What Is The Surgeon General Good For?

Part of the liberal line in the political battle over Ebola is that we’d be much better placed to respond to the crisis if only Congressional Republicans would stop stonewalling the confirmation of Obama’s nominee Dr. Vivek Murthy to the post of surgeon general, which has been empty for over a year. But Mike Stobbe doubts this would really make much difference, considering how the role of the surgeon general has changed over time from front-lines crusader against disease to mere public health advocate:

[I]t was in the 1960s, during the Democratic presidencies of John F. Kennedy and Lyndon B. Johnson, that things really started to go downhill for the surgeon general. Administration officials were pushing to enact Great Society programs, and increasingly viewed the surgeon general and his troops as foot-draggers reluctant to take on the new initiatives—especially Medicare and Medicaid. … Dr. Luther Terry became renowned in 1964 for releasing a report that finally convinced many Americans of the deadliness of cigarette smoking, but he was shown the door a year later, after only one term. By 1968, the HEW Secretary had stripped away the surgeon general’s administrative powers and redistributed them to others.

Since then, the surgeon general has been little more than a health educator—“a pathetic shadow of authority who traveled around the country lecturing high school students on the hazards of smoking,” as the political scientist Eric Redman once wrote.

McArdle takes a broader view, noting that “this is not your grandfather’s public health system”:

Public health experts were, in a way, too successful;

they beat back our infectious disease load to the point where most of us have never had anything more serious than Human papillomavirus or a bad case of the flu. This left them without that much to do. So they reinvented themselves as the overseers of everything that might make us unhealthy, from French Fries to work stress. As with the steel mills, these problems are not necessarily amenable to the organizational tools used to tackle tuberculosis. The more the public and private health system are focused on these problems, the less optimized they will be for fighting the war against infectious disease. It is less surprising to find that they didn’t know how to respond to a novel infectious disease than it would have been to discover that they botched a new campaign against texting and driving.

Don’t get me wrong: Fighting infection is still one of the things that the public health infrastructure does, and though I hope it doesn’t come to that, I expect that our system will do a much better job next time. But the CDC did not botch the job because there’s something wrong with Barack Obama, or government, or the state of Texas, or private hospitals. They dropped the ball because the public health system no longer needs to work so many miracles, and consequently hasn’t had much practice.

The way Steven Malanga sees it, CDC Director Thomas Frieden’s embrace of that new role as nanny-in-chief is part of why he’s not really that good at his job:

As New York City’s health commissioner, Frieden engineered a law requiring food chains to post calorie counts on menus, though there was no evidence that the availability of such information has any effect on eating habits. Frieden also led a campaign to cut salt consumption despite studies that had shown, in fact, that some individuals fared poorly on a salt-restricted diet. Frieden’s campaign led one world-renown hypertension expert to proclaim that New York was attempting to engineer a giant uncontrolled experiment.

As time passed, Frieden’s practice of recommending sometimes outrageous solutions to health problems based on few facts grew more disconcerting. In 2007, he even proposed a campaign to persuade uncircumcised adult men in New York to get circumcised to reduce their risk to HIV; a study in Africa had concluded that the practice helped lower infections there. But Frieden’s proposal was widely derided and quickly dismissed because of the vast differences between the two populations and the preliminary nature of the research.

Ugh. Back to the issue at hand, Byron York blames the surgeon general vacancy on Democrats rather than Republicans:

[H]ere is the basic fact about charges that Republicans are blocking the surgeon general nominee: There are 55 Democrats in the Senate. Since Majority Leader Harry Reid changed the rules to kill filibusters for nominations, it would take just 51 votes to confirm Murthy. Democrats could do it all by themselves, even if every Republican opposed. But Democrats have not confirmed Murthy.

The reason has more to do with Murthy himself than anything else. As doctors go, he is a very political man, so it’s no surprise his politics have created political problems.

York notes that the NRA “took a strong stand against Murthy, a position that caught the attention not only of Republicans but of red-state Democrats seeking re-election.” Weigel adds context:

The NRA actually promised to score votes for Murthy – anyone who backed him would see a drop in his grade from the gun lobby. Among the horribles that made Murthy unacceptable were tweets like this (as York cites):

You can see why the NRA wanted to prevent such a doctor from becoming surgeon general. And you can sort of see why red state Democrats begged Harry Reid to prevent a vote on him.