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  • The Case for a USPHS Surgeon General From the Ranks - Former SG Richard Carmona

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    Published on 12-18-2014 01:11 PM
    1. Categories:
    2. General Interest

    This article was written by Former SG Richard Carmona and is reprinted from The Daily Caller

    On Dec 15 the U.S. Senate took action largely along party lines to confirm Dr. Vivek Murthy as the next U.S. Surgeon General. This nomination has languished for a year due to insufficient Senate support for Dr. Murthy. But, as the lame duck session entered its 11th hour, Senator Reid again invoked the nuclear option to clear the way for Dr. Murthy’s confirmation.

    Dr. Murthy barely received enough votes to be confirmed – culling together the support of just 51 Senators primarily along party lines. This is indeed unfortunate since the doctor of the nation needs bipartisan support to be successful. For disease and the public’s health knows no party affiliation. Dr. Murthy is a gifted young physician very early in his career. He has some early significant accomplishments behind him but no formal public health training and little management or senior leadership experience. His nomination became controversial due to his inexperience and his political advocacy and perceived bias and on several issues. That being said it is important to recognize that the problem is in the politicization of the Surgeon General nomination process and Dr. Murthy’s nomination and confirmation simply reflect that dysfunction.

    The Surgeon General is the leader of the U.S. Public Health Service Commissioned Corps, one of the seven uniformed services of the United States. The position carries with it the rank of Vice Admiral. This is a three star rank equivalent to the Surgeons General of the Army, Navy and Air Force. The difference is that the Army, Navy and Air Force Surgeons General earn their rank and title after decades of selfless service, as did the U.S. Surgeon General before politicians began to circumvent the uniformed service merit system for their own benefit.

    This blatant act of political self-interest does not benefit the public but does undermine the credibility of the office of the Surgeon General and serves to demoralize and demean the career uniformed service of our men and women who are now marginalized and prevented form meritoriously being considered for Surgeon General as they once were.

    Partisan politicians acting in self-interest is nothing new. However, we should recognize that by politically conferring the rank of vice admiral and the title of Surgeon General on any person who has not earned that right you are actually disadvantaging that person from the start. In the beltway where the Surgeon General resides and works his peers are real admirals, generals and senior health professionals who have earned their respective positions.

    Politicians have many opportunities such as ambassadorships and appointed partisan positions to reward political support and advocacy. The office of the Surgeon General should never be a pawn for political patronage. The public expects and deserves the most qualified public health professional who merits consideration.
    Ironically, if not but for a late political strategic blunder by a Republican senator, Dr. Murthy’s name may never have been advanced for confirmation.

    Putting the plague of politics aside we now must turn to the more important issue of protecting the health, safety and security of the nation. Dr. Murthy is fortunate in that he will be surrounded by members of the USPHCC. True professionals who, after many years of public health leadership and management experience, can provide him with historical perspective and public health guidance moving forward. Dr. Murthy would be wise to follow their lead.
    Published on 12-15-2014 09:35 PM
    1. Categories:
    2. General Interest

    Murthy, 37, is a British-born Indian-American who was educated at Harvard and Yale and has both medical and business degrees. He completed his residency in 2006 at Boston's Brigham and Women's Hospital, where he is an attending physician. He will be the first Indian-American to serve in the role. Murthy's nomination comes from his political advocacy during the election campaign for President Obama, although his past statements on gun control slowed his nomination. In 2008, he co-founded Doctors for Obama, a group of doctors and medical students who supported the Obama campaign. The group transitioned to Doctors for America after President Obama won. Normally, Dr. Murthy would enter the Corps as a LCDR but with this nomination and confirmation, he is an Acting Vice Admiral.

    Murthy is the latest in a string of executive nominations that were only able to pass the Senate after Majority Leader Harry Reid, D-Nev., pushed through a rules change last year to lower the threshold from 60 to 51 votes to advance certain presidential nominations. Republicans have not said whether they will keep the rules change in place in the next Congress. Murthy replaces Acting Surgeon General Boris Lushniak, who has been serving since former Surgeon General and Acting VADM Regina Benjamin resigned in July 2013. RADM Lushniak has resumed his role as Deputy Surgeon General.

    RADM Lushniak was simply the best Acting Surgeon General the career Corps could have hoped for; moving up the rank and experience ladder since joining the Corps in 1988, he led the Corps like no other ASG. His experience in CDC's EIS Program, at NIOSH and FDA made him an ideal Surgeon General with the breadth of experience necessary for the job. RADM Lushniak is highly experienced in the field, having completed service with the Indian Health Service in Winslow, Arizona and most importantly, serving with NIOSH in the field where he conducted epidemiological investigations of workplace hazards. RADM Lushniak is well established as a first responder and member of the Command cadre, having served on special assignments and disaster response activities in Bangladesh, St. Croix, Russia, and Kosovo, as part of the CDC/NIOSH team at Ground Zero (World Trade Center) and the CDC team investigating the anthrax attacks in Washington, DC. He served as the Chief Medical Officer of the Office of Counterterrorism at the FDA, and in 2005 was appointed FDA Assistant Commissioner, Counterterrorism Policy and Director of the Office of Counterterrorism and Emerging Threats within the Office of the Commissioner.

    RADM Lushniak was born in Chicago to post-World War II immigrants from Ukraine. He is an inspiration to many inside and outside the ranks of the Corps and will likely go down in Corps history as one of finest examples of the unfairness of the current nomination system that minimizes the career officers of the Corps as only able to attain Acting or Deputy roles in the service of our nation, despite being far, far, more qualified for the Surgeon General position than any civilian nominee.
    Published on 11-24-2014 11:04 AM

    MONROVIA, Liberia — A cluster of American uniformed officers gathered in the sticky heat this week to say a prayer for a dead Liberian nurse, the first loss to Ebola at the only U.S. government-operated clinic in West Africa.

    The 34-year-old nurse's death Wednesday hit the American staff hard at the clinic charged with caring for health care workers sickened by Ebola.
    "She was one of us. She was a health care provider just like all of us," said Russ Bowman, 53, of Albuquerque, a lead physician here. "This is what this unit is for — to provide care to folks ... providing care for the people of Liberia. We're here to back them up. And we weren't able to save her. And that's a tragedy."

    Reporter's Notebook: Inside Liberia's Ebola fight

    The nurse — whose name was not made available — was unconscious and already failing when she arrived by ambulance the night before. "It's a shame she wasn't here a lot earlier," said Jennifer Malia, 41, of Laytonsville, Md., a lab medical technician. "I believe we really could have helped and maybe had a different outcome."

    Her arrival at such a late stage of the disease raises concerns that the new clinic, which opened Nov. 7, is not being adequately publicized by Liberian health officials. Four Liberian health workers with Ebola are being treated there. All are improving. "I'd like to be able to answer that, definitively, yes (word has spread)," says Paul Reed, the chief medical officer. "But I don't know that."

    Chief Medical Officer Paul Reed.(Photo: Gregory H. Stemn for USA TODAY)

    When President Obama announced in September he was sending U.S. troops to Liberia, it was with the caveat that none would directly treat patients infected with Ebola, which has killed 3,000 in this country.

    U.S. diplomat doubts Liberia Ebola cases will end soon

    But with health workers among the most threatened by the disease, the responsibility for a clinic devoted to treating doctors and nurses who become ill fell upon the U.S. Public Health Service, a little-known branch of the Department of Health and Human Services. "It's a very noble mission, an honorable mission," says Reed, who left behind a wife and four children to deploy.

    The Public Health Service is one of the nation's seven uniformed services with members who carry military ranks and wear uniforms similar to those of the U.S. Coast Guard. They often are sent to domestic and international health disasters.

    This is the first time Public Health Service members have operated an Ebola clinic. All 69 workers here are volunteers. "I told my oldest before I left 'This is what God wants us to do. We're here to help people. That's what Mommy does,' " says Malia, a married mother of three. Malia and her colleagues live on pre-packed military Meals Ready-to-Eat. The clinic sits near Liberia's international airport and looks much like a military field hospital with air-conditioned, barrack-like structures assembled neatly into a green zone and a hot zone for Ebola patients.

    Liberian president hopes to defeat Ebola by Christmas

    Clinicians follow painstaking procedures for donning and taking off protective gear, thoroughly dousing themselves with a chlorine mix to kill the virus as they shed the suits.
    With the hoods and masks on in the red zone, they are nearly unrecognizable. So many carry a small photo on their suit allowing patients to see what they look like.

    Bowman says he has developed a healthy respect for Ebola. Clinicians are methodical about how they move around patients. One staff member always watches for any safety breach. "It's kind of like a rattlesnake," Bowman says of the disease. "You don't poke it. You know what it can do. You prepare for it. You avoid things that can put you in harm's way."

    Hand washing is key to protecting U.S. troops from Ebola

    The Liberian nurse was in the last stages of the disease, her body teaming with the virus. The U.S. Public Health officers washed her repeatedly with water tinged with chlorine and kept fluids flowing into her veins, hoping that by morning she might improve. But the nurse was too far gone, Bowman says. "She was unresponsive when she came in and clearly very ill. ... We did what we could for her," Bowman says. "It's a very tenacious illness."

    Lt. Shane Deckert and CDR David Lau work inside the Monrovia Medical Unit.(Photo: Gregory H. Stemn for USA TODAY)
    Published on 10-31-2014 04:01 PM
    1. Categories:
    2. General Interest

    CAPT Calvin Edwards has deployed to Liberia to oversee a U.S. Public Health Service team combating Ebola.

    CHAMBERSBURG, Pa. — A Chambersburg man has deployed to Liberia to oversee a U.S. Public Health Service team combating Ebola.
    Calvin Edwards, 51, received recognition from President Barack Obama in a Wednesday afternoon speech about American health care workers fighting the outbreak. Obama’s remarks apparently referred to The Washington Post’s interview with Edwards as he prepared over the weekend to board a C-17 aircraft headed to Monrovia, the capital of Liberia.

    “We read about how on his 29th wedding anniversary, carrying a pillow from home and a copy of the New Testament he takes on deployments, he left for training to oversee a team in Liberia … but before he did, he made sure to buy his wife a dozen roses,” Obama said, as quoted in a transcript of the speech.

    The Washington Post quoted Edwards as saying he is respectful of Ebola, but not afraid of it.

    “It doesn’t hop from person to person. It requires contact with bodily fluid,” he told The Post.

    On a typical day, Edwards does food-safety inspections for the U.S. Food and Drug Administration in Harrisburg, Pa. However, he also is a member of the Public Health Service Commissioned Corps, one of the seven uniformed services. The Public Health Service is composed of health professionals overseen by the U.S. surgeon general. The nation does not currently have a surgeon general in place because the Senate has stalled on confirming the nominee submitted by Obama last year.

    A U.S. Department of Health and Human Services spokeswoman confirmed Thursday that Edwards is the officer in charge of the Monrovia Medical Unit. Sixty-five officers comprise the team that is caring for health care workers who become ill from Ebola. “The Commissioned Corps are trained and ready to respond to public health crises and humanitarian missions. The dedicated officers have the skills to make a significant impact in one of the international community’s most devastating public health emergencies,” Acting Surgeon General Rear Adm. Boris Lushniak said in a statement.

    Ebola in West Africa has sickened more than 13,000 people and killed nearly 5,000 of them.

    The Post reported Edwards, an amateur beekeeper, left for training in Alabama on Oct. 19. He has four children. “As he boarded the plane to Monrovia, Capt. Edwards reminded his team of their oath to defend our country, and they responded with a rousing rendition of ‘The Star-Spangled Banner.’ And they’re all there right now, making us proud,” Obama said in his speech.

    Reprinted from Herald Mail Media
    Published on 10-28-2014 08:11 PM

    HARBEL, Liberia—”Where have you done this before?” USAID Administrator Raj Shah asked on October 15, as he stepped through the taupe colored tent flap into the new 25-bed critical care hospital being built to treat all health care and aid workers who fall ill to Ebola. “Nowhere, sir. No one has,” replied an army engineer.

    Historically, mobile medical units like this one provide versatile trauma care for military operations. In this case, the Department of Defense (DoD) and the U.S. Public Health Service (USPHS) customized the Monrovia Medical Unit to treat highly contagious Ebola patients.

    Once complete, the hospital will be operated and staffed by a team of 65 specialized officers from the USPHS Commissioned Corps – an elite uniformed service with more than 6,800 full-time, highly qualified public health professionals, serving the most underserved and vulnerable populations domestically and abroad.

    The Commissioned Corps will deploy clinicians, administrators, and support staff to Liberia to treat health care workers with Ebola, and to continue efforts by USAID, DoD and international partners to build capacity for additional care in Liberia.

    Link to Photos
    1. Categories:
    2. General Interest

    Do We Need a Surgeon General?
    Federal Times - By Richard H. Carmona, M.D., M.P.H., FACS

    As I finished writing this opinion piece, the title seemed to evolve into a rhetorical question. The Ebola crisis has metastasized to the United States and the media and numerous government and private spokespersons are attempting to educate and calm the American public while not inflaming or confusing the situation.

    A single credible, trusted, nonpartisan recurring voice is what is needed to educate and reassure America and the world who is watching us.
    Recently, Surgeon General Jesse Steinfeld, the 11th surgeon general of the United States (serving from 1969 to 1973), passed away. His obituary heralded his many significant accomplishments as surgeon general and commander of the United States Public Health Service Commissioned Corps, one of the seven uniformed services of the United States. What was particularly striking and concerning and voiced in his obituaries and commentary about his life, were references to Surgeon General Steinfeld having to fight and battle various individuals, groups and entities in order to promulgate health policy that would benefit the public he served.

    This prompted me to review the obituaries and commentary about other surgeons general who passed away in the last decade. These would include Surgeons General Julius Richmond, #12; Bill Stewart, #10; and C. Everett “Chick” Koop, #13.

    These surgeons general were extraordinary public servants who served selflessly in increasingly embattled positions. Like Surgeon General Steinfeld, their obituaries and press commentary were often punctuated with adjectives such as, “fighting,” “combative,” “battling entrenched political interests,” “adversarial maneuvering” and “stressful attempts to take out or eliminate the surgeon general”. These descriptors often sounded as if the surgeons general were officers in a combat unit battling hostile adversaries as they attempted to survive in an increasingly partisan battlefield. The sad truth is they were, we still are and in some cases the surgeons general succumbed to the lethal wounds of political warfare where resuscitation is rarely possible.

    Surgeons general of the Army, Navy, Air Force and U.S. Public Health Service were always career uniformed officers who merited consideration for promotion and advancement by their seniority, accomplishments, demonstrated leadership, education and training. The White House would receive recommendations from the respective uniformed service chiefs and the President would then recommend names to the Senate for confirmation as a surgeon general with the rank of Vice Admiral or Lt. General, depending on the service.

    This tried and true process, over a century old, still exists in the uniformed services except for the U.S. Public Health Service. Since the late 1960s and early 1970s, various political administrations have gone outside of the USPHS to identify and nominate candidates who were believed to be more politically aligned with the political party in power at the time. By doing so, they demean the service of career USPHS officers who are qualified but passed over in attempts to align science with desired political platforms.

    Interestingly, these attempts at prospectively attempting to identify politically aligned surgeons general nominees have usually failed and caused frustration for leaders in both political parties over the years; all surgeons general come to understand that you are the doctor of the nation and not the surgeon general of the Republican or Democratic parties.

    In addition, those outside nominees, if confirmed, are immediately promoted to vice admiral even though some have no military or uniformed service experience. This process is offensive to all career officers who selflessly sacrifice throughout a long uniformed service career to merit consideration for promotion as an admiral and surgeon general. This politically motivated action also diminishes the credibility of the Office of the Surgeon General.

    It is also apparent that not every physician is capable of being surgeon general. An example would be the current nominee for surgeon general who is very early in his professional career, with great potential but without significant progressive leadership experience or specific public health education or in depth experience with complex policy, global and public health issues. However, he was the co-founder of Doctors for America, a partisan organization supporting President Barack Obama.

    In a recently published book, Surgeon General’s Warning, author Mike Stobbe painfully discusses the gradual political demise of the United States surgeon general and suggests that therefore, it may be time to end the position. As much as I appreciated Stobbe’s scholarly work, my review of it leads me to a very different conclusion. We should actually act to strengthen the Office of the Surgeon General by protecting it from political manipulation. In our hyper-partisan political world characterized by gridlock and great political poetic license in the interpretation of science to support ones preconceived political bias, who will have the responsibility to speak scientific truth to power? Who will provide the scientifically based “informed consent” to the American public and at times, the world?

    Eliminating or allowing further diminishment of the Office of the Surgeon General to occur is not in the best interest of the American public although it may benefit politicians.

    In July 2007, I joined Surgeons General Koop and Satcher testified before a congressional committee investigating the attempts to politicize the Office of the Surgeon General. Three surgeons general serving four separate presidents, from the very liberal to the ultraconservative administrations, all testified on the issues challenging them during their tenures. The surgeon general testimonies were remarkably similar and a clear bipartisan indictment of the attempts to manipulate science and diminish the Office of the Surgeon General. Not surprising but extremely disappointing, Congress took no action on this unprecedented testimony that they themselves had requested.

    It is clear that our nation needs and deserves a strong, qualified and nonpartisan surgeon general who resides in a protected and well-funded Office of the Surgeon General. The public we have the privilege to serve deserves no less.

    Richard H. Carmona, M.D., M.P.H., FACS, served as the 17th Surgeon General of the United States.
    by Published on 10-09-2014 10:57 AM

    A White House Office of the Press Secretary-issued FACT SHEET entitled "The U.S. Government's Response to Ebola at Home and Abroad" identifies the U.S. Public Health Service Commissioned Corps as operating and staffing a hospital for infected health workers. The USPHS is preparing a cadre of 65+ officers, composed of Safety / Preventive Medicine, Pharmacy, Nurse, Physician, and support staff for 60 day mission rotations to operate a treatment facility for health care workers who have contracted Ebola Virus Disease (EVD). The 25-bed hospital will be established in Liberia, West Africa. The USPHS officers will be selected from multiple Tier deployment teams.

    To illustrate the challenges faced by health care workers, symptoms may present post 2 - 21 days after exposure to body fluids, which include fever, unexplained bruising, headache, vomiting, stomach pain, muscle pain, unexplained bleeding, and diarrhea. This means constant vigilance among health care workers and our officers to be both self-aware and observe others for symptoms. Further complicating ebola symptomology, West Africa is a physical and mental challenge due to heat stress and vectorborne / foodborne / waterborne transmitted diseases that can cause physical symptoms similar to EVD. Officers will need to be in optimal fitness and heat acclimatized as much as possible.

    At symptom onset, transmission of the virus can occur from contact with blood, saliva, urine, tears/conjunctive tissue, sweat, vomitus and feces. After symptom onset, death occurs (on average) after 10 days without intervention. If the patient survives into convalescence, secretions of blood, urine, tears/conjunctive tissue, semen, vaginal, milk and fecal matter may transmit the virus over 84 days post symptom onset. Medevac from Liberia takes approximately 3 days, and return from Africa approximately 5 - 7 days, after which officers will need to monitor themselves for symptom onset.

    The U.S. Public Health Service is the only uniformed service taking a role in direct patient care. The Department of Defense will provide specimen testing and health care worker training, logistics and infrastructure.
    Published on 09-26-2014 06:22 AM

    09-24-2014 09:10 AM

    A Burlington Nurse Takes On Ebola in Liberia
    Seven Days
    Dressed in jeans and a navy blue polo shirt emblazed with the U.S. Public Health Service logo, Goode explained the ravages of Ebola in the manner of someone used to distilling wonky topics into simpler form. The disease manifests itself in fevers, ...

    Link to the story...
    Published on 07-05-2014 10:58 AM
    1. Categories:
    2. General Interest

    Published: Jul 6, 2014

    By Crystal Phend, Senior Staff Writer, MedPage Today

    The politicalization of surgeon general selection should be eliminated, rather than scrapping "the nation's doctor," a former holder of that post argued.
    Powers gutted by federal reorganization in the 1960s and further weakened by risk-averse politics in the White House aren't likely to return, Mike Stobbe, DrPH, of the Associated Press had argued last week in an interview with MedPage Today. That interview coincided with the release of Stobbe's book "Surgeon General's Warning: How Politics Crippled the Nation's Doctor."

    However, Stobbe's conclusion that "it's probably time to get rid of the surgeon general," moved the 17th Surgeon General, Richard Carmona, MD, MPH, to send a comment to MedPage Today. Carmona, whose term ended in 2006, was sharply critical of Stobbe's conclusion, which prompted MedPage Today to follow-up with an interview.

    "It is an extremely important role and one that the public recognizes as important because of the credibility of the surgeon general," he told MedPage Today. "I would argue very strongly that more than ever we need the office of surgeon general today, as we do the U.S. Public Health Service." Carmona, now a public health professor at the University of Arizona in Tuscon and a professor at Ohio State University College of Nursing in Columbus, explained his reasoning in this interview, which was edited for length.

    Does the politics surrounding selection undermine the position?
    Carmona: The challenge has been more a political one than any issue of relevance to the office of surgeon general. If you go back to the late '60s and early '70s the surgeon generals were always promoted from within the ranks in a merit system and this is the same system that the other services follow. The Army, Navy, and Air Force have surgeons general too. Their secretary offers a name to the White House, the president nominates, the same process takes place and ultimately the Senate confirms that person. The departure started few decades ago when both parties started to politicize the office and go outside of the system and pretty much ignore the career officers in the uniformed system in hopes of probably finding someone that may be more aligned to the political party in power at that time. I think it's wrong for a lot of reasons. First and foremost, it's devaluing the service of career officers. In the Army, Navy, and Air Force you never see those challenges. It becomes an embattled position because of the politics.

    It is an extremely important role and one that the public recognizes as important because of the credibility of the surgeon general. The surgeon general really is not the doctor of the Democratic or Republican party; you are the nation's doctor. I look at the surgeon general's office much like we look at the Federal Reserve or even a Supreme Court Justice. You are supposed to rise above the political bias and rule on the best finance information, the best law information, and, the surgeon general, opining on the best scientific information. Why would you want to marginalize that position in a world that depends on understanding complex science and applying it to policy?

    What changes would you like to see?
    Carmona: First of all, I think we should revert back to promotions to U.S. Surgeon General based on merit from the career public service officers who merit consideration because they have dedicated their lives to the health, safety, and security of the nation. Number two, would be to reaffirm that the surgeon general is the commander of the U.S. Public Health Service and that the surgeon general should be involved interpreting and understanding complex science and translating it to the American public, translating it to Congress, translating it to the secretaries in other departments.

    Last, my recommendation to Congress and the president would be that we should not ask, but demand, that that the surgeon general prepare a State of the Nation's Health every year and that would include an assessment of global health because we are inextricably tied to the rest of the world. And it should include what are the challenges that we're facing now, whether they be infectious diseases, whether they be chronic diseases, whether they be the long-term effects on our veterans in the war effort -- there are so many issues that our government are involved in where there's an intersection of health, or safety, or security. The surgeon general is the interface there as well.

    How likely are the kind of changes you describe?
    Carmona: No question it will be tough. There's nothing happening in Washington these days that isn't tough. This will be among many things but we shouldn't shy away from it because it may be difficult or it may be caught in a political discourse, especially by ill-informed people. The fact is this is a very valued position both to the American public and to America in general. I strongly believe a strong surgeon general and a strong Public Health Service is in best interest of the United States and, in some cases, the rest of the world.
    Published on 07-05-2014 10:20 AM
    1. Categories:
    2. General Interest

    As Published with comment from Former SG Richard Carmona: Jun 27, 2014
    By Crystal Phend, Senior Staff Writer, MedPage Today

    Once "the kings of U.S. public health," surgeons general have seen their powers gutted to the extent that the post should be done away with, according to one expert. "It's probably time to get rid of the surgeon general," said Mike Stobbe, DrPH, a national medical correspondent for the Associated Press and author of the book "Surgeon General's Warning: How Politics Crippled the Nation's Doctor," released on the University of California Press Thursday.

    The position is at a nadir and unlikely to rise again in the perennially risk-averse political climate, he concluded from 7 years of research and interviews.

    "Federal reorganizations in the 1960s stripped away most of the job's responsibilities and gave them to people appointed by whoever was in the White House at the time," Stobbe wrote, adding, "The surgeon general, meanwhile, became a bench-riding bureaucrat and glorified health educator."

    "It was a conclusion I was sad about," he told MedPage Today,

    MedPage Today
    caught up with Stobbe about the impact of this vacuum of power on both physicians and the public. His responses have been edited for length.

    What are the issues today that are in need of a strong surgeon general?

    Stobbe: "A surgeon general can really do a service to the public not only when they continue to hammer on continuing concerns, like smoking, but take on newer issues that the public seems to be confused about or uncertain about. I mention in the book that in recent years some topics were really ripe for a surgeon general to step in on, like tanning. There's evidence suggesting the public health message is just not getting through. Studies have found the majority of teens who tan are girls. Girls and their parents don't seem to take extensive visits to tanning salons as a serious health threat. That's something a surgeon general who is forceful about this could really change some thinking about.

    The vaccination rates -- there has been uncertainty among a lot of parents in last decade about are vaccines safe and will my child get autism from them. We've seen a resurgence of measles, mumps -- diseases that should be all but erased from our country but are bouncing back because, at least partly, of parents feeling uncertain about the safety. Testing for HIV -- every adults in U.S. is supposed to be tested for HIV but rates in some sectors have been disappointing. HPV -- uptake of that vaccine has been low.

    Physicians are really in kind of a tough spot. They've got so much to deal with. These are touchy topics and the doctor is trying to get through so many issues and tasks with each patient. When we had a strong surgeon general talking about smoking or talking about HIV, it has been a big help to many physicians in broaching the topic or even getting some patients on the same page as physicians even before they walk in the door. It's a tall order to ask each physician in the country to do the surgeon general's work, to do all the public health communications, to sell them on vaccinations, to sell them on taking it easy on sun tanning, to sell them on taking it easy on the weight. There are a lot of things that an effective and aggressive surgeon general could help the public and the physicians communicate with."

    We do have strong figures taking on some of this role in public health, like Dr. Oz, Sanjay Gupta, and former New York City Mayor Michael Bloomberg. Could that be part of the solution?

    Stobbe: "There's been a vacuum when we haven't had these strong surgeons general. People want somebody. They have these questions about vaccines; they've got questions about other things. They're looking to somebody who says it straight and is a good communicator and helps them make health decisions for themselves and their family. They're not getting it from the government. Even the people at the CDC, they speak in public health speak. So it's not something we can ask of them. Who is stepping into the vacuum? Dr. Oz -- he's a great communicator and he's got a lot of good information. Surgeons general have been on his show because they see he's this platform. But he's promoting alternative remedies that aren't proven by science. He has mystics on talking about the afterlife. There are a lot of people who have other motives trying to step into that vacuum. It would be nice if we had a surgeon general who didn't have other agendas, wasn't selling a book, wasn't doing other things, just giving the best science available and trying to help people."

    What are your thoughts on the current acting surgeon general, Rear Admiral Boris D. Lushniak, MD, MPH?

    Stobbe: "The actings are temporary appointments who don't have as much leeway to tackle issues. So we can't really expect too much. But I have to tell you, I think he's pretty good. Boris Lushniak was the person in the office at this 50th anniversary smoking report released in January. He's a very animated speaker who really showed emotion in talking about the deadliness of smoking. I suspect that if he were chosen to become official surgeon general, he really could be very good. He seems interested in taking on some of the touchier topics that have been untouched by surgeons generals."


    karl lehn, 06/27/14
    It seem Mr. Stobbe forgets the primary role of the Surgeon General's office is to be the head of the USPHS Commissioned Corps a uniformed service with the same rank structure as the US Navy. These officers are required to serve with the Coast Guard as their physicians and also serve as medical staff in many Federal facilities. The USPHS does valuable research in the various medical fields as well. Removing the Surgeon General from his post is the same as removing the USPHS' leader. Bad idea..

    Name Withheld, 06/28/14
    "Federal reorganizations in the 1960s stripped away most of the job's responsibilities and gave them to people appointed by whoever was in the White House at the time,' Stobbe wrote." The SG is the titular head of the USPHS but the Office of the SG functions primarily as a personnel office for the Commissioned Corps with very little authority. Officers assigned to the Coast Guard work for the Coast Guard, those assigned to the Bureau of Prisons work for the Bureau of Prisons, etc. Even for Corps personnel issues, the important decisions are made by the Assistant Secretary for Health who outranks the SG. See http://www.surgeongeneral.gov/about/history/ for an excellent, brief summary of past and current responsibilities of the SG and Office of the SG. Mike Stobbe is an outstanding reporter on health but I think he understates the case for making Boris Lushniak the SG. Dr. Lushniak would make a great SG..

    DNADOC, 06/30/14
    Thank you Karl, excellent point! There are several more SGs; one for each branch of the military, the Joint Staff Surgeon General and tbe Coast Guard's Surgeon General. For those of us either in or working with the military, we often forget about the USPHCC SG and I often have to explain that position to the 'real military.' But the USPHCC fills a vital role in our country and should not be dismissed so lightly. I don't think anyone wants a military SG advising the HHS Secretary (who right now is about as far as you can get from being a physician or scientist) on public health issues. During these times when we have an HHS Secretary that is a program manager instead of a scientist or a physician and who has no experience in these fields whatsoever, the Secretary's office really NEEDS advice from the SG's office. Can you even picture what would happen without the SG's office??!?!.

    richard carmona, 06/30/14
    I applaud the previous comments and as The 17th Surgeon General of The United States and a former US Army Special Forces soldier I want to also respectfully disagree with Mr Stobbe's conclusion. I was interviewed for this book and in no uncertain terms made the strongest of cases for the need and strengthening of the Office of The US Surgeon General and for a strong and mobile US Public Health Service. We are the only nation in the world who has an army of deployable health warriors to respond to 'all hazards' as well as successfully working on a daily basis throughout govt. Eliminating the OSG hurts the people because of the immense credibility of The OSG. The gradual and persistent attempts at marginalization of The OSG are due to the plague of politics and not any inherent weakness in the OSG. Until a few decades ago and for over 100 years all surgeons general came from the ranks of the USPHS via earned successive promotions through rear admiral and then presidential nomination and senate confirmation as a Vice Admiral based on merit and not patronage or politics. As one of the 7 uniformed services of The United States this is also how the Army, Navy and Air Force all promote their Surgeons General. Why is The OSG of The USPHS different? Why is there no longer a regular change of command and continuity of service that benefits the public and gov't like the other services? Why has it now become common to have huge time gaps between US Surgeons General filled by an 'acting SG'? I would respectfully suggest that a more appropriate solution is to fix the political problem, develop a 'vaccine' for the political plague that is hurting our nation and revert back to the time honored and tested method of nominating Surgeons General, just like the Army, Navy and Air Force do, by earned merit! The public would expect no less. To not do so de values the career officers who sacrifice much as they aspire and work diligently over a career to be considered for the position of SG. Last, RADM Boris Lushniak, the current acting SG is eminently qualified to be considered for nomination as SG as are several other career USPHS officers..