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…