Enemies or allies? The organ transplant medical community, the federal government, and the public in the United States, 1967-2000.

The transplant medical community in the United States has frequently been divided over the appropriate role of the federal government and of the public in matters related to organ transplantation. Using public statements in government hearings, newspapers, and press releases, this article traces the thinking of the transplant medical community in particular during three especially politicized periods: the heart transplant and brain death controversies in the late 1960s, consideration of the National Organ Transplant Act and other legislation during the mid-1980s, and the controversy over organ allocation regulations issued by the Department of Health and Human Services in the late 1990s. Even while sometimes denouncing "politicization," over time surgeons, physicians, representatives of the United Network for Organ Sharing, and other leaders in the field became increasingly politically active and more accustomed to the notion that because of the unique nature of organ transplantation, both the public and the federal government have a legitimate and potentially beneficial oversight role.

"Managing the unmanageable" the U.S. Department of Health and Human Services, 1989-1993.

The author served as the 17th U.S. Secretary of Health and Human Services, from March 1, 1989 until January 20, 1993. The department had 250 programs and 38 percent of the expenditures of the federal government ($600.0 billion), the fourth largest budget in the world. The history of the department included the fact that the tenure of previous Secretaries had ranged from only eight months up to 37 months, and had averaged 27.5 months, resulting in the view that the department was unmanageable. The author's tenure as Secretary was 47 months, and, in the author's view, the department was indeed manageable. The United States Department of Health, Education and Welfare (DHEW) was created as a cabinet agency in 1953, during the administration of President Dwight D. Eisenhower. The Department was formed by bringing together the Social Security Administration (founded in 1935), the United States Commissioner of Education, and the United States Public Health Service (founded in 1798) to serve the United States Merchant Marines). This new cabinet department contained the nation's major domestic programs concerned with income security, public health and education. Oveta Culp Hobby of Texas was the first Secretary of the Department. By 1989, the department's programs had increased to more than 250, including Medicare, Medicaid, Headstart, Welfare, and others. During the administration of President Jimmy Carter, the Education programs were separated into a new cabinet agency, the U.S. Department of Education, and the name of the U.S. Department of Health, Education and Welfare became the U.S. Department of Health and Human Services (DHHS).