[Congressional Record Volume 144, Number 6 (Wednesday, February 4, 1998)]
[Senate]
[Pages S343-S350]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                         Privilege of the Floor

  Mr. ASHCROFT. Mr. President, I ask unanimous consent of the Senate 
that several members of my staff be given floor privileges during the 
pendency of this debate: Don Trigg, Annie Billings, David Ayres, Lori 
Sharpe, and Sarah McElroy.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ASHCROFT. Thank you very much.
  Mr. President, as I explained earlier when the unanimous consent was 
sought by the leader to bring this matter to the floor of the Senate, 
there is an absence of some materials that are important and pertinent 
to an evaluation of this nominee as a result of the failure or lack of 
cooperation of this administration to provide to Senators information 
upon our request. So I indicate at this moment that there will be 
things that are reserved for debate at a later time when we have that 
material available to us.
  I am pleased to go forward now and take this opportunity to outline 
some of my reasons for opposing the nomination of Dr. David Satcher for 
U.S. Surgeon General and Assistant Secretary for Health.
  While a case against Dr. Satcher is a compelling one, I must confess 
from the outset to being a grudging participant in these struggles over 
political nominees. It is really not one of the more pleasant tasks in 
the Senate. It gives me no satisfaction to deny anyone an opportunity 
to serve his or her country. Nomination fights can be difficult, they 
can be abrasive, they can be partisan, and sometimes they work neither 
to educate nor to unify the Senate. Yet, after three years in 
Washington, I believe that America deserves better, America deserves 
higher quality, and America deserves higher standards of ethics than 
the standard that has been sent to this Senate by the administration 
for confirmation.
  A nation, like a person, rarely loses its integrity, or its capacity, 
or its ethics all at once. Instead, our values tend to be lost little 
by little. And I think we have seen that in this administration.
  I can remember a Surgeon General of this administration who wanted to 
legalize drugs. We have seen Cabinet Secretaries come forward to admit 
their infidelity. Then one day the Vice President goes out and endorses 
and embraces Hollywood and all of the values that Hollywood would 
propound to undermine the ethics and character of America. The next day 
the President vetoes a partial-birth abortion bill and basically 
defends what Patrick Moynihan, the Senator from New York, has labeled 
as ``infanticide.'' And so it goes.
  Finally, we wake up to find our President accused of a kind of 
conduct in the White House with employees that I wouldn't even want to 
try to describe here on the Senate floor. Frankly, I don't know what is 
more tragic: That the Office of the President has been so thoroughly 
debased in the debate and comments and accusations in the society, or 
that our values have been so demeaned, that it appears much of the 
public doesn't believe that we can expect any better.
  Frankly, if my time in government has taught me any one thing it is 
that we teach when we govern. We are assigning values to things when we 
govern. When we approve of something we say to the culture ``This is 
good,'' and when we disapprove of something we say ``This is bad.'' In 
assigning values in a culture, the values of which have been under 
serious attack, asking questions is an important one of our 
responsibilities.
  Government and its officials teach, and what we are teaching these 
days is wrong. Although Dr. Satcher is a person of incredibly strong 
medical credentials in terms of his expertise and his capacity, his 
effort has been devoted in an area and in a number of ways which call 
into serious question the values that we would be teaching and the kind 
of ethical standards we would be saying are OK, if we were to confirm 
him.
  While our Nation is challenged by the crisis of drugs, the tragedy of 
illegitimacy, and the breakdown of the family, our public officials 
have been too busy accommodating America in these things, rather than 
calling America to her highest and best. Piece by piece, our Nation's 
integrity has been sacrificed, and too often the Senate of the United 
States has participated in confirming nominations or ratifying 
proposals without looking carefully at the ethics involved or the 
values that are being challenged when a nomination is being confirmed.
  Dr. Satcher's elevation to the post of Surgeon General of the United 
States, Dr. Satcher's confirmation, would reject America at her highest 
and best and would simply say that we are willing to accept a series of 
values which are far beneath what the American people endorse. Dr. 
Satcher, for example, has embraced partial-birth abortion. He tolerates 
abortions for minor children without parents' consent. He supports free 
needle programs, so that drug addicts would be aided and assisted in 
the administration of their drugs by a Government program that provides 
free needles.
  I think this accommodates people where they are, at a low level, 
instead of challenging people to where we need to be, at a high level. 
I think America deserves that kind of challenge for quality and 
integrity and ethics. I question the value of a Government program and 
its ethics when it provides needles to drug addicts so they can 
administer drugs in a way which is more healthy--if you could say that. 
Why should the United States of America participate in that?
  Consider the following information. Dr. Satcher has promoted research 
on African women who were HIV positive. That research denied them 
known, lifesaving drugs and therapy. Our Nation's top medical journal 
is the New England Journal of Medicine. Virtually everything that you 
ever hear, in terms of something new, something at the cutting edge of 
improving medicine, is written of and announced in and discussed on the 
pages of the New England

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Journal of Medicine. The New England Journal of Medicine chastised Dr. 
Satcher, literally branding his research in these African HIV trials--
in which some African women bearing children were given sugar pills or 
placebos--as being unethical.
  I think America deserves better. America deserves a Surgeon General 
who repairs to the highest standard of ethics. America deserves better 
than a Surgeon General who would experiment on the most vulnerable 
members of the world's population.
  Dr. Satcher has championed blind tests that sent thousands of HIV 
positive infants home without parental notification. That happened in 
this country, not in Africa. Infants were tested for HIV. The tests 
were maintained as blind so that no parent would know if the child that 
was tested, their baby, was testing positive for HIV. This practice 
intentionally left moms and dads without an awareness or understanding 
of whether their child was infected with the HIV virus.
  It might be argued, ``Well, the moms and dads might be able to find 
this out because they realized they were living in risky lifestyles or 
were at high risk for HIV infection themselves.'' That might be true. 
It might not be true. But what happens if that mom or that family 
decides to give the child up for adoption? If there had been a test of 
the child's blood which indicated whether or not it was HIV positive, 
the adoptive parent might not be privy to that information, especially 
if the information isn't even available to the natural birth parent. I 
think America deserves better. I think this country deserves better 
than a Surgeon General who would have those kinds of tests conducted 
and not provide that kind of vital, potentially lifesaving information.

  I understand that people might want this kind of information for 
statistical purposes, so we could develop an awareness of the 
statistics about AIDS and which communities have the highest levels of 
AIDS. But I think Government too often views people as statistics. I 
think we need a Government that views people as human beings and 
understands the importance of individuals and parents and children. 
Ignoring the potential for an early diagnosis on the HIV virus is, I 
think, something that would raise serious questions. I would not want 
to be a parent who was not told if my child had HIV, in spite of the 
fact that the Government had conducted a test which would reveal it.
  Certainly, if I weren't the natural parent and I were in the shoes of 
someone adopting a child, I think I would want to know, not so that I 
might not adopt the child, but so that I might take whatever measures 
would be necessary. One might begin to take the steps which could 
curtail the incidence of the kinds of diseases that can attend and 
participate in the eventual collapse of an individual who is HIV 
positive. There is progress being made in the area of AIDS research. 
But it seems to me if you have some life extending knowledge, you would 
want to make that available because you might extend a life to the time 
when a cure would become available.
  America deserves better than a Surgeon General who is more concerned 
about the secrecy of experiments than he is about the lives of the 
specific patients involved. There are scientists and medical doctors 
who are more concerned about statistics. It may well be that they 
should be commended for their interest in statistics. But I think 
America's family doctor, the Surgeon General of the United States of 
America, should be one who reflects a concern about individual lives 
and about individual health conditions. He should call America to her 
highest and best as it relates to health and should never, never settle 
for America at her lowest and least.
  Maybe this is what America has come to expect from Washington. It may 
be what we expect, but it is less than we deserve. It is time for us to 
stand up and defend values--values like honesty, integrity and 
decency--and it's time for us to demand a Surgeon General who will 
appeal to the better angels of our nature, who will attend the health 
of the Nation, not one who would participate in the ``clean needles'' 
approach to the drug problem.
  These are issues that I intend to elevate in the Senate's 
consideration of this nomination: The African HIV studies overseen by 
Dr. Satcher during his supervision of the Centers for Disease Control 
and the ethical debate that swirls around these studies, including the 
indictment by the New England Journal of Medicine that these studies 
were unethical; the domestic AIDS detection programs that refused to 
identify the blood samples with the children so that the parents would 
never be told as a result of that test whether their children had AIDS, 
sending parents home with AIDS-infected children without giving them 
the benefit of what the studies could have shown; there are the clean 
needles programs which, frankly, don't appeal to us at our highest and 
best but accommodate the culture at its lowest and least and put the 
Government in the drug business.
  I think there are real reservations about the kind of signals that 
sends. What does it teach? What does it teach a young person if a 
junkie says to him or her, ``You ought to try this,'' and the young 
person says, ``Well, I don't know if I should.'' Then the junkie says, 
``Well, look, the Government gives us these clean needles,'' rips open 
a pack, and says, ``so that you won't have any problem, so this will be 
a safe procedure for you.'' I have real reservations about that. I 
think the people of the United States of America deserve better than 
that.

  I think the United States of America deserves better than a Surgeon 
General who is willing to endorse the President's position on partial-
birth abortion. It is clear to me that the people of this country 
understand the heinous terror, the horror, and the tragedy of partial-
birth abortion. We do teach by what we endorse, when, by confirming 
something, we authorize and ratify it. I think we have real problems 
when we would purport to confirm an individual who is endorsing 
partial-birth abortion, especially when it is now well understood by 
medical authorities that it is not even a medically needed or indicated 
therapy.
  All of these things are interesting points. There are other matters 
which will be the subject of discussion. But America deserves better. 
We deserve a family doctor who will lead us to our highest and best, 
rather than accommodate us at our lowest and least. I mentioned in a 
colloquy, with the leader of this Senate, that we had sought 
information from the Centers for Disease Control and from the 
administration about this nominee and we had not been sent that 
information. Some of the information which we will be using in the 
debate has come as a result of Freedom of Information Act demands, 
which information hasn't been forthcoming without those kinds of 
inquiries. As a result, I think you can expect the debate to be more 
thorough as the information arrives.
  These are the broad outlines. America deserves better. America ought 
to have a Surgeon General who calls us to our highest and best, not one 
who accommodates us at our lowest and least. We should not have a 
Surgeon General who would participate in an assault on the values of 
America, opposing 80 percent of Americans who believe partial-birth 
abortion is wrong. We should not have a Surgeon General who believes 
that it would be OK to have clean needles programs that put the 
Government in the business of participating in the administration of 
illegal drugs. We should have real reservations about a Surgeon General 
whose regard for Third World populations allows him to use your tax 
dollars to have lower standards in conducting medical research on 
people overseas than the standards he would use in the United States of 
America. I think that has implications for who we are as a people and 
it has implications for the way other nations view us, if we are 
willing to do things with their population we wouldn't do with our own 
population. Obviously we would have reservations about the maintenance 
of a program which tests the blood of young children for HIV but does 
not provide their parents with the information that would allow them to 
make good judgments about their health care later on.
  With those things in mind, I would just signal that, as the 
information becomes available, I would expect additional Members of the 
Senate to come to the floor and participate in this debate. We will 
have a chance to examine each of those categories in detail with a view 
toward assessing whether or not

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this Senate should teach the kinds of things that would be taught to 
the American public if we were to confirm this nomination.
  The PRESIDING OFFICER (Mr. Gregg). The Senator from Vermont is 
recognized.
  Mr. JEFFORDS. Mr. President, I have listened very carefully to my 
friend from Missouri. I was disturbed about these matters, as he was, 
when I initially looked into the background of Dr. Satcher. These were 
fully investigated. They were answered in detail by the nominee. The 
record of those requests, involvement in these particular issues--the 
two most dramatic ones being perhaps the so-called free needles, clean 
needles, and also the AZT trials--the answers to those interrogatories 
are a matter of record and available to all Senators. In addition to 
that, they are on the Internet so the public can freely look into them.
  Let me very briefly give you an idea of the nature of the situation. 
The Senator referred to the New England Journal of Medicine. That would 
give you considerable credibility. But you should know that two members 
of the editorial board who were familiar with the AZT trials, which 
were in Africa, and were familiar with the methodology used resigned 
from the board as a result of that journal editorial. They understood. 
And I will go into length later on these trials, but I do not desire to 
do so now.
  Also, the question of needles and drugs is a matter of AIDS as well, 
AIDS prevention, and therefore when you understand fully the issue you 
will understand that this is a defensible way to prevent the spread of 
AIDS.
  But with that brief discussion, I will yield to my good friend who 
has been so very helpful on my committee, the Senator from Tennessee, 
Mr. Frist.
  Mr. FRIST addressed the Chair.
  The PRESIDING OFFICER (Mr. Gregg). The Senator from Tennessee.
  Mr. FRIST. Mr. President, I am delighted to rise because I think we 
have before us a very important issue and one that we have not dealt 
very well with, at least since I have been in the Senate. There will be 
a lot of debate as we just heard on a number of issues and I am happy 
to debate those issues. I think they are important to the American 
people. If the allegations that have been sent to me by fax machine, 
some of which we have heard just expressed in the Chamber, are true, I 
would agree that America does deserve better. What I hope that I can do 
is offer a reasoned voice, a voice based on some experience but more 
importantly one that is close to science, one that has been involved in 
placebo controlled trials, one who participates in ethical 
decisionmaking in medicine, in health care, one who knows Dr. Satcher, 
whom I hope we hear something about. In fact, I will take a few minutes 
and talk about Dr. Satcher, the man, the man who came before our 
committee, the man who has contributed so much throughout his life for 
the betterment of public health, his fellow man and, more importantly, 
for that next generation.
  I do think we need a Surgeon General. I was in Africa last week and 
asked a lot about these AZT trials, and I hope to have a chance to 
comment on those a little bit later. About a month ago, there was what 
we thought was a new disease, what the world thought was a new disease 
called Rift Valley Fever, which killed about 400 people in Kenya over a 
period of 3 weeks. It came quickly. It came because of the flooding. 
There was an awakening of a mosquito larvae that carried a deadly virus 
which could not be identified. There was mass confusion in the 
scientific community, really all around the world, about, is this a new 
virus? It causes a huge hemorrhagic bleeding and terrible death. Is it 
going to extend beyond the borders of Kenya to Africa and to the United 
States?
  Amidst all that confusion there was not a single voice either in the 
United States or anywhere in the world to step forward and take that 
available information to reassure the public, to point out what is 
known by science.
  Luckily, a few weeks later, the virus itself was described, the 
floods actually got much better and hopefully we have seen the end of 
that particular virus for hopefully the next decade. It is a virus that 
does stay around for decades and decades. But it made me think how 
important it is to have a reasoned, educated, articulate, concise 
voice--we do not have it--in the United States right now to interpret 
the innovation and changes in how health care is delivered today to the 
American people.
  Just yesterday on this floor we introduced a bill on cloning. It is a 
difficult bill, a bill I have had to go back and spend a lot of time 
on, putting on my hat as a scientist to understand, and it made me 
think once again, wouldn't it be nice to have somebody whose sole job 
is to be the Nation's doctor and to help interpret science, help 
interpret what we know, to talk directly to the American people. I am 
talking really generically about the Surgeon General now, because many 
of my colleagues have come forward in the past and said, do we really 
need a Surgeon General? Wouldn't it be easier to escape all the 
politics?

  Let me say I think much of the discussion we are going to hear about 
is straight politics, nothing beyond that, and I hope we show over the 
next few hours and the next few days the lack of substance that has 
been demonstrated by a number of groups today in terms of getting down 
to reality, the truth, and that is what I want us to demonstrate in 
this body not just to each other but the American people. Let's rise 
above politics.
  Now, unfortunately, some people point back to several years ago when 
the position of Surgeon General appeared to be used for political 
agendas and social agendas which were outside of the mainstream and 
America did at that time deserve better. The case I wish to make is 
that Dr. David Satcher does better. He is the most appropriate person 
for this position today and will carry it out with the integrity, with 
the dignity, with the moral values and the forethought, the background 
and the training that we as Americans expect.
  Now, what is this position of the Surgeon General? A lot of people 
say, ``What does he do?'' I already told you my impression of what we 
need in terms of that articulate, concise, straightforward voice that 
can listen and talk to the American people.
  In addition, the Assistant Secretary of Health oversees 
administration of eight agencies of the Public Health Service, which 
include the office of Surgeon General. In these dual roles, Dr. Satcher 
would serve as the public doctor, but in interpretation of what is 
going on, the direction we should go, looking into the health and the 
future welfare of our children, but also in advising the Secretary of 
Health and Human Services. That is a void which we have today. The 
Secretary of Health and Human Services does not have a person to come 
in and advise on the sorts of policy that will affect everybody in this 
Chamber today and their children and that next generation.
  I sat through a lot of meetings today with talk about how much money 
the President can spend, and the President has proposals, the private 
sector has proposals, how many hundreds of millions of dollars can we 
spend on television to educate people so that their children won't 
start smoking or how we can set up a new bureaucracy with new employees 
out of Washington, DC, or take an old bureaucracy and have them come in 
and educate our young people today.
  I just want to throw up my hands and say, listen, let's go back to 
those basic principles. You do not have to spend more money. You do not 
have to set up big bureaucracies. Let's get that one vocal, 
intelligent, trained, articulate, eloquent spokesman who can speak for 
mainstream values, and that one position can be the Surgeon General, 
without spending all this money on this extra bureaucracy that we do 
not know whether it will work or not.
  We know the role of Surgeon General works. On this same issue, in 
1964, if you asked the world who is the one voice who has had the most 
impact today on this issue of smoking and teenagers, it has to go back 
to the Surgeon General's report of 1964. Yes, way ahead of its time. 
But who better than to have the Surgeon General? Is it better to have 
the heads of the tobacco companies or the manufacturers or politicians 
or somebody who can intelligently go in and digest the available 
scientific data, who can reach out to the American people and interpret 
what is right and what is wrong for the public health?
  I contend it is the Surgeon General, and if you look back over that 
longer

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record, not just the last 6 years but back to 1964 and before, you will 
see that the Surgeon General's voice has been effective.
  Dr. C. Everett Koop in the 1980s, all of us remember, woke America up 
to an emerging public health threat. Some people wanted to hide in the 
sand and say it is not a problem; it is not affecting my family, my 
community. Therefore, let's not make any progress. Dr. C. Everett Koop, 
as Surgeon General, stepped forward and he said we have an emerging 
crisis. He said it is HIV positive. It is called AIDS. In candor, in 
realism, let's help the public.

  I needed help as a health professional at the time to help separate 
out the facts from the fiction, what you read in the press, what you 
receive over your fax from some special interest group that wants to 
take a tiny little topic and blow it out of proportion. Who sets that 
perspective? I would argue that if it is in the field of public health, 
the Surgeon General sets that perspective for an audience of health 
practitioners as well as the public.
  Although we have not been very effective in looking to this office. 
Yet there the Surgeon General's reports have been very effective and 
informative regarding public health. About a year and a half ago, the 
Surgeon General's office issued a report demonstrating that moderate 
physical activity can reduce the risk of heart disease and some 
cancers. These very effective reports produced over time have helped to 
interpret for the public the direction of living a healthier lifestyle.
  Now, if you look back historically at these reports--and I went back 
and did it because I haven't been around that long, in terms of looking 
at what has been generated from the office of the Surgeon General--my 
conclusion is that there has been no political agenda in mind in these 
reports--I don't want to say without exception because I haven't read 
every report, but the well being of the Nation, of the public health 
was at the heart of each of these reports. And I guess as I was in 
Africa 2 weeks ago as a scientist who looks at new viruses, who looks 
at the public health challenges, I thought we have public health 
threats in this country, such as smoking and drug abuse. Just last year 
we talked in this body about foodborne illnesses, alcoholism, emerging 
infectious diseases, resistance to antibiotics which we feel so 
comfortable with. I can tell you the resistance to antibiotics is one 
of the greatest challenges we have in this Nation but also the world 
that stands before us. Who is going to help us interpret what that 
means? Is it going to be a Senator? I don't think so. Is it going to be 
the Secretary of HHS? I don't think so. Is it going to be the 
President? No. It is going to be the Surgeon General.
  Dr. Koop called this position of Surgeon General a ``high calling 
with an obligation to interpret health and medical facts for the 
public.'' A high calling. I will tell you, it is a high calling because 
you put yourself through the sort of accusations which I will contend 
and hopefully show that many are false. They are totally untrue. They 
are accusations, totally unproven, and that is going to be the subject 
I think of much of our discussion today. I hope the American public 
keeps faith in this institution and in the sort of debate we will 
engage in and at every case come back and ask those fundamental 
questions about integrity, about looking at one's past record as we 
look to the future.
  I haven't said very much yet about Dr. David Satcher. Let me say at 
the outset that I know Dr. David Satcher. I have known him for a long 
time. I knew him as a physician, a fellow physician in Nashville, TN. I 
have known him as an educator, as somebody who has run a medical 
school. And as we look to the sorts of challenges we have in the 
future, medical education is one of those challenges--how we maintain 
the excellent physicians that we have today in a world of managed care, 
reduced funding by the Federal Government.
  Dr. Satcher is an administrator. I guess a lot of the focus is going 
to be on the large public health agency, the Centers for Disease 
Control and Prevention (CDC). Over the next several days, I have a 
feeling what is going to happen is that you have the head of a large 
organization and you have thousands of programs under that 
organization, and we are going to have people find in some program down 
at the community level where there is some tracing through the large 
organization to the fellow at the top who is held responsible, and he 
should be responsible for it as long as the American people look at all 
of the other positive things that he--in this case, Dr. Satcher--has 
done in leadership of that organization, which is the largest public 
health organization, not just in the United States but in the world.

  So I ask my colleagues to paint the larger perspective as we go 
through, as these examples of local programs are brought forward that 
have something that I don't agree with personally. We will come back to 
that. So I hope we can get above the politics and look at the 
qualifications of this family physician.
  As we move into this next millennium, we need to be thinking about 
family practice. He is a family practitioner. He has the endorsement of 
the society that represents family practitioners. Dr. Satcher has 
taught family practice and chaired a department of family practice.
  Science. Again, I mentioned that yesterday I spent most of the day 
interpreting what somatic cell nuclear transfer is to my colleagues, to 
the media, and to the American people and that's good, but I am not 
sure a United States Senator needs to be spending so much time talking 
about a specific scientific technique year after year after year. And 
here we have somebody who is nominated to be the next Surgeon General 
who has not only a medical degree but a Ph.D., another advanced degree 
in an advanced science, the science of cytogenetics, somebody who has 
written research papers, been in the laboratory, applied for grants and 
received those grants, somebody who understands what a clinical trial 
is, what peer review is, what a placebo control trial is, somebody who 
has been in the room as we talk about medical ethics. And medical 
ethics is tough. You can always find people within the field who 
disagree.
  But I will contend that as we look at these ethical issues, such as 
the clinical trials in Africa and other parts of the world, we will 
come to the conclusion that the appropriate ethical process was 
undertaken under the leadership of Dr. David Satcher.
  Another hat. Dr. Satcher has a distinguished record of promoting the 
public health, improving health based upon science, not one's feelings 
or one's politics, but on science.
  I don't agree with everything that Dr. Satcher says or does, nor do I 
expect to, but I do want to go back to what he has told me, what he 
presented to our committee, because it is important for the American 
people and for my colleagues to fully understand what his vision is, as 
well as his background, because there is going to be an attempt to 
insert another agenda on Dr. Satcher which is not his agenda.
  I think in the confirmation process, we have to ask a couple of 
questions.
  No. 1, does this man, Dr. David Satcher, have the commitment, the 
intelligence, the training, the experience, the honesty, and the 
integrity to be the chief spokesperson for Americans on matters 
concerning health?
  I contend that he does.
  And can he articulate those views?
  He is a good spokesperson. For my colleagues who have had the 
opportunity to talk to him, he can articulate his views with dignity 
and with clarity as an eloquent spokesperson.
  He has a demonstrated public service record, which has been reviewed 
by the chairman in part. He is a good manager. Scientific integrity I 
have mentioned.
  President of Meharry Medical School in Nashville, TN, how important 
is that? I contend it is important to have had that past experience. If 
you had to go out and choose a physician to participate in 
understanding public health, I think that being the head of a medical 
school is a wonderful credential to bring to the table. He has an 
understanding of population-based medicine, a broad understanding of 
the health care delivery system and--I can tell you and I am sure over 
the course of the day, a number of people will put in letters of 
endorsement by the medical societies and by his peers--he is a widely 
respected physician by the medical community.
  He is a scientist, I mentioned. I should also mention, because we are

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going to be talking about ethics so much, that he is a wonderful family 
man with a wonderful wife, wonderful children, teaches Sunday school, 
understands medical ethics. From everything that I know about Dr. 
Satcher, he is a reasoned, scientific voice, and he will represent us 
well as the next Surgeon General.
  Let me look a little bit more at his experience. I mentioned he 
received his medical degree and his Ph.D. The Ph.D. was in 
cytogenetics. It was at Case Western Reserve.
  I think it important to have both, that understanding of individual 
patients--and he has practiced medicine--as well as an understanding of 
the science and having that advanced degree, a Ph.D. in cytogenetics.
  His experience is broad. We know about the Centers for Disease 
Control and Prevention. We know about Meharry Medical College. What you 
may not know, is that for 3 years, he was professor and chairman of the 
Department of Community Medicine and Family Practice--that was back in 
1979 to 1982--thus, demonstrating his concern for his local 
communities.
  In a theme which he gave again and again, both in our committee and 
with me directly, was his commitment to allowing decisions to be made 
by local communities instead of decisions dictated by the federal 
government out of Washington, DC. I think that is important, because as 
we look at a number of these programs and information we are reaching 
out for, I hope my colleagues will ask the question, did Dr. Satcher, 
through the CDC, make the decision on that program or did he allow a 
local community to make a decision using the resources that are 
available?
  I think his commitment, which has been made very clear to me, to have 
both resources and decisions about public health made by local 
communities comes from his experience having been a chairman of the 
Department of Community Medicine and Family Practice at the School of 
Medicine in Morehouse College down in Atlanta.

  Before that time, Dr. Satcher was a dean, an interim dean, at the 
Charles R. Drew Postgraduate Medical School. He was also a professor 
and chairman of the Department of Family Medicine at the Charles R. 
Drew Postgraduate Medical School in Los Angeles. And, he was medical 
director of the Second Baptist Free Clinic.
  His professional experience is interesting, because we talk about 
populations, and I don't want to get too far into the science, but I 
think it is important that whoever is the Surgeon General does 
understand what happens with large populations. The Surgeon General 
becomes the Nation's doctor. And just like when I, as a physician 
before coming to this body, would see a patient who came in the door, 
it was my job to interpret, to educate, to listen to and to diagnose. 
The Nation's doctor does the same for over 250 million people. 
Therefore, it is important he understands populations and disease in 
populations.
  It is interesting that Dr. Satcher also was an assistant professor of 
epidemiology, and that is the statistical study of population-based 
diseases. Once again, a wonderful credential for the position of 
Surgeon General. That was at the School of Public Health at the UCLA 
School of Medicine in Los Angeles.
  Does he understand medical problems? Yes.
  Remember his many published articles--I don't need to go through the 
articles, but let me relate to you that he has written extensively 
about hypertension, high blood pressure. Cardiovascular disease is the 
No. 1 killer in the United States of America today. In the early 1970s, 
he was director of the hypertension outreach program. He has done 
research. He understands the importance of preventive as well as 
therapeutic medicine.
  Board certification. His qualifications: 1994, fellow, American 
College of Preventive Medicine. Yes, this man understands what we need 
to do now to prevent, not just treat, the problems that we inevitably 
will face and probably will face with increasing frequency in the 
future.
  In 1980, fellowship, American Academy of Family Physicians. I have 
already mentioned their broad support for their medical colleague in 
this position.
  1976, board certification, American Board of Family Practice.
  Active in communities. I mentioned that he spent a large period of 
his life in Nashville, TN, which is my home. These are the sort of 
things we don't look at a lot here because we get lost in rhetoric. I 
think a lot is how involved one is as a role model in their own 
communities. Dr. David Satcher was involved in his own community. I 
mentioned he taught Sunday school. He is active with the United Way and 
has been on the board of United Way in middle Tennessee. He was chair 
of the Minority Health Professions Foundation. He was a board member of 
the Boy Scouts of America for 10 years. Board member, Easter Seals 
Society. This man understands his commitment to large populations. He 
understands public health. What is wonderful to me is it starts with 
him as a role model, as a father, as an active participant in his own 
community.
  We are going to come back to a lot of the issues, issues which mostly 
arose after the committee hearing on Dr. Satcher's nomination. At the 
hearing, Dr. Satcher had the opportunity to articulate his vision of 
what this Office of Surgeon General is. And, therefore, I would like to 
refer back just very briefly to what he has said, to use it as the 
foundation upon which the discussions about looking to the future will 
rest.
  This is from the testimony before the Labor Committee. He basically 
said:

       As Assistant Secretary for Health and the Surgeon General, 
     I would take the best science in the world and place it 
     firmly within the grasp of all Americans. I would not just 
     speak to Americans but would also listen to them, really 
     listen to them. I would want to hear about their expectations 
     and their experiences, their questions and their concerns 
     and engage them in an ongoing conversation about physical 
     activity, about good nutrition.

  We haven't heard much about that thus far in this body, about Dr. 
Satcher's agenda.
  I hope we talk about Dr. Satcher's plans for good nutrition.

       For responsible behavior and passports to good health and 
     long life.

  He says:

       As Surgeon General, I would strive to provide our citizens 
     with cutting-edge technology in plain old-fashioned straight 
     talk. Whether we are talking about smoking or poor diets, I 
     want to send the message of good health to the American 
     people.

  He continued:

       My goals as Assistant Secretary for Health and Surgeon 
     General are to be an effective advisor to the Secretary by 
     providing sound medical public health and scientific advice 
     as appropriate. I want to bring more attention, awareness and 
     clarity to the opportunities for disease prevention and 
     health promotion that are available to individuals, families 
     and communities in this country. I want to help make the 
     health of children and youth a greater priority for the 
     Nation and serve as a positive and inspirational role model 
     to them.

  That is his vision.
  One last quotation from that testimony, again more to get it in the 
Record and have my colleagues understand where Dr. Satcher wants to go. 
He said in closing:

       I will challenge the American people to be the best they 
     can be and to respect the roles of parent, families and 
     communities. I will try to bring people together. That is who 
     I am.

  Let's keep that in mind, that fundamental kernel in mind as we go 
through and listen to the various arguments made why he should not be 
Surgeon General.
  As a way of introduction, because that is what we are doing in terms 
of setting the parameters, instead of going into each of the issues 
that have been mentioned earlier, let me cite several of the 
allegations and start that debate as we go back and forth.
  As I have said, a number of allegations have come forward, and I am 
sorely disappointed in the substance behind those allegations as they 
come across the fax machine and are presented to me by well-meaning 
constituents who came forward and said, ``What is it? Did Dr. Satcher 
really do that?'' I hope to point out over the next day or so that, no, 
he did not, and that our responsibility is to come to the truth behind 
Dr. Satcher.
  Position No. 1 is partial-birth abortions and the proposed ban, and 
this is one I dealt with very early on, because

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I feel strongly that this body has a responsibility as trustees to the 
American people to ban this procedure which offends the sensibilities 
of everyone.
  The issue of partial-birth abortion also deeply troubles Dr. Satcher, 
and I hope that everybody who is concerned about this issue has sat 
down and talked with him and listened to his statements.
  In a letter dated October 28 to me, Dr. Satcher wrote the following:

       Let me state unequivocally that I have no intention of 
     using the positions of Assistant Secretary for Health and 
     Surgeon General to promote issues related to abortion. I 
     share no one's political agenda--

  Let me read that one more time--

       I share no one's political agenda, and I want to use the 
     power of these positions to focus on issues that unite 
     Americans, not divide them. If confirmed by the Senate, I 
     will strongly promote a message of abstinence and 
     responsibility to our youth, which I believe can help to 
     reduce the number of abortions in our country.
  In the written responses to the Labor Committee--also it is important 
to refer at least to that in passing; we will probably come back to 
it--Dr. Satcher says he supports in concept the ban of this partial 
birth abortion procedure, and then explains what his position is. But I 
think what is important, if you look over his past, his 25 years as a 
professional, abortion has not been on his agenda in terms of promoting 
the public health, and as you look forward, based on the statements he 
has made to us directly to the committee and in our own conversations, 
abortion is not going to be on his agenda.
  I think the people who feel so strongly about the litmus test on the 
statement by Dr. Satcher that he thinks those sorts of decisions should 
be made locally--if the litmus test is so strong, I can understand my 
colleagues voting against Dr. Satcher. But I hope they look more 
broadly since it is not going to be on his agenda for the future and 
has not been over the last 25 years.
  Number 2. Dr. Satcher's position regarding AZT, which is a drug that 
is used successfully, if it is given in a certain high-tech way, to 
prevent the transmission of the HIV virus from a mother to a child. We 
are going to come back to this a lot. It is a good issue. It is a good 
issue because there has been years of extensive debate on this very 
issue by the countries that are involved, by the United States, by 
scientists, by theologians, by trained ethicists. We can relive those 
debates, if you would like.
  But let me try to boil it down to several issues. I was in Africa 
last week, in countries including Kenya. The per capita spending on 
health care for an individual in Kenya is about $5 annually.
  Should we take a therapy, ethically, that in this country we know 
works--the cost down there, if we adopted it, is about $1,000. This 
therapy works in the United States. But in truth, from a practical 
standpoint, logistically, because it is intravenous therapy, it 
requires a series of doses with followup that extends over a long 
period of time. Practically, economically, logistically, that therapy 
has zero chance--and nobody says otherwise--to become the standard 
therapy in a country like Kenya today, zero chance.
  Is it ethical, I ask, for us in the United States to take that arm, 
that therapy to Kenya and experiment there when there is absolutely no 
chance that that therapy can ever be used to benefit that population? 
The answer is, no. By international standards, the answer is, no.
  That is the standard basically. If you are going to be using clinical 
trials which are dealing with people directly, the therapy has to be in 
some shape or form potentially beneficial to that population. And $5 
per person is what is spent on health care totally--child care, 
prenatal care, treatment in the hospitals, clinics, medicines. And to 
thrust a therapy which cost $1,000 into a health care system that 
cannot support it is, to my mind, unethical. That is No. 1.
  No. 2, placebo control trials. What does that mean? It means 
basically that someone comes in, you are looking to see whether an 
intervention works or not, the HIV virus is transmitted from mother to 
daughter. What can you do to intervene to stop transmission of that 
virus that is practicable, that is reasonable, that has some chance of 
being applied there broadly?
  Well, the question is, can you take that very complicated, Western-
style, intravenous $1,000 AZT therapy, which is the standard in America 
now, can you in some way modify that so there is some chance that a 
shorter course, hopefully given orally, or maybe a shorter course with 
one intravenous dose, but a shorter, less expensive course, works? 
Because if it works, you can go out and prevent the transmission of HIV 
to the millions of babies who are born to mothers who are HIV positive.
  How do you know if it works or not? You have to compare it 
to something. From an ethical standpoint, nobody has been in any one of 
these AZT trials under discussion that informed consent has not been 
obtained. So when you go out and say this is like Tuskegee--we can go 
into that--it is nothing like it. And I look forward to that, coming to 
the floor in relation to that, because I received these faxes comparing 
it to a terrible, terrible experiment in this country. It is not like 
that. We will come back to that. But every person had informed consent 
in these trials. That is very important because that is one of the 
national, international norms.

  AZT. Does it work or not? What do you compare it to? Well, the 
standard today in clinical trials all over the world is that you have a 
control population and a population that you intervene with. How else 
are you going to know what the difference is, whether this AZT therapy 
works?
  Yes, this was a placebo controlled trial. It is the standard of 
therapy today. People do not get treatment right now for the 
transmission of HIV. When I was down there as a physician asking, 
``What do you do?''--one out of four people in this community are HIV 
positive--``What do you do?'' they laughed. ``We can't do anything. Why 
don't you help us devise a protocol?'' That is what happened.
  These countries came to the United States of America, through the 
World Health Organization, and said, ``We have to design an 
intervention that will work, that is practical, that is consistent with 
it being applied in these countries.'' And the response, going through 
the appropriate ethical channels, were these trials that we are talking 
about.
  Why placebo control? Why can't we use placebo controls, since we had 
this control population, in the United States? Well, we do not know 
today whether AZT, this drug, interacts in some way with a background 
of malaria. And you have to have a placebo control trial because the 
population there is not the population in the United States of America 
or in France or in England or wherever these past trials have been 
conducted. The only way you can get the answer is through carefully 
designed placebo control prospective trials to be able to answer that 
question--does AZT work or not?
  The third issue that has come forward is this needle exchange 
program. And I think we will get back to that. Let me just make the 
following statement because it boils it down to everything.
  Dr. Satcher has never advocated taxpayer-funded needle exchange 
programs for drug abusers. Dr. Satcher has recommended to Congress that 
we allow scientific studies to answer the key questions involved with 
this particular issue. Dr. Satcher believes strongly that we should 
never do anything to advocate the use of illegal drugs. The intravenous 
use of illegal drugs is wrong. He has said that. He opposes the use of 
any illegal drugs.
  Secretary Shalala, in a February 1997, report to Congress, concluded 
the following in regard to this needle exchange program, because it can 
be pulled out and draw up these images in people's minds of needles 
going into the arms of drug addicts, especially free needles. We have 
to step back and look at what the scientific studies show.
  In the letter that she sent to Congress, the following conclusions 
could be made. Needle exchange programs--and I quote--``can be an 
effective component of a comprehensive strategy to prevent HIV and 
other bloodborne infectious diseases in communities that choose to 
include them.'' That is what the science said. We can argue that and we 
can talk about the social policy. That is what the science says today. 
But most importantly, the department itself has not yet concluded that 
the

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conditions set forth by Congress on Federal funding of needle exchange 
programs have yet been met. We in Congress have crafted a protection to 
disallow federal funding of needle exchange programs unless the science 
shows that such programs will not only reduce HIV infection, but also 
not increase drug use.
  Fourth, is Dr. Satcher's position on the survey of childbearing 
women, the blinded surveys. We have heard already this morning, and we 
will continue to hear, that opponents of Dr. Satcher have erroneously 
claimed--and I use the word ``erroneously;'' and I underline it--that 
the infants known to be HIV positive were sent home without parental 
notification after being tested specifically for HIV. And this is 
simply untrue. It is not true.

  Again, it takes some understanding of how science today, and the 
medical community and the public health, obtains baseline data from a 
population so you will know where you are starting, whether or not 
interventions work or not, how much of a public health issue it should 
be.
  In this particular case, samples were gathered from left over blood 
specimens that were taken for standard tests. The rest of the blood is 
discarded and put over in a cabinet, typically thrown away.
  Under this study, all personal identifying information is taken off. 
But that blood has some useful purpose from an epidemiologic 
standpoint, from a public health standpoint because we can see what the 
baseline of something like HIV positivity actually is. The information 
that was gathered from these surveys of this discarded blood is not 
labeled, is not attached to an individual--Why not? For reasons of 
privacy, something that we all respect. We do not want people taking 
blood from us, having our name attached to it, testing it, and then 
releasing it to the world. However, those same women were counseled 
about the benefits of being tested and offered an HIV test that would 
allow them to know their and their baby's HIV status. The allegation is 
that this was a secret test. Yet, women were offered and encouraged to 
be tested and to be aware of their HIV status.
  This blind survey was critical. We can look how far we have come and 
the progress that has been made, in terms of treating HIV infection, 
with our public health officials, because it was the only totally 
unbiased way to provide a valid estimate of the number of women 
infected with HIV as well as their demographic distributions.
  Thank goodness we have access to such information. But again, this 
whole accusation that infants known to be HIV positive were sent home 
without telling their parents they were being diagnosed with HIV is 
simply untrue. This survey yielded population-based numbers of the 
incidence of HIV, not linked to individuals unless they gave their 
informed consent.
  Well, as you can tell, I feel strongly about this position of Surgeon 
General. I will bring my remarks to a close for this time around. I 
feel strongly that we need a Surgeon General who can articulate the 
needs, the challenges of public health, which are inevitably there. We 
need a Surgeon General who can advise the administration because the 
administration is making decisions every day that affect the public 
health whether it be in the area of disease or prevention or managed 
care, organization and delivery of our health care system.
  Secondly, I feel very strongly that Dr. David Satcher is the man for 
this position. He is a scientist. He is a family man. He is committed 
to local decisionmaking. He is an educator. He is a spokesperson. He is 
an eloquent spokesperson. But most importantly, he is committed to his 
fellow man, to improving the public health.
  I look forward to the debate. I hope our colleagues do participate in 
the debate. And I think that at the end of the day, hopefully, we will 
get to the truth and the kernels of truth that lie behind all the 
accusations and ultimately confirm Dr. David Satcher.
  Mr. JEFFORDS. Mr. President, I thank the Senator from Tennessee for a 
well-documented, very thorough and careful examination of the nominee.
  I now yield 20 minutes to the Senator from Massachusetts, my esteemed 
ranking member.
  The PRESIDING OFFICER (Mr. Santorum). The Senator from Massachusetts.
  Mr. KENNEDY. I thank the Senator.
  Are we under a time agreement?
  The PRESIDING OFFICER. There is no control of time.
  Mr. KENNEDY. Thank you.