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Who Should Ascend To The Office Of Surgeon General?

President-elect Obama’s nomination of CNN medical correspondent, Sanjay Gupta, for the Office of Surgeon General of the United States has ignited a firestorm of debate across the Internet. Some argue that he is not qualified for the position, others say that his charisma would be a boon to public health communications, though the lay majority appear to have mixed feelings.

It is highly irregular for a Surgeon General nominee to be announced before the Secretary of Health and Human Services is confirmed. This faux pas in itself may speak to an irresistible opportunity for self-promotion, or that the Senate confirmation hearing is not the independent review event that we assume it is.

At age 39, Gupta has long aspired to become the Surgeon General, as sources close to him report that he has been saying (since age 33) that “it’s the next logical step in his career development.”

But before we draw conclusions about who’s right for the job, we need to understand what the job entails.

I asked Dr. Richard Carmona, 17th Surgeon General of the United States, to explain the roles and responsibilities of the office. A summary of our conversation follows:

Dr. Val: What is the primary role of the Surgeon General?

Dr. Carmona: It’s the Surgeon General’s responsibility to protect, promote, and advance the health, safety and security of the United States. The office of the Surgeon General dates back to 1798, when President Adams passed a law to create the Marine Hospital Service. The lead physician of the service became known as the Surgeon General. The Marine Hospital Service eventually became the US Public Health Service, and the roles and responsibilities of the Surgeon General broadened to include immigration, disaster preparedness (in the case of nuclear and biological warfare), national safety, health prevention, and many complex public health issues that face our nation and the world.

Dr. Val: What sort of experience is appropriate for a candidate of the office of Surgeon General?

Dr. Carmona: A successful candidate for the office of Surgeon General should have deep and broad public health experience, especially as a public health or uniformed military officer.  The Surgeon General is given the rank of Admiral, and as such he or she will interface with other Admirals and Generals, and Army and Navy Surgeon Generals, most of whom are career officers with decades of experience in military matters. The Surgeon General must have the wisdom and experience to take on the position of an Admiral and represent our country internationally.

Dr. Val: What does the Surgeon General do on a daily basis?

Dr. Carmona: The Surgeon General is the commander of the US Public Health Service Commissioned Corps, which consists of thousands of officers in hundreds of locations around the world working anonymously to keep our nation and our world safe. The Surgeon General interfaces on a daily basis with the NIH, CDC, SAMHSA, HRSA, and all of the federally related health agencies as well as global health organizations like the World Health Organization, Pan American Health Association, and the American Public Health Association. The Surgeon General provides in-depth analysis of health policy for every cabinet minister, including the Interior, Commerce, and Homeland Security. It’s a very visible, credible, and iconic position.

Dr. Val: What’s the selection process for the office of Surgeon General?

Dr. Carmona: The Surgeon General is nominated by the President of the United States after much due diligence, and under the recommendation of his staff. The candidate is then introduced to the United States Senate. Then the Senate, if they so choose, extends the candidate the privilege of appearing before them for a Senate confirmation hearing. During the hearing they review the candidate’s credentials and ask him or her questions about anything and everything related to the public health of this nation and the world. You’re essentially put in a hot seat, and rightfully so because the Surgeon General is America’s face of public health to the world.

Dr. Val: What should Americans expect of their Surgeon General?

Dr. Carmona: The Surgeon General of the United States needs to remain a non-partisan physician. He or she should always communicate the honest, scientific truth to the American public so that they can make informed decisions about improving their health. Often, that scientific information is not the same as the policy that the President or Congress come out with, because policy is a very complicated process.

The Surgeon General has the largest medical practice in the nation (300 million), and when he or she issues reports, they actually change behavior in our country and the world. The Surgeon General is the true, honest broker of the best science for the people, offered in an a-political fashion. He or she is a patient advocate at the very highest level of government, and is expected to address the most complex health problems that face our nation. There is no more important or influential office that an American physician can hold.

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There is no doubt that Sanjay Gupta is a slick communicator. But there is so much more to the office of Surgeon General than relaying talking points to the American public. That may be why Americans are confused about what the Surgeon General does – most of them work hard to influence policy  and spend the majority of their time coordinating very high level public health initiatives on a national and international scale. Their primary role is not to be a talking head – but a strong, independent, pro-science voice of reason to both educated and less educated healthcare decision-makers. One must have conviction and spine to do the job. We don’t need a communicator to be the Surgeon General but a Surgeon General who can communicate.

The fact that the American public hasn’t been as aware of the work of the more recent Surgeons General may be a testament to their selflessness. If they were more interested in getting in front of a camera, than having those difficult private conversations about stem cell research (and such matters) with people who have the power to enable or disable funding for entire programs, then I guess we’d be more familiar with their work.

The office of Surgeon General is the most influential public health position that a  physician can be offered. He or she is ultimately responsible for upholding science based medicine at the highest level of government, and must be willing to openly disagree with policies that are inconsistent with its standards. I don’t know if Sanjay Gupta will tow the line on science, but his previous lack of clarity on vaccine safety is certainly reason for pause. What do you think?

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

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