Why We Need to Strengthen the Office of the Surgeon General

Dr. Vivek Hallegere Murthy, President Barack Obama's nominee to be the next U.S. Surgeon General, prepares to testify on Capi
Dr. Vivek Hallegere Murthy, President Barack Obama's nominee to be the next U.S. Surgeon General, prepares to testify on Capitol Hill in Washington, Tuesday, Feb. 4, 2014, before the Senate Health, Education, Labor, and Pensions (HELP) Committee hearing on his nomination. (AP Photo/Charles Dharapak)

At a time when we are bombarded with information, it is hard to know what to believe about health. Are we to believe those toting "magic weight-loss cures" or the doctor walking around the Atlanta airport in a hazmat suit emblazoned with the words, "The CDC is lying"? Add to this the nearly constant onslaught of contradictory messages from political groups and corporations, whose existence depends on our continued consumption of sugar, alcohol, high fat and calorie foods, and tobacco.

Through all of this confusion, we should be able to look toward our governmental public health leaders -- those experts whose experience and leadership have elevated them to positions of significant authority like state or local health officers or directors of federal health agencies -- for guidance.

These leaders represent some of the best and brightest minds in public health. However, like any other political appointee, their ability to speak without regard for political consequence is limited even when offering a professional or scientific opinion. Often their speeches are vetted and their positions crafted to align with political rather than scientific agendas.

The link between politics and public health was evident in the recent Ebola outbreak in the United States. At a time when we must trust our government health officials, the handling of the outbreak -- as limited as it was here -- became a political referendum on the Obama administration. Political influence on public health has also been clear in the recent controversy surrounding President Obama's nominee for Surgeon General, Dr. Vivek Murthy.

Like many doctors, Murthy considers firearms to be a worrying health issue. In 2012, long before he was nominated for surgeon general, Murthy tweeted, "Tired of politicians playing politics w/ guns, putting lives at risk b/c they're scared of NRA [National Rifle Association]. Guns are a health care issue." He also expressed support for limited gun safety measures like a ban on assault weapons, mandatory safety training, and limits on ammunition.

Murthy is in good company. In a 2013 letter to the White House, twenty-seven medical organizations supported stronger gun safety laws, and the American Public Health Association cites gun violence as a major public health problem and cause of premature death.

In response to Dr. Murthy's nomination, the NRA mounted a campaign against his confirmation.

The NRA has every right to oppose Murthy and any other person they find incompatible with their political objectives. A national public health leader should have the same ability to present his or her public health, medical, and scientific perspective.

However, in response, Murthy stated that he would not use the Surgeon General's Office as a bully pulpit for gun control if confirmed. This exchange highlights the central problem at the heart of the surgeon general's position, and that of every other government-appointed public health official. When public health goes toe-to-toe with politics, politics usually wins.

Campaign contributions and lobbying efforts already provide organizations like the National Rifle Association and the American Beverage Association with influence on legislators and policymakers that public health workers can't ever expect to enjoy. Shouldn't the American people have at least one voice free of political influence that they can trust to level with them on health issues?

In the wake of the Ebola scare, there has been increased conversation about the need to have a confirmed surgeon general and, more specifically, increased calls for Murthy's confirmation (#TOPDOCNOW). The Hill recently reported that a vote on Murthy's confirmation could come this week.

If Murthy is confirmed, are we to believe that political leaders will allow him to freely discuss soda's contribution to obesity or the consequences of sugar? Why would the American Beverage Association, Sugar Association, or the Corn Refiners Association will exert any less influence on the Surgeon General than the NRA?

We must take action to ensure that our surgeon general is insulated from politics to allow him to focus and share the best science available with the American people. Equal energy should be spent on calling for reform of the position as is spent on calls for the confirmation of Murthy.

In his book,
, AP health reporter
revisits different proposals to strengthen the Office of the Surgeon General. Some of them include:
  • Requiring the Institute of Medicine to nominate candidates when the Office of Surgeon General is vacant,
  • Mandating terms of office that do not align with presidential terms (following the example of the comptroller general, who is appointed for 15 year terms), and
  • Endowing the Office of the Surgeon General with political autonomy similar to that of the General Accounting Office or inspectors general.

Regardless of what action we take to establish a separation of public health and politics, the Surgeon General will only be able to truly fulfill her or his role as our nation's doctor when s/he is able to operate unconstrained by the opinions and objectives of politicians.

At the 2014 American Public Health Association Annual Meeting, former Surgeon General David Satcher said that role of the surgeon general is to share the best information based on science, not politics or religion. However, Stobbe concludes that the surgeon general can no longer be trusted to do or say the right thing in crucial moments when best public health practices differ from political policy.

While often referred to as the "nation's doctor," the surgeon general has largely not had the same freedoms to address health issues with the public as a doctor does with his/her patient.

There have been some exceptional surgeons general. C. Everett Koop spoke out about AIDS before his political bosses acknowledged the growing epidemic, and Luther Terry issued the first Surgeon General's Report on Smoking and Health. Their success occurred despite the limitations of their post, however. They are the exceptions.

With so many health care issues facing the nation, the success of the surgeon general should not be predicated on the ability of the office holder to navigate political challenges.

If we can't alleviate the political stranglehold on the surgeon general, then Stobbe might be right -- we will lose a champion for the health of the nation. What would America look like if Luther Terry hadn't sounded the alarm on tobacco? Where would we be if C. Everett Koop hadn't rallied our nation's resources to address the AIDS epidemic? If we can't save the office of the surgeon general -- or turn to another position in its stead -- the health of many Americans will suffer for it.


Brian Castrucci is the Chief Program and Strategy Officer at the de Beaumont Foundation. Prior to joining the Foundation, Brian spent a decade working in state and local health departments. Follow Brian on Twitter at @BrianCCastrucci.

The opinions expressed in this post do not necessarily reflect the opinions of the de Beaumont Foundation.