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 tunnel. 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!