San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Sunday, November 9, 1997 - Page 3/Z3
Sabin Russell, Chronicle Staff Writer

After a stormy tenure of only 16 months, Dr. Elders returned to her old job in January 1995 as a pediatric endocrinologist at the University of Arkansas School of Medicine in Little Rock. Her plain-spoken approach to such topics as sex education, AIDS, drug abuse and -- yes -- masturbation, have ever since kept her in heavy demand on the U.S. lecture circuit.

Whether she is drawn to controversy, or whether it simply finds her, Dr. Elders has never been at a loss for words. She remains a wellspring of insight and refreshing candor on difficult issues of the day. -------------------------------------------------------

Q: Do you feel you've been able to speak more freely since you resigned as surgeon general?

A: No, I don't. I never felt any inhibitions about saying what I thought when I was surgeon general. Maybe I should have felt inhibited, but I didn't. I felt that I was the people's surgeon general, and I should be out there always speaking up for them.

Q: Do you have regrets that you weren't more circumspect?

A: No, I don't. And, again, maybe I should have. I enjoyed being the surgeon general. I did it the very best way I knew how. And if I had it all to do over again, if I started this minute, I would do it exactly the same way.

Q: One of the senators during your confirmation hearing, who favored your confirmation, said: ``Dr. Elders has degrees from many schools, but not from the school of diplomacy.'' Is it that some people are just born tactful and diplomatic and some people aren't?

A: No, I think you learn that. I felt strongly that I should speak very clearly and very forcefully. I'll never get up and say anything that's not mine.

Q: Let's talk about some current controversies. What do you think of the African AIDS trials, in which women in the Ivory Coast are being given varying dosages of AZT, with some women getting a placebo? A lot of medical experts are saying this could not have been performed in the United States, so it's unethical to do it in Africa. Do you have a point of view on this whole debate?

A: You know, you're in a very, very difficult area for me. I think, in America, we would not think of doing the placebo trials. So you can say, ``Well, if you wouldn't think of doing it in America, why would you do it in Africa?'' That's one point of view. The other point of view is that if we can really look at this and find a dose, people will get treated who would not have been treated at all.

So, you could argue both sides of the question and make points on both sides. I think if I was up against the wall, I would use the study to find out the information so we could absolutely get the data. Then we could go in and, hopefully, provide treatment.

Q: This is a difficult issue for you in many ways, because Dr. David Satcher, director of the Centers for Disease Control, is one of the people who signed off on this. And, obviously, he's up for your old job. What do you think of Dr. Satcher?

A: I think that Dr. Satcher has proven to be an excellent administrator. He's an excellent physician, he's well-trained and well-versed in preventive health medicine. I like him a lot.

Q: What makes a good surgeon general?

A: You're primarily an administrator. But if you're going to go out there and be active and aggressive and take it on -- I think that's why all this country knows Dr. Koop. He took it on and ran into the buzz saw. And, of course, I probably hit a buzz saw. But I think I made people think. Once we are aware of our problems, we'll begin to discuss them, and we'll do something about it.

Q: Let me bring up another controversy that you might be right in the middle of if you were still in Washington: Should the federal government support needle exchanges to prevent the spread of AIDS among drug users?

A: If there was one thing that I should have done when I was there, this was it. . . . They had this ruling that (federal funding of needle exchanges would be approved) if the surgeon general, after reviewing all of the data, felt that it did not increase drug abuse and it reduced the transmission of

HIV.

There is no question. The data has been reviewed five or six times. Every study has said it reduced transmission of HIV disease; it does not increase drug use. And yet we have failed to provide clean needles, because we're sitting around saying, ``Well, it might say that we support drugs.'' I can't believe that our government would just sit and allow people to die because of how they think it might make them look.

Q: I guess you're saying that if you had it to do over again, you would have approved needle exchanges back then.

A: Listen, you know I spoke out about everything else. (Laughter) And I would have called a press conference and just spoken out about it. Then they would have had a real reason to fire me. (Laughter) But at least, we probably would have gotten it done.

Q: Do you fault President Clinton for not having more political leadership on this issue?

A: No.

Q: What do you think of him? He fired you, after all.

A: I really have the utmost admiration and respect for President Clinton. I feel his heart is in the right place. I feel he's a compassionate person and that he wants to do the right thing. I just think Washington is a place where it's an awful lot harder to do the right thing.

Q: Another controversial issue is whether people with AIDS -- or any other disease, like cancer -- should be allowed to smoke marijuana. There is a lot of anecdotal evidence that it makes them feel better and may actually make them more healthy.

A: I have for a very long time supported the medical use of marijuana, as a prescription by doctors, if they feel their patients would benefit from it. If it makes a patient with cancer feel better, a patient with AIDS feel better, if it helps someone who has glaucoma to feel better, whatever, I support that.

Marijuana has never -- that we know of -- killed anybody. And we've got cigarettes out there in the stores that kill 400,000 people a year. I'm just saying that I think marijuana has been so politicized that we've lost our ability to think rationally.

Q: If the office of surgeon general is associated with any one issue, it's tobacco control. What do you think of the proposed tobacco settlement?

A: I think it shows that we've finally made a little crack in the armor of the tobacco industry. But I'm not sure the tobacco industry didn't have super lawyers and was able to see through some of the deals.

Q: There have been some complaints by other countries that this is an agreement to allow the tobacco industry to exit gracefully from the United States market and finance the settlement by addicting people overseas. A: I think that's happening. It's happening all over, and I think that we should be ashamed.

Q: You got into trouble once for saying -- I guess in response to a reporter -- that maybe the country should study the issue of legalizing drugs.

A: Absolutely. I do think that. I feel very strongly about that. If we are going to spend $17 billion to $70 billion a year on trying to keep drugs out of the country, on the incarceration of people -- when we spend very little on treatment and education by comparison -- we should really study what it is we should do.

Q: There are a number of people on the right wing of the political spectrum here who think we should legalize drugs. Do you find yourself in agreement with them?

A: You know, I don't know which side is right, and I don't know which way to go. This was one of the reasons why I felt we should look at this nationally. But we are so short- sighted. We have put ourselves in the position that we aren't going to even talk about it.

Q: Speaking of words that get you in trouble, I have to ask this: Are you really writing a book about masturbation?

A: Yes, I am.

Q: Is there really a whole book in the subject?

A: There are whole books on all of the myths. There are more how- to books out there, and nobody needs a how-to book. That's ridiculous. But I think parents need to be able to talk to their children sensibly and with the facts.

Q: Why do you think there's such a taboo about this subject? A: Well, it's preached in our churches.

Q: So, it's primarily religious?

A: Yes. That's why a theologian and I are working on it together. But it's not really written for the church. It's got to be written more for ordinary people.

Q: You've mentioned frequently that teenage pregnancy is the single most potent threat to the social fabric of the United States. In plain terms, if teenagers were masturbating, would they be less likely to have sex with each other?

A: Well, obviously, if they were masturbating and didn't engage in other sexual activities, we would markedly reduce teenage pregnancy. But let me say this: We have to understand that the problem with teenage pregnancy is that 70 percent of teenagers that become pregnant are made pregnant by adult men. And 84 percent of those less than 14 were made pregnant by somebody in their own home.

Q: Some people might say that if we don't discuss sexual issues with children, we won't draw their attention to it, and it won't become a problem. Don't they have a point? A: I think they have a very negative point. That's saying ignorance is bliss. It's been shown that the more the young have had sexuality education, the less likely they are to go out and engage in sexual activity. You see, many children learn about sex from the radio, the TV, the girlie magazines, the streets and their peers.

Q: There seems to be a subtext concerning why you're controversial: that you are an African American woman. One of the subjects Americans get uptight about is sex, and the other subject they get uptight about is race. President Clinton has said we need a dialogue on race in America. If you were participating in that dialogue, what would you have to say? A: We are already having a dialogue about race in America, and I think we've really made a lot of progress. I lived through absolute segregation in the South -- born in the '30s and then slowly watching the change with integration. We went through a period where, for a while, even if you liked black people, you didn't say anything. Then we went through the period where all of a sudden you didn't say anything negative about black people, regardless of what you thought -- because it wasn't in vogue.

Now I think we're slowly getting to the point where we are really expressing our true feelings, even though sometimes it looks like things have gone back.

Q: It seems as if some of the racial issues in this country now are more nuanced and complex than they were 30 years ago. Now we have issues like affirmative action, where even black men, like Ward Connerly in California, are using the words of Martin Luther King Jr. -- to say that people should be judged not by the color of their skin but by their character -- to try to reverse affirmative action programs. What are your thoughts on the subject?

A: Yes. I very strongly support affirmative action. I feel that affirmative action was never really designed for black people. It was designed for sick institutions that were not hiring minorities, or not promoting them, or not giving them a chance. And I think they're still sick, and need the medicine. Four hundred years of slavery and negativism against women and against blacks cannot be cured by 25 years of affirmative action.

Q: How long do you think it will take?

A: I think it's going to happen very gradually. We probably won't even notice that it's happening. We'll just wake up one day and realize that it's changed. -------------------------------------------------------

DR. JOYCELYN ELDERS

-- 1933: Born August 13, in Schaal, Ark.

-- 1952: Receives B.A. from Philander Smith College.

-- 1956: Discharged from U.S. Army as a first lieutenant with training as a physical therapist.

-- 1960: Earns M.D. at the University of Arkansas Medical School.

-- 1964-76 Joins pediatrics faculty at the University of Arkansas.

-- 1978: Receives board certification as a pediatric endocrinologist.

-- 1987: Appointed director of Arkansas' Department of Public Health.

-- 1993: Is appointed U.S. Surgeon General.

-- 1994: Clinton administration requests her resignation.

-- 1995: Returns to University of Arkansas Medical School. -------------------------------------------------------

WHERE TO SEND SUGGESTIONS

Who do you think should be featured in the Sunday interview? Send suggestions to Sunday, San Francisco Chronicle, 901 Mission Street, San Francisco, CA 94103.
971109
SC971101

Always watch for outdated information. This article first appeared in 1997. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .