The Ebola crisis has metastasized to the United States, and the media and numerous government and private spokespeople are attempting to educate and calm the American public while not inflaming or confusing the situation.
A single credible, trusted, nonpartisan voice is what is needed to educate and reassure America and the world.
Recently, Surgeon General Jesse Steinfeld, the 11th surgeon general of the United States, passed away. His obituary heralded his many significant accomplishments as surgeon general and commander of the United States Public Health Service Commissioned Corp, one of the seven uniformed services of the United States. What was particularly striking and concerning and voiced in his obituaries and commentary about his life were references to Surgeon General Steinfeld having to fight and battle various individuals, groups and entities in order to promulgate health policy that would benefit the public he served.
This prompted me to review the obituaries and commentary about other surgeons general who passed away in the last decade, including Surgeons General William Stewart (10th), Julius Richmond (12th), and C. Everett "Chick" Koop (13th).
These surgeons general were extraordinary public servants who served selflessly in increasingly embattled positions. Like Surgeon General Steinfeld, their obituaries and press commentary were often punctuated with adjectives such as "fighting," "combative," "battling entrenched political interests," "adversarial maneuvering and stressful attempts to take out or eliminate the surgeon general."
These descriptors often sounded as if the surgeons general were officers in a combat unit battling hostile adversaries as they attempted to survive in an increasingly partisan battlefield. The sad truth is they were. And in some cases the surgeons general succumbed to the lethal wounds of political warfare where resuscitation is rarely possible. [1] Warfare that public health professionals are stilling battling today.
Surgeons general of the Army, Navy, Air Force, and U.S. Public Health Service were always career uniformed officers who merited consideration for promotion and advancement by their seniority, accomplishments, demonstrated leadership, education, and training. The White House would receive recommendations from the respective uniformed service chiefs and the president would then recommend names to the Senate for confirmation as a surgeon general with the rank of vice admiral or lieutenant general, depending on the service.
This tried and true process, over a century old, still exists in the all of the uniformed services except for the U.S. Public Health Service.
Since the late 1960s and early 1970s [1,2], various political administrations have gone outside of the USPHS to identify and nominate candidates who were believed to be more politically aligned with the political party in power at the time. By doing so, they demean the service of career USPHS officers who are qualified but who are passed over due to attempts to align science with desired political platforms.
Interestingly, these attempts at prospectively attempting to identify politically-aligned surgeons general nominees have usually failed and caused frustration for leaders in both political parties over the years, since all surgeons general come to understand that you are the doctor of the nation and not the surgeon general of the Republican or Democratic party [3]. In addition, those outside nominees, if confirmed, are immediately promoted to vice admiral even though some have no military or uniformed service experience. This process is offensive to all career officers who selflessly sacrifice throughout a long uniformed service career to merit consideration for promotion as an admiral and Surgeon General.
This politically motivated action also diminishes the credibility of the Office of the Surgeon General. It is also apparent that not every physician is capable of being Surgeon General. [3] An example would be the current nominee for United States Surgeon General who is very early in his professional career, with great potential but without significant progressive leadership experience or specific public health education or in-depth experience with complex policy, global, and public health issues. However, he was the co-founder of Doctors for America, a partisan organization supporting President Obama.
In a recently published book, Surgeon General's Warning by Mike Stobbe4, he painfully discusses the gradual political demise of the United States Surgeon General and suggests that therefore, it may be time to end the position. As much as I appreciated Mr. Stobbe's scholarly work, my review of it leads me to a very different conclusion. We should actually act to strengthen the Office of the Surgeon General by protecting it from political manipulation. In our hyper-partisan political world characterized by gridlock and great political poetic license in the interpretation of science to support preconceived political biases, who will have the responsibility to speak scientific truth to power? Who will provide the scientifically based "informed consent" to the American public and at times, the world?
Eliminating or allowing further diminishment of the Office of the Surgeon General to occur is not in the best interest of the American public, although it may benefit politicians.
In July 2007, I joined Surgeons General Koop and Satcher to testify before a congressional committee investigating the attempts at politicization of the Office of the Surgeon General5. Three Surgeons General serving four separate presidents, from the very liberal to the ultraconservative administrations, all testified on the issues challenging them during their tenures. The Surgeon General testimonies were remarkably similar and a clear bipartisan indictment of the attempts to manipulate science and diminish the Office of the Surgeon General. Unfortunately, Congress took no action on this unprecedented testimony that they themselves had requested.
Due to the aforementioned experience and testimony, I recommended significant changes to the Office of the Surgeon General in publications and presentations [3]. They are as follows:
•Return to nominating the United States Surgeon General from the cadre of career USPHS officers based on merit and core competencies and not politics or patronage, just as the U.S. Army, Navy, and Air Force do.
•The Office of the Surgeon General should have a separate budget that is free of political interference and be legislatively protected, a model like the Federal Reserve Chief.
•The United States Surgeon General, on an annual basis, should be mandated to give a public State of the Nation's Health and Global Health address which is based on current scientific facts so that prudent national policy may then be generated by the President and Congress and political leadership can then be held accountable for their actions or inactions.
The United States Surgeon General should still be held accountable by the chain of command, as are all uniformed service Surgeons General; however, accountability should be based on honesty, integrity, leadership and the unwavering pursuit of scientific truth -- and not on political partisanship.
It is clear that our nation needs and deserves a strong, qualified, and nonpartisan Surgeon General who resides in a protected and well-funded Office of the Surgeon General. The people we have the privilege to serve deserve no less.
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Bibliography
1 Bell, H, Surgeons General: Defenders of Public Health, The New Physician, Jan-Feb. 2001,Vol. 51,Issue 1
2Mullan, F, Plagues and Politics: The Story of the United States Public Health Service, Basic Books Inc., 1989
3Carmona, R, The Trauma of Politics: A Surgeon General's Perspective, Journal of Trauma and Acute Care Surgery, 2012 Aug, 73(2):314-318
4Stobbe, M, Surgeon General's Warning, How Politics Crippled the Nation's Doctor, University of Ca. Press, 2014