The new Surgeon General nominee and CAM: Is there a problem here?

Our fearless leader, Steve Novella, has informed me that he is traveling today. Unfortunately, I am preparing a talk for later today, and no one else seemed able to come up with a post; so I decided to adapt a recent post from my not-so-super-secret other blog and see what a different readership thought of it. I realize that I’m risking subjecting you all to Gorski overload, but, hey, if the world needs more Mark Crislip, why wouldn’t the world need more David Gorski too? Steve will return next Wednesday, as usual.

I don’t normally give a lot of thought to the Surgeon General because, quite frankly, in recent years it hasn’t been a position of much authority or influence. That’s why I didn’t noticed late last week that President Obama had nominated a new Surgeon General. Normally, my failure to notice isn’t such a big deal, because there really hasn’t been a Surgeon General who has really been particularly well-known or had much of an impact since Dr. C. Everett Koop, although back when President Obama first took office Dr. Sanjay Gupta’s name was floated as a possibility for the position. Obviously, he didn’t get it. (I’m guessing that being a neurosurgeon and CNN’s chief medical correspondent probably pays much better than being Surgeon General.) To be honest, I didn’t even know that the prior Surgeon General had stepped down, but apparently she did in July, leaving the position filled by an interim Surgeon General until a new one could be nominated.

The other day, I learned whom President Obama nominated to be her successor, Dr. Vivek Murthy, a faculty member at the Harvard Medical School:

President Obama will nominate Dr. Vivek Murthy of Harvard Medical School and Brigham and Women’s Hospital as surgeon general of the United States, the White House announced Thursday night.

Murthy is a hospitalist at the Brigham and is co-founder and president of Doctors for America, a Washington, D.C.-based group of 16,000 physicians and medical students that advocates for access to affordable, high quality health care and has been a strong supporter of the Affordable Care Act.

If he’s confirmed by the Senate, Murthy would replace acting surgeon general Boris Lushniak. The surgeon general serves a four-year term and the post is essentially a bully pulpit to speak out on public health issues.

The official White House biography of Dr. Murthy reads:

Dr. Vivek Hallegere Murthy is the Co-Founder and President of Doctors for America, a position he has held since 2009. Dr. Murthy is also a Hospitalist Attending Physician and Instructor in Medicine at Brigham and Women’s Hospital at Harvard Medical School, a position he has held since 2006. In 2011, Dr. Murthy was appointed to serve as a Member of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. Dr. Murthy has been the Co-Founder and Chairman of the Board of TrialNetworks, formerly known as Epernicus, since 2007. Dr. Murthy co-founded VISIONS Worldwide in 1995, a non-profit organization focused on HIV/AIDS education in India and the United States, where he served as President from 1995 to 2000 and Chairman of the Board from 2000 to 2003. Dr. Murthy received a B.A. from Harvard University, an M.B.A. from Yale School of Management, and an M.D. from Yale School of Medicine.

So far, at least on the surface, there doesn’t appear to be anything particularly alarming about Dr. Murthy. He’s very accomplished for his age, which is only 36. The group he leads, Doctors for America, seems to have fairly conventional moderate-to-left views and has lobbied for Medicaid expansion, to protect Medicare, and to support the Affordable Care Act. In general, it supports expanding access to health care coverage to the entire population. Of course, no one would expect President Obama to nominate a doctor for Surgeon General who doesn’t support the ACA, and, since it’s the law of the land now, one would expect the Surgeon General to support it.

Although opponents of the ACA might not like Dr. Murthy’s staunch advocacy for the ACA, that’s not a problem for me. If anything, it’s a point in his favor. What worries me about Dr. Murthy is his connection to so-called “complementary and alternative medicine” (CAM), otherwise known these days as “integrative medicine.” My skeptical antennae started twitching when I saw that Dr. Murthy has been serving on the U.S. Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health since 2011, along with Dr. Dean Ornish. (Come to think of it, it’s disturbing that President Obama would have appointed Ornish to such a committee.) Also on the council is Janet R. Kahn, PhD, who is described as a having been a “Faculty Preceptor in the Fellowship Program in Complementary, Alternative, and General Medicine at Harvard Medical School” since 2000 and having served on the National Advisory Council for Complementary and Alternative Medicine at the National Institutes of Health since 2009. You know who also serves on that particular advisory council? Brian Berman. There’s also an acupuncturist, Charlotte Kerr, on the U.S. Presidential Advisory Council on Prevention, Health Promotion, and Integrative and Public Health.

OK, OK, none of this proves anything about whether or not Dr. Murthy has far too much credulity towards quackademic medicine. After all, there are also perfectly respectable science-based health care practitioners on that council, although it is truly disquieting to see an acupuncturist there, even more so than Dean Ornish. Ornish, after all, has managed to make himself seem scientific to the point where many physicians don’t realize how far down the road of woo he has traveled. In contrast, there’s no excuse for an acupuncturist to be on a President’s health care council—any President. Annoyingly, the advisory council has issued reports that cite the problematic section 2706 of the ACA that mandates nondiscrimination of health plans to urge consistency between state and federal law. Translation: The council wants the ACA to be interpreted to guarantee that any quacks that states license (like chiropractors and naturopaths) count as valid health care providers whose services should be reimbursed by insurance companies selling policies through the government exchange. Meanwhile, the 2011 National Prevention Strategy, which Dr. Murthy contributed to, emphasizes “evidence-based” CAM, an oxymoron if ever there was one.

More concerning is what Dr. Murthy said in this article, published in Harvard Magazine in 2003:

Murthy’s combined expertise in medicine and business (and he still might pursue an advanced degree in public health) makes him well qualified to follow through with one of his dreams: to develop a system that provides proven, affordable, integrated (traditional and alternative) healthcare in a standardized fashion.

His interest in alternative medicine stems from his own cultural background—both his parents emigrated from India. Although he grew up in Miami, Murthy’s frequent visits to his parents’ homeland allowed him to witness that country’s ancient art of healing, Ayurveda (Sanskrit for “the science of life”). “I have tried various alternative medical therapies myself,” he reports, “and I have found that many alternative modalities are based in principles that make sense, and seem to frequently be effective with patients.” Research in recent years has made important strides in investigating alternative medicine in the United States, Murthy says, but much more needs to be done, and he would like to be a part of that process.

Oh, dear. “Based on principles that make sense?” That’s the sort of thing no physician whose practice is science-based should ever utter about Ayurveda or other “alternative medicine.” He also seems to have been prone to the same sorts of deficits in reasoning that lead all too many people to confuse correlation with causation or placebo effects for real effects.

In fairness, I realize that this is a ten year old interview, and Dr. Murthy was very young at the time, but it’s concerning nonetheless, although elsewhere, in a book entitled The Yale Guide to Careers in Medicine and the Health Professions, Dr. Murthy was quoted as a fourth year medical student as being interested in integrative medicine. Has Dr. Murthy followed through with his youthful interest in “integrative medicine,” or, as I like to call it, integrating quackery with real medicine? Is he practicing and/or supporting CAM or integrative medicine? It’s hard to tell. There’s not much that can be found about him with regards to this question on the Harvard Medical School or Brigham Women’s and Children’s Hospital websites. I’ve also been Googling my little brain and fingers off, and I haven’t been able to find any “smoking gun” that indicates that Dr. Murthy is still as enamored of quackademic medicine as he was 10 to 15 years ago, although there are niggling little indications. But who knows? Maybe he’s reformed himself.

In my perfect world, if I were a Senator asking Dr. Murthy questions, I wouldn’t ask so much about Medicaid, Medicare, the ACA, or other health policy. Well, I would, but that wouldn’t be my primary line of questioning. I figure that Dr. Murthy has political views compatible with those of President Obama, otherwise President Obama wouldn’t have appointed him. Presidents rarely appoint people with highly incompatible views to theirs to positions that are very public, like that of the Surgeon General. What concerns me more is that the Surgeon General should be a voice of science-based medicine, even if it means bucking the prevailing views, existing government policies, the pharmaceutical companies, whatever. Think of the Surgeon General in 1964 warning that cigarettes cause cancer, even though cigarettes were popular (not to mention extremely profitable) and the tobacco companies were doing everything they could to bury or counter the developing body of evidence linking smoking tobacco to lung cancer and heart disease. What we don’t need is a Surgeon General who will be a voice in favor of the ongoing pollution of science-based medicine with quackery.

If Dr. Murthy is that kind of doctor—and there are far too many of these doctors around—then to me he should be disqualified from being the Surgeon General. Perhaps what’s more distressing is that the President’s Advisory Group on Prevention, Health Promotion, and Integrative and Public Health has Dean Ornish and an acupuncturist on it. It’s just another example of how much quackery has “integrated” itself into legitimate medicine.

Posted in: Acupuncture, Politics and Regulation, Public Health, Science and the Media

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