42 United States Code section 264) authorizes the Health and Human Services (HHS) Secretary to make and enforce regulations necessary to prevent the introduction, transmission, and spread of communicable diseases from foreign countries into the United States and from one state or possession into another" (Misrahi, Foster, Shaw, & Cetron 2004). HHS has sought to increase its ability to quarantine individuals with highly communicable diseases. In 2000, FDA transferred a portion of its domestic quarantine authority regarding human beings to CDC, although the FDC retained its ability to quarantine or exclude animals and other products that may transmit or spread communicable diseases from entering the nation's borders (Misrahi, Foster, Shaw, & Cetron 2004). In 2002, "President Bush signed into law the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which, among other things, eliminated the need to convene an advisory committee to amend the list of diseases" listed as quarantineable (Misrahi, Foster, Shaw, & Cetron 2004).

This law became significant during the SARS scare. Before 2002 "the list of federal quarantinable diseases in the United States had not been revised since 1983. It included cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, and viral hemorrhagic fevers such as Marburg, Ebola, and Congo-Crimean" fevers (Misrahi, Foster, Shaw, & Cetron 2004). The CDC was able to quickly ad SARS to the list. In the past, the CDC "generally deferred to state and local health authorities...to restrict the movement of persons within their boundaries" with such diseases (Misrahi, Foster, Shaw, & Cetron 2004). Its greater legislative ability to move quickly in classifying the illness as requiring extraordinary measures to quarantine individuals or exclude them from entry into the country was cited as a reason SARS did not reach the proportions it did in the Far East. Additionally, a comment that a "lesson learned from the outbreak is that federal, state, and local officials will have to work closely in coordinating quarantine actions at all levels of government" with HHS departments might behoove the HHS to heed in other areas of its operation such as the FDA's issuance of dietary guidelines (Misrahi, Foster, Shaw, & Cetron 2004).

A further agency under the control of the HHS is the Agency for Toxic Substances and Disease Registry. This Agency works with states and other federal agencies, to prevent exposure to hazardous substances from waste sites, often in conjunction with the U.S. Environmental Protection Agency. Yet again, the extent to which human health is affected by substances produced by powerful corporations and the burning of fossil fuels and global warming may embroil aspects of HHS's auspices in controversy, especially when it is in conjunction with other agencies (Definition of HHS, 2008, Medicine Net)..

Another part of the HHS that has been the subject of recent debate is that of the Health Resources and Services Administration -- HRSA helps provide health resources for medically underserved populations (additionally the Indian Health Service provides a similar array of social services and cares to individuals in need of Native American ancestry). Issues pertaining to sexuality are often affected in this aspect of the HHS's work. For example, quite recently the Bush Administration issued a statement that expanded the ability of health care workers, hospitals, and health insurance companies to refuse to provide health services for "sincere religious belief or moral convictions" (DeNoon 2008). HHS issued the press statement which defended the new policy covering an estimated 571,947 health provision entities including doctors' offices, pharmacies, hospitals, insurers, medical and nursing schools, diagnostic labs, nursing homes, and state governments agencies that provide health care.

The Bush Administration, an admitted foe of abortion, was viewed by many women's groups as using the policy to limit the reproductive right of choice. Even the American Medical Association decried the new Bush law noting that it: "expands the range of health care institutions and individuals who may refuse to provide services, and broadens the scope... beyond the actual provision of health care services to information and counseling about health services as well as referrals" (DeNoon 2008). The American Medical Association AMA was also worried that the new protections were so broad in terms of who was defined as a health care provider that receptionists could refuse to schedule patients for medically necessary services, and people who "clean or maintain equipment or rooms" could interrupt patient care if they claimed the treatment went against their conscience (DeNoon 2008). To repeal the rule, the incoming Obama administration could act on its own, or Congress could take the initiative pass a law repealing the rule. Regardless, this is an illustration of how the policy of the HHS is affected, some would say, tainted with politics. The FDA in the past was subject to similar political criticism from anti-abortion advocates when it approved Plan B, an emergency contraceptive method known as the 'morning after pill' opposed by anti-abortion activists who disliked the fact it would prevent a fertilized embryo from anchoring in a mother's womb (Johnson 2006).

Thus health advice is never politically or socially 'neutral' when disseminated through the law or a government agency like HHS. Take even the seemingly noncontroversial subject of breast-feeding babies. In 2004, HHS was pressured to end its advertising campaign warning that not breastfeeding could hurt a newborn's health. "It featured striking photos of insulin syringes and asthma inhalers topped with rubber nipples," implying that not breast-feeding is linked to babies that are more likely to develop obesity and Type II Diabetes as well as asthma later in life (Kaufman & Lee, 2008, p.1). "Plans to run these blunt ads infuriated the politically powerful infant formula industry, which hired a former chairman of the Republican National Committee and a former top regulatory official to lobby the Health and Human Services Department. Not long afterward, department political appointees toned down the campaign" (Kaufman & Lee, 2008, p.1). The formula industry's influence to change the advertisement's content eventually subjected HHS to scrutiny by Congress, which felt that the "administration repeatedly allowed political considerations to interfere with his efforts to promote public health" (Kaufman & Lee, 2008, p.1). The "campaign HHS used did not simply drop the disputed statistics in the draft ads. The initial idea was to startle women with images starkly warning that babies could become ill. Instead, the final ads cited how breast-feeding benefits babies -- an approach that the ad company hired by HHS had advised would be ineffective. The department also pulled back on several related promotional efforts" (Kaufman & Lee, 2008, p.1).