“Where Is the Surgeon General?” New England Journal of Medicine

Vivek Murthy M.D.

Obama's nominee for Surgeon General

http://en.wikipedia.org/wiki/Vivek_Murthy

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That’s the title of the lead editorial (publicly available) in the latest issue of the New England Journal of Medicine (NEJM), arguably the most prestigious general-circulation medical journal in the US. The position of Surgeon General has been vacant since July, 2013, when Regina Benjamin stepped down, and the responsibilities have been covered by her deputy, Boris Lushniak, as acting Surgeon General.

Very few people in the general public, and few in Congress, noticed or cared about this vacancy until a case of Ebola was diagnosed in Dallas. Suddenly, it’s on the national radar, with Republicans, as usual, blaming the President.

The NEJM gives a good description of the role of the Surgeon General and the qualifications and fate of President Obama’s nominee for the job. They suggest a few highly qualified people who might be viable alternative nominees. More after the General’s orange epaulet.

What does the Surgeon General do? (And is she actually a General?)

As the nation's principal public health official, the Surgeon General leads a 6500-member commissioned corps focused on the critical health issues we face. The U.S. Public Health Service is responsible for communicating important health information to the public — including, for example, information about influenza vaccination as we enter the 2014–2015 influenza season. Because the symptoms of influenza may closely mimic those of Ebola, we can expect confusion between the two diseases in the months ahead. Clear communication of accurate health information to the public, which is the job of the Surgeon General and the Public Health Service staff, will be vital.

So the Surgeon General needs medical expertise, public health knowledge, and management experience. Communication skills are imperative. The Surgeon General is the public face of such efforts as the Surgeon General’s Reports on smoking and health (1964), television and violence (1972), passive smoking (1986, 2006), HIV and AIDS (1988, 1992), and suicide (2012). The Surgeon General is also the cheerleader for efforts to improve public health - immunization, exercise, better nutrition, and more.

In March, 2014, President Obama nominated Dr. Vivek Murthy as the next Surgeon General. The NEJM article describes Dr. Murthy as "A highly respected physician with impressive credentials who would have been an outstanding Surgeon General .”

Unfortunately, Dr. Murthy had expressed previously his view that 30,000 firearm deaths a year was a public health problem that warranted study and evidence-based interventions. Republicans, at the behest of the NRA, have blocked a confirmation vote.

The NEJM concludes that Dr. Murthy’s confirmation will not happen under the current political circumstances, and they urge the President to put forward another nominee. They recommend Dr. Harvey Fineberg, who would certainly meet all the criteria. He is a distinguished physician; he was the Dean of the Harvard School of Public Health; he has headed for 12 years the Institute of Medicine (IOM), a federal government group responsible for reviewing medical evidence and communicating it to the public.

Would Dr. Fineberg’s nomination, too, be blocked by the hard-line right wing? As Dean at Harvard and as IOM president, Dr. Fineberg has overseen researchers and reports that concluded that there were too many firearm deaths and injuries in this country, and that we should try to find ways to address this problem.

Will any nominee be approved only if willing to avow, under oath, that the death of 30,000 Americans a year from firearms is not a public health concern, while 1 death from Ebola is a national crisis?