Congressional Record, Volume 144 Issue 9 (Tuesday, February 10, 1998)

[Congressional Record Volume 144, Number 9 (Tuesday, February 10, 1998)]
[Senate]
[Pages S532-S541]
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. Under the previous order, there will now be an
hour debate, equally divided between the Senator from Vermont and the
Senator from Missouri or their designees, prior to the cloture vote on
the nomination of Dr. David Satcher of Tennessee to be Assistant
Secretary of Health and Human Services and to be Surgeon General.
The Senate resumed consideration of the nomination.
The PRESIDING OFFICER. Who yields time? The Senator from Tennessee is
recognized.
Mr. THOMPSON. Mr. President, I yield myself 10 minutes.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. THOMPSON. Mr. President, I rise in support of the nomination of
Dr. David Satcher of Tennessee. I have listened to the debate. I have
talked to Dr. Satcher about the issues involved. I am convinced that
this is an outstanding appointment that the President has made. Whether
you look at Dr. Satcher's history in terms of his commitment to his
family, whether you look in terms of his commitment to his community,
or whether you look in terms of his commitment to his profession, I
believe he is an outstanding individual. From everyone that I have
talked to, I have come away with that conclusion. Clearly there are
some policy issues on which we disagree. I think we have one in terms
of the debate on partial-birth abortion. Frankly, in looking at the
issues and listening to the debate, I think that that is at the crux of
the concern as far as Dr. Satcher's confirmation. I think a lot of
these other issues are collateral issues.
I have talked to him about this. I am a strong supporter of the ban
on partial-birth abortions. I think there is no justification
whatsoever for that onerous procedure. And, in response to questions on
this issue, Dr. Satcher has said:

While I support the concept of a ban on late-term
abortions, like the President I feel that if there are risks
of severe health consequences for the mother then that
decision should not be made by the Government, but by the
woman in conjunction with her family and her physician.

Again, he supports the concept of a ban on late-term abortions but he
believes there should be more thought given to the situation of severe
health consequences for the mother. I understand what he is talking
about. Personally, I have concerns about that exception and its
potential for abuse. Without getting into that whole debate again, I
can simply say I disagree with the President's position on that issue.
However I have discussed this issue with Dr. Satcher and I have read
what he has written in response to questions on this issue. I am
satisfied he does not intend to use the position of Surgeon General to
advocate or promote abortion in any way. In fact, he said:

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
and not divide them.

He went on to say:

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.

This is the commitment that he has made. Many of us have been
concerned in times past that this particular position of Surgeon
General would be used as a bully pulpit by individuals to promote
policies that are contrary to the best interests of this country. I
think it has been done in the past. I do not feel that Dr. Satcher will
do this. I think he has a good concept of the good that can be done in
this job. I think he understands the terrible problems that our young
people have. I think he sees an opportunity to do some good for these
young people. Everything in his history indicates that that would be
his attitude in approaching this position, and I believe him when he
says that and I respect his position on that.
I believe that, generally speaking, a President has the right and
should have the right to appoint the kind of nominees, the kind of
people he wants to these positions. I believe that, whether the
President is a Democrat or a Republican. There are some situations
where the positions or the background is so out of the norm, out of the
mainstream, that we as a confirming body have to take a contrary
position to that of the President. I think those situations ought to be
rare. I have considered Dr. Satcher's record. I do not see anything in
his record where that particular result on our part should obtain.
Unfortunately, I think sometimes in these confirmation debates we
have a policy problem with the President, or we have a policy problem
with the individual who the President nominates. But, instead of
concentrating on that policy problem we begin to look for other things
that we perhaps could use against this nominee. I think we get into,
then, issues sometimes of credibility and veracity and character and
things like that that, frankly, I think is unfortunate. I think it has
happened on both sides of the aisle with regard to nominees from both
sides of the aisle in times past.
I think we would be well served to keep our eye on the ball. Let's
look at the history of this particular individual. I don't think
anybody can question his character or his veracity or his commitment to
his profession. We have a policy issue here. We need to address whether
or not the fact that he supports the President, as all the President's
nominees for any position that comes up are going to do--whether or not
his support for the President in this case is sufficient to disqualify
him for this position. I think the answer to that is no. I think he
will be a good Surgeon General.
He does happen to be a Tennessean. That does not disqualify him
either, in my estimation. And therefore I respectfully submit this
gentleman should be confirmed.
I thank the Chair for the opportunity to speak this morning. I yield
the floor.
The PRESIDING OFFICER (Mr. Gregg). Who seeks time? The Senator from
Missouri.
Mr. ASHCROFT. Mr. President, I suggest the absence of a quorum and
ask unanimous consent the time be allotted equally to both sides.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will call the roll.
The legislative clerk proceeded to call the roll.
Mr. ASHCROFT. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Hutchinson). Without objection, it is so
ordered.
Mr. ASHCROFT. Mr. President, I rise to speak against the confirmation
of Dr. David Satcher, and I allocate myself so much time as I may
consume, but I ask that I be notified when 8 minutes have expired.
The PRESIDING OFFICER. The Chair will notify the Senator at that
point.
Mr. ASHCROFT. Thank you very much.
Mr. President, we live in an information age. We have come to a
conclusion and an understanding of an important fact, which is that
those individuals who control information and have information are in a
position to make good decisions. And, as a matter of fact, the basis of
good decisions really determines the outcome of arguments and
determines the strategy that will be developed, determines the course
of a nation. No one is able to make good decisions without good
information. In the computer world, it is put this way: Garbage in,
garbage out. If you don't have good information going in, you don't get
good information coming out. It is that simple and easy to understand.
It works with computers; it also works with the U.S. Senate. If we
don't get good information, we can't make good decisions. If we don't
get accurate information, we can't make the kinds of decisions the
people expect us to make in this office.
There are a variety of issues which have characterized the debate as
it relates to the potential confirmation of Dr. David Satcher: issues
relating to the New England Journal of Medicine's

[[Page S533]]

conclusion that the African AIDS studies were unethical and that they
were improper; issues relating to the study of newborns and the
transmission of AIDS from mothers to their children in the United
States; the maintenance of an experiment that left the identification
of the children unknown long after we had therapy that would have been
available to them if we just identified the children by virtue of the
blood samples.
We have had the issue of both of those AIDS studies. We have had the
issue of partial-birth abortion. We have had the issue about needle
exchanges. We have had issues raised in this Chamber about the Accident
Prevention Center at the Centers for Disease Control, that center which
is so focused, in some respects, on guns and their impact on the lives
of Americans. It has been an issue because there has been a suggestion
that guns, in some respects, qualify as a disease and has become
something that we should address in the Congress. I personally don't
believe that the second amendment to the United States Constitution,
which guarantees the opportunities of individuals to have guns, is a
disease. I think it is a valuable right for this country, and it is one
we ought to cherish.
But in all of these issues, the ability of the Congress to make good
decisions, the ability of the Senate, specifically, to make decisions
about a confirmation depends on the reliability and availability of the
information.
There are some troubling aspects about the unavailability and the
unreliability of information that have characterized the information
flow in this confirmation proceeding. The Centers for Disease Control
seems to have felt that it could selectively provide information
regarding the controversial AIDS study in Africa, the study which the
New England Journal of Medicine criticized because people were given
sugar pills, or placebos, at a time when there was a known therapy. And
it is pretty clear that when there is a known therapy, medical ethics
say you are not allowed to give people just sugar pills and send them
on their way, watching them die.
The New England Journal of Medicine took the Centers for Disease
Control to task over this. The Centers for Disease Control was asked
about it by my office and by others, and a meager stream of information
came out.
I hold in my hand today a report of May 22, 1997. This report has yet
to be delivered to me by the Centers for Disease Control but came into
my possession from a third party who had gotten this report through a
Freedom of Information Act demand last year. It seems to me that when
we ask for information like this, the Members of the Senate ought to be
accorded at least the courtesy of the information being provided, but
when we read the report, it may well be that it is the nature of the
report, it is the content of the report that makes it difficult for
them to want to share it with the Senate.
Paragraph No. 3 says:

Whether the use of a placebo in this study is ethical.

So they are still debating 3 or 4 years after the start of this study
serious questions at CDC about whether what they are doing is ethical,
the way they are treating individuals in these African trials. I
personally agree with the New England Journal of Medicine that to treat
people as if they are laboratory subjects and not as human beings, to
give them placebos when it is known that the HIV virus ultimately is
fatal is unethical.
But what is important here is, and I quote the language:

This concern is because a placebo-controlled trial in the
United States would be unethical.

Here you have a document from the Centers for Disease Control
admitting that for us to do this in the United States to the citizens
of the United States would be unethical. I think that is substantial.
For me, human beings are indivisible. It says in our Declaration of
Independence, we are endowed by the Creator with certain inalienable
rights. We don't have superior standing in terms of ethics and
expectation because we happen to live in the United States. This flat
statement by those in authority at the Centers for Disease Control
reporting on this randomized placebo-controlled study in Africa flatly
states that a placebo-controlled trial in the United States would be
unethical.
I find the unavailability of this kind of report to the U.S. Senate
in a confirmation process to be troublesome. I think we have a right to
be asking for good information. I think absent good information we
won't make good decisions.
If this were the singular situation in which there had been the
absence of information in this confirmation hearing, I might say,
``Well, gee, they have a lot of things and perhaps this is to be
overlooked. This must have been an error.'' But early in the debate,
needle exchange programs and the support by Dr. Satcher of such
programs were raised. Several Senators came to the floor saying he has
never supported a needle exchange program; he would never support
federally funded needle exchange programs.
We asked for information from the CDC about that. We only got the
information, frankly, after we had the leader intercede to give us
information. When it came, it did show that there was a report from CDC
that said that they approved of and thought reasonable and appropriate
substantial Federal funding for needle exchange programs.
But even--I thank the Chair for the 8-minute warning. I allocate
myself 5 minutes additional.
So there was a report that said the CDC itself supported substantial
Federal funding for needle exchange programs. That is where you give
dope addicts needles so that they can shoot up the dope and have less
opportunity to be contaminated by a dirty needle.
But what was strangely missing, uniquely missing, was the fact that
Dr. Satcher had written a cover letter to the report endorsing the
report. When I asked for the information, it wasn't forthcoming.
Finally, when we insisted, they sent the report, but they didn't send
the cover letter of Dr. Satcher. That had to come from collateral
sources that we were able to generate.
Stonewalling is a problem in Washington, and it is inappropriate to
think that we can fail to tell the truth in this city and have the kind
of Government that Americans deserve. It is a problem in a variety of
settings, but it is a problem as it relates to the U.S. Senate and to
this confirmation hearing.

Additionally, I asked in my exchanges with the CDC whether or not
they ever funded conferences that promoted clean needles, and they said
no. They even sent documents showing that there were certain
conferences devoted to clean needles which they declined to fund. But
then later we find that there are documents, as the agenda of
conferences, that reveal the cosponsorship of the Centers for Disease
Control and other so-called health agencies that are designed
exclusively for the purpose of clean needles. The name of the
conference was ``Getting the Point''--the needle point.
We can debate needle exchange programs. There are very serious
ethical problems in providing dope addicts with clean needles. What is
a young person to think when the junkie comes up and says, ``The
Government provides us with these clean needles.'' Must be OK to use
dope, to have tax dollars spent by Americans to provide clean needles
to dope addicts so that they can focus their activities and operate
safely to inject drugs. The folks who pay taxes in those neighborhoods
where the clean needles are distributed must wonder about the
commitment of their Government to protect them rather than to provide a
safe haven for drug users.
But this is a disturbing set of circumstances, where we simply have
an absence of information as a result of a stonewall on the part of the
administration, and I believe that those who provide that approach are
not the kind of individuals who ought to be trusted with the
responsibilities of Government.
I believe an individual who supports needle exchange programs, who
would accommodate drug use instead of seeking to curtail drug use, who
thinks that the problem is dirty needles instead of the addiction to
heroin, is not the type of person who ought to be leading our culture
as it relates to drug policy or health policy.
I believe that the absence of information and the willingness to
stonewall and not provide information does not

[[Page S534]]

characterize the way in which we would want to deal with our own
doctors, our family doctors, and certainly would not characterize the
way we would expect the family doctor of the United States of America
to deal with us.
It is in that respect that I think we understand that the absence of
information keeps us from making good decisions--garbage in, garbage
out. And when the agency decides to provide to the U.S. Senate,
selectively, information which reinforces what it wants us to know, but
withhold information about things that it hopes we do not find out, we
should not reward that kind of behavior, that stonewalling, if you
will, that absence of truth, that selective revelation of what they
want us to know but not what we need to know. We should not reward that
with confirmation.
There is an epidemic in Washington, DC, of bureaucracy that feels
like it can tell people only what they think the people want to know.
It is because there are those in the bureaucracy who feel they know so
much better than the people. But that is contrary to the values of
America.
The real value of America is not that the values of Washington, DC,
be imposed on the people. The genius of this democratic republic is
that the values of the people would be imposed on Washington, DC. For
the values of the people to be understood, they have to be recognized
and accorded dignity and respect, and they have to be formed in the
context of information which is complete and thorough.
Mr. President, I reserve the remainder of my time.
Mr. FRIST addressed the Chair.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. FRIST. How much time is remaining on this side?
The PRESIDING OFFICER. The Senator from Tennessee has 18 minutes
remaining. The Senator from Missouri has 10 minutes 41 seconds.
Mr. FRIST. Mr. President, I rise in strong support of the nomination
of Dr. David Satcher for the positions of Surgeon General and Assistant
Secretary for Health. Dr. Koop called the position of Surgeon General
``a high calling, with an obligation to interpret health and medical
facts for the public.'' ``A high calling''--a high calling because one
subjects oneself to all sorts of accusations, in portraits painted that
may not quite be accurate. In fact, sometimes they may be false and
sometimes misguided and certainly misleading. Therefore, I would like
to focus my comments over the next several minutes on debunking some of
the accusations we have heard on the floor over the past week, one by
one.
No. 1, Dr. Satcher's position regarding abortion. Let me say at the
outset that I strongly support the ban on partial-birth abortions
passed by this Congress, vetoed by the President. I questioned Dr.
Satcher about his agreement with the President's position. Let me say
that in talking with him, the issues of partial-birth abortion deeply
trouble Dr. Satcher. He has said both to me and in writing to this
committee that he supports the ban of this procedure in concept, but he
stops short of Federal legislation when the health of the mother is
involved.
I do not agree with the President's position or Dr. Satcher's
agreement with the President. In a letter of October 28, he wrote me
the following, which is reassuring to me. It says:

Let me state unequivocally that I have no intention of
using the positions of the Assistant Secretary for Health and
Surgeon General to promote issues related to abortion.

He continues:

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.

He continues:

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.

If you look over Dr. Satcher's past--not an agenda we want to impose
on him, but his past--over the last 25 years, he has never made
abortion a part of his agenda in promoting the public health. And, as
you look forward, using the words that I just quoted, he has made the
statement that abortion is not going to be a part of his agenda in the
future.
No. 2, AZT trials in Africa and Asia. I have talked about this on the
floor, but let me just very briefly say that today, actually over the
course of the day, 1,000 HIV-infected babies will be born in developing
countries. These babies will go ahead and, unfortunately, die.
The goal of the studies that have been carried out, proposed, and are
under discussion, was to find a way to stop transmission of that HIV
virus from HIV-infected pregnant women to their children. You do not do
that--you do not do that--by studying Western-style, prohibitively
expensive technology impractical in developing countries, Western-style
medicine that requires intravenous administration, repeated visits back
to the physician or to the clinic, because there is absolutely no
chance that that sort of therapy can be applied in the developing
countries where the goal is to prevent transmission.
That is the goal of the study--not to make us feel good, not to prove
that the therapy works for the United States or England or France--but
to decrease transmission in those countries. And you do not do that by
eliminating an arm of the study that includes the current standard of
care. We are blessed in this country where the standard of care is not
a placebo or doing nothing. Unfortunately, in Africa--and I was just
there 3 weeks ago--the current standard of care is no therapy. That has
to be an arm of the trial when you are looking at a new intervention.
I am absolutely convinced, as a physician, as a clinical researcher,
that the trials in Africa met the institutional, the national, and the
international ethical standards as defined today.
These studies came in 1994. The World Health Organization recommended
that studies be done to test the safety and efficacy of this short-term
AZT therapy which had the potential of helping developing countries. In
fact, I would argue that it would be unethical to take a Western-style
therapy that can only be applied in countries that have the
technological advances, that can have repeated visits, that have the
money, it would be unethical to take that and experiment on a
population that could not potentially benefit from that in the future.
Third issue. Federal funding of needle exchange programs and
educational conferences has come up again and again and again. Dr.
Satcher will very simply--talking about the man; no programs and
documents coming from here and there; talking about the man--Dr.
Satcher, the man nominated, has never advocated, has never supported
taxpayer-funded needle exchange programs for drug abusers. Let me
repeat, Dr. Satcher has never advocated or supported taxpayer-funded
needle exchange programs for drug abusers.
Dr. Satcher, furthermore, in both written and oral conversations,
believes strongly that we should never do anything to advocate the use
of illegal drugs.
Mr. ASHCROFT. Would the Senator yield?
Mr. FRIST. Let me run through this in the interest of time.
No. 4, research on guns. The CDC National Center for Injury
Prevention and Control has been criticized by some for supporting
grantees with an alleged bias against guns as we look at violence.
These studies have been carried out.
Again, I have talked to Dr. Satcher personally and discussed, in my
office, this issue. I brought up at that time the fact that raw data
had not been made available from a study published in the New England
Journal of Medicine, that it should be made public. And I am actually
very pleased that the raw data is now available on the Internet for
everybody to see. I appreciate his rapid response.
Fifth issue. Dr. Satcher has been accused of secretly conducting
blind HIV studies on newborn babies and sending them home infected
without treatment. Not true. Not true. It makes for great sound bites,
and it catches the people's imagination, but it is simply not true.
Again, look at what happens. The big issue is what is the incidence
at the time? What is the incidence? What is the prevalence of HIV
infection in your

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community? How would you find that out today?
Well, the study that was actually carried out was that samples were
obtained that had been discarded, set aside from clinics and from
hospitals, all done once again with ethical standards of the time, and
tests were done on that blood to see what the underlying incidence was.
Yes, they were not labeled. In fact, all of the personal labeling had
been stripped from the discarded samples. Why? Because of the privacy
of those individuals.
Another point that has not been mentioned is that each of these
clinics, each of these hospitals who participated in this baseline
study to see what the incidence of HIV infection is, had at the time
offered voluntary HIV counseling and testing at every site where this
study took place. Therefore, each and every woman did have the
opportunity to learn her HIV status.
Those are the issues that have come forward. Let me just briefly say,
in Dr. Satcher's own words, because we have tended to look at all these
other issues--I think we need to look at his past, his principles, and
his agenda. What is his agenda? His agenda is--and I quote--

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

He continued, as he looked forward in his vision:

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

Personal responsibility and prevention, that is Dr. Satcher's agenda
for the future.
Dr. Satcher has dedicated his career to public health. He is well
qualified to lead the U.S. Public Health Service and its commissioned
officers to meet these worthy goals. I urge my colleagues to support
the vote which will take place in a few minutes, the cloture vote, and
to support Dr. Satcher as the next Surgeon General.
I yield the floor.
Ms. MOSELEY-BRAUN. Mr. President, the position of Surgeon General was
created in 1870 and played a vital role in fighting infectious diseases
and other threats to public safety. Communicating with the American
public about the health of their families and communities is probably
the most important responsibility of a Surgeon General. This person
serves as our nation's chief spokesperson for public health. This is
the bully pulpit from which we may be lead down the path to a strong,
healthy, and productive society.
After nearly eight years of dormancy, President Reagan recognized the
importance of a national health leader in 1981 and revived the position
of Surgeon General with the nomination of Dr. C. Everett Koop. At the
time, this too was a very controversial nominee, but the Congress and
nation grew to deeply respect his leadership. Dr. Koop and his
successors made tremendous strides in educating the public about the
spread of AIDS, the prevalence of domestic violence, and the need to
control out-of-wedlock births. There should be no doubt that Dr. David
Satcher will continue this legacy.
This critically important post has been vacant for three years and
our nation does not have anymore time to spare. The longer the Senate
delays this appointment, the greater the lost opportunity to improve
public health. For example, there is a developing consensus across the
nation about the need to reduce teen smoking. Three thousand children
become permanent smokers every day. We need a Surgeon General in place
to spearhead a national strategy to meet the challenge of teen smoking.
Mr. President, I have listened to a lot of the debate on this
nomination. I want to offer my support to Dr. Satcher and highlight
some the experiences and qualities that make him the right person for
this position.
Dr. Satcher is a physician, a scholar, and a public health leader of
national stature. His almost uniform endorsement by the medical,
business, and education communities are a testament to the respect
which Dr. Satcher's work has earned him. I ask unanimous consent that a
list of more than 120 of the nation's medical associations, allied
health groups, businesses, and educational institutions that have also
endorsed Dr. Satcher be printed in the Record.
There being no objection, the list was ordered to be printed in the
Record, as follows:

Endorsements of Dr. David Satcher

(as of November 24, 1997)

medical associations

American Medical Association.
American Academy of Family Physicians.
National Medical Association.
National Hispanic Medical Association.
Tennessee Medical Association.
American Academy of Child and Adolescent Psychiatry.
American Academy of Pediatrics.
American Association of Clinical Endocrinologists.
American Association of Neurological Surgeons.
American Association of Public Health Physicians.
American College of Chest Physicians.
American College of Emergency Physicians.
American College of Gastroenterology.
American College of Nuclear Physicians.
American College of Obstetricians and Gynecologists.
American College of Occupational & Environmental Medicine.
American College of Physicians.
American College of Preventative Medicine.
American Dental Association.
American Gastroenterological Association.
American Medical Group Association.
American Medical Women's Association.
American Osteopathic Association.
American Psychiatric Association.
American Society of Cataract and Refractive Surgery.
American Society of Clinical Pathologists.
American Society of Internal Medicine.
American Society of Pediatric Nephrology.
American Society for Reproductive Medicine.
American Society for Transplant Physicians.
California Medical Association.
College of American Pathologists.
Congress of Neurological Surgeons.
Interamerican College of Physicians and Surgeons.
Mississippi State Medical Association.
Society of Nuclear Medicine.
Society of Thoracic Surgeons.

nurses

American Nurses Association.
American Association of Nurse Anesthetists.
National Black Nurses Association.
Emergency Nurses Association.

hospitals

American Hospital Association.
InterHealth.
National Association of Public Hospital and Health Systems.
National Association of Children's Hospitals.
The Hospital and Health System Association of Pennsylvania.

pharmaceutical companies

Merck.
Smith Kline Beecham Pharmaceuticals.
Zenecca Inc.
Wyeth-Lederle Vaccines and Pediatrics.

businesses

American Airlines.
American Association of Health Plans.
American Greetings.
Avon.
Community Health Resources, Inc.
Ford.
National Pharmaceutical Association.
Phoenix Healthcare Corporation.

academic health centers

Association of American Medical Colleges.
Charles R. Drew University of Medicine & Science, Los
Angeles, CA, Dr. W. Benton Boone.
Harvard University Medical School, Cambridge,
Massachusetts, Dr. Julius B. Richmond.
Meharry Medical College.
Morehouse School of Medicine, Dr. Louis W. Sullivan.
Rollins School of Public Health of Emory University.
Vanderbilt University Medical Center.
University of California, School of Medicine, San
Francisco, California, Dr. Phil Lee.
University of Washington School of Public Health and
Community Medicine.
University of Pittsburgh Graduate School of Public Health.
University of North Carolina School of Public Health,
Chapel Hill, NC, Dr. William L. Roper.

children's groups

Children's Defense Fund.
The Children's Health Fund.

allied health group

AIDS Action Council.
American Cancer Society.

[[Page S536]]

American Diabetes Association.
American Dietetic Association.
American Lung Association.
American Public Health Association.
Association of Schools of Public Health.
Association of Maternal and Child Health Programs.
Association of State and Territorial Health Officials.
Coalition for Health Funding.
Council of State and Territorial Epidemiologist.
Intercultural Cancer Council.
National Association of County and City Health Officials.
National Association for Public Health Policy.
National Family Planning and Reproductive Health
Association.
National Black Child Development Institute.
National Association of People With AIDS.
National Mental Health Association.
National Osteoporosis Foundation.
National Task Force on AIDS Prevention.
Partnership For Prevention.
Society for Public Health Education.
U.S. Department of Health and Human Services Hispanic
Employee Organization.

education

Bethune-Cookman College, Daytona Beach, Florida.
Claflin College, Orangeburg, South Carolina.
National Alliance of Black School Educators.
Voorhees College, Denmark, South Carolina.
West Virginia State College, Institute, West Virginia.
Mississippi Valley State University, Itta Bena,
Mississippi.
Coppin State College, Baltimore, Maryland.
St. Paul's College, Lawrenceville, Virginia.
South Carolina State University, Orangeburg, South
Carolina.
Langston University, Langston, Oklahoma.
Paine College, Augusta, Georgia.
Texas Southern University, Houston, Texas.
Tuskegee University, Tuskegee, Alabama.
University of the District of Columbia, Washington, DC.

disability groups

March of Dimes Birth Defects Foundation.
National Multiple Sclerosis Society.

youth groups

College Democrats of America.

fraternities and sororities

Alpha Phi Alpha Fraternity, Inc.
Phi Beta Sigma Fraternity, Inc.
Zeta Phi Beta Sorority, Inc.
Delta Sigma Theta Sorority, Inc.

women's organizations

Joint Action Committee for Political Affairs.
National Black Women's Health Project.
National Asian Women's Health Organization.
National Breast Cancer Coalition.
Women's Legal Defense Fund.

senior groups

National Council of Senior Citizens.

religious groups

Ray of Hope Christian Church.
Shiloh Baptist Church of Washington.
Southern Christian Leadership Conference, Joseph Lowery.

civil rights groups

Dr. Martin Luther King, Jr., Commemoration Commission.
National Association for the Advancement of Colored People.
National Urban Coalition.

law enforcement groups

American Correctional Association.
National Association of Blacks in Criminal Justice.
National Organization of Black Law Enforcement Executives.

other

Family Violence Prevention Fund.

individuals

Sister Mary Alice Chineworth, OSP.

Ms. MOSELEY-BRAUN. There can be no doubt that Dr. Satcher is
eminently qualified to be Surgeon General. He has spearheaded
successful public health improvements at each stage of his career. As
director of the Centers for Disease Control, he lead four important
advancements in public health which distinguished his tenure there.
Under his leadership, childhood immunization rates have risen to a
record 78 percent. Vaccines have become more affordable and vaccine-
preventable childhood illnesses have fallen to the lowest level in
history.
All states now participate in the special breast and cervical cancer
screening program due to Dr. Satcher's leadership. When he became CDC
director in 1993, only 18 states were participating in this program. In
almost two-thirds of the nation, women were excluded from this early
outreach and cancer detection program. Today, more than one million
women are receiving cancer screening tests and 21,000 cases of
treatable cervical cancer have been identified. This is the result of
Dr. Satcher's leadership.
Further, he led the development of a comprehensive strategy to combat
infectious diseases. Recent outbreaks of e. coli and other bacterial
infections, as well as the reemergence of malaria and cholera, have
raised national awareness. Dr. Satcher brought networks of physicians
and clinics together to monitor emerging diseases and formed an
innovative seven-state surveillance program.
Finally, Dr. Satcher also developed an early warning system to
respond to outbreaks of food-borne illnesses. Food safety is clearly
one of our nation's most important issues, particularly so given the
increasing globalization of trade. As more imported foods products find
their way to Americans' dinner tables, having a strong food safety
systems in place will be vital. Thankfully, the early warning system
established by Dr. Satcher was in place last year to catch salmonella
contaminated alfalfa sprouts and e. coli contaminated lettuce and apple
cider which might have caused a public health tragedy.
These are just four examples of improvements in public health Dr.
Satcher has achieved during his tenure as CDC director. These are the
types of results and initiatives that Dr. Satcher would continue to
work towards in his role as Surgeon General and Assistant Secretary of
Health.
Concerns have been raised during this debate about Dr. Satcher's
limited involvement in controversial HIV/AIDS studies in Africa, Asia,
and the Caribbean. I share many of these concerns and wrote to the
President in this regard in April of last year. Subsequently, I
discussed these concerns at length with Dr. Satcher and others in the
scientific community. They advised me that, useful medical research and
clinical trials in developing countries often pose special challenges.
The resources available to people of developing worlds are not
comparable to resources available to individuals in this country. Even
though I strongly disagree with their conclusions, I understand
scientists' belief that we may need to balance our research standards
in this country with the public health needs in developing nations.
This issue poses a debate concerning medical ethics which is yet
unresolved in the scientific community. We can certainly not expect to
resolve it with this nomination process. Dr. Satcher's position on
these studies is not central to whether he would serve the nation well
as Surgeon General. We can have the professional disagreement over the
merits of the HIV studies, but the defining question should be whether
this individual, is qualified for the challenges of the position. I
believe unequivocally, that Dr. Satcher has that ability, the
experience, and commitment to be an excellent Surgeon General.
It is reasonable for many of us to have various disagreements with
nominees for executive branch posts. This ability to voice opposition
and debate ideas is what makes our democracy great. At the end of the
day, however, reason should prevail. The President has done the country
a service by nominating such an outstanding candidate. Dr. Satcher is
qualified to be Surgeon General and would be the first family physician
to hold the post. What better person to be the nation's doctor? I hope
that my colleagues will join me in supporting his confirmation.
Mr. BOND. Mr. President, I have observed the debate over the
nomination of Dr. David Satcher over the past couple weeks. It has been
a very productive, yet intense, discussion which has raised some
critical questions.
Today, there is an unmistakable need for a capable individual to fill
the position of United States Surgeon General--a position which has
been vacant for over three years. Marked increases in smoking and
substance abuse by our nation's youth, combined with the continuing
plague of disease such as heart disease, cancer, diabetes, and others,
have made it imperative for the nation to have access to advice that is
both scientifically accurate and trustworthy.
The person who occupies the Surgeon General's Office is our Nation's
number one doctor and public health leader. Kids around the country
will seek and heed the advice of the Surgeon General, and for this
reason alone, thorough scrutiny of Dr. Satcher's qualifications and
views is well-placed.

[[Page S537]]

Dr. Satcher has proven that he is an effective leader. Under Dr.
Satcher's direction of the Centers for Disease Control and Prevention,
child immunization rates have increased from 52 percent to a record 78
percent. As a result, vaccine-preventable childhood diseases are at
record lows. Dr. Satcher also has led CDC's efforts to strengthen our
nation's defenses against infectious diseases and food-borne illnesses.
These are just a couple of significant results that have been achieved
under Dr. Satcher's guidance.
Despite Dr. Satcher's remarkable credentials and achievements, there
have been some questions raised by my colleagues concerning his
positions on partial-birth abortion and gun control. I have known and
worked with Dr. Satcher on numerous occasions, especially in the area
of birth defects prevention. In fact, I just met with him last week to
discuss these grave concerns that have arisen since his nomination. Dr.
Satcher has personally assured me that he will rely on science, instead
of politics, to influence his decisions--thereby preserving the
independence of the Office of the Surgeon General.
Let me make it clear. I will continue the battle to ban partial-birth
abortion, and have consistently voted to prohibit federal funds for
abortion. In addition, I have consistently fought efforts to restrict
the ability of law-abiding citizens to purchase and own firearms.
Dr. Satcher has exemplified the utmost dedication, ability, and
professionalism throughout his distinguished career. I am satisfied
that he will continue to operate in this manner as Surgeon General of
the United States. We may not agree on all issues, but I have the
utmost confidence in his character and ability to serve with
distinction. Dr. Satcher is a strong choice for this position, and I
look forward to witnessing Dr. Satcher's efforts to preserve the
independence of this office.
With an issue as important as our nation's health, which rises far
above partisan politics, I am confident that Dr. Satcher will serve
America well.
Mr. KYL. Mr. President, I do not doubt Dr. Satcher's competence as a
physician, scholar, and medical researcher. However, serious questions
on two important issues have arisen during Senate debate on his
nomination to be U.S. Surgeon General.
I am concerned about Dr. Satcher's position on partial birth
abortion. The vast majority of Americans (84 percent, according to a
1996 Wirthlin poll), a majority of the Senate and U.S. House, and the
American Medical Association support banning partial birth abortion.
Former Surgeon General C. Everett Koop has said that there is ``no way
to see partial birth abortion as a medical necessity * * *'' It is
clear that Dr. Satcher's view on this controversial procedure is out of
the mainstream of public and medical opinion. Since Dr. Satcher is
apparently willing to subordinate mainstream medical judgment to
politics in this instance, I have concerns that he may do so on other
important health issues as well.
I am also troubled that, as administrator of the Centers for Disease
Control, Dr. Satcher approved a questionable medical research project
in Africa and Asia. The researchers gave one group of HIV-infected
pregnant women placebos while another group received AZT, a drug known
to decrease by 67 percent the probability that the unborn children
would be infected by the HIV virus. A September 18, 1997 editorial in
the New England Journal of Medicine concluded that this research was
``unethical.''
The editorial explains that the reason the code of medical ethics is
unambiguous with regard to the investigators' primary responsibility to
care for the human subjects of scientific testing ``is due to the
strong temptation to subordinate the subjects' welfare to the
objectives of the study.'' The editorial concludes that the ``research
community must redouble our commitment to the highest ethical
standards, no matter where the research is conducted.''
As the ``nation's doctor,'' the U.S. Surgeon General should embody
the highest professional and ethical standards. He or she should
clearly reflect the views of a majority of Americans and the medical
community. Because Dr. Satcher's views on these two issues raise doubts
in my mind--and because, after three years without a Surgeon General,
it is unclear whether the position is necessary--I have decided to
resolve my doubts against his confirmation. If the president strongly
believes the country needs a Surgeon General, I am sure there are
thousands of well-qualified candidates whose nominations would not
raise these issues.
Mrs. MURRAY. Mr. President, I come to the Senate floor today to
express my frustration and concern with the opposition to the
nomination of Dr. Satcher as the new Surgeon General and Assistant
Secretary for Health. I will not reiterate what has been said here
today about Dr. Satcher's outstanding credentials or his outstanding
work as head of the Centers for Disease Control. This has been well
documented. I do not wish to lengthen the debate any more than
necessary. Dr. Satcher is an ideal candidate who should already be
serving the American people as our Surgeon General.
I come here today to unmask some of my Colleagues who are attempting
to further delay the nomination of Dr. Satcher to advance their own
political agenda. They are not opposing him because his is not
qualified, but rather because he stands with the President, and the
Supreme Court in defense of a women's right to adequate medical care
that protects her life and health.
What my Colleagues on the other side are attempting to do is to ask a
nominee for the position of Surgeon General to disregard the law and
acceptable medical practice. This is what the debate is about.
I have heard and read other concerns expressed by opponents, but
interestingly enough these issues were not debated at any great length
during the Committee process. This would have been the opportunity to
air these other issues or concerns. Instead they chose to block the
nomination on the floor all because Dr. Satcher believes in protecting
the health and life of women. They are trying to do what they could not
and would not do in the Labor and Human Resources Committee. They did
not have the votes.
I have listened to many of my Colleagues come to the floor as
champions of women's health care. I see bill after bill being
introduced in the Senate, all in the name of protecting or improving
women's health. But, when it comes to really protecting women's health
many of these same Senators are silent or stand in direct conflict with
what is good for women's health.
Women's health is not just about breast cancer or cardiovascular
disease. We all know that these are important women's health concerns
and issues, but women's health also includes reproductive health. Dr.
Satcher recognizes this fact and realizes the importance of standing
for women's health.
In addition to the reproductive health issues involved here today, I
think I should remind many of my Colleagues that we need a Surgeon
General and we need one now. The American people need someone who they
can trust and depend on as they try to negotiate through a more
complicated and frustrating health care delivery system than any of us
ever envisioned. We need someone who will talk to us about health care
and access to health care, especially prevention services. While there
is little consensus on what reforms or changes need to be made in the
way our health care system currently delivers care, the one thing that
we all can agree on is consumers need more information that speaks to
their needs and concerns. It is no wonder so many of my constituents
are concerned about the increasing role of non medical personal in
making their health care decisions. Who else is out there talking to
consumers, besides insurance companies?
For those of you so concerned about women's health, keep in mind that
women are the true health care consumers in most American families.
They pick the family doctor; they take care of the sick child; they
make the doctors appointments for the aging parent; and they worry the
most about lack of information available to make informed decisions.
Let's end this debate and move to vote on the nomination of an
outstanding doctor to be our new Surgeon General. We all know that
there will be another day to debate the issues surrounding late term
abortions. This has become an annual event so we do not need to delay
the nomination of Dr. Satcher simply to have yet another debate on late
term abortion.

[[Page S538]]

Mr. INHOFE. Mr. President, I rise today in opposition to the
nomination of Dr. David Satcher to the position of Surgeon General of
the United States. In my view, Dr. Satcher represents many of the
problems undercutting the moral fabric of American life. Too many,
including myself, Dr. Satcher is outside the mainstream of public
opinion.
I understand that Dr. Satcher is a remarkable man, with many years of
distinguished service as a doctor. My position on his nomination does
not stem from his history of service or his qualifications. Rather, my
opposition comes from the ideals that Dr. Satcher represents. It is
unfortunate that the office of the Surgeon General, America's family
doctor, has become politicized. Due to this increasing political role,
Dr. Satcher remains unfit to fulfill the position of Surgeon General.
As head of the Center for Disease Control and Prevention, Dr. Satcher's
actions and decisions have wandered into the political arena time and
again.
Dr. Satcher has publicly supported the President's position on
partial-birth abortion. His position is completely at odds with over
80% of the American public and the America Medical Association. The AMA
has said that there is never any medical circumstance where this
particular procedure should be used to terminate a babies life. I find
the elitism and arrogance of Dr. Satcher on this issue completely
irresponsible. When asked by the Labor and Human Resources Committee
about his support of the President's position, Dr. Satcher re-affirmed
his support for this procedure. I need not remind my colleagues the
description of this outrageous procedure. Even Senator Daniel Patrick
Moynihan, an abortion rights supporter, has termed this procedure
``infanticide.'' Continued support for this barbaric procedure borders
on the ridiculous.
Dr. Satcher also has apparently adopted the opinions of his
predecessor, Dr. Jocelyn Elders, on many sensitive cultural issues as
well. As head of the CDC, Dr. Satcher has endorsed the distribution of
condoms to our children in public schools. This is Dr. Satcher's way of
teaching our kids how to deal with problems like teen pregnancy and
AIDS. Mr. President, I must say I am appalled at this blatant attempt
at undermining the concept of abstinence as the best form of disease
prevention and birth control. Are we truly teaching children
responsibility by providing them with condoms in their classrooms?
Dr. Satcher also supports using tax-payer dollars to promote this
dangerous agenda. In 1994, Dr. Satcher began an $800,000 national
advertising campaign aimed at out nation's youth promoting condom
usage. This was all done in the name of AIDS prevention. I find this
egregious use of precious resources disturbing. By promoting condom
usage, we are simply encouraging our children to become sexually
active. I understand the issue of responsibility, however, I have never
heard the word abstinence associated with Dr. Satcher. To me,
abstinence is truly the responsible way to prevent unwanted pregnancies
and AIDS.
It is interesting to that note Dr. Satcher's view of responsibility
is convenienent when it conforms with his political beliefs, when in
reality his actions often appear to be irresponsible from both a moral
and scientific point of view. I say this because much has been made
recently of Dr. Satcher's morally questionable African HIV study. As we
have all become aware, as head of the CDC, Dr. Satcher approved of
research conducted in Africa and Asia that called for a groups of HIV
positive pregnant women to receive placebos (sugar pills), without
their knowledge, while others knowingly received valuable lifesaving
medication (AZT). Those receiving the placebo served as the control
group and those receiving the medication the study group. All this,
despite the fact that it was known that AZT decreased by \2/3\ the
likelihood that the disease would be transmitted from the mother to the
child.
This experiment is both repulsive and morally questionable. It
violates every know protocol from the Hippocratic Oath to the Nuremberg
Code and the Declaration of Helsinki which requires doctors to provide
any and all lifesaving measures. The Declaration of Helsinki states:
``In a medical study every patient--including those in a control group,
if any, should be assured of the best proven diagnostic and therapeutic
method.'' Apparently, Dr. Satcher viewed his research outside
established international ethical protocols.
A September 1997 New England Medical Journal of Medicine editorial,
our most recognized medical journal in the United States, declared Dr.
Satcher's actions unethical and likened the study to the Tuskegee
Incident, where medication with known benefits was withheld from a
control group. Truly, this represents a dark day in American history.
However, sadly, one we chose not to learn a lesson from.
In responding to the criticism, Dr. Satcher admitted that this human
experiment would not have taken place in the United States because all
participants in any clinical trial must be given at least small amounts
of AZT. He argued, however, that cost and efficiency dictated that the
experiment be done in developing countries. Did he really mean to imply
that those childrens' lives are any less of value than our own? As a
grandfather, I feel for those grandparents who lost grandchildren and
potential grandchildren because of Dr. Satcher's experimentation.
I wish that this was the first and only time Dr. Satcher had promoted
blind testing in regard to HIV. Sadly, it is not. Dr. Satcher has also
endorsed anonymous testing of domestic newborns.
In 1988, the CDC began collecting anonymous blood samples from
newborn children right here in the United States. The results of these
blood tests were subsequently withheld from the parents of the
children. Mothers of newborns with HIV were sent home without being
told that their child was carrying a fatal disease. Because the results
were withheld, important life-sustaining treatment was denied.
When this blind testing became public, Dr. Satcher defended the CDC's
practices saying the mothers would panic and ultimately leave their
health system. These were life and death decisions made by Dr. Satcher.
Apparently, he did not appreciate that fact as much as he should have.
With the public enraged over these unethical tests, Congress quickly
sprang into action. Representative Gary Ackerman introduced legislation
to prohibit the continuation of the studies. In response to this
legislation, Dr. Satcher personally lobbied Representative Ackerman to
abandon the bill. Fortunately, Representative Ackerman refused. The CDC
was eventually forced to abandon the blind testing due to public
outcry. Now just imagine for just a second if you will, what would have
happened if the public had not become aware of the CDC's activities?
How many countless children would have been denied access to health
care.
Mr. President, Dr. Satcher's conduct in these cases was not only
disturbing, but horrifying. Essentially, depending on which group you
were in, Dr. Satcher was playing God. If anything is unethical, this
must be. Surely, this sort of behavior cannot and should not be
overlooked by this Senate today.
If Dr. Satcher's questionable ethical conduct were not enough, the
CDC, under Dr. Satcher, has been attempting to subvert our right to
keep and bear arms as guaranteed by the Constitution of the United
States. The National Center for Injury Prevention and Control (NCIPC)
has begun tracking gun-related injuries and turning the research over
to anti-gun liberals with a political agenda. Now, I'm not exactly sure
how the NCIPC developed this authority. However, these activities
constitute nothing less than an all out political assault on the Second
Amendment paid for by the American taxpayer.
The director of the NCIPC, Dr. Rosenberg, is a known anti-gun
crusader. He is on record equating gun ownership to cigarette usage.
Apparently, Dr. Rosenberg's, and presumably Dr. Satcher's, copy of the
Constitution differ greatly from mine. My copy of the Constitution
talks openly about the right and the freedom to keep and bear arms. Dr.
Rosenberg has openly and repeatedly said that firearms are ``dirty,
deadly, and [should be] banned.'' All of this is done with the tacit
approval of Dr. Satcher and at taxpayer expense. In fact the very
agency Dr. Satcher wishes to head, the

[[Page S539]]

U.S. Public Health Service, has had since 1979 one of its primary goal
``to reduce the number of handguns in private ownership,'' starting
with a 25% reduction by the end of this century. Unfortunately, not
enough taxpayers are aware of how their money is being used to promote
this activist liberal agenda.
In responding to questions about the relevancy of the CDC's work on
gun issues, Dr. Satcher predictably defended the agency saying that
those who were upset by its work should be more upset about the
relationship between firearms and injury. I can assure Dr. Satcher
unequivocally, no one is more concerned about gun safety than gun
owners. In defending the CDC's practice, Dr. Satcher failed to comment
on why the data, collected at taxpayer expense, is not being released
to the public. Once again, it is ironic that responsibility has been
confused with truthfulness.
In closing, Mr. President, I would like to reiterate my opposition to
Dr. Satcher's nomination. The position of Surgeon General should be
someone the American people can trust to advise them on important
health issues. However, through his deeds and words, Dr. Satcher has
demonstrated again and again that his ethics must be questioned and
that he carries a biased politically driven agenda into a position that
requires non-partisan action. Is Dr. Satcher the man for the position
of America's family doctor? I cannot and do not come to this
conclusion. I would urge my colleagues to evaluate their positions
carefully before elevating someone with such a blatant and aggressive
political agenda to such an esteemed position.
Thank you Mr. President. I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. KENNEDY. Mr. President, what is the allocation of time that
remains?
The PRESIDING OFFICER. The proponents have 7 minutes 49 seconds
remaining. The opponents have 10 minutes 41 seconds remaining.
If neither side yields time, time will be charged equally to both
sides.
Mr. KENNEDY addressed the Chair.
The PRESIDING OFFICER. The Senator from Massachusetts.
Mr. KENNEDY. Mr. President, how much time again do we have?
The PRESIDING OFFICER. The proponents have 7 minutes 19 seconds
remaining.
Mr. KENNEDY. Mr. President, I know Senator Daschle wants to speak in
favor of the nominee, and there are only 7 minutes left. I will take
just 2 minutes, and then I hope that those who are opposed to the
nominee will take what time they need, and then the time-honored
tradition is that those who are in support of the nominee are generally
accorded the courtesy of the last response.
Mr. President, as we approach the vote, I want to point out that the
various questions, allegations and charges that have been made to try
to disqualify Dr. Satcher have been responded to, and none more
eloquently than by our friend and colleague, the chairman of the Health
Subcommittee of the Human Resources Committee, Senator Frist.
I hope that those Members who have some questions in their mind have
listened very carefully to those responses, because I think they
accurately respond to the various allegations and charges.
Finally, I just want to say that Dr. Satcher is uniquely well
qualified. His life has been a life of service. He was one of 3 out of
70 students who graduated from his high school to go on to college. He
graduated magna cum laude from his college. He was at the top of his
class at Case Western Reserve University where he pursued a medical
degree and a Ph.D.
Dr. Satcher is a respected family doctor, researcher, teacher, and
administrator, affiliated with some of the great universities of this
country. He is an individual who has looked out for fairness and
decency in the service to families in this country. Dr. Satcher has a
unique background and it is due to this background that every single
health organization, without exception, has endorsed Dr. Satcher. Every
single one of them has endorsed him. The past Secretary of HEW, the
very distinguished Dr. Louis Sullivan, has endorsed him as well.
We are very fortunate to have Dr. Satcher as a nominee. I commend the
President and look forward to a vote of cloture so we can get on with
the business of getting him in place to serve the American public.
Mr. President, I ask unanimous consent that letters of endorsement of
Dr. Satcher from the head of the Office of National Drug Control
Policy, Barry McCaffrey, and the Director of the National Institutes of
Health, Dr. Harold Varmus, be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

Executive Office of the President, Office of National
Drug Control Policy,
Washington, DC, February 10, 1998.
Hon. Edward M. Kennedy,
Committee on Labor and Human Resources,
U.S. Senate, Washington, DC.
Dear Senator Kennedy: Dr. David Satcher's written response
to a question for the record from his confirmation hearing
clearly indicates that he supports the Administration's
needle exchange position. We do not have clear scientific
evidence to conclude that needle exchange programs do not
encourage drug use. His statements is fully consistent with
federal law which requires the Secretary of HHS to make two
science-based findings before lifting the ban on use of
federal funds for needle exchange programs. Specifically, the
Secretary must demonstrate that: (1) needle exchange programs
reduce the transmission of the HIV virus and (2) do not
encourage drug use.
Dr. Satcher has a distinguished background as the President
of Meharry Medical College for eleven years, as a faculty
member of the UCLA School of Medicine and the King/Drew
Medical Center in Los Angeles, and outstanding service as the
Director of the Centers for Disease Control since 1993. He is
eminently qualified to serve as the nation's Surgeon General.
Dr. Satcher will bring enormous expertise to bear on our
efforts to reduce drug abuse and its consequences in America.
I fully support Dr. Satcher's nomination for Surgeon
General.
Respectfully,
Barry R. McCaffrey,
Director.
____

Department of Health & Human Services, National
Institutes of Health,
Bethesda, Maryland, February 9, 1998.
Hon. Edward M. Kennedy,
U.S. Senate, Washington, DC.
Dear Senator Kennedy: I am writing to support the
nomination of David Satcher, M.D., Ph.D., currently the
Director of the Centers for Disease Control and Prevention,
to be Surgeon General of the United States and Assistant
Secretary for Health in the Department of Health and Human
Services. Dr. Satcher is a medical scientist of outstanding
ability, a leader of great energy and vision, and a public
servant of the highest integrity.
As Director of the Centers for Disease Control and
Prevention, Dr. Satcher has led the Federal Government's
primary programs for promoting health and preventing disease,
injury, and premature death. He has directed a revamping of
Federal efforts in AIDS prevention and led Federal actions to
revitalize our attack on emerging infectious diseases. Dr.
Satcher's accomplishments in his medical career, which has
included work in sickle cell research and family medicine at
King-Drew Medical Center in Los Angeles, earned him election
to the Institute of Medicine of the National Academy of
Sciences as well as selection to receive the 1978 Watts
Grassroots Award for Community Leadership. His academic
career has included positions on the faculty of the Morehouse
School of Medicine and the King-Drew Medical Center and UCLA
School of Medicine. During a distinguished tenure as
president of Meharry Medical College from 1982 through 1993,
Dr. Satcher's leadership and public service were recognized
with the National Conference of Christians and Jews Award in
1985 and the ``Nashvillian of the Year'' Award in 1992. His
expertise and background, as well as the outstanding personal
qualities obvious to anyone fortunate enough to work closely
with him--as I have--qualify Dr. Satcher exceptionally well
to serve as Surgeon General and Assistant Secretary for
Health and to be the single, clear voice in communicating to
the Nation on issues that affect public health.
Sincerely,
Harold Varmus, M.D.,
Director.

The PRESIDING OFFICER. The distinguished Democratic leader.
Mr. DASCHLE. Let me commend the distinguished senior Senator from
Massachusetts for his summary comments with regard to the Satcher
nomination. I don't think anyone could have said it more persuasively
or more succinctly. As he noted, every single organization in this
country with any standing, with any credibility in regard to health
care, has said this is an extraordinary individual, a leader in health
care.
The Senate ought to confirm him today. Nothing else really needs to
be said.

[[Page S540]]

I commend the Senator from Tennessee for his leadership and his
advocacy of Dr. Satcher. I, secondly, join with all of my colleagues in
supporting very strongly the nomination today. I hope that we can pass
his nomination on an overwhelming vote, Republicans and Democrats,
given the circumstances that we have now faced over the last 3 years.
We ought to be saying to the country, unequivocally: ``We need
leadership in health care. We can no longer tolerate a void in that
leadership by not having a Surgeon General in the United States of
America.'' That is what this is about, acknowledging that void,
recognizing the need for leadership, recognizing the need for a strong
agenda in health care, spearheading efforts to place greater emphasis
on children's health, to intensify the youth antismoking campaign and
the array of responsibilities that the Surgeon General takes on as the
Nation's top public health advocate.
There shouldn't be any doubt about what this is all about. It is at
long last acknowledging the need for leadership, acknowledging the
tremendous contribution Dr. Satcher has made in an array of different
roles, especially in the Centers for Disease Control, and acknowledging
the opportunity that we now have to ask him to take on the nation's
most important public health role. I believe Dr. Satcher's nomination
deserves broad-based Republican and Democratic support.
I hope, Mr. President, that the people will listen to the words of
Senator Kennedy, Senator Frist and others as they have so eloquently
argued for his nomination over the last several days.
Mr. President, I fully support the nomination of Dr. David Satcher
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 to
take on this important role.
Dr. Satcher has served the American people as a family practice
physician, an educator and 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 the nation's public health structure. He tackled the national
problem of lagging childhood immunization rates, increasing the number
of children immunized by nearly 25 percent.
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 fatal.
Dr. Satcher also spearheaded a highly successful program to provide
breast and cervical cancer screening to women throughout the nation,
and launched an early warning system to detect and prevent food-borne
illnesses such as e-coli.
I have received an unprecedented number of letters and calls in
support of Dr. Satcher's nomination: physicians, nurses, hospital
administrators, public health organizations, individuals from my state
and others. Clearly, Dr. Satcher is already recognized as a guiding
force in our health care system. I believe the nation can only benefit
from asking him to serve as the nation's leading voice for public
health, science and medical education.
In a recent letter, Dr. Satcher wrote: ``If I am 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 they
can maximize their access to--and quality of--the health care they
receive.''
I believe Dr. Satcher's goals are on target. The nation will be well
served by a public health leader who can help us foster healthy
lifestyles, a consumer advocate who recognizes that strengthening our
health care system means empowering individuals to make informed
decisions about the care they receive.
I am confident that Dr. Satcher, a man of experience, integrity and
insight, will help us make these goals a reality. I hope that my
colleagues on both sides of the aisle will join me in confirming his
nomination.
I ask unanimous consent that a letter I received from the Director of
the Office of National Drug Control Policy, Barry McCaffrey, be printed
in the Record.
There being no objection, the letter was ordered to be printed in the
Record, as follows:

Executive Office of the President, Office of National
Drug Control Policy,
Washington, DC, February 10, 1998.
Hon. Thomas A. Daschle,
Democratic Leader,
U.S. Senate, Washington, DC.
Dear Mr. Leader: Dr. David Satcher's written response to a
question for the record from his confirmation hearing clearly
indicates that he supports the Administration's needle
exchange position. We do not have clear scientific evidence
to conclude that needle exchange programs do not encourage
drug use. His statement is fully consistent with federal law
which requires the Secretary of HHS to make two science-based
findings before lifting the ban on use of federal funds for
needle exchange programs. Specifically, the Secretary must
demonstrate that: (1) needle exchange programs reduce the
transmission of the HIV virus and (2) do not encourage drug
use.
Dr. Satcher has a distinguished background as the President
of Meharry Medical College for eleven years, as a faculty
member of the UCLA School of Medicine and the King/Drew
Medical Center in Los Angeles, and outstanding service as the
Director of the Centers for Disease Control since 1993. He is
eminently qualified to serve as the nation's Surgeon General.
Dr. Satcher will bring enormous expertise to bear on our
efforts to reduce drug abuse and its consequences in America.
I fully support Dr. Satcher's nomination for Surgeon
General.
Respectfully,
Barry R. McCaffrey,
Director.

Mr. DASCHLE. I yield the floor.
The PRESIDING OFFICER. If neither side yields time, time is charged
equally to both sides.
Mr. ASHCROFT. Mr. President, would you please inform the Chamber of
the remaining time for each side.
The PRESIDING OFFICER. The time of the proponents has expired; the
time remaining for the opponents is 8 minutes and 21 seconds.
Mr. ASHCROFT. Would the Chair please notify me when 2 minutes remain.
The PRESIDING OFFICER. The Chair will so advise.
Mr. ASHCROFT. Mr. President, I rise to say to the U.S. Senate that
this responsibility which we are considering today is a very important
responsibility. The Nation's doctor is a very important position. We
should be very careful about doing those things which can and need to
be done in making sure we confirm appropriately or deny confirmation
appropriately to someone nominated for that responsibility.
It is in that regard that I have sought to raise issues that are, I
think, fundamental to the values of the American people and ask serious
questions about them. I want to review those at this time.
The first thing I mention is that Dr. Satcher transmitted to the
Secretary of Health and Human Services a report favorably saying that
substantial Federal funds should be committed both to providing needle
exchange services and to expanding research into these programs. Both
recommendations, according to the CDC's comment, are reasonable and
appropriate. That transmission saying that needle exchanges should have
substantial funding was made in a report under Dr. Satcher's signature
going to the Secretary of Health and Human Services.
It is pretty clear to me that one of the leadership responsibilities
of the Surgeon General is the responsibility to inform the President or
the Secretary of Health and Human Services of policies that ought to be
adopted. This nominee has said that needle exchange programs ought to
have substantial Federal funding and they ought to be studied
carefully.
Now, in my view, it doesn't make sense to give dope addicts needles
with which to conduct their poisonous activity and with which to
propagate bad habits of intravenous drug use. What are we saying to
young people if the junkie comes along and says, ``Don't worry about
this, we have clean needles. The Government approves it. They give us
the needles to use.'' What are we saying to the families when the
needles from the junkies are left by the hundreds around the
neighborhoods so that young children will find them? As soon as you
provide free needles--a

[[Page S541]]

town that tried this found 300 discarded needles by junkies in one
week.
No. 2, this nominee for Surgeon General conducted studies on
individuals in Africa when the studies would have been unethical in the
United States. The regulations provide that you are not allowed to do
to other people what you won't and can't do to yourself. The New
England Journal of Medicine made clear the absence of ethics in this
situation.
No. 3, David Satcher persisted in conducting blind HIV studies of
newborns in the United States, ignoring the need to identify the blood
samples and notify parents of HIV infections in children, even after
therapies were developed which could help those children in those
settings. When the Congress got upset about it and decided to
discontinue the program altogether, Dr. Satcher said, ``No, we want to
continue it without telling parents and without identifying which of
the children is HIV infected,'' and came and lobbied the Congress in
that respect.
I don't think that calls us to our highest and best. I think that
accommodates America at something far less. So you have this pattern.
In addition, we have tried to get information from the Centers for
Disease Control and Dr. Satcher. They have given us partial bits of
information. The report in which the CDC commended the idea of Federal
funding for needle exchange was sent to us but it didn't have Dr.
Satcher's cover letter on it--conveniently didn't. The denial of needle
exchange support by Dr. Satcher conveniently didn't indicate that
Federal funds, provided through the CDC, had the sole purpose of
promoting needle exchange programs.

When we asked about the ethics of the African trials we simply didn't
get all the information from the CDC. We were not given memos internal
to the agency which we have received from other sources that have
raised the very ethical issues in CDC by medical personnel there that
we have been raising on this floor.
Now if trust is a fundamental component of the relationship between
the doctor of a nation and the people of the Nation, there has been in
some substantial measure a breach of the necessary trust in the absence
of candor and the absence of providing information in this setting.
Last but not least, let me say that Dr. Satcher has said that he
supports the President's position on partial-birth abortion. The
President's position has been that he is going to continue to make it
available in this country and refuse to have a reasonable law which
would prevent it. In my judgment, it is time for us to say that we
expect the leadership on health in this country to comport with the
understanding of the health community that partial-birth abortions are
not indicated, they are not necessary, and that to endorse the
political agenda of the President rather than the health agenda of
America is inappropriate. This is about whether someone who is
indifferent to infanticide can care for our children.
The PRESIDING OFFICER. The Chair advises the Senator that he has 2
minutes remaining.
Mr. ASHCROFT. Mr. President, I ask unanimous consent the time
remaining be yielded to the chairman of the Senate Labor and Human
Resources Committee so that he has the custom of concluding the remarks
in the Chamber in a way that is favorable to the nominee.
The PRESIDING OFFICER. The chairman of the committee, the Senator
from Vermont, is recognized.
Mr. JEFFORDS. Mr. President, first I want to thank my good friend for
allowing me to do this.
Mr. President, this is one of the relatively few times in the Senate
when we have had a cloture motion on a nomination.
I want to remind everyone of the fine, fine man that we are voting on
here today. I urge my colleagues to vote for cloture, and then to
confirm Dr. Satcher.
When we opened this debate last week, I stated that Dr. Satcher's
record of service to the people of the United States was exemplary. I
noted that his character and integrity were absolutely without blemish.
Nothing has been said over the past two days that has challenged these
assertions. Not even Dr. Satcher's critics question his professional
qualifications to serve in the positions for which he has been
nominated.
Senators Frist and Thompson, and others, have already spoken
eloquently about Dr. Satcher's commitment and integrity. They described
the unprecedented support Dr. Satcher enjoys within the medical
community, the public health community, and the research community.
They have also described firsthand their own experiences working with
the nominee to address public health issues in the State of Tennessee.
I wish to associate myself with their remarks and to urge my
colleagues to support Dr. Satcher's nomination. I know of no reason why
we should not vote for cloture, and then support Dr. Satcher.
Mr. President, I yield the remainder of my time, if any.

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