Nation’s Doctor May Be In, but He Seems Out of the Loop

As the anthrax scare unfolds, America’s national doctor has been largely out of sight, unable to reassure a jittery public about the health threat.

Even as Surgeon General David Satcher steps up appearances on talk shows and at news conferences, some health experts say it is too little too late.

The Bush administration, in its efforts to contain the escalating crisis, has virtually ignored its lame-duck surgeon general.

In part, that’s because Satcher is a Clinton administration holdover. But more broadly, the White House has been slow to relinquish control over information given to the public to anyone other than Cabinet-level officials, according to knowledgeable sources.

This changed abruptly about two weeks ago when “they realized it was a huge mistake” not to let the doctors talk, said an official at the Centers for Disease Control and Prevention.

“The early communications strategy was not a good one,” said Dr. Allan Rosenfield, dean of the Mailman School of Public Health at Columbia University. “There should have been experts with a medical and public health background speaking out about the health aspects of it. That’s what a surgeon general is for.”

Instead, the administration has turned primarily to two former governors, Health and Human Services Secretary Tommy G. Thompson of Wisconsin and Homeland Security Director Thomas J. Ridge of Pennsylvania.

“This administration will learn, like previous administrations, how important the surgeon general’s voice is in a time of health crisis. [But] they haven’t learned that lesson yet,” said a senior health official who worked for Thompson’s predecessor in the Clinton administration, Donna Shalala.

Before Sept. 11, the administration made little secret of its political differences with Satcher, whose term expires in February. In June, the White House distanced itself from a report by Satcher that called for comprehensive sex education for teenagers.

The White House declined to comment for this story, as did Satcher.

During his appearances in recent days, Satcher acknowledged that the government erred in not treating sooner postal workers who may have been exposed to anthrax. But, he said, “we’re learning together.”

“The American public and all of us should remain on high alert,” he said on CNN last week. “They should know that we are doing everything we can to stay ahead of the attackers as it relates to this bioterrorist attack.”

Dr. Jeffrey P. Koplan, director of the CDC, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have also made more media appearances to discuss the anthrax threat.

Increase in Information From Health Agencies

The CDC has begun issuing daily updates, and Koplan and others are holding regular briefings with the medical community and reporters. Initially, agency officials were too busy learning about the threat to convey much information about it.

The communications problem is compounded, public health experts said, because the Bush administration has yet to fill two key posts: director of the National Institutes of Health and commissioner of the Food and Drug Administration. Both the NIH and FDA have referred anthrax inquiries to Thompson’s office.

For his part, Thompson has made some missteps. When the first case of inhalation anthrax was reported in Florida, he suggested that tabloid photo editor Bob Stevens had contracted the disease by drinking water from a stream. Such a rare diagnosis should have raised concerns that something more serious was occurring, experts said.

Last week, Thompson suggested that people get flu shots to avoid confusing their symptoms with anthrax infection. A day later, after the CDC recommended the opposite, he reversed himself. If everyone rushed to get flu shots now, the CDC warned, those most at risk for influenza, including senior citizens and health-care workers, could have trouble getting them.

Satcher, a former director of the CDC, enjoys widespread respect from the medical community. Moreover, he has a style that effectively blends expertise and candor with a reassuring and calm presence, his supporters say.

“My sense is that their natural instinct is to put the political faces out front and not put the health faces out front,” the former Clinton administration official said. That approach backfired in Britain’s “mad cow” disease crisis, when political ministers wrongly reassured the public.

“The political figures always tend too much toward reassurance--and aren’t realistic enough about the risks,” the official said.

Thomas Milne, executive director of the National Assn. of County and City Health Officers, applauded the administration for recognizing its initial mistake and offering more access to medical experts. But he said more is needed.

“It would be good to hear from the surgeon general, who is viewed as the people’s doctor, in the context of calming major concerns and [offering] a reassuring voice.” But policy decisions, he said, “really should come from Dr. Koplan. We don’t need two voices doing that.”

Several of Satcher’s supporters note that he is no longer an insider at the Health and Human Services Department.

The Bush administration, when it took over, stripped Satcher of his role as assistant secretary of health, which came with a large staff and an inside track to departmental decisions on public health policy. Moreover, under an executive order signed by President Clinton, the assistant secretary of health has the legal authority to coordinate the department’s response to bioterrorism.

When Satcher released his report calling for sex education for teenagers, the White House instead called for abstinence.

“The president understands the report was issued by a surgeon general that he did not appoint,” Bush Press Secretary Ari Fleischer said in June.

Asked then whether Satcher enjoyed Bush’s confidence, Fleischer replied, “This is not a question I’m addressing.”

Satcher, who said in August that he intended to leave office when his term expires, said this month that he has not changed his mind.