Bioethics Discussion Blog: Doctor of a Nation or Doctor of a Political Party: Duty of the U.S. Surgeon General

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Tuesday, July 10, 2007

Doctor of a Nation or Doctor of a Political Party: Duty of the U.S. Surgeon General

From today's Los Angeles Times:

President Bush's first surgeon general charged today that administration officials prevented him from providing the public with accurate scientific and medical information on such issues as stem cell research and teen pregnancy.

"The reality is that the 'nation's doctor' has been marginalized and relegated to a position with no independent budget and with supervisors who are political appointees with partisan agendas," Dr. Richard H. Carmona told the House Committee on Oversight and Government Reform. "Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried.

"The problem with this approach is that in public health, as in a democracy, there is nothing worse than ignoring science or marginalizing the voice of science for reasons driven by changing political winds," said Carmona, who served from 2002 to 2006. "The job of surgeon general is to be the doctor of the nation — not the doctor of a political party."


So, who is the Surgeon General and what is his or her duties? Here is some background information from Wikipedia:

The Surgeon General of the United States is the head of the United States Public Health Service Commissioned Corps and, ex officio, is the leading spokesperson on matters of public health in the U.S. government. The Surgeon General is nominated by the U.S. President and confirmed via majority vote by the Senate. The Surgeon General serves a four year term of office and is commissioned as a Vice Admiral in the PHSCC. [1] In carrying out all responsibilities, the Surgeon General reports to the Assistant Secretary for Health, who is the principal advisor to the Secretary of Health and Human Services on public health and scientific issues, and who serves as the overall head of the United States Public Health Service. The former Surgeon General, Vice Admiral Richard Carmona, appointed by President George W. Bush in 2002, left office when his term expired on July 31, 2006. [2]. Rear Admiral Kenneth P. Moritsugu is functioning as the Acting Surgeon General. [3].

On May 24, 2007, President Bush nominated Dr. James W. Holsinger, Jr., a University of Kentucky medical professor to be the 18th surgeon general of the United States. [4]

The Surgeon General functions under the direction of the Assistant Secretary for Health and operationally heads the 6,000-member Commissioned Corps of the United States Public Health Service, a cadre of health professionals who are on call 24 hours a day, and can be dispatched by the Secretary of HHS or the Assistant Secretary for Health in the event of a public health emergency. The Surgeon General is also the ultimate award authority for several public health awards and decorations, the highest of which that can be directly awarded is the Surgeon General's Medal (the highest award bestowed by board action is the Distinguished Service Medal).

The Surgeon General also has many informal duties, such as educating the American public about health issues and advocating healthy lifestyle choices.

The office also periodically issues health warnings. Perhaps the best known example of this is the Surgeon General's Warning labels that can be found on all packages of American cigarettes. A health warning also appears on alcoholic beverages.

Past American Surgeons General have often been characterized by their outspoken personalities and often controversial proposals on how to reform the U.S. health system. Because the office is not a particularly powerful one, and has little direct impact on policy-making, Surgeons General are often vocal advocates of unconventional, unusual, or even unpopular health policies. Vice Admiral C. Everett Koop and Vice Admiral Joycelyn Elders were two former Surgeons General who were well known for their controversial ideas, especially on sex education.

The U.S. Public Health Service was under the direction of the Office of the Surgeon General and was an independent government agency until 1953 at which point it was integrated into the United States Department of Health, Education and Welfare, and later into the United States Department of Health and Human Services. Although the U.S. Public Health Service and the Surgeon General were at various times under the umbrella of the Department of the Treasury or the Federal Security Agency, the agency operated with a substantial amount of independence.

The U.S. Army, Navy, and Air Force also have officers overseeing medical matters in their respective services who hold the title Surgeon General.

In Republic of Ireland and United Kingdom, the term chief medical officer is used as equivalent.


Service rank
The Surgeon General holds the rank of Vice Admiral [5] in the Public Health Service Commissioned Corps, one of the seven Uniformed services of the United States. Officers of the PHSCC and the National Oceanic and Atmospheric Administration Commissioned Corps are classified as non-combatants, but can fall under the uniform code of military justice (UCMJ) and the Geneva Convention when designated by the Commander in Chief as a military force. Officers Members of these services wear uniforms that are similar to those worn by the U.S. Navy, except that the commissioning devices, buttons, and insignia are unique. Officers in PHS and NOAA wear unique devices which are similar to U.S. Navy Staffing Corps Officers (e.g., Medical Services Corps, Supply Corps, etc.)


Though in today's Congressional hearings where Dr. Carmona and two previous Surgeon General's told their story of political pressures being applied to the Surgeon General during the current and previous administrations, it was brought out that Carmona in the current administration was under the most pressure. It is interesting to find that President Bush who has made much of the fact that he was depending and listening to the views of the "generals on the ground" would seem to avoid listening to his Surgeon General about the science regarding stem cell research and teen pregnancy and stick to his political ideology. ..Maurice.

5 Comments:

At Wednesday, July 11, 2007 9:24:00 AM, Blogger LisaMarie said...

Scientists who choose to become politicians shouldn't whine when they find that policy is made based on shifting political winds, not science. To think otherwise is awfully naive (or disingenuous) for someone who has enough political juice to become the surgeon general. The government regularly thinks it can pull off feats like altering the laws of economics at will. Why should it pay any attention to scientific evidence? Reality is seldom useful for pandering to multiple interest groups at once.

 
At Wednesday, July 11, 2007 6:44:00 PM, Blogger MY OWN WOMAN said...

Sigh.... Isn't that the truth. The lines between what is good, what is right and what is political become more and more blurred everyday.

 
At Wednesday, July 11, 2007 7:25:00 PM, Blogger Maurice Bernstein, M.D. said...

I fully agree with both commenters. But faced with this conflict between what is possible, what is appropriate, just and beneficial for all of society versus what is seemingly, to the politicians, the best way to get reelected, what can be done beyond just sighing? Since this issue seems to involve to varying degrees both parties in our two party governmental system, it doesn't seem that simply electing the other party is the answer. Does it require a different political system or a system with longer terms of service or different kinds of people working in our government who are more ethical, more academic training in the work (or might it be the profession) of politics or more independent oversight to prevent aquisition of too much power? Maybe the problem is the power. Perhaps there is already too much power in the three parts of the U.S. government, nothwithstanding so-called "checks and balances". Maybe, it ends up, even with our electoral process, that the public doesn't hold enough power or the appropriate kind of power to assure that those in government serve in a manner that is more good, more right and overall more ethical than what we have experienced. ..Maurice.

 
At Friday, July 13, 2007 1:50:00 PM, Blogger LisaMarie said...

The answer to the question about power is kind of complicated. Here's a thought exercise I'd like to try in order to better answer it:
I am absolutely certain that I, LisaMarie, am much better qualified than you, Mo Bernstein, to run your life. Were I given a sort of all-encompassing power of attorney over your existence, I would make much better decisions for you in all aspects of your life than you have made, are currently making, and will make for yourself. This is because I know what is in your best interests. The fact that you are NOT now doing what I know is in your best interests is proof that you yourself do not even know what is in your best interests. Therefore, you would be much better off if I ran your life.

Rebut my argument. Enjoy!

 
At Friday, July 13, 2007 3:09:00 PM, Blogger Maurice Bernstein, M.D. said...

The fallacy of your argument is that you are basing "best interest" on the environment (the world) around me. That is the only interest you can observe. However, I and I am sure you do too, have hidden personal interests which are within our minds and conscience and unless you have the capacity of a mind-reader to read mine you will never be able to reach them.

This is what makes surrogate decision-making based on the patient's "best interest" potentially unreliable. What the surrogate thinks is in the patient's best interest or what the "average person" under the same conditions would most likely have wanted may not what the patient themselves would have wanted.

What a politician says is in the public's best interest also may represent what the politician may consider is in his or her best interest also, perhaps leading to a conflict of interest. That is why independent oversight is necessary to control the power of those who would like to make "best interest" decisions for others. ..Maurice.

 

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