Coburn Discusses Post-Retirement Plans, Interest in HIV/AIDS
The Kaiser Daily HIV/AIDS Report sat down this week with Rep. Tom Coburn (R-Okla.) to find out his
post-retirement plans. Below are excerpts from the interview.
What are your post-retirement plans? Do you intend to return to obstetrics? Public policy?
I'll be returning to medicine, obstetrics and family practice ... I'll spend a day a week doing other things, four days a week practicing medicine. ... My practice was and will be again about 80% mamas and their babies. I'll be on several boards, most of them charity boards and things like that that I've wanted to do for a long time. A couple [are] corporate boards, where I'll use my experience prior to becoming a physician to help a couple of businesses ... not in a lobbying context, but in a management context. One's specific to education, one's specific to health care. One of them is a textbook publishing company, Saxon Publishing, and the other one hasn't been announced yet, so I can't give you specifics on what that is.
Is the textbook company specific to health care? For example, will it have a sex education focus?
No. What I've seen in children and what I've seen in my experience in education is that we've taught our kids how to memorize, but we haven't taught them how to learn, and we haven't taught them how to reason and think. Saxton publishing is a company that started less than 10 years ago with the concept that you have to build concepts and think and build off those and use them every day so that you eventually learn to reason and think and be able to solve problems, rather than memorize, pass the test and forget it, and can't ever recall it again.
It has been rumored that you are a candidate for HHS secretary in a potential Bush administration. Is this a position you would consider if offered?
Nobody knows what that is, it's all pure speculation and hype and there's no reason to consider because it's not ...
If offered, though, would you take it?
It's all contingency. It would depend on what the position would be, what the dedication of the principles behind it are. The one thing I don't want to do is be a part of any team that doesn't have a plan, or is afraid to lose for what they believe, and that's what, for me, has been a hallmark of the Republican Congress ... They haven't been willing to lose on the principles ... they compromise before they ever get there. And it's okay to lose. We learn from our losses. When we fail to take something with a position of loss, you don't define the issue [and] the issue never comes to [the] public. ... There's a lot of integrity in standing for a principle that you believe to be correct, even if you're in the minority. It's okay to lose, and in Washington, that's a foreign concept. So anything that I would do in a [Bush] administration would depend on, number one, position, and what the backing would be for what the goals were. ... I really don't seriously think that I would be under consideration for something like that, simply because of my reputation in the House.
Who do you anticipate will fill your shoes as the Ryan White CARE Act champion?
I think Ryan White is one of our great accomplishments. ... We did win a major shift in that this year, moving more towards prevention. Every dollar that we spend on prevention will be hundreds of dollars of savings in the future. It seems to me that the CDC has forgotten that part of their name is Center for Disease Control and Prevention. You never hear that any more and they've really lost that, and my recommendation for whoever the president is going to be is that they reinstitute prevention, because it's not only wise, and it's not only lifesaving, it is tremendously more efficient than treatment. I believe we've seen the fear and the ... ignorance about the AIDS issue, and I think people understand that this isn't a disease that you get from shaking hands or kissing. It is a lifechanging disease that can be prevented [through] cogent public policy. With that comes a national drug treatment program, which no administration has addressed. People that are addicted to drugs, rather than going to jail, ought to go into a mandatory drug treatment program, where we're really going to give these people the tools to be through with addiction. We've got tremendous ... resources that ought to be going towards that, because we've got tremendous costs associated with it, not only in terms of crime, but in terms of health costs, from newborns to people who have very productive lives otherwise, but because of their dependence on drugs, they're not successful. What they're really screaming out for is help -- nobody who is drug dependent really wants to be drug dependent. We don't have a national policy on that. We could save a lot of money if we redirected treatment, but nobody's talking about that.
What led you into obstetrics, and what inspired your passion for HIV/AIDS issues?
In 1982, I had one of my patients come in and die in about four days. I had delivered her child for her, and we diagnosed her on her second hospital day with ... AIDS, but it was too late to save her. The daughter that she had given birth to eventually died ... we diagnosed her right away. [The daughter] eventually died at eight [years of age] ... we were able to keep her alive for that long a period of time. And I saw a disease that didn't have to be, and I still think that when history judges our response to the HIV epidemic, it will judge us very, very harshly because we truly abandoned public health policy. Maybe it was worth it and maybe it wasn't. There is no question that there was discrimination and continues to be discrimination against those with "alternate lifestyles," but the price we paid in protecting that or, at least responding to that, was a policy that allowed no prevention. Consequently, I believe 600,000 or 700,000 Americans have HIV today that would not have had it if we had had cogent public policy and had we done what was right from a medical and public health standpoint, while at the same time protecting those who felt discriminated against and were actually discriminated against. I think we will be judged harshly, and seeing the government's response to that and seeing my own experience with several people who were HIV-positive, somebody has to raise a flag and say, wait a minute, can we rethink this... Just like HIV reporting ... 36 or 37 states now have HIV reporting. It's important to do contact first. It's important to stop the CDC ... who continues to do blind testing today. They're testing people, finding out they have HIV and never telling them. They don't have to track the disease that way. To me, I find it not any different than Tuskegee in terms of what the government is doing: finding out somebody has a disease they're going to die from. They're not into treatment, and consequently, they're experimenting with their lives so they can have a few numbers. ... We're marching down this path without thinking. So I think it's a great lesson. We're going to have to do the same thing, unfortunately, on tuberculosis and hepatitis C. The [American College of Obstetricians and Gynecologists] doesn't recognize it yet, but in our practice, we have a standard practice of checking everybody for hepatitis C antibodies. ... The CDC should put that out as a standard of care in the nation. We found in the last year 16 positive hepatitis C moms. There's lots of that in terms of transmitting it to the baby, and there are all sorts of things that you can do to prevent transmission to the baby ... yet organized institutional medicine is behind the curve. The question is, why? Most of medicine has been infiltrated with politics. It didn't used to be that way: we used to make decisions based on what was the best medical advice, not what was the best political advice and will the best medical advice fit with that. Most of the institutions that represent organized medicine today have forgotten medicine and are into politics, and the country's the worse for it (Ingrid Dries-Daffner, Kaiser Daily HIV/AIDS Report, 12/5).