For some years I have been playfully asking students and colleagues (all active health professionals or professionals to be) if they could tell me the name of the Surgeon General of the United States. Few could. In fact, last night the current Acting Surgeon General’s name was mentioned and I had not only forgotten who it was, but I actually know the guy (Steve Galson). If you ask public health professionals to name any SG, however, they all can. Most often it’s C. Everett Koop but might also be David Satcher, Joycelyn Elders or (for some of us older folk) the late Julius Richmond (Julie used to complain about how hard it was stamping those warnings on all the cigarette packs every day).
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. C. Everett Koop made effective use of this bully pulpit to promote a variety of important public health ideas. However under the Bush administration, the Surgeon General has been pretty much invisible (see posts here, here, here, here and here). If you don’t care about public health, you surely don’t care about the Surgeon General. But if you do care about public health, you might want someone who can again be its public face, “the nation’s doctor.” So who will serve in that position next is of some interest.
Yesterday the Obama administration let slip a name they were considering for the post. It took many people by surprise. It is CNN’s medical reporter and practicing neurosurgeon, Dr. Sanjay Gupta. Last night I saw progressive health policy analyst Ezra Klein (American Prospect) say on MSNBC he thought it was a shrewd choice. He may be right, although I am less confident. But his reasoning is sound. Klein noted that the main (and possibly only) real function of the SG these days is to communicate to the nation about public health. He reasoned that choosing a professional communicator and already high profile doctor for the post was a savvy move by Obama and signaled both his understanding of the potential for the post and his determination to give his health policy the best chance of success by going directly to the public with it.
It’s hard to know what Gupta’s own views are. At CNN he had to appear “objective,” which sometimes meant he had to distort reality to accommodate powerful interests in health care. Michael Moore pretty much eviscerated him over Gupta’s review of Moore’s film, Sicko, but Gupta took the push back fairly graciously. I think he will dependably represent the Obama administration’s position, whatever it happens to be. My only real hesitation has to do with whether he has that indefinable thing called gravitas. That might be because he’s a lot younger than I am (and older than Ezra Klein).
It’s a Presidential appointment (term of four years) and requires Senate confirmation (which should be trouble free).
Addendum (2 pm, 1/7/09): My sources within CNN tell me this isn’t a done deal. Gupta is still working out the personal side of it. I also wonder if he will be able to continue to practice (a major issue for a surgeon who needs to keep his skills limber) and of course there will almost certainly be a big time pay cut. So it wouldn’t surprise me if this didn’t go through.