SURGEON GENERAL ATTENDS TO HEALTH

After 10 weeks as U.S. surgeon general, a job that has become a political
lightning rod, David Satcher focused his first report as the nation's top
doctor on tobacco use among minorities. But Satcher insists that he'll have
little role in the coming political battle over whether to pass a sweeping
tobacco bill.

He says his fight is to keep the public health risks of tobacco use and
other unhealthy lifestyle choices before the public.

Until his Feb. 13 confirmation, Satcher, 57, was director of the U.S.
Centers for Disease Control and Prevention. A physician and scientist,
Satcher received medical and doctoral degrees from Case Western Reserve
University in Cleveland. He also served as president of Meharry Medical
College in Nashville.

In an interview with Jessica Lee of USA TODAY, Satcher discusses smoking,
AIDS prevention, gun violence, alcohol and narcotics abuse — and even the
new drug Viagra.

Q: Why are smoking rates among minority youths rising more sharply than
those among white teen-agers?

A: They (minority youths) still smoke less than whites. We don't claim to
know why. One of the conclusions in the report is that there is no single
reason. Obviously we know that advertisement and promotion have a role. We
also know there's a disproportionate impact of advertisements on minority
communities. We say it's known to be a major factor, but it's not the only
factor.

Q: Will counteradvertising be where you try to make the biggest impact on
reducing teen smoking?

A: As surgeon general, most of my efforts are going to be on prevention, in
terms of working with individuals and families. I support the push to
reduce the appeal and the access of tobacco to youth very strongly. But the
major thrust of the surgeon general will be promoting healthy lifestyles
for children and families.

Q: Are you going be part of the administration's lobbying effort to get
Congress to pass a tobacco bill?

A: Our role is to make sure we put into clear perspective the public health
aspects of smoking, some of the causes, risk factors, results, some of the
things that tend to work in terms of helping people quit.

Q: But the smoking debate is at the political stage now. What will your
role be?

A: When people do political things, they also need input about the public
health effects. They don't ask me to come up and talk about politics. They
ask me to talk about the public health.

Q: Tobacco companies are talking about freedom of choice. How will you
respond to that?

A: The public health response is that every day in this country 3,000 new
teen-agers become smokers. More important than that, 80% of new smokers
begin smoking before they are 18 years of age. So most people who become
addicted to tobacco become addicted before they are old enough legally to
purchase cigarettes.

So obviously we need to do anything we can do to reduce the appeal of
tobacco to teen-agers and the access. If it's illegal to purchase tobacco,
then we have to make sure that we work to help see that's enforced, because
when people become addicted to nicotine, it is not easy to quit. Seventy
percent of people who smoke would like to quit. Yet every year only 2.5% of
them are able to quit.

Q: Some in Congress say there is more trouble with illegal drugs such as
marijuana than with legal tobacco and that more federal funds should be
devoted to eradicating drug abuse than tobacco use. How do you respond?

A: Marijuana is illegal and dangerous and wrong. That's the message we have
to send to teen-agers. There are a lot of things about marijuana that we
don't know yet. It's wrong. Tobacco is not illegal, but it's illegal to
sell tobacco to teen-agers. Therefore, there is illegality in the market.
We hope that the FDA will be able to regulate it so it will be illegal to
market to teen-agers, too. But teen-agers need to know that tobacco is a
very dangerous drug. It is as addictive as cocaine, if not more so.

Q: What about efforts to control alcohol use compared with those to control
tobacco?

A: Alcohol use, especially by children and youth, is very dangerous. There
are many concerns we have about the role of alcohol in violence, the role
of alcohol in indiscreet, inappropriate sexual behavior, the role of
alcohol in motor vehicle crashes and other unintentional injuries.

Q: On needle exchanges to reduce the transmission of HIV (the AIDS virus),
is that issue dead now that the president has decided not to use federal
funding?

A: The first battle was to get a clear message out about what the science
says about needle-exchange programs. And we did that. We clearly said that
based on scientific studies, it is very clear that needle-exchange programs
done properly in the context of a comprehensive prevention program can
reduce the spread of this virus.

No. 2, there's no evidence that in the process needle-exchange programs
increased the use of drugs or encouraged the use of drugs. That message is
very important to people in communities throughout this country. Regardless
of what the federal government does about funding, that message helps local
communities. In some cases it helps them to get state funds. In other cases
it helps them to get private funds. But it gives them credibility because
they now have a clear message about what the science says.

So we're going to continue to spread the message. We have to educate people
about injection drug use. We don't make decisions about the federal
funding. Our role as scientists is to do what we did.

Q: You've said teen pregnancy, violence and drug abuse will be your
priorities. This week we've seen a 4-year-old shoot a 6-year-old. Is there
some special campaign you'll press against gun violence?

A: First, let me make sure you know what I mean when I say violence is a
public health problem. I mean that violence is preventable and that it is
susceptible to the public health approach. Clearly, the ease of access to
guns to children, unsupervised access, is a major concern. I know that this
has been politicized.

The Centers for Disease Control had money taken away from it because the
(National Rifle Association) said we were pushing gun control when we
really were trying to talk about the public health approach. We stand by
that. Even before Jonesboro, (Ark., where four middle-school students and a
teacher were fatally shot March 24) we stood by it.

I think it is unfortunate that we do not take seriously the responsibility
that goes with having a gun in this country. And I don't want you to
politicize it.

Q: What do you think of this drug Viagra?

A: Obviously, the problem of impotence is real for many couples. We have to
help people deal with that. There are various ways to do that. It seems
like for many men this new drug, and I think it's still early, has been
effective. There's some question about whether it's not also effective for
women. . . .

We're learning more about this drug Viagra. We're getting great testimonies
from men about how great it works. Sexual relationship is a very important
part of the relationship be- tween men and women, especially in the context
of marriage. Ann Landers put it best: After all these years and all our
discussions, what we forget is that probably the most important sexual
organ is the brain.

Q: What's your best experience of the 10 weeks as surgeon general?

A: The most positive experience has been the response of people to having a
surgeon general. It's just been overwhelming. I have thousands of
invitations to speak from all 50 states and several countries outside the
United States. I get a lot of letters from people raising concerns with me.

Q: What's the hardest test you've faced as surgeon general?

A: The most challenging thing has been to try to maintain the integrity of
the office of the surgeon general. I think the independence of that office
relates to the fact that you have this direct communication with the
American people and the fact that the American people rely on the surgeon
general to bring them the best science and to tell them the truth. I don't
want to stay away from political issues; I just don't want my tenure to be
defined by politics. I want people to be able to look to me for good
science and health advice.

©COPYRIGHT 1998 USA TODAY, a division of Gannett Co. Inc.

Checked-by: Richard Lake