Just another quick note reflecting further on my 8-minute gut reaction yesterday to word that Sanjay Gupta might be nominated as Surgeon General in the Obama administration.

I still contend he’s a great communicator but realize that the “both sides of the story” aspect of journalism has made some uneasy about where he’d actually stand on issues as a government leader of public health. In my post yesterday, I also neglected to consider some of the more controversial moments in Gupta’s past stories as elegantly and comprehensively pointed out by my colleague and surgeon, Orac.

I was also delighted to see Dr Val’s scoop in interviewing the current SG, Dr Richard Carmona, on just what the job of Surgeon General entails (megaprops to Val Jones for getting Carmona before even CNN!). I did not truly appreciate the comprehensive responsibilities, especially the military leadership position, of the SG as described by Carmona at Better Health:

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.

The primary concern that many in the blogosphere have expressed is that Gupta lacks the seniority, respect – gravitas – to assume such a senior position. Here, again, Orac’s analysis is quite valuable in noting that Gupta, while a neurosurgeon, is even fairly junior to mid-career by academic standards (Assistant Prof of Neurosurgery at Emory, Associate Chief of Neurosurgery at Grady Memorial Hospital), although I suspect that he’d be higher in the academic ladder if he wasn’t a full-time journalist.

However, I still come down on the side of supporting Gupta as choice for this position, certainly less enthusiastically than I did yesterday, but still primarily for his ability to connect with the American public. The scientific rigor with which he approaches those messages is an area where I hesitate because I’m not sure that his record as a journalist tells us much about how he will operate as a public servant. I anticipate that he will surround himself with top public health and military advisors; the only question there is whether his celebrity will attract or repel high-ranking military medicine and public health advisors.

Given that I respect my senior colleague revere (Effect Measure) on all issues related to public health, I’d have to say that I concur with his summary:

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).

Sarah Rubenstein also has some interesting insights at the WSJ Health Blog noting the enthusiasm for Gupta that I share as well as objections from official in the Public Health Service:

The folks at the Public Health Service seem to prefer insiders, whether or not they have name recognition. “I am unaware of any public health experience or qualifications he has to be the leader of the nation’s public health service,” said Gerard Farrell, executive director of the service’s Commissioned Officers Association, according to WaPo. “This would be akin to appointing the Army chief of staff from the city council of Hoboken,” N.J.

I’ll certainly continue to reevaluate my position based on more data but the discussion thus far has been fascinating.