Fill the Medical Leadership Void

Ever since Surgeon General Joycelyn Elders resigned in 1994 amid controversy over her remarks on sex education, Americans have lacked a leader who could help them make sense of a raft of confusing public health issues. Sugar substitutes are deemed safe one day and toxic the next; there are legal battles over how much responsibility the tobacco industry should assume for the ravages of smoking; medical research leaps ahead of our ability to make ethical sense of its effects.

Until recently, it looked as if that leadership void was going to be filled by Dr. David Satcher, the Clinton administration’s able nominee for surgeon general. Last fall, a Senate committee voted to confirm Satcher, who is supported by leading health groups. Senate Majority Leader Trent Lott (R-Miss.) promised to hold a confirmation hearing in the full Senate by early February.

Last week, however, Sen. John Ashcroft (R-Mo.) announced that he had placed a hold on Satcher’s nomination, a privilege of U.S. senators. The time may have come to challenge this quaint Senate custom, which has also been used against federal judicial nominees.

As head of the Centers for Disease Control and Prevention, Satcher has ably supervised the nation’s watchdog agency for chronic and emerging diseases. This family physician, who trained in Los Angeles early in his career, has won wide respect for helping the CDC broaden child immunization and increase water and food safeguards.

Not all of the doctor’s views will match those of every other American. Ashcroft says he is troubled by Satcher’s support for giving drug addicts clean needles in exchange for tainted ones. But this is a proven method to substantially reduce the rate of HIV infections among addicts and to lure more of them into treatment.

Satcher’s chances should not turn on an opinion he holds that is scientifically sound and at most a matter of honest debate. The surgeon general’s job is to develop medical consensus and articulate a broad public health vision, tasks for which Satcher seems well prepared. The rest of the Senate should override Ashcroft, who is abusing his prerogative, and schedule a vote for Satcher.