Former AMA trustee Dr. Benjamin nominated to be surgeon general

Washington -- President Obama's choices to be the nation's top physician and top scientist are both hands-on practitioners with extensive leadership experience.

On July 13, Obama announced that he was nominating Regina M. Benjamin, MD, a family physician from southern Alabama, to be surgeon general. Dr. Benjamin, 52, became the first woman and first African-American president of the Medical Assn. of the State of Alabama in 2002. She also completed a term in June as chair of the AMA Council on Ethical and Judicial Affairs and served on the AMA Board of Trustees from 1995 to 1998, becoming the first physician under 40 to serve on the board in a non-resident role.

Dr. Collins, NIH director nominee and author, says science and religion can coexist. God "is not threatened by our scientific adventures."

On July 8, Obama nominated Francis S. Collins, MD, PhD, as director of the National Institutes of Health. Dr. Collins, 59, led the Human Genome Project -- an effort to sequence and map human genes, that concluded in 2003. He left his position as director of the NIH's National Human Genome Research Institute in 2008 after 15 years but maintains a lab at the NIH's Bethesda, Md., campus.

Both nominees must first be confirmed by the Senate.

AMA President J. James Rohack, MD, said Dr. Benjamin has an impressive list of accomplishments, including receiving a MacArthur Fellowship in 2008, commonly known as the "genius grant." But awards are not her main focus, he said. "Dr. Benjamin's most important qualification for surgeon general is her deep commitment to her patients."

Dr. Benjamin said in the White House Rose Garden announcement that the deaths of close relatives from preventable diseases drove her to focus on public health. "My father died with diabetes and hypertension. My older brother, and only sibling, died at age 44 of HIV-related illness. My mother died of lung cancer, because as a young girl, she wanted to smoke just like her twin brother could."

Dr. Collins' colleagues said he is a natural choice to head the primary federal agency for funding and conducting medical research because of his thoughtfulness, willingness to listen and experience as a spokesman for the genome mapping effort. "He's a forceful personality," said Tom Murray, PhD, head of the Hastings Center, an independent bioethics research institute. "He wants to hear from people who don't agree with him."

Patients before profits

If confirmed, Dr. Benjamin would be the nation's lead public health educator. Fellow physicians see the role as a good fit.

Besides experience with family illnesses, Dr. Benjamin said she also was influenced by her medical school training under David Satcher, MD, PhD, who later became surgeon general, and others who focused on public health issues in underserved areas.

Jorge Alsip, MD, the Alabama medical society's president, said Dr. Benjamin has seen how much patients in poor and rural areas appreciate her help. "That can't help but affect you and make you want to do something for these people," said Dr. Alsip, an emergency physician who has known Dr. Benjamin for more than 15 years.

Dr. Alsip also said Dr. Benjamin is tenacious. "If Regina's in a fight, don't ever bet against her." She rebuilt her clinic in Bayou La Batre, Ala., twice after hurricanes destroyed it and is rebuilding it a third time after a fire.

Obama said his surgeon general pick has personally witnessed how the U.S. health system is broken. "She's seen an increasing number of patients who've had health insurance their entire lives suddenly lose it because they lost their jobs or because it's simply become too expensive."

Dr. Benjamin lamented the difficulty some doctors face in caring for patients, regardless of ability to pay. "It shouldn't be this expensive for Americans to get health care in this country," she said. Obama said Dr. Benjamin has forgone a salary when her clinic faced financial hardship.

Jeff Terry, MD, chair of the AMA's Alabama delegation and a urologist, said Dr. Benjamin has proven herself through work in organized medicine and elsewhere. The two co-founded the young physicians section of the state medical society nearly two decades ago. Since then, she has held leadership positions in physician organizations and other groups.

Dr. Benjamin is also probably more politically liberal than many physicians on Alabama's Gulf Coast, Dr. Terry said. "Maybe President Obama saw a little of that in her."

Both scientific and religious

Obama lauded Dr. Collins' experience in the July 8 announcement. "Dr. Collins is one of the top scientists in the world, and his groundbreaking work has changed the very ways we consider our health and examine disease." Dr. Collins' laboratory discovered several important genes, including those responsible for cystic fibrosis and Huntington's disease.

Acquaintances and colleagues predicted that Dr. Collins would do a good job representing NIH in front of lawmakers and others. He is a very approachable person who doesn't rely on jargon to communicate, said Sean B. Tipton, spokesman for the American Society of Reproductive Medicine. "He has an ability to interact with the public and with policymakers and the press that I think will serve him very well as an NIH director."

The Hastings Center's Murray said that if Dr. Collins ever made a mistake, it may be that he was a bit overly enthusiastic when describing the potential for breakthroughs when he was leading the Human Genome Project. Still, "I can't fault the scientist who really believes in their work for being enthusiastic as they talk to Congress," Murray said.

Dr. Collins has garnered attention by professing that his belief in God can coexist with his pursuit of science. He's written books on the topic, including the 2007 best-seller The Language of God: A Scientist Presents Evidence for Belief. He is also founder and president of the BioLogos Foundation, whose purpose is to find compatibility between the scientific and religious searches for truth.

In an interview with the spiritual Web site Beliefnet in 2007, Dr. Collins said Christians who reject scientific evolutionary theory are also rejecting humans' ability to understand, a God-given skill. But there are limits to the questions science can answer, such as why we are here or what happens after death, he said.

William Hurlbut, MD, a consulting professor of neuroscience at Stanford University and a former member of President George W. Bush's Council on Bioethics, said the idea that science and religion can't coexist is ridiculous. "A person with Francis' background is a very wise choice" for NIH chief, he said.