Obama's choice of Sanjay Gupta as Surgeon General (part 2)

by: los anjalis

Tue Jan 13, 2009 at 23:55:19 PM PST

In my previous post, I quoted the website of the Surgeon General's office for the job's description.  Since that post, Dr Val Jones conducted an excellent and timely interview with Dr Richard Carmona, a physician who served in the position of Surgeon General from 2002-2006 (and disagreed strongly with the Bush administration on many issues).  You can listen to the interview or read the transcript.  An excerpt:

Dr. Val: What does the Surgeon General do on a daily basis?

Dr. Carmona: 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.

I won't belabor this point, but Dr Gupta is a well respected neurosurgeon but still a neurosurgeon (not a public health or primary care physician) and has one year's experience working as a White House Fellow with then First Lady Hillary Clinton on healthcare issues.  Previous surgeons general have essentially been those with years of experience in the public health corps or in the field of evidence-based public health.

Dr. Val: What should Americans expect of their Surgeon General?

Dr. Carmona: The Surgeon General of the United States needs to remain a non-partisan physician. He or she should always communicate the honest, scientific truth to the American public so that they can make informed decisions about improving their health. Often, that scientific information is not the same as the policy that the President or Congress come out with, because policy is a very complicated process.

The Surgeon General has the largest medical practice in the nation (300 million), and when he or she issues reports, they actually change behavior in our country and the world. The Surgeon General is the true, honest broker of the best science for the people, offered in an a-political fashion. He or she is a patient advocate at the very highest level of government, and is expected to address the most complex health problems that face our nation. There is no more important or influential office that an American physician can hold.

Dr Carmona brings up some important points here.  The Surgeon General MUST be apolitical, and must have the ability to go against the President or Congress in favor of the honest, evidence-based findings on public health issues.  Dr C Everett Koop and Dr Jocelyn Elders stand out as surgeons general who accomplished these things, whether controversial at the time or not.  Which brings me to qualifications and causes for concern.  Many people share the following concerns about Dr Sanjay Gupta:

Concern #1: Numerous visible conflicts of interest, tarnishing Dr Gupta's credibility.

This is huge.  Dr. Gupta has no lack of conflicts of interest.  As said so well by Gary Schwitzer, Professor of Journalism and Mass Communication and blogger at Schwitzer Health News Blog, "Usually where there's smoke, there's fire".  

(Click on "There's More" for the remainder of the post)

A second example is his "Reality Check" fact-checking Michael Moore's film "Sicko".  Check out the previous Cure This post on this topic for more information on that. There were GLARING conflicts of interests (from health insurance companies and from CNN's administrators and advertisers) in Dr Gupta's smearing of Moore's film.  With a volunteer staff of just me, I could have fact-checked in a more efficient manner.  There is no way that his highly-paid staff could have made this many mistakes in their smearing of Moore. The smearing was entirely intentional.  

Third, Schwitzer quotes a piece by the British Medical Journal in his post "Entanglement of Medical Journalists and Big Pharma":

A powerful contemporary example of entanglement involves a television network called Accent Health (whose logo includes the words "Your target is waiting"), said to be watched monthly by more than 10 million viewers in US medical waiting rooms. The network, which is produced by CNN, overtly offers sponsors, including drug companies, the chance to boost sales of their products, by, for example, putting "your brand in front of the valuable Baby Boomer population just before they discuss their health conditions with their doctor." One of the hosts is Sanjay Gupta, CNN's chief medical correspondent and host of at least one other CNN health programme that is funded partly through drug company advertising.

Fourth, Dr Gupta has also espoused the virtues of the drug Vioxx even after evidence to the contrary, and omitted that he only spoke to the maker of the vaccine Gardasil (Merck Co) before reporting on the vaccine. (source: Dr Steve B's post, and a Counterpunch article by Pam Martens).

Fifth, Dr Steve B adds:

Dr. Gupta has apparently gone out of his way to downplay concern with lead paint in toys (it is a legit concern) and to suggest that cooking beef at regular cooking-for-eating temperatures will prevent the prion based "Mad Cow" disease (even well done does not do it). In other words, when push comes to shove his instinct is to go with the industry line not the public health line.

Concern #2: Dr Gupta has shown a blatant lack of respect for evidence-based medicine.

What is evidence-based medicine?  From Wikipedia:

It seeks to assess the quality of evidence relevant to the risks and benefits of treatments (including lack of treatment). According to the Centre for Evidence-Based Medicine, "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

Gary Schwitzer notes:

The prevention & wellness messages that Gupta so often promoted on CNN can go too far - pushing screening tests outside the boundaries of evidence and ignoring that such screening may cause more harm than good. If that is the message that he would promote as Surgeon General, I would consider that a non-evidence-based abuse of the bully pulpit. And a huge mistake by the Obama administration...

Presumably Surgeon General Gupta would work closely with new HHS secretary Tom Daschle. Several passages from Daschle's book, "Critical: What We Can Do About the Health Care Crisis," raise questions in my mind about the Gupta appointment. Daschle wrote about "using evidence-based guidelines and cutting down on inappropriate care" as effective ways to control rising health-care costs. But Gupta's reporting, as noted in the entries above, often didn't reflect a great appreciation for evidence-based health care. Daschle also wrote, "It is relatively easy to misinform the public and stoke fears, no matter how strong the desire for reform." Promoting screening outside the boundaries of evidence is fear-mongering. These are potentially troublesome disconnects for an Obama health care team.

Sandy Scwarz notes in her blog Junkfood Science:

As Dr. Gupta has told reporters, he wants to test every American for heart disease, stroke and cancer - which will require the will of the federal government, insurance companies and the public - and put everyone on a prevention track. He supports calcium scores and CT angiograms and medications so, he said, no one ever need have a heart attack, stroke or cancer again.

(CT angiograms and calcium scores are expensive, not rational uses of our health dollars, and the evidence behind their is not substantive).

She also mentions Dr Gupta's book Chasing Life, in which he discusses and promises a longer life by following numerous unproven anti-aging therapies.

It is hard to know which is more frightening: that the government - which will decide what medical care we can receive, what clinical guidelines our doctors must follow, what research is funded, and where limited healthcare resources will be spent - selected this doctor to represent the best scientific information available on health. Or, that only one in ten consumers polled at WSJ saw a problem with this selection.

These are all legitimate concerns.  Putting this all together is what's interesting.  Drs. Lisa Schwartz and Steve Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice (and the authors of the British Medical Journal article on Dr Gupta's connect with Accent Health) stated that a surgeon general would "need to demonstrate skills that are too often missing in medical news on TV: skepticism about the science and a careful analysis of both the benefits and harms of medical care".

I do not think there is disagreement that improving the US Public Health Service Commissioned Corps or the visibility of the Surgeon General is a positive thing.  And making public health issues cool is the stuff that makes my colleagues and I salivate.  But to weigh these qualifications of a candidate over others can be dangerous.  The last several years have shown a clear move towards a lack of accountability, less integrity, greater conflicts of interest, and a rebuking of real science in the policies of our government.  We need a move away from that, we desperately do.

New York Times columnist and Nobel Prize winner Paul Krugman says this about Dr Gupta's "reality check" segment that ran on CNN television right before Michael Moore's presence on CNN's Situation Room with Wolf Blitzer:

So apparently Obama plans to appoint CNN's Sanjay Gupta as Surgeon General. I don't have a problem with Gupta's qualifications. But I do remember his mugging of Michael Moore over Sicko. You don't have to like Moore or his film; but Gupta specifically claimed that Moore "fudged his facts", when the truth was that on every one of the allegedly fudged facts, Moore was actually right and CNN was wrong.

What bothered me about the incident was that it was what Digby would call Village behavior: Moore is an outsider, he's uncouth, so he gets smeared as unreliable even though he actually got it right. It's sort of a minor-league version of the way people who pointed out in real time that Bush was misleading us into war are to this day considered less "serious" than people who waited until it was fashionable to reach that conclusion. And appointing Gupta now, although it's a small thing, is just another example of the lack of accountability that always seems to be the rule when you get things wrong in a socially acceptable way.

Brilliant.

Now, nobody has any delusions about just how large (or small) the office of the Surgeon General is, but it's important that we take this appointment process very seriously.  It is imperative that Dr Gupta's conflicts of interests be examined very carefully by the Senate (the body that would approve his appointment to Surgeon General).  And if/when Dr Sanjay Gupta is our next Surgeon General, it will be imperative for people and organizations to hold the office accountable to the public health needs of the U.S.  I have a feeling that might be a bit easier to do in the coming years than in the last eight years.  

Finally, I very much look forward to an enhanced role of new media technologies, savvier communications, effective public health messaging, and openness around important public health issues, in the coming administration, and I'm curious to see (and for all of us to be involved in) what direction Obama wants to take public health policy in the U.S.