June 7, 2007  -- President Bush's nominee for surgeon general, Dr. James W. Holsinger Jr., wrote a paper in 1991 that purported to make the medical argument that homosexuality is unnatural and unhealthy. Doctors who reviewed the paper derided it as prioritizing political ideology over science, and Democratic aides on Capitol Hill say the paper will make his confirmation hearings problematic, if not downright bruising.

Holsinger, 68, presented "The Pathophysiology of Male Homosexuality" in January 1991 to a United Methodist Church's committee to study homosexuality. (Read the paper here.) The church was then considering changing its view that homosexuality violates Christian teaching, though it ultimately did not do so. Relying on footnotes from mainstream medical publications, Holsinger argued that homosexuality isn't natural or healthy.

"A confirmation fight is exactly what the administration does not need," said David Gergen, a former adviser to Presidents Nixon, Ford, Reagan and Clinton, who predicted the paper would cause a "minor storm" among Democrats on Capitol Hill.

"You have to wonder given the quality of some of the nominations that have gone forward recently, whether the selection group in the White House has gone on vacation," Gergen said. "There has been a growing criticism the administration favoring ideology over competence, and this nomination smacks of that."

White House Avoids Direct Response to Paper

"Dr. Holsinger has dedicated his life to the care of others and public service and his respect for all is evidenced by his actions and his career ," said White House spokesman Emily Lawrimore. "On numerous occasions, he has taken up the banner for under represented populations and he will continue to be a strong advocate for these groups and all Americans. Dr. Holsinger is a highly respected, well-qualified physician and educator. His impressive medical background, which includes leading one of the Nation's largest healthcare systems, decades of service in the armed forces, along with his commitment to combating childhood obesity, will serve him well as Surgeon General. We urge the Senate for a swift confirmation."

HHS: Paper Not Reflective of Holsinger's Thinking

But Holly Babin, a spokeswoman for the Department of Heath and Human Services -- the agency that will take the lead on trying to achieve Holsinger's confirmation -- insisted that the paper was by no means reflective of Holsinger's thinking.

"That paper was a survey of scientific peer-reviewed studies that he was asked to compile by the United Methodist Church, it's not that he was saying 'this is what I believe,'" Babin said. "It's a reflection of the available scientific data from the 1980s. It should be noted that in 1991, homosexuals were banned from the military and several years before that, homosexuality and Haitian nationality were considered risk factors for HIV/AIDS. Over the last 20 years, a clearer understanding of these issues has been achieved.

Asked about medical experts who disputed that Holsinger's paper expressed opinions timely in 1991 and pressed to explain what Holsinger's views on homosexuality are currently , Babin said, "we look forward to the confirmation process, where we can share Dr. Holsinger's qualifications and views."

Advocacy Groups Protest Nomination

Those answers will likely not quell the controversy. Critics say the paper certainly seems to be written from Holsinger's point of view.

Noting that Holsinger also belongs to a church that offers a ministry to "cure" gays of the sexual orientation, gay and lesbian rights advocates immediately protested Holsinger's nomination. "His writings suggest a scientific view rooted in anti-gay beliefs that are incompatible with the job of serving the medical health of all Americans," said the Human Rights Campaign in a statement. "It is essential that America's top doctor value sound science over anti-gay ideology."

Democrats will likely be sympathetic to such arguments. Holsinger's confirmation hearing, which has yet to be scheduled, will be heard by the Senate Health Committee, chaired by longtime gay rights advocate Sen. Ted Kennedy, D-Mass. Members of the committee include three Democratic presidential contenders -- Sens. Hillary Clinton, D-N.Y., Chris Dodd, D-Conn., and Barack Obama, D-Illinois -- eager to prove their bona fides during the primary season to the gay and lesbian community.

Holsinger, a professor of preventive medicine at the University of Kentucky College of Public Health, did not return calls for comment.

When announcing his nomination on May 24, Bush said that as "America's chief health educator, [Dr. Holsinger] will be charged with providing the best scientific information available on how Americans can make smart choices that improve their health and reduce their risk of illness and injury."

What Holsinger's Paper Argues

Holsinger wrote that "[a]natomically the vagina is designed to receive the penis" while the anus and rectum -- which "contain no natural lubricating function" -- are not. "The rectum is incapable of mechanical protection against abrasion and severe damage ... can result if objects that are large, sharp or pointed are inserted into the rectum," Holsinger wrote.

The cardiologist details many different diseases gay men can catch, and several sexual practices they may engage in, including "anal eroticism," which can lead to injuries and even death. "From the perspective of pathology and pathophysiology, the varied sexual practices of homosexual men have resulted in a diverse and expanded concept of sexually transmitted disease and associated trauma ?"

In the context of the larger argument in his church as to whether homosexuality should be accepted, Holsinger presented a medical and scientific argument that anal intercourse was not natural.

"It is absolutely clear that anatomically and physiologically the alimentary and reproductive systems in humans are separate organ systems, i.e., the human does not have a cloaca," he said, referring to the posterior orifice that serves as the one opening for genital, urinary and intestinal tracts in amphibians, birds and reptiles. The surgeon general nominee wrote that "even primitive cultures understand the nature of waste elimination, sexual intercourse and the birth of children. Indeed our own children appear to 'intuitively' understand these facts."

A Political Agenda?

Professor Eli Coleman, Director of the Program in Human Sexuality at the University of Minnesota Medical School said that the paper seems to have a pre-1970s view of human sexuality. "I an't imagine that any scientific journal would be able to publish this material because of its very narrow views of homosexuality," he said.

In fact, if one of his students handed the paper in, Coleman would give it a failing grade, he said. "I find it rather outdated in terms of its scientific knowledge and also narrow in its view of homosexuality," Coleman said. "It concerns me because I think our public policy really should be based upon best available science."

"It's a totally faulty paper. The man doesn't know anything about human sexuality," said June M. Reinisch, Ph.D., director emeritus of the Kinsey Institute for Research in Sex, Gender & Reproduction. "There's clearly a political agenda in this paper. This is not a scientific paper."

Paragraph by paragraph, Reinisch said Holsinger presents faulty arguments. Many homosexuals do not engage in the sexual act he criticizes; 40 percent of heterosexuals do. "It seems to me he's arguing the only way reproduction happens is in a loving heterosexual environment which is of course not true," Reinisch said, noting artificial methods, rape and one-night stands.

Reinisch, who was director of the Kinsey Institute when Holsinger wrote this paper, said that if Holsinger "is going to come up with this position in 2007 I think I can clearly say that he is not qualified to be surgeon general."

Holsinger holds a doctorate in anatomy and physiology and an M.D. from Duke University. He spent much of his career working for the Veteran's Health Administration. From 2003 to 2005 he was Kentucky's secretary of the Cabinet for Health and Family Services.