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A Conversation With... David Satcher

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A Conversation With... David Satcher A Conversatonwith. David Satcher Neil A. Campbell David Satcher began his about genetic factors in such conditions as heart career as a medical geneti- disease and cancer and even mental illness? cist. In 1972, he helped de- Satcher: I think the future of medicine is greatly tied .? velop the King-Drew Sick- up with medical genetics. Every day we find new f le-Cell Research Center in genes that cause various problems, which means that U Los Angeles and served as in time we will have genetic solutions for those Downloaded from http://online.ucpress.edu/abt/article-pdf/58/6/353/47690/4450176.pdf by guest on 25 September 2021 _ its directorfor six years. In problems. For example, recently we've had reports out _ addition to his abilities as a of San Francisco about the ability to genetically make researcher and physician, cells that could resist the AIDS virus. The implications _. Dr. Satcher began to dis- of that are tremendous. And new genetic information tinguish himself as a gifted and developing technology will also have an impact leader and administrator on sickle-cell disease, diabetes, and other conditions. in a succession of posi- tions, leading in 1982 to Campbell: Speaking of sickle-cell disease, much of the Presidency of Meharry Medical College in Nashville. In your early work was in that area. What did you do, 1993, when Dr. Satcher was appointed director of the and what accomplishments were especially satisfy- Centers for Disease Control and Prevention (CDC), he ing? becameone of the most visible and important health scien- Satcher: I directed one of the 10 national sickle-cell tists in the world. In this interview, Dr. Satcher talks about research centers starting back in 1972. The center I the responsibilities of the CDC and explains how a child- directed, the King-Drew Sickle-Cell Research Center, hood experience inspired his interest in medicine and his at the King-Drew Medical Center in Los Angeles, continuing commitment to community service. emphasized community education, early diagnosis, screening, and counseling programs as well as treat- ment. I think we made major contributions in all those Campbell: Dr. Satcher, you started your career in the areas. field of genetics, specifically cytogenetics. Could you explain what cytogenetics is and what its medical significance is? Campbell: What exactly happens in sickle-cell dis- Satcher: I was actually in the M.D.-Ph.D. Program at ease, and what's the genetic basis? Case Western Reserve School of Medicine and my Satcher: The genetic basis is interesting: The single Ph.D. was in cytogenetics. Cytogenetics is the study of amino acid valine replacing glutamic acid in the chromosomes located in cells. I studied the effects that hemoglobin molecule is enough to create the sickling. X-radiation and radioactive iodine, 1-131, had on chro- This makes the hemoglobin molecule more rigid, so mosomes and was able to show a linear relationship the blood cells tend to clump up in the small blood between radiation dosage-and, to a certain extent, vessels, leading to severe pain. The immune system is 1-131 dosage-and chromosome damage. That was also affected, so that sickle-cell patients are not as some of the earlier work looking directly at the impact capable of fighting off infectious diseases. For a long of radiation on chromosomes. time, many sickle-cell patients died early in life from pneumonia and other infections. We've made a lot of progress in the development of the pneumococcal Campbell: More broadly, how do you see the future vaccines and the early recognition and treatment of of medical genetics, especially as we learn more infections. There are a lot of sickle-cell patients who now not only live to adulthood but live to be 50, 60 and 70 years of age. That was not true 20 or 30 years Neil A. Campbell is a VisitingScholar in the Department of ago. And in the area of medical genetics, I think we're Plant Sciences at the Universityof California, Riverside, CA 92521. moving toward a significant impact on sickle-cell disease, probably even a cure. A CONVERSATION WITH ... 353 Campbell: You mentioned screening and counseling. Campbell: So when you started as an undergrad at What is the objective of screening? How is it done? Morehouse, you already wanted to become a physi- And what role do counselors play? cian. How did you decide that? Satcher:That's a very importantissue. In the absence Satcher: That's an interesting story. I grew up in of community education, screening for sickle-cell dis- Anniston, Alabama. Neither of my parents had fin- ease can be a problem.The sickle-cellgene is recessive, ished elementary school. When I was 2 years old, I which means that a person can be a carrier-have came down with a severe case of pertussis or whoop- "sickle-cell trait"-but not be affected with the dis- ing cough and it led to pneumonia. I was severely ill. ease. Because communities didn't understand that in The situation was such that we couldn't go to the the early days of screening programs,there were laws hospital, but my parents were able to get Dr. Jackson, saying that people with sickle-cell trait couldn't go to the only black physician in Anniston at the time, to public schools because it was thought to be conta- come out to the farm where we lived and check on me. gious. This is one of the best examples of what's He came on one of his days off and spent almost the necessary if you're going to develop a mass screening whole day there working with me and my parents. program.We don't recommendmass screening,but if When he got ready to leave, he didn't want to get my you are going to do it, you have to make sure you have parents' hopes up yet, so he told them I probably the education first so that you are prepared to deal wouldn't live out the week. But he did take the time to Downloaded from http://online.ucpress.edu/abt/article-pdf/58/6/353/47690/4450176.pdf by guest on 25 September 2021 with the results. Although the cause is not genetic, we show my mother how to keep my chest clear and my have a similar problem right now with HIV/AlDS. temperaturedown. My mother worked very hard and You might ask why only 15% of the people in this I pulled through. And my mother told me that story country have been tested for HIV/AIDS. Part of the from the time I was old enough to understandwords. answer is that people are afraid to find out the results. By the time I was 8 years old, I was already telling Similarly, if you don't have the appropriatesupport people that I was going to be a doctor,like Dr. Jackson. mechanisms in place, genetic screening programs can All through elementaryschool and middle school and do more harm than good. You also have to have high school, I had this drive: I'm going to be a trained people other than geneticists, for example physician. At that time, I was going to come back to physician's assistants and nurse practitioners,to do Anniston and be a family doctor. As time went on, my genetic counseling. That is happening now, all over vision grew and I realized there were a lot of Annis- the country. ton, Alabamasin the world, and that I could probably contributeto a lot of them. That's how it started. And Campbell: You mentioned that at Case Western that motivation still drives me. Reserve you earned dual medical and Ph.D. degrees. Why did select such a tough course of study, and how does one actually go about an M.D.-Ph.D.? Campbell: As your vision grew, you made the tran- Satcher: Let me first answer the question, "Why?" sition to health science administration at some point. When I came to Morehouse College here in Atlanta in What motivated that? 1959, my goal was to do premedicine and then go to Satcher:It really started back when I went out to Los medical school to be a physician. At Morehouse, I Angeles to King-Drew in 1972. That was a fairly new became interested in research.Some of my professors institution, one that King Hospital had just opened supported me, and in addition to working and being a three months earlier, and they were developing the preceptorin the laboratory,I actually got involved in school. I pulled people together from throughout the doing research. By the time I graduated from More- institution-basic scientists as well as clinicians-to house, I thought maybe I could make a contributionin get our first major grant for the sickle-cell research the area of researchsince I really enjoyed it. So I went center. Within a few months, I was asked to become to Case Western,where you get both the M.D. and the directorof the center, which meant that I had a major Ph.D. It took seven years, but it was enjoyable. I administrative responsibility, not just a scientific or attributea lot of my success to the fact that I have been medical one. I had to make the team go. I guess I did able to relate to the basic scientist as well as the a good job because people kept asking me to do more physician. things administratively.At one point, I decided that I needed some more trainingin that area so I spent two years at UCLA as a JohnsonClinical Scholar, studying Campbell: It sounds like a good case for getting planning and evaluation.
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