August 2, 2006

Today, the news is full of the nation’s spontaneous outpouring of regret, as we bid goodbye to our beloved Surgeon General Dr. Richard Carmona. What, you never heard of him?

When he was confirmed by Congress four years ago, Dr.Carmona, described by a colleague as a ‘charismatic cowboy,’ seemed like the can-do, ‘hell with the bureaucracy’ kind of guy our President likes; a tough-talking emergency room physician who jumped out of helicopters. A man who took out a gun-wielding felon in a confrontation on the highway. A man’s man. He had a reputation for a hot temper, for being difficult to work with. Which makes it all the stranger that during his tenure there was barely a peep out of him.

Compare his career with Surgeon General C. Everett Koop. You probably still remember him from the Reagan years. That’s because he took the politically risky, but admirable course of warning the public about the dangers of HIV/AIDS while advocating for effective prevention and treatment. This good doctor won respect from all points on the political spectrum because he put people ahead of politics

Then there was Dr. Joycelyn Elders. She was a pediatrician who had devoted her career to public health. The religious right had it in for her from the beginning, labeling her ‘The Condom Queen.’ I guess if you’re a Black woman who speaks out, being called a queen is a risk you have to accept. Dr. Elders was at a public forum on sex education, when a questioner asked her if a sex education program would teach young people anything about masturbation. She said that it would be mentioned as one of the topics discussed in teaching human sexuality. All hell broke loose. Now Dr. Elders was portrayed as being on a mission to teach masturbation techniques to the nation’s youth. In case they hadn’t figured it out themselves. President Clinton, showing the style of leadership characteristic of his administration, tossed her overboard.

She was succeeded by Dr. David Satcher,, a family physician, college president, and, like Dr. Elders, an African-American who grew up poor in the South. I admit I had a major crush on him. He came to Rhode Island to speak about health care for the mentally ill, a very under-served population. He was surrounded by a group of cool D.C. professionals, one of whom called the present administration, ‘amazing’. He was so suave it was impossible to tell if he was amazed at the pace of change, or amazed that these nimrods got elected, though I suspect the latter. Dr. Satcher was soft-spoken but politically brave. He supported needle exchange to help reduce the spread of AIDS and Hepatitis. And he set a ten-year plan called ‘Healthy People 2010’, a plan whose goal is to — Increase Quality and Years of Healthy Life and To Eliminate Health Disparities! Is that cool or what? I’m not betting on us eliminating health disparities by 2010, but you have to set the goal. What if President Kennedy told NASA to aim, ‘kind of near the moon’? How far would that get us?

So Dr.Carmona could have just kept the momentum going, but his tenure was marked by what is tactfully called, ‘a low profile’. I suspect that his profile was low because the Bush administration was sitting on his head. We have an administration that is so one-sided, that no one dares to go against the President. Congress should have asked many more hard questions about Dr.Carmona before confirming him, but they are afraid of seeming cranky. The flip side of this is that if Dr.Carmona disagreed with the administration on any issue, there wasn’t anyone likely to stand up for him. (I heard some researchers are working on a way to grow backbones for Democrats.)

What passes for political bravery today is Dr.Carmona’s parting shot, a report that second-hand smoke is bad for you. Who would have thought? This has actually ticked off the tobacco people though, so I should give him credit for doing at least that much.

Was it any loss to have the office fairly inactive for four years? You bet. During that time we had the SARS crisis, a flu vaccine shortage in 2004, and a supply problem in 2005 that had the elderly panicked and public confidence damaged. We continued to have large numbers of Americans unable to access health care, and a Bird Flu threat that may or may not happen. In any case we are totally unprepared. We had people quitting the Food and Drug Administration because politics was suppressing science in the evaluation of the ‘morning after pill’. We have a cervical cancer vaccine that could save lives, but we waste time debating whether it’s moral to use it. We had Hurricane Katrina. Is New Orleans prepared to handle another hurricane? Governor Blanco declared a day of prayer. (I’m praying that some of our politicians are ready to take responsibility for doing their jobs). We have a health care system that spends more money and gets worse outcomes than other developed nations, and it’s not getting better.

I wish Dr. Satcher would apply for the Surgeon General position, or Dr. Elders, or Dr. Koop, although he’s pretty old now. We need a really good, honest and fearless advocate for the nation’s health, and a Congress with the political courage to back them up. I’m not holding my breath.’