President-elect Obama has reportedly chosen Sanjay Gupta, CNN’s chief medical correspondent and one of People magazine’s “sexiest men alive,” for the post of surgeon general. Those aren’t the only reasons that the surgeon general’s position ought to be abolished.
The original version of the surgeon general position was created in 1870 to administer what was then known as the Marine Hospital System (MHS), which cared for sick and injured merchant seaman. The MHS, including a uniformed “Commission Corps” of physicians, was converted in 1902 into the Public Health and Marine Hospital Service, and its mission was expanded to medical inspection and quarantine of arriving immigrants, such as those landing at Ellis Island in New York.
In 1912, the Service was renamed the U.S. Public Health Service (PHS) as its mission was further expanded to conduct investigations into infectious diseases (such as tuberculosis, hookworm, malaria, and leprosy), sanitation, water supplies, and sewage disposal. Between 1930 and 1944, the Commission Corps officers were expanded to include engineers, dentists, research scientists, nurses, and other health care specialists.
But in 1968, the surgeon general position fell victim to President Lyndon Johnson’s reorganization of the then-Department of Health Education and Welfare (HEW, or what is known today as the Department of Health and Human Services). The Office of Surgeon General that administered the PHS was scrapped, and responsibility for the PHS was assigned to the assistant secretary for health, who reported directly to the secretary of HEW. A position of “surgeon general” was then created to merely “advise” the assistant secretary on professional medical matters.
After almost two decades of more bureaucratic reshuffling — during which time the surgeon general was made a direct adviser of the secretary of HEW followed by the combining of the positions of surgeon general and assistant secretary for health in 1977 and their separation again in 1981 — the Office of the Surgeon General was re-established in 1987 with largely nominal responsibility for managing the PHS Commissioned Corps personnel.
The surgeon general doesn’t actually command all of the Commission Corps officers. Most of them work in other federal agencies — like the EPA, Coast Guard and Bureau of Prisons — and report directly to the various line managers in those agencies who may or may not be in the PHS.
Although C. Everett Koop attempted to revitalize the Corps in the late 1980s, the superfluous nature of the surgeon general position became glaringly obvious during the tenure of Jocelyn Elders, President Bill Clinton’s first surgeon general. Besides taking controversial positions on drug legalization and the distribution of contraceptives in schools, in early December 1994, Elders spoke in support of the teaching of masturbation. She was promptly fired by Clinton. The position of surgeon general remained vacant for three years, until Clinton nominated David Satcher.
At the time of Satcher’s nomination, the Cato Institute’s Dr. Michael Gough and I observed in a Wall Street Journal column, “We have not had a surgeon general for three years. Has anyone noticed? Is anyone’s health at risk?”
The answer, of course, was that no one’s health was at risk and, in fact, the U.S. public health had never been better. Life expectancy was at an all-time high. Death rates from cancer, heart disease and AIDS were falling. This trend continues today, no thanks to whatever it is that the surgeon general does. And, by the way, what exactly has the current surgeon general been doing?
Judging by 23 of the 32 press releases issued from his office during 2008, Acting Surgeon General Steven Galson has spent a great deal of time traveling coast-to-coast promoting the “Healthy Youth for a Healthy Future” project, which “focuses on recognizing and showcasing those communities throughout the nation that are addressing childhood overweight and obesity prevention by helping kids stay active, encouraging healthy eating habits, and promoting healthy choices.”
So let’s look at a few examples of Surgeon General Galson in action:
In Harrisonburg, Pa., Galson presented, “… the Healthy Youth for a Healthy Future Champion Award to the Girls Golf Program, a partnership between the Ladies Professional Golf Association, the United States Golf Association, James Madison University, and Mulligan’s Golf Center." The media release continued: “This program is helping local girls and women stay physically active, gain self-confidence, and develop lasting friendships, while fostering an enjoyment for the game of golf.”
At Disney World, Galson honored the Walt Disney Company for removing trans fats from the foods on its menu and for making sure that the use of the Disney name and its characters is limited to kid-focused products that meet specific guidelines that limit calories, fat, saturated fat and sugar.”
In New Mexico, Galson honored a wellness center that “will help students stay fit and healthy using new tools such as exer-gaming and interactive stationary bicycles.”
So over the last 96 years, the Surgeon General has gone from working on genuine public health problems (infectious disease, clean water and sanitation) to advocating golf, Mickey Mouse-less food and beverage containers and video exercise games as public health measures.
It may very well be that Gupta’s celebrity — apparently his unique qualification to hold office — makes him the ideal nominee to continue the Office of Surgeon General’s downward trajectory into obscurity and oblivion. On the other hand, if Gupta were really serious about advising Americans on health matters, he would stay at CNN where he could reach more people on any given day than he could by traveling the country handing out dubious prizes that amount to little more than corporate public relations.