Satcher morally unqualified to serve as Surgeon General

When is it permissible for a doctor to treat a human being like a laboratory rat?

The pagan Greeks thought they had settled that question 2400 years ago, when they said, emphatically, Never.

But President Clinton's surgeon general nominee, Dr. David Satcher, has now reopened the issue. He believes it's okay to use human beings like so many rodents provided they live in poor Third World countries.

Four centuries before the birth of Christ, the Hellenic healer Hippocrates composed a pledge for doctors to swear by the gods Apollo and Aesculapius. "I will," says the Hippocratic Oath, "follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous."

In 1964, with the atrocities of Nazi doctors fresh in mind, the World Medical Association convened at Helsinki. The doctors there issued a declaration aimed at governing that area of modern medical research designed to test the relative effectiveness of alternative therapies for people suffering from debility or disease.

The Declaration of Helsinki confirmed that every physician is bound by this law: "The health of my patient will be my first consideration."

The collectivist thinking then championed in the Communist world was explicitly rejected. A doctor was strictly forbidden from reducing an individual human being to an experimental tool to maximize the well-being of the state or any other group. "In any medical study," said the declaration, "every patient-including those of a control group, if any-should be assured of the best proven diagnostic and therapeutic method....

"The physician can combine medical research with professional care, the objective being the acquisition of new medical knowledge, only to the extent that medical research is justified by its potential diagnostic or therapeutic value for the patient."

Would-be Surgeon General David Satcher has stepped over this bright moral borderline recognized by good doctors from Hippocrates to Jonas Salk. He claims instead that it is all right to subject your patients to a treatment you know will kill them if the data you gain from doing so help some other group or population of people.

From 1991 to 1993, the National Institutes of Health (NIH) sponsored research in the United States and France to discover if the antiviral drug AZT could be used to prevent the transmission of the AIDS virus (HIV) from a pregnant mother to her child. The research was conducted, in the lingo of the medical researchers, as a "randomized, doubleblind, placebo-based trial." This meant that some women were given real AZT and some were given fake AZT (a placebo)-but that neither the women themselves nor their doctors would know who got which.

This research was indeed ethical. The doctors honestly didn't know whether AZT would have a positive or negative effect on the babies. The intention at all times was to help all babies in the research group live healthy AIDS-free livesand, given that AIDS is always fatal, the experimental treatment was worth the risk.

In December 1993, an independent NIH review board examined the data accumulated to date. The results were clear: Any AZT at all was better than none.

Better still, according to Doctors Sidney Wolfe and Peter Lurie of Public Citizen, who have studied the data, the evidence showed that "shorter and longer AZT treatments may have equal efficacy:" In other words, cheaper treatments might even be better than more expensive ones. Both saved about two-thirds of the babies who otherwise would have died from AIDS.

The NIH responded by immediately terminating the research and putting all the pregnant mothers still in the program on AZT. No more placebos were given-in the United States or France.

But, remarkably, both the NIH and the Centers for Disease Control and Prevention (CDC) went ahead with similar placebo-based studies on Third World mothers. These were purportedly designed to test shorter, cheaper AZT treatments-treatments the original test had already proven were far better than placebos.

On April 28, 1994, five months after the results of the U.S.-French study were known, Dr. Satcher, then and now the director of the CDC, bragged about the benefits of these Third World experiments when he testified about his budget in the House Appropriations Subcommittee on Foreign Operations.

"What may not be readily apparent to all is how much CDC and the United States have learned and benefited from our international health activities, including those related to HIV/AIDS prevention," Satcher said. "First, it is clear that in some instances research relevant to both developing countries and the United States can be conducted more efficiently and expeditiously in a developing country setting. Examples of such research, already detailed above, include our overseas studies of HIV transmission from mother to child."

Satcher knew that babies who could be saved by AZT would die in his "developing country" research because CDC-sponsored researchers were giving them placebos instead of medicine.