Pubdate: Fri,  8 Feb 2002
Source: Associated Press (Wire)
Copyright: 2002 Associated Press
Author: Laura Meckler
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

U.S. SURGEON GENERAL'S TERM TO END

WASHINGTON - David Satcher doesn't mind telling Americans what they might 
not want to hear.

As surgeon general, he's praised programs that give drug addicts clean 
needles to shoot up. He's said there's no evidence that teaching teens 
sexual abstinence by itself is effective. He's said Americans should learn 
to accept gays and lesbians for who they are.

If the science is clear, he says, that's enough for him. And when the White 
House spokesman denounced his report on sexual health, he figured that just 
comes with the territory.

"The surgeon general has to be prepared to be beat up from the podium of 
the White House," said Satcher, whose four-year term ends next week.

He leaves with a thorough understanding of where science ends and politics 
begins.

"When you say drug addiction is a medical problem, the public health 
science is overwhelming. Does that mean the Congress is going to act that 
way when it passes legislation? People are much more comfortable putting 
drug addicts in jail, in prison, than they are in funding programs for 
treatment," he said in an interview this week.

He says he's proud of taking on politically tough issues like sex, and 
emotionally tough issues like suicide and mental health.

It's easy to be honest, he says, when the science is clear. It's much 
harder when it isn't. After Americans began getting sick with anthrax, 
there were more questions than answers.

Satcher sees his role as communicating established scientific information, 
so he figured he should lay low, given the lack of solid information.

But with misinformation swirling and people panicking, it became clear that 
he needed to start talking, he said.

"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 it was only to say what I often said, which is we're all learning 
together," he said.

His role was essential, providing some of the "only clear messages we got," 
said Dr. C. Everett Koop, surgeon general under President Reagan. 
Politicians, Koop said, "were saying we have everything in hand," while 
Satcher told people that much was unknown.

"All you've got to be with the public is honest," he said.

Overall, Koop concludes, Satcher was effective by simply talking 
straightforwardly about important issues. "He didn't do it in a radical 
way. He doesn't rant and rave from a pulpit," he said. "He just says what 
needs to be fixed."

The surgeon general's position has been a magnet for controversy. In the 
1960s, it was radical to suggest smoking causes cancer. In 1980s, it was 
bold to talk frankly about AIDS.

The position had been vacant for three years when Satcher took office. His 
predecessor, Joycelyn Elders, was fired after she suggested that teaching 
teens about masturbation made sense.

Just two months into Satcher's term, President Clinton decided to bar 
federal funding for needle exchange programs, which give addicts clean 
needles for dirty ones in hopes of stemming the spread of HIV, the virus 
that causes AIDS. Research found that needle exchange programs do not 
increase drug use, but Clinton decided that they send the wrong message.

Satcher served as assistant secretary for health as well as surgeon 
general, meaning he was caught between supporting his team's decision and 
speaking frankly about what the science showed. On the day Clinton's 
decision was announced, he ducked a question about his personal feelings.

It made it difficult for him to truly be independent, he said.

"I hope that ... the American people will (always) be able to say the 
surgeon general does not speak for the administration," he said. "Is that 
comfortable when your budget comes from the administration? No, it's not."

Sex and drugs generate headlines, Satcher said. But he believes some of his 
most rewarding work involved mental health and suicide prevention.

"I didn't realize there were so many people out there hurting because 
somewhere along the way they lost a loved one to suicide and they've been 
walking around blaming themselves, saying what did I do wrong, why didn't 
he or she love me enough to want to live," he said.

One of the most gratifying experiences, he said, was being able to tell 
people that most suicide victims were suffering from mental illness of some 
sort and "you're not responsible."

Satcher's rise to the post sometimes called "America's family doctor" began 
on a farm in Anniston, Ala., in a home with parents who didn't finish 
school and had little money. With far from adequate health services, he 
almost died of whooping cough at age 2.

As he went through college and medical school, Satcher was often the only 
black man in the classroom.

He says it's helped him make a real difference in such a public post.

"Based on my own experience ... I know role models make a difference," he 
said. "When you see someone in a position like that it raises your 
aspirations, it raises your hope about what you can do in your own life."

But being a black man in a top post has also had its disadvantages.

"This is still a town where it's not easy for African-Americans, especially 
African-American men, to get the same kind of credibility," he said. "I 
think we're still struggling with our history."
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