TOXIC POLITICS
Politicians were responsible for some of the most difficult problems we faced. Not all bullies end up in politics. But some do, and they find the rules favor the bully. The system is definitely stacked in favor of politicians and against workers in government programs. Testifying at a congressional hearing makes this clear. The room is set up to illuminate one part of the caste system in our society. Congressmen and senators sit on an elevated platform, always looking down on the witnesses. In a courtroom, having the judge elevated may be appropriate, but the practice seems like overkill in Congress—or at least an effort at false importance.
Some members of Congress would attempt to establish a sympathetic environment to let you know they were interested in the hearing or the problem at hand. But many established from the beginning that you were an enemy, as a government employee, and they, the politicians, had the most power.
Philip Zimbardo’s famous experiment at Stanford University demonstrated how quickly students who were assigned randomly to be guards or prisoners began to alter their behavior to actually live those roles. The power of being a guard caused good people to become abusive. Zimbardo’s book (1) applies the lessons learned in that classroom experiment to actual life situations with prison guards or with priests preying on children. He points out that these aren’t problems of “bad apples” but rather of “bad barrels,” in which the social situation alters the behavior of good people.
Not all politicians act out the power they have been given in unacceptable ways. Senators Dale Bumpers, Paul Simon, Mark Hatfield, Ted Kennedy, Bob Graham, Bill Lehman, and Richard Schweiker and Congressmen Paul Rogers and Henry Waxman never seemed to abuse their power. They demonstrated that it was possible to exercise the political role humanely and successfully.
One of the most extraordinary examples of genuine kindness happened one day when I was to testify in front of Senator Schweiker. A contentious problem was being discussed, and the room was filled, with standing-room only. As I stood in back waiting for a panel to finish testifying before I took my turn at the witness table, Senator Schweiker spotted me, sent an aide to ask me to follow him, and took me to sit next to him as the panel was questioned. It was uncomfortable for me, as the panel could see I was getting special attention and would soon counter their testimony, but it filled me with respect for the senator.
I watched my predecessor, David Sencer, absorb egregious political criticism over the Swine Flu Vaccination Program, as well as over the investigation of Legionnaires’ disease (see chapter 9). Congressman John Murphy of the 17th District of New York was unceasing in his criticism.
One congressman from the South, Congressman William Natcher, a fine and fair person at hearings in most regards, would start each appropriations hearing by asking me whether I knew Dr. Ted Cooper. I would answer that I did and that he oversaw the CDC in my earlier years, as the assistant secretary of health.
“Do you respect Dr. Cooper?” he would ask. I would say that I did.
“Is he recognized as being a good scientist?”
Yes he is, I would respond. He would then read a quote from Dr. Cooper taken many years earlier to the effect that he did not think smoking was a significant health problem. Having made his point for his tobacco-growing constituents, Natcher would then proceed with the appropriations hearing.
Some politicians seemed fair in many respects but were willing to make decisions against the health of people for their own personal gain. People who take a daily vitamin pill with breakfast assume it is safe and approved by the FDA. However, because of Senator Orrin Hatch, the FDA lost its ability to control vitamins and supplements with passage of the Dietary Supplement Health and Education Act of 1994. These products have no federal scientific oversight and are not required to use truth in advertising. A number of the nutritional supplement programs are based in Utah, Hatch’s home state, and in 2003, it was reported that Hatch owned shares in at least one nutritional supplement company. But Hatch was simply a leader. A majority had to vote with him to make this happen. It is a sad commentary on our elected officials and the influence they have on our lives.
My own theory is that we were fortunate to have such enlightened founding fathers. How could we have expected to get Washington, Jefferson, Adams, Franklin, and their ilk from such a small population base? And why do we not see that quality in politicians today? Perhaps because in the late eighteenth century, outlets for people with intellectual gifts were limited. They could go into teaching, theology, or politics. Now the opportunities are boundless for the curious and gifted. They can go into multiple fields of science, computing, teaching, theology, and business, to name a few. We are left with a diminished percentage of the gifted who find their passion in politics, and this may well be skewed toward those seeking attention who are also able to get financial backing. In that sense, as Lincoln Steffens asserted a century ago, representative government may be difficult to achieve.
Some politicians were more difficult to figure out. Congressman Ted Weiss represented much of Manhattan’s West Side and was very popular. Indeed, a federal office building on Broadway was named in his honor. His story is a typical American immigrant success story. His family fled the Nazis in 1938 for the United States. He grew up in New Jersey and received a law degree from Syracuse University. He became a naturalized citizen, worked for the district attorney in New York, and then entered politics. He was a strong supporter of civil rights. Nothing in his history would have predicted the problems he caused us.
Congressman Weiss asked to inspect our files on human immunodeficiency virus (HIV) and AIDS. Since he represented a district with many cases, it was natural that he would be interested in the problem. I informed him that we would accommodate his request, but it would take us some time to remove all identifiers, such as the actual names of AIDS patients. He then held a press conference to say that he suspected the CDC had information on AIDS that we were not sharing with him or the public. He asked whether he could send an assistant to the CDC to review our files on AIDS. I said he could but repeated that we would remove identifying information on the names of patients, and that we would do this for privacy reasons.
The investigator came and said that the congressman wanted the full files, including the names of patients. We stood firm and refused to release patients’ names. To my surprise, I received a letter from the congressman attempting to bully me into acquiescence; the letter stated that he was interested in the entire file, including the names of patients.
My refusal led him to another press conference, in which Weiss talked about my refusal to let Congress see the records, never mentioning that the contentious issue was his request for the names of AIDS patients. He simply said that he had asked for the whole file, and I insisted on redacting the files before sharing them. He then said he would call for a hearing at which I would be questioned. I decided on my approach but did not share what I planned to do with my superiors. At the hearing, I was accompanied by my supervisor, Ed Brandt, assistant secretary for health and a scientist of the highest ethical standards. The congressman started by castigating me and my lack of cooperation with Congress. He painted me in unflattering terms and then asked me for my statement.
I thanked him and then held up his letter to me and asked for his permission to include this letter (asking for the personal identifiers of people with AIDS) into the record of the hearing. Because other committee members were present, he could not refuse my request. The letter exposed his duplicity of asking for information on the names of persons with AIDS, while publicly denying that he had made such a request. This changed the tenor of the hearing.
Congressman Obey
Perhaps the most difficult of all congresspeople for me to deal with was David Obey from Wisconsin’s 7th District. With so many good qualities and his genuine interest in education, health, and the environment, he was nonetheless a bully.
I intended to put one of the CDC’s best scientists into a particular position when I received a call from Congressman Obey’s office to say that the scientist’s nomination would be a mistake. I did not know at the time that the scientist in question had once investigated an outbreak in Obey’s district and had given a statement to a reporter on his interpretation of the problem. The scientist was unaware that his interpretation was counter to what Congressman Obey had told the press. The congressman was not pleased.
I was next surprised to get word from Secretary Califano’s office requesting that I withdraw the scientist’s nomination. My concern was that the administration should not allow congressional influence on personnel decisions within agencies. Congress has a quite different responsibility for high-level positions in departments. I did not heed the request and was told again, by an assistant to Secretary Califano, to withdraw the nomination.
When I again refused, the secretary asked to see me. I never feared being fired. Because I always knew I could return to the field of global health, I could separate scientific decisions from personal ramifications. Nonetheless, it is anxiety-producing to know you are about to be reprimanded. I entered his office, knowing it would not be pleasant but also believing that a principle was involved. The secretary had just completed a run and was in sweat clothes with his feet propped up on the desk.
He said, “I have asked my staff to ask you to withdraw the nomination, and there has been no action. What is the problem?” Recall that I had not sought this job. I was enjoying it but would enjoy other things also. So I replied, “The problem is that I know the difference between right and wrong, and your staff is trying to get me to do wrong.” His feet immediately hit the floor; he sat up and said, “Let’s hear your side of the story.” Secretary Califano was a demanding boss in many ways because he expected everyone to work as hard as he did. But he was a good boss. You could expect his full support on projects of importance, and he showed himself to be, above all, fair.
When I finished, he said he understood and would not force me to do that. But he said that he had a friendly relationship with Obey and therefore could not help me. I would be on my own. I said I understood … but perhaps I didn’t.
Sometime later, I received a call directly from Congressman Obey. He was angry. He was not calling me to discuss the situation. He was calling me with a naked threat. He said, “I will get you, and I will get the CDC. If you think I can’t do that, wait until you come up for your next appropriations hearing.”
The hearing was everything Obey said it would be. The CDC hearing was supposed to be two hours long, followed by an appropriations hearing for the Health Services Administration. When I realized how hard it was going to be, I decided to simply bear it but to avoid letting Obey see me get rattled or angry. So I just answered his questions, as inane as they became.
“How much does the CDC spend on printing each year?”
My response was, “I don’t know the figure but will get it and provide it for the record.”
“You mean you are the director of the CDC and you don’t know how much you spend on printing?”
“That’s right, but I can get the information for the record.”
And so it went, question after ridiculous question, for the next four hours. He called a break for lunch and said we would continue after lunch.
Meanwhile, Dr. George Lythcott, director of the Health Services Administration and the former chief of the CDC Regional Office in Lagos, Nigeria, had appeared for his hearing, sat through two hours of my hearing, and could not figure out what was going on. At the break for lunch, George asked me, “What in the world is happening?”
I reassured him that Congressman Obey would be docile by the time George testified. I told George, with much sarcasm, “I think I have him on the run.” Indeed, I did. You cannot continue to ask such questions without your colleagues on the committee beginning to wonder about your motives. But it always made me wonder whether he knew how much trouble he was causing.
Next, I heard from an influential health leader that Congressman Obey had informed him that I was the single biggest threat to disease prevention in the United States. We have some major threats, such as tobacco, but now I was being classified as even worse than tobacco.
Politics and NIOSH
But this bizarre story was not yet complete. The National Institute for Occupational Safety and Health (NIOSH) was a division of the CDC. It was the most political program in the CDC at that time because workers were interested in safer working conditions and corporations were interested in profit. It often came down to management versus labor, and both groups would lobby Congress. Congress therefore had an interest in this program that it might not have in most CDC programs.
The program headquarters were located in Washington, DC. And while NIOSH included fine scientists with many working in other locations, it was subjected to political forces that often made it difficult to use the science fairly.
I became convinced that NIOSH headquarters should be moved out of Washington for a number of reasons. The first was to get the headquarter’s staff away from the political pressures that seemed inherent in that location. A second reason was to provide synergy with the Center for Environmental Health. The issues for the two programs were similar, except that one had to do with the time on the job and the other with the time off the job. Both dealt with injuries and chemical exposures, for example. It was my hope that in the future the two programs would actually be merged. It made scientific sense to avoid duplication of effort. That could not happen until NIOSH became less political and the Center for Environmental Health became stronger and more robust.
Dr. Julius Richmond, the assistant secretary for health, was sympathetic but could not see a way to do it. When Ed Brandt became assistant secretary for health in the Reagan administration, he reexamined the issue and became strongly convinced that NIOSH should be housed in an area of science rather than in an environment of politics.
The NIOSH staff was strongly resistant to the idea of moving their headquarters to Atlanta. Another scenario was developing at this time. It involved an attempt by some politicians and some NIOSH staff to move the institute to NIH. Since NIH headquarters were already in the Washington area, if NIOSH answered to NIH, attempts to move NIOSH headquarters to Atlanta would be halted.
Several leadership changes at NIOSH complicated the issue. Director Jack Finkle resigned in March 1978. J. Donald Millar was acting director for a year until Tony Robbins took the position in 1979. After Robbins left, Millar became the permanent director in 1981. He provided solid, long-term leadership to NIOSH and made it a better organization.
Before Millar became director, the attempted move to NIH became serious. We learned that NIOSH staff members were working with Congressman John Dingell, who had agreed to take the lead to get NIOSH moved to NIH. We also learned that Dingell planned to bring it up as an incidental floor motion; this move would take people by surprise and would minimize opposition. The decision would be made before we would know the issue was going to be raised. We pretended to know nothing about these efforts, but Bill Watson, deputy director of the CDC, along with George Hardy, the CDC’s representative in Washington, lined up people who were willing to resist such a move. The problem was that we would have to know when the motion was coming to the floor to be sure those people were actually in the chambers. We were not quite sure how to determine that.
And then fortune blessed us. I was chairing a session in Texas at the American Public Health Association annual meeting. The session was the first item on the program that morning. Tony Robbins was supposed to be on the panel, but when I got there a few minutes early, I learned that Tony had been called back to Washington the night before. I went to a pay phone, called Bill Watson, and we guessed that this was the day for the floor motion. I returned to the panel in Texas, while Bill Watson put our plan into action.
We were correct. Dingell made the motion on the floor with some disparaging remarks about the CDC’s stewardship of the program. He then proposed righting this wrong by moving NIOSH to be supervised by NIH. But then, seemingly out of nowhere, various people surprised Dingell with forceful statements opposing the motion, and it went down in defeat. I had a chance to watch the proceedings later on CSPAN. The plotters had no idea why that plan was killed.
With the help of Ed Brandt, we began planning to move NIOSH headquarters to Atlanta. Those in Congress who wanted continual political input into occupational health issues were not about to let that happen.
Congressman Obey effectively killed the plan when he put a rider on the CDC appropriations bill specifically prohibiting the use of money to move NIOSH. He knew how to play the game, and we were neophytes. We appeared stymied.
I became acquainted with Senator Mark Hatfield of Oregon when he called me to his office to ask questions about the health problems of Africa. We continued to discuss a number of issues, and I regarded him as a wise and sensitive person. I asked his advice on the NIOSH move. When I explained the problem, he immediately agreed it was the right thing to do but said it would be very difficult to get around a savvy person like David Obey. But he said if we had our minds made up that this was the correct thing to do to improve health, and if we could have all the plans made to actually make the move, there would be a day when the CDC might have a continuing resolution regarding their appropriations. That would, for a short period of time, not include the restrictions inserted by Congressman Obey. If we could move fast during that window, it would be legal to do so, but of course we would have to be prepared for the political fallout of an angry Obey.
Sometime after this advice was given, a representative from Obey’s office, a public health professional, came to see us at the CDC. Clearly, he had been sent by Obey, but he presented himself as a public health professional wanting to help the CDC. He said he was well aware of the problems we had with Obey and that Obey had with us. He wanted us to understand that Obey was a power player. He knew how to use power and was unafraid to do so. “Someday,” he said, “he will be the chair of the Appropriations Subcommittee and then the full committee.” (This became true in 2006.) The representative for Obey went on to say that the “CDC’s budget at that time would be totally dependent on him.” He said that Obey was angry with me, but if I would make a public statement saying I was wrong and that I had decided against moving NIOSH, he thought Obey would reward the CDC with more resources.
During this discussion, Carol Walters brought me a note to say that Senator Hatfield was on the phone. I excused myself to take the call. Senator Hatfield told me that there would be a continuing resolution before the end of the week. This was our chance, but we didn’t know whether the continuing resolution would last for days or for weeks. I told Bill Watson, who got the process started to move NIOSH headquarters from Washington, DC, to Atlanta on the following Saturday.
I went back to the meeting and was much more congenial. I told the person how pleased I was that he took the time to give us his ideas and suggest some options. Now we would have to discuss the ideas and make some decisions. In my mind, I watched him going to the airport, calling Obey to say he thought he had convinced us.
NIOSH was moved that weekend, Obey fumed, and NIOSH became a better program as it entered a scientific environment and the opportunity to work with environmental health staff over the next years. As director, Don Millar brought no-nonsense science to the enterprise. I saw that a merging with environmental health was a possibility in the future to the benefit of public health.
But the future is hidden from us. Bill Clinton became president; he named Dr. Phil Lee as the assistant secretary for health (his second time in that position) and—after pressures in Washington, DC, that I don’t understand—Lee made the decision to move NIOSH headquarters back to Washington. I wrote Lee a memo on why a move back to Washington would once again compromise the health of Americans. He sent the memo to David Satcher, the new director of the CDC, with a personal note, asking Satcher to fix my unhappiness. It is not helpful for new directors to be plagued by old directors, so having expressed my concerns, I withdrew from the fight. Our hard-won victory was undone in a moment by politics, and David Obey won in the end. But public health did not win.