Jewish World Review April 9, 2002 / 28 Nisan, 5762

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports

No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors | Just as we sat down to reactivate our carpal tunnel syndrome, in order to complain that the four most important public-health positions in the country are or will be vacant, President Bush selected nominees for two of them. It's a good start, but two major obstacles remain to restoring some sanity to the situation.

One is that old bugaboo, political and ideological litmus tests -- no small problem at that "bloody crossroads" (to borrow from Lionel Trilling) where medicine and public policy meet. The other is that, now more than ever, we must find and empower the best people for these and other public-health positions that have such heavy impact on both national health and national security.

If litmus tests are a luxury we can no longer afford, so is mediocrity. Wise and earnest people can disagree on issues such as abortion and stem cells -- in our case, one of us agrees with the president, one doesn't -- but we both agree that when the Osama bin Ladens next come calling, we'd better be prepared. In times of war and on-call terrorism of all flavors -- nuclear, bio, cyber, and chemical -- prudence should outweigh patience and politics.

For far too long, vital public-health positions -- director of the National Institutes of Health, surgeon general, FDA director -- have been vacant. The NIH job has gone unfilled for more than two years, and at least five of its major institutes lack permanent directors (including those for mental health and drug abuse). Prominent scientists have been reluctant to accept positions within the NIH until the director position is filled. The top job at the FDA sits empty after more than a year. To make matters worse, the current director of the Centers for Disease Control and Prevention is leaving next month with no successor on tap or in plain sight.

But we may be seeing the light at the end of the funnel. Last week, President Bush nominated Elias Zerhouni, M.D., to run the NIH and Richard Carmona, M.D., to replace the departed David Satcher, M.D., as surgeon general. Both nominees are qualified. Carmona, 52, is a trauma surgeon, clinical professor at the University of Arizona, former Green Beret, and part-time lawman. Zerhouni, 50, is a high-level administrator at the Johns Hopkins School of Medicine and chief of its radiology department.

It's with pleasure that we note Zerhouni's specialty -- radiologists, as we can assure you, being the most incisive, well-organized, and benign of all practitioners. However, both men must win confirmation from a Senate not exactly renowned for the aforementioned qualities. Here's hoping that senators judge the two men on their professional qualifications, not their private beliefs, and move expeditiously to confirm them.

These doctors-turned-public-servants are going to have their hands full trying to ready the country for whatever comes our way, while simultaneously reinvigorating their own domains. Why have so many vacancies gone unfilled? One answer, of course, is that ever fewer qualified people seek high-level government service in any field. What with the ordeal that any high-level political nominee must face to get confirmed -- having his past rummaged through, dredged up, and passed around; getting smeared by enemies; suffering financial loss; watching the emotional toll on loved ones -- well, who needs it?

Another disincentive is a keen awareness that a nominee may be walking into bureaucratic and political minefields. Many fine physicians with a calling for public service in the current emergency are understandably reluctant to accept jobs until they know who their new boss will be and what course that boss intends to steer. Moreover, insiders tell us that morale within the CDC and NIH suffered terribly from Clinton-era political correctness. Those wounds take time to heal.

But taking on the challenges of biowar requires more than medical expertise, political acumen, and a thick skin. Thirty years ago, America's senior public-health officials were barely known outside their fields. AIDS changed all that. The surgeon general became not just a public figure but also a national teacher, and C. Everett Koop showed us just how bully a pulpit the surgeon general's job could be. In the weeks following 9/11, public- health officials became fixtures on national TV. People listened. They're going to have to, again.

We have a national medical emergency. This is no time for political, ideological, and medical litmus tests. We need a surgeon general and directors of the NIH, FDA, and CDC, stat!

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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10/26/01: Your right to medical privacy --- even in terror time
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