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.
Oh, dear Abel. Let me try to reason with you a little bit more. There is no doubt that 39 year old 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 in the right direction 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. You've gotta 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 is 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 highest and most noble post that a physician can be offered. It should be reserved for the wise, the selfless, and the courageous - not offered to a news reporter for self-promotional purposes. Obama is devaluing the office by offering it to an inappropriate candidate. I can only hope the Senate sees it that way.
We don't need a communicator to be the Surgeon General but a Surgeon General who can communicate ... The office of Surgeon General is the highest and most noble post that a physician can be offered. It should be reserved for the wise, the selfless, and the courageous - not offered to a news reporter for self-promotional purposes. Obama is devaluing the office by offering it to an inappropriate candidate.
Okay, okay, now I get it, Val. This is very much a lesson to me in the breadth of a cabinet appointment as well as how physicians view the office of the Surgeon General. I really appreciate your reasoning (wasn't your old blog called Voice of Reason?) and your aggressive and comprehensive coverage of this issue.
Dr. Val -- if that is indeed his name -- is afraid Sanjay Gupta wants to be Surgeon General for "self-promotional purposes." Val doesn't think the office should be used to glorify the individual, to shine light on the office holder. Val thinks the office should be awarded to truly selfless medical professionals, not vain egomaniacs who seek only to elevate themselves.
Elsewhere on this site, Dr. Val seeks your vote:
"Well," Val says, "I'm a finalist in the medblog awards, but I need your votes to win. I'm pretty sure that I'm going to be crushed by Respectful Insolence - but it'd be nice to give him a run for his money. Any takers?"
You're so vain, doc, you probably thought this blog was about you! Don't you? Don't you?
I basically agree with you, Abel, with this one caveat: We all think C. Everett Koop was a terrific surgeon general because he made the decision to focus both his and the public's attention on a grave yet preventable medical problem that few people had adequately addressed: smoking. He WAS Dr. No Smoking, in my recollection. His effective anti-smoking campaign probably saved or extended the lives of millions.
What I'd like to know is, what is Dr Gupta passionate about in the public health sphere? I think that if he finds an important topic he cares about and is determined to improve in the US, then his brilliant advocacy will be ideal. Say he picks reducing corn/sugars in the US diet. Same heavy industry opposition, same potential benefit to America's health. If he really gets behind it, he could be amazing because he knows how to communicate passionately about science and medicine.
So I am a tentative yes, but I want to know what he and Obama talked about as his passion or planned advocacy.