Science, Public Health and the Bush Administration:

Keroak Nomination Continues the Assault on Sound Public Health Policy


By Mark Edgar, Green Institute
Science Policy Initiative


Science and science-based
policymaking have been subverted to an unprecedented degree in recent years. At
a time when evidence-based practice has emerged as the ideal within public
health, medicine and other disciplines, ideologically driven policy makers have
silenced noted scientists, promoted unproven programs, packed scientific review
committees with ideologues and generally espoused a view so antithetical to science
and rationality that it has been reasonably described as an “American Disenlightenment”
(Phillips 2006).


The peril at which this type of
misinformed and willfully retrograde thinking places the public’s health can
not be overstated. The tremendous advances in public health and medicine over
the past 150 years are firmly rooted in the scientific approach to the natural
world. Future advances are dependent
upon continued application of the scientific approach. Perhaps more urgently,
current public health threats can only be avoided by the judicious use of the
same methods.


Yet the Bush administration has
consistently allowed religious ideology to trump sound science as documented in
a number of recent books (Mooney 2005; Schulman 2006), a congressional report
(Waxman 2003), two reports and a sign-on letter by the Union of Concerned
Scientists (UCS 2004) and an editorial in Scientific American (Scientific
American 2001). The litany of transgressions include: misguided policy
decisions (discontinuation of funding of international organizations that
provide information on legal abortions; rejection of the Kyoto Protocol);
suppression of scientific discourse (most notably on climate change); the
blatant dissemination of misinformation (the breast cancer–abortion link; dramatic
understatement of condom effectiveness); deliberate obfuscation (the ridiculous
suggestion that schools should teach intelligent design “…so people can
understand what the debate is about” [Washington Post 8/3/05]), disregard of the
consensus of scientific advisory panels and committees (over-the-counter
provision of emergency contraception) and the subversion of such panels by the
appointment of ideologues with scientific views far outside the mainstream,
largely due to religious beliefs at the expense of established fact.


The latest in this shameful reign
of irrationality and rapprochement between religion and government is the
appointment of Dr. Erik Keroak to be deputy
assistant secretary for population affairs (DASPA
) in the federal
department of Health and Human Services (HHS). In that capacity Keroak, an
unabashed opponent of sex education and contraception, not to mention a staunch
anti-abortion advocate, will oversee the Title X monies that fund family
planning activities in the US.


As one
might imagine advocates for women’s reproductive rights have been most outraged
at the choice of an individual who has espoused such fringe views. Planned
Parenthood has mounted a national petition campaign urging HHS Secretary Mike
Leavitt to replace Keroak.
Newspapers across the country have railed
against the nomination. The Chicago Sun-Times (11/28/06) called the nomination
as puzzling a choice as it is ill-considered”. The
Los Angeles Times (11/27/06) points out that Keroak "has agitated against
abortion and even contraception -including for married women". The New
York Times (11/24/06)
labeled the choice a "family planning farce"
while Cynthia Tucker suggested in an editorial in the Baltimore Sun (11/27/06) that it is proof
that President Bush is continuing "his dogged resistance to reality”.


The source of all the acrimony is the anti-contraception, anti-sex
education positions taken by Keroak’s former employer, A Woman’s Concern, and
the frankly, rather bizarre nature of some of Dr. Keroak’s “research”. A
Woman’s Concern (AWC) operates six Christian pregnancy crisis centers in Massachusetts that
provide free pregnancy testing, ultrasounds and counseling. The policies of AWC
include a Policy on Contraception and
“Emergency Contraception”
(A Women’s Concern [AWC] 2007). The policy states that “Clearly, overwhelming social science
data support the wisdom of abstinence until marriage” but validates this dubious
claim by citing work of the Medical Institute for Sexual Health (MISH), an
organization that promotes abstinence only sex education and questions the
effectiveness of condoms. As related in The
Republican War on Science
(Mooney 2005),
MISH “…promotes teaching teenagers to abstain from sex, while criticizing
educational programs that promote ‘safe sex’ and questioning the ability of
condoms to prevent STDs” (Mooney 2005, p. 212).


The AWC policy says that “A Woman’s Concern is persuaded that the
crass commercialization and distribution of birth control is demeaning to
women, degrading of human sexuality, and adverse to human health and happiness”
(AWC 2007) and goes on to suggest that provision of contraception actually increases out-of wed-lock pregnancy. In
a bizarre bit of referencing, the policy cites an eight year old edition of Glamour magazine as a reference for a
comment on sexually transmitted diseases. In equating contraception with
abortion, the policy cites a publication by DeCook and McIlhany, et al. (1998)
published by Frontlines Publishing, an organization that produces materials for
crisis pregnancy centers (McIlhaney is the director of the aforementioned Medical
Institute for Sexual Health).


In another bit of odd referencing,
the AWC policy includes a reference to Abortion,
Breast Cancer and the Pill
from a website called The reference
is listed last and labeled number 14 but the body of the text contains no
number 14 nor does it mention breast cancer. Abortion, Breast Cancer and the Pill was written by Dr. Chris
Kahlenborn, a physician who opposes contraception and has espoused the
so-called ABC (abortion-breast cancer) link despite the mounting evidence that
no such link exists (American
of Obstetricians
and Gynecologists [ACOG] 2003; National Cancer Institute [NCI] 2003; Reeves, et
al. 2006). Kahlenborn relies on a 10 year old meta-analysis by Joel Brind founder
of the Breast Cancer Prevention Institute and a leading proponent of the ABC
link (Jasen 2005). Brind’s work has been refuted by a number of more recent
publications (ACOG 2003; Beral, et al. 2004; Jasen
2005; Reeves, et al. 2006) that have informed the evidence-based positions of
the American College of Obstetricians and
Gynecologists (ACOG), the American Cancer Society (ACS) and the National Cancer
Institute (NCI).


In addition to Dr. Keroak’s extreme positions on
contraception and abortion, he has propounded some rather odd views on a number
of other subjects that have been widely quoted on abstinence-only web
sites.  In particular, several sites
reference an article entitled Bonding Imperative: A Special Report From The
Abstinence Medical Council,
as authors Keroak and John R. Diggs, however access to this article seems to be
limited to those who are members of the Council (it appears only “members” have
access to the resource library on the Abstinence Clearinghouse website). One of
the internet-based
articles that references the Keroak report is
entitled Fornication and Oxytocin. It
promotes Keroak’s claim that too many sexual partners will ruin a woman’s ability
to bond. To quote from Fornication and
, “If a woman's sexual history is sufficiently adverse, she will
lose her ability to bond in the current relationship”.


Dr. Keroak is embedded in the right-wing religious network that promotes
science and social policy based on belief
and biblical pronouncement, however much he tries to wrap it in the cloak
of “medical science”. To be sure, he has a right to his opinion; what is in question
is his right to help set policy for the US government and to affect the
lives of other citizens. One hundred and seven members of the US House of Representatives
took up exactly that question when they recently signed a letter calling on the
Bush Administration to replace Keroak (Sullivan 2006).


should use their new found power in Congress to force a return to sound science
policy and the repudiation of the faith-based science of people like Keroak is
a good start, but only a start. Much remains to be done to repair the damage
inflicted by the Bush Administration.


Dr. Mark Edgar has
over 20 years of experience working with public health and human services
programs, schools of public health, medicine and nursing, and nonprofit
organizations throughout the country. He is the Director of Assessment and Planning at the Illinois Public Health
Institute and adjunct faculty at University
of Illinois at Springfield in the Public Health Department.
Dr. Edgar
holds a BA in Psychology, a Masters in Public Health and a PhD
in Public Health from Saint Louis
. He has had
articles published or accepted by the Journal of Public Health Management and
Practice, Public Health Reports and by the National Network of Public Health


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