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| NEWSMAKER: DR. SATCHER
April 29, 1998The NewsHour with Jim Lehrer Transcript |
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Although it acknowledged that needle exchange programs help slow the spread of HIV, the Clinton administration has decided not to lift the federal funding ban on such programs. Following a background report on the needle exchange debate, Surgeon General David Satcher discusses this and other medical issues facing the nation.
A RealAudio version of this segment is available.
NEWSHOUR LINKS:
April 29, 1998
The debate over needle exchange programs.
April 17, 1998
The debate over medical marijuana in California.
December 1, 1997
Assessing the fight against AIDS.
December 17, 1996
President Clinton announces an AIDS action plan.
September 17, 1996
Heroin once again in on the rise.
Browse the NewsHour's health coverage.
OUTSIDE LINKS:
A Department of Health and Human Services fact sheet on needle exchange.
A Presidential Advisory Council on HIV/AIDS report recommending federal support for needle exchange programs.
PHIL PONCE: Dr. David Satcher has been in office now for just over two months. Dr. Satcher was one of ten children in his family in the rural town of Anniston, Alabama. In 1970, he became the first African-American to earn a medical degree and a doctorate at the same time from the Case Western School of Medicine. Early in his career he worked on sickle cell anemia and opened a free clinic in the Watts section of Los Angeles. From 1982 to 1992, Dr. Satcher served as president of Meharry Medical College in Nashville. In 1993, he became the director of the Federal Centers for Disease Control. Now, 57 years old, he is the nation's 16th surgeon general and Dr. Satcher joins us now. Welcome, sir.
DR. DAVID SATCHER, Surgeon General: Thank you very much.
PHIL PONCE: First of all, quickly, your reaction to the House vote today to ban the use of federal money in needle exchange programs.
"I'm disappointed because I'm concerned that it's a repudiation of science."
DR. DAVID SATCHER: Well, I'm disappointed because I'm concerned that it's a repudiation of science. And yet I understand the complexity of this issue. And let me just briefly say that the science which comes not only from the federal government's scientists at NIH and a consensus conference but the National Academy of Science's Institute of Medicine, the American Medical Association, the American Public Health Association all agree that when you examine needle exchange programs scientifically, you find the following things: Number 1, needle exchange programs, if conducted properly, can prevent the spread of the HIV of the HIV virus. Number 2, they do it without encouraging drug use. And, more than that, many needle exchange programs have been very successful at getting people who are addicted to drugs into treatment programs. So that's what the science says.
However, I want to say two other things. Number 1, I agree with people who say that we cannot afford to send any messages to our young people that encourages them to use illicit drugs, and throughout my life and career, I have worked to make sure that young people understood the dangers of drugs and will continue to work; however, I do have a responsibility as a scientist, as a public health scientist, to really state what the science shows. I realize the complexity of these issues, but I'm going to continue to say what the science shows. I believe this country has a tremendous record for supporting science. It has not always been easy but probably more than any other country this country has listened to the science. I believe ultimately we will listen to the science, but I realize that we have some difficult communications to do about this issue.
PHIL PONCE: Earlier, you were quoted as also expressing disappointment in the Clinton administration's decision not to use federal funds to support these programs. Should federal funds be used to support these programs?
DR. DAVID SATCHER: Well, let me say what I said that I'm disappointed about. I'm a scientist and I'm a public health scientist. And I think whenever we do work in the area of science, we want it to be supported. But I also understand that if anybody is uncomfortable with the messages that we're sending, they would want to wait for more science or more discussion, and I think that's basically the message from the administration. We're not ready to use federal funds yet. What bothers me about the House action today is the permanent ban. In other words, we don't care what the science says. We're not listening to the science. I think we have to move beyond that, and I think we will.
PHIL PONCE: So you're saying that if science were later to more persuasively establish that these programs work, then you would at least like the option of federal funds?
"What we're trying to do is to fight an epidemic. And I think we're trying to do it using the best science that we have available to us...."
DR. DAVID SATCHER: Exactly. I just think that we have to continue to listen to science. I think we have to continue to be open to science. At the same time we have to continue to be very clear with our young people that it's wrong to use illicit drugs; it's dangerous; and we strongly discourage it. But it's also wrong not to respond when people are dying from the virus. 40 percent of new cases of HIV are related to injection drug use. 70 percent of women are--understand me--most of these women are not using drugs. They are infected because of their relationship with somebody who is using drugs, and many times they don't even know it. 75 percent of the babies today who are born with the HIV virus get it directly--indirectly from drug use. What we're trying to do is to fight an epidemic. And I think we're trying to do it using the best science that we have available to us, and yet, at the same time, let's face it, it's not as easy as it was when we were fighting micro-organisms, and the enemy was a micro-organism, and we could just target that. We're also dealing with human behavior, and that's going to become increasingly true in public health. We're dealing with human behavior and not just micro-organisms.
PHIL PONCE: Moving away from the needle exchange question, what do you see as your mission? You've been in office now for two months. What are your goals?
"...working to see that every child in this country has an opportunity for a healthy start in life."
DR. DAVID SATCHER: Well, I think very clearly we have talked about No. 1, working to see that every child in this country has an opportunity for a healthy start in life. And all that that means in terms of making sure that parents are ready to be parents, that they're responsible as parents before becoming parents, but also making sure that mothers have access to quality prenatal care, and that the environment in which babies develop is a healthy environment. The second thing that we've been talking about, of course, is promoting healthy lifestyles. And that includes nutrition, regular physical activity, and avoiding toxins like tobacco, like excessive use of alcohol and other drugs, so those are some of the critical things. We've also been talking increasingly about mental health and the need for this nation to take a different kind of attitude and approach to mental health so that people don't feel isolated, families don't feel isolated if they have a problem with mental illness. We talked about suicide as an example of that and the need to really be more supportive of families who have to struggle with mental health problems. But I must say that addiction to drugs is another one of those issues, and several physicians, including Dr. Louis Sullivan, Dr. Lonnie Bristow and others, have recently come out to say we really need to deal with drug addiction as a medical problem, just as we deal with diabetes. And I agree with that. It's not going to be easy to get there. As you've seen today, we have some more discussion to do. But I'm not discouraged. We just have to keep moving forward, and we have to keep communicating.
PHIL PONCE: Dr. Satcher, you've been quoted as saying that you want to eventually be known as the surgeon general who listened better than any other surgeon general in history. What are you hearing so far from people?
DR. DAVID SATCHER: Well, as I said, some of the things that you've heard me say recently I'm saying because of what I've heard, especially on the suicide issue. Every year in this country over 31,000 people die from suicide, only 22,500 from homicide. So more people die from suicide. Teenagers are increasingly committing suicide. And I think what we're hearing is that people want us to deal with that problem in terms of prevention. They want more attention given to preventing suicide. I think we have to bring more attention to bear. We're going to have a major conference on suicide. Hopefully, out of that will come a surgeon general's report that will be helpful.
PHIL PONCE: Two of your predecessors, C. Everett Koop and Dr. Joycelyn Elders, both found themselves mired in controversy at certain points in their tenure, Dr. Koop with condoms and AIDS, Dr. Elders with issues involving teen sexuality. Is controversy just part of the turf for being surgeon general?
DR. DAVID SATCHER: If you look back at the history of surgeon general--surgeons general, you would have to say, yes. Thomas Perrin in 1936 was on a radio program and used the word "syphilis." That was not acceptable at the time to use the word syphilis. They tried to ban him from the networks and to get him fired. Luckily, he survived that, but he--what he did wrong was to say the word syphilis at a time in history when it was not acceptable. So yes, I think it is, but I think the responsibility of the surgeon general is to bring the best science to bear on every problem. And that is going to be controversial because people are not always ready to deal with the best science.
PHIL PONCE: So what lessons have you taken from Dr. Elders' experience, for example?
DR. DAVID SATCHER: Well, I mean, I bring to this position the benefit of my own experience as director of the CDC, as president of a medical college that dealt with young people for over 12 years, so I bring that experience to this position, and certainly I'm aware of the fact that Dr. Elders tried to deal with some very difficult issues. So did Dr. Koop, so did Dr. Perrin, and so did many others. And I'm going to deal with some difficult issues. I'm going to do a lot of listening to people who disagree with me, however.
PHIL PONCE: What do you say to those people who observe that your position was empty for three years and who take the position that maybe the position is not all that relevant?
The relevance of the surgeon general.
DR. DAVID SATCHER: Well, I point out the relevance of it when you look at the surgeon general's report on smoking in 1964, that we estimate now has saved at least 3 million lives; I look at the relevance of it in terms of responding to an epidemic like AIDS in the early days. So I think there's a lot of tremendous evidence of the relevance of the office of the surgeon general in this country and even the way people have responded to me, a thousand invitations to speak in the first two weeks being in this office. People definitely feel the need to hear from a voice in medicine that's based on science. And so I think that's the evidence that the position is relevant.
PHIL PONCE: Have you been surprised or gratified by people, the way people respond to you? For example, I read that the uniform is an issue for people; they like to see it.
DR. DAVID SATCHER: People like the uniform and the response has been very positive. This is not an easy job, but what's gratifying is the fact that--the very positive response that so many people have to the surgeon general.
PHIL PONCE: Dr. Satcher, I thank you for being with us.
DR. DAVID SATCHER: Thank you very much. Delighted to be here.
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