January 7, 2009 The Pump Handle 1Comment

Word is out that Obama will probably nominate Sanjay Gupta, a neurosurgeon and television correspondent, for the post of U.S. Surgeon General. Reactions in my office yesterday weren’t very positive, but several bloggers have pointed out that Gupta’s high profile and credibility with the general public can help him advance the administration’s health priorities.

First, Revere helpfully reminds us what the Surgeon General actually does:

The SG is the head of the uniformed services of the United States Public Health Service, wears a Navy uniform and holds a rank equivalent to a Vice Admiral. If this makes you think the Surgeon General is a powerful position, you’d be half right. Whatever power the SG has comes from your thinking he or she (and there have been a number of women SGs in recent years) is powerful. The SG has a very small staff and even less real power to do anything — except look and sound powerful. The SG is the public face of the USPHS and to some extent federal public health (although the Director of CDC is much more visible and genuinely powerful and shares that public perception). The Office of the Surgeon General’s also issues reports, some of which have been very influential in highlighting important public health problems. One of the most famous in recent history was the 1964 Smoking and Health Report which established cigarettes as an officially recognized cause of heart and lung disease. More recently Reports on sexuality and ethnic disparities have also been useful contributions to advancing health policy in the US. Pretty much the importance of the SG comes from the fact that it is a tall platform to stand on.

Dr. Val at Better Health interviewed Dr. Richard Carmona, the 17th U.S. Surgeon General, about the roles and responsibilities the position entails, and she also spoke with “one source close to the nomination proceeedings” who warned, “It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.” Val herself doesn’t think Gupta has “the gravitas or appropriate experience” necessary.

Whether or not his future government peers accept him, the general public seems to already have embraced Gupta. He hosts CNN’s “House Call” and writes a column for Time magazine; The American Prospect’s Ezra Klein calls him “the smiling face of America’s medical establishment.” Aman at Technology, Health & Development argues that this kind of celebrity will allow Gupta to have an impact:

And actually much more than a rockstar, public health in this country and globally needs an ambassador, a champion and an activist. This pick is good for both domestic and global health, and the two have never been so intertwined (not just with the migration of infectious diseases across borders but also with the explosion in chronic disease (and see here Jan 2009)  in developing countries and issues like brain drain). You would have someone who has appeal beyond the experts and policy wonks, he has strong credibility with the American public. As such, this is a great media strategy by the Obama team – they have found someone who is well known, a media professional (and as some criticize – a propaganda machine), and can deliver complex health policy messages. …

[It] is time for us to think creatively beyond our traditional notions and perhaps take a risk with someone who doesn’t have a strong public health background, but who has the potential to have a major positive impact.  Gupta is someone who can link both local and global health causes together and that is rare and signficant skill.

Abel Pharmboy points out these advantages:

1. He knows firsthand the limitations of the US health care system, especially in poor rural and urban areas where access to care is a challenge even under normal circumstances. Gupta has also been on-site for several of the most challenging medical emergencies the US has faced in recent years, most significantly the aftermath of Hurricane Katrina in New Orleans.

2. Literally millions of Americans already trust him for health care information. Some may consider this a detriment but let me frame this in the context of the recent brouhaha between science bloggers and traditional science journalists: as accurate and influential as science bloggers or top-tier science journalists think we may be, the vast majority of Americans still obtain health information from television, again, in poor or rural areas where internet access is limited or too expensive. The Sanjay Gupta’s of television play an incredible role in dissemination health information to much of this country.

Be thankful Obama didn’t pick Dr Phil.

If he’s confirmed as Surgeon General, Gupta won’t just be encouraging people to stop smoking, eat right, and exercise (though we could certainly use a compelling voice delivering those messages).  Ezra Klein reports:

According to Howard Kurtz, Gupta has negotiated “an expanded role in providing health policy advice.” And if he’s advising the project, he’ll almost certainly be advocating for it, too. Which means Sanjay Gupta, arguably the nation’s most trusted health care authority, will back on TV screens arguing for Obama’s universal health care plan, lending it his credibility as a doctor, a trusted media presence, and the nation’s surgeon general.

So, much as I’d like to see an experienced public health leader heading the Public Health Service, I can see that Obama’s selection of Sanjay Gupta is a smart choice.

One thought on “Reacting to Obama’s Surgeon General Pick

  1. Respectfully, I disagree, but for different reasons:

    The Surgeon General position is important, but of late, it has only been seen as a factotum of Bush-carrying, science-undermining placeholders. I wrote about health policy, professional nursing and patient advocacy for several years, but I was and am still dismissed out of hand. The audacity of a nurse having an informed and legitimate opinion!

    I wrote specifically about former Surgeon General Rich Carmona and what he offered during Congressional testimony. It was hair-raising, but it didn’t garner a ripple from progressives. Carmona has excellent emergency preparedness expertise and experience. He testified that he requested to be sent to New Orleans as a Katrina first responder and that he was denied. Gupta never mentioned that.

    Gupta, on the other hand, reports advertiser, commercial pharma crap as unbiased health reportage. He stays to a Wall Street Journal, free market, traditional corporate model of healthcare messaging. He is a commercial sell-out, and he also has many undisclosed conflicts of interest.

    Moreover, there is a growing body of evidence that commissioned officers of the USPHS working in the DIHS – the branch that Gupta would be attached to – have been used as agents of abuse and torture on immigrant detainees. The Surgeon General would certainly be obligated to investigate that and report, but no one has. Sec HHS Leavitt has methodically weaponized HHS and used it against the health of the citizenry. DIHS, which was accountable to the USPHS somehow magically migrated to ICA and DHS, and no one is investigating or stopping abusive practices. So not unsurprisingly, people are suffering and dying and no one is doing anything about it.

    Gupta has never investigated any Bush/Leavitt/HHS policy or practice. He’s remained silent while the FDA and CDC abdicated their oversight and regulatory responsibilities and imperiled the public safety. For the past eight years, Gupta has never questioned a single thing that the Bush Admin has done.

    CNN has even proudly announced that they have repressed all coverage of health policy and health reform since Obama contacted Gupta. The public can not be informed by media who deliberately and willfully withhold vital information.

    Carmona would have been a much better pick as he has tons of motive and ability for ferreting out Bush appointee burrowers. He knows the specifics of the science and public health that has been undermined and subverted, and he is passionate about making things right. He also has the support of other former surgeons general.

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