[Congressional Record Volume 144, Number 7 (Thursday, February 5, 1998)]
[Senate]
[Pages S439-S440]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           NOMINATION OF DAVID SATCHER TO BE SURGEON GENERAL

  Mr. HATCH. Mr. President, I have listened with great care to our 
debate about the nomination of Dr. David Satcher over the past few 
days. It has been a constructive discussion, one which has raised a 
number of important issues.
  I have the greatest respect for the Offices of the Surgeon General 
and Assistant Secretary for Health. The individual who occupies this 
position will become the Nation's No. 1 public health official, our top 
doctor, if you will. For this reason, this nomination deserves the 
utmost scrutiny.
  I have the greatest respect for our colleague, the Senator from 
Missouri. I think he has made some arguments that raise very valid 
concerns, and it behooves this body to examine them.
  That being said, after a great deal of analysis, I have concluded 
that Dr. Satcher is eminently qualified for the position, and that 
there is a more than adequate explanation for his position on two key 
issues--partial-birth abortion and HIV testing in Third World 
countries. Accordingly, I intend to support his nomination.
  From a humble rural background, David Satcher has risen to become a 
leading public health expert--the director of the prestigious Centers 
for Disease Control and Prevention, a doctor who is widely respected 
for his ability to communicate scientific information in a credible 
manner. He has done a great job at the Centers for Disease Control and 
Prevention.
  I have spoken at length with Dr. Satcher and became convinced that he 
has an agenda that Americans of both parties should support. Tobacco 
control is at the top of that agenda. On the issues of teen pregnancy 
and sexually transmitted disease, Dr. Satcher intends to promote 
abstinence and assures me that he believes health and sex education are 
a parental responsibility, in which the Government should play only a 
supportive role. Moreover, Dr. Satcher believes science should 
determine health policy, attendant upon which we have based virtually 
all of the public health legislation that has passed this body.
  Let me note for the Record that Dr. Satcher has experience with three 
of the four historically black medical schools. He learned firsthand of 
the problems that Americans face in seeking care, and he does not 
advocate for a Federal solution.
  During Dr. Satcher's tenure at CDC, the Centers for Disease Control, 
he worked to increase childhood immunization rates, to develop better 
ways to protect Americans from new infections, and decrease teenage 
pregnancy rates. He has also demonstrated U.S. leadership in attacking 
the world AIDS problem.
  Critics of the nomination have raised concern that he supports the 
President's position on partial-birth abortion. It is no secret that I 
disagree vehemently with that position and will continue to work until 
a prohibition on partial-birth abortion is the law of the land.
  Yes, it is true that Dr. Satcher supports the President's position, 
which is not surprising given that Dr. Satcher is the President's 
nominee. I certainly understand the motivation of some in saying that 
he should be opposed for that reason.
  But in reviewing the hearing record on this nomination, I am 
impressed by Dr. Satcher's assurances to the committee on this issue. 
He said, ``Let me unequivocally state that I have no intention of using 
the positions of Assistant Secretary for Health and Surgeon General to 
promote issues relating to abortion. 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.'' I believe that nothing in Dr. Satcher's background, 
including his work as CDC Director, suggests that he would try to make 
the Surgeon General's post into a pro-abortion bully pulpit. Indeed, he 
has personally given me his assurances to the contrary.
  I remember when Dr. C. Everett Koop was nominated by a Republican 
President and his nomination was held up for some 8 or 9 months on the 
issue of abortion, even though Dr. Koop asserted he would not use the 
Surgeon General's Office as a public forum for advocacy for abortion. 
As things worked out, we finally were able to get him confirmed, and I 
won't go into all the details on how that happened. He proved to be one 
of the great Surgeons General of the United States. I believe Dr. 
Satcher will likewise prove to be a very successful Surgeon General of 
the United States. I urge my colleagues to vote for him.

  In addition, I am aware that another series of questions has been 
raised regarding joint CDC/NIH-sponsored clinical trials conducted in 
Thailand and the Ivory Coast to determine the effectiveness of AZT to 
prevent pregnant mothers from transmitting the HIV virus to their 
children.
  In a nutshell, concern has been raised because the foreign trials 
were placebo-controlled against a ``short course'' regimen, whereas, in 
the United States a ``long course'' AZT regimen would have been the 
baseline for care. While it is clear that an argument can be made that 
the U.S. standard of care could have been used, this would not have 
resolved a more difficult problem of lack of access to expensive 
medications.
  While opinion is hardly unanimous on this issue, the better view is 
that these grounds were appropriate to the nations and the populations 
studied. These trials were done in complete partnership with the local 
patients, health officials, and the World Health Organization.
  As our debate on the Hatch-Gregg FDA export bill in 1995 made 
abundantly clear, we need not and should not second-guess the choice of 
patients and officials in other countries who, for a myriad of reasons, 
seek not to use the American standard of care. I believe it is critical 
for those in Congress to respect differences of the health and wealth 
characteristics of other countries. What is appropriate policy in the 
United States is not necessarily appropriate in the Third World.
  Mr. President, I want to emphasize the importance of the position Dr. 
Satcher seeks to assume. The Surgeon General is the head of the United 
States Public Health Service Commission Corps. And, formerly, the 
position of Assistant Secretary for Health was the top public health 
slot in the government. Unfortunately, the position of Assistant 
Secretary for Health was downgraded in the Clinton administration and 
has become less important since the ``ASH'' no longer has line 
authority over the public health agencies such as CDC, NIH and FDA.
  I hope that Dr. Satcher will undertake a review of that decision 
because I think it was a mistake, and I hope to discuss that with him 
in the future.
  In closing, I want to point out that Dr. Satcher has a distinguished 
record that will be an asset to those important public health 
positions.
  Doctor Satcher is a recognized public health leader and a member of 
the Institute of Medicine of the National Academy of Sciences, the 
recipient of numerous awards, such as the 1996 awardee of the AMA's 
prestigious Dr. Nathan B. Davis award.
  In short, Dr. Satcher is a well-credentialed, highly effective public 
health leader. If confirmed, he will be the highest-ranking physician 
within HHS and could be counted on to be an articulate national 
spokesperson on a wide range of public health issues that we all agree 
are important.

[[Page S440]]

  I think we can all learn by the example set almost 20 years ago when 
this body, as I mentioned earlier, confirmed C. Everett Koop to be 
Surgeon General over the objections of many in the other party.
  The fears about Dr. Koop's partisanship were unfounded. Today, he is 
widely respected by Senators on both sides of the aisle, and it is my 
hope that this is a legacy Dr. Satcher will leave as well.

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