[Congressional Record Volume 144, Number 8 (Monday, February 9, 1998)]
[Senate]
[Pages S509-S511]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           EXECUTIVE SESSION

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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 Senate continued with the consideration of the nomination.
  Mr. McCAIN. Mr. President, I wish to speak briefly about the 
nomination of Dr. William Satcher to become the United States Surgeon 
General and Assistant Secretary of Health and Human Services.
  I have been closely following the Senate debate regarding Dr. 
Satcher's nomination and his qualifications to serve as the next 
Surgeon General and Assistant Secretary of Health and Human Services. 
In particular, I found his views regarding partial birth abortion and 
his role in clinical AZT trials to treat patients infected with HIV in 
Africa and Southeast Asia disturbing.
  While Dr. Satcher initially expressed his opposition to partial birth 
abortions, he also stated that he shares President Clinton's view that 
a ban on this procedure should include an exception for cases in which 
the procedure might be needed to protect the health of a pregnant 
woman. This raises serious concerns for me, since I am adamantly 
opposed to partial birth abortions except to save the life of a woman. 
This is a procedure which is inhumane and offensive to anyone who 
values human life. No matter what a person believes regarding the 
legalization of abortion, we should all be appalled and outraged by the 
practice of partial birth abortions.
  Since these concerns were raised, however, Dr. Satcher has provided 
written assurances regarding his intentions if nominated. Dr. Satcher 
wrote, ``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.'' Dr. Satcher also wrote that he would promote a message of 
abstinence from premarital sex and behavioral responsibility to our 
youth. This is a commendable objective that should be promoted among 
our nation's youth.

[[Page S510]]

  The other major concern raised for me was Dr. Satcher's role in 
clinical trials of AZT conducted in Africa and Southeast Asia. In 1994, 
the World Health Organization (WHO) recommended that studies be 
conducted to test the safety and efficacy of short-term AZT therapy in 
developing countries in reducing the transmission of HIV from pregnant 
women to their babies. This study was needed because 1,000 babies are 
born every day infected with HIV in developing nations. This study was 
intended to determine an effective and affordable treatment for women 
in the nations that can not afford the expensive AZT and are unable to 
receive intravenous treatments. The developing nations, in conjunction 
with the WHO, determined that placebo controlled trials offered the 
best method for determining an alternative to the expensive and 
culturally incompatible AZT drug treatment.
  After reviewing the available materials on these studies and 
conferring with Senator Frist, who is a practicing medical physician 
and has extensive knowledge and experience with the complex issue of 
biomedical ethics, I am confidant that these AZT trials were conducted 
in a scientifically sound and ethical manner. It is my understanding 
that the appropriate protocols for these clinical trials were developed 
and extensively reviewed for scientific and ethical integrity by 
Institutional Review Boards in the United States and by equivalent 
committees in the counties conducting the clinical trials. According to 
these medical standards, it is clear that the CDC's decision, under the 
guidance of Dr. Satcher, regarding the AZT trials researching methods 
for providing functional, affordable and effective care to people 
worldwide was based on sound ethics and science.
  Mr. President, I believe that the individual who fills the position 
of Surgeon General must be a person who unites our nation and promotes 
healthy living. This individual must place the health and well-being of 
our nation's citizens far above any political agenda. They must provide 
leadership in disease prevention and health promotion throughout our 
country by developing innovative and worthwhile public health 
initiatives. In short, our nation's Surgeon General must be capable of 
serving as a national symbol of commitment to protecting and improving 
the public's health.
  After carefully reviewing all the facts surrounding Dr. Satcher's 
professional career and consulting with members of the medical 
community, including our colleague, Senator Frist, I am confident that 
Dr. Satcher is well-qualified to serve this nation in these important 
public health positions. It is my belief that the concerns raised about 
Dr. Satcher have been adequately and openly addressed. I believe that 
he has continually demonstrated his commitment to public health 
throughout his life and is ready and willing to continue these efforts 
as Surgeon General and Assistant Secretary of Health and Human 
Services. Therefore, I am confident that when Dr. Satcher is confirmed 
as the next U.S. Surgeon General and Assistant Secretary of Health and 
Human Services, he will serve the health needs of our nation and I will 
support his efforts.
  Mr. ASHCROFT. Mr. President, I rise to speak in opposition to the 
confirmation of the nominee for Surgeon General of the United States, 
David Satcher, and I allocate myself such time as I may consume in 
opposition.
  Mr. President, we have had extended debate on this nomination. It is 
conceded by individuals from every quarter that the nominee is a person 
of great talent, of substantial intellectual capacity, and who has made 
a substantial contribution to the medical community. The reservations 
which I have expressed in no way are designed to derogate the record of 
achievement that this medical doctor has assembled. But there are a 
series of concerns which I have raised, some of which are so serious 
that I believe they would cause us to refrain from voting to confirm 
this nominee to lead us as America's family doctor.
  I would like to just mention four of them, as I conclude my remarks 
today. As is contained in the unanimous consent order, there will be 
another hour of debate on this issue tomorrow prior to the vote on 
cloture, and in the event cloture is invoked, there will be a vote on 
final passage immediately thereafter.
  These four points, though, I would like to raise, and I believe each 
of these would be adequate or sufficient as a basis for denying 
confirmation here. But certainly the cumulative impact of these 
particular concerns should weigh heavily on the minds of Senators as we 
move toward the votes related to the confirmation of this nominee. And 
in my case they clearly indicate that we should not vote in favor of 
this confirmation.
  The first is this. This is a nominee who favors partial-birth 
abortion. Partial-birth abortion is a procedure that has been 
demonstrated to be a cruel, inhumane, unnecessary procedure. The 
American Medical Association opposes it. Three-quarters of the American 
people oppose it, especially those who understand what it is. And for 
this nominee to side with the political agenda of the President rather 
than the health agenda of the United States of America indicates, I 
think all too clearly, that the agenda will be politics rather than 
health. We ought to have a Surgeon General who has a health agenda and 
does not repair to the politics of the President or anyone else.
  Next, during the time when this nominee presided over the Centers for 
Disease Control, he and the Centers for Disease Control sponsored 
studies in Africa regarding the transmission of AIDS from HIV infected 
mothers to their children.
  Rather than implement an ethical strategy for that research that was 
consistent with the ethics in the United States, they conducted the 
tests by giving half of the individuals in the study sugar pills or 
placebos, when there was a known, effective treatment. This was such a 
breach of the ethics of the medical profession in testing that the New 
England Journal of Medicine, the No. 1 medical journal in the United 
States of America, very seriously and aggressively cited this ethical 
lapse and said that these studies were unethical and should be 
discontinued on that basis.
  The truth of the matter is, the studies go forward. There are a lot 
of reasons that have been put forth in this debate about why they have 
gone forward. Some have talked about informed consent. It is clear the 
level of informed consent there would never pass muster here.
  What is clear to me is this nominee views lives differently in Africa 
than he could be allowed to view them in the United States. This 
nominee views lives differently before they are born, in the partial-
birth abortion arena, than I think the American people do.
  Next, there were CDC studies on HIV-infected newborns in this 
country. No identification was made of the newborns. The studies were 
conducted after the blood samples were de-identified. This may have 
been an appropriate strategy before we knew that we could help a 
newborn that tested positive for HIV. But once we developed a potential 
therapy, to persist with the studies in the absence of identification 
of the infected newborn and notification to the parent so that remedial 
action could be taken, it seems to me a tremendous moral lapse, and it 
was characterized by one of the most notable AIDS researchers in the 
world as a breach of the ethics not only of the United States, but 
international ethics.
  When the Congress got upset about this and sought to ask Dr. Satcher 
and the CDC to cease these tests where you learned about the fact that 
there were X number of HIV-infected babies but you couldn't identify 
them, and therefore, you weren't able to tell the parents, what did Dr. 
Satcher do? He came to the Hill to lobby Congress that we should keep 
doing that, in spite of the fact that we had the ability, once we 
learned about the HIV virus, to be able to curtail it with the therapy, 
with the administration of drugs and other things. I think that 
compounds the ethical problems that were identified in the Africa 
studies, and it compounds the ethical problems that relate to the 
disregard for human existence that characterizes his embrace of the 
President's position on partial-birth abortion.
  The last item which was the subject of significant debate today was 
the needle exchange program. While Dr. Satcher has indicated that he 
doesn't support needle exchange programs, the

[[Page S511]]

documents that have only recently been released by the Centers for 
Disease Control find him in endorsement of needle exchange programs, 
and urging that there be large amounts of Federal money to support 
needle exchange programs.
  I don't believe that we need a family doctor for America who says we 
ought to subsidize the drug culture by providing free needles, by 
saying to the drug dealers, you can get all the needles you want, and 
when you want to go and tell our young people that they should get 
involved in your drug culture, you can have the authority of the 
Government with you to say it must be OK; surely, the Government 
wouldn't provide us with these free, clean, sterile needles to use in 
shooting up drugs if it weren't in your best interest.
  I think that sends the worst message possible to young people that 
the Government is a subsidizer of and a promoter of an environment in 
which drugs can be used with lowered risk.
  My own sense is that it makes no more sense to provide clean needles 
to drug dealers than it would be to provide bulletproof vests to bank 
robbers. We could surely make bank robbing a safer occupation by 
providing bulletproof vests, but we wouldn't want to do it. Neither 
should we make intravenous drug use a sort of project of the Government 
because we might be able to provide some safety to some user.

  I won't go into the details; we have already done that. We already 
know that people who don't care enough about themselves to use good 
needles or clean needles in drug use won't take care of the needles 
once they have used them. One town found over 300 needles in the course 
of 1 week after a privately funded clean-needle program was implemented 
there. I don't think we want our playgrounds and our streets and our 
cities to be littered with once-used free needles supplied by the 
Government that could later infect our children.
  All of these things that relate to a disregard for the right health 
strategy for America are disqualifying events for this candidate: 
partial-birth abortion, the African AIDS studies, the domestic blind 
HIV tests on newborns, where we persisted in this practice even after 
we discovered an effective therapy for these infants, and last but not 
least, the clean-needle exchange program, which basically wants to 
accept drug culture as a way of life instead of calling America to its 
highest and best and saying that the real problem is heroin, the real 
problem is drug addiction, the real problem is not the absence of a 
needle program funded by the taxpayers. The taxpayers do not want us to 
destroy their neighborhoods by subsidizing drug dealers who will not 
only use the clean needles, but leave them in places where they can 
infect the children of America.
  For those reasons, I believe it would be appropriate for us to reject 
the nomination of Dr. David Satcher to be Surgeon General. We do need a 
Surgeon General, but we don't need one so badly that we need to welcome 
one who doesn't really call us to the highest and best health that 
America ought to have.
  Mr. President, I thank you very much for the opportunity to make 
these concluding remarks. With that, I yield back the remainder of my 
time on today's debate, reserving, obviously, the time to be a 
participant in the debate tomorrow on this issue. I suggest the absence 
of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. NICKLES. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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