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Published January 06, 2009 @ 10:36PM PT
In a sentence I never, ever thought I'd be writing, Dr. Sanjay Gupta is being strongly considered for the role of Surgeon General. Without a doubt, Dr. Gupta is an engaging reporter on health issues, and is one of the more recognizable public voices on health education. He is also a board-certified and practicing neurosurgeon of well-deserved renown. But does he truly fit on the team Obama has assembled, particularly when it comes to health care reform? It's a mixed bag, with some major red flags. But, after some soul-searching, there are five reasons why I learned to stop worrying and love the Gupta.
First the red flags:
1.) He's still young in his career, and his experience is restricted to the practice of medicine and journalism on health issues, plus some honorifics related to the above. Traditionally our Surgeon Generals have either been long on military service (Richard Carmona) or had an incredibly long and impressive medical career (David Satcher) -- or both. In either case, the phasers were set to "Gravitas."
Also, more often than not, they were set for "Wicked Impressive Beard."
2.) You're going to give a former Sexiest Man of the Year nominee the rank of Admiral and expect him to be taken seriously around the Pentagon. Good luck with that!
3.) Many progressives -- myself included -- don't want to see him in the inner circle on health care reform. First of all, his qualifications on health care policy are much more slender than on health issues in general. He was a White House Fellow working for Hillary Clinton, and then... what? As Niko Karvounis explains on Health Beat Blog, the media is actually pretty bad -- no, strike that, TERRIBLE at reporting health care policy. He cites a Kaiser report that health care policy only was reported as a "health issue" story 27.4% of the time. Ask a random person about what Dr. Sanjay Gupta story they remember, and they might say the surgeries he performed in Iraq, or his Katrina stories, or one of his "Fit Nation" profiles. They're not likely to remember him talking about insurance regulation and cost control.
And then there's this...
Honestly, neither Dr. Gupta nor Michael Moore acquit themselves well here. They spend a lot of time playing, "Whose numbers are right?" rather than making a coherent argument.
But for many progressives -- myself included -- this is an indelible image. Dr. Gupta may have thought he was asking the tough questions or doing his job as a reporter, but his antagonistic logic on the issue is wrong-headed, bordering on mean. There's the focus on minute mistakes, as though if one detail was wrong, your whole argument fails. There's the smug rejoinder, "We've got Michael Moore speechless." There's the put-down of government's ability to care for its citizens. Even eighteen months later, it's hard to watch this and not see Dr. Gupta in the guise of a supporter of our broken status quo.
Suffice to say, President-elect Obama's track record is better than mine at making political appointments. So I thought about it some more. Here are the 5 ways I talked myself off the ledge:
1.) I’m a jerk when it comes to numbers, too.
As frustrated as I am by the nit-picky “You can’t mix and match numbers from different sources” back and forth that takes up the entire first ten minutes of the Larry King clip – I have to admit, that sure sounds like something I would do. When it comes to nerdy numbers about health care policy, there’s a little Dr. Gupta in all of us.
2.) The surgeon general doesn’t have much to do with health care reform – really!
It seems counter-intuitive that the chief public health officer has given comprehensive reform a skip for the past 40 years, but that’s the history. Jesse L. Steinfeld played no significant role when Nixon was pushing for universal health care. Jocelyn Elders made an unfortunate big splash during her tenure, but had no hand in the Clinton reform plan. Richard Carmona didn’t have a hand in Medicare Part D. It’s not their bag, baby.
But let’s say Dr. Gupta demands to be part of the health care reform team as a condition of his appointment. Imagine the meeting in the Roosevelt Room when the White House Office of Health Care Reform meets with the relevant Democratic legislators in the Senate and House. You’ve got Barack Obama, Tom Daschle, Jeanne Lambrew, Pete Orszag, Zeke and Rahm Emmanuel, Harry Reid, Ted Kennedy, Max Baucus, Nancy Pelosi, John Dingell, Pete Stark, Henry Waxman, Charlie Rangel… and Dr. Sanjay Gupta around the table.
Which one of these folks is least likely to get a word in edgewise, would you say?
3.) The surgeon general role has changed in the past 25 years.
Leaving aside the military tradition angle, which doesn’t have anywhere near the relevance to the general public that it does within the military, what does the public imagine the Surgeon General’s role to be?
Say what you will about C. Everett Koop, but his celebrity during the Reagan years codified what we imagine the Surgeon General to be –- a deeply knowledgeable authority on issues of health education. A trusted source. Someone whose job it is to inform the public of ways to increase help and avoid harm. A specialist in communicating public health issues with authority.
Isn’t that why Dr. Gupta does now for his televised audience? Hasn't he had more of an impact on educating the public than the current acting-Surgeon General... you don't even know his name, do you?
(It's Steven Galson. And yes, I had to look it up.)
4.) Dr. Gupta is excellent on the issues we’ll need him to be excellent on.
Obesity. Nutrition. Food safety. Infectious diseases like avian flu. Post-traumatic stress disorder. AIDS. Global health issues and how they intersect with climate change. These are the public health challenges we face in 21st century America. They are also the topics for which Dr. Gupta has received the most accolades for his coverage.
5.) Charisma counts when you’re rehabilitating the role
Being the chief public health officer means you deal with hard science. Therefore, the past 8 years have not been kind. When former Surgeon General Richard Carmona testified before Congress in 2007, his story would have been shocking if it were not already par for the course. The man charged with being the trusted authority on public health was ordered by the Bush Administration to censor himself time and again on the effects of tobacco and second hand smoke, stem-cell research and contraception.
The public health and pandemic implications global warming were even worse. As Carmona testified:
"I remember thinking, 'I know why they want me here, they want me to discuss the science; they don't understand the science.' So I had this scientific discussion for about a half an hour, and I was never invited back to the meeting."
And people think the Sexiest Man Alive nomination would be an insult to the office?
There’s no doubt that health education, based on hard science and the best available medical evidence, needs to reclaim its good name. It’s been sacrificed for too long to politics and ideology. If the celebrity of Dr. Gupta at the bully pulpit of the Surgeon General’s desk can spark a national debate about public health that improves our quality of life, then I don’t care how silly he looks in an Admiral’s uniform.
(Though if you’re reading this, Dr. Gupta, might I suggest an impressive beard?)
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Timothy Foley
Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.


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HOW DO YOU SUPPORT CHANGE, THEN SAY THE MAJOR RED FLAG IS THAT
HE DOESNT FIT THE NORML STEREO TYPE OF THE SURGEON GENERAL!
MORE OPEN WISE MINDS IS WHAT THIS COUNTRY NEEDS FOR CHANGE TO STABILITY AND PRIDE
NOT THE SAME OLE DEBT, CLOSED MINDEDNESS THAT GOT US TO AMERICA'S PROBLEMS!
Posted by rev baker aka rev420 on 01/07/2009 @ 06:07AM PT
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Well, if it's any consolation, if you read the post, I moved beyond those red flags. If you like, what changed as me (as well as what I'm comfortable with in a Surgeon General.)
Posted by Timothy Foley on 01/07/2009 @ 06:38AM PT
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We need a Surgeon General, not a celebrity, and it would be prudent of President-elect Obama to consider an individual without regard to race or gender, and more in regard to the real health concerns of the American people. I, for one, am overly tired of celebrities in general. They do little from the economic status they have gained from the American people, they are poor role models for our children and they seem mostly interested in promoting their own status, not the status of the American people. I ask that President-elect Obama give consideration for the position of Surgeon General to a public servant who has at least a 20 year history of serving for the people, not for CNN!
P.S. A note to Brad Pitt and Oprah Winfrey: Mr. Pitt how about just taking the money you earn from your lastest film and rebuilding the entire 9th Ward in New Orleans? I don't think it will break you or your wife! Ms. Winfrey how about sending a check to every school in the United States regardless of the color of the children? I don't think one check is nearly enough of a payback for the millions of dollars the American people have given to you in promoting your economic status as a entertainer. Mr. Pitt and Ms. Winfrey (and your peers in the "entertainment world") you both make more in one month than most American make in two years. How about organizing all entertainers to start to give 10% of their monthly earnings back to the American people to rebuild America. Remember "to much who is given, much is expected."
Karen A Duncan
Posted by Karen Duncan on 01/07/2009 @ 08:49AM PT
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Dr. Gupta's stance on healthcare alone should take him out of the running for the post. I'm very surprised Obama approached him since Gupta's support of the status quo conflicts with the need for universal healthcare.
Posted by Terri Haber on 01/07/2009 @ 11:14AM PT
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Glib, glib, and more glib. I appreciate your style as a blogger, but your "why can't we all be friends, hey, lighten up" attitude about why progressives shouldn't get too excited about this very poor choice for SG isn't even remotely convincing. The SG is an extremely important appointment, why can't we expect the appointee to be both a citizen's advocate, capable of articulating substantive policy reform, and also dedicated to helping American's understand and navigate these issues? It seems hypocritical to tout Gupta's credentials for the position on the one hand and then to denigrate the post and the nominee by suggesting neither are relevant to the policy reform effort. American's turn to the SG as the person capable of helping them make sense of all matters health related, this is not a throw-away post. Gupta's journalistic standards are shoddy at best. His poor judgement, evidenced by his tacky reporting on Moore's SiCKO and his superficial analysis of McCain's ill-conceived health policy proposals during the campaign should be enough to demonstrate he is an inappropriate choice for SG.
Posted by Theodore Herman on 01/08/2009 @ 08:00PM PT
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PLEASE SAY "NO WAY SANJAY". I've heard Gupta (more than once) help perpetuate the false assumption that any health care "reform" will cost us billions more dollars while refusing to even mention both the excessive humanitarian and monetary costs of the broken non-system we have now. The opposite is true; HONEST reform would SAVE us hundreds of billions of dollars and hundreds of thousands of innocent lives each and every year. His proven misuse and abuse of his media position to perpetrate a broken and immoral status quo disqualifies him as an honest health care leader advocating for the public good in any capacity.
Posted by B. Spoon on 01/09/2009 @ 02:48PM PT
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The combination of his lack of any serious admin or public health experience, his close ties to the drug industry and his willingness to disregard facts to discredit single payer pretty much disqualify him in my mind.
Posted by David Welch on 01/09/2009 @ 03:15PM PT
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Sanjay Gupta is a TERRIBLE choice for Surgeon General, and it's quite surprising that Obama even considers him as a viable candidate. Gupta is challenged professionally, ethically, and experience-wise. Another blogger (rightly too) suggested that he might be "another Brownie". Please do some research about your topics, such as the SG's responsibilities http://www.surgeongeneral.gov/about/duties/index.html
and what the Public Health Service does http://www.usphs.gov/ before you write. This isn't stuff that is arrived at through deep introspection--it's facts!
Gupta is challenged professionally because he knows nothing about evidence-based science or epidemiology--that's clear from his TV show and his go-round with Michael Moore. He is ethically challenged because the sponsors of his TV show are drug companies; can you see him support Obama's (promised) reform of negotiating with the drug companies for better prices for beneficiaries of public programs, like the VA does now for veterans? Also, he takes fees for speaking engagements, a practice that is considered unethical among journalists. He has no experience as a manager--can you see him being the "boss" of 6,000 doctors who must go into the trenches every time there's a disease outbreak or a natural disaster to analyze the situation, do public health surveillance, and design interventions to solve the problem? (BTW, this isn't a military position. The PHS is in the Dept. of Health and Human Services. Where did you get this idea about the "Pentagon"???)
With regard to healthcare policy: he has shown absolutely no understanding of and no interest in addressing our broken healthcare system, and no understanding of the negative effects of it on the lives of US citizens daily. He ignores evidence that true healthcare reform will SAVE the US billions of dollars collectively, and citizens hundreds of thousands of dollars individually, and businesses millions of dollars. Instead, he intentionally scares his viewers with disinformation by claiming that healthcare reform will cost billions and is not achievable. What part of Gupta's background doesn't Obama understand?
Posted by A Carroll on 01/09/2009 @ 04:13PM PT
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This is a poor, and frankly disappointing choice for Surgeon General. He is a lightweight on the serious public health policy issues confronting this country. He is not even openminded about, let alone supportive of universal single-payer care. He doesn't understand that the current medical/health insurance system in this country is profoundly broken. He is too much in the pocket of big pharma. His management qualifications are almost nil-he would be a photogenic figurehead, at best.
Posted by Karin Ahmed on 01/09/2009 @ 05:25PM PT
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Dr. Gupta demonstrated his debating skills in his interview with Michael Moore, but demonstrated to me his incompetence. Larry King asks "how vast is the difference between $7000 and $6000 per capita expense in the US for health care?" Well, Larry - IT'S $300 BILLION DOLLARS! The auto companies have to grovel for 15 (or is it 30) billion dollars when they pay that much in health care expenses for employees that are paid for by government sponsored insurance in other countries ($1500 a car in the US, $150 per car in Japan). This difference is a big deal. The extra money we pay compared to Canada is $3000 per capita -- $900 BILLION DOLLARS. We pay to much for what we get. Objective data on mortality (total, infant, and maternal) document poorer results than Canada and Western European countries. No doubt about it. Dr. Gupta does not recognize, admit or appreciate this issue.Dr. Gupta asks Michael Moore to admit that tax driven, government paid health insurance is not free. DR. GUPTA -- ARE THE ROADS YOU DRIVE ON FREE? NOT THE TOLL ROADS -- THE FREEWAYS!!!! IS ELEMENTARY SCHOOL FREE? YES IT IS. Perhaps your baiting of Michael Moore is good debating but is disgusting in its obscuring of the truth. NO WAY SANJAY!!!
Posted by Donald Steinmuller on 01/09/2009 @ 07:25PM PT
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He has already shown extreme willingness to sell out the good of the people for the almighty dollar, and that alone disqualifies him completely.
Posted by B. Spoon on 01/10/2009 @ 05:29AM PT
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I tend to concur with many of the previous comments about Gupta, and his inappropriateness for the Surgeon General position. Most of his topics seem to address health solely from the perspective of personal culpability, rather than some of the systemic aspects of our system.
When Blue Cross/Blue Shield can lower the per bed / per day / patient reimbursement rate of one hospital housing a family practice (preventative health care) residency program, 3 or four dollars less than other proximate hospitals without such a residency program, and force it to "run in the red" hoping it will close so the Family Practice will "go away"; and when it was common knowledge during the implementation of the National Health Planning Act of 1974, that by pre-paying for "health" care through the mechanism of insurance, you encourage a more costly product! A quick read of Health/PAC's book "Prognosis Negative" has ample documentation of many of the other substantial systemic problems in need of "health care reform".
When "democratic health care decision making" began during the implementation of the National Health Planning and Resources Development Act of 1974-which mandated consumer majorities on all the health planning bodies, the "Providers" just waited until Reagan got in, and cut the funding for Consumer participation (oops, I almost said citizen participation, like the old OEO mandate of "Maximum Feasibile Participation").
The ethical issues of speaking fees and perks from Drug Companies (Big Pharma) are more than enough reason to propose another nominee--the scientific/academic community has been "up in arms" about this of late. This one is more blatant than Bill Richardson's nomination was-after the grand jury announcement.
I concur with the comment concerning the job description / responsibility of the Surgeon General. Gupta may speak very well on health matters of personal culpability, but I haven't heard any serious opinions on systemic problems with our supposed health care system. I even question his ability to address radiation/biologic/chemical terrorist threats like anthrax-which the President needs a knowledgable advisor like Surgeon General for, to say nothing of the anthrax tainted heroin that started showing up all over Europe ten years ago-which warranted a level of both campassion and scientific inquiry. I hesitate to expect that quality of compassion from someone who tries to take down Michael Moore on network television!
There is currently a leadership vacuum in our Federal government. I daresay that Colin Powell would be a better surgeon general than Gupta. A quick read of the American Journal of Public Health would give us a field of more appropriate candidates than the one proposed.
If someone calls in or e-mails CNN asking Gupta to explain the epidemiology of the anthrax tainted heroin in Europe 10 years ago, or the 90% PTSD epidemiology in Detroit of 10 years ago, and Gupta can calmly explain the ramifications without inducing public panic or hysteria, I'll reconsider my opposition to his nomination. This International Traumatic Stress association has specific criteria for its journalist members, and I do not believe Gupta meets those criteria either.
Posted by Bob Olcott on 01/10/2009 @ 05:54AM PT
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Sanjay is the personification of everything that is wrong with our health care today and insurance in general. All flash. No substance and when you need him to perform he remains loyal to the almighty dollar and not providing care. He's dangerous and will lead us away from true reform.
Posted by Cat Jab on 01/10/2009 @ 06:29AM PT
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Hi folks--
Thanks for joining the discussion. If you could, please also take a look at today's post, "Dr. Who: Croudsourcing the Next Surgeon General."
The link is here:
http://healthcare.change.org/blog/view/dr_who_crowdsourcing_the_next_surgeon_general
Posted by Timothy Foley on 01/10/2009 @ 03:30PM PT
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