Public health has had a magnificent and resplendent history. Sadly, the public health establishment has strayed far from its glorious origins and has gone from a lean, effective medical discipline composed of dedicated, independent physicians and health care workers to a bloated, politicized, entrenched, bureaucracy more concerned with political agendas --- and its own existence and budgets --- than the public health it had been charged to protect.
You may say the golden age of public health occurred in the late nineteenth and early twentieth centuries, following the great discoveries of Edward Jenner, the English physician who developed a vaccine against small pox (vaccination); Louis Pasteur, the French chemist who played a significant part both in the discovery of the germ theory of disease and the development of immunizations; Joseph Lister, the surgeon who developed antiseptic techniques both in the treatment of wounds and in the implementation of surgical procedures; and Robert Koch, the German pathologist who expounded on the concepts of microbes, pathology of tuberculosis, and the development of microbiology. Following the lead of these great public health workers, the men and women in the public health realm popularized the blessings of cleanliness, hygiene and sanitation, militated for the application of statistics for epidemiology, and aided private physicians in the life and death struggle against illness and disease, at home and in the work place.
The great discoveries of public health up to this time were largely decentralized, the achievement of gifted individuals who followed in the tradition of independent physicians and their private, supporting staff, and bolstered financially by the blessings of free market capitalism, private grants, and philanthropic and charitable donations. Those were indeed the golden years of public health.
During the first half of the twentieth century, the fountain of public health discoveries gradually became exhausted and the breakthroughs in medicine and science were made by individuals and organizations in the burgeoning, highly-specialized fields of biochemistry, genetics, embryology, pharmacology, and other basic and clinical sciences.
After the first half of the twentieth century, the great era of public health in its traditional format had come to a close. By this time, government and bureaucracies had entered the picture in great force in the wake of the New Deal of Democrat president Franklin D. Roosevelt. At that point in time, the leaders of the public health establishment determined that rather than disband and pursue their work in specialized areas of study, they would continue to exist as a separate discipline in the arena of public health. But, to do so, they had to find work to keep themselves busy, commence new projects, and seek new sources of funding. Meanwhile, even though the private sector had also been squeezed by the unparalleled growth of government, it responded to the drying up of discoveries in public health and the less private funds available from charitable and philanthropic donations with more efficiency in research and development (R&D) and technical specialization. With the concomitant growth of government, public health became allied and more entwined with the state, and overtime, became fully dependent on the federal government and its self-perpetuating bureaucracies.
With the release of the Kerner Report of 1968, the leaders of the public health establishment (PHE) took the initiative to cross their Rubicon and leave the realm of science to enter that of politics. They began to take political stands on issues only tangentially related to medicine or health, regardless of the wishes of its component members. The PHE, now boldly incarnated in the "American Public Health Association (APHA), embraced the federal government's Kerner Report on the 'root causes' of poverty and announced that social policy rather than public health, per se, would henceforth become its main focus."(1) The PHE began requesting and receiving more resources in the form of more taxpayers' monies and used these resources, not for the betterment of the health of the population, but for its own financial sustenance and political agendas.
In the 1970s and 1980s, the PHE rapidly became a bloated, politicized, entrenched bureaucratic establishment more concerned with its increasingly radical political agendas and its own budgets than the public health with which it had been charged by Congress.
And this is where James T. Bennett and Thomas DiLorenzo's book, From Pathology to Politics: Public Health in America, comes in. This great little book provides verifiable documentation of how the APHA has strayed far from its former path to that of a politicized, left-wing, radical organization. From Pathology to Politics is an eye-opening indictment of the public health establishment and its perverse politicization of science and medicine.(1)
The average middle class American pays 40 percent in taxes to Uncle Sam. A large portion of this amount goes to fund unneeded public health projects and other boondoggles concocted by experts using nothing but junk science to promote their political agendas. The ever-increasing amount of money going to public health is now in the billions of dollars per year. Perhaps, this allocation could be justified, if the money was used for the intended purposes it was allocated by Congress and the American taxpayers. The reality is quite different.
Instead of being used to combat disease and to fund needed research, much of the allocated money is used by the public health establishment for political purposes --- e.g., promoting regulations in the workplace, calling for and establishing more bureaucracies, promoting greater government involvement in the lives of citizens, lobbying to procure ever larger amounts of money for politically correct researchers, etc. The claim of the public health establishment is they must protect the public (apparently from ourselves), while negating individual autonomy and resenting citizen empowerment.
At one time, the PHE depended on campaigns of public education. No more. Now, it prefers and depends on raw power and government coercion to enforce its paternalistic policies on citizens, who apparently do not know any better. If there is any education, you can be sure it will be immediately followed by calls for reform, militating for the establishment of more agencies and bureaucracies, more regulation, more money extracted from the taxpayer, greater restrictions of civil liberties, more welfare, and a greater role of government in all aspects of our lives.
The PHE incarnated in the APHA cares more for the socialistic political agenda to which it now subscribes than for the public health to which it is theoretically beholden. Politics always comes first, and in politics, the PHE stands to the far left of even the most liberal legislators and the most strident political pressure groups.
Since many of their battle cries proclaim they want reform "for the children," an illustrative example cited by the authors is particularly revealing. In the name of protecting the Earth's ozone layer, the APHA joined the EPA and the FDA in proposing a ban on asthma inhalers because they purportedly contain chlorofluorocarbons, or CFS, that supposedly deplete the ozone layer. The AMA pointed out that inhalers relieved the symptoms of children with asthma and in many cases can be lifesaving. The plea to prevent the ban on lifesaving inhalers was even seconded by the leftist Congressional Black Caucus, who represent thousands of inner-city asthma sufferers, as well as a number of other liberal legislators. Nevertheless, the APHA, to the far-left of the political spectrum, and other public health-related agencies, as the EPA and the FDA, as well as the American Lung Association (this latter organization has been known for endorsing questionable products in return for financial rewards from manufacturers) continued to support the ban, showing more concern for environmental ideology and dubious science than for the health of asthmatic children, including those of the inner-cities who they always claim to protect in their bureaucratic proposals.
Another area where the APHA has also shown duplicity is welfare reform. Although studies have shown that children born to welfare mothers tend to have lower IQs and the longer the family stays on welfare the lower the IQ, the APHA continues to support welfare for children. After controlling for other variables, Bennett and DiLorenzo point out that studies have shown children on welfare have lower cognitive abilities, are more likely to drop out of or fail to graduate from school, have lower educational achievement, have high teenage crime rates, are more likely to be illegitimate, etc.; nevertheless, the APHA leadership, again to the far left of the political spectrum (unreconstructed 1960s radicals rather than mainstream liberals, as the authors correctly assert), strongly opposed the bipartisan bills of the 104th Congress to reform welfare.
Even though Congress and President Clinton went on to enact welfare reform in 1996, the APHA went on the record continuing to oppose the reforms, countering with all its heart and soul the phasing out of welfare spending by "working with coalition partners concerned about the children."(2)
The APHA continues to support social policies that have already been discredited as failures. For example, the APHA leaders subscribe to the erroneous belief that "being on welfare is conducive to improving public health; government income redistribution programs can improve public health; individuals should not be held responsible for their health (government should be)," etc.(3)
The APHA strongly favors government control of medical care and, as Bennett and DiLorenzo described, has publicly stated it is opposed to the expansion of free market medical care. Totally out of step with the American people and other health care researchers and policy makers, the APHA "even criticized the failed Clinton health care plan in 1993 --- which would have abolished the private health insurance industry and placed the federal government in charge of most of the health care market --- as being 'too market oriented.' "(4) In other words, the APHA favors fully nationalized, single payer, government controlled health care.
The authors write, "It was apparent by the mid-1970s that the American Public Health Association was being directed not by mainstream liberals, but by radicals who place much greater reliance on political activism in the name of public health than had their predecessors."(5) As examples of good medical care, the APHA has pointed to Nicaragua (in the 1980s under the communist Sandinista regime) and has specifically singled out the Cuban health care system, as a "political and economic role model for the United States, especially with regard to health care."(6)
To pay for a nationalized, single payer, health care system in the United States, the APHA rejects published scholarship and the economic facts revealing how exorbitant the cost of such a system would be for American taxpayers. Their answer for funding comes straight out of Karl Marx's Communist Manifesto, "increasingly progressive taxation."(7)
And again, while continuing to profess a concern for "the children," the APHA rejects the solid scholarship behind the fact that day care centers are plagued by outbreaks of epidemics and other infections. Citing the work of Dr. Stanley Schuman, the authors recount how "day care centers are responsible for the recent outbreaks of diarrhea, dysentery, giardiasis, and epidemic jaundice --- reminiscent of the pre-sanitation days of the seventeenth century. Other serious day care hazards include cyto-megalovirus, shigellosis, hepatitis, HiB [Hemophilus influenza virus], and ear infections."(8)
The APHA response to these problems --- namely, the same as what Hillary Rodham Clinton tried to label America's "silent crisis" --- was to reject the idea of having a variety of day care centers based on the market place where parents can have their preferences, but to have a "single, government-controlled, monopoly system of 'quality' day care."(9)
Regardless of the issue being discussed, the public health establishment always chooses the far left, socialistic side of the debate. Rather than acting as an organization of professionals advocating for the public health, they have become a political pressure group, always pushing for greater government in all aspects of our lives. Despite contrary scholarship, the APHA, as pointed out by the Bennett and DiLorenzo, believes that free market capitalism is generally hazardous to health and that socialism and nationalized health care provides all the answers to the world's woes.
The APHA is committed to its own self-aggrandizement and within the larger context, increasing and magnifying the power of the state at the expense of the individual. To the extent that the state is acting to protect us from ourselves in the area of public health, injuries and disease prevention, coercion may be used, and individual autonomy can be restricted, for the common good.
In the area of scientific research, the APHA has used results-oriented, politicized published research based on what can only be characterized as junk science and systematically ignores opposing scholarship. The example provided by the authors on the issue of public health and gun control is instructive. Bennett and DiLorenzo write, "the CDC-funded gun control research simply ignores a large body of data that contradict its pro-gun control position. For example, 'in the 25 years from 1968 to 1992, American gun ownership increased almost 135 percent (from 97 million to 222 million), with handgun ownership rising more than 300 percent. These huge increases coincided with a two-thirds decline in accidental gun fatalities.' "(10) Obviously, increased gun availability in ordinary, law-abiding citizens does not translate to more crime.
Moreover, the public health establishment continues to ignore the fact that up to 2.5 million defensive uses of firearms take place by ordinary citizens in the U.S. every year thwarting crime and protecting life and property, as has been demonstrated conclusively by the sound scholarship of Prof. Gary Kleck of Florida State University. The PHE has also ignored the evidence gathered by Prof. John Lott at Yale University demonstrating that the expansion of concealed carry gun laws caused a decline in firearm violence, because law-abiding citizens with firearms are able to defend themselves and their families and deter crime in those states that have enacted those laws. Inconvenient facts and statistics that do not support PHE views are thus rejected or ignored.
The sheer amount of money involved in public health research and the increasing number of bureaucracies and agencies in the PHE are of themselves corrupting influences. You can be sure much of the research that is conducted by the public health establishment, whether for AIDS, carcinogens, gun control, etc., has an ideological bias against capitalism. As shown by the authors, the great cancer health threat of the 1970s was found to be "an anti-capitalist, ideological crusade funded with tax dollars and carried out by various segments of the public health profession."(11) Other public health-related agencies, and not just the APHA, support this cancer scare. The EPA has supported a variety of cancer scare episodes with the cooperation of most of the PHE.
One particularly flagrant example was the Alar scare, a bogus episode that caused many mothers to be unnecessarily fearful of giving apples and apple juice to children because of flawed studies purporting to show a link to cancer. The alleged culprit was said to be the chemical Alar that was used to preserve apple freshness. The Alar scare was in fact what turned out to be hazardous to the public health because people, particularly children, were discouraged from eating fruit and drinking juices which, of course, are beneficial and have been shown to reduce cancer and other diseases.(12)
The PHE, as the authors state, also plays "fast and loose" with the scientific method. For example, researchers claimed "that a statistical association connotes causation. This kind of 'cooking' the data to get politically correct results is especially prevalent in studies of 'relative risk.' "(13) Sloppy techniques are used routinely in data collection to arrive at preordained conclusions (results-oriented research). We have already mentioned the example of public health and gun control, which we have also covered at some length in the Medical Sentinel.
Another meaningless source of public health anxiety is the supposed health threat caused by "disease clusters," ignoring more important risks such as heredity and socioeconomic status. The PHE also has a predilection to ignore sound scientific principles, such as the principle in toxicology of hormesis, "the dose makes the poison." For example, medications and vaccines are beneficial at lower doses intended to do what they are suppose to do, but at higher doses, they may result in fatal overdoses and lethal diseases. Ignoring this scientific fact, public health researchers, instead, conveniently uphold the "linear nonthreshold model," asserting that miniscule exposure to chemicals or radiation (radon) is equivalent to massive exposure and is always related to dosage via extrapolation rather than by actual experimentation.(14)
A complete assault on the scientific method is the PHE's penchant for so-called "relative risk." In the case of secondhand smoke, Bennett and DiLorenzo point out that when the EPA wasn't able to obtain the statistically significant relationship it desired, the researchers took it upon themselves to increase the level of confidence from 5 to 10 percent. (By convention, epidemiologists have used the confidence level of 5 percent or less as being insignificant. This is referred to as the 5 percent confidence level.) To obtain the desired results, the EPA, for example, used a 10 percent confidence level, in effect doubling the threshold, to obtain the desired result and statistical association.(15) And, when all else fails to reach the desired conclusion, public health researchers employed the new methodology of "relative risk." As the authors relate, this methodology is used "to prove a preconceived notion rather than test a scientific hypothesis."
Relative risk studies do not account for confounding variables, other things that may cause disease. So it's not surprising that by this flawed methodology, "the politicization of science takes on bizarre proportions, such as the 'relative risk' study that reported that women who wore brassieres all day are 12,500 times more likely to contract breast cancer than those who go braless."(16) It is worth repeating: the APHA and the EPA also ignore contradictory studies that do not support or go against their political agenda.
Bennett and DiLorenzo write that "tax dollars for bureaucrats' budgets and research grants --- is the driving force behind the corruption of public health science."(17) This assertion is entirely correct. "The whole purpose of the politicization of public health science is to expand the size and scope of the government agencies that sponsor this shoddy 'research,' to advance the careers of politicians and bureaucrats in the public health field, and to provide millions of dollars in research grants to government-funded researchers. It is all about money and power."(17)
When their studies are totally discredited, as in the case of the studies of particulate matter by the EPA, the public health agencies involved continue to push for their agendas apparently believing that science can be corrupted for a worthy cause such as a "smoke-free society."(18)
Public health researchers, including those of the EPA, frequently refuse to make their data public, even though the data accumulated and obtained for their research was financed by grants funded by taxpayers.(18) The authors discussed this and so has Michael Fumento in the case of the EPA and myself in the case of public health and gun control in articles in the Medical Sentinel which were cited by the authors.(19)
In short, PHE expresses hypocrisy of the highest order when it criticizes industry-funded research as automatically flawed or labels it "biased" or "suspect" simply because the research was funded by the private sector. PHE researchers ignore the criticisms of their own research, even when it has been shown repeatedly to be flawed, biased and politicized, particularly in the areas pertaining to social and economic policy, because it relies on government funding. The PHE simply seeks to aggrandize and increase the size and scope of government because it depends on government funding for its own existence. Moreover, public health research funding is used disproportionately and, perhaps, illegally and unethically for lobbying and political activism to bring about for itself ever increasing funding in a never-ending cycle of corruption and politicization of research.(20)
In conclusion, Bennett and DiLorenzo have written a hard-hitting exposé of the public health establishment, provided an excellent synopsis on the deteriorated state of affairs of that discipline of American science and medicine and its "scientific" research. I hope I have given this compelling and revealing book the praise it deserves. This book ought to be read by every American, not just by those interested in the role of public health in society, but also by civic-minded citizens concerned with the momentous balance of power, which today perilously tilts between the preservation of individual liberty on the one hand and the increasing power of the state on the other. This book adds to the body of accumulating evidence that the centralization of public health has caused the politicization and perversion of science and medicine. The state of affairs of the PHE needs serious revamping. Its functions should be surveyed and re-assigned, decentralized and, as much as possible, returned to the private sector. The public health structure, as it stands today, has outlived its usefulness and may be causing more harm than good to the public. Many of the functions of public health should be returned to the private sector --- private philanthropies, research laboratories and universities --- encouraged by tax reductions and other incentives. The worst thing Congress can do is to continue to support the PHE government agency monopoly and indiscriminately continue to increase funding for the CDC, the EPA, and other public health agencies. To continue to do so may not only be unethical from a moral perspective but also counterproductive from an economic perspective and actually very dangerous to our health.
1. Bennett JT, DiLorenzo TJ. From Pathology to Politics: Public Health in America. New Brunswick, New Jersey, Transaction Publishers, 2000, p.136. This essay is, in fact, an extended review of this momentous book.
2. Ibid., p.81.
3. Ibid., p.137.
4. Ibid., p.33.
5. Ibid., p.35.
6. Ibid., p.37.
7. Ibid., p.39.
8. Ibid., p. 124.
9. Ibid., p.125.
10. Ibid., p.60.
11. Ibid., p.98.
12. Ibid., p.99.
13. Ibid., p.100.
14. Ibid., p.102.
15. Ibid., p.104.
16. Ibid., p.138.
17. Ibid., p.108.
18. Ibid., p.105.
19. The article cited by the authors was included in Faria MA Jr. The perversion of science and medicine (Parts I-IV). Medical Sentinel 1997;2(2):46-53 and Medical Sentinel 1997;2(3):81-86. More recent articles that pertain to the area of public health and gun control are Faria MA Jr. Public health and gun control - a review. Part I: The benefits of firearms. Medical Sentinel 2001;6(1):11-13 and Part II: Gun violence and constitutional issues. Medical Sentinel 2001;6(1):14-19; Faria MA Jr. The tainted public-health model of gun control. Ideas on Liberty 2001;51(4):38-43.
20. Bennett and DiLorenzo, op. cit., p.95.
Dr. Faria is Editor-in-Chief of the Medical Sentinel, the official journal of the Association of American Physicians and Surgeons (AAPS), and author of Vandals at the Gates of Medicine (1995) and Medical Warrior: Fighting Corporate Socialized Medicine (Macon, Georgia, Hacienda Publishing, Inc., 1997).
Originally published in the Medical Sentinel 2001;6(2):46-49. Copyright ©2001 Association of American Physicians and Surgeons.