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Home : About Us : Pritzker Pulse : Spring/Summer 2006

Interview with Dr. Joycelyn Elders

Joycelyn Elders, MD

Joycelyn Elders, MD

By Samuel C. Seiden, MS 4

Dr. Joycelyn Elders was U.S. Surgeon General during the Clinton administration from September 8, 1993 to December 31, 1994. The Pritzker Pulse interviewed Dr. Elders prior to her participation as the 2006 Commencement keynote speaker. Below is an extended version of the interview with Dr. Elders.

Jump to Dr. Elder’s opinion on:

SS: What kind of advice would you give to young physicians just about to start residency?

JE: The advice that I would give is to be the very best doctors that they can be. And also realize there are a lot of problems still out there. We are the richest country in the world, and the only country that does not provide universal access to healthcare for all of our people. We need to reduce the disparities in healthcare [and] income. Not to try and make people richer, but I do feel we have an awful lot of children who are living in extreme poverty. There are a lot of children that are members of what I call the 5H club. Children that are hungry, helpless, homeless, hopeless and hug-less.

I would hope that future doctors would use their “3 Ps,” power, position, and prestige, to make life better for their patients, but also for the community. And I would hope that they would use that to make life better for the many people that they will be caring for, but also in the community. Don't just feel that because you take care of somebody who is bleeding, or somebody that comes in very ill, that you have done your job.

I also want to tell them that medicine has not done nearly as well as the law, where every criminal has a constitutional right to a lawyer. But we as doctors have not felt that all of our people have a right to healthcare. And I think that is something that as new doctors going out there that is some of the unfinished agenda which we have got to take care of.

SS: Do you favor a system of national healthcare in this country?

JE: Yes I do. We are presently spending close to 15 % (1.6 trillion dollars) of our gross domestic product on healthcare, and yet our healthcare system lacks what I call the 4 CEUs: it is not coherent or comprehensive; we do not have choice (we may think we have choice, but we don't); it's not cost effective; it's not equitable, and it certainly is not universal. I look at that as the four CEUs. [because] doctors think of continuing education units.

SS: What kind of system would you advocate for a national health care system in the US?

JE: The simple answer is I'm not sure we have developed what I would consider a very good healthcare system. We've got the best sick care system in the world. We've got the best doctors, the best nurses, the best hospitals, we do cutting edge research. Our problem is that we do not have a healthcare system. We spend vast majority of our healthcare dollar on very expensive dying. And we spend less than 3 % on really keeping people healthy. And I think the new doctors that are coming along really have a chance to work on and get this unfinished agenda taken care of.

SS: What do you think are the barriers to implementing such a national system of healthcare in the US?

JE: [O] ur greatest barrier to a healthy America is education, education, education. We've got to start with early childhood education and comprehensive health education to educate our people on how to be healthy. Don't wait until I am 50 and have a stroke and then come put me on a diet and tell me not to smoke and put me on blood pressure medicine and say don't eat salt. You need to do that when I am in grade school and I wouldn't end up there.

SS: What do you think as young physicians we should be doing to work toward improving access to healthcare for all of America?

JE: You've asked a really tough question, but I think the most important thing is that young physicians first of all need to care. Then I think you have to reach out and be responsible. You've got to say I am going to be responsible if nobody is responsible but me. And then we have to educate and empower our patients, empower our community, and make sure they are aware of the importance preventive healthcare. You can say, well I am busy taking care of patients, I don't have time to all that. Well you can't get so busy downstream pulling out bodies that you forget to go upstream and fix the bridge.

We all can't do everything. But everybody can do something. You may say, what I am going to do is begin to educate my patients, and make sure they are aware of the importance of preventive healthcare. If every doctor did that, it would not take us long. Somebody else might say, I am going to work on making sure we have comprehensive health education in our schools, from Kindergarten through 12 th grade. That we are going to educate our young people so they'll know good nutrition, they will know to exercise at least 20 minutes a day, they will know to eat three meals of high fiber low fat diet, they will know not to get involved in high risk sexual behaviors. If we start teaching them that in kindergarten, by the time they get to 12 th grade they will know that.

SS: When my mother graduated from Pritzker School of Medicine in 1964 (just four years after you graduated from medical school) she was one of only three women in her medical school class and less than 500 women in the country in medical school. Not a climate that was dominated by women. I'm curious about your reflections are having trained in this male dominated climate?

JE: I'm very pleased that we're having more and more women in medical school. I think women by nature are more nurturing. And I think that because of the increased numbers of women that we are going to see the real changes in healthcare.

SS: Similarly, do you have reflections on your professional life and medical career from an African American perspective?

JE: I came along during a little bit different era. I grew up in very segregated black schools through college. And so the one thing that I was very much indoctrinated in was hard work. My mom said, “If you want to get off the cotton patch, you got to get something in your head.” Black students, when we were in high school, took four hours of home economics every day for four years. The idea was to train your girls to be good maids. Having a job as a maid was better than being in the cotton patch.

Dr. Elders resigned from the Clinton administration after being affirming at a United Nations conference on AIDS that promoting masturbation might be an appropriate means to discourage young people from engaging in riskier forms of sexual activity. I asked Dr. Elders whether she thought scientists are asked to conform their beliefs not to data, but to political or social agendas.

JE: I think that science can be very much influenced by political and social agendas. There is a big battle about teaching young children sexual education. We have got to teach, and make sure that it is age and developmentally appropriate and scientifically correct. And we can't go around allowing these half truths to be indoctrinated into our children. We need to stop our politicians from using their myths, if you will, to really abort what it is going on in science. The minute that people become politicians, they abort common sense. Common sense is that sense that we all have which keeps our other five senses from acting a fool. I think that many of our politicians have spent all their time worrying about abortion, I think they have aborted their common sense.

SS: If you were asked today, would you give the same answer about masturbation?

JE: Yes, oh yes. I feel that I gave the correct answer at that time. And I would give the exact same answer again. I feel that it has allowed this country to talk about masturbation at the dinner table. Masturbation has never given anybody a disease. It has never gotten anybody pregnant. Never made anybody go crazy. Hair won't grow on your hands. I think that we have to educate our children and use common sense.

SS: What do you think of President Bush's efforts to enforce an abstinence only sex education policy?

JE: I think that's the worst policy I have ever heard, and that if America, American mothers, and American women allow it to continue to go on, what they're doing is selling out our children for myths. I think that children should have comprehensive health education. People out there are teaching that oral sex and anal sex are not sex. There has never been a single study that says abstinence only works. And it has been shown that in children who have comprehensive health education and access to condoms, sexual activity is not increased. Instead it reduces the number of partners and increases the likelihood of using a condom if they do choose to be sexually active.

SS: What do you think about making contraception free?

JE: I feel that it should be free. The countries that have free contraception and condoms regularly available, and even abortions on demand, free, have found out they have less abortions. We have about 21 abortions per 100,000. Belgium and the Netherlands have about 4-7 abortions to our 21. Uganda and some of the Latin American Countries, and some of the countries that absolutely are opposed to contraception, condoms, and abortions have 40-55 abortions per 100,000 women.

Also, the number of women dying related to abortions has dropped. They did a study in Romania when abortions were entirely prohibited, and the number of women dying from pregnancy related death went from 20 to 200. When they stopped [the abortion prohibition], it dropped back down to 12. We're talking about women dying.

SS: What do you think about the legalization of the morning after pill?

JE: Oh I think that it definitely should be legal, and it should be available over the counter, it should be available for any person who comes in and feels that they want it or desire it. And I feel that any pharmacist who feels that it is against his morals should get out of pharmacy.

SS: So again this interface between politics and science. The FDA's advisory group said that this was a safe and effective drug, and then the FDA doesn't take their opinion.

JE: Well the FDA is being political rather than scientific. We've sold our children out to the politicians. I mean we've just sold our society to the politicians, and we better wake up. We're in an area where I talk and I get mad.

Dr. Elder's is retired from practicing pediatric endocrinology. She continues to serve as the Distinguished Professor of Public Health and Pediatrics at the University of Arkansas.