• Surgeon General: No Longer Relevant?

    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..