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Nation Finally Gets New Surgeon General

The Clinton administration overcame conservative opponents in the Senate to win confirmation Tuesday of Dr. David Satcher as surgeon general, filling the nation’s top health post after a threeyear vacancy marked by clashes over abortion policy and sexuality.

Satcher, well-regarded within the medical community for his leadership of the Centers for Disease Control and Prevention in Atlanta, promised when he was nominated last September he would use public health’s bully pulpit for “plain, old-fashioned straight talk” about exercise, diet and smoking.

He assumes the office as issues of science and public health rank high on the legislative agenda. The Senate is engaged in a debate on human cloning, and Congress later this year will consider a national settlement on tobacco, a public-health issue first highlighted 34 years ago by a surgeon general.

“No one is better qualified than Dr. Satcher to be America’s doctor,” President Clinton said in a statement after the 63-35 confirmation vote, adding Satcher will be a “leading voice” in efforts to pass a tobacco settlement.

The surgeon general’s post has gained in prominence since Reagan appointee C. Everett Koop first spoke out on AIDS policy during the 1980s, and the position increasingly has become embroiled in bitter battles over social issues.

Dr. Joycelyn Elders, Satcher’s predecessor, was fired from the post because of impolitic remarks she made about teenage sexuality. Dr. Henry Foster, an obstetrician who was the administration’s first choice to replace her, failed to win Senate approval because of a dispute over the number of abortions he had performed.

Satcher, 56, ran into opposition from social conservatives led by Sen. John Ashcroft, R-Mo., largely because of Satcher’s support for the Clinton administration’s position on a proposed ban on certain late-term abortions. Clinton opposes the ban, unless an exception is made for women whose health is at risk.

“America deserves better,” said Ashcroft, who also criticized Satcher for attaching a favorable letter to a CDC study on needle-exchange programs for drug users to prevent the spread of AIDS. “Needles to conduct … poisonous activity,” Ashcroft fumed.

The Senate voted Tuesday to cut off a weeklong filibuster against Satcher and then approved the nomination, with 19 Republicans joining 44 Democrats.

Sen. Edward Kennedy, D-Mass., dismissed the opposition to Satcher as “an excuse to play to the raw emotions that are out there.” Abortion policy, he said, “is going to be resolved by the Congress and not (Satcher).”

Although Ashcroft lost the battle against the nomination, the filibuster could enhance the presidential hopeful’s standing with social conservatives, who will be a key group in Republican presidential primaries in 2000.

Another Republican, Sen. Bill Frist of Tennessee, the only doctor in the Senate, said Satcher would make “a fine surgeon general.”

“We need a voice who can pull together medical and scientific evidence,” Frist added. “When the surgeon general speaks, the world listens.”

Satcher had the support of major health groups, including the American Medical Association. Since he became head of CDC in 1993, the agency has improved childhood immunization rates, expanded screening for breast and cervical cancer and laid the groundwork for a new system of detecting food-borne illnesses.

Created shortly after the Civil War, the surgeon general’s office has little direct authority but can at times command the power to focus public attention. The position’s visibility has waxed and waned throughout its history, periodically becoming the object of public controversies.

About a century ago, Surgeon General Walter Wyman sent unwelcome health corps doctors to San Francisco to control an outbreak of plague. Municipal officials didn’t want the world to know about the outbreak.

During the 1930s, campaigning to raise awareness of rising rates of infection by sexually transmitted diseases, Surgeon General Thomas Parran made headlines when he refused a radio network’s demand to delete the word “syphilis” from a broadcast.

Surgeon General Luther Terry’s declaration in 1964 cigarette smoking caused cancer also was controversial, coming at a time when smoking was well accepted by society.

And Reagan appointee Koop, an evangelical Presbyterian with a stern Old Testament countenance, parried objections to his campaign to promote condom use and distribute pamphlets on AIDS to every American mailbox by saying he was chosen “surgeon general, not the chaplain.”

More recently, Clinton’s first appointee, Elders, was criticized for statements she made on sex education, condom distribution and legalization of some drugs. She finally was fired for the response she gave when she was asked during a United Nations conference whether masturbation should be promoted as part of sex education.

“That is something that is part of human sexuality, and it’s part of something that perhaps should be taught,” Elders answered.

Satcher’s formative medical history goes back to the age of 2, when he nearly died from whooping cough. Although a vaccine existed, immunization was rare then for the poor blacks he grew up among in rural Alabama.

The son of a foundry worker, Satcher went on to an education at Morehouse College. He was the first African-American to simultaneously earn medical and doctoral degrees at Case Western Reserve University in Cleveland in 1970.

His medical career began in Los Angeles directing a program on sickle-cell anemia, a debilitating genetic disorder that mostly affects blacks. He also started a clinic in a church basement in inner-city Watts.

Later, he spent more than a decade as president of the historically black Meharry Medical College in Nashville.

Satcher also was confirmed Tuesday as assistant secretary for health at the Department of Health and Human Services, a job with more policy-making authority but less public visibility than surgeon general. He is the first person to hold both posts simultaneously since Dr. Julius Richmond in 1981.

“This is an American dream come true,” Satcher said in a statement, “to go from a humble farm in Anniston, Ala., to the office of surgeon general, to have the chance to serve the country I love, and to earn the confidence of so many leaders I honor and respect.”

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