[Congressional Record Volume 144, Number 8 (Monday, February 9, 1998)]
[Senate]
[Pages S474-S500]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           EXECUTIVE SESSION

                                 ______
                                 

NOMINATION OF DAVID SATCHER, OF TENNESSEE, TO BE AN ASSISTANT SECRETARY 
  OF HEALTH AND HUMAN SERVICES, MEDICAL DIRECTOR OF THE PUBLIC HEALTH 
       SERVICE, AND SURGEON GENERAL OF THE PUBLIC HEALTH SERVICE.

  The PRESIDING OFFICER. The clerk will report the business pending 
before the Senate.
  The legislative clerk read the nomination of David Satcher, of 
Tennessee, to be an Assistant Secretary of Health and Human Services, 
Medical Director of the Public Health Service, and Surgeon General of 
the Public Health Service.
  The PRESIDING OFFICER. Who yields time?
  Mr. ASHCROFT addressed the Chair.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.
  Mr. ASHCROFT. Mr. President, I yield myself as much time as I may 
consume.
  Mr. President, the nomination of David Satcher for U.S. Surgeon 
General has been a matter of significant discussion over the last 
several days. I would like to indicate that I rise to oppose this 
nomination. There are a number of very important reasons why I believe 
we should not confirm this nominee.
  During the last several days of discussion here on the Senate floor, 
we have gone through a number of topics, none of which reveals a record 
that would recommend Dr. Satcher to be the Surgeon General of the 
United States of America, none of which would say that this individual 
ought to be America's family doctor.
  We looked at the Third World AIDS studies that have been conducted 
and that are ongoing under Dr. Satcher's supervision at the Centers for 
Disease Control. You will remember that those Third World AIDS studies 
were the subject of an editorial in the New England Journal of 
Medicine, which has simply said that those studies are not being 
ethically conducted, that as a matter of fact, the studies were 
unethical. In short, the New England Journal of Medicine says that to 
give people sugar pills, or placebos, when there is a clearly 
understood and accepted therapy that is available, pharmaceutically or 
otherwise, is unethical, and that has been the position of the CDC in 
this situation. They have simply persisted with the administration of 
placebos, or sugar pills, for individuals, in spite of the fact that 
there is proven therapy available that should be or could be given to 
those individuals. It has been clear, even in the words, I believe, of 
Dr. Satcher himself, that these are studies that could not be conducted 
in the United States. It is simply that we don't treat human beings as 
laboratory subjects--to give them a placebo when there is a known 
therapy in this country. So the first thing we discussed pretty 
substantially last week were the Third World AIDS studies. In these 
studies the activities of the CDC, under Dr. Satcher, had been labeled 
conclusively, in my judgment, and at least very strongly by the New 
England Journal of Medicine, as unethical. They were called unethical 
because, in the face of known therapy, individuals were just given 
sugar pills, even though we know that an infection or a virus like HIV 
is often considered a fatal virus.
  The second item of concern related to the way in which Dr. Satcher 
has conducted himself as the head of the CDC has related to domestic 
newborn AIDS studies. In the eighties, there was a program to test the 
blood of newborn infants. It was a test that was conducted after 
identifying marks were taken off the blood samples so that researchers 
just found out what percentage of the samples were HIV-infected. 
Researchers kept that for epidemiological reasons or for statistical 
purposes, in order to find out in a particular community what 
percentage of the newborns were being born with HIV.
  Now, since that study began, and during the pendency of Dr. Satcher's 
tenure at Centers for Disease Control, new

[[Page S475]]

therapies have been developed that could maybe make a difference for 
some of these children. But Dr. Satcher persisted in doing the tests 
after the markings were taken off the blood samples, so that no one 
would be able to know which babies had the HIV and which didn't. We 
just continued to assemble the statistical data in the blind newborn 
studies.
  There are individuals who have raised very serious questions about 
this. Those individuals have been very prominent in the AIDS research 
community and in the medical community. These individuals say it's one 
thing to maintain a statistical basis if there is no known therapy, if 
there is nothing you can do, but it is another thing after a therapy is 
found to continue forward in a situation where you don't take the 
identifying characteristics for the blood and you just persist and then 
you don't notify--so you don't have any information to give to parents 
because you have taken the names and the identifying characteristics 
away from the blood. That was irresponsible. As you well know, there 
was quite a controversy in the Congress about that. And that whole 
program has been shut down.

  But my view is that the leading doctor for American families should 
have a view toward how to help families understand how to improve their 
health standing. When there is a therapy that becomes available, one 
should not persist in the maintenance of nameless statistical records 
and epidemiological data. One should try quickly to get that data to 
the people so that they can arrest the development of the disease in 
their children, so they can take remedial steps. And not only did Dr. 
Satcher preside over a continuity in the program that ignored the 
potential therapies, but also when the Congress came in to shut down a 
program designed for statistics which ignored the potential for helping 
individuals, Dr. Satcher sought to stop the Congress and lobbied the 
Congress to allow it to continue.
  I have discussed these two issues: The HIV studies in Africa and the 
HIV studies on newborns in the United States with the epidemiological 
data and statistics about how many in each town were HIV infected.
  I think it is important for us to understand that both of these 
studies place too much emphasis on the data and upon the research 
aspects without enough emphasis on the actual health of individuals.
  In each of those cases, very serious questions have been raised about 
the ethics and the conduct of those kinds of experiments. There is, 
though, another area of concern which I hope to be involved in more 
fully today during the debate, and that is the concept of needle 
exchanges for dope addicts. Most Americans do not want their tax 
dollars to support programs which provide drug paraphernalia, needles 
or other things, to drug addicts. There are some of those in the public 
community who think that we can preserve the health of drug addicts if 
we will provide them with good paraphernalia, if we can just provide 
them with the right kind of needles we can help them lead healthy 
lifestyles. We could help armed robbers have greater health in the 
conduct of their robberies if we would provide them with bulletproof 
vests. But I don't think we want to do that. As a culture, we are not 
in the business of supporting the administration of illegal drugs.
  I will spend substantial time later in the day talking about the 
commitment of Dr. Satcher in promoting needle exchange programs and 
using public resources to help promote needle exchange programs. There 
has been substantial debate over this. Frankly, there has been some 
confusion in the Senate about this, and I think it results from the 
fact that the CDC and Dr. Satcher have not been forthcoming. It is very 
clear to me that they have not been complete in their disclosure of 
what they have been doing and what they have been supporting. We have 
asked for document after document and, as previous discussion in this 
debate revealed, the CDC has been loath to send us information and 
documents. But all the trickle of information reveals a greater and 
greater commitment, on the part of this nominee to be Surgeon General 
of the United States, to support needle exchange programs which would 
provide those who are breaking the law with the capacity to do so, 
perhaps at less disease risk. But I question whether or not most 
Americans want to be spending their tax resources to provide needles 
for dope addicts instead of improving the education of their children 
or pursuing a variety of other objectives which might be undertaken.
  A fourth, very important item that relates to my reservations about 
Dr. Satcher is that the Centers for Disease Control, instead of 
focusing its energy on diseases and the eradication of diseases, has in 
some cases diverted its attention to areas far afield from the area of 
disease control or prevention, or even the development of therapies for 
diseases.
  Here is one example of another area they have moved into--the area of 
accidents. The CDC has decided that significant studies related to gun 
ownership are the equivalent of the examination of diseases. As Larry 
Craig, the Senator from Idaho, has eloquently argued on this floor, the 
second amendment to the Constitution--the right to bear arms--is not an 
epidemic. The second amendment to the Constitution of the United States 
is not a disease. We really do not intend for the Centers for Disease 
Control to be involved in some debate about the politically correct 
response to this set or the other about gun ownership. The Centers for 
Disease Control should focus its energy and deploy its resources in a 
way that will help American families have greater health and will help 
them maintain freedom from disease and the threats that real health 
problems can bring to them.

  Those are an array of issues which I think will be discussed again 
today, and have been discussed in this debate at some level. But I 
would like to focus my remarks on one additional matter for the next 
few minutes in this debate. It is simply this: That a Surgeon General 
who sanctions partial-birth abortions is unfit to serve the people of 
the United States of America. A Surgeon General who acquiesces in 
partial-birth abortions is unfit to serve as the family doctor for the 
people of this country.
  Dr. Satcher, in a letter of October 28th, 1997, to Senator Frist, 
said the following:

       I have no intention of using the positions of Assistant 
     Secretary for Health and Surgeon General to promote issues 
     related to abortion. I want to use the power of these 
     positions to focus on issues that unite Americans, not divide 
     them.

  Satcher goes on in his letter:

       As a family physician, medical educator, and public health 
     leader, I have devoted my entire career to mainstream 
     consensus building efforts to improve the health of the 
     American people.

  Yet, Dr. Satcher has stated that he supports the President's position 
regarding partial-birth abortion. On October 21, 1997, in a response 
written to Senator Coats of Indiana, Dr. Satcher stated that he 
supports the President's position on partial-birth abortion.
  Mr. President, is that a mainstream consensus building position 
shared by America? Is the position of President Clinton mainstream? Is 
that position supported by most Americans? Does it build consensus? 
Thankfully not. This is pretty clear.
  A recent CNN-Times poll reveals that fully 3 out of every 4 Americans 
believe that partial-birth abortion is wrong. Nonetheless, President 
Clinton, Dr. Satcher, and their allies on Capitol Hill persist. The 
suggestion that Dr. Satcher is only going to do things that are 
mainstream to build consensus is immediately belied by his performance 
on this issue.
  Lest there be any confusion, we are talking about an abortion 
procedure that allows a child to be partially born from a mother's womb 
only to have its skull crushed by a doctor who pledged to ``do no 
harm.'' Most Americans by now understand the horrors of partial-birth 
abortion. They understand that this is a late-term abortion. They 
understand that these abortions are conducted in a way that results in 
the child being born 80 to 90 percent, and while just a small portion 
of the child remains in the mother's body, the child is then killed. 
This procedure occurs at a time in the pregnancy when the child could 
survive outside the mother's womb.
  One of the things that really strikes me is that partial-birth 
abortion is revealed on a continuing basis by science

[[Page S476]]

to be less and less acceptable in the American culture, because there 
are so many things known today that weren't known a few years ago. We 
held hearings in the Senate Judiciary Committee, Constitution 
Subcommittee on Abortion, and we solicited the testimony of Jean A. 
Wright, medical doctor and master of business administration. She is an 
individual who is board certified in pediatrics, anesthesia, and in 
both sub-boards of critical care medicine. What she pointed out was 
very important; that is, that these children who are subject to 
partial-birth abortion have an increased sensitivity to pain.

  So much of the argument surrounding abortion has alleged that these 
children can feel no pain, that it is not a person, that this is just a 
group of cells, and this is not anything to be concerned about. As 
technology progresses, science reveals that indeed these young, preborn 
children are very sensitive to pain.
  I just wanted to point out that in our hearings Dr. Wright made a 
very, very compelling presentation about the nature of this pain. The 
way they found out about pain in preborn infants comes from techniques 
that have been developed for doing surgery on preborn infants. When 
these surgeries are performed they sometimes measure things like blood 
pressure and the level of hormones and other substances in the blood. 
And when a person is undergoing pain, his blood pressure goes up. When 
a person is undergoing pain, that person's blood composition changes in 
response to pain.
  Medical personnel have noticed, both when they are doing surgeries on 
preborn infants inside the mother and when they withdraw the child from 
the mother for later placing it back in the womb to do surgery, that 
the elevation in the pain levels of these preborn infants is very 
substantial, at least as seen in the indicators that are associated 
with pain. So that the child's blood pressure goes up very 
substantially and the blood's hormonal content goes up. As a matter of 
fact, it is not a suggestion that preborn infants feel pain less than 
full-term infants and newborns. It looks as if prior to being born the 
sensitivity to pain is higher than it is once one is born. That would 
make sense because the preborn infant is not accustomed to being 
knocked around, or invaded, or cut on, or otherwise injured. So the 
child's sensitivity is very high.
  With that in mind, I think this knowledge just dramatizes the whole 
issue of partial-birth abortion--this issue of taking a late-term 
child, withdrawing that child substantially from the mother, and then 
destroying that child, which otherwise could survive with the kind of 
medical help that is frequently attendant to premature births.
  Dr. Satcher says that he has a mainstream approach and that he is 
going to pursue consensus, but he indicates that he favors these kinds 
of abortions. I just do not think that is a very unifying approach. I 
don't think it is the kind of view that is reflected in the mainstream 
of America. But not only is Dr. Satcher's view outside the mainstream 
of America, Dr. Satcher's view on this issue is also outside the 
mainstream of America's medical community. It is not just that the 
American people broadly defined don't accept his views. Dr. Satcher 
departs also from thousands of his colleagues in the medical profession 
who have declared emphatically that there are no health reasons or 
health justifications for performing partial-birth abortions. The 
American Medical Association opposes the procedure.
  I have to leave it to the AMA, in the face of their opposition to 
this procedure which Dr. Satcher is willing to embrace, to explain why 
they would support Dr. Satcher, and I would leave it to them to explain 
the inconsistency which I believe that particular position reveals.
  The group called the Physicians Ad Hoc Coalition for Truth is a 
nationwide coalition of doctors now numbering over 600 members. This 
organization has insisted there is no medical need or justification for 
the partial birth abortion procedure and that it should be banned.
  So we have a clear indication that not only is partial-birth abortion 
in the mind of the public improper--three out of four people do not 
support it--but groups as diverse as the American Medical Association 
and the Physicians Ad Hoc Coalition for Truth say there is no reason 
for it and reject it. Of course, as I indicated, testimony from Jean 
Wright of Emory University about pain in preborn infants provides 
another basis for the American people to say this isn't the kind of 
thing we want to support.
  Dr. Roy C. Stringfellow, of Colorado, wrote:

       President Clinton's medical reasoning for his stance on 
     partial-birth abortion has been clearly shown to be flawed 
     and not in any way in touch with reality.

  I am sure Dr. Satcher understands this, and I am sure he is aware of 
the fact that the AMA as well as many other medical groups and medical 
experts have recognized President Clinton's flawed reasoning.
  It concerns me greatly that Dr. Satcher does not have the courage to 
take an appropriate stance in regard to this issue. If he cannot be 
trusted to take the side of medical reality versus political expediency 
in this case, how can we trust him to fulfill the office of Surgeon 
General?
  We haven't had a Surgeon General for 3 years. We did not have a 
Surgeon General for 3 years because the last Surgeon General was so 
irresponsible, so outspoken as to literally wage an assault on the good 
judgment and values of the American people and on the values of the 
medical community. But I do not think we need a Surgeon General so 
badly that we will have to embrace a Surgeon General who will be 
politically instead of medically correct. And I don't think anyone who 
supports widely-opposed medical issues that are as clear, convincing, 
and consensus oriented as partial-birth abortion, or who will just 
defer to what political bosses dictate in that respect, should be 
elevated to such a position of high trust and respect as Surgeon 
General.
  I have just a few exemplary letters that I will be reading. They are 
by individuals from all across the country, from Massachusetts, 
Colorado and Montana to Florida and Louisiana.
  Dr. Helen T. Jackson of Brookline, MA, shares a concern:

       As a practicing obstetrician and gynecologist, I hereby 
     state that there is no place in medicine for partial-birth 
     abortion. This is a barbaric procedure which should not be 
     accepted in any civilized society. No Surgeon General should 
     be a rubber stamp for the President's position.

  This is not just a question here about partial-birth abortion. This 
becomes a larger question. If a Surgeon General is willing to go 
against the best of medicine in order to cave in to political demands 
from the President on an issue so important as the life and death of 
unborn children by partial-birth abortion, I think we have to ask 
ourselves, will we get the kind of advice and help from the Surgeon 
General that we need and want?
  Dr. Douglas B. Boyette wrote:

       Please let it be clearly understood that I would oppose the 
     appointment of Dr. David Satcher in his quest to become 
     Surgeon General. He supports President Clinton's veto of the 
     Partial-Birth Abortion Ban Act. Obviously, this physician 
     lacks clear judgment and, therefore, would be an 
     inappropriate candidate for such an important position.

  Let me read a letter from yet another doctor. Dr. John I. Lane of 
Great Falls, MT, writes:

       I strongly urge you and your colleagues in the Senate to 
     let the President know that this Nation deserves a physician 
     of the highest caliber, not a politician, to serve as Surgeon 
     General of the United States.

  I think Dr. Lane would reflect the concerns of a lot of people in 
this country. Sure, we would be glad to respond to someone as our 
America's family doctor, as our leader in terms of health concerns, but 
there is nothing more important between the doctor and the patient than 
the responsibility of trust. You would hate to think you were going to 
your doctor and, instead of getting good medical advice, were getting 
political advice. The American people want a doctor to lead us to 
better health, not to parrot politics. I agree with the letter of Dr. 
John Lane of Great Falls, MT, when it says, ``The Nation deserves a 
physician of the highest caliber, not a politician, to serve as the 
Surgeon General of the United States.'' I think it is pretty clear that 
we owe a duty of responsibility to the American people in this 
confirmation deliberation to make sure that we do not confirm someone 
who is going to advance a political agenda rather than a health agenda.

[[Page S477]]

  Too often I think a lot of people realize this. They feel there are 
going to be political health agendas instead of the real health 
agendas. People have had real reservations about the way the research 
funds of the United States have been allocated. They have had real 
reservations about what has been done in terms of trying to conquer 
various diseases. It seems to them that some diseases are more 
politically popular and get a lot of support and research dollars, in 
spite of the fact that the same number of dollars might really save far 
more lives somewhere else or might be devoted to developing a promising 
therapy which is on the verge of complete development and discovery. 
But, instead, politicians take the resources and redirect them toward 
political objectives or to political constituencies instead of having 
the resources directed in the areas of real medical assistance.
  In a setting like this, we should find out whether an individual is 
going to be subject to political exigencies or whether the individual 
is going to take the direction of medicine. I think a real question is 
raised here when, repudiating the American Medical Association position 
on partial-birth abortion, repudiating the advice of the overwhelming 
number of experts that it is never medically indicated, the proposed 
Surgeon General of the United States decides to embrace a political 
position of the President rather than to advocate a medical position 
for the people. That is troublesome.
  Or consider the letter of Peggy B. James, a clinical assistant 
professor at the University of Florida College of Medicine:

       As a physician practicing for the past 17 years, and as a 
     mother of three children, one of whom was delivered very 
     early and was very ill but is doing very well now, I am 
     abhorred that Dr. Satcher's confirmation may take place.

  Here you have a clinical assistant professor, a mother, a medical 
doctor, who has had experience--one of her own three children born very 
ill and very early, but doing very well now--who understands the 
tangibility of a child that is not born at full and the tangibility of 
its survival. She is, frankly, shocked that a person might be endowed 
with the mantle of respect to lead America in health decisions who 
favors allowing the destruction of such children rather than trying to 
protect them. ``I am abhorred,'' she says, ``that [the confirmation] 
may take place.''
  One more letter. Finally, W.A. Krotoski, a retired medical director 
of the U.S. Public Health Service, living in Louisiana, asserted:

       The position of Surgeon General of the United States is too 
     important to place in the hands of people who are willing to 
     deny their oaths and medical facts. Should Dr. Satcher be 
     selected, he will have enormous influence over the dedicated 
     group of health care professionals who constitute the U.S. 
     Public Health Service. Please don't allow this influence to 
     be that of denied integrity regarding human life.

  It is not a matter of minor consequence. The opportunity of the 
Senate in confirmation hearings is a sobering opportunity, and it is 
not a matter of pleasure to come to the floor to say that we can and 
ought do better and that we need someone who is a physician above being 
a politician, someone who will lead us to better health rather than 
reinforce the politics of an administration. I think that is something 
we are owed and something for which we ought to aspire.
  So I read through these letters from Dr. Stringfellow, Dr. Jackson, 
Dr. Boyette, Dr. Lane, Dr. James, and Dr. Krotoski. These are letters 
which speak about the mainstream medical community's understanding, and 
they call us to our highest and best. They diagnose something. The best 
diagnosis is the diagnosis that is in advance; it doesn't wait until 
you get the disease. It says, if you persist in a kind of behavior, you 
will find yourself in a substandard position.
  This is what we have here. We invite someone to be the health leader 
for the United States of America whose commitment, when push comes to 
shove, is to politics over health, or at least who is willing to 
accommodate the political position of the President on partial-birth 
abortion, rather than someone who is willing to stand up and say what 
is true in the hearts and minds of mainstream and what is true in terms 
of the medical community. I think that kind of diagnosis by these 
physicians is very helpful. We should heed the warning of these 
doctors. In a sense it is a health warning.

  Mr. President, what message would we send by embracing a Surgeon 
General nominee who would support such barbarism? What does it say 
about who we are? What does it say about the moral condition of our 
Nation, when the Surgeon General, in the face of the American Medical 
Association and in the face of expert medical testimony, would seek to 
put a political position in place, or would reinforce that political 
position? He may say, well, I am not going to be there to talk 
aggressively on this issue. I am not going to be there to make a big 
thing over abortion.
  I can assure you that when the debate comes to the floor of the 
Senate, the Surgeon General's position will be recited. To have it 
suggested that there would be an opportunity for a person to be Surgeon 
General and not lead on an issue this important, whose position would 
be inconsequential on a position this important, would simply be to 
deny what the responsibility of the job is. The job is to lead. The job 
is to lead toward better health. And if a person is willing to put 
politics above better health in situations like this and say we are not 
going to emphasize it, I do not believe a person really is saying they 
understand what the nature of the job is.
  There has been and there will be more talk of what Tuesday's vote 
signifies. The New York Times suggested that this is a fight about 
abortion. They put it this way:

       Conservatives want to block this highly respected nominee 
     because of his mildly stated views on abortion.

  Well, frankly, this is about partial-birth abortion. This is about 
whether we are going to cloak an individual with the title, prestige, 
impact and influence of the Surgeon General of the United States of 
America who is willing to support partial-birth abortion against the 
will of the American people and against the wisdom of America's medical 
community.
  Now, there are other issues involved here. It is not exclusively 
about abortion, but it is about abortion. The New York Times is right. 
It suggests that it is about abortion, and, Mr. President, this is 
about abortion. It is about partial-birth abortion, a procedure so 
cruel, a procedure so inhumane, a procedure the barbarism of which is 
so significant that rational support is hard to generate. I do not 
believe that reasonable and rational support can be accorded this 
procedure. The procedure itself defies that kind of support. This 
nomination is about whether a man who championed this horrific act is 
fit to serve as the Nation's family doctor. I am a little bit troubled 
by the phrase in the New York Times editorial, ``mildly stated.'' It 
has been stated on the Senate floor, I believe by the senior Senator 
from New York, that this procedure is ``infanticide.''
  I wonder if the New York Times believes that if someone just mildly 
states their support for infanticide that makes infanticide 
appropriate? I wonder if we had a mild statement in support of 
genocide, whether that would make genocide acceptable? You know, mild 
statements sometimes cover over the most serious of circumstances. I 
remember a Presidential nominee who resolved that abortion should be 
safe, rare and legal--a pretty mild statement. But it is the same 
President who has consistently vetoed bans on the barbaric procedure 
known as partial-birth abortion. If my time as Governor and Senator 
have taught me anything it is this, that government and its officials 
teach. Teaching that partial-birth abortion is acceptable is wrong.
  There is a struggle in the country. There is an idea that our young 
people do not have the right view of themselves. They do not have the 
kind of esteem which we would like young people to have. Somehow, our 
children do not have the kind of self-image, according to a number of 
individuals, that we would want them to have. Maybe we contribute to 
the absence of the right kind of esteem and self-image in children when 
we indicate to them that they can be survivable, and they can be 
substantially born, but it's still OK and appropriate if someone wants 
to destroy them at that stage of their existence.
  If we want to teach children self-esteem, maybe we should begin to 
esteem

[[Page S478]]

children a little more ourselves. In the absence of the right value for 
children to place on their own lives, maybe we should seek to place a 
greater value on the lives of children ourselves. I think America 
deserves better than a Surgeon General who would show a callous 
disregard for innocent human life, even if it is a mild statement of 
approving partial-birth abortion. A man who would sanction and support 
partial-birth abortion cannot provide the moral leadership that the 
office of Surgeon General so desperately needs.
  Mr. President, I thank you for this opportunity to open this debate. 
I believe more than anything else, America needs a Surgeon General who 
will tell the American people the truth; whose efforts in the Surgeon 
General's office will not be to protect the political agenda of any 
individual but will be to help the health agenda of the American 
people. When we are offered individuals who are willing to go in the 
face of the American Medical Association and the medical community to 
support partial-birth abortion and support the President rather than 
the health concerns of the country, I think are shown a clear symptom 
of a problem which we would rather do without. The best way to avoid 
that problem is to insist on better for the United States of America.
  I note the presence of the senior Senator from New Hampshire on the 
floor. He introduced the legislation to ban partial-birth abortion. He 
is an individual who has been a great fighter for the rights of the 
unborn. He tackled the issue of partial-birth abortion in a setting 
that was very difficult and thereby demonstrated his outstanding 
courage. I am pleased to yield to the senior Senator from New 
Hampshire, such time as he may consume in regard to this nomination.
  The PRESIDING OFFICER (Mr. Coats). The Senator from New Hampshire.
  Mr. SMITH of New Hampshire. Mr. President, let me say to my colleague 
from Missouri how much I appreciate his leadership, being out here hour 
after hour, many times alone, in opposition to this nomination. It is 
the right thing to do. I don't think it is a secret that probably we 
are going to lose this fight. But in the effort the Senator has 
distinguished himself in accenting what I think are the issues that 
need to be accented in this debate.
  The Senator pointed out a number of important other questions that 
have arisen, but I want to focus on one particular issue because, as 
the Senator said, I have written the legislation to ban partial-birth 
abortions here in the country.
  Regretfully, I must say, but for 3 votes in the U.S. Senate we would 
have a ban on partial-birth abortions--or, better put, perhaps if the 
President had not vetoed it, since we have 64 votes already in the 
Senate but we need 67, it would have come to pass.

  As I sat here for the last 15 or 20 minutes listening to my 
colleague, I couldn't help but think how frustrating it must have been, 
even for Lincoln in the time of the Civil War, basically having the 
courage to take on the issue of slavery. Ironically, it led to the 
destruction of one political party. The Whig Party went down and the 
Republican Party was formed in opposition to slavery. In those days, 
people refused to stand up on principle and lost a political party. I 
do not know if there is a lesson to be learned here, but it is 
certainly something to which we ought to give serious consideration.
  I know how the Senator feels because for many hours I stood here on 
the floor, in 1995, and took abuse from the national media. I still do 
take abuse from the national media, and many in the media in my own 
State, for pointing out what this procedure is and how horrible it is 
and how wrong it is. But we all know that there are many out there who 
fight hard to keep us from telling the truth on this issue. I want to 
get into that in a little more detail later, about just exactly what 
happened. But let me say on behalf of many, thank you for your 
leadership and stepping into the breech.
  As you know, there are many people who did not want us to make an 
issue of this; who wanted this nomination to slip by quietly so people 
wouldn't be ``embarrassed'' by having to vote on the Satcher 
nomination. But let me point out that the Surgeon General is America's 
family doctor. That is what he or she is supposed to be. When you go to 
see your family doctor you look for competence, certainly. You might 
want to take a look on the wall to see what his qualifications are, see 
where he studied. You certainly want to look for expertise. You want to 
look for somebody who works hard, who does a good job.
  You also want someone with moral authority. I know Dr. Satcher has a 
very distinguished record. But I ask whether or not, on an issue as 
important as this issue is, whether being passive is sufficient. Is it 
sufficient to say that you are not going to make an issue of partial-
birth abortion if you are the Surgeon General, to say that you are not 
going to crusade for it, that you are just going to be passively for 
it? That is not good enough. That is not good enough.
  You want somebody who is grounded in common sense, who knows and 
understands the difference between right and wrong. Every day in the 
press today--we don't have to get into it. The American people know 
full well what I am talking about. But every day we are hearing 
suggestions that Americans no longer care. They do not care about right 
or wrong. They do not care about lying. They do not care about 
untruthfulness. They do not care about cheating. They do not care about 
setting a good example. We have to turn the television off now when our 
kids are in the room when we are talking about issues involving some of 
the leaders in our country. That is a pretty tragic commentary.
  Similarly, the family doctor, the Nation's family doctor, ought to be 
about saving lives, not taking lives. We are talking about taking lives 
here. Make no mistake about it.
  I was in a debate with a colleague on the floor of the Senate here a 
few years ago, in which this particular Senator said he had studied 
this issue very carefully and he realized that, until the third month, 
the fetus wasn't a person. I asked him if he could tell me what it was, 
then, for the first 3 months? There was not an answer. What is it for 
the first 3 months? We all know what it is. It's a life. It is a young 
child. And of course, in the context of partial-birth abortion, we are 
not talking about the first three months. What we are talking about in 
partial-birth abortion, as Senator Moynihan has said on the floor of 
this Senate, is infanticide of a later-term baby. It is executing a 
little child. That is what it is.
  We are hearing today that families of America should not care whether 
their family doctor--the doctor for America--knows the difference 
between right and wrong, that we should not care whether our family 
doctor believes that killing a little child as her body rests in your 
hands is wrong or right. You should not care about that. It does not 
matter, as long as he believes in the President, as long as he supports 
the President and doesn't say anything about it. It will be all right.

  Would we have ended slavery if we had taken that approach? Would we 
have ended generations and generations of racial prejudice and 
discrimination? We still have not ended these, but would we have made 
the inroads that we have made? I don't think so. I don't believe it and 
I don't believe that deep down in their souls the American people 
believe it either.
  That is why I am here today.
  I am not here today to cast any aspersions or make any commentary on 
Dr. Satcher's general character. He has had a very distinguished 
career. But he is wrong. He is wrong on this issue. And as long as I 
have a vote I intend to exercise that vote against this nomination. I 
know it is not going to be a vote that we are going to win--and that is 
unfortunate.
  Now I should probably know better than to expect this President to 
pick someone for Surgeon General who is going to be against abortion or 
even against partial-birth abortion. This President is for abortion. He 
is for partial-birth abortion. He has vetoed the legislation we sent 
him two or three times now. We do not have quite the number of votes to 
override him. We are only 3 short, though.
  When you hear people tell you that votes don't matter, or your vote 
doesn't matter, or one vote doesn't matter--I would ask you to reflect 
for a moment on this. This bill has been brought through the process 
two or three times, through the House, through the Senate, up to the 
President's desk and vetoed. We are but

[[Page S479]]

three votes away from stopping the execution of little children as they 
come from the womb. That is what we are talking about. That is what 
partial-birth abortion is. Three votes. If three people in the U.S. 
Senate changed their mind we could change that.
  If we had a family doctor who would be willing to use the bully 
pulpit to talk about this issue, we might be able to influence those 
three votes. You never know. But we are not going to influence them 
with a Surgeon General who says, ``It's OK. It is all right. There is 
nothing wrong with it.'' And that is why we are here.
  I am going to oppose this nomination, along with Senator Ashcroft and 
others, because it is morally wrong to kill little children as they 
exit their mothers' wombs.

  I would say, deep down in your heart--no matter where you are, who 
you are, how you feel about abortion in general--you probably agree 
with me. You can get into all these other debates about who is 
responsible, who has the right to do this, who has the right to choose 
and all that. But deep down in your heart, do you think that is right? 
Do you think it is right that the chief medical person, the family 
doctor of America, won't speak out against it? Do you think it is right 
that the President of the United States refuses to appoint someone who 
will speak out against it to this post? Do you think the President is 
right?
  Maybe some of these folks ought to witness some partial-birth 
abortions, like nurse Brenda Pratt Shafer did. Until shortly before I 
came to the floor in 1995 and discussed this issue, I didn't know what 
partial-birth abortion was. One of the people I discussed it with was 
nurse Brenda Pratt Shafer who considered herself ``pro-choice'' until 
she accepted a temporary assignment at a clinic where partial-birth 
abortions are performed.
  Of course, we've heard all kinds of things from the other side of 
this debate. They said we only do a few of them a year, maybe a few 
dozen. They said it is only done in the case of extreme deformities. I 
said it wasn't so and I was attacked on the floor of the Senate and 
attacked in the press. I still am being attacked in the press.
  Come to find out, it is several thousand a year. This news came from 
prominent people in the abortion industry, a few people like Ron 
Fitzsimmons, the head of the National Coalition of Abortion Providers 
who came out and told the truth. He said, ``I lied through my teeth.'' 
Now we know, and in spite of the fact that we know, we still are faced 
with a nominee for Surgeon General who won't oppose this brutal 
procedure.
  With all the problems we face in America today, all the terrible 
things, what is wrong with our country when we can't get enough people 
in the Senate to override the President's veto of a bill to stop the 
killing of children, as their bodies are literally in the hands of the 
abortionist? What is wrong with this country? What are we coming to?
  We shouldn't even have to be on the floor of the U.S. Senate talking 
about this. We shouldn't have to be here. The Constitution protects 
life, but we are not abiding by the Constitution.
  When I introduced the partial-birth abortion ban in the Senate in 
June of 1995--we prevailed with 54 votes ultimately. I believe that is 
correct, 54 votes. I think we started off with maybe 40, but then I 
began to describe the procedure, and I remember Senators coming down 
here saying how horrible it was that in front of the American people I 
would talk about this. Well, why not? Why shouldn't we talk about it?
  Do you know what a partial-birth abortion is? Let me tell you what it 
is. We are talking about a child anywhere from the fifth month to the 
ninth month.
  In the first step, guided by ultrasound, the abortionist grabs the 
baby's leg with the forceps. This is the first step.
  The baby's leg, in the second step, is pulled into the birth canal.
  Then in the third step, the abortionist, by taking hold of that 
little child's feet, pulls the child entirely through the birth canal 
with the exception of the head, restraining it from being completely 
born.
  The abortionist then uses scissors which he puts into the baby's 
skull. He then opens the scissors to enlarge the hole, and, the final 
step, the scissors are removed and a suction catheter is inserted. The 
child's brains are sucked out, causing the skull to collapse, and the 
dead baby is then removed.
  That is what partial-birth abortion is. Let's understand what it is. 
That is a process that our Nation's family doctor will not oppose, that 
our President, the President of the United States will not oppose.
  There are two very famous ships in American history. One of them was 
the Titanic that sailed from Great Britain in the early 1900s. The 
other was the Mayflower that sailed in the 1600s from England.
  On the Mayflower, there was a group of people who knew where they 
were going and who knew what they wanted to do when they got there. 
They had a turbulent voyage. People died during the voyage. They hit 
storms. It was a long, long ride, but they got here. They landed on the 
beaches and began to found a nation. They knew what they wanted to do, 
and they did it.
  The Titanic sailed from England three centuries later. They were 
happily and merrily enjoying themselves, drinking and dining. But the 
crew failed to navigate the obstacles and the Titanic hit an iceberg 
and sank. Figuratively speaking, the Roman Empire hit an iceberg and 
sank into history.
  I say to you today, with the greatest respect for the differences of 
opinion on this issue, that there are huge moral icebergs out there 
facing the U.S.S. America today, the ship of state. There are a lot of 
them. Abortion is one of them, and partial-birth abortion itself is a 
big one. If we can't speak up for the babies who are innocent victims 
of an abortionist's scissors, then we are going to run smack into that 
iceberg and we are going to sink.
  Sometimes, when we take the Senate floor to speak, we wonder how 
important our words are. Sometimes they are not important at all; 
sometimes they are very important. But at some point, you have to look 
back and you have to say to yourself, ``Did I sit by and not do what 
was right or say what was right?'' or ``Did I speak up for what I 
believed in?''
  I don't want to serve in the U.S. Senate if I can't do that. I am 
perfectly happy to have history judge me. Not by contemporaries in the 
media. I could care less what they say or how often they say it. It is 
irrelevant. History will be my judge, and history will be the judge of 
this debate. History will be the judge of the debate on abortion, and 
history will be on the side of those who stood up for life. I am 
convinced of that. I know that. So I don't worry about it.
  I used to get upset, but today I am very calm about it. Inside I am 
not calm, because it is a sad, sad commentary on America. That iceberg 
looms out there, and it is big. With three more votes in the U.S. 
Senate, we could melt that iceberg and take it out of the way of the 
American ship of state.
  We could get those three votes if we had a Surgeon General and a 
President who had the courage to hold a two minute press conference to 
say: ``This is wrong, this is wrong. You know, I've thought about this. 
I'm for abortion but this is infanticide'' We could succeed if the 
President came to the same conclusion that Senator Pat Moynihan did and 
said, ``This is wrong. I am going to stop it. You send me that bill 
again and I won't veto it. And I'll send you a Surgeon General who will 
speak out against this and let's try to stop this brutal procedure that 
takes innocent life in such a brutal way.''
  I can't get a hard-and-fast number for how many partial-birth 
abortions are performed. Nobody will really talk about it but it is 
estimated to be several thousand. You have to ask yourself, what those 
several thousand human beings would have done with their lives. Just as 
we must ask the same question about each of the more than one million 
human beings destroyed by abortion every year in this country. We will 
never know. Is there a President of the United States in that group? Is 
there a doctor who will find a cure for cancer or a preacher who will 
save some souls? We will never know. They never had a chance. This 
Nation, but for three votes, stands by and lets it happen, to several 
thousand of these children even as they leave the birth canal.

[[Page S480]]

  And this Senate tomorrow will vote to make Surgeon General a man who 
won't speak out against it.
  When this debate began in 1995, some worked hard to hide the truth. 
But Ron Fitzsimmons had the courage to speak out and admit, ``I lied 
through my teeth.'' They denied there was such a thing as a partial-
birth abortion. ``It's a phrase that was coined by the pro-life 
lobby,'' they said, ``There's no such thing.'' And when they had to 
admit that there was such a procedure, they lied about what happens to 
a baby who is a victim of the procedure.

  But the web of lies spun by those determined to defend the 
indefensible has finally unraveled, and the American people now know 
the truth.
  And how do our two great political parties face up to this truth? In 
one political party, there is not even an issue. That party doesn't 
make any comment on life. Abortion is fine in that political party. In 
my political party, we take a position in favor of life. But--and this 
is the part that sends me in orbit--we say ``be pro-life but don't talk 
about it. It offends too many people. Just say, `I'm pro-life, what's 
your next question? Is there a question on Iraq or maybe a question on 
education? Could we talk about something else?' '' I have been hearing 
it for 13 years in politics. All the consultants say, ``Don't talk 
about abortion.''
  Well, I did in my last election. They tried to make me pay the price 
for it. I barely won, but I won, and you know what: If I had lost, I 
would have lost because I believed in something, and I would have gone 
on with my life.
  I often wonder what would Lincoln have said about this, or what would 
Jefferson have said? It is really sad; it is really sad.
  In 1995, the abortion industry said that all of these procedures are 
performed in situations where the mother's well-being is imperiled. But 
then the American Medical Association endorsed a ban on partial-birth 
abortions. And both Houses of Congress passed such a ban. And now only 
Bill Clinton and his veto pen prevent us from stopping this procedure.
  So as we consider Dr. Satcher's fitness to fill an office that 
provides a bully pulpit on matters of health, I believe that it is 
appropriate to inquire about his views on the subject. This has been 
quoted before here on the floor, but let me repeat it. Here is what Dr. 
Satcher said about partial-birth abortion:

       I support the President's position. The President opposes 
     late-term abortions except where necessary to protect the 
     life and health of the mother.

  The partial-birth abortion ban bills passed by Congress protect the 
life of the mother. But the President's insistence on a ``health'' 
exception is really a demand for language so broad that courts will 
interpret it to mean partial-birth abortion-on-demand. For that reason, 
we must ask: Does politics or science guide Dr. Satcher's abortion 
views? The Physicians' Ad Hoc Coalition for Truth, a nationwide 
coalition of hundreds of doctors formed to refute misinformation about 
partial-birth abortion, has asked why Dr. Satcher is so far out of the 
mainstream on partial-birth abortion. Physicians' Ad Hoc Coalition for 
Truth--citing the opinions of doctors holding a variety of views on the 
broader issue of abortion, including the American Medical Association--
have concluded there is no medical reason for using this barbaric 
partial-birth abortion procedure. They express concern that Dr. Satcher 
``may be relying on politics rather than medicine in reaching his 
conclusions about abortion.''
  The ``life-and-health'' position is a political position. Worse, is 
politics that will cost the lives of innocent unborn children.
  It is amazing really to look at the intensity of the attacks on those 
of us who stand up here and speak out on this issue. They are venomous, 
they are vicious, but it's worth it.
  Someday I will look back. If any of my grandchildren ask me where I 
was when this issue was being debated, I can tell them in good 
conscience where I was. I am proud to be here today on the Senate floor 
defending unborn children in the context of this nomination. I am proud 
to be here. I wish I did not have to be here because we should not have 
to stand here on the floor of the Senate to do this because it is a 
right that these children have under the Constitution, one outrageous 
Supreme Court decision notwithstanding.
  Mr. President, I will oppose President Clinton's choice of Dr. 
Satcher for the position of Surgeon General. I will make that vote 
proudly. It is the least we can do when, as a result of the President's 
position--the position upheld by the nominee under consideration 
today--thousands of innocent lives will be brutally extinguished.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I understand that we are under a time 
control. Am I correct?
  The PRESIDING OFFICER. The Senator is correct.
  Mr. KENNEDY. So I will yield myself such time as I might use on 
behalf of those who are supporting Dr. Satcher.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I, first of all, again want to commend 
the Senate leadership for moving to consideration of the nomination of 
Dr. Satcher. It is long past time for the Senate to vote on his 
nomination to be Surgeon General. It is long past time for the country 
to have a Surgeon General and have an Assistant Secretary for Health. 
And it is important that we make a judgment, which we will do tomorrow. 
I believe there will be strong bipartisan support, as there should be, 
for this really extraordinary, outstanding nominee.
  I listened with interest and read a good part of the debate. Mr. 
President, the discussion thus far is a very brief sketch of Dr. 
Satcher's extraordinary achievements. He rose from poverty, obtained 
his doctorate and medical degree. He has been published in many of the 
scientific publications. He has been recognized with honorary degrees 
and various awards over the course of his lifetime.
  He has been endorsed by an overwhelming number of groups and 
organizations. When you look through the list virtually every medical 
association--the American Medical Association, the Academy of 
Pediatrics, the Public Health Physicians--and the list goes on and on; 
virtually all of the nursing associations; the hospitals; the principal 
pharmaceutical companies; the major academic centers; the Association 
of American Medical Colleges; virtually all the children's groups, such 
as the Children's Defense Fund, the Children's Health Fund; virtually 
all of the allied health groups, the Cancer Society, the Lung 
Association, the Public Health Association, the Association for 
Maternal and Child Health Programs, the National Mental Health 
Association; all of the disability groups, the March of Dimes, National 
Multiple Sclerosis--again the list goes on--women's groups, such as the 
Women's Legal Defense Fund, the Breast Cancer Coalition, the National 
Black Women's Health Project, the National Asian Women's Health 
Organization; virtually all the senior groups, the National Council of 
Senior Citizens; and very strong support from the various religious 
groups; virtually all of the civil rights groups, law enforcement 
societies, the other groups; family, violence prevention, and a number 
of extraordinary individuals.
  I do not agree with all of these organizations on all of their 
various matters, but the breadth of the type of support that we have 
here, virtual uniformity, the men and women who have judged him on the 
basis of his professional life and also about his commitment and 
caring, it is virtually uniform. And these are the men and women, the 
organizations, who over a lifetime have been associated with this 
really extraordinary individual.
  It is interesting. Are all these groups and individuals that support 
Dr. Satcher out of step with those that have spelled out their 
reservations about him? I daresay, this is about as mainstream a group 
of organizations as we would find in our country. Basically, it is a 
group of organizations that understand the extraordinary life and 
achievements and accomplishments of a very, very exceptional 
individual.
  Mr. President, Dr. Satcher's life story is the story of America at 
its best. He eminently deserves the Senate's overwhelming support and 
confirmation.

[[Page S481]]

  Dr. Satcher learned his work ethic early. As a young boy in rural 
Alabama, he often rose before dawn to work on his family's farm before 
heading off to his segregated school. In addition to helping on the 
farm, he worked after school and on weekends in the foundry where his 
father worked for some 55 years.
  His extraordinary ability was evident early. He did so well in high 
school that he sometimes substituted for the school's chemistry teacher 
and other teachers when they were ill.
  Dr. Satcher rose above the poverty and racism of his youth to become 
a national public health leader. His early commitment to his family, 
his education, and his community reflect the best American values. 
Today, he is a respected family doctor. He is a respected researcher 
and educator and public health leader. He is a role model for everyone, 
especially those from disadvantaged backgrounds.
  Before becoming the director of the Centers for Disease Control and 
Prevention, Dr. Satcher was President of Meharry Medical College in 
Nashville, the Nation's largest private historically black institution 
for educating physicians, other health care professionals, and medical 
researchers.
  This is a nominee whose whole life has been committed to making 
health better for fellow citizens, as an educator, practicing 
physician, and as a teacher. How fortunate we are to have this nominee.
  Earlier in his career, before he served as president of Meharry, he 
served as professor and chairman of the Department of Community 
Medicine and Family Practice at Morehouse School of Medicine in 
Atlanta. He served on the faculty of UCLA School of Medicine and the 
King/Drew Medical Center in Los Angeles, one of the top medical 
teaching schools in the country.
  For 5 years, Dr. Satcher ably led the Centers for Disease Control and 
Prevention in Atlanta, the Federal agency responsible for protecting 
the Nation's health and preventing disease, injury and premature death.
  Dr. Satcher has many accomplishments as director of the CDC. In 1992, 
under his leadership, CDC developed and implemented the extraordinarily 
successful childhood immunization initiative. Before the initiative 
that was developed, only a little more than half of the Nation's 
children--55 percent--were immunized. Today, it is 78 percent. As a 
result, vaccine-preventable childhood diseases are now at record lows. 
He has borne an important responsibility. There are others that should 
share in those achievements, but Dr. Satcher was there and fighting and 
in a key position to make a very, very important difference--and he 
has, and he will.
  Dr. Satcher has also led the CDC efforts to deal more effectively 
with infectious diseases and food-borne illnesses. We rely heavily on 
CDC to provide the rapid response needed to combat outbreaks of disease 
and protect public safety. Under Dr. Satcher, CDC has implemented a 
strategy against new and re-emerging infectious disease, like 
tuberculosis, using better surveillance and detection. In response to 
recent food-poisoning incidents, Dr. Satcher has been instrumental in 
developing a new early warning system to deal with such illnesses.
  Dr. Satcher has received numerous honors and prizes, including the 
Watch Grassroots Award for Community Service in 1979, the Human 
Relations Award of the National Conference of Christians and Jews in 
1985, Founders' Award of Distinction of the Sickle Cell Disease 
Research Foundation in 1992 and the Martin Luther King Jr. Drum Major 
for Justice Award in 1994. He was elected to the Institute of Medicine 
of the National Academy of Sciences for his leadership skills in 1986; 
recognized again by the National Academy of Sciences as being one of 
the outstanding leaders in health policy and for all of his leadership 
skills brought into the Academy of Sciences. We are fortunate to have 
this extraordinary human being as a nominee. In 1996, he received the 
prestigious Dr. Nathan B. Davis Award given to Presidential appointees 
for outstanding public service to advance the public health.

  More recently, he received the James D. Bruce Memorial Award for 
distinguished contributions in preventive medicine from the American 
College of physicians. And the list goes on: the John Stearns Award for 
Lifetime Achievement in Medicine from the New York Academy of Medicine, 
and the Surgeon General's Medallion for significant and noteworthy 
contributions to the health of the Nation.
  Dr. Satcher's broad range of skills and experience and his strong 
commitment to improving public health make him well qualified to be the 
country's principal official on health care and policy issue--America's 
doctors.
  Today, the public is constantly bombarded with reports about new 
diseases from other parts of the world--from the Ebola virus to dengue 
fever to Hong Kong flu to mad cow disease. Yet there is no Surgeon 
General in office to educate the public about these threats and to 
dispel the widespread concern and fear about them. The public also 
continues to be confused about rapid changes in the health care system, 
especially on issues such as access and quality and cost and managed 
care. We need a Surgeon General who can address these challenges.
  For more than three decades, the Surgeon General has been effective 
in educating the public about the dangers of smoking. Now we know there 
are those that don't like that message and take it out on the 
messenger, and we understand that.
  At his hearing in the Senate Labor Committee, Dr. Satcher said with 
typical eloquence that he would like to ``take the best science in the 
world and place it firmly within the grasp of all Americans.'' That 
challenge is a big part of the job of the Surgeon General--to translate 
scientific research into plain talk that the public can use to improve 
their health.
  Dr. Satcher's nomination has received broad bipartisan support and is 
endorsed by a large numbers of organizations, including medical 
societies and all of the various groups I mentioned earlier. Clearly, 
he has the credentials, the commitment and integrity to serve 
brilliantly as Surgeon General and as the Assistant Secretary for 
health.
  Mr. President, some of the critics have raised questions about some 
of the particular issues, and I will respond to some of those. Some 
critics of Dr. Satcher have argued that he and CDC want to fund needle 
exchange programs that will increase the use of illegal drugs in the 
name of AIDS prevention. It is preposterous to suggest that Dr. Satcher 
would do anything to advocate the use of illegal drugs. Use of illegal 
drugs is wrong and is a major public health problem and a major law 
enforcement problem. The needle exchange is a strategy for preventing 
the spread of infectious diseases by providing clean needles in 
exchange for old ones. One to two million Americans inject illegal 
drugs. Sharing of needles is a leading cause of AIDS transmission. 
Approximately a third of all AIDS cases are linked to drug use. For 
women, 66 percent of all AIDS cases are caused by drug use or sex with 
partners who inject drugs. More than half of the children with AIDS 
contracted the disease from mothers who are drug users or their sexual 
partners.
  A report to Congress from Secretary Shalala in February of 1997 
concluded that needle exchange can be an effective part of a strategy 
to prevent HIV and other blood-borne diseases. The GAO, National 
Academy of Science, National Commission on AIDS, and the Congressional 
Office of Technology Assessment have all concluded that needle exchange 
is an effective strategy. Despite the scientific and public support for 
such programs, a congressional ban on Federal funding of the program is 
in effect unless the Secretary of HHS determines that certain 
conditions are met. These include a finding that the program is 
effective in reducing AIDS transmission, and it has not encouraged 
illegal drug use.

  Dr. Satcher is an eminent scientist. He has recommended to Congress 
we allow scientific studies to answer the key questions involved with 
this issue. Dr. Satcher supports Federal funding for research and 
evaluation of State and local needle exchange programs to assess the 
effort. That is the extent of his position, to find out what the best 
in terms of science is going to provide, whether it does make a 
difference. That sounds to me to be a very reasonable and responsible 
position to have on that question.

[[Page S482]]

  Some critics have alleged Dr. Satcher, as head of CDC, has been 
promoting a pro-gun-control agenda. In reality, Dr. Satcher, through 
CDC's National Center for Injury Prevention and Control, is simply 
carrying out a congressional mandate to collect data relating to all 
types of injuries that occur outside the workplace, including those 
caused by motor vehicle accidents, fires, and firearms.
  President Bush established the National Center for Injury Prevention 
and Control in the hope that just as the Federal highway fatality 
reporting system helps to reduce unintended death from automobile 
accidents, better information about other injuries would lead to better 
education and prevention programs. Recent public service campaigns have 
focused on such injury prevention strategies, especially children's 
safety, bicycle safety, seatbelt use, watercraft safety.
  Preventing violence is a public health issue and a criminal justice 
issue. Thirty-eight thousand Americans were killed with firearms in 
1994; 17,800 were homicides, 18,700 were suicides, and 1,300 were 
caused by unintentional discharge of a firearm. Approximately 100,000 
citizens are treated in hospital emergency rooms each year for nonfatal 
firearm injuries.
  The budget of the Center for Injury Prevention and Control amounts to 
$49 million a year or 2 percent of the overall CDC budget of $2.5 
billion. Of the $49 million, only $7.5 million is spent on research 
concerning youth violence, and less than 11 percent of that deals with 
firearm-related violence.
  Even that is enough, listening to the speeches in opposition to Dr. 
Satcher--a center set up by a Republican President, that has these 
broad responsibilities, and people are flyspecking that there will be 
less than $1 million and, therefore, somehow he is going to violate 
second amendment rights.
  Injuries resulting from violence are preventable. CDC's purpose is to 
save lives. Firearm injuries have a huge impact on public health. We 
cannot ignore the issue. Instead of criticizing Dr. Satcher's efforts 
as a public health leader to address this serious problem, we should 
condemn the attempts by the National Rifle Association to shut down 
this important aspect of research into the causes and the prevention of 
injury.
  Now, critics have also charged that Dr. Satcher, as CDC director, 
conducted HIV studies on newborns and allowed them to be sent home 
without informing parents of the HIV status of their children. This 
survey was part of the Nation's effort to obtain more information on 
the spread of HIV in various populations. The survey was implemented 
through State and local health departments with support from CDC.
  In fact, the survey, which was initiated under President Bush, was 
implemented in 45 States, including the State of Missouri, when Senator 
Ashcroft was Governor of that State. He signed the papers. And as I 
understand it, the effort was made to continue at the time when they 
were going to halt this study.
  Mr. ASHCROFT. Will the Senator yield?
  Mr. KENNEDY. Briefly.
  Mr. ASHCROFT. Does the Senator purport to know when those papers were 
signed and what the condition of AIDS research was at the time?

  I think the Senator indicated that the Governor of Missouri had 
signed papers, I take it, personally signed papers in this respect; is 
that correct?
  Mr. KENNEDY. It is my understanding, that these papers were approved 
either by the Governors of the States or their Administrators and that 
you signed for your state.
  Mr. ASHCROFT. Does the Senator have a copy of that?
  Mr. KENNEDY. I will make it available later on this afternoon.
  Mr. ASHCROFT. Do you know what date it was in which that study was 
commenced?
  Mr. KENNEDY. As I understand, the way it was represented to me, when 
you were Governor.
  Mr. ASHCROFT. The Senator from Missouri had the privilege of being 
Governor for a period of time that spanned 8 years, and during that 
time there were substantial changes made in terms of the known 
treatments for AIDS. Since that time there have been substantial 
changes made, not the least of which is the O76 regimen for AZT 
treatment of newborns and expectant mothers.
  Do you know whether or not at the time of this alleged signature by 
the then Governor of Missouri that treatment was known and had been 
proven and had been developed?
  Mr. KENNEDY. I don't believe just from personal knowledge that it 
was, but I will provide the papers during the course of the debate with 
regard to this particular program which the Senator is familiar with 
because he has criticized it quite extensively. But it has been 
represented to me by the Department that this program was put in place 
while you were Governor. If you tell me it was not, I am willing to 
accept that, but I have been informed it was.
  I was not aware that you had been critical of it prior to the time 
that we had Dr. Satcher's nomination--or were critical of it at the 
time it was in place in Missouri, but all I am saying is you or your 
Administration signed the paper for these studies which you have been 
critical of and I want them in the Record. I think you obviously will 
make whatever comment you want in interpreting it.
  Mr. ASHCROFT. I ask the Senator if developments in the technology 
which make treatment available at some time subsequent to the 
commencement of the study and subsequent to my time as Governor might 
change whether or not you should continue with the study, which would 
remain a blind study when treatment becomes available.
  My question is: Is it possible that a study that is based on 
epidemiological and statistical value would have that value and be 
appropriate until such time as maintenance of a blind study would be in 
a position to deprive individuals of care which had recently been 
developed.
  Mr. KENNEDY. Senator, you will be able to explain it when we put it 
into the Record.
  This study was stopped by Dr. Satcher for some of the reasons that 
you are just mentioning at the present time.
  The point I was making here is that I listened to your very eloquent 
statement and criticism of this kind of a study last week, and then in 
the preparation for this debate found out, to my surprise, when it was 
initially proposed that your Administration signed on for it for the 
State of Missouri.
  Now, I am sure there are other changes, perhaps, that were brought 
about while you were Governor. That is fine. Whatever explanation you 
have on it--and maybe you were critical of it at the time that you 
received it.
  My information from the DHHS is that your Administration signed it 
and that you never expressed any criticism of it at the time that you 
were Governor, and that Dr. Satcher eventually halted it.
  I may be wrong in that series of time line, but that, at least, is my 
understanding.
  Mr. ASHCROFT. I guess I will have an opportunity to respond, but my 
point is that it may be appropriate to do blind studies when there is 
no known therapy, but when a therapy is discovered, like it was in 
1994, a year after I left the Governor's office, then it would be 
incumbent upon one seeking to protect the health of the children to 
identify the children and provide the information to those children. So 
I look forward to the opportunity and I look forward to seeing the 
documents that you would present purporting to bear my signature 
approving those studies. I would be interested to see those documents. 
I ask that you please provide them.

  Mr. KENNEDY. Fine. I will make every effort to provide them this 
afternoon. Are you questioning whether you did OK it for the State of 
Missouri, or not, just so I have an understanding?
  Mr. ASHCROFT. I would be very interested in seeing my signature on 
the document. More importantly, the point is this: There are times when 
it's appropriate to have a study and not provide notice. But when it 
becomes clear that there are therapies available and to persist in the 
studies without providing notice, that changes the whole dynamic. I 
think this is an essential and critical fact that hasn't appeared in 
your analysis and maybe hasn't appeared adequately in mine. So I will 
be pleased to discuss it, because the 1994

[[Page S483]]

discovery of the AZT regimen, which cut by two-thirds the incidence of 
HIV virus cases that otherwise would occur, changes the dynamics.
  That brought the issue to the attention of the Congress, and the 
Congress forced the cessation of the studies on the part of Dr. 
Satcher. He lobbied against ceasing the studies even in light of that.
  I thank the Senator.
  Mr. KENNEDY. Well, I certainly agree with the Senator that at the 
time when you have this kind of progress made for alternative remedies, 
there has to be full notification. The point that I also mention is 
that Dr. Satcher halted the studies.
  Mr. ASHCROFT. If the Senator will yield, are you aware of the fact 
that after the new therapy was available and the Senate and the House 
began to debate this issue, even in the face of the new therapy and in 
the face of the informed consent laws, Dr. Satcher came to the Congress 
to lobby Members of the Congress against stopping the studies?
  Mr. KENNEDY. I am familiar that he came with others on that. I think 
it is an open question whether he was lobbying for the continuation or 
not.
  Mr. President, this survey went on, as I mentioned, in 45 States. It 
began at a time when little was known about the impact of HIV on women 
and their children. Studies were carried on to check for the presence 
of antibodies to HIV in newborns. The presence of such antibodies could 
indicate that a mother has the HIV virus and the child has been exposed 
to the virus. Approximately 25 percent of the children exposed to HIV 
by mothers developed HIV infection, too.
  They were carried out by using blood samples left over from other 
procedures, which otherwise would have been discarded. The samples 
could not be identified as coming from specific individuals because the 
identifying information had been removed to protect confidentiality.
  At the time, because AIDS was so poorly understood, CDC decided to 
survey newborns as a group to learn more about the level of AIDS in 
particular communities at the time. Science offered no treatment for 
the newborns. The goal was to obtain information as quickly as possible 
about the prevalence of HIV in each population so that the resources 
could be targeted quickly and effectively. The survey adhered to the 
ethical principles, was approved by the Office of Protection From 
Research and Risk at NIH, the Institute of Medicine. The Academy of 
Sciences also agreed with using this well-established approach. No 
infants known to be HIV positive were sent home without parental 
notification. The information in the surveys was used by communities 
for education screening and treatment.
  In 1995, the survey ended when a combination of treatment options for 
infants with HIV and better ways to monitor HIV trends in women of 
childbearing age became available in September of 1997. Dr. Satcher 
recommended that the study be formally terminated, and HHS agreed.
  Some in the scientific community have questioned the surveys. Dr. 
Satcher's opponents cite the opposition of Dr. Arthur Ammann, the 
Professor of Pediatrics of the University of California Medical Center 
in San Francisco. These clinical trials are support for their 
opposition. They ignore the fact that Dr. Ammann has endorsed Dr. 
Satcher.
  I ask unanimous consent that a letter to Senator Lott from Dr. Ammann 
be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                         Department of Pediatrics,


                                     University of California,

                                 San Rafael, CA, February 4, 1998.
     Hon. Trent Lott,
     Majority Leader, U.S. Senate,
     The Capitol, Washington, DC.
       Dear Senator Lott: It is my understanding that my 
     objections to the HIV seroprevalence study once conducted by 
     the Centers for Disease Control and Prevention (CDC) are 
     being used as an argument against the confirmation of Dr. 
     David Satcher. This is taking my position totally out of its 
     context and is not an argument I would support.
       I believe that the study was initiated long before Dr. 
     Satcher's arrival at the CDC. When I initially raised my 
     objections to the study, I felt that Dr. Satcher and Dr. 
     Phillip Lee (then assistant secretary for health) gave me a 
     full and fair hearing, and I was very satisfied with the 
     meeting we had.
       I know David Satcher, and I believe he has the interests of 
     all people, including children with HIV, close to his heart. 
     I support his nomination fully, and I would urge that you and 
     your colleagues vote to confirm him.
           Sincerely,
                                              Arthur Ammann, M.D.,
                                                Adjunct Professor.
  Mr. KENNEDY. Dr. Wolfe raised some questions about ethical issues 
about the studies in Africa, and then we find Members of the Senate 
using his kind of statements and representations and saying, isn't this 
horrible, shouldn't we oppose it? And Dr. Wolfe is supporting Dr. 
Satcher. Then we have these studies and hear Dr. Ammann quoted here 
about how Dr. Ammann himself was very much involved in interacting with 
Dr. Satcher. He indicated his full and complete support for the nominee 
despite his concerns about these surveys. He stated, ``I support the 
nominee.''
  We have heard it said considerable times over the past few days that 
these issues were never raised in the committee hearings. Dr. Satcher 
has the credentials, integrity, and commitment to be Surgeon General 
and Assistant Secretary for Health, and he really is outstanding.
  I mentioned the other day, Mr. President, we have the extraordinary 
letter of support from Dr. Sullivan, who was the Secretary of HEW, a 
Republican under the previous administration, who is familiar with 
these various kinds of issues that are being raised and considered here 
on the floor of the Senate. He goes into analyzing just about all of 
them. I urge my colleagues who are having any questions about it, take 
the time, and I will include it in the Record.
  I ask unanimous consent that Dr. Sullivan's letter be printed in the 
Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                                  Morehouse School


                                                  of Medicine,

                                    Atlanta, GA, October 29, 1997.
     Hon. Trent Lott
     U.S. Senate, Russell Senate Office Building, Washington, DC.
       Dear Trent: I enthusiastically support the nomination of 
     David Satcher, M.D., for the positions of Surgeon General and 
     Assistant Secretary for Health of the Department of Health 
     and Human Services.
       In light of the recent debate about issues regarding his 
     nomination, I wish to communicate with you my experience 
     with, and opinion of, David Satcher. I have known David for 
     over twenty-five years, and I can state unequivocally that he 
     is a physician and scientist of integrity, conviction, and 
     commitment. As Surgeon General and Assistant Secretary for 
     Health, I know that David has no intention of using these 
     positions to promote issues related to abortion or any other 
     political agenda. He has worked throughout his career to 
     focus on health issues that unite Americans--not divide them.
       I first met David Satcher in the early 1970's when he 
     served as the Director of the King-Draw Sickle Cell Center in 
     Los Angeles, California and I was the Director of the Boston 
     University Sickle Cell Center. I also had the opportunity to 
     work with David during my first tenure as President and Dean 
     of the Morehouse School of Medicine in the late 1970's, 
     before I served as Secretary of the Department of Health and 
     Human Services, from March 1989 to January 1993. While at 
     Morehouse School of Medicine, David worked on my faculty as 
     the Chairman of Community Medicine and Family Practice. He 
     brought a wealth of experience in patient care, health 
     policy, education and research to this critical post.
       Dr. Satcher has devoted his entire career to mainstream 
     efforts to improve the health of the American people. He has 
     a long history of promoting messages of abstinence and 
     responsible behavior to our youth. As a physician, manager, 
     and public health leader, David is a man of tremendous 
     commitment and dedication to the health of our citizens.
       I strongly support Dr. David Satcher. I am hopeful that the 
     Senate will act swiftly to confirm him as Surgeon General and 
     Assistant Secretary for Health.
           Sincerely,
                                          Louis W. Sullivan, M.D.,
                                                        President.

  Mr. KENNEDY. Dr. Sullivan goes through the studies and regimens and 
deals with those in a very responsible way--I would say we could call 
it an unbiased way. He has been the head of the whole department, HHS, 
under a Republican administration. He has known this man for a 
lifetime, and he has heard all of the charges we have heard last week. 
He discusses them and provides strong support for Dr. Satcher. It is a 
very, very powerful letter. I won't take the time of the Senate now to 
go through the letter. It is a

[[Page S484]]

very important letter, which I hope our colleagues will consider.
  Now, Mr. President, there are other issues. I would like to briefly 
address the AZT trials. Some of our colleagues have questioned Dr. 
Satcher's support for clinical trials of the drug AZT in foreign 
countries as part of the international public health effort to stop the 
epidemic of mother-to-infant transmission of the AIDS virus.
  Every day, more than 1,000 babies in developing countries are born 
infected with HIV. Clinical trials in the United States in 1994 showed 
that it is possible to reduce mother-to-infant transmission of HIV by 
administering AZT during pregnancy, labor and delivery. It was obvious, 
however, that such treatment would not be feasible in developing 
countries. It is too expensive and requires ongoing therapy, including 
intravenous administration of AZT, which is not possible in remote 
areas. It also prohibits breastfeeding, which the various populations 
that were the most at risk were following. Thus, the standard treatment 
in the United States termed the ``076 Regimen,'' was not a feasible 
option for the developing countries.
  Dr. Satcher could have washed his hands of the whole matter, but he 
didn't. He felt he could help. A group of international experts 
convened by the World Health Organization in June 1994 recommended 
research to develop a simpler, less costly treatment. Responding to the 
urgent need, the Centers for Disease Control and Prevention, the 
National Institutes of Health, the World Health Organization, and other 
international experts worked closely with scientists from developing 
countries to find treatment that is feasible for use in these countries 
and that can reduce the devastating toll of HIV on their children.
  In cooperation with experts and leaders from countries where the 
studies were to be conducted and with careful input from ethical 
committees, it was recommended that placebo-controlled trials offer the 
best option for a rapid and scientifically valid assessment of 
alternative treatments to prevent mother-to-infant transmission of HIV.
  The decision to go forward with the trials was carefully made by the 
countries themselves and by the international medical research 
community. They did so because it was the only approach that could be 
expected to produce a sufficiently clear response, in a reasonable time 
period, to the questions that had to be answered about safety and 
effectiveness of an alternative treatment in the developing world.
  The point is made that they might have followed a different 
experimental design or a different regimen and could have gotten the 
outcomes, perhaps not quite as accurate, but fairly accurate, but it 
would have taken a good deal longer to receive the outcomes if they had 
not used a placebo.
  Dr. Satcher has acted entirely ethically and responsibly on this 
issue. The World Health Organization and the developing countries had 
urgently requested help from CDC and NIH in designing and conducting 
these trials.
  Before patients were enrolled in the clinical trials, they were 
specifically informed of their AIDS status. They were specifically 
counseled about the risks and benefits of participation, including the 
fact that they might be in a study group that received a placebo 
instead of an experimental AZT antivirus drug. I think that is an 
enormously important responsibility, that full information is available 
and that those who are participating in these various regimens have a 
full understanding of the risks. There is no indication that they did 
not. The best we have heard from those opposed to Dr. Satcher is 
anecdotal kinds of information. But we never heard that prior to the 
time that we had this opposition on the floor of the Senate to his 
nomination.

  As a practical matter, the only AZT treatment available to any women 
in these developing countries is the treatment provided to participants 
in the study.
  Ethics Committees in both the United States and developing countries 
conducted continuous, rigorous ethical reviews of the trials. The 
committees are made up of medical scientists, ethicists, social 
scientists, members of the clergy, and people with HIV. The role of 
these committees guaranteed that the trials conform to strict ethical 
guidelines for biomedical research, including the Declaration of 
Helsinki and the International Ethical Guidelines for Biomedical 
Research involving human subjects.
  Even those within the scientific community who have raised the 
concerns about these trials, such as Dr. Sidney Wolfe, director of 
Public Citizen's Health Research Group, have expressed their support 
for Dr. Satcher's nomination. Dr. Wolfe has said that he thinks Dr. 
Satcher will ``make an excellent Surgeon General.''
  Dr. George Annas and Dr. Michael Grodin of Boston University's School 
of Public Health have stated, ``While it is true that we have expressed 
concern regarding the U.S.-sponsored trials in Africa, it is also true 
we strongly support Dr. Satcher's nomination as Surgeon General.''
  These judgments that are made on these ethical issues are complex, 
and it is very difficult to get virtual uniformity on some of them, 
particularly when they are at the cutting edge of various kinds of 
research. We understand that is part of the debate on these issues. But 
to those who have expressed a differing opinion regarding the various 
studies, even though every effort was made to go through the various 
regimens to make sure they adhere to ethical standards--and I believe, 
having gone through this in great detail myself that it certainly meets 
all of those standards--but the ones that have expressed some 
reservation by and large are enthusiastic about Dr. Satcher. It isn't 
that they reached a different conclusion with regard to this but they 
also respected the process Dr. Satcher followed.

  Again, this was not an issue during the confirmation hearings, not 
that we should be restricted from talking about it. But it is something 
that we welcome the opportunity to try to respond to.
  Some colleagues have also questioned Dr. Satcher's views with regard 
to abortion. Again, this was an issue during Dr. Satcher's confirmation 
hearing. But some Senators appear eager to use the controversial and 
unconstitutional Partial-Birth Abortion Ban Act to attach his 
credibility.
  Dr. Satcher believes--as do most Americans--that abortions should be 
safe, legal and rare. His position reflects 25 years of medical 
experience and is entirely consistent with Supreme Court decisions.
  In fact, Dr. Satcher supports a ban on most late-term abortions. He 
believes that ``if there are risks for severe health consequences for 
the mother, then the decision [to have an abortion] should not be made 
by the government, but by the woman in conjunction with her family and 
physician.'' Dr. Satcher's position on this issue is shared by the 
American College of Obstetricians and Gynecologists, the American 
Medical Women's Association, the American Nurses Association, and the 
American Public Health Association.
  Some of our Republican colleagues have raised this issue in an 
attempt to defeat a supremely qualified nominee. They point out that 
Dr. Satcher's position on this issue is at odds with the position of 
the American Medical Association--but what our Republican colleagues 
don't point out is that the AMA has unequivocally endorsed Dr. 
Satcher's nomination.
  I ask unanimous consent that the letter of endorsement from the AMA 
may be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 American Medical Association,

                                  Chicago, IL, September 15, 1997.
     The Hon. Edward M. Kennedy,
     U.S. Senate,
     Washington, DC.
       Dear Senator Kennedy: The American Medical Association 
     (AMA) enthusiastically supports your nomination of David 
     Satcher, MD, for the position of Surgeon General and 
     Assistant Secretary for Health of the U.S. Public Health 
     Service. As Surgeon General and Assistant Secretary for 
     Health, Dr. Satcher will serve as a national advocate for 
     public health and a trusted advisor to you and Secretary 
     Shalala on critical health policy issues.
       Dr. Satcher has the expertise and talent to do an excellent 
     job in this dual position. He will bring to the office a 
     wealth of experience in both the private and public sector. 
     Dr. Satcher's distinguished career has been broad in scope 
     and deep in experience, including work in patient care, 
     health care policy, education and research. He is a 
     physician, manager and outstanding public health leader.

[[Page S485]]

       Under Dr. Satcher's leadership at the Centers for Disease 
     Control and Prevention (CDC), childhood immunization rates 
     have increased dramatically from 55 percent in 1992 to a 
     record 78 percent in 1996. Dr. Satcher also spearheaded CDC's 
     efforts to significantly improve the nation's ability to 
     detect and respond to emerging infectious diseases and 
     foodborne illnesses. While at CDC, Dr. Satcher has emphasized 
     the importance of prevention. Under his direction, CDC 
     released the first Surgeon General's Report on Physical 
     Activity and Health. Dr. Satcher appreciates the importance 
     of effectively communicating to the public on health-related 
     issues.
       Through our work with Dr. Satcher over the years, the AMA 
     has learned first hand that he is a man of tremendous 
     integrity and commitment to public health. We are proud to 
     highlight that in 1996 the AMA awarded Dr. Satcher our most 
     prestigious honor, the Dr. Nathan B. Davis Award for his 
     outstanding service to advance public health.
       The AMA strongly supports Dr. Satcher and we are hopeful 
     that the members of the Labor and Human Resources Committee 
     and the full Senate will act swiftly to confirm Dr. Satcher 
     as Surgeon General and Assistant Secretary for Health.
           Sincerely,
                                               P. John Seward, MD,
                                         Executive Vice President.

  Mr. KENNEDY. Mr. President, in addition, Dr. Satcher emphatically 
stated on October 28, 1997, in a letter to Senator Frist, chairman of 
the Subcommittee on Public Health and Safety, ``I have no intention of 
using the positions of Assistant Secretary for Health and Surgeon 
General to promote issues related to abortion.''
  I ask unanimous consent that this letter from Dr. Satcher to Senator 
Frist may be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                 October 28, 1997.
     The Hon. William H. Frist,
     Chairman, Subcommittee on Public Health and Safety, Committee 
         on Labor and Human Resources, U.S. Senate, Washington, 
         DC.
       Dear Senator Frist: I appreciate the support you gave me in 
     the Committee on Labor and Human Resources meeting for my 
     nomination to be Assistant Secretary for Health and Surgeon 
     General. I was surprised and disappointed, however, to learn 
     of the discussion that took place during the Committee 
     meeting. The discussion about abortion is an issue that was 
     not raised during my hearing before the Committee. I would 
     like to take this opportunity to set the record straight 
     about my focus and priorities if I am confirmed for these 
     important positions.
       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 and I want to use the power 
     of these positions to focus on issues that unite Amercians--
     not divide them.
       If I am 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 will also work to ensure that every child has a 
     healthy start in life. I will encourage the American people 
     to adopt healthy lifestyles, including physical activity and 
     diet. And I will try to help the American people make sense 
     of a changing health care system, so they can maximize their 
     access to--and quality of--the health care they receive.
       As a family physician, medical educator and public health 
     leader, I have devoted my entire career to mainstream, 
     consensus-building efforts to improve the health of the 
     American people. I believe it would be unfair and 
     inappropriate to have my nomination complicated at this time 
     by an issue that has little, if anything, to do with my 
     background or agenda for the future.
       I look forward to working with you to advance the health of 
     the American people.
           Sincerely,
                                        David Satcher, M.D., Ph.D.

  Mr. KENNEDY. Mr. President, this assurance has been enough to 
persuade many of our Republican colleagues to put this issue aside and 
support Dr. Satcher's nomination.
  I see others who want to address the Senate.
  I yield the floor.
  Mr. DeWINE addressed the Chair.
  The PRESIDING OFFICER. Who yields time?
  Mr. KENNEDY. I yield 5 minutes to the Senator from Ohio.
  The PRESIDING OFFICER. The Senator from Ohio is recognized.
  Mr. DeWINE. I thank my colleague from Massachusetts.
  Although cigarette smoking continues to be a major problem in this 
country today, I don't think there is anyone who doubts that the 
Surgeon General using his bully pulpit in 1966 had a profound impact on 
public opinion and behavior in this country.
  Mr. President, the nomination of Dr. David Satcher poses a difficult 
problem for those of us who oppose the procedure known as partial-birth 
abortion. The vast majority of Americans agree that it is a barbaric 
process and procedure. As our distinguished colleague, the senior 
Senator from New York, has pointed out, it is disturbingly close to 
infanticide.
  As a matter of conscience, Mr. President, I cannot support a nominee 
for the position of Surgeon General--in essence, America's chief 
doctor--who is a defender of this procedure.
  That, Mr. President, is why I will vote no on this nomination. While 
I suppose it would be unrealistic for any of us to hope this 
administration would send us a pro-life nominee for Surgeon General, I 
don't think it's too much to ask that their nominee oppose this 
particularly brutal procedure of partial-birth abortion.
  But we are now left, Mr. President, with the compellingly serious 
problem of a three-year vacancy at the post of Surgeon General. The 
Surgeon General is our number one public health official--the only 
doctor who can command the national bully pulpit to alert America to 
public health threats. This is a very important position. As our 
distinguished colleague, Dr. Frist, has said, and I quote:

       A Surgeon General brings national and international 
     recognition to public health problems. Their expertise and 
     credibility as well as a national forum can bring life-saving 
     attention to issues Americans may not otherwise hear.

  Mr. President, I could not agree more. Whoever occupies the position 
of Surgeon General can command America's attention. For example, we all 
know that in 1966, the Surgeon General used that bully pulpit to warn 
Americans about the health dangers of cigarette smoking.
  Although cigarette smoking continues to be a major problem in this 
country today, I don't think there is anyone who doubts that the 
Surgeon General using his bully pulpit in 1966 had a profound impact on 
public opinion and behavior in this country.
  And there are other serious public health problems confronting 
America--challenges that cry out for a strong voice--for a physician 
who will use the bully pulpit of the office of Surgeon General to be a 
teacher, and to be a leader.
  Mr. President, I would like to note in this context that this 
nominee, Dr. Satcher, has promised that if he is confirmed, he will 
not--he will not--use the bully pulpit of his office to promote 
partial-birth abortion.
  He has been very clear about that.
  We need a Surgeon General. There may well be important challenges out 
there that we don't yet know about. Who knows what public health 
threats might emerge in the next 6 months, or 12 months, or 2 years?
  Mr. President, we need somebody on the job. That is why, while I 
cannot support this nominee, I cannot in good conscience vote to delay 
the filling of this position.
  Consequently, I will vote in favor of cloture on this nomination. But 
it's time to move forward with this matter, it is time to have a vote 
on this nominee.
  If Dr. Satcher is then in fact confirmed, we should extend all 
possible cooperation to him, as he undertakes what is a very important 
task for the American people. Senator Frist says Dr. Satcher is, and I 
quote, ``an accomplished researcher with a long and truly distinguished 
record in promoting public health'' and ``will reclaim the integrity 
historically associated with the position of Surgeon General.''
  Mr. President, if the nominee is successful, I wish him well in the 
difficult and very important task facing him and facing the country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. Who yields time?
  Mr. KENNEDY. Mr. President, I yield to the Senator from Georgia.
  The PRESIDING OFFICER. The Senator from Georgia is recognized.
  Mr. CLELAND. I thank the President, and I thank the Senator from 
Massachusetts for yielding to me time to speak.
  Mr. President, I am here today to convey my enthusiastic support for 
the nomination of Dr. David Satcher for the positions of U.S. Surgeon 
General and Assistant Secretary of Health.
  The job of Surgeon General is to serve as a defender of public health 
and

[[Page S486]]

safety and bring important health issues to the forefront of public 
awareness. I regret the long vacancy that has existed in the position 
of U.S. Surgeon General and I implore the Senate to support the 
nomination of Dr. David Satcher and fill this long vacated seat as 
expeditiously as possible.
  Dr. Satcher's background reflects a strong emphasis on preventive 
medicine and an intense care for our nation's youth and underserved 
communities. His expertise covers a wide range of medical fields, and I 
believe Dr. Satcher will certainly be a strong voice for public health 
and medical education.
  For the past four years, Dr. Satcher has directed the world renowned 
Centers for Disease Control and Prevention, an agency located in my 
home state of Georgia, which has 11 major branches and worldwide 
responsibility. While at the CDC Dr. Satcher has championed stepped-up 
immunization drives, spearheading initiatives that have increased 
childhood immunization rates from 55% in 1992 to 78% in 1996 while 
simultaneously reducing vaccine-preventable disease to the lowest rates 
in U.S. history. In addition, Dr. Satcher has boosted programs to 
screen for cancer, upgraded the nation's capability to respond to 
emerging infectious diseases and laid the groundwork for a new Early 
Warning System to detect and prevent food-borne illnesses.
  Throughout his career Dr. Satcher has worked in patient care, health 
care policy development and planning, education, research, health 
professions education, and family medicine. He is a physician, scholar 
and a public health leader of national stature and has received broad 
support from the medical community. In 1986, Dr. Satcher was elected to 
the Institute of Medicine of the National Academy of Sciences in 
recognition of his leadership skills. In 1996, he received the 
prestigious Dr. Nathan B. Davis Award from the American Medical 
Association for outstanding service to advance the public health. Dr. 
Satcher has also received the American College of Physicians' James D. 
Bruce Memorial Award for distinguished contributions in preventive 
medicine, the New York Academy of Medicine's John Stearns Award for 
Lifetime Achievement in Medicine, and the National Conference of 
Christians and Jews' Human Relations Award. These are awards given by 
Dr. Satcher's colleagues, experts in the fields of medicine and health, 
who have decided among themselves to praise Dr. Satcher and acknowledge 
his outstanding service and significant contributions to the health 
field.
  As Americans we look toward the Supreme Court justices as a strong 
national voice for the cause of justice. We look toward our priests, 
rabbis and ministers for spiritual guidance. The people of this great 
nation deserve a strong and respected voice on the issue of health, an 
issue that affects every single American without exception.
  I believe that Dr. David Satcher's strong background in public health 
matters, his dedication and unquestionable commitment to the practice 
of medicine, and his strong and sensible opinions on health issues make 
him the ideal choice for the positions of Surgeon General and Assistant 
Secretary of Health. Dr. Satcher will be a strong and forceful voice of 
the highest quality whom every American can look to with respect and 
admiration.
  I ask of my colleagues, what attributes could we possibly look for in 
a Surgeon General that Dr. Satcher does not possess? He has dedicated 
himself to bettering the human condition and has worked tirelessly to 
improve the lives of people throughout this country and the world. 
Through his work, Dr. Satcher has touched millions of people, and has 
made their lives better. We would be doing every American a great 
disservice by denying the nation Dr. Satcher's service as Surgeon 
General. To quote an editorial from the Atlanta Constitution, Dr. 
Satcher ``is the right man at the right time for these two positions, 
and the Senate, which must confirm him, should recognize that.''
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Ashcroft). Who yields time?
  Mr. COATS. Mr. President, I yield myself such time as I may consume.
  The PRESIDING OFFICER. The Senator from Indiana is recognized.
  Mr. COATS. Mr. President, I thank you for trading places with me so 
that I could come down and make remarks regarding the nomination.
  First of all, I want to commend the Senator for conducting what I 
think is an informative and factual and civil debate on this very 
important nomination.
  We have over the past several years had some very controversial 
Surgeon General discussions and debates on this floor. The previous 
Surgeon General, Joycelyn Elders, was controversial, to say the least, 
and resigned after one of her more controversial actions. Then, 
subsequent to that, one of the nominees for that position failed to 
achieve majority support in the U.S. Senate and withdrew his name. So 
that is the position that has been open for some time.
  Earlier, Mr. President, a speaker on the floor said that those who 
oppose this nomination never mentioned the experience and the 
qualifications and the life experiences of Dr. Satcher--his help for 
children, women, and the poor and disadvantaged. That is not true, at 
least in my experience, having been in the Chair for the last hour and 
a half. I think each speaker I have heard has acknowledged Dr. 
Satcher's fairly remarkable life experience in terms of providing help 
to people; in terms of dedicating his life to advancing the cause of 
medicine. He is an engaging person. He is a fine person with a history 
of achievements at the institutions for which he has worked.
  My personal meetings with him in my office have been cordial and 
informative, and his presentation before the Labor and Human Resources 
Committee on which I sit was also one of cordiality and civility. But, 
Mr. President, those are not just the qualifications for someone to 
occupy the position of Surgeon General. Cordiality and life experiences 
in the ability to be, as someone said and I have said on previous 
occasions, the Nation's doctor are important qualifications but there 
are other criteria by which I believe it is important Members make the 
determination. I cannot speak for other Members. They can and will 
speak for themselves. However, I can state to the Senate and to the 
people I represent why I intend to cast my vote tomorrow in opposition 
to the nomination of Dr. Satcher. It is based on the committee hearings 
we have had. It is based on the answers to questions that I personally 
proposed to Dr. Satcher. My opposition is based on his answers to some 
of the questions I have raised during meetings which I have conducted 
in my office. Other Members have spoken on issues that have been of 
concern to me--his involvement and his role in the AIDS trials in 
Africa, his support for needle exchange programs, his inability to 
state clearly the relative importance of abstinence by children and 
avoiding drug use by teens.
  I will leave further details of those issues to others. The Senator 
from Missouri has already touched on some of those, as have others. 
Each of those matters could be potentially disqualifying. The 
accumulation of those matters could be disqualifying. But for me 
ultimately my opposition to the nominee is based on his support for a 
practice that I consider indefensible, partial-birth abortion, a 
practice which we now know is brutal killing of a living child who has 
been partially delivered from the mother.
  Some have claimed that the nominee has not in fact stated that he 
opposes legislation to ban this practice, and he made that statement to 
me. But I need to read from the following exchange of the nominee with 
my office as was printed in the hearing record and available on the 
committee's web site.

       Mr. COATS. Please indicate, Dr. Satcher, whether you 
     support the President's recent veto of legislation regulating 
     partial-birth abortion.

  Dr. Satcher's brief but critical reply:

       I support the President's position.

  Mr. President, I cannot support someone who supports that position. 
Some have claimed that they expect the nominee won't do anything to 
further advance the President's position on this question. But it is 
precisely on a matter so crucial to defining who we are as a nation and 
who we are as a people that I expect, and the qualifying criteria for 
me, is that our Nation's doctor show some independence and integrity on 
this question. I can understand why a nominee feels compelled to 
``support the President's position.'' But this is a matter of such 
fundamental importance, of such defining importance that I believe each 
has to speak

[[Page S487]]

their own moral conscience on the matter and come to their own 
conclusion regardless of the political consequences or any other 
implications.
  Whether or not you will be an advocate or not an advocate for a 
position is not the criteria. The question is, what is your position on 
this, the most critical of all and the most defining of all issues, the 
issue of life itself. By supporting a procedure that I personally 
consider infanticide, this nominee has in fact joined forces with those 
who would create questions about whether or not that is the case, who 
supports without qualification a radical procedure that is not 
justifiable in any case except to save the life of the mother, and we 
have heard testimony from witness after witness, medical provider after 
medical provider, expert after expert, that it has never been the case 
that it is necessary to utilize the procedure of partial-birth abortion 
to save the life of the mother.
  It is a grotesque practice. It has been described in this Chamber. It 
is not justifiable for any medical reasons, and yet that is the reason 
why it is defined here.
  Mr. President, we need a Nation's doctor who unequivocally stands 
for, speaks for, advocates life itself, the sacredness of life itself 
and who will not hedge that qualification with an answer that simply 
says, I support the position of the President. Whether that person 
privately supports that position or not is irrelevant. That person is a 
public figure. The Surgeon General is the doctor to whom the Nation 
looks for advice and counsel on medical matters. He speaks, he 
advocates for those issues, and that someone says on this issue, I 
simply support the President's position, is unacceptable to this 
Senator because the President's position is unacceptable to this 
Senator.
  So for that reason, Mr. President, I oppose this nomination and 
intend to do so when we vote tomorrow.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. HATCH. Mr. President, I have listened with great care to the 
arguments that have been made today and in the past, on past days, in 
opposition to the nomination of Dr. David Satcher.
  The PRESIDING OFFICER. If the Senator will withhold for a moment, I 
would like to find out who yields time to the Senator?
  Mr. HATCH. I am sorry. Will the Senator from Massachusetts yield some 
time to me?
  Mr. KENNEDY. Could I ask how much time remains?
  The PRESIDING OFFICER. The Senator from Massachusetts has 1 hour and 
58 minutes remaining.
  Mr. KENNEDY. Yes, I yield such time as the Senator requires, and then 
could I ask consent that the Senator from South Dakota be recognized 
after the Senator from Utah, for whatever time he requires?
  Mr. ASHCROFT. Reserving the right to object, the proponents have been 
on the floor for quite some time. Does the Senator know how much time 
will be consumed for the two?
  Mr. KENNEDY. I think the Senator from South Dakota indicated 6 or 7 
minutes; 5 minutes?
  Mr. ASHCROFT. No objection.
  The PRESIDING OFFICER. Without objection, the Senator from Utah is 
recognized.
  Mr. HATCH. Mr. President, as I said, I have listened with care to the 
arguments made today in opposition to the nomination of Dr. David 
Satcher for the position of Surgeon General of the United States Public 
Health Service and Assistant Secretary for Health, and I feel compelled 
to rise again in support of this nominee.
  Let me make perfectly clear that I do not agree with all of Dr. 
Satcher's positions. I do not agree with all of the positions, indeed 
with many of the positions, of the Administration he will represent.
  But, on balance, my overriding consideration, after having spoken 
extensively with Dr. Satcher, is my conviction that he has exemplary 
qualifications and experiences that will enable him to hold this 
important office with great distinction.
  I know that others, like my friend from Missouri, Senator Ashcroft, 
and Senator Coats and others earnestly believe that Dr. Satcher should 
not be confirmed as Surgeon General. I respect their point of view, 
especially Senator Ashcroft's and Senator Coats' point of view. I 
believe they have raised some necessary questions for the nominee to 
answer.
  The debate over this nomination has focused on important issues of 
public policy such as partial birth abortion and the appropriate role 
of the United States conduct of clinical trials in the Third World.
  These are indeed serious issues worthy of debate by this chamber. It 
is important for this body to know what the Surgeon General thinks 
about key issues pertaining to the health of the American public and 
the health of our international neighbors.
  This year Congress has the opportunity to pass historic public health 
legislation that can protect our nation's teenagers by materially 
reducing the next generation of smokers.
  If we accomplish this--and I think we should because each day 3,000 
young people begin to smoke and ultimately 1,000 will die early from 
smoking related diseases--a portion of this success must be attributed 
to the involvement past Surgeons Generals.
  In 1964, it was Surgeon General Luther Terry who first reported to 
Americans that smoking is a major cause of disease. Frankly, it was 
this Surgeon's General report that did as much as anything that set the 
course that places us on the verge of this historic legislation.
  Since 1964, all succeeding Surgeons General have played an active 
role in warning the public of the risks of tobacco use.
  In the 1980s, it was Surgeon General C. Everett Koop who did so much 
to put this issue back on the front burner of public opinion.
  I don't think that there is any question about the fact that one of 
the most important legacies of the Office of Surgeon General over the 
last 35 years is the great contribution that these officials have 
played in significantly cutting down the number of Americans who use 
tobacco products to about 25 percent of the population.
  But 25 percent is still too high because it results in an estimated 
400,000 premature deaths annually and runs up billions in extra health 
care costs.
  In my view, we must have a Surgeon General who is able to communicate 
effectively with the American people about the risks of tobacco use.
  On the Today Show last Friday morning, former Surgeon General Koop--a 
strong supporter of Dr. Satcher--pointed out that in the years since 
the Office of Surgeon General has been vacant, certain types of youth 
tobacco use have gone up about 4 percent.
  It just seems to me that it is critical at this time to have in 
office a Surgeon General who can lead the Government's anti-tobacco use 
efforts.
  From his past efforts in this battle against smoking while at CDC--
and from my personal conversations with him--I am convinced that Dr. 
David Satcher can be a major public figure in the country's battle 
against tobacco use.
  No one is saying that a policy of prohibition for tobacco would be 
workable. This makes it all the more important that public opinion 
leaders, like the Surgeon General, be able to communicate the risks of 
tobacco use in a fashion that convinces the public about the benefits 
of stopping to use these deadly products.
  I think Dr. Satcher can play the role of public spokesman in an 
effective fashion because, when the American people get to know him, he 
will have earned their respect and will listen to his advice of matters 
of public health.
  While tobacco alone is critically important, there are many other 
public health issues that cry out for the national focus and leadership 
that a strong Surgeon General can provide.
  In many respects, we are at a critical juncture in the battle against 
HIV transmission and other sexually transmitted diseases. Fortunately, 
the latest triple combination therapies have shown--at least in the 
short run--great promise in combating the progression of the AIDS 
virus.
  But, unfortunately, this may lead some people to conclude falsely 
that HIV has been cured or is at least not dangerous, or not very 
dangerous.
  This may lead some young people to engage in sexual behaviors and 
drug abuse behaviors that not only are morally troublesome, but can be 
potentially lethal.

[[Page S488]]

  In this regard, there are some recent indications that certain types 
of sexually transmitted disease are once again on the rise.
  We need a strong Surgeon General to help teach our citizens, and 
particularly our young citizens, that abstinence from promiscuous 
sexual behavior and illicit drugs is good for your health.
  I am pleased that Dr. Satcher has a strong track record in getting 
this message out--and as a long time health educator he knows how to 
get this message out in a way that young people will listen to. And 
given his long record of involvement as a health leader with special 
ties to those in the minority community--from his work at Morehouse 
College and Meharry Medical School and the King-Drew Medical Center--
Dr. Satcher promises to be able to use his leadership position as 
Surgeon General to direct greater attention on health problems that 
disproportionately affect minority communities.
  I have no doubt in my mind that Dr. Satcher will be able to serve 
effectively as Surgeon General for all the people in this country.
  Under his leadership at CDC, the agency put greater emphasis on 
prevention. I think that there is much truth in the old adage, ``An 
ounce of prevention is worth a pound of cure.'' Frankly, as a 
conservative, I think Government debates pounds and pounds of cures, 
having completely lost sight of the benefits of a little old-fashioned, 
non-governmental ounce of prevention.
  In the past I have been involved in a number of confirmations of 
Surgeons General.
  During the Bush Administration, I enthusiastically supported the 
nomination and confirmation of Surgeon General Antonia Novello.
  Dr. Novello came from a research background at the National Institute 
of Child Health and Development and did a very good job for this 
country. Dr. Novello spent much of her efforts on pediatrics problems 
such as pediatric AIDS programs.
  Before that, I was involved in the then very controversial nomination 
of Dr. C. Everett Koop by President Reagan.
  At the time of his nomination, many had concerns that Dr. Koop, a 
pediatric surgeon by training who held strong pro-life views on 
abortion, would turn the Surgeon General's role into a polarizing 
position because of the politics of abortion.
  Dr. Koop and I went to his opponents and explained that the great 
challenge and responsibility of the Surgeon General's office is not to 
stress issues that divide Americans but to act to unite the public by 
educating our citizens about the medical and scientific facts of health 
issues.  I might mention that was a big battle. It took 8 months to get 
Dr. Koop approved because of pro-choice Senators. But, finally, he was 
approved and those Senators became some of his strongest supporters 
through the years.

  I agree with Dr. Koop's oft-repeated statement that the job title is 
Surgeon General of the Public Health Service, not chaplain of the 
Public Health Service.
  I think that history will judge that I was correct in my assessment 
that Dr. Koop was the right man for the job. I know that many who voted 
against him now agree that Dr. Koop was an outstanding Surgeon General.
  It is somewhat ironic that one of the issues raised in the Koop 
confirmation has also been raised in the Satcher confirmation.
  That matter is abortion, in particular the nominee's view of partial 
birth abortion.
  Let me be abundantly clear: I am firmly and resolutely opposed to 
partial birth abortion. I disagree with the views of both the President 
and Dr. Satcher on this issue. I think that they are in the minority on 
this issue.
  Nevertheless, I don't think that Dr. Satcher's views on this issue 
should disqualify him for this  position, so long as he does not make 
it a matter of public policy and does not advocate for it. And he has 
indicated to me that he will not advocate for it, that he will not 
bring abortion into the debate if he is confirmed as Surgeon General.

  While others who have held this post have endeavored to use it as a 
bully pulpit for a controversial social policy agenda, I am assured by 
Dr. Satcher that he fully understands the extreme sensitivity of these 
issues, particularly abortion. In my discussions with him, he has 
assured me that he will not use the Surgeon General's Office as a pro-
abortion platform, and I believe him. And, with that assurance, I am 
willing to support him here today.
  As Dr. Satcher has written to the Congress:

       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 and I want to use the power 
     of these positions to focus on issues that unite Americans--
     not divide them.
       If I am 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.
  Let me tell you, I can't tell you how much that means to me, that we 
have a Democrat-appointed Surgeon General who is willing to preach 
abstinence throughout this country to our youth. And to preach--I 
should say teach, would be a better word--good health practices.
  I have to say some of our Republican Surgeons General haven't done 
this as well as I think Dr. Satcher will be inclined to do it. So that 
is one reason alone to vote for Dr. Satcher. And it is about time.
  It seems to me that Dr. Satcher and Dr. Koop, while having almost 
completely opposing views on abortion, share the view that the Surgeon 
General's post is not the place to press the public debate on this 
contentious issue.
  Given his public assurances--which have been butressed by my private 
conversations with the nominee--I am satisfied that Dr. Satcher can 
effectively help set the public health agenda of this country and can 
do it in a way that perhaps no other person at this time can. I think 
it is time to get this position filled and I think he will do a great 
job in it, and I intend to see that he does.
  I also recognize that a lot of this debate has focused on the 
question of certain AZT trials co-sponsored by CDC and NIH in Thailand 
and the Ivory Coast.
  I think that this debate has been healthy and has been helpful in 
facilitating a better understanding of the proper role of United States 
public health agencies in conducting research in the Third World.
  First off, let me just make the point that I believe that any 
comparisons with the infamous Tuskegee experiments is way wide of the 
mark. Those natural history studies held no promise of treatment and, 
in fact, after a treatment was found, this treatment was denied to the 
participants of the study.
  Unlike Tuskegee, these AZT trials have a strong informed consent 
component.
  These trials were undertaken in close cooperation with the World 
Health Organization and the national and local public health officials 
of the country where the trials took place. As a proponent of the 
successful FDA export bill in 1995, the Hatch-Gregg amendment, I 
believe that it is imperative in forming public health policy that the 
United States must recognize and respect the differences in health and 
wealth characteristics of our foreign neighbors.
  What is the standard of care in the United States may simply not be 
appropriate, proper, or possible in another country.
  In fact, as former Secretary of Health and Human Services, Dr. Louis 
Sullivan has written to me to rebut criticisms raised against Dr. 
Satcher. Dr. Sullivan pointed out with respect to these AZT trials:

       Part of the problem is that the cost of the drugs involved 
     is beyond the resources of developing nations. In Malawi, for 
     example, the regimen for one woman and her child is more than 
     600 times the annual per capita allocation for health care.

  I ask unanimous consent this letter be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                  Morehouse School of Medicine

                                                 February 6, 1998.
     Hon. Orrin Hatch,
     U.S. Senator,
     U.S. Senate, Washington, DC.
       Dear Senator Hatch: I understand that questions have been 
     raised about the ethics and leadership of Dr. Satcher because 
     of his support of AZT trials to reduce perinatal HIV 
     transmission in developing countries.

[[Page S489]]

     Questions have also been raised about his role in the HIV-
     blinded Surveys of Childbearing Women which started in 1988 
     and was suspended in 1995. As a biomedical scientist, former 
     Secretary of the Department of Health and Human Services 
     (DHHS) under President Bush, and one who has known and worked 
     with Dr. Satcher for twenty-five years, I write to 
     respectfully take exception to this assessment of the studies 
     and especially of Dr. Satcher. I share the view of the World 
     Health Organization (WHO), UNAIDS, the National Institutes of 
     Health (NIH) and the Centers for Disease Control and 
     Prevention (CDC) that these studies were ethical, appropriate 
     and critical for the health of babies in developing 
     countries. I also agreed which public health leaders at every 
     level of government that the HIV-blinded survey which was 
     started five years before Dr. Satcher entered government were 
     ethical, appropriate and critical during the early phase of 
     the AIDS epidemic. More importantly, I agree with those who, 
     while questioning the AZI trials in Africa, strongly attest 
     to the ethics and leadership of Dr. Satcher and strongly 
     support his nomination for Surgeon General.
       In 1994 scientists in the United States found a regimen 
     using the drug AZT that dramatically reduces the transmission 
     of the HIV virus from mothers to newborns. As a result of 
     this breakdown, perinatal AIDS transmission in the United 
     States has dropped by almost half since 1992. Naturally, such 
     an advance raises hopes of making dramatic reductions not 
     only in the developed world, but in developing nations, where 
     100 babies were born each day infected with HIV.
       Unfortunately, it is generally agreed that the regimen that 
     has worked so well in the United States is not suitable for 
     these developing nations. Part of the problem is that the 
     cost of the drugs involved is beyond the resources of 
     developing nations. In Malawi, for example, the regimen for 
     one women and her child is more is more than 600 times the 
     annual per capita allocation for health care.
       Just as important, developing nations lack the medical 
     infrastructure or facilities required to administer the 
     regimen, which requires (1) that women undergo HIV testing 
     and counseling early in their pregnancy, (2) that they comply 
     with a lengthy therapeutic oral regimen, and (3) that the 
     anti-HIV drugs be administered intravenously at the time of 
     birth. In addition, mothers must refrain from breast feeding; 
     the newborns must receive six weeks of oral drugs; and both 
     mothers and newborns must be closely monitored for adverse 
     effects of drugs.
       Given the general recognition that this therapy could not 
     be widely carried out in developing nations, the WHO in 1994 
     convened top scientists and health professionals from, around 
     the world to explore a shorter, less costly, and less 
     complicated drug regimen that could be used in developing 
     countries. The meeting concluded that the best way to 
     determine efficacy and safety would be to conduct research 
     studies that compare a shorter drug regimen with a placebo--
     that is, no medicine at all.
       After the New England Journal of Medicine (NEJM) published 
     its editorial criticizing the AZT trials in developing 
     countries, two of the three AIDS experts on this editorial 
     board resigned in protest because they disagreed. Many other 
     outstanding biomedical scientists and ethicists have since 
     taken issue with the NEJM editorial.
       As one who feels strongly about what happened in Tuskegee, 
     let me say that it is utterly inappropriate to compare these 
     trials with Tuskegee where established treatment was withheld 
     so that the course of the disease could be observed while 
     these men died. The AZT trials being carried out in 
     developing countries are for the purpose of developing 
     treatment that is appropriate, effective and safe to prevent 
     the spread of HIV from mother to child. Unlike Tuskegee, 
     these programs have a very strong informed consent component.
       Likewise, I do not believe that criticism of the blinded-
     surveys of childbearing women is appropriate. These surveys, 
     which started in 1988, five years before Dr. Satcher came to 
     government, were supported by public health leaders at every 
     level. They were considered to be the best way to monitor the 
     evolving epidemic during that very difficult period when we 
     knew so little of the nature of the problem and virtually no 
     treatment was available. These surveys use discarded blood 
     from which all identifying information had been removed, to 
     measure the extent of the HIV problem in various communities 
     and groups. The information was invaluable to state and local 
     communities in planning education and screening programs. 
     Using these surveys we were able to document that the 
     percentage of women infected with HIV grew from 7% in 1985, 
     to almost 20% in 1995. At no time was any baby, known to be 
     positive for HIV, sent home without the parents being 
     informed.
       Again, I acknowledge the right to criticize Dr. Satcher, 
     the nominee for Surgeon General. But, I believe that Dr. 
     Satcher's long and distinguished career speaks for itself 
     relative to his commitment to ethical behavior, service to 
     the disadvantaged, to excellence in health care and research 
     and to human dignity.
       Should you wish, I would be happy to review any of the 
     areas where there is any remaining confusion or questions.
       With best wishes and regards, I am
           Sincerely,
                                          Louis W. Sullivan, M.D.,
                                                        President.

  Mr. HATCH. Let me be clear: This economic circumstance is a sad fact 
of life in many developing nations but it is a fact of life 
nevertheless.
  A key question is how best to bring new treatments and new hope to 
these underprivileged peoples around the world.
  As Dr. Sullivan goes on to explain what happened in the construction 
of these trials you can see that the U.S. standard of care--the so-
called long course AZT treatment could not serve as the proper 
baseline:

       Given the general recognition that this therapy could not 
     be widely carried out in developing nations, the WHO in 1994 
     convened top scientists and health professionals from around 
     the world to explore a shorter, less costly, and less 
     complicated drug regimen that could be used in developing 
     countries. This meeting concluded that the best way to 
     determine efficacy and safety could be to conduct research 
     studies that compare a shorter drug regimen with a placebo--
     that is, no medicine at all.

  Let me just go on to tell you what Dr. Sullivan--the Bush 
Administration's HHS Secretary who is currently President of the 
Morehouse School of Medicine--thinks about the comparison of this study 
to the Tuskegee study:

       As one who feels strongly about what happened in Tuskegee, 
     let me say that it is utterly inappropriate to compare these 
     trials with Tuskegee where established treatment was withheld 
     so that the course of the disease could be observed while 
     these men died. The AZT trials being carried out in 
     developing countries are for the purpose of developing 
     treatment that is appropriate, effective and safe to prevent 
     the spread of HIV from mother to child.

  Dr. Sullivan is joined in his opinion by many health experts such as 
the American Medical Association and the American Academy of 
Pediatrics, that support Dr. Satcher.
  Let me just conclude that I respect the views of those who have 
raised issues about this nominee. I certainly respect their right to 
raise these issues, but when I weigh all the evidence, I come to the 
conclusion that Dr. Satcher's nomination should be strongly supported.
  Frankly, I find his life inspiring. He comes from humble roots. He is 
an American success story. He is a good man. And I judge that he will 
be a fair man. I am confident that if we confirm him, David Satcher 
will do his best to advance and protect the health of the American 
public.
  I do not agree with all his views but I do believe that this good 
American merits our votes.
  Let me mention a few of Dr. Satcher's accomplishments both before and 
during his tenure at CDC:
  Dr. Satcher has led an international effort to reduce transmission of 
HIV from mother to child;
  He has worked to close the health gap between the ``haves'' and the 
``have-nots.'' He was the Chair of Community and Family Medicine at 
Morehouse College. He served as the President of Meharry Medical 
College which has as a primary mission caring for the underserved.
  In fact, Dr. Satcher has led an innovative public/private effort to 
consolidate the Meharry teaching hospital with the county facility in 
order to reduce cost and improve care;
  During his tenure at CDC, the childhood immunization rate has risen 
from 55 percent to 78 percent. Over 90 percent of children are now 
immunized against measles, mumps, rubella, tetanus, pertussis and 
hemophilus. With particular respect to measles, between 1989 and 1991, 
over 27,000 kids suffered each year. In 1995 there were less than 500 
cases, and last year there were no deaths.
  In years prior to approval of a vaccine for hemophilus B influenza, 
about 1,000 children died a year. Dr. Satcher has worked to promote use 
of this new vaccine, and last year, only nine families suffered a 
death;
  During Dr. Satcher's tenure, the number of states with breast cancer 
screening programs has risen from 18 to 50;
  Another accomplishment of Dr. Satcher's is Food Net, a new 
surveillance system which detects foodborne illnesses. It worked in 
1996 when there was a salmonella outbreak from apple juice and again 
with the tainted raspberries from Guatemala;
  Dr. Satcher has developed and nurtured a program to provide public 
health information on the leading

[[Page S490]]

cause of death for African-Americans between 15 and 24. These 
statistics, along with a teenage suicide rate that has tripled since 
1950, are a problem our Nation's physicians and leading public health 
authorities have stated they cannot ignore any longer;
  Dr. Satcher has also developed a much-needed comprehensive approach 
to detecting and combating infections emerging in both the U.S. and 
around the world. The possibility that world travel could quickly 
result in an epidemic underscores the need for a rapid detection 
system.
  All of these are tremendous accomplishments in a relatively short 
period of time by a man who had just one small agency under his 
control.
  I do not agree with all of Dr. Satcher's views. But I didn't agree 
with all of Dr. Koop's views or all of Dr. Novello's views either, but 
probably more with them than I do with Dr. Satcher. But I believe this 
good American merits our votes.
  President Clinton did win the election. He should have the right to 
have a Surgeon General of his choice, so long as that person is within 
the mainstream and so long as that person will not advocate a radical 
agenda that divides America. This man has indicated that he will 
encourage an agenda that will bring America together, an agenda that 
will help our youth to abstain from promiscuous sexual activity. He has 
indicated he will be sensitive in so many other areas that will bring 
America together. I think Dr. Satcher is a man who, at this time, could 
do this better than anyone else I know. That is why I support his 
nomination. I hope that our colleagues will also support him in our 
vote tomorrow. I yield the floor.
  Mr. JOHNSON addressed the Chair.
  The PRESIDING OFFICER (Ms. Collins). The Senator from South Dakota is 
recognized.
  Mr. JOHNSON. Madam President, I rise to fully join in the strong 
bipartisan support for the nomination of Dr. David Satcher, as 
expressed on the Senate floor today, for the dual position of U.S. 
Surgeon General and Assistant Secretary of Health.
  This Nation is fortunate that a man of Dr. Satcher's dedication, 
vision and deep commitment to public service has agreed, in fact, to 
take on this critically important role, a critical role, I might add, 
that has been unfilled--unfilled--since 1994. It is time to fill this 
critical position. We have gone more than 3 years without a Surgeon 
General to push Americans toward better health and healthier 
lifestyles.
  Dr. Satcher has served the American people as a family practice 
physician, as an educator and as an established leader in the public 
health arena. During his tenure as the Director of the Centers for 
Disease Control, Dr. Satcher worked to strengthen the critical 
prevention link in our Nation's public health structure. He tackled the 
problem of lagging childhood immunization rates, increasing the number 
of kids immunized by nearly 25 percent. Rates increased from 55 percent 
in 1992 to 78 percent in 1996. This is an exceptional accomplishment.
  Under Dr. Satcher's leadership, we reduced by one-fourth the number 
of children at risk for immunization-preventable diseases, some of them 
permanently disabling, or even fatal.
  Dr. Satcher also spearheaded a highly successful program to provide 
breast and cervical cancer screening to women throughout America. State 
participation in the CDC breast and cervical cancer screening program 
increased from 18 to 50 percent.
  He helped launch an early warning system to detect and prevent 
foodborne illnesses, such as E. coli. This system was instrumental in 
tracking and containing salmonella, E. coli and cyclospora, in imported 
raspberries, outbreaks.
  Dr. Satcher has wide-ranging support. He is clearly of the political, 
of the medical mainstream in our Nation. He is endorsed by 133 
organizations, including the American Medical Association and many 
physicians groups, the American Hospital Association and most hospital 
organizations, the American Nurses Association and many others, 
including prominent pharmaceutical companies.
  Dr. Satcher has indicated very clearly to this Senate that he sees 
his role as providing a focus on issues that unite Americans and not 
divide them; that he wants to strongly promote a message of abstinence 
and responsibility to our youth.
  In a recent letter Dr. Satcher wrote:

       If I'm confirmed by the Senate, I will work to ensure that 
     every child has a healthy start in life. I will encourage the 
     American people to adopt healthy lifestyles, including 
     physical activity and diet, and I will try to help the 
     American people make sense of a changing health care 
     system so that they can maximize their access to and the 
     quality of the health care they receive.

  I believe, Madam President, that Dr. Satcher's goals are squarely on 
target. Our Nation will be well served by a public health leader who 
could help us foster healthy lifestyles, a consumer advocate who 
recognizes that strengthening our health care system means empowering 
individuals to make informed decisions of their own about the care that 
they receive. I am confident that Dr. Satcher, a man of experience, 
proven integrity and great insight will help us make these goals a 
reality. I am confident that my colleagues on both sides of the aisle 
will join me in confirming this important nomination. I yield back my 
time.
  Mr. ASHCROFT addressed the Chair.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.
  Mr. ASHCROFT. Madam President, I yield myself as much time as I may 
consume in my opposition to this nomination.
  The PRESIDING OFFICER. The Senator is recognized.
  Mr. ASHCROFT. Madam President, may I ask how much time remains on 
each side?
  The PRESIDING OFFICER. The Senator from Missouri has 1 hour and 42 
minutes; the Senator from Massachusetts has 1\1/2\ hours remaining.
  Mr. ASHCROFT. The Senator from Missouri thanks the Chair.
  Madam President, I rise to oppose this nomination because this 
nominee has an approach to America's drug crisis which is an approach 
of tolerance--in many respects--rather than an approach of eradication. 
That is clear by the fact that this nominee has shown a clear 
willingness to encourage needle exchange programs and to groups of 
individuals that want to sponsor needle exchange programs and to 
embrace a concept waiving State laws in America that are against drug 
paraphernalia that accommodates the problem of drug abuse.
  This afternoon, I would like to take some time to review evidence 
that shows where we are in this debate in our culture. We can then 
juxtapose that with the views of the current nominees.
  To begin the discussion, we must understand that the Surgeon General 
of the United States has a very important responsibility, not only to 
the people of America--advising you and me and families across America 
on our health concerns--but also in advising the Secretary of Health 
and Human Services and advising the President of the United States in 
terms of health policy the Nation should be following.
  In that role, the Surgeon General--``America's Doctor''--should not 
only value life, but also should value the quality of life in this 
great land.
  Drugs in America impact not only the quality of life of those 
addicted to the illegal narcotics, but also the children in our schools 
and the citizens of our cities. If you look carefully, it is pretty 
clear that of the number of people in our prisons--the majority of them 
have been involved with some substance abuse in the commission of their 
crimes.
  The Nation's drug policy should be one of zero tolerance. It should 
not be a policy of accommodation. Drugs are turning our once vibrant 
cities into centers of despair and hopelessness. We need a Surgeon 
General who rejects and fights the drug culture--who has no tolerance 
for the drug culture. A Surgeon General who says that America can be 
called to a higher standard rather than accommodated in a culture of 
consuming drugs.
  Many special interest groups are calling on Congress and the 
administration to turn our drug policy into a policy of accommodation 
and tolerance. Let me just sort of try to help you understand what kind 
of an approach that would be.
  Rather than treating drug addiction as the problem-- understanding 
that it is a criminal act and that it should not

[[Page S491]]

be tolerated, many groups have increasingly called for a ``harm 
reduction'' policy. Harm reduction advocates policies to literally 
reduce the harm of injecting illegal drugs. These policies include 
providing clean needles to drug addicts and for some--legalization of 
drugs.
  This was the case with the former Surgeon General of the United 
States, Joycelyn Elders, who actually said that we ought to just 
legalize drugs, we should make them available on a broad basis so that 
more people could have easy access to them. I think that is the wrong 
approach. I think accommodating drug users, I think providing a greater 
accessibility to drugs, providing safe accessibility to drugs sends all 
the wrong messages.
  The ``harm reduction'' school of thought is the idea that if we 
provide people with either free drugs or clean needles, so that there 
will be less risk involved in using drugs, that we will have done the 
right thing.
  The Harm Reduction Coalition's Home Page provides that HRC ``supports 
individuals and communities in creating strategies and obtaining 
resources to encourage safer drug use. . . Rather than perpetuating the 
`all or nothing' approach to drug intervention, harm reduction--and 
here is the key phrase--``accepts drug use as a way of life.''
  Once you come to the conclusion that you want to accept for this 
country drug use as a way of life, you really have embraced something 
that is--very troublesome as far as I am concerned. I think America 
wants to reject drug use as a way of life. We do not want to 
accommodate ourselves with the concept of more and more young people 
and more and more citizens of our culture who are involved in drug use. 
I think what we really want to be able to do is say we want fewer 
people to be involved in drug use, and that as a way of life it is 
something we want to reject rather than embrace.
  I see that my colleague from the State of New Mexico is here and has 
come to the floor. And I intend to speak for quite some time on this 
issue. I would be happy to ask for unanimous consent that he be able to 
make some remarks, and then that the Record would reflect that his 
remarks would be somewhere outside the confines of mine. I think he 
would probably prefer that.
  Mr. DOMENICI. Madam President, if we could have unanimous consent 
that I could deliver my remarks at 4:30, in which event the Senator 
would be finished. It is 3:20.
  Mr. ASHCROFT. Yes. I would be finished by 4:30.
  Madam President, I ask unanimous consent that the Senator from New 
Mexico be allowed to speak at 4:30, and that his time be taken--I 
understand he is supporting the nomination--that his time be taken from 
the time on the supporting side for the nomination.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. I note the presence of Senator Bingaman, my colleague 
from New Mexico. He wanted to speak for 2 or 3 minutes on the same 
subject. I am not sure if 4:30 will accommodate that. I ask unanimous 
consent that Senators Domenici and Bingaman have 15 minutes together at 
4:30, and that for part of that 15 minutes we be permitted to speak on 
a resolution regarding the 400th anniversary of the commemoration of 
the first permanent Spanish settlement in New Mexico.
  The PRESIDING OFFICER. Is there objection to the unanimous consent 
request?
  Mr. ASHCROFT. Reserving the right to object, let me say, to the 
extent the time is expended in favor of the nomination, that I ask 
unanimous consent that it be taken from the time allotted to the side 
favoring the nomination.
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  Mr. DOMENICI. Madam President, has time for every Republican in favor 
of the nominee been taken out that way? If that is the case, I want to 
be treated that way.
  The PRESIDING OFFICER. That is correct.
  Mr. DOMENICI. Thank you very much, I say to Senator Ashcroft.
  I yield the floor.
  Mr. ASHCROFT addressed the Chair.
  The PRESIDING OFFICER. The Senator from Missouri is recognized.
  Mr. ASHCROFT. Thank you very much.
  As I said, there was a stream of thought in this country that says, 
we ought to begin accepting drug use as a way of life. It is known as 
the ``harm reduction'' school of thought. It is a philosophy that tries 
to limit some of the harm and to provide as much support as is 
necessary to drug users in the culture.
  Now, this is the philosophy behind the needle exchange programs which 
have gained the favor of the nominee, Dr. Satcher. By giving addicts 
clean needles, the argument goes, you reduce their chance of becoming 
infected with HIV, therefore, you improve their quality of life.
  I, along with a majority of Americans, believe that such policies are 
nothing more than a subsidy for drug use--providing equipment for drug 
users to administer illegal drugs to themselves, and hoping somehow 
that in this safer environment for them and somehow that they have 
fewer infections.
  I indicate that that is not the view of most Americans. And I do not 
think it is the view of many sensible individuals, including Gen. Barry 
McCaffrey, who is the director of the Office of National Drug Control 
Policy. We frequently refer to General McCaffrey as the ``Drug Czar.'' 
These are the words of General McCaffrey:

       The problem is not dirty needles, the problem is heroin 
     addiction. . . The focus should be on bringing help to this 
     suffering population--not give them more effective means to 
     continue their addiction. One does not want to facilitate 
     this dreadful scourge on mankind.

  Well, I couldn't agree more with General McCaffrey. We do not want to 
facilitate the dreadful scourge of drugs on mankind. We do not want to 
accept drug use as a way of life. Furthermore, it is crucial that we 
understand whatever we do in Government--we teach--we send signals to 
young people.
  What are young people to think when they encounter a junkie who wants 
to convince them to use IV drugs, and young people say, ``Oh, I don't 
know. I've been told that's wrong. And I've been told that's 
dangerous.'' But the junkie says, ``Oh, don't worry about that. The 
Government gives us needles. And we can do this without risk or harm. 
You don't think the Government would provide us with the tools if this 
was something that's really wrong, do you?''
  I think it would be hard, as a young person who was otherwise 
tempted, to understand that the government would not be endorsing drug 
use. What does this do to our children? What kind of message does it 
send to America in terms of that to which we aspire? Does it carry us 
to our highest and best or does it accommodate us at our lowest and 
least?
  Is this harm reduction a means, by saying that we will tolerate this, 
that we are willing to embrace it, and not only embrace it but to 
subsidize it? And in so doing, are we willing to corrupt the next 
generation because we are trying to provide a clean needle? Besides--
there are real questions about whether clean needles reduce drug use or 
not.
  Obviously, the Congress has rejected this policy of facilitating, in 
the words of General McCaffrey, the ``dreadful scourge on mankind.''
  In 1988, the U.S. Congress began banning the use of Federal funds for 
needle exchange programs. The representatives of the people of the 
United States of America said, ``My taxpayers, the people who send me 
here, don't want to spend their money buying needles for drug 
addicts.''

  I keep thinking to myself, I will bet you they don't want to buy 
bulletproof vests for bank robbers either. You could improve the health 
condition of bank robbers, if you wanted to, and make it safer for 
them. Under those circumstances, they would less likely die in the 
commission of a robbery if you would strap a bulletproof vest on them. 
But I don't think we want to do that because we don't want to 
participate, with Federal money or State money or any money, in the 
commission of a crime. It is something we are against doing.
  I do not think we want to participate in the commission of the drug 
crimes which spawn the robberies, spawn the assaults in our cities by 
saying, ``We're going to make this easier for you.

[[Page S492]]

 We're going to make it less risky for you. We're going to make it 
cleaner for you. We're going to make it more convenient for you. So any 
time you need a needle, we can give you one. You won't have to find one 
or you won't have to try and get one some other way illegally. We'll 
just make it available to you. That way, you won't ever have to quit 
taking drugs.''
  In 1988, Congress began banning the use of Federal funds for needle 
exchange programs.
  Last year, in 1997, Congress included language in the Labor, Health 
and Human Services Appropriations bill that would allow the ban to be 
lifted if the Secretary of Health and Human Services determines that 
needle exchange programs reduce HIV among intravenous drug users and 
does not encourage drug use. Well, I think it would be a very difficult 
finding to be able to make.
  Since it is the function of the Surgeon General to advise the 
Secretary of HHS on such policies, Dr. Satcher's position on the needle 
exchange program is crucial in the debate.
  Here you have it. The law now says that we will not spend tax dollars 
in this respect unless the Secretary of Health determines that needle 
exchange programs reduce HIV among intravenous drug users and they do 
not encourage drug use. So all he would have to do is say, well, I kind 
of think they probably will reduce--or accept a study that might say 
that they do, or accept a study that says they don't encourage drug 
use. And having done that, he is in the position to have the law of the 
United States go from not supporting needle exchange to supporting 
needle exchange programs.
  Dr. Satcher's needle exchange position has been very difficult to 
determine. It has been difficult to determine in substantial measure 
because they have not been forthcoming. There has been a set of 
responses made by the Centers for Disease Control which are incomplete. 
And the more complete they are, the more troublesome they become.
  A 1992 study conducted by the University of California moved the harm 
reduction debate into the mainstream of public debate. Also, this is 
the most often cited study showing that needle exchange programs reduce 
HIV in intravenous drug users.
  In 1993, CDC was asked to ``review'' the California study and give 
its ``opinions and recommendations for Federal action in response to 
needle exchange'' programs.
  In the review, the CDC embraced the study findings that needle 
exchange programs reduce HIV infection among IV drug users and show no 
evidence of encouraging drug use.
  The CDC, led by Dr. Satcher, made its recommendations not only on 
Federal action but also made recommendations on policy changes to State 
and local governments.

       The ban on Federal funding of needle exchange programs 
     should be removed to allow States and communities the option 
     of including needle exchange programs in comprehensive 
     programs [programs that share Federal funding].

  In the review, the CDC found the recommendation that State and local 
governments repeal their drug paraphernalia laws as they ``apply to 
syringes,'' to be ``reasonable and appropriate.''
  So here you have the Centers for Disease Control, under the 
leadership of Dr. Satcher, saying that we ought to urge States to 
repeal their drug paraphernalia laws concerning syringes that it is a 
reasonable and appropriate recommendation. He is sending word up the 
chain to the Secretary of Health and Human Services that that is what 
ought to be done.
  He is also saying the ban on Federal funding of needle exchange 
programs should be lifted to allow States and communities the option of 
including needle exchange programs in comprehensive programs.
  The review also found the California study recommendation that 
``substantial Federal funds should be committed both to providing 
needle exchange services and to expanding research into these 
programs.'' And they found that recommendations was ``reasonable and 
appropriate.''
  So here is what you have. You have the CDC recognizing and evaluating 
the California study. And then you have the CDC saying, under Dr. 
Satcher's direction and leadership, that the recommendations are both 
reasonable and appropriate.
  And what are those recommendations?
  They are to spend substantial Federal funds to provide needle 
exchange services and to expanding research into such needle exchange 
programs, and they are to recommend that state and local governments 
repeal their drug paraphernalia laws as they relate to syringes, and 
they are to say that the ban on Federal funding of needle exchange 
programs should be lifted.
  Here you have a real conflict. You have the people of the United 
States against providing needles for drug addicts. You have Dr. Satcher 
running the CDC, evaluating studies and saying that it is reasonable 
and appropriate to start spending Federal tax dollars. Then he 
concludes, based on the studies, that there is no increase in HIV 
transmission or drug use as a result of needle exchange programs.
  Now, I have to say that this so-called review by CDC has been very 
controversial. In fact, it was made public only during the past 2 years 
after a needle exchange advocacy group obtained and disseminated a 
copy. Prior to that time CDC even denied Freedom of Information Act 
requests to obtain copies of the review.
  Here is what you have. You have the CDC on record in favor of needle 
exchange programs under the direction of Dr. Satcher. You have a 
refusal of the agency to provide copies of their review of the report. 
I can understand Dr. Satcher's trying to distance himself from this 
review. When I asked for a copy of the CDC's review of this report, it 
was not forthcoming. And when it was forthcoming, it came to me with a 
critical piece of the operation missing. What was missing from the 
report was the letter of Dr. Satcher--the cover letter--where he is 
``pleased to submit the attached review.''
  Now, I have some real reservations about the fact that the CDC would 
send out the report and not include the cover letter from this nominee. 
I can understand why this nominee would not want the cover letter to 
accompany the review because he has sought to lead Members of the 
Senate and committees of the Senate that he has not endorsed, not 
participated in programs that would promote needle exchange or clean 
needles for drug addicts. But I think it is beneath the dignity of the 
CDC and beneath the integrity of the Senate of the United States to 
send out the review without having the letter of endorsement on the 
review that is signed on behalf of David Satcher.
  In my opinion, for us to make good judgments about individuals who 
are before the Senate, we have to expect agencies to comply completely 
with our requests. To provide documents that we ask be provided--
selectively--in ways which favor prior statements of a nominee, and to 
withhold items which might not be as favorable to the nominee and to 
provide items that might be more favorable to the nominee reflects 
poorly on the compliance of the agency. It could reflect on the 
integrity of the nominee if the nominee himself or herself is in 
control of the agency.
  It might be possible to argue that, well, maybe the cover letter does 
not really apply to the recommendations and maybe the signature on the 
cover letter, which purports to be a signature for Dr. Satcher, is not 
one that ought to be considered, but I hope that agencies in providing 
information to the Senate would allow the Senate to make judgments like 
that.
  The Centers for Disease Control has withheld relevant and material 
information I believe in an effort to mislead this body on Dr. 
Satcher's position on Federal funding for needle exchange programs.
  A statement was made on the Senate floor that suggested I was trying 
to mislead my colleagues by saying that Dr. Satcher supports needle 
exchange programs. A Senator stated that ``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 issue. Dr. 
Satcher believes 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.''
  The key point here is after I indicated Dr. Satcher had promoted and

[[Page S493]]

sought to promote illegal drug use, statements were made in the Chamber 
that he has never advocated taxpayer funded needle exchange programs 
for drug users.
  Well, I think you can tell from the report I just quoted, which was 
sent to us finally, begrudgingly--minus the cover letter from Dr. 
Satcher--that directly contradicts ``Dr. Satcher has never advocated 
taxpayer funded needle exchange programs.'' No question about it.
  Let's look at the record. In addition to this, although it is 
difficult to find since the CDC consistently has withheld and delayed 
getting requested information to my office, Dr. Satcher has not been 
forthright in addressing his view on public funding for needle exchange 
programs. He has embraced the lawyer speak, Clinton speak that we have 
all heard too much of in the last 6 years. When asked the question 
about his position on the Federal funding of needle exchange programs, 
he talks about quality science or the administration's position. He 
does not simply answer the question.
  When my office requested information from the CDC on the ``number of 
needle exchange programs, education or research conferences sponsored 
with Centers for Disease Control funds,'' I was told that the CDC did 
not fund such conferences. The cover letter, transmitted with part of 
the information that we had requested, stated that the ``CDC has 
participated in several conferences and other activities designed to 
reduce the spread of HIV/AIDS'' but said categorically there were no 
CDC funded conferences in this respect.
  Understanding again the lawyer speak, the CDC only funds conferences 
``designed to reduce the spread of HIV/AIDS,'' therefore, we had to ask 
for information on all conferences funded by the CDC that were designed 
to reduce the spread of HIV and AIDS. We asked for this information 5 
days ago and still have not received it.
  Even though the CDC stated that it did not fund such conferences. 
Even though we have a great deal of information, including conference 
brochures, indicating that the CDC does fund such conferences. They 
found one ``Award of Notice'' relevant to my request, it was a needle 
exchange conference that the CDC decided not to fund. This was a Harm 
Reduction Action Coalition conference that was supposed to be funded by 
the CDC but the funding was terminated because the CDC could not 
approve the final agenda. The CDC is forthright in giving me 
information about a needle exchange conference finding--it is relevant 
to the request when they terminated funding but not when the funding 
for the conference actually went through.
  Let me go over it. We asked them if they had ever funded a conference 
that regarded needle exchange and whether they would fund such a 
conference and they sent us documentation that said here is a 
conference which we're going to fund--which happens to be the needle 
exchange advocacy group we already have talked about today--but the 
funding was terminated because we could not agree on the final agenda. 
They understood that they wanted to support Dr. Satcher's 
representations to Senators and to the members of the committee of the 
Senate that he does not support needle exchange programs.
  So we will look at the record. First, he submitted the review I just 
mentioned recommending the end to the Federal ban. Under Dr. Satcher's 
leadership the CDC has cosponsored conferences designed to advance the 
needle exchange agenda.
  I have mentioned the cover letter that I was sent by the Department 
of Health and Human Services Legislative Affairs Office, but now I 
quote:

       The CDC does not provide funds to support needle exchange 
     programs, nor has the CDC directly funded any educational 
     research conference on needle exchange, although CDC has, of 
     course, participated in several conferences and other 
     activities designed to reduce the spread of AIDS.

  What you have here is I have asked them if they ever 
support conferences on needle exchange. They say no. They say we can 
show you a document of a conference we denied because it had needle 
exchange in it. And then outside of their own response with documents 
we get this logo from a conference sponsored by CDC ``Getting the 
Point.'' I do not think it takes a rocket scientist to know that this 
is a needle. ``A conference about clean needle programs sponsored by 
the Chicago Department of Public Health and the Centers for Disease 
Control and Prevention.''

  Now, it may be a coincidence that the Centers for Disease Control 
provided me information about a conference which they were going to 
fund but then terminated the funding, but when I have asked for 
information from them about conferences which they did sponsor and they 
omit those carefully--but I doubt it.
  It may be a coincidence that they omitted the cover letter which 
provided Dr. Satcher's direct connection to the assessment of the 
Centers for Disease Control for Federal funding for clean needles and 
for the conclusions of the California study--which--incidentally are 
not based on good science--but I doubt it.
  It seems like it is all too convenient that this agency--in pursuit 
of this nomination--selectively has provided to the Senate those things 
which reinforce the stated position, the public position of the nominee 
and has then deleted from the record those things which do not comport 
with the position of the nominee.
  It not only happened as it related to the cover letter on the 
evaluation of the California study; it happened when we wanted to know 
whether we really find ourselves sponsoring clean needle conferences 
and agendas around the country. And conveniently enough the cover 
letter was deleted and conveniently enough the conference that was 
funded was deleted, but the conference which was not funded was 
included in the evidence.
  I quote from a letter from the Illinois Drug Education Alliance--who 
attended this Chicago--``Getting the Point'' Conference which was 
addressed to Dr. Satcher.

       Dear Director Satcher. As President of the Illinois Drug 
     Education Alliance, I take strong exception to how the 
     Centers for Disease Control and Prevention are promoting 
     clean needle programs in the State of Illinois. My 
     understanding is that no Federal money is to be spent on 
     clean needle programs, so I do not understand how the CDC can 
     justify promoting clean needle programs.
       In Chicago, on June 30, 1997, the Chicago Department of 
     Public Health and Centers for Disease Control and Prevention 
     cosponsored a conference ``Getting The Point'' on clean 
     needle programs. I was one of three IDEA (Illinois Drug 
     Education Alliance) board Members who attended the 
     conference, and I can personally testify that it was totally 
     weighted toward clean needle programs. There were no (in 
     italics ``N-O'') speakers presenting the opposite view.

  Judy Kreamer, the President of the Illinois Drug Education Alliance, 
persists to write:

       We were further alarmed to learn that the CDC is providing 
     technical assistance and financial support for another 
     conference ``HIV Prevention Among Injection Drug Users.'' 
     This Illinois Department of Public Health conference also 
     presents a clearly biased perspective. After a number of 
     telephone calls and cooperation of IDPH, we were able to 
     include a panel, featuring a nationally known expert, to 
     present the opposing view.

  Critical point. The kind of representations made by Dr. Satcher to 
Members of the Senate have been that he opposes Federal funding, does 
not advocate Federal funding for clean needle programs.
  That was made so convincingly to a number of Members of this body 
that when I rose to say early in the debate that he advocated clean-
needle programs or needle exchange programs, there were those who rose 
to vociferously contradict it and assure us that that was not the case. 
I think this evidence speaks for itself.
  One, he has endorsed the report saying it's reasonable and 
appropriate to have substantial Federal funding for clean-needle 
programs. No. 2, he has endorsed a report saying it's reasonable and 
appropriate to urge that the State laws be changed so that drug 
paraphernalia laws provide an exception for needles and syringes. 
Secondly, there is clear evidence, when all the evidence is in--or at 
least when enough evidence is finally provided--that not only did the 
Department fail to provide us with notice of the clean-needle programs, 
there was a selective provision of material requested by the Senate, 
and that is very, very distressing. The reasoning for not providing the 
letter was that it was just a transmittal letter, although they did 
send us, of

[[Page S494]]

course, a substantial amount of information. I would like to submit the 
conference agenda and letter for the Record.
  I ask unanimous consent that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

Selected Readings Regarding HIV/AIDS and Access to Sterile Syringes and 
                                Needles


                               disclaimer

     (The following printed materials are provided as background 
     for the ``Getting the Point'' conference. Inclusion here does 
     not represent endorsement by the conference sponsors for the 
     accuracy or views expressed in the materials. Refer to CDPH 
     notes throughout. In all cases, readers are urged to review 
     original copies of the full documents and supporting 
     materials)


                           getting the point

     (A Conference about Clean Needle Programs Sponsored by the 
     Chicago Department of Public Health and Centers for Disease 
     Control and Prevention; Monday, June 30, 1997, Harold 
     Washington Library Center, Chicago, Illinois)


                                sponsors

       Sponsored by the Chicago Department of Public Health and 
     The Centers for Disease Control and Prevention (CDC)


                               background

       HIV/AIDS, hepatitis and other blood-borne illnesses are 
     often spread through contaminated equipment used by injection 
     drug users (IDU). As one effort to address the problem, 
     Illinois legislators are debating measures to legalize 
     possession of hypodermic syringes/needles and allow their 
     limited sale without prescription at pharmacies. Such 
     measures are intended for people who cannot or choose not to 
     get treatment for their substance abuse.


                               objectives

       Our conference is intended to educate and encourage 
     discussion regarding clean needle programs. Participants will 
     learn about: (1) epidemiology and demographics of HIV/AIDS 
     related to IDU; (2) treatment availability and harm-reduction 
     for IDU; (3) evaluations of current clean-needle programs; 
     (4) related legal/legislative issues; and (5) community 
     response.
       Information and feedback from the conference will assist 
     the Chicago Department of Public Health in formulating 
     policies regarding the role of clean needle programs as part 
     of a comprehensive system of prevention, education, and care 
     for injection drug users and their sex partners.


                            keynote address

       Jonathan Mann, M.D., M.P.H. The plenary keynote will be 
     delivered by Dr. Jonathan Mann, founding director of the 
     World Health organization's Global Program on AIDS and Chair 
     of the Global AIDS Policy Coalition. At the Harvard School of 
     Public Health, Dr. Mann is Director of the International the 
     Francois-Xavier Bagnoud Center for Health and Human Rights. 
     Additionally, he is Professor of Epidemiology and 
     International Health, and Director of the International AIDS 
     Center of the Harvard AIDS Institute. Dr. Mann will discuss 
     public health lessons and challenges related to the HIV/ADIS 
     epidemic and clean needle programs.


                          special presentation

       Connecticut Representative William Dyson in 1992, the 
     Connecticut legislature legalized the sale and possession of 
     up to ten clean syringes/needles. State Representative 
     William Dyson, D-New Haven, reports on the results of clean 
     needle legislation in his state.


                               workshops

       All three workshops will be held twice (11:00 AM and 1:30 
     PM). Each features a panel of authoritative speakers and 
     opportunity for audience participation. Indicate your 
     preference on the attached form.
       Workshop A: Needle Programs. Place: Video Theater: What 
     does research say about the effectiveness of needle exchange 
     programs? Does access to clean needles reduce disease? Will 
     easier access increase the use of drugs and encourage drug 
     injection? Moderator: Supriya Madhavan, Epidemiologist, CDPH. 
     Speakers include: Steve Jones, CDC; Andrea Barthwell, 
     Encounter Medical group, Chicago; Beth Weinstein, Connecticut 
     Dept. of Public Health.
       Workshop B. Community Response. Place: Main Auditorium: How 
     strong is the public sentiment for and against clean needle 
     programs? What are opinions of affected neighborhood groups, 
     churches and community leaders? Moderator: Theordora Binion-
     Taylor, CDPH. Speakers include: Sandra Crouse Quinn, 
     University of North Carolina, Chapel Hill; Johnny Colon, VIDA 
     SIDA; Sidney Thomas, Woodlawn Adult Health Clinic.
       Workshop C: Legal and Legislative Issues. Place: 
     Multipurpose Room B: How are legislators handling proposals 
     to legalize possession of hypodermic syringes and needles? 
     How would such proposals impact law enforcement, pharmacies, 
     and other interested parties? Moderator: Fikrite Wagaw, 
     Epidemiologist, CDPH. Speakers include: William Dyson, 
     Connecticut State Representative; Sara

``Getting the Point'' A Conference About Clean Needle Programs (Monday, 
  June 30, 1997 8:30 a.m.-4:30 p.m.--Harold Washington Library, Lower-
   Level Conference Center, 400 South State Street, Chicago IL 60603)


                                 AGENDA

     8:30-8:55  Welcome and Overview:
       Robert Rybicki, M.A., Assistant Commissioner, CDPH Division 
     of HIV/AIDS Public Policy and Programs.
       Steve Whitman, Ph.D., Director of Epidemiology, Chicago 
     Department of Public Health.
     9:00-9:30  Keynote Address:
       ``The HIV/AIDS Epidemic: Public Health Lessons and 
     Challenges.'' Jonathan Mann, M.D., M.P.H., Harvard School of 
     Public Health.
     9:30-9:50  Legislative Issues:
       State Representative William Dyson, Connecticut General 
     Assembly.
     9:50-10:10  Treatment Dilemmas:
       Andrea Barthwell, M.D., Encounter Medical Group, Chicago.
     10:10-10:30  Community Perspectives:
       Sydney Thomas, M.S.W., Woodlawn Adult Health Clinic.
     10:30-10:45  Questions and Answers
     10:45-11:00  Break
     11:00-12:30  Concurrent Workshops A, B, C
     12:30-1:30  Wintergarden Lunch
     1:30-3:00  Concurrent Workshops A, B, C (Repeated)
     3:00-3:20  Break
     3:20-4:30 Closing Plenary

     Workshop Summations
     Complexities for Law Enforcement: Views From the Chicago 
         Police Department, Commander Dave Boggs
     Perspectives of Public Health: Sheila Lyne, R.S.M., 
         Commissioner, Chicago Department of Public Health

     4:30  Adjournment

  Mr. ASHCROFT. Madam President, the CDC also cosponsored with the 
Atlanta Harm Reduction Coalition, which is one of the groups who 
believe that reducing the harm of IV drug use through needle exchanges 
is an appropriate way for us to begin to accept drug use as a fact of 
life and a way of life in the United States.
  I ask unanimous consent that the agenda of the Atlanta Harm Reduction 
Coalition Conference, cosponsored by the CDC, also be printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                             Harm Reduction

       Harm reduction is a model and a set of strategies, based in 
     the public health ideology, that encourage users and service 
     providers to reduce the harm caused by licit and illicit 
     substance use. In allowing users access to the tools needed 
     to become healthier, we recognize the competency of their 
     efforts to protect themselves, their loves ones and their 
     communities.
       The Atlanta Harm Reduction Working Group Conference is a 
     two-day meeting designed to advance harm reduction in the 
     Southeastern United States. Although this area of the country 
     is a focal point for several prominent schools of public 
     health and government controlled health agencies, most local 
     policies do not use public health or harm reduction when 
     dealing with substance users.
       This conference is designed for health care workers, social 
     service providers, outreach workers, drug treatment workers, 
     educators, lawyers, law enforcement officials, researchers 
     and academics for education on harm reduction policies. The 
     specific objectives include presenting practical strategies 
     for incorporating harm reduction into existing services and 
     programs; providing local and national examples of successful 
     harm reduction strategies; and developing networks of people 
     who are or will be working in the field of harm reduction.


                         Friday, March 22, 1996

     8:30-9:30 a.m.--Registration and Coffee

                   Rita Anne Rollins Room--8th Floor

     9:30-10:00 a.m.--Welcoming Remarks by Sponsoring Agencies:
       Jim Curran, MD, MPH, Dean, Rollins School of Public Health.
       Ariane Kraus, Coordinator, Atlanta Harm Reduction 
     Coalition.
       Sara Kershnar, Program Director, Harm Reduction Coalition.
       Ethan Nadelmann, JD, Director, The Lindesmith Center.
       David C. Condliffe, Exec. Director, The Drug Policy 
     Foundation.
     10:00-11:00 a.m.--Introduction and Keynote Address:
       Jim Curran, MD, MPH, Dean, Rollins School of Public Health.
       Steven Jones, MD, U.S. Centers for Disease Control and 
     Prevention.
     11:15 a.m.-12:30 p.m.--What Is Harm Reduction?
       Michael Poulson, MPH, Atlanta Harm Reduction Coalition.
       Imani Woods, Training Specialist, Progressive Solutions.
       Jon Paul Hammond, Harm Reduction Coalition.
       Margaret Kadree, MD, Morehouse School of Medicine.
       Cheryl Simmons, SISTERS.


                        Saturday, March 23, 1996

     9:30-10:00 a.m.--Coffee.

                    Rollins School of Public Health

     10:00 a.m.--12:00 p.m.--Working Groups-Repeated

[[Page S495]]

     12:09--1:30 p.m.--Lunch

                    Rita Anne Rollins Room-8th Floor

     1:30-3:30 p.m.--Where Do We Go From Here?
     Community Organizing and Grass-Roots Policy Change:
       Sara Kershnar, Harm Reduction Coalition.
       Joyce Perkins, Nashville Needle Exchange Program.
       Dave Purchase, North American Syringe Exchange Network.
       Cathalene Teahan, Georgia AIDS Coalition.
       Sterling White, Starr Team.
     3:45-5:30 p.m.--Southeast Harm Reduction Coalition Meeting.

 Please Attend the Fund-raising Events for the Atlanta Harm Reduction 
                               Coalition

  Friday Evening: Whole World Theater Benefit, Saturday Evening: Red 
                          Light Cafe Benefit.


                          conference sponsors

       U.S. Centers for Disease Control and Prevention; Atlanta 
     Harm Reduction Coalition; Harm Reduction Coalition (HRC); The 
     Drug Policy Foundation; The Lindesmith Center; Dogwood 
     Center; Common Sense for Drug Policy; The Criminal Justice 
     Policy Foundation; Summerhill One-to-One; Emory Harm 
     Reduction Working Group; Sisterlove; Nyarko & Associates; 
     Emory University Center for Health, Culture and Society; 
     Georgia AIDS Coalition; Georgia Men's Health Education 
     Network; North American Syringe Exchange Network; Southeast 
     AIDS Training and Education Center; Rollins School of Public 
     Health of Emory University.

     12:30-1:45 p.m.--Lunch

             Rollins School of Public Health-Working Groups

     2:00-3:45 p.m.--Drug Treatment, Twelve-Step and Harm 
         Reduction: How They Best Relate:
       Imani Woods, Training Specialist, Progressive Solutions.
       Nana Nyarko, Nyarko and Associates.
       Bruce Stepherson, NDRI.
       George Kenney, AIDS Action Committee.
     2:00-3:45 p.m.--Harm Reduction in the Black Community: Key 
         Challenges and Effective Techniques:
       Michael Poulson, MPH, Atlanta Harm Reduction Coalition.
       Ricky Bluthenthal, Harm Reduction Coalition.
       Ben Selasi, MPH, MSW, GA Men's Health Education Network.
       Dazon Dixon, Executive Director, Sisterlove.
       Cheryl Simmons, SISTERS.
     2:00-3:45 p.m.--Harm Reduction and the Criminal Justice 
         System:
       Erick Sterling, JD, Criminal Justice Policy Foundation.
       Nicholas Pastore, Chief of Police, New Haven, CT.
       Sterling White, Starr Team.
       Cheryl Epps, Dir. of Government Affairs, The Drug Policy 
     Foundation.
       Nancy Lord, MD, Attorney at Law.
     2:00-3:45 p.m.--Needle Exchange, a Harm Reduction 
         Intervention: Savings Lives One at a Time:
       Davd Purchase, North American Syringe Exchange Network.
       Ariane Kraus, Atlanta Harm Reduction Coalition.
       Mark Kinzly, Bridgeport, CT, Department of Health.
       Jon Paul Hammond, Harm Reduction Coalition.
     2:00-3:45 p.m.--Reaching Youth:
       Whitney Taylor, The Drug Policy Foundation.
       Heather Edney, Santa Cruz Needle Exchange Project.
       Rosa Colon, Lower East Side Harm Reduction Center.
       Abeni Bloodworth, Summerhill One-to-One.
       Gwen Alford, MPH, Acupuncturist.

                   Rita Anne Rollins Room--8th Floor

     4:15-6:00 p.m.--Harm Reduction: The New Paradigm for Public 
         Health:
       Jim Curran, MD, MPH, Rollins School of Public Health.
       Bob Fullove, Assoc. Dean, Columbia University School of 
     Public Health.
       Margaret Kadree, MD, Morehouse School of Medicine.
       Claire Sterk-Elifson, PhD, Women's and Children's Center.

  Mr. ASHCROFT. Madam President, the CDC claims it does not sponsor 
needle exchange conferences. Two times during the confirmation process, 
Dr. Satcher was given the opportunity to make his position on Federal 
funding for needle exchange programs known. Both times, in response to 
written questions, he wrote:

       I believe that, as a nation, we must remain open to the 
     input of quality science. Secretary Shalala's 1997 report to 
     Congress concluded that needle exchange programs ``can be an 
     effective component of a comprehensive strategy to prevent 
     HIV and other blood-borne infectious diseases in communities 
     that choose to include them.'' At the same time, the 
     administration's position on Federal funding of needle 
     exchange programs is that we do not have adequate science to 
     conclude that such programs do not encourage drug use in 
     communities. Thus, we have not asked that the ban on Federal 
     funding for these programs be lifted.

  Dr. Satcher was asked and given the opportunity to state clearly, in 
writing, what his position was, and it is pretty clear that this answer 
is consistent with the way they responded to my request for documents. 
Asked about his commitment to a clean-needle program, he said that he 
believed we must remain open to the input of quality science, and then 
he cited the administration's position. Well, quality science without 
values can be dangerous.
  The Surgeon General of the United States should reject such policies 
as an acceptance of defeat and an embrace of hopelessness. We should 
not decide we are going to accept drugs as a way of life in the United 
States. We should not spend resources providing clean needles to drug 
addicts or for conferences that promote the distribution of clean 
needles.
  In theory, there are those who really think clean needles would help. 
In practice it doesn't work that way. Let me just give you some 
information about needle exchange programs.
  First, needles are not always exchanged. Therefore, they do not keep 
dirty needles out of our communities. The New York Times' reporter went 
into a needle exchange center and received 20 syringes without 
exchanging any needles. His companion received 40 syringes. They serve 
them up by the dozen. According to the Associated Press, in 
Willimantic, CT, ``More than 350 discarded hypodermic needles were 
collected from the city's streets, lots and alleys'' in a single week.
  Now, there's a great environment for children in America--to have 
used hypodermic needles from drug addicts discarded under the guise of 
a ``clean-needle program,'' protecting the drug addicts, but exposing 
the children of America. It is obvious that we are teaching the wrong 
things to children when we teach them that we will provide them with 
clean needles so that they can involve themselves in drugs, but in one 
week in a small town in Connecticut, there were 350 discarded syringes. 
You know, of all the clean-needle studies I have heard about, they 
don't talk about the discarded syringes. Frankly, I suppose it is 
supposed to be laid at the feet of the Congress because we said it 
would cut down on HIV infections in drug users and would not increase 
drug use. Well, it doesn't ask about what happens to the children of 
the country. I think maybe we ought to think a little more carefully 
about what happens to the children.
  Here is an article from USA Today, September 17, 1997:

       Ms. Fiske says the exchange gets back one-third to one-half 
     of the needles it gives out. That's not ideal, she says, but 
     ``one-for-one exchange does not fit the reality of how 
     injection drug users live. Some of them are homeless. What 
     are they going to do--put the dirty needles in their pockets 
     for a week?

  So the clean-needle advocates say, if we have 50 percent of the 
needles tossed on the road or available as sort of medical waste, 
contaminated with perhaps the deadly virus of HIV, that is a sacrifice 
we are willing to make in order to be able to accept drug use as a way 
of life. I don't think that is leadership or where we want to lead this 
country. That is not the kind of health to which we want the Surgeon 
General of the United States to summon us. We don't want to be summoned 
to an environment of drug use and dirty needles laying around.

  It goes on:

       It is 1:30 p.m., time for the exchange to close. Within 
     minutes, the tables and leftover supplies are wedged back 
     inside Acker's car. But she isn't done yet. Now she drives 
     about a mile back to the neighborhood near the old exchange 
     site and pulls up in front of a row house.
       Out comes Kellie Jones, a sometime drug user who has spent 
     a rough 45 years on the streets. Acker gives her a garbage 
     bag full of 900 boxed, sterile syringes. By 10 that night, 
     Jones says, the bag will be empty and the clean needles will 
     be in neighborhood shooting galleries.
       She distributes the needles, she says, because ``AIDS is 
     such a horrible death,'' one she has seen. ``The public 
     should know that this isn't about condoning drug use. This is 
     about stopping the madness.''

  I think if you are going to give out 900 needles in one night, 450 
will come back and the rest will be found somewhere in the culture, it 
is about the madness. I think it injures the quality of life in our 
communities.
  From the Pittsburgh Post Gazette, a letter to the editor:

       . . . Aside from my personal aversion to the destruction 
     needle exchange undeniably perpetuates in the life of the 
     addicts, there are several other key issues that . . . are of 
     concern to myself and my neighbors.

[[Page S496]]

       Our community has worked hard to battle the drug problem 
     that plagues our neighborhoods at many levels. But the needle 
     exchange program gives dealers and users one more reason to 
     stay here. In addition, drug users from outside our community 
     now find reasons to frequent our neighborhood.
       Drug addiction is not a victimless crime. Not only does it 
     kill the addict, but also, in the process, the addict preys 
     on those around him. Prostitution, burglary, and now violence 
     are an increasing problem in our community. So while the 
     needle exchange people try to help addicts, they do so at the 
     expense of our neighborhood.

  You wonder about taxpayers who establish neighborhoods, who own 
homes, pay their taxes, what they think of a Government that provides 
needles so that addicts will come to their neighborhoods and they help 
addicts at the expense of the neighborhood.

       The needle exchange people, who do not live in our 
     community, have been allowed to operate openly for more than 
     two years here, while the police and neighbors looked the 
     other way. We have seen no noticeable changes of a positive 
     nature. The drug problem only gets worse.
       Sadly, AIDS is a fact of drug addiction. But the truth is, 
     nothing but recovery and abstinence can truly save the 
     addict. Most addicts do not die from AIDS, but from a host of 
     other tragic consequences directly related to a life of 
     addiction . . .

  This citizen from Pittsburgh, PA, I think tells us something about 
needle exchange programs.
  Here is a letter from the editor of the New York Times:

       Ever since the Lower East Side Harm Reduction Center--

  Remember the harm reduction group, the kind of group that sponsors 
these kinds of programs that have been subsidized by American tax 
dollars through the CDC.

       Ever since the Lower East Side Harm Reduction Center, a 
     needle exchange program, began operating in a storefront in a 
     residential population of working poor, our community has 
     witnessed drug abuse not seen since Operation Pressure Point 
     cleared the area of drugs in the 1980's. Needle exchange is a 
     link in a chain called ``one-stop shopping.'' You can receive 
     your Government-sponsored clean needles (there is no limit to 
     the number), rob and steal to get money for drugs (or sell 
     your clean needles), buy cocaine in store fronts, or heroin 
     on any corner, then leave behind a pool of blood, dirty 
     syringes, glycine bags, alcohol swabs, and bottle caps--
     the debris of a depraved individual. The needle exchange 
     program has legitimized drug use on the lower east side.

       ``The needle exchange program has legitimized drug use.'' 
     That is the key. That is the problem. We don't want to make 
     drug use legitimate.

       And by a tacit approval has invited a population of 
     predators into our community. Statistics on the spread of 
     AIDS cannot be the only criterion for measuring the success 
     of the program.

  One of the inevitable consequences of needle exchange programs is 
that the police look the other way. I mean, after all, if you are going 
to give them the needle with which they are to use the illegal drug, 
you are not really in the position to go and ask them to stop using the 
illegal drug.

       So we compromise the integrity of the law enforcement 
     community. We make them duplicitous individuals who say one 
     thing but have to do another. We make the police house, a 
     station house, a house divided.

  From South Tucson, the Arizona Daily Star News:

       When the unmarked police car pulled behind the Wagon Wheel 
     Bar yesterday afternoon, a young woman in a black hat was 
     squatting by the back wall with both hands on one ankle. 
     ``She is shooting,'' said Gerald Brewer, South Tucson Police 
     Chief. Brewer was checking areas frequented by intravenous 
     drug users when he happened upon the woman who stood and 
     walked over toward South 6th Avenue when the police car 
     stopped. ``Police, stop,'' Brewer yelled, as he stepped from 
     the car and walked after the woman. But she didn't stop, even 
     as Brewer pulled a gun from his ankle holster and shouted at 
     her several more times. She disappeared around the corner of 
     the bar and Brewer didn't follow. She had shot the dope up 
     and already she was rubbing her ankles. So there is no 
     substance on her. ``She has discarded the syringe,'' Brewer 
     said, explaining why he didn't chase her. After turning a 
     trick, prostitutes go to drug houses near South 6th Avenue to 
     buy heroin. Then they fire up in a vacant lot, or an alley, 
     before heading back to 6th Avenue to repeat the cycle.

  The point here that is being made is since it is no longer illegal, 
since the government gave you the needle, once the drug is injected 
into you, and you are no longer carrying the substance-- at least 
outside your body and in your bloodstream --you are no longer subject 
to arrest, you end up demoralizing the police, and you end up making it 
impossible for individuals to enforce the law.
  This article is from the Vancouver Sun about Glasgow, Scotland which 
is called ``The drug injecting capital of the world.'' That is a title 
we don't want to wrest from their control. They have a massive needle 
exchange program there that makes it possible for individuals to be 
drug injectors very conveniently, theoretically, safely.
  The article from the Vancouver Sun says:

       Michelle is 20. She is soaked through, wearing all the 
     clothes she owns. A thin, pretty, guarded girl in a sodden, 
     flimsy top and light trousers. She has been on drugs for 5 
     years, and sleeps in an abandoned warehouse with her 
     boyfriend, Michael, 26. Both had spent the equivalent of $800 
     Canadian on two days of heroin. Michelle isn't sure if she 
     has 17 or 25 convictions for shoplifting. Michael has spent 
     all but six months of the past 10 years in prison for two 
     serious assaults. ``I was out of it, stoned, both times'', 
     and has been on drugs for longer. Before Michael, Michelle 
     lived with another junkie who repeatedly beat her up. She 
     lost the baby she was carrying. ``I'd rather be dead than to 
     live like this,'' she says. The unemotional delivery 
     convinces you she means it. And, as she walks away in the 
     rain, you realize that she is almost certainly moving toward 
     it.

  Yes. ``The drug injection capital of the world,'' fueled by a clean 
needle program.

  As teen drug use continues to rise, as the use of heroin, cocaine, 
and marijuana continues to rise, the Federal Government should not be 
sending the message that drug use should be accepted. The Federal 
Government should not embrace drug use as a way of life. The Federal 
Government should not subsidize illegal drug use through clean needle 
programs. And the Centers for Disease Control should not advocate 
spending taxpayer dollars to provide clean needles which will find 
their way into the alleys and playgrounds and streets of American 
cities discarded by irresponsible IV drug users. And people who run the 
programs now that are privately funded or otherwise locally funded say 
that the 50 percent return is all you can expect.
  Teen drug use is up 105 percent from 1992 to 1995. The Office of the 
National Drug Control Policy, led by America's Drug Czar, General Barry 
McCaffrey, strongly opposes the needle exchange program.
  On August 20, the Office of National Drug Control Policy issued a 
statement: ``Federal treatment funds should not be diverted to short-
term harm reduction efforts like needle exchange programs.''
  We are told by those who keep statistics on drugs that more teenagers 
and young adults tried heroin for the first time in 1996 than ever 
before. Imagine what would be the case if it had the endorsement of the 
Federal Government.
  Speaking in front of a Harvard research conference, General McCaffrey 
called spending money on the needle exchange program a ``copout.'' He 
said, ``The problem isn't dirty needles. It is the injection of illegal 
drugs.''
  His statement, I believe, is the policy that is appropriate.
  Here is a story from the Buffalo News, August 24, 1997 ``Accepting 
Defeat.''

       The needle exchange is one of the few places where addicts 
     aren't treated like losers, although that is how many view 
     themselves. ``There is no more shame in me,'' said a 36-year 
     old woman from the Buffalo who has been shooting up for 15 
     years. The woman, who asked not to be identified, has lived 
     in heroin shooting galleries, and worked as a prostitute to 
     support her addiction that costs more than $100 a day. She 
     wears her terrible life on a racked, puffy face. To prevent 
     three of her children from being placed in foster care, she 
     sent them away years ago to live with a sister in North 
     Carolina. But she can't stop thinking of them. She has 
     attached to her blouse a section of an old rosary that 
     belonged to her daughter's godmother. Next to it is a piece 
     of jewelry she found, a gold heart surrounded by the words 
     ``Perfect Mom.'' ``I pray a lot despite the life I lead,'' 
     she said. ``I know it sounds farfetched. It helps me think 
     that maybe there is a chance I can have my children back.''

  The Buffalo News talked about the two sites which together have 
distributed 713,000 hypodermics in less than 4 years. They have also 
taken in about 600,000 needles, not in the exchange program 
necessarily, many of which would have littered the city neighborhoods 
in the exchange program.
  Needle exchange programs are not always as effective as their 
advocats suggest to the public. Connecticut has six needle exchange 
programs, and repealed its syringe prescription law in

[[Page S497]]

1992. It has intravenous drug use related AIDS at 61 percent. This is 
almost double the national average.
  New York has 10 needle exchange programs, but has intravenous drug 
use related AIDS at 49 percent. It is also a lot higher than the 
national average of 33 percent.
  Italy and Spain have a 70-percent HIV rate among IV drug users, and 
have never had a restriction on the sale of needles. So they are freely 
available there. It is pretty clear, at least, I think from looking at 
the data, that there is no conclusive evidence that making needles 
available and providing them freely reduces the HIV infection rate. 
Embracing the harm reduction--defeatist--philosophy to any degree will 
lead to further tolerance of drug addiction.

  The so-called ``syringe experiment'' I think we have all heard about. 
First, they started a needle exchange program. Then they opened the 
needle park so that they could give addicts a place to shoot up. 
Obviously, it is a park in which they just allow drug use. Then, in 
order to cut down on crime, they began giving 1,000 addicts doses of 
heroin. And that will increase to 5,000 this year. This is an effort, a 
growing momentum, to legalize all drugs.
  It is a question of whether or not we as a culture want to say that 
we accept drug use as a way of life, or whether we want to say we want 
to correct this problem in America.
  I believe that we ought to stay with General McCaffrey; that the 
problem is not dirty needles. ``The problem is heroin addiction. The 
focus should be on bringing help to this suffering population--not to 
give them more effective means to continue their addiction. One doesn't 
want to facilitate this dreadful scourge on mankind.''
  How does this relate to the nomination of Dr. David Satcher? 
Unfortunately it relates directly. Dr. Satcher has been less than 
candid with the U.S. Senate, and has been less than candid with Members 
of this Senate in providing his record on the needle exchange programs. 
The Centers for Disease Control, under his direction and authority, 
selectively has provided to the Senate materials which would indicate 
that he does not have a program supporting needle exchange when a more 
thorough review of the Record indicates that he has personally endorsed 
programs that would promote needle exchange opportunities.
  It is troublesome to me why this nominee would provide information on 
a selective basis.
  It is, second, troublesome to me that he would support a clean 
needles program.
  And, third, I would say that the single most important thing that 
must exist between the Nation and its family doctor is the idea of 
trust. I believe that the elements of that required trust are lacking 
in the way that the CDC has provided information, and its selective 
provision of information and its withholding of information that is 
important.
  The needle exchange program is just one of the reasons that I believe 
this nomination should not go forward. The needle exchange program 
flies in the face of the values of the American people whom I believe 
really endorse General Barry McCaffrey--understanding that the 
addiction is the problem, and for us to support that addiction with a 
clean needle program would make no sense.
  For these and the reasons relating to the AIDS studies, for the 
reasons related to the deployment of the resources of the Centers for 
Disease Control to limit the availability of or access of citizens to 
their second amendment rights, I believe we should reject this 
candidate.
  I was, I think, safely in the population of the Senate believing that 
there were no problems with an individual whose record is so replete 
with qualification and qualification at one time. It is true that Dr. 
Satcher is a remarkable person, and he has done great things. I thought 
that one of the Senators failed to mention that the Denver Broncos had 
won the Super Bowl for the first time under Dr. Satcher's direction of 
the CDC. But that is about the only good thing that hasn't flowed.
  But the truth of the matter is that there are other important 
considerations. David Keene came to my office late last year and began 
to alert me to the need for us to look more carefully at this 
candidacy, and to see the critical points of attention between the 
values of America and the willingness of this candidate to support 
things like the needle exchange, and to support things like research on 
other continents that could not be done here to support concepts like 
partial-birth abortion. While all of these things are related to 
science and can be undertaken by individuals of great intellect and may 
only be undertaken by individuals of great intellect and training, they 
are at odds with the values of America. There should be an 
understanding that Americans do not want to sponsor the criminal 
activity of intravenous drug use, that Americans do not want to treat 
people on the other side of the world as medical experiment subjects 
instead of as human beings. They don't want to give them sugar pills if 
giving sugar pills would be illegal in the United States. They don't 
want to pretend that we have been ethical by saying that we got the 
consent of all the people involved in the medical studies when those 
consents were not only seriously challenged--but had to be 
strengthened--on the advise of ethics boards because the consents were 
not appropriately obtained.

  This conflict of values is at the heart of this nomination. I believe 
the conflict is so substantial that we would be well served to ask the 
President to send us an individual whose commitment to the public 
health reflected the values of the American people.
  I take this opportunity to thank Mr. Keene who came to see me and who 
brought to my attention the need for this particular kind of 
investigation, which I believe demonstrates that this nomination should 
not be confirmed by the Senate.
  Mr. KENNEDY. Madam President, the Senator from Missouri asserted that 
the CDC funded an Illinois needle exchange conference ``Getting the 
Point.'' The H.H.S. informs us that the CDC did not cosponsor that 
conference.
  The Center's for Disease Control do not fund ``needle exchange 
conferences.'' CDC does make a number of small grants to local 
organizations to support HIV-AIDS prevention conferences, and awarded 
approximately $600,000 to 65 projects last year. The conferences can 
include such topics as community planning; HIV testing; counseling; 
referral and partnership notification; health education and risk 
reduction; public information programs; and training and quality 
insurance programs. The content of the conferences is determined 
locally, according to the needs of the community. However, CDC reserves 
the right to review the conference agenda.
  The only documents CDC located that were determined to be at all 
responsive to Senator Ashcroft's request on needle exchanges were 
documents related to an HIV conference in Denver, Colorado. After 
reviewing the agenda, which focused on the transmission of HIV through 
drug use and included sessions on needle exchange, CDC found it 
inappropriate for funding. CDC withdrew its award of $4,719 to the 
conference in October 1997.
  In March of 1996, CDC was incorrectly listed as a cosponsor of a 
conference held in Atlanta which included sessions on needle exchange. 
CDC did not fund the conference, which was held at the Rollins School 
of Public Health at Emory University, and Dr. Satcher did not 
participate in it. A CDC scientist participated in the conference to 
discuss the HIV epidemic among intravenous drug abusers. The scientist 
was unaware that Dr. Satcher had declined to participate in or sponsor 
the conference. Following the conference, one of the participating 
organizations released information listing CDC as a cosponsor. When the 
error was discovered the organization withdrew the materials.
  Dr. Satcher is opposed to illegal drug use, and would never do 
anything to encourage the use of illegal drugs. He agrees with the 
Administration's position. While the studies summarized in Secretary 
Shalala's February, 1997 report showed that needle exchange programs 
can be an effective HIV prevention strategy, the Administration has not 
yet found a similar degree of evidence on the question of whether such 
programs encourage drug use. Therefore, both tests--as mandated by 
Congress--have not been met.
  Senator Ashcroft has charged that HHS inappropriately withheld a copy

[[Page S498]]

of an intra-departmental transmittal memo when it supplied Senator 
Ashcroft with information concerning CDC's staff review of a University 
of California Needle Exchange study.
  The truth is that Senator Ashcroft received everything he requested 
from HHS less than 24 hours after his request was first sent to HHS by 
Majority Leader Lott's staff. Senator Ashcroft's request included ``The 
CDC's 1993 and 1994 written reviews of the California Study'', which he 
received with all the other materials.
  The transmittal memo in question, which was prepared subsequent to 
the CDC staff review as a cover note to a non-CDC official, was 
supplied to Senator Ashcroft several hours later when HHS realized that 
his staff was interested in additional material beyond his original 
request.
  The charge that this transmittal memo was inappropriately withheld is 
untrue. The memo is an innocuous six sentence cover note to the Deputy 
Assistant Secretary for Health that summarizes the subject of the CDC 
needle exchange staff review and indicates that it was reviewed for 
scientific comment by staff of other HHS health agencies.
  If anything, the memo indicates how little Dr. Satcher and other top 
HHS public health officials were involved in the CDC staff review of 
the needle exchange study. In the memo, Dr. Satcher states that 
``Directors of these [public health] agencies have not been asked for 
final concurrence on the review.''
  It is also important to remember that the CDC review of the 
University of California needle exchange study was a scientific 
evaluation prepared by CDC career staff. Most of the work was completed 
before Dr. Satcher joined CDC on November 15, 1993. And as Dr. 
Satcher's cover note indicates, it was not intended to represent the 
views of the leaders of the HHS public health agencies.
  I ask unanimous consent that the full text of the transmittal letter 
be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                          Department of Health and


                                               Human Services,

                                                December 10, 1993.
     Note to Jo Ivey Boufford
     Subject: Review of University of California Report on Needle 
       Exchange and Recommendations on Needle Exchange

       On October 15 you requested that the Centers for Disease 
     Control and Prevention (CDC) review the University of 
     California research report on needle exchange and provide 
     opinions and recommendations for Federal action in response 
     to needle exchange.
       The UC report and recommendations were reviewed by CDC 
     staff. CDC also requested and received comments on the UC 
     report and recommendations for needle exchange from the 
     National Institutes of Health, the Substance Abuse Mental 
     Health Services Administration, the Health Services and 
     Resources Administration, and the Food and Drug 
     Administration. The comments attached to the review were 
     provided by the Principal AIDS Coordinators of the four 
     agencies. Directors of these agencies have not been asked for 
     final concurrence on the review.
       I am pleased to submit the attached review (Tab A).
                                                     ------ ------
                                              (For David Satcher.)
       Attachment
       Tab A--Review of University of California Report on Needle 
     Exchange and Recommendations on Needle Exchange
       Tab B--NIDA/NIH Comments on the University of California 
     Report on Needle Exchange and Recommendations on Needle 
     Exchange

  Mr. KENNEDY. The subject of that transmittal was a University of 
California needle exchange study, commissioned in 1992 by the Bush 
Administration. The goal was to provide a scientific evaluation of 
local needle exchange programs.
  Senator Ashcroft has requested and received a review of the 
University of California study prepared by CDC scientific staff. The 
CDC review was conducted by career CDC scientists and the bulk of the 
review was done before Dr. David Satcher joined CDC.
  The CDC staff analysis was not intended to reflect scientific 
consensus within the Department of Health and Human Services, which 
must include the National Institutes of Health, the Substance Abuse and 
Mental Health Services Administration, the Health Resources and 
Services Administration and the Food and Drug Administration.
  While scientific review of needle exchange issues continues, HHS has 
not yet concluded that the conditions set forth by Congress on federal 
funding of needle exchange programs have been met.
  Dr. Satcher has never advocated taxpayer funded needle exchange 
programs for drug abusers. He also believes strongly that we should 
never do anything to advocate the use of illegal drugs. The intravenous 
use of illegal drugs is wrong. It is a major public health problem as 
well as a law enforcement concern.
  Dr. Satcher does believe that to realize our goals of effective HIV 
prevention, it is vital that we identify and evaluate sound public 
health strategies to address the epidemic of HIV and substance abuse.
  Dr. Satcher, like Secretary Shalala, has recommended to Congress that 
we allow scientific studies to answer the key questions involved with 
this issue.
  Dr. Satcher supports the Administration's position as summarized in 
Secretary Shalala's February 1997 report to Congress that concluded 
that needle exchange programs ``can be an effective component of a 
comprehensive strategy to prevent HIV and other blood borne infectious 
diseases in communities that choose to include them.'' But, the 
Department has not yet concluded that the conditions set forth by 
Congress on federal funding of needle exchange program have been met. 
Specifically, it has not yet been concluded that needle exchange 
programs do not encourage drug use, one of the key standards set by 
Congress. The Department continues to look at the science on this 
issue.
  The federal government continues to fund the research and evaluation 
of state and locally funded needle exchange programs in order to 
increase scientific knowledge concerning their impact, if any, on drug 
use. But at present, this is, and should be, a local decision. Under 
current law and policy, local communities remain free to use non-
federal funds to support such programs if they choose.
  Madam President, earlier today, the Senator from Missouri and I had a 
colloquy about surveys of child-bearing women for HIV.
  The surveys began in 1988 and the State of Missouri requested to 
participate in them from the beginning, including while Senator 
Ashcroft was Governor, the director of the division of administration 
signed on behalf of Missouri.
  I ask unanimous consent that two applications on behalf of the State 
of Missouri be printed in the Record at this point.
  There being no objection, the applications were ordered to be printed 
in the Record, as follows:

                   APPLICATION FOR FEDERAL ASSISTANCE

       1. Type of Submission:
       Application:
       [ ] Construction
       [X] Non-Construction
       Preapplication:
       [ ] Construction
       [ ] Non-Construction
       2. Date Submitted: 9/3/91.
       Applicant identifier: U62/CCU706241-01.
       3. Date Received by State:
       State Application identifier:
       4. Date Received by Federal Agency:
       Federal identifier: U62/CCU706241-02.
       5. Applicant Information:
       Legal Name: Missouri Department of Health.
       Address (give city, county, state, and zip code): 1730 E. 
     Elm, P.O. Box 570, Jefferson City, MO 65102.
       Organizational Unit: Bureau of AIDS Prevention.
       Name and telephone number of the person to be contacted on 
     matters involving this application (give area code): Theodore 
     D. Northup, Chief, Bureau of AIDS Prevention, (314) 751-6438.
       6. Employer Identification Number (EIN): 44-6000987.
       7. Type of Applicant: (enter appropriate letter in box) [A]
       A State
       B County
       C Municipal
       D Township
       E Interstate
       F Intermunicipal
       G Special District
       H Independent School Dist.
       I State Controlled Institution of Higher Learning
       J Private University
       K Indian Tribe
       L Individual
       M Profit Organization
       N Other (Specify) __________
       8. Type of Application:
       [ ] New
       [X] Continuation
       [ ] Revision

[[Page S499]]

       If Revision, enter Appropriate Letter(s) in box(es) [ ] [ ]
       A Increase Award
       B Decrease Award
       C Increase Duration
       D Decrease Duration
       Other (specify) __________
       9. Name of Federal Agency. Centers for Disease Control.
       10. Catalog of Federal Domestic Assistance Number: 13-118.
       Title: HIV/AIDS Surveillance Announcement #103.
       11. Descriptive Title of Applicant's Project: FY 1992--
     Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency 
     Syndrome (AIDS) Surveillance.
       12. Areas Affected by Project (Cities counties, states, 
     etc.): Statewide.
       13. Proposed Project:
       Start Date: 1/1/92.
       Ending Date: 12/31/92.
       14. Congressional Districts of:
       a. Applicant: Fourth.
       b. Project: Statewide.
       15. Estimated Funding:
       a. Federal: $1,367,876.00.
       b. Applicant:
       c. State:
       d. Local
       e. Other:
       f. Program Income:
       g. Total: $1,367,876.00.
       16. Is Application Subject to Review by State Executive 
     Order 12372 Process?
       a. Yes, this preapplication/application was made available 
     to the state executive order 12372 process for review on 
     (date) 9/3/91.
       b. No [ ] Program is not covered by E.O. 12372.
       [ ] or program has not been selected by state for review.
       17. Is the applicant delinquent on any federal debt?
       [ ] Yes. If ``Yes.'' attach an explanation.
       [X] No.
       18. To the best of my knowledge and belief all data in this 
     application/preapplication are true and correct. The document 
     has been duly authorized by the governing body of the 
     applicant and the applicant will comply with the attached 
     assurances if the assistance is awarded.
       a. Typed Name of Authorized Representative: John R. Bagby.
       b. Title: Director.
       c. Telephone number: (314) 751-6002.
       d. Signature of Authorized Representative: H. Douglas 
     Adams, Director of Administration, Missouri Department of 
     Health.
       e. Date Signed: 9/3/91.
                                                                    ____


                   APPLICATION FOR FEDERAL ASSISTANCE

       1. Type of Submission:
       Application:
       [ ] Construction
       [X] Non-Construction
       Preapplication:
       [ ] Construction
       [ ] Non-Construction
       2. Date Submitted: 9/14/90.
       Applicant identifier: U62/CCU702028-06.
       3. Date Received by State:
       State Application identifier:
       4. Date Received by Federal Agency: 9/17/90.
       Federal identifier: U62/CCU706241-01.
       5. Applicant Information:
       Legal Name: Missouri Department of Health.
       Address (give city, county, state, and zip code): 1730 E. 
     Elm, P.O. Box 570, Jefferson City, MO 65102.
       Organizational Unit: Bureau of AIDS Prevention.
       Name and telephone number of the person to be contacted on 
     matters involving this application (give area code): Todd 
     Baumgartner, Bureau of AIDS Prevention, (314) 751-6438.
       6. Employer Identification Number (EIN): 44-6000987.
       7. Type of Applicant: (enter appropriate letter in box) [A]
       A State
       B County
       C Municipal
       D Township
       E Interstate
       F Intermunicipal
       G Special District
       H Independent School Dist.
       I State Controlled Institution of Higher Learning
       J Private University
       K Indian Tribe
       L Individual
       M Profit Organization
       N Other (Specify) __________
       8. Type of Application:
       [ ] New
       [X] Continuation
       [ ] Revision
       If Revision, enter Appropriate Letter(s) in box(es) [ ] [ ]
       A Increase Award
       B Decrease Award
       C Increase Duration
       D Decrease Duration
       Other (specify) __________
       9. Name of Federal Agency. Centers for Disease Control.
       10. Catalog of Federal Domestic Assistance Number: 13-118.
       Title: HIV/AIDS Surveillance Announcement #103.
       11. Descriptive Title of Applicant's Project: FY 1992--
     Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency 
     Syndrome (AIDS) Surveillance.
       12. Areas Affected by Project (Cities counties, states, 
     etc.): Statewide.
       13. Proposed Project:
       Start Date: 1/1/91.
       Ending Date: 12/31/91.
       14. Congressional Districts of:
       a. Applicant: Eighth.
       b. Project: Statewide.
       15. Estimated Funding:
       a. Federal: $1,312,383.00.
       b. Applicant:
       c. State:
       d. Local
       e. Other:
       f. Program Income:
       g. Total: $1,312,383.00.
       16. Is Application Subject to Review by State Executive 
     Order 12372 Process?
       a. Yes, this preapplication/application was made available 
     to the state executive order 12372 process for review on 
     (date) 9/3/91.
       b. No [ ] Program is not covered by E.O. 12372.
       [ ] or program has not been selected by state for review.
       17. Is the applicant delinquent on any federal debt?
       [ ] Yes. If ``Yes.'' attach an explanation.
       [X] No.
       18. To the best of my knowledge and belief all data in this 
     application/preapplication are true and correct. The document 
     has been duly authorized by the governing body of the 
     applicant and the applicant will comply with the attached 
     assurances if the assistance is awarded.
       a. Typed Name of Authorized Representative: John R. Bagby.
       b. Title: Director.
       c. Telephone number: (314) 751-6002.
       d. Signature of Authorized Representative: H. Douglas 
     Adams, Director of Administration, Missouri Department of 
     Health.
       e. Date Signed: 9/14/90.

  Mr. KENNEDY. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ASHCROFT. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ASHCROFT. Madam President, I ask unanimous consent that for any 
quorum call made, time be reduced on the different sides in the debate 
equally.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ASHCROFT. Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. CHAFEE. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CHAFEE. Madam President, last week I put into the Record a 
statement expressing my support for the nomination of Dr. David Satcher 
for U.S. Surgeon General and Assistant Secretary for Health. As I 
indicated then, I believe in his qualifications and achievements, and 
think he would serve well as the Nation's top physician. Dr. Satcher 
has excelled in many aspects of the health care system. He has been a 
provider, a scientist, a teacher, an administrator, in both the private 
and the public sector.
  I must say I was impressed that the American College of Physicians, 
which is a very prestigious organization, awarded Dr. Satcher its James 
D. Bruce Memorial Award for distinguished contributions in preventive 
medicine. Dr. Satcher has dedicated his career to improving public 
health.
  The United States has been without a Surgeon General for a little 
over 3 years. This is unfortunate, I believe. Just last week, Dr. C. 
Everett Koop, former Surgeon General of the United States, spoke at a 
press conference which I had the privilege of attending. In that press 
conference Dr. Koop spoke forcefully about the grave health risks posed 
by tobacco use, lack of exercise, and poor diet. He did not pull any 
punches. He gave a stern lecture to all those who were present and 
hopefully beyond that, about the dangers in America to American young 
people and to all our citizens from the so-called couch potato 
lifestyle.
  I have reviewed the statements that Dr. Satcher has made before the 
Senate Labor Committee and he is clearly anxious to follow in the 
footsteps of Dr. Koop and his successor, Antonia Novello. At his 
confirmation hearing Dr. Satcher stressed the importance of disease 
prevention and health promotion. This is what he said: ``Whether we are 
talking about smoking or poor diets, I want to send the message of good 
health to the American people.''

[[Page S500]]

So I was delighted to learn that one of his top priorities would be to 
put the health of our children and our grandchildren in the national 
spotlight. All of these matters fall directly within the job 
description of a U.S. Surgeon General.
  I might say, it seems to me what we are concerned with, Madam 
President, is not just extending the life expectancy of Americans. It 
is beyond that. We want to have Americans in good health as they 
proceed in their elder years, and throughout all their lives. In other 
words, it's what they call the quality of their lives that we are 
concerned with. It is not just living longer, it's that they be healthy 
and be able to construct a healthy life and a happy one, where they 
feel good about themselves.
  In the period we have gone without a Surgeon General, we have been 
confronted with a host of tough public health issues. I believe the 
need for a Surgeon General has never been greater. We have these 
problems in my home State of a very substantial percentage, something 
like 27 percent, of our seniors in high school smoke. This is on the 
increase, not just in my State but throughout the Nation. We have seen 
widespread substance abuse, and continued struggle with AIDS, and a 
startling rate of obesity amongst our youngsters. They just don't get 
out there and exercise.
  As we consider the potential consequences of human cloning research, 
I for one would benefit from the perspective that a Surgeon General 
would bring to this issue
  Several of my colleagues have expressed misgivings about this 
nomination. Some have raised concerns about Dr. Satcher's views on 
late-term abortions. Others have questioned his role in a series of AZT 
trials that have been conducted in Africa.
  I just heard the distinguished Senator from Missouri talk about 
concerns about the free needle exchange, or needle exchange program. As 
Senator Jeffords, the chairman of the Labor Committee, and Senator 
Frist, the chairman of the Public Health and Safety Subcommittee, 
stated during the debate on the nomination last week, these are not new 
charges. I am not familiar with the needle exchange that was just being 
discussed here before, but apparently the AZT trials and the late-term 
abortion matters were thoroughly discussed in the committee and 
subcommittee. Each of these issues was raised by the committee during 
Dr. Satcher's confirmation and it is my understanding he responded 
satisfactorily--satisfactorily to the committee. They reported out the 
nomination. Indeed, his answers on those and other matters have been 
available for all Senators and the American people to view.

  So I want to say I am pleased that we have the nomination for a new 
Surgeon General before us. I applaud the majority leader for 
recognizing the importance of this post and moving the Senate forward 
on this matter.
  So I urge my colleagues to join me in voting for cloture and in favor 
of Dr. Satcher's nomination.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. DOMENICI. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DOMENICI. Madam President, I am slightly late but is it fair to 
assume that I have 15 minutes?
  The PRESIDING OFFICER. Under the previous order, the Senator is 
recognized for 15 minutes.
  Mr. DOMENICI. If Senator Bingaman arrives I will yield time to him. 
If he does not, I will speak on my own for the 15 minutes.
  The PRESIDING OFFICER. The Senator is recognized.
  Mr. DOMENICI. Madam President, I rise today to support Dr. David 
Satcher to be Surgeon General of the United States and Assistant 
Secretary for Health at the Department of Health and Human Services. 
Let me first say I base this on many things, but I would like to tell 
the Senate right up front that we have a wonderful doctor who is a 
United States Senator, Dr. Bill Frist from the State of Tennessee. 
While I am not saying that he knows everything about medicine, he knows 
a lot more than I do. We have talked at length about this nominee and 
he not only knows him, but he knows of him in ways that I probably 
would not discern from just reading the same things that my friend 
Senator Frist has read. Because he reads into some of these past 
performances and past professorships and various things that Dr. 
Satcher has done--he reads much more into them than I can because he 
knows what they are all about.
  Suffice it to say that no Senator should rely on another Senator as 
the only source of why he votes one way or another, but I would like to 
say right up front that I started with at least a presumption on my 
part that I would find out a little more and read what I could on my 
own in addition to receiving some excellent advice.
  On my own, beyond that, I have looked at his career and, frankly, I 
think the President has picked a very, very distinguished American 
doctor. He has been a rather reputable scholar, a rather renowned 
teacher, and obviously a very good physician. In addition to that, he 
has obviously done considerable research and already in his career has 
been the head of one of America's premier institutions that pertain to 
preventive medicine and well-being, the Centers for Disease Control and 
Prevention.
  I have recently been fortunate, in turning the channels as I do with 
the flipper on cable TV, to see a rather exciting report on how great 
the Centers for Disease Control are. And then I have been reading about 
some new breakthroughs they are constantly making, and some of the work 
they do, to catch viruses and learn about them before they strike. I 
think it is a pretty good qualification to say that this nominee headed 
that organization during a period of time that it gained in renown and 
prestige, and clearly I think that is another significant plus for this 
nominee.
  From my own standpoint, some may know that I, over the last few 
years, have added a significant concern regarding a certain illness to 
the arena that I worry about. That has to do with diabetes, in this 
case because in my home State the Navajo Indian people and a couple of 
other tribes of Indian people are suffering from diabetes at rates and 
ratios well beyond any other group of American citizens; not just a 
little bit more, but way, way more to the point of being significantly 
in trouble. And I actually believe that if we don't do something about 
the problem, there are a couple of great groups of Indian people that 
may not be around in 50 to 100 years. That worries me very much.

  I am very grateful that this good doctor and others helped work on 
the diabetes issue with Secretary Shalala and others, and our good 
friend Newt Gingrich from the House, and in the last reconciliation 
bill, the Balanced Budget Act, we put in $150 million over the next 5 
years for enhanced research in diabetes in America and, believe it or 
not, we put in $150 million, $30 million a year, for special attention 
to this disease among the Indian people.
  I happened to talk to Dr. Satcher at length about that. While I 
assume most doctors can talk about diabetes in a very understandable 
way, steeped in facts, there is no question that he knew precisely what 
we were talking about. For that I give him another accolade.
  So, I intend, when it is right, to vote in favor of this nominee.
  Madam President, I ask unanimous consent I be permitted to speak on a 
subject that is not on the floor of the Senate.
  The PRESIDING OFFICER. Without objection.
  Mr. DOMENICI. I believe I have some time left. How much time do I 
have left?
  The PRESIDING OFFICER. The Senator has 12 minutes remaining and may 
proceed.

                          ____________________