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Wednesday, January 7th 2009

Sanjay Gupta As Surgeon General

Sanjay Gupta has been offered, and apparently accepted, the post of Surgeon General in Barack Obama’s incoming administration. It appearsObama holds a special place in his heart for neurosurgeons, which of course brings a smile to my face. I heard on the interview trail that Chicago neurosurgeon, Dr. Gail Rosseau, was close to the Obama camp. Whatever the validity of those claims, apparently she was at least considered for the position of Surgeon General.

Neurosurgeons having their say on matters of public health and health policy is obviously something that interests me and that I have a stake in. But even if that wasn’t the case, Dr. Gupta’s nomination as Surgeon General is something that should be welcomed. That has not been uniformly the case in the media.

Sanjay Gupta Will Have To Grow The Beard

Definitions of both Dr. Gupta and the role of the Surgeon General are probably in order.

Dr. Sanjay Gupta is a Michigan raised neurosurgeon and journalist. He has a significant presence at CNN and has filed pieces and covered everything from public health issues in the United States to international natural disasters to the war in Iraq. Dr. Gupta got his MD and did his neurosurgery training at Michigan with a spine fellowship at UT-Memphis. Not small accomplishments. He holds a faculty position in the Department of Neurosurgery at Emory University.

The role Dr. Gupta would take on as Surgeon General is one with many hats. The Surgeon General heads up the U.S. Public Health Service Commissioned Corps. The Corp has several, sometimes ambiguous, goals but in general works to promote public health. In practice they play a large role in delivering health care to Native American and other underserved populations and providing medical officers for the U.S. Coast Guard. The U.S. Public Health Service Commissioned Corp is a uniformed service and as such shares unique organizational challenges with other uniformed services including the military. Beyond that role however, the Surgeon General’s most important and highest profile responsibility is in communicating public health issues to the public.

The reality is the Surgeon General is vested with little real authority. This is both a challenge and a gift. It has allowed prior Surgeon General’s to voice medically valid opinions on highly politicized topics such as sexuality or drugs of abuse or obesity.

That is where Dr. Gupta’s nomination is so brilliant. As the WaPo piece linked to above notes,

The offer followed a two-hour Chicago meeting in November with Obama, who said that Gupta could be the highest-profile surgeon general in history and would have an expanded role in providing health policy advice, the sources said.

Dr. Gupta would serve a cross appointment in Obama’s new Office of Health Reform directly under new Secretary of Health & Human Services Tom Daschle (who would technically be Dr. Gupta’s boss’ boss as Surgeon General).

I would argue their is no more important skill than communication for the Surgeon General considering his limited influence on policy and the public health of the nation. At least historically. Dr. Gupta is obviously unrivaled as a physician in that aspect. Because of his role on television he has established a relationship with the American public and indeed the world. As a journalist he has proven effective at distilling complicated medical issues down to bite sized chunks that the public can understand and digest.

I have no doubt that Obama intends to use the Surgeon General position as a spokesman not only on matters of public health, as has always been the role of the modern Surgeon General, but on maters of health care policy. I would hope that Dr. Gupta’s position in the Office of Health Reform would be a legitimate one and his voice would be prominent. Apparently he is satisfied as such, as he spoke with Tom Daschle before accepting the position. Dr. Gupta has legitimate experience in the policy arena, he served as a White House Fellow in a previous life. That is impressive.

His experience as a journalist, I would argue, has also made Dr. Gupta, admittedly far removed from some public health issues as a highly specialized surgeon, more than well versed on public health issues. The very issues the Corps is tasked to face.

Dr. Gupta’s nomination is not without criticism however. From what I’ve read the criticisms fall into two categories. Either people question Dr. Gupta’s experience or they cherry pick some commentary he made over the course of his career as a journalist to chide him.

For some the Surgeon General should have some experience in a uniformed service. Dr. Gupta has indeed never served in the military or the Public Health Service. But having donned a uniform in the past, in terms of being able to organize and lead a uniformed service, does not seem an absolute necessity.

Without a doubt, the most famous Surgeon General was C. Everett Koop. Dr. Koop served his time during World War II in the Public Health Service instead of in the military. When he came back to serve as Surgeon General under Reagan, it was to head a Corp he had been a member of. But you will never convince me the Commissioned Corp Dr. Koop came back to, forty years after he had left, was the same Corp he briefly served in during wartime.

Dr. Val over at Get Better Health has an interesting comment from an anonymous source apparently either somewhere in politics or in the U.S. Public Health Service. Here’s what s/he says,

If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.

First, obviously the Surgeon General is required to coordinate and interact with high ranking military leaders but playing the Commissioned Corps of the Public Health Service as analogous to a military uniformed service (as I read the anonymous commenter doing) is a little disingenuous. Let’s draw out that assumed analogy and see why it doesn’t hold up. C. Everett Koop spent a limited amount of time in the lower echelons of the Public Health Service, left for nearly forty years, and then came back to head it. And yet was both accepted and arguably effective (if controversial at times). A similar experience would be a drafted man serving as a private in the U.S. Army through World War II, then leaving and maybe working in the arms industry for thirty years and then suddenly being appointed to head the Joint Chiefs. Impossible, unrealistic and just itching for a disaster.

But that isn’t the case with the Public Health Service. While heading a uniformed service and coordinating with career military and other uniformed service officers, the skills necessary to be Surgeon General and lead the U.S. Public Health Service Commissioned Corp are readily learnable in other careers; making it completely unanalogous to the military.

I understand why those in the U.S. Public Health Service Commissioned Corp would want one of their own to lead them but their really is not something wholly unique about the role of Surgeon General that you must be a career public health servant to be effective.

Second, I think some criticizers are ignoring what the role of Surgeon General has grown into. Let’s be honest, the Surgeon General’s most important role is as a public relations man. Maybe not for the administration, but for something more ambiguous; for public health and healthy living. He or she is the chief medical correspondent for the American public. Dr. Gupta is as qualified as anyone I can think of for such a role.

The other criticisms of Dr. Gupta are more specific. Being a public figure in government is difficult when you’ve put a lot of the record. Dr. Gupta has certainly put a lot on the record as a journalist. He’s put both factual errors and his own opinions, free for others to disagree with, on the record. And even before word of Obama’s choice leaked, and certainly after, critics have cherry picked his work and cited his own words against him.

Here’s what Paul Krugman had to say soon after word of Sanjay Gupta as Surgeon General leaked.

I don