Resident Scholar Sally Satel

President George W. Bush has nominated Dr. James W. Holsinger Jr., a Kentucky cardiologist, to be surgeon general. Today he is to go before the Senate Committee on Health, Education, Labor and Pensions. Sally Satel, M.D., joins other health-care experts in offering a few questions the committee members might want to ask.

1. If confirmed, you will be working in the city with the highest rate of AIDS cases in the country. Intravenous drug users are estimated to make up about one-third of Washington's new AIDS cases. The House recently lifted a ban preventing the District from using municipal money to set up a needle exchange program. However, the Bush administration remains opposed to the use of federal funds for needle exchange.

If asked to advise the president about changing this stance, using the epidemiological data on the effect of needle exchange on H.I.V. transmission, what would you tell him? And how would you, as a physician and former health administrator, weigh the pros and cons of needle exchange?

2. In the wake of the Virginia Tech shootings there was much discussion about re-examining the range of state laws on involuntary treatment of the severely mentally ill. In Virginia, the standard is so narrowly defined that a patient has to be on the verge of harming himself or someone else before the courts can act. What can the federal government do to bring needed change to reduce the chances of another Virginia Tech?

3. As you know, we are experiencing a dire shortage of organs for transplantation. Close to 100,000 people are waiting for kidneys, livers, hearts and lungs. Last year barely one-third of those on the lists received an organ, and 17 died each day. (Disclosure: I am one of the fortunate few who have received a kidney.) How would you remedy the shortage?

Also, even if every usable cadaver kidney were transplanted, there would remain a vast demand for kidneys. This is why a growing number of transplant surgeons, legal scholars and ethicists believe we should conduct pilot programs in which living kidney donors can receive some form of compensation to give one up. Is it time to try this?

Sally Satel, M.D., is a resident scholar at AEI.