Surgeon General fades away . . .

The very first post, ever, on Effect Measure, "The Surgeon General as appetite suppressant" was posted in the morning of Thursday, November 25, 2004. I did it on a lark. Mrs. R. was preparing Thanksgiving dinner and my presence in the kitchen was declared unwanted if not a health hazard. What else was there to do but start a blog?

Since the Surgeon General has just resigned, quietly and without explanation, we bring you some nostalgic excerpts from that very first post and some remarks on his departure:

The United States Surgeon General has a new approach to the obesity epidemic specially for Thanksgiving. As reported in today's Chicago Sun Times, he suggests you discuss Uncle Frank's colon cancer at the dinner table:

It's not just Thanksgiving today.

U.S. Surgeon General Richard Carmona is declaring today also is the first annual National Family History Day.

As extended families gather today, it's a perfect time to compile medical histories, Carmona said. Show it to your doctor and keep a copy for your records, updating when necessary.

[snip]

In the future, genetic tests likely will pinpoint your risk for common diseases, but in the meantime, the best predictive tool is a family history. However, doctors often don't have time to ask about family histories, and even when they do, patients often are vague on the details.

[snip]

In the future, genetic tests likely will pinpoint your risk for common diseases, but in the meantime, the best predictive tool is a family history. However, doctors often don't have time to ask about family histories, and even when they do, patients often are vague on the details.

[snip]

You can't change your genes, of course. But if your family history indicates you are susceptible to a given disease, you can take steps to prevent it, or at least detect it early with screening tests such as mammograms and colonoscopies. (Chicago Sun Times)

[snip]

We know that many diseases are truly preventable by removing their causes. To the extent that those causes are environmental or occupational the "fixes" lie in political action. In the meantime, my advice is to relax with your family and friends, enjoy the day and worry about your weight some other time. Yes, obesity is a problem in this country. But holidays and family gatherings are special and come infrequently. Tomorrow you can return to a proper diet (which in my lexicon, means "everything in moderation").

So now it seems The Nation's Doctor has taken a powder. One of my colleagues amuses himself by asking seasoned public health professionals if they know the name of the Surgeon General. He tells me only about 10% can do it. On the other hand, they all can name at least some of the past Surgeon Generals, usually C. Everett Koop. Koop was lousy before he became Surgeon General and he has been a lousy, grasping internet profiteer afterwards, but he was a damn good Surgeon General, putting to good use the tall platform it gave him. He used the position to promote for public health and advance its mission. His face was well known. He had gravitas and credibility. He exerted leadership.

And who is the current -- or I should say, most recent -- Surgeon General? His name is Richard Carmona and as Surgeon General he was virtually invisible. In fact it sounds like he has been gone for a month and a half and most of us didn't even know it. His 4 year term expired on July 29 and he either resigned or was not reappointed. We didn't even know it until reader tympanacus (hat tip, tymp) sent us an Editorial from the Pittsburgh Post-Gazette:

Perhaps there was nothing nefarious about the unusually quiet departure of Richard Carmona as U.S. surgeon general. With the ultra-secretive and business-friendly Bush administration, personnel changes don't always go down as advertised.

[snip]

Some sources indicated that Carmona was told that he would not be retained as surgeon general, but who ushered him out and the reason were not revealed by the hunker-in-the-bunker folks at the White House.

In any case, Carmona merits praise for at least one major health initiative: The recent report that labeled secondhand tobacco smoke for what it indisputably is a deadly health hazard to millions of Americans.
The surgeon general's report validated the need for a comprehensive ban on smoking in public places.
As Carmona put it back in June, "I am grateful ... to be able to say unequivocally that the debate is over. The science is clear: secondhand smoke is not a mere annoyance, but a serious health hazard that causes premature death and disease in children and nonsmoking adults."

The declaration demolished the central claim of the special interests that oppose a smoking ban: that secondhand smoke is not hazardous to those forced to breathe it, whether as patrons or workers in public places.

Did Carmona's bold stand get him fired? We wouldn't be surprised. After all, the business interests hard at work against real smoking bans are the same businesses routinely found on Bush's list of influential campaign contributors. Regardless of the circumstances of his departure, Carmona managed what few appointees of this laissez-faire administration have even attempted to advance the cause of legitimate public health protection for the American people. For that, he deserves credit.

More credit than we are willing to give him. The Editorial is correct that secondhand smoke is indisputably a health hazard for millions of Americans. It's like praising someone for not stabbing his grandmother in the back. Of course the Surgeon General of the United States should say this -- and much more. Instead he gave us the silent treatment, unless he was counseling us on how to be the world's wettest blanket at Thanksgiving Dinner.

I don't know if declaring the end of the manufactured debate on secondhand smoke is the reason he got fired. It wouldn't surprise me. I think it's fair to say, though, he will be missed now every bit as much as he was missed when he was Surgeon General.