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Independence of the US Surgeon General
THE LANCET
THE LANCET Volume 350, Number 9090 EDITORIAL
Independence of the US Surgeon General Dr David Satcher is a strong nomination for the position of US Surgeon General but conservative politicians will not accept it. Satcher is director of the US Centers for Disease Control and Prevention (CDC). Without coming from a privileged background he became a family doctor, researcher, and medical college president. While at CDC he helped increase childhood immunisation rates in the USA from 55% to 78% in just 4 years, expand programmes for breast and cervical cancer screening, awaken colleagues around the world to the threat of emerging infectious diseases, and institute surveillance programmes for foodborne illnesses. But his nomination has been stalled by a band of conservative ideologues who are threatening to filibuster if it comes to a full vote of the Senate. How strange. Just last month the Senate Committee on Labor and Human Resources gave Satcher their endorsement by a margin of 12 to 5. One might have thought that vote would have clinched the appointment. But during Committee deliberations—when Satcher was no longer present to defend himself—conservatives began laying the groundwork that may eventually foil the nomination. “Would you clarify”, came the letter to Satcher from the Committee a couple of weeks after the deliberations, “whether you believe the office of Surgeon General should be used to advance or promote an agenda on abortion?” It seems the conservatives “discovered” that Satcher supports President Clinton’s position that partial-birth abortions should remain legal only when a pregnant woman’s life or health are jeopardised by childbirth. The role of the Surgeon General is to “protect and advance the health of the nation”. This requires an understanding of and proven commitment to a vast array of difficult and controversial problems. The savagely narrow political litmus test of partialbirth abortion demonstrates the conservatives’ ignorance of the greater role and potential of the Surgeon General. Their stance arises only from the Vol 350 • November 22, 1997
political demands of parochial lawmakers and ignores any rational concern for what is best for the country. If successful, it will deprive the USA of a man with broad perspective and experience. The politicisation of the Surgeon General’s post threatens the independence that sound publichealth practice requires. When President Clinton fired Dr Joycelyn Elders for her insistence that control of the epidemics of AIDS and teenage pregnancy required public discussion of sex and sexuality, he established a precedent for the kind of treatment Satcher endures today. It was not always so. During the 1980s, Dr C Everett Koop triumphed bravely over the unhappy silence of President Reagan to awaken the country to the threat of HIV. From 1936 to 1948, Dr Thomas Parran continually agitated for the prevention of sexually transmitted diseases, and through the 1950s and 1960s Dr Leroy Burney and Dr Luther Terry published the unpopular first reports on cigarette smoking and lung cancer thereby inciting perhaps the longest, bloodiest, and potentially most beneficial public-health battle we may see. But there is a new, vitriolic shortsightedness to Satcher’s detractors. The nominee responded to the Committee’s questions by stepping carefully yet remaining firmly independent. “I share no one’s political agenda”, he wrote, “I believe it would be unfair and inappropriate to have my nomination complicated at this time by an issue that has little, if anything, to do with my background or agenda for the future”. We agree. Satcher’s background is praiseworthy and his commitment to public health would be a credit to a nation whose health-care policies often seem directionless and inequitable. We hope the more sensible voices of the US Senate will be heard. And President Clinton should have the courage to fight for Satcher’s approval and to restore the independence of the Surgeon General.
The Lancet 1489
THE LANCET Volume 350, Number 9090 EDITORIAL
Independence of the US Surgeon General Dr David Satcher is a strong nomination for the position of US Surgeon General but conservative politicians will not accept it. Satcher is director of the US Centers for Disease Control and Prevention (CDC). Without coming from a privileged background he became a family doctor, researcher, and medical college president. While at CDC he helped increase childhood immunisation rates in the USA from 55% to 78% in just 4 years, expand programmes for breast and cervical cancer screening, awaken colleagues around the world to the threat of emerging infectious diseases, and institute surveillance programmes for foodborne illnesses. But his nomination has been stalled by a band of conservative ideologues who are threatening to filibuster if it comes to a full vote of the Senate. How strange. Just last month the Senate Committee on Labor and Human Resources gave Satcher their endorsement by a margin of 12 to 5. One might have thought that vote would have clinched the appointment. But during Committee deliberations—when Satcher was no longer present to defend himself—conservatives began laying the groundwork that may eventually foil the nomination. “Would you clarify”, came the letter to Satcher from the Committee a couple of weeks after the deliberations, “whether you believe the office of Surgeon General should be used to advance or promote an agenda on abortion?” It seems the conservatives “discovered” that Satcher supports President Clinton’s position that partial-birth abortions should remain legal only when a pregnant woman’s life or health are jeopardised by childbirth. The role of the Surgeon General is to “protect and advance the health of the nation”. This requires an understanding of and proven commitment to a vast array of difficult and controversial problems. The savagely narrow political litmus test of partialbirth abortion demonstrates the conservatives’ ignorance of the greater role and potential of the Surgeon General. Their stance arises only from the Vol 350 • November 22, 1997
political demands of parochial lawmakers and ignores any rational concern for what is best for the country. If successful, it will deprive the USA of a man with broad perspective and experience. The politicisation of the Surgeon General’s post threatens the independence that sound publichealth practice requires. When President Clinton fired Dr Joycelyn Elders for her insistence that control of the epidemics of AIDS and teenage pregnancy required public discussion of sex and sexuality, he established a precedent for the kind of treatment Satcher endures today. It was not always so. During the 1980s, Dr C Everett Koop triumphed bravely over the unhappy silence of President Reagan to awaken the country to the threat of HIV. From 1936 to 1948, Dr Thomas Parran continually agitated for the prevention of sexually transmitted diseases, and through the 1950s and 1960s Dr Leroy Burney and Dr Luther Terry published the unpopular first reports on cigarette smoking and lung cancer thereby inciting perhaps the longest, bloodiest, and potentially most beneficial public-health battle we may see. But there is a new, vitriolic shortsightedness to Satcher’s detractors. The nominee responded to the Committee’s questions by stepping carefully yet remaining firmly independent. “I share no one’s political agenda”, he wrote, “I believe it would be unfair and inappropriate to have my nomination complicated at this time by an issue that has little, if anything, to do with my background or agenda for the future”. We agree. Satcher’s background is praiseworthy and his commitment to public health would be a credit to a nation whose health-care policies often seem directionless and inequitable. We hope the more sensible voices of the US Senate will be heard. And President Clinton should have the courage to fight for Satcher’s approval and to restore the independence of the Surgeon General.
The Lancet 1489