down’ [his] landmark report” on the effects of secondhand smoke (Harris, 2007). Former Surgeon General David Satcher’s initial attempts to publish a report on sexual health in the late 1990s were thwarted by the White House in light of increased political sensitivity to these issues (Satcher, 2007).

  • Testimony before congressional committees. CDC Director Julie Gerberding’s statement before a Senate committee on the health effects of global warming was cut in half by the White House, with references to the health effects of climate change removed (Revkin, 2007).

The department’s policy-making role is credible only to the extent that it is based on sound science. In the regulatory sphere, for example, the link between valid, reliable information and policies must be strong enough to meet legal challenges, as well as critiques by members of Congress, the news media, organizations representing various HHS constituencies, and the public. In short, decision makers must have access to scientific findings, transparent methods of reviewing them, free of influence by the regulated industries, and plausible ways to resolve questions when scientific findings conflict or are inconclusive (Wagner and Steinzor, 2006).

Basing policy on the best science can directly serve patient interests and protect the public’s health. Through the years, policies developed by Medicare have played a leadership role in clinical areas by, for example

  • mandating the replacement of hospital wards with semiprivate rooms, which helps control the spread of infection;

  • ending racial segregation of hospitals, which led to better care for African Americans;

  • covering influenza immunizations (CDC, 1993);

  • providing data that permitted analysis of both costs and effectiveness of selected new medical technologies (Coye and Kell, 2006; Hlatky et al., 2005);

  • using quality rankings to promote certain best practices in inpatient care and group practice by physicians;

  • using evidence-based quality measures in producing hospital and state report cards and in pay-for-performance (P4P) quality incentive initiatives (IOM, 2006); and

  • implementing “coverage with evidence development,” a new concept of making evidence generation a condition of coverage.

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