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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