Challenges Await Bush Surgeon General Nominee

President Bush has nominated Kentucky doctor James Holsinger to be the nation's new surgeon general. If confirmed by the Senate, Holsinger's impact in the office will likely depend on his relationship with the Bush administration.

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This week, President Bush nominated a doctor from Kentucky to be the next surgeon general. If the Senate confirms the nomination, James Holsinger would take on a job that has waxed and waned in power over the years.

NPR's Joanne Silberner reports.

JOANNE SILBERNER: By all accounts, James Holsinger is one of the nicest guys around. Holsinger at one time headed the University of Kentucky Medical Center. Stephen Wyatt, head of the College of Public Health there, used to work for him.

Dr. STEPHEN WYATT (Head, College of Public Health, University of Kentucky): He's a very gentle man. He does have a sense of humor, but he is very serious. He's very serious about the issue of health and health care and public policy.

SILBERNER: Holsinger has a Ph.D. in anatomy as well as an M.D. He's trained in cardiology and surgery. He's been undersecretary for health in the Department of Veterans Affairs in Washington and secretary of health for the Commonwealth of Kentucky. Holsinger himself isn't talking to the media. That's a tradition when you're up for a Senate confirmation hearing.

If confirmed, his effectiveness will depend on whether the administration bases its health messages on politics and how hard Holsinger pushes back, says physician and historian Fitz Mullin(ph). Moen has written about the history of surgeon's general. Ultimately, he says, the administration holds the power.

Dr. FITZ MULLIN (Physician; Historian): By and large, a person is constrained by their political seniors, who both can tell him what to say and when to say it, can constrain their travel and their accepting speaking engagements.

SILBERNER: Still, Surgeon General C. Everett Koop pushed back hard in the 1980s when the Reagan administration was promoting abstinence to prevent AIDS. Koop went to Congress to say that condom ads were crucial.

Dr. C. EVERETT KOOP (Former Surgeon General, Reagan Administration): The threat of AIDS is so great that it overwhelms all the considerations, and advertising, I think, therefore, is necessary in reference to condoms and would have a positive public health benefit.

SILBERNER: Koop's popularity soared and that scared subsequent administrations. In 1993, Joycelyn Elders had great hope for her bully pulpit when she was named surgeon general. She talked about it recently on NPR's NEWS & NOTES.

(Soundbite of archived interview)

Dr. JOYCELYN ELDERS (Former U.S. Surgeon General): I went to Washington to make a difference for our adolescents, or that was what I thought I went there for, and to improve the health of America. And I didn't really worry about other folk's agenda.

SILBERNER: But that attitude lost Elders her job the next year, after an off-the-cuff comment about masturbation as a type of sexual activity that does not spread AIDS.

Surgeons general often experience wins and losses. David Satcher, surgeon general from 1998 to 2002, couldn't get the government to support needle exchange programs, even though research showed that they reduce the spread of AIDS.

But Satcher was able to put out the first surgeon general report that established mental illnesses as medical conditions, not a weakness of will. Now Satcher directs the Center for Health Disparities at Morehouse School of Medicine. He says the big part of the job of surgeon general is being able to inspire.

Dr. DAVID SATCHER (Former U.S. Surgeon General; Director, Center for Health Disparities, Morehouse School of Medicine): The surgeon general has a major role in educating the American people about health issues, and I would go further than educate, to say motivate because communication is not just us getting as motivating people in terms of lifestyle and behavior.

SILBERNER: At the University of Kentucky, Wyatt says Holsinger can do that and that he has already demonstrated the backbone and the leadership qualities he'll need to be a good surgeon general. Wyatt points to the way Holsinger set up a school of public health at the University of Kentucky, cutting to academic jealousies and financial limitations.

Dr. WYATT: It's a huge success story that showed a lot of commitment to an issue, overcoming a lot of barriers and putting in place something that he deeply believe in.

SILBERNER: Secretary of Health and Human Services Mike Leavitt says, Holsinger has set the problem of childhood obesity as his top priority. The Senate has not yet announced the date for the confirmation hearing.

Joanne Silberner, NPR News.

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