U.S. SURGEON GENERAL'S TERM TO END

WASHINGTON - David Satcher doesn't mind telling Americans what they might
not want to hear.

As surgeon general, he's praised programs that give drug addicts clean
needles to shoot up. He's said there's no evidence that teaching teens
sexual abstinence by itself is effective. He's said Americans should learn
to accept gays and lesbians for who they are.

If the science is clear, he says, that's enough for him. And when the White
House spokesman denounced his report on sexual health, he figured that just
comes with the territory.

"The surgeon general has to be prepared to be beat up from the podium of
the White House," said Satcher, whose four-year term ends next week.

He leaves with a thorough understanding of where science ends and politics
begins.

"When you say drug addiction is a medical problem, the public health
science is overwhelming. Does that mean the Congress is going to act that
way when it passes legislation? People are much more comfortable putting
drug addicts in jail, in prison, than they are in funding programs for
treatment," he said in an interview this week.

He says he's proud of taking on politically tough issues like sex, and
emotionally tough issues like suicide and mental health.

It's easy to be honest, he says, when the science is clear. It's much
harder when it isn't. After Americans began getting sick with anthrax,
there were more questions than answers.

Satcher sees his role as communicating established scientific information,
so he figured he should lay low, given the lack of solid information.

But with misinformation swirling and people panicking, it became clear that
he needed to start talking, he said.

"When it was obvious there was confusion and there was concern, I felt it
was appropriate that the American people hear from the surgeon general,
even if it was only to say what I often said, which is we're all learning
together," he said.

His role was essential, providing some of the "only clear messages we got,"
said Dr. C. Everett Koop, surgeon general under President Reagan.
Politicians, Koop said, "were saying we have everything in hand," while
Satcher told people that much was unknown.

"All you've got to be with the public is honest," he said.

Overall, Koop concludes, Satcher was effective by simply talking
straightforwardly about important issues. "He didn't do it in a radical
way. He doesn't rant and rave from a pulpit," he said. "He just says what
needs to be fixed."

The surgeon general's position has been a magnet for controversy. In the
1960s, it was radical to suggest smoking causes cancer. In 1980s, it was
bold to talk frankly about AIDS.

The position had been vacant for three years when Satcher took office. His
predecessor, Joycelyn Elders, was fired after she suggested that teaching
teens about masturbation made sense.

Just two months into Satcher's term, President Clinton decided to bar
federal funding for needle exchange programs, which give addicts clean
needles for dirty ones in hopes of stemming the spread of HIV, the virus
that causes AIDS. Research found that needle exchange programs do not
increase drug use, but Clinton decided that they send the wrong message.

Satcher served as assistant secretary for health as well as surgeon
general, meaning he was caught between supporting his team's decision and
speaking frankly about what the science showed. On the day Clinton's
decision was announced, he ducked a question about his personal feelings.

It made it difficult for him to truly be independent, he said.

"I hope that ... the American people will (always) be able to say the
surgeon general does not speak for the administration," he said. "Is that
comfortable when your budget comes from the administration? No, it's not."

Sex and drugs generate headlines, Satcher said. But he believes some of his
most rewarding work involved mental health and suicide prevention.

"I didn't realize there were so many people out there hurting because
somewhere along the way they lost a loved one to suicide and they've been
walking around blaming themselves, saying what did I do wrong, why didn't
he or she love me enough to want to live," he said.

One of the most gratifying experiences, he said, was being able to tell
people that most suicide victims were suffering from mental illness of some
sort and "you're not responsible."

Satcher's rise to the post sometimes called "America's family doctor" began
on a farm in Anniston, Ala., in a home with parents who didn't finish
school and had little money. With far from adequate health services, he
almost died of whooping cough at age 2.

As he went through college and medical school, Satcher was often the only
black man in the classroom.

He says it's helped him make a real difference in such a public post.

"Based on my own experience ... I know role models make a difference," he
said. "When you see someone in a position like that it raises your
aspirations, it raises your hope about what you can do in your own life."

But being a black man in a top post has also had its disadvantages.

"This is still a town where it's not easy for African-Americans, especially
African-American men, to get the same kind of credibility," he said. "I
think we're still struggling with our history."