The surgeon general nominee: Both the NRA and Vivek Murthy are wrong

There’s a bit of buzz in the news recently over President Obama’s nominee for surgeon general, Dr. Vivek Murthy.

It’s worth pausing here to note the last truly consequential surgeon general:  Dr. C Everett Koop single-handedly carried out the entirety of the Reagan Administration’s AIDS response (to be clear — this is true because of how little the Reagan administration did, not because of how much Koop did); fought hard against smoking, and refused to bow to the administration and release a report saying that abortion was medically harmful — despite strong personal views against abortion.  Because of his conservative views, he was initially overwhelmingly supported by the right-wing, while opposed by most of the liberals — to the point that the latter group held up his nomination for a year.

However, once in office he took a principled stand on science, and astounded his critics by basically doing the opposite of what his personal views were, and strictly following the science.  He is widely admired as the greatest surgeon general in history, but was also the first controversial and political appointment — his initial supporters widely expected him to release a report calling for the banning of abortion due to it’s medical risks.

Who is the next surgeon general you remember?  Probably Dr. Jocelyn Elders.  She’s famous for responding to a question on human sexuality by saying that perhaps masturbation should be taught in order to discourage riskier sexual activities.  This was after she stated that drugs perhaps should be legalized, and then seeing her son arrested for dealing drugs.  At this point, President Bill Clinton decided she was one scandal too many (especially after the 1994 Republican victory in the midterms) and fired her.  It’s worth noting that Dr. Elders was also widely perceived as political — she was a strong public supporter of Clinton’s health care reform plan.

Thus we come to Dr. Murthy.

Dr. Vivek Murthy, MD was born in England but by 3-years-old was being raised in the United States.  He finished his medical training in 2006 — and managed to snag an MBA as well as an MD.  Just two years later in the run-up to the 2008 election he helped found a group called Doctors for Obama, and (duh) campaigned to get Obama elected.  Soon after, he turned the group into Doctors for America, which basically functioned as a pro-health care reform organization that helped pass the ACA.

Four years later, he’s nominated to be the surgeon general.  Unfortunately, Dr. Murthy is discovered to have touched one of the third rails of American politics: gun control.  After a relatively smooth committee hearing, the NRA starts it’s attack machine, and his nomination process is rapidly stalled.

I happen to believe that most forms of gun control are relatively ineffective, but regardless the NRA made a mistake going after Dr. Murthy.  He’s the surgeon general for crying out loud — they haven’t been particularly consequential since the 1980s.  In fact, they only are powerful when they are pushing a clear science-backed agenda — Dr. Koop had strong evidence on his side in each of his stands.  In comparison, Dr. Murthy has no such evidence: The recent Institute of Medicine report on guns and public health basically said the data is inconclusive, that defensive gun uses are probably equal to crimes committed with guns, and that a lot of people on both sides are mostly wrong about everything.

Actually, with that report Dr. Murthy might have gone the other way and pushed medicine to cease pushing gun control and start pushing urban poverty reduction (full disclosure: My personal opinion is that most gun violence is a result of concentrated urban poverty, and that alleviating that poverty will do a lot more to solve the gun violence problem than anything else.)  All the NRA did was draw attention to the incontrovertible fact that a lot of doctors don’t like guns because they see gun shot wounds and their consequences every day — and the NRA did this for no real gain whatsoever.

Now, here’s the thing: I don’t think the NRA should have gone after Dr. Murthy, but I also think Dr. Murthy was not a good choice as surgeon general, at least from the perspective of the American public.  An independent, established surgeon general could have been a powerful spokesperson in these times of upheaval in the medical world.  Instead, President Obama basically nominated someone who will be widely perceived as an administration surrogate selling the ACA to the public 24/7.  This is why Dr. Richard Carmona, a Democrat and a former surgeon general, wrote a letter opposing Dr. Murthy’s nomination.  I am not alone in holding these views.  Ultimately, Dr. Murthy’s nomination (and now probable defeat) are merely symptoms of the politicization of posts that shouldn’t be politicized.

Would it have killed the administration to nominate a titan in the medical field, like Dr. Peter Provonost?  This doctor is the leading light of the patient safety field, and is reputed to have saved more lives with his checklist than any researcher in the past decade, per Atul Gawande.  Right now, medicine is going through traumatic times.  Accusations are rife that doctors are killing 200,000 people through mistakes as simple as not washing their hands.  The way that doctors have been paid is changing wholesale for the first time in decades to performance measures.  One survey found that 90% of doctors don’t recommend the profession to their children and 60% believe that healthcare reform will negatively impact the profession.  It should be noted that this survey probably captured a high proportion of private practice doctors, and therefore may not be a representative snapshot, but still.  These are times in which a strong, independent voice could have calmed the waters and greatly impacted American medicine.

There are many highly qualified and accomplished doctors who could have been selected, who would have been able to be a real force in these troubled times.  Instead, what we got Dr. Murthy, who (fairly or unfairly) was perceived as a political hack.  While I do not like the NRA’s tactics, I won’t mourn his defeat.

Vamsi Aribindi is a medical student who blogs at Follies of an Amateur Intellectual.

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  • Robert Luedecke

    I am the Texas State Co-Director for Doctors for America and I wrote an editorial saying it may be
    too late for the President to honor his promise to let you keep your
    insurance, but it is not too late for Gov. Perry to honor his promise to
    lower your taxes by expanding Medicaid. When I asked the director of
    Doctors for America if I should resign as a “problem child,” I was
    encouraged to “keep doing what you are doing.” http://www.mysanantonio.com/default/article/Let-s-be-honest-expand-Medicaid-5049141.php

    While I think this article by a medical student is well-written, I could not disagree more with his conclusions. Vivek Murthy is a wonderful guy that I have know personally for about 3 years. His devotion to doing what is best for patients is not in doubt to those who know him. At the time he founded Doctors for Obama, the need for healthcare reform was very clear and Obama had the only real plans for change. When the organization became Doctors for America, the goal was to find a way to provide quality affordable healthcare for every American. Doctors for America contains some doctors that will support President Obama, no matter what, but it also contains doctors like Vivek who want the best healthcare, no matter the source. I don’t think you should punish Vivek for trying to improve healthcare in the US, even if you don’t always agree with him, because he really is trying bring all the educated voices to the table. Any doctor is welcome to join Doctors for America and speak up.

    I am a gun owner and some of my most fond memories are hunting with my family. I am not at all uncomfortable about Vivek trying to decrease the number of people we all have seen with gunshot wounds. His ideas on decreasing gun violence are in line with any medical professional. Do you want a Surgeon General that is in favor of gun violence? He has said he will not use his office as a bully pulpit for any gun issues.

    Vivek is an outstanding preventive doctor and wants to focus our nation’s energies on decreasing obesity. Obesity is soon predicted to massively increase out nation’s healthcare costs. The US already spends about twice as much per person as the next highest country and is the only developed country not to have good healthcare for every citizen.

    Vivek Murthy may have a funny-sounding name, but I have no doubt he is a true American devoted to the best for American healthcare. He should be confirmed now as the next Surgeon General!

    • http://intellectualfollies.blogspot.com/ Vamsi Aribindi

      Dr. Luedecke,

      Thank you for taking the time to respond to my article.

      I’d like to clarify that I have nothing against the ACA, and hope that it succeeds. Like every loyal American, I believe that it is our responsibility to try and make work most passed laws that we may oppose personally- and I don’t even oppose the ACA personally. I also DO NOT support the attack on Dr. Murthy for his gun views.

      You state that, “Doctors for America contains some doctors that will support President Obama, no matter what, but it also contains doctors like Vivek who want the best healthcare, no matter the source.”

      In that passage, you try to separate out two groups: those who are political and those who joined to advance healthcare reform, with the latter group containing Dr. Murthy. However, Dr. Murthy founded the group when it was “Doctors for Obama”, a political group devoted explicitly to electing our President. I do not see anything wrong with doctors participating in politics in that manner, but I think his participation in such a group makes Dr. Murthy a better candidate to be Secretary of Health and Human Services (a political cabinet post) than Surgeon General (which I believe should remain apolitical).

      Thank you again for your comment-

      Respectfully,
      Vamsi Aribindi

  • Katherine Scheirman

    I am a retired Air Force colonel and physician, and therefore have a pretty extensive knowledge of gunshot wounds and their sequellae, including the problems of suicide and injuries from military weapons. I am also the Oklahoma State Director of Doctors for America.
    I’ve known Vivek personally for about 4 years. One of the reasons I like Doctors for America is that it is truly non-partisan. Yes, we all support health reform, but the ACA has some things in it each of us dislikes. We agree, though, that our previous system was severely dysfunctional, cost far too much for too little value, and that the ACA offered the best chance of starting the process of reform. We also think that physicians’ voices need to be heard, and Doctors for America works hard to help us get our message out.
    Dr. Murthy’s views on gun safety are well within the mainstream, which is why he has been endorsed by most of the medical establishment.
    Some people “perceive” Dr. Murthy as political only due to a relentless smear campaign run by a narrow special interest group. Watch the video of his confirmation hearing and notice the praise he received from both sides of the aisle. He is a brilliant, innovative, accomplished physician with incredible energy – exactly what we need in a Surgeon General.

    • http://intellectualfollies.blogspot.com/ Vamsi Aribindi

      Dr. Scheirman,

      Thank you for your service and your comment. I myself hope to commission into the Air Force Reserves after I finish my residency, and give back in a small way to the country to which I owe so much.

      I accept that Doctors for America may be non-partisan. But Doctors for Obama, which was founded by Dr. Murthy, certainly wasn’t. As I said above to Dr. Luedecke, I think this makes Dr. Murthy more qualified to be Secretary of Health of Human Services than Surgeon General.

      To explain further:
      Ma’am, I briefly googled you to understand your background and biography. You would be an acceptable (to me) choice for Surgeon General. Your long, non-political service and proven advocacy and leadership skills make you a physician who can speak and be respected as a leader of and within the profession of medicine. Your involvement in Democratic party politics is incidental to your source of authority- the years spent leading fellow doctors and other soldiers, sailors, and airmen delivering health care to our armed forces under difficult conditions and with limited resources.

      In comparison, Dr. Murthy’s source of authority stems primarily from his involvement in politics. Would he have any chance at being nominated at all if he hadn’t participated in Doctors for Obama? Has he led and administered another large organization of fellow doctors? From the public record, I don’t believe he has. This would limit his ability to rally and speak to and on behalf of the profession. This does not disqualify him from inhabiting a post such as the Secretary of Health and Human Services- after all, Secretary Sebelius is not even a physician- but I think it means that he would not make for a Surgeon General who can truly lead the profession.

      Very respectfully,
      Vamsi Aribindi

  • http://intellectualfollies.blogspot.com/ Vamsi Aribindi

    I only meant that physicians who are employed or in academics (and therefore receive their malpractice insurance through the state or through their hospital) may have differing levels of satisfaction compared to private practice doctors insured by one company.

    Respectfully,
    Vamsi Aribindi

  • Maggie Keavey Kozel

    Somewhow, no matter how we try to come around to whether or not Dr. Murthy is qualified for Surgeon General, opponents only want to discuss guns. Drake burwood does not even mention the SG in this. Is he suggesting we should look for a SG that thinks a ” lack of Guns in the hands of the Poor iare a health care issue?” Does he not see the current widespread circulation of illegally acquired guns d as a “Prohibition economy” already?
    Guns are a tool, yes. Pools are a form of recreation. Kids drown in them. Towns make laws to ensure property owners take the necessary measures to prevent this. Doctors counsel on pool safety. Nobodies trying to ban pools. Burrwood’s disregard fro common sense, and failure to adress the actual issues involved in choosing a surgeo general when he writes an article about choosing a surgeon general, are emblematic of the whole problem here, and underscore why we have to keep this kind of fuzzy thinking special-interesy tunnel vision in its place – at the fringe.