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Room at the top
EDITORIAL
THE LANCET Volume 359, Number 9309
Room at the top As minimum requirements for a job go, the following should not be too demanding: a degree from an accredited medical school; 1 year of postgraduate medical training; and a licence to practise medicine in one American state. The job? Surgeon General of the USA. This position is one of five vacancies at the top of health and science in the USA after Jeffrey Koplan, director of the Centers for Disease Control and Prevention (CDC), announced his resignation last week. The Commissioner of the Food and Drug Administration (FDA) became vacant in January 2001, when Jane Henney, appointed by Bill Clinton, was not asked to stay in the post by George Bush. There has been no-one at the head of the National Institutes for Health (NIH) since 1999 when Harold Varmus left. Another key vacancy is administrator of the Health Resources and Services Administration, the agency with a remit to remove inequalities in access to health care. Why are all of these posts vacant? One reason might be that President Bush simply does not believe how critical they are for health and science policy in the USA, and hence filling them has not been a priority for him. The second reason is the often unstated, but implicitly understood, need for candidates to agree with the president and his supporters on several key issues, including stem-cell research, family planning and abortion, and the role of business in health care. Candidates who, for example are known to be in favour of a woman’s right to choose to have a termination are unlikely to even be considered for these jobs, whatever other qualifications they might have. Drug company representatives recently made known their disapproval of one candidate for the FDA job, who was thought to be too critical of them. And in addition to all their other qualifications, candidates should now have some knowledge of bioterrorism. The third reason for the vacancies may be that doctors and scientists are increasingly unwilling to move into the unforgiving spotlight of public and political life. To start with, candidates must be confirmed by the Senate—a painful process that can last up to a year while the Senate examines every aspect of their professional, and sometimes personal, lives. THE LANCET • Vol 359 • March 9, 2002 • www.thelancet.com
Whatever the reasons, this lack of leadership has serious implications for the USA. Tommy Thompson, the Secretary of Health and Human Services who has responsibility for these positions, has appointed interim leaders, who as temporary appointees, do not need senate confirmation. Without confirmation however, the interim leaders do not have the necessary authority when it comes to budget and policy negotiations. The budgets involved are huge—for example $US23 billion in 2002 for the NIH to distribute to 36 000 research projects. Among the important scientific issues on which the USA needs to develop clear policies rapidly are: stem-cell research; where research priorities should lie after the sequencing of the human genome; and, in the wake of the terrorist attacks of last year, how the USA should prepare for bioterrorism. The administration needs talented leaders in place to advise on these issues. Decisions made (or not made) now will have long-term implications. The US administration needs to resolve this lack of leadership quickly. Political considerations should not be allowed to override science and health priorities. The president is unlikely to be able to find a worldclass scientist capable of leading the NIH who does not at least have some reservations about Bush’s conservative views on stem-cell research. Similarly the president is unlikely to find a Surgeon General who agrees with all his views on abortion, family planning, and the role of business in health, and who will also be able to command the respect of his or her peers. George W Bush should remember C Everett Koop who was appointed Surgeon General by Ronald Reagan. Although he shared Reagan’s view on abortion, in other areas Koop went against the wishes of the White House, speaking out against the tobacco industry and promoting the idea of AIDS as a public health issue, rather than a moral one. The White House disapproved, but Koop was a good advocate for public health in the USA. The present US administration should have the courage and foresight to appoint the best leaders of science and health whatever their views. The Lancet 811
For personal use. Only reproduce with permission from The Lancet Publishing Group.
THE LANCET Volume 359, Number 9309
Room at the top As minimum requirements for a job go, the following should not be too demanding: a degree from an accredited medical school; 1 year of postgraduate medical training; and a licence to practise medicine in one American state. The job? Surgeon General of the USA. This position is one of five vacancies at the top of health and science in the USA after Jeffrey Koplan, director of the Centers for Disease Control and Prevention (CDC), announced his resignation last week. The Commissioner of the Food and Drug Administration (FDA) became vacant in January 2001, when Jane Henney, appointed by Bill Clinton, was not asked to stay in the post by George Bush. There has been no-one at the head of the National Institutes for Health (NIH) since 1999 when Harold Varmus left. Another key vacancy is administrator of the Health Resources and Services Administration, the agency with a remit to remove inequalities in access to health care. Why are all of these posts vacant? One reason might be that President Bush simply does not believe how critical they are for health and science policy in the USA, and hence filling them has not been a priority for him. The second reason is the often unstated, but implicitly understood, need for candidates to agree with the president and his supporters on several key issues, including stem-cell research, family planning and abortion, and the role of business in health care. Candidates who, for example are known to be in favour of a woman’s right to choose to have a termination are unlikely to even be considered for these jobs, whatever other qualifications they might have. Drug company representatives recently made known their disapproval of one candidate for the FDA job, who was thought to be too critical of them. And in addition to all their other qualifications, candidates should now have some knowledge of bioterrorism. The third reason for the vacancies may be that doctors and scientists are increasingly unwilling to move into the unforgiving spotlight of public and political life. To start with, candidates must be confirmed by the Senate—a painful process that can last up to a year while the Senate examines every aspect of their professional, and sometimes personal, lives. THE LANCET • Vol 359 • March 9, 2002 • www.thelancet.com
Whatever the reasons, this lack of leadership has serious implications for the USA. Tommy Thompson, the Secretary of Health and Human Services who has responsibility for these positions, has appointed interim leaders, who as temporary appointees, do not need senate confirmation. Without confirmation however, the interim leaders do not have the necessary authority when it comes to budget and policy negotiations. The budgets involved are huge—for example $US23 billion in 2002 for the NIH to distribute to 36 000 research projects. Among the important scientific issues on which the USA needs to develop clear policies rapidly are: stem-cell research; where research priorities should lie after the sequencing of the human genome; and, in the wake of the terrorist attacks of last year, how the USA should prepare for bioterrorism. The administration needs talented leaders in place to advise on these issues. Decisions made (or not made) now will have long-term implications. The US administration needs to resolve this lack of leadership quickly. Political considerations should not be allowed to override science and health priorities. The president is unlikely to be able to find a worldclass scientist capable of leading the NIH who does not at least have some reservations about Bush’s conservative views on stem-cell research. Similarly the president is unlikely to find a Surgeon General who agrees with all his views on abortion, family planning, and the role of business in health, and who will also be able to command the respect of his or her peers. George W Bush should remember C Everett Koop who was appointed Surgeon General by Ronald Reagan. Although he shared Reagan’s view on abortion, in other areas Koop went against the wishes of the White House, speaking out against the tobacco industry and promoting the idea of AIDS as a public health issue, rather than a moral one. The White House disapproved, but Koop was a good advocate for public health in the USA. The present US administration should have the courage and foresight to appoint the best leaders of science and health whatever their views. The Lancet 811
For personal use. Only reproduce with permission from The Lancet Publishing Group.