PPA was an over-the-counter drug used as an appetite suppressant and decongestant. Reports of strokes in women who had used PPA occurred over a 20-year period, and the Food and Drug Administration (FDA) raised questions about the drug’s safety. The trade association representing PPA’s manufacturers used scientists and lobbyists to prevent PPA’s removal from the market. Finally, the drug manufacturers and the FDA agreed to select an investigator to design a study of PPA; the findings indicated PPA causes stroke. But, instead of removing the drug from the market, the manufacturers used a product-defense firm to criticize the study. The FDA finally ordered PPA off the market in 2000 (Michaels, 2005).

In 2005, the clash of politics and science played out in dramatic fashion in Dover, Pennsylvania. Eight members of a school board were sued for requiring that intelligent design be included in the Dover school system’s biology curriculum as an alternative to evolution. Concerned residents challenged the incumbent school board members. Ultimately, all eight members of the school board were voted out of office and replaced by a group of challengers, including nurse Bernadette Reinking, who campaigned against the intelligent design agenda (Goodstein, 2005). The newly elected board members rescinded the intelligent design policy two weeks after Judge John E. Jones III ruled the policy was unconstitutional. Jones stated the concept of intelligent design is religious, not scientific (Raffaele, 2006).

Controversy erupted in 2009 when a government panel abruptly changed mammogram screening guidelines. The U.S. Preventive Services Task Force recommended routine mammogram screening for women begin at age 50, not age 40 as recommended for the previous 25 years, and that mammograms be done every 2 years rather than annually (Agency for Health Care Quality and Research, 2009). Government guidelines are powerful because they influence the behavior of patients, health care providers, and insurers. In this case, the data may actually support the altered recommendation. Trials in Sweden that monitored 265,000 women found virtually no benefit from mammograms for women under age 55 (Crewdson, 2009). Despite this, the push back has been robust and was fueled by media coverage that failed to explore the potential dangers of unnecessary mammograms. The American Cancer Society has refused to change its recommendation to reflect the new federal guidelines (American Cancer Society, 2009). The Society of Breast Imaging president released a statement that the recommendations are a “step backward and represent a significant harm to women’s health” (Steenhuysen, 2009). Allegations have flown back and forth like tennis volleys and have left some women and health professionals confused about how best to proceed, but the task force was clear that the decision should be made between the patient and provider.

Policymakers had recognized in 2004 that disadvantaged minority groups received poorer health care and often have poorer health outcomes. Despite this, a draft report by the Agency for Healthcare Quality and Research (AHRQ) providing evidence of health disparities was ordered rewritten, and researchers were directed to drop their conclusion that racial disparities are pervasive in the U.S. health care system. The rewrite downplayed the researchers’ conclusions and “broke with the weight of scientific opinion” (Bloche, 2004). Disgruntled government staff members leaked the altered draft reports. Secretary of Health and Human Services Tommy Thompson ultimately called the episode a mistake and said that the goal had been to produce a report that was more positive (Bloche, 2004). In an analysis of the controversy, Bloche noted, “The affair was embarrassing because Americans expect scientific rigor, not aggressive advocacy, from federal research agencies” (2004).

Kraemer and Gostin (2009) chronicled a troubling conflict between the Infectious Diseases Society of America (IDSA) and the Connecticut attorney general. IDSA issued clinical practice guidelines for management of Lyme disease in 2006. The guidelines did not recommend antibiotic treatment for non-specific symptoms (fatigue, headache, and others) that persist after standard antibiotic treatment. The IDSA guidelines also did not recommend the use of alternative diagnostic tests (the Centers for Disease Control and Prevention and the Food and Drug Administration had deemed the tests invalid). The Connecticut attorney general initiated an investigation and alleged the IDSA had violated state antitrust law by recommending against the use of long-term antibiotics to treat “chronic Lyme disease.” Despite developing guidelines that were based on scientific evidence, the IDSA was forced to settle the case after spending more than $250,000 on legal fees (Kraemer & Gostin, 2009).

Controversy has emerged over the existence of premenstrual dysphoric disorder (PMDD). The American Psychiatric Association is debating whether to add PMDD to the DSM-5 (the fifth edition of its diagnostic manual) due to be published in 2013 (American Psychiatric Association, 2010). Part of the controversy involves whether or not scientific evidence exists to support inclusion of PMDD as a diagnosis. Including PMDD in the DSM-5 would increase the chances that health insurers would cover the cost of PMDD treatment and may encourage further research and development of new therapies (Chen, 2008).

The Agency for Healthcare Quality and Research (AHCPR) was established in 1989. Its mission was to use outcomes research to develop practice guidelines to improve health care cost and quality. Only 6 years later, it was on the brink of closure due to several political realities: A special-interest group launched an attack, the agency had fewer powerful political allies in Congress, it was criticized for inefficiency, and it was target for partisan political attack (Gray, Gusmano, & Collins, 2003). AHCPR published practice guidelines in 1995 supporting nonsurgical treatment for low back pain. The North American Spine Society, an association of spine surgeons, protested the guidelines and underlying research. The Society formed an advocacy organization devoted to shutting down AHCPR (Deyo & Psaty, 1997). Their efforts gained significant traction. After having its budget “zeroed out” by the House of Representatives in 1996, it was resuscitated, given a new name and an altered mission. The new Agency for Healthcare Quality and Research, launched in 1999, would no longer produce practice guidelines and the word policy was removed from its name. The agency’s story illustrates the complexities of mixing politics and research.

Many controversies plagued President George W. Bush’s administration, including perceived manipulation of science and science policy. The Democratic staff of the House Government Committee on Oversight and Government Reform assessed the handling of science and scientists by the Bush Administration and released a report that stated the administration’s “political interference with science has led to misleading statements by the President, inaccurate responses to Congress, altered Web sites, suppressed agency reports, erroneous international communications and the gagging of scientists” (U.S. House of Representatives Committee on Oversight and Government Reform, 2003). A Bush political appointee, George Deutsch, resigned after he prevented reporters from interviewing the leading climate scientist at the National Aeronautics and Space Administration (NASA) and instructed a NASA scientist to insert the word theory in discussions of the Big Bang because NASA should not discount the possibility of intelligent design by a creator. Deutsch lied about having a nonexistent undergraduate degree, which led The Washington Post to state in an editorial, “The spectacle of a young political appointee with no college degree exerting crude political control over senior government scientists and civil servants with many decades experience is deeply disturbing” (The Politics of Science, 2006).

While other allegations regarding the Bush administration’s possible manipulation of science policy arose, few were as dramatic as those raised by former U.S. Surgeon General Richard Carmona who served from 2002 to 2006. In testimony before the House Committee on Oversight and Government Reform, Carmona stated that public health reports were withheld unless they praised the administration and that he was prevented by political appointees within the Department of Health and Human Services from speaking out on scientific evidence concerning stem cell research, contraception, and sex education. Carmona testified “Anything that doesn’t fit into the political appointee’s ideological, theological, or political agenda is often ignored, marginalized or simply buried” (Vergano, 2007). He added that “The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science or marginalizing the voice of science for reasons driven by changing political winds” (Lee, 2007). The White House denied political interference; spokesman Tony Fratto stated that it was disappointing Carmona “failed to use his position to the fullest extent in advocating for policies he thought were in the best interest of the nation” (KaiserNetwork.org, 2007).

Climate science has generated significant interest since global warming emerged as a potential threat. This science has become embroiled in particularly ugly politicization efforts. “Warmists” believe the evidence of heating in the stratosphere and other types of man-made climate change is compelling (Begley, 2009). “Deniers” contend global warming is an alarmist, political crusade. One particular controversy in the ongoing battle between global warming believers and skeptics concerned “Climate-gate”—the theft of some British climate scientists’ e-mail and the attempt to use them to discredit the science. Hackers stole about 1000 e-mails from scientists in the University of East Anglia’s Climate Research Unit and posted them online. Some of the scientists’ language in the messages was used by skeptics who argued the scientists were engaging in manipulation of their findings to support global warming. The second of three investigations into allegations of research misconduct cleared the scientists; investigators did note the scientists could have used more rigorous statistical procedures (Adam & Eilperin, 2010).

The Union of Concerned Scientists (UCS) is a nonprofit group that combines research and action to urge responsible change in government policy, corporate practices, and consumer choices to promote a healthy environment and safer world (Union of Concerned Scientists, 2010a). The UCS has identified problems in the relationships between science and politics and has proposed solutions. The UCS published the A to Z Guide to Political Interference in Science. This website, using a periodic table–like graphic, presents dozens of cases of perceived political interference in science (Union of Concerned Scientists, 2010b). The Union also published findings from surveys they conducted of government scientists from 2005 to 2007. Participants reported political interference in federal science including direction to alter the reporting of scientific findings, fear of retaliation for speaking out, and being pressured to remove certain language from their communications (Union of Concerned Scientists, 2009).