Medical Examiner

Doctor, Doctor, Give Me the News 

Why doesn’t the Bush administration have a physician in chief? 

Illustration by Mark Alan Stamaty 

Most Americans, especially the thousands on Cipro, have probably noticed that while Secretary of Health and Human Services Tommy Thompson and Director of Homeland Security Tom Ridge both play doctors on television, neither is one.

Now that bioterror has replaced body-mass index as our greatest health concern, the United States desperately needs a national doctor. The absence of a trustworthy authority who could provide matter-of-fact explanations—or even acknowledge how much wasn’t known—was amply evident as the crisis began. Instead, we got from the administration unreliable assurances or contradictions. The Bush administration lacks a physician with the stature and independence of a C. Everett Koop, surgeon general during the Reagan administration, or a David Kessler, head of the Food and Drug Administration during the Clinton years.

While no administration could be expected to confront anthrax flawlessly, it is not just unexpected events that have caused this vacuum in medical leadership. There is a reason why President Bush and his team haven’t sought a top doc. They haven’t wanted one.

The lack of M.D.s speaking for the administration finally became so glaring that a few muzzled government doctors—Director of the Centers for Disease Control and Prevention Jeffrey Koplan and Director of the National Institute of Allergy and Infectious Diseases Anthony Fauci—have been allowed to speak. Even Surgeon General David Satcher, a Clinton appointee, who seemingly was bound to his chair with condoms—his advocacy of condom use in a June report on sexual health infuriated the administration—has now appeared on Larry King Live. But none of these physicians can offer the authoritative reassurance that a doctor supported by the administration could.

Surgeon General Satcher is certainly the likely candidate for national medical spokesman. That is, essentially, the surgeon general’s job description. It would have been especially fitting for the job to fall to Satcher because he also held the title of assistant secretary of health at HHS, a position, the Los Angeles Times reported, that came with the authority to coordinate the department’s response to bioterrorism. But early in the Bush administration, Satcher was stripped of the assistant secretary title and exiled from his downtown office to a satellite office in Rockville, Md. In spite of these humiliations, he determined to serve out his term, which expires in February.

Why didn’t the Bush team seek a physician in chief? Until last month, public health was a low administration priority. Bush has not yet appointed a head of the FDA or the National Institutes of Health.

The administration’s obsession with loyalty has also kept the administration from anointing a physician already in government as chief medical spokesperson. The Bush people are instinctively wary of career government employees—how can people who have been contaminated by working for a Democratic administration for the past eight years be trusted? Better to have the know-nothing but faithful Thompson speak than someone who hasn’t proved his fealty.

This is also an administration obsessed with controlling its message. As the stem-cell deliberations illustrated (oh where, oh where have those petri dishes gone?), decision-making is closely held in the White House. Not having a high-profile doctor, who would have been viewed as an alternate center of information about the issue, served the administration’s goals of secrecy and discipline.

The issue of controlling the message has also caused a rift between the administration and the very people who are on the front lines of any bioterrorism crisis: public health workers. The American Public Health Association, the oldest—and with 50,000 members, the largest—public health association in the United States, had been ignored by the administration until it was included in a conference call between Thompson and other health organizations after the first case of anthrax was reported. The HHS secretary urged the group to reassure the public that only one person had died and there was nothing to be alarmed about. The organization disagreed. “We said from the very beginning that this is a big thing,” says APHA spokeswoman Carole Zimmerman, both because of the likelihood of bioterrorism and the lack of knowledge about anthrax. Then an op-ed in the Washington Post by the organization’s executive director, Dr. Mohammad Akhter, stated that the nation’s public health system lacked the ability to respond to any major bioterrorism threat. This directly contradicted Thompson’s emphatic, thus terrifying, assurances that the government was prepared for all contingencies.

A national doctor might also have interfered with the administration’s inclination to frame medical issues as moral ones. They don’t want an independent thinker like Koop, who ended up angering the Reagan administration when he labeled AIDS a medical crisis, not a moral one. This inclination becomes explicit in the abortion litmus test that must be passed by any high-level medical appointee in this administration, a test that drastically reduces the pool of potential nominees. In an op-ed piece in the New York Times in April, former Clinton FDA official William Schultz wrote that the job of commissioner of the FDA—an agency that will be crucial in approving medicines against biological warfare—is in limbo because of abortion politics. Thompson promised during his confirmation hearing that the agency would review its approval of the abortion drug RU-486. Since approval can only be challenged for medical, not political, reasons, a review would almost certainly find the drug to be safe and effective. Any FDA nominee who agreed to review the drug would infuriate the Democrats; any nominee who agreed to stand by a review endorsing the drug’s approval would infuriate conservatives.

The abortion question also came up last May when the administration pointedly excluded the APHA from its expected place in the U.S. delegation to the World Health Assembly in Geneva. Invited instead was a lobbyist for the International Right to Life Federation. The APHA favors sex education, condom use, and abortion rights. Bush officials also excluded from the assembly those libertine organizations the American Medical Association and the American Nurses Association, a move that again suggested that this administration does not embrace strong, independent voices from the medical community.

Recently, in anticipation of the end of Satcher’s term, the name of a potential replacement has been floated: Dr. Kenneth Cooper, who is credited with coining the term “aerobics.” If Cooper is appointed surgeon general, he will embody all the forces that have governed the administration’s medical decision-making. He’s loyal: the Dallas-based Cooper has been Bush’s personal physician. He’s conservative: He opposes abortion. He’s a businessman: According to the San Antonio Express-News, the Cooper Aerobics Center has an annual budget of $36 million, and Cooper has his own line of nutritional supplements. Cooper’s main message, that most of Americans’ health problems are caused by inactivity and overeating, is undeniable. If we remain lucky in the coming years, being lazy and fat will remain our primary health problems. But in the world after Sept. 11, perhaps an aerobics king is not the person the administration should tap to be the nation’s chief doctor—unless he’s going to advise us to run for the hills.