Surgeon general persisted, prevailed
By Karen Blakeman
Advertiser Staff Writer
David Satcher, former surgeon general of the United States, has advice for people who advocate controversial public health policies and find themselves in the center of a political maelstrom:
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"Don't give up. The worse thing you can do is to give up."
David Satcher was honored at the National Medical Association convention's opening ceremonies Saturday night.
Health policies based on scientific research are worth the effort it takes to implement them, he said, and sometimes it just takes a little time for politicians to catch up.
Satcher, who was honored at the National Medical Association convention's opening ceremonies Saturday night, led doctors on a run up Diamond Head yesterday morning, then spoke at the convention yesterday afternoon.
The 61-year-old physician was the 16th surgeon general, serving from February 1998 until February 2002, through the administrations of both Bill Clinton and George W. Bush.
Though he encouraged bipartisan dialogue, Satcher refused to shy from controversy. During his term, he demonstrated that it is possible to work within government and oppose some of its policies at the same time.
The former director of the Centers for Disease Control survived confirmation hearings that included a filibuster by then-Sen. John Ashcroft, who objected to Satcher's support of abortion rights and advocacy of national needle-exchange programs to prevent the spread of disease among addicts.
After Satcher took office, Clinton also objected to the needle-exchange program. Satcher stood his ground; it was the right thing to do to prevent the spread of AIDS and other diseases, he said. A clean-needle law passed recently in Hawai'i was based on Satcher's recommendation.
When Clinton left office and was replaced by President Bush, his critics waited to see whether the surgeon general would bend to the political winds.
He didn't. Over Bush's objections, Satcher issued a report on sexual health that called for sex education in schools as well as homes and churches. He rejected the administration's position that abstinence outside heterosexual, monogamous marriage was the only way to show sexual responsibility. The use of condoms was also viable, Satcher said, recommending distribution of condoms in schools.
Satcher, who considers himself an independent, said sticking to science and avoiding actions that could be construed as politically motivated helped him to survive his confirmation hearings.
When he needed support from powerful Republicans, he asked long-time friend Louis Sullivan, Secretary of Health and Human Services during the first Bush administration, to call Sen. Orrin Hatch. The Utah Republican's support opened the door for backing from other Republicans, whose votes helped put a stop to Ashcroft's filibuster.
During the hearings, Ashcroft, a Missouri Republican, cited a paper written by ethicists questioning the CDC's use of a control group while testing a well-known AIDS drug on African mothers.
"He was trying to say that I was exploiting African women," Satcher said. Refusing be drawn into lashing out at the ethicists, Satcher had the ethicists who had written the paper come to the hearing and testify on his behalf.
In addition to his report on sexual responsibility, Satcher's work as surgeon general included advocating a greater focus on mental illness, and calling on health care professionals to help remove the stigma attached to it.
He called for a greater emphasis on dental care and oral health, and worked for the equal dissemination of health care to patients of all economic and ethnic groups.
He also has called for increased emphasis on physical fitness in the schools and removal of soft drink vending machines from school property.
Satcher said the one thing he regrets about his government service is that he did not see universal health care instituted.
Clinton's national health care initiative was defeated, at least in part, he said, because having Hillary Clinton head the project was seen as political. Satcher was not surgeon general then, but head of the Centers for Disease Control.
He said Clinton had admitted recently that he had been wrong to oppose the clean-needle measure.
And shortly after Ashcroft made it through his own stormy confirmation hearings, the newly appointed attorney general approached Satcher during a swearing-in ceremony in the White House rose garden.
"He apologized," Satcher said. "He said: 'I was wrong, and you did a great job.' "
"Maybe he changed his mind after the sexual health report," Satcher said.
Since leaving government service, Satcher has served as a visiting fellow at the Kaiser Family Foundation in Washington, D.C. Next month he will take over as the director of the National Center for Primary Care at the Morehouse School of Medicine.
