Why There Is No Surgeon General Today.

Posted on | November 13, 2014 | Comments Off on Why There Is No Surgeon General Today.

Mike Magee

The New England Journal of Medicine asks this week, “Where is the Surgeon General?”

In their words: “As an unchecked Ebola epidemic moves out of West Africa to touch the United States and the rest of the world, we should rightfully ask, ‘Where is the Surgeon General?’ The answer is, quite simply, that we do not have one. We face a growing crisis of confidence in our ability to protect patients and health care workers, and the position of the chief public health officer of the United States remains unfilled. How did this happen?”

In 2007, Health Commentary asked , “Do Americans know there is (or ever was) a Surgeon General, and do they care? Do they recall specific Surgeons General and what are their opinions (favorable and unfavorable) regarding those individuals? Are younger generations as aware of this position as older Americans?”

To answer these questions, a nationwide study with Yankelovich in September 2006 was commissioned – involving more than 1,000 Americans — that addressed these issues. The findings:

1. Most Americans, 71%, said they did know whether or not the United States had a Surgeon General.

2. At the same time, only one in three (32%) was able to recall unaided the name of any particular Surgeon General.

3. C. Everett Koop was by far the most commonly recalled Surgeon General, with 28% volunteering his name on an unaided basis, and an additional 24% recalling him when aided. This was especially remarkable since he had been out of the office for 17 years.

4. Jocelyn Elders, perhaps based on her highly publisized comments on masturbation, was the next highest at 3% unaided, and 33% aided.

5. Knowledge and awareness of Surgeons General was highest among older Americans. Younger Americans – those under 35 years of age – were generally unaware of any Surgeon General.

6. Men were more aware than were women.

In 2001, I interviewed a large number of Christian Conservatives (nearly 20), including Pat Robertson, about the Surgeon General position. To my surprise, they universally viewed the disposition of this position as among their most important issues. The primary take-aways were:

1. They continued to harbor deep anger and resentment toward C. Everett Koop, a well known fundamentalist Christian pediatric surgeon from the University of Pennsylvania, who they felt had betrayed their trust. These feelings were connected to Koop’s refusal to state that abortion carried with it substantial physical and psychological risk to women, as well as his activist promotion of condoms and the distribution of his HIV/AIDS Report by mail to American households. Koop had produced and distributed tens of thousands of copies of the report, which included the recommendation that AIDS education “be started at the earliest grade possible”, without prior clearance from the Reagan White House. He also refused to support mandatory testing for HIV which conservatives like Bill Bennett and Phyllis Schafly we’re pushing with a vengeance.

2. In the wake of these “betrayals”, their top preference regarding the position was that President Bush dissolve it or at least leave it unfilled.

3. Their second choice, if it had to be filled, was that it be done with a candidate who would be dormant and inactive in that position – ceremonial only.

In this week’s article, the editors of the Journal list a number of highly qualified candidates from the ranks of academia, public health, and government, urging the President to act now. As they say in their final sentence, “We urge the President to nominate and the Senate to confirm a strong leader and trusted voice as the nation’s next Surgeon General.”

While this is sound advise, I believe that, were I to interview the same individuals today that I did in 2001, I would find that their views were unchanged, and their passion for elimination or deliberate vacancy of the position would be even more entrenched and passionate today than it was back then.

For Health Commentary, I’m Mike Magee