"I've had the rare opportunity to live my life in the company of a remarkable group of women," Dr. James Holsinger, the former chief medical director of the Veterans Health Administration, told a Senate committee yesterday morning. The soft-spoken Kentucky cardiologist, who President Bush has nominated as surgeon general, gestured toward his 98 year old mother, his wife, and their four daughters, all in attendance.
Later, when Sen. Barbara Mikulski of Maryland asked Holsinger if he had changed since the early 1990s, when he resisted accountability at the VHA even after female vets reported a lack of access to care and staffers at an Atlanta hospital were found guilty of egregious sexual harassment, Holsinger responded with the non sequitur, "I have mentored women throughout the past 15 years. There are a number of women who come to me because they feel I am willing to do that. ... I have the joy of working with them on a daily basis."
Greeted outside the Dirksen Senate Office Building by chanting Planned Parenthood protesters and inside the hearing by HIV/AIDS advocates opposing his nomination, Holsinger knew he'd have to defend himself against charges of misogyny and homophobia. But he also had to convince Democratic senators on the Health, Education, Labor, and Pensions Committee -- Mikulski, Chairman Ted Kennedy, Sherrod Brown, Bernie Sanders, and Patty Murray -- that he was capable of independence from the Bush administration's corrosive influence on the federal bureaucracy.
Since his May nomination to the post, Holsinger has been at the center of a growing storm of criticism focused on his participation in United Methodist Church activities. As part of a church committee studying homosexuality in the late 1980s and early 1990s, Holsinger authored a paper -- maligned by Sen. Kennedy yesterday morning as "wholly unscientific, biased, and incredibly poor scholarship" -- that ignored medical consensus to argue that homosexuality is unnatural and unhealthy, a view rejected by the American Psychological Association in 1973. Holsinger wrote in 1991 that the anus is not anatomically "complementary" to the penis, and thus gay sex is more likely to spread infections. But the paper ignored risky sex practices of heterosexual couples.
On the Methodist committee, Holsinger was part of a minority that believed homosexuality could not be part of a moral, Christian lifestyle. Yesterday he assured the Senate committee that his views on homosexuality have changed over time: "The issue is very different today. ... The paper does not represent where I am today, it does not represent who I am today," he said, recalling that in 2002 as chancellor of the University of Kentucky Medical Center, he supported students' rights to hold a conference on lesbian women's health, despite intense political pressure. But as late as 2000, according to hometown paper the Lexington Herald-Leader, Holsinger voted with other members of the United Methodist Church's Judicial Council that a lesbian could not be a minister and a gay man could be denied church membership.
Concern over Holsinger's ideology only intensified after former Surgeon General Richard Carmona revealed to Congress on Tuesday the extent of the Bush administration's politicization of the surgeon general's office. Carmona said the administration banned him from publicly discussing emergency contraception, sexual education, mental health, and public health, and also required him to name-drop the President three times on each page of public speeches.
"What happened to Dr. Carmona frankly sounds more like what would happen under a Stalinist dictatorship than what would happen under American democracy," thundered Sanders, the fiery liberal senator from Vermont.
But pressed and pressed again on his ability to withstand political pressure, Holsinger eked out little more than mealy-mouthed promises to seek "compromise." What would you do if the administration asked to edit your speeches, asked Murray? "I would sit down and talk through what were the issues they wanted to be edited," Holsinger said. But Sanders was skeptical. "No matter how qualified you are, Dr. Holsinger, the administration might not allow you to do your job."
The primary day-to-day responsibility of the surgeon general is to lead the Public Health Service Commissioned Corps, comprised of 6,000 medical professionals who are deployed to tackle public health issues ranging from serving disadvantaged populations to responding to emergencies such as Hurricane Katrina. But the position has also traditionally provided a megaphone to educate the public about health problems such as smoking and the AIDS crisis. And as Bill Clinton-appointed Surgeon General Joycelyn Elders learned when she said teen masturbation was healthy, that megaphone can be a lighting rod for criticism when it's used to discuss sex.
In front of the committee, Holsinger laid out a non-controversial three-pronged agenda of better preparing medical responders for national emergencies, fighting childhood obesity, and continuing to call attention to the risks of tobacco use. He did tepidly endorse condom use, calling it "an important approach to unintended pregnancy" that should be available to teenagers alongside calls for abstinence. And he supported stem cell research -- a position that earned him the ire of the Family Research Council and other conservative groups that initially supported him -- though he would not comment on whether Bush's restrictions on federal funding for new stem cell lines should be lifted. Holsinger even spoke rather eloquently about the need for universal health care and a national electronic medical record-keeping system. As head of the VHA, Holsinger presided over "the largest socialized medical system in the world," he laughed, with none of the usual conservative derision.
But there's no reason to think Holsinger would champion these much tougher issues in front of the American public. He's a Bush appointee. And we all know what that means.
