Leaving Office, Satcher Reflects on Four-Year Surgeon General Term

Feb. 13 is Surgeon General David Satcher's last day as the nation's top doctor, ending a four-year term in which he "walked a fine a line between science and politics," the AP/Baltimore Sun reports. Satcher was sworn in as the nation's 16th surgeon general on Feb. 13, 1998, after being nominated for the position by former President Clinton (AP/Baltimore Sun, 2/10). In a recent interview with NPR's "Morning Edition," Satcher discussed his "controversial opinions and policies concerning sex, drugs and mental illness," as well as the role of the surgeon general. Satcher said that the surgeon general should "communicat[e] directly" with the public to provide the "best available public health science" without regard to personal opinion, politics or White House support. After taking office, "Morning Edition" reports, Satcher supported a needle-exchange program to reduce HIV transmission, despite opposition from the White House. Satcher said, "The science showed very clearly that needle-exchange programs could reduce the spread of HIV and that they did it without increasing drug use. In fact, later studies showed that people involved in needle exchange programs were more likely to go into treatment programs to stop using drugs. So I spoke for that public health science." In 2001, Satcher pushed for "broader" sex education programs by releasing a study that found no evidence that abstinence-only programs are effective in reducing the spread of sexually transmitted diseases (Edwards, "Morning Edition," NPR, 2/11). Noting that the Bush administration "denounced" the study, Satcher told the AP/Baltimore Sun that "the surgeon general has to be prepared to be beat up from the podium of the White House" (AP/Baltimore Sun, 2/10). "I enjoy a good fight," he told the New York Times (Stolberg, New York Times, 2/9). Satcher said that he considered it his responsibility to "communicate established scientific information." Therefore, he opted to "lie low" during the anthrax scare because of the lack of solid information. However, he "start[ed] talking" about anthrax when people began panicking. "When it was obvious there was confusion and there was concern, I felt it was appropriate that the American people hear from the surgeon general, even if was to only say ... we're all learning together" (AP/Baltimore Sun, 2/10).

Words of Advice
Satcher warned that his replacement's success might be jeopardized without a "meaningful budget" that gives the office the independence it needs. President Bush has proposed $1 million for the office in his fiscal year 2003 budget plan, which would keep funding at its current level. However, that level of funding does not cover the cost of "even one" report from the office. Satcher said he often sought funding from other sources, including Congress, where lawmakers occasionally attempted to "meddle with results" of the studies (New York Times, 2/9). After leaving office, Satcher plans to spend the next six months working on a book about his experience as surgeon general as a senior visiting fellow at the Kaiser Family Foundation. Then, he will direct the National Center for Primary Care at Morehouse School of Medicine (AP/Baltimore Sun, 2/10). The full NPR report is available online. Note: You must have RealPlayer to listen to the report.

Replacement's Qualifications
The next surgeon general needs to be "smart, honest, plain-spoken" and able to "fac[e] controversy to do what's right," the Boston Globe writes in an editorial. Noting that the White House's rumored selection is Kenneth Cooper, a doctor "credited with popularizing aerobics," the Globe says that although Cooper could "offer a great deal" to those who are overweight, "the times demand a surgeon general who can talk about fitness and bioterrorism." Also, the next surgeon general will need to address "lingering issues" such as needle-exchange programs. The Globe concludes: "The next surgeon general has to be willing to sift out the politics, to offend powerful leaders and use the best public health science to educate Americans" (Boston Globe, 2/13).