Weekly Pulse: America’s Next Top Doctor

Lindsay E. Beyerstein

As surgeon general, Dr. Sanjay Gupta will be an effective public advocate for public health goals, but will he be a good administrator and an effective leader of America's public health professionals?

2009 already is shaping up to be a year of surprises. Yesterday, we
learned that America’s favorite TV doctor, Dr. Sanjay Gupta, will
likely be the next Surgeon General of the United States.

President-Elect Barack Obama is assembling a healthcare dream team. In November 2009, Obama named former Senate Majority Leader Tom Daschle
as Health Czar and Secretary of Health and Human Services. The Daschle
pick was widely taken as a sign that Obama was determined to pass a
healthcare plan. Daschle’s political skills will be critical to getting
a plan through Congress.

While Daschle will be in charge of selling the politicians on
Obama’s healthcare agenda, Gupta will be tasked with winning over the
general public.

Ezra Klein of the American Prospect is delighted with prospect of Gupta for Surgeon General:

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Gupta is a great pick. To illustrate why, here’s another
question: Who’s the current surgeon general? Odd that you just blurted
out Steven K. Galson are low. That’s not necessarily a problem. The
surgeon general isn’t just the guy who writes warnings for cigarette
labels. He commands the 6,000 health professionals in the Public Health
Commissioned Corps. He gives out awards. There’s no evidence Galson is
failing in those duties.

But Gupta is not leaving CNN and Time to give out medals.
The surgeon general has an informal role as the country’s leading
medical and lifestyle educator, and it’s that role the Gupta is
uniquely positioned to fill. There’s not a doctor in this country with
half his media training and experience, nor one with a rolodex of
editors and reporters a tenth as large.

Steve Benen of the Washington Monthly is cautiously optimistic,
even if Gupta isn’t what you’d call red meat for the progressive base.
Benen recalls a famous 2007 exchange between liberal documentarian
Michael Moore and Gupta in which Moore took Gupta to task for a number
of errors in Gupta’s "fact-check" of Moore’s healthcare film, Sicko:

Clearly, Gupta will be the biggest star to occupy the office of
Surgeon General since C. Everett Koop. Certainly, the 39-year-old will
be the first Surgeon General in history to have been deemed one of the Sexiest Men Alive by People Magazine.

Gupta hasn’t officially accepted yet, but he’s expected to say yes,
if all goes well with the final vetting process. However, Gupta is
reportedly concerned that he’ll have to take a pay cut to become America’s next top doc.

The Gupta pick won’t get rave reviews from everyone. He’s a great communicator, but his political experience is limited-though he did serve as a White House fellow in the late 1990’s and advised Hillary Clinton on healthcare.

Howie Kurtz of the Washington Post claims that Gupta has a longstanding interest in health policy
and that he has even negotiated an expanded policy role for himself as
Surgeon General. However, surprisingly little is known about which
policies Gupta, a Michigan-born brain surgeon, actually supports.

The choice of a celebrity commentator
with a background in high-tech, interventionist medicine will make some
public health professionals uneasy. The Surgeon General is America’s
top public health official. Ezra Klein anticipates that Gupta will be
an effective public advocate for obesity prevention and other public
health goals. However, it’s not clear from Gupta’s record if he will be
a good administrator or an effective leader of America’s public health

In other healthcare news this week, Mother Jones kicks off the New Year with a miscellany of facts and figures on obesity in America. Last month, the Washington Post
reported that Barack Obama is setting an example when it comes to
physical fitness, noting that the president elect had been to the gym
every day for at least 48 days. It’s only a matter of time before conservatives start blaming eating disorders on an imaginary "Obamarexia" epidemic.

But maybe prevention is overrated. At the American Prospect,
M. Gregg Bloche says that preventative medicine won’t save the
healthcare system money in the long run. Yes, it costs less to prevent
a case of diabetes than it does to treat the condition once it sets in.
But people who avoid diabetes tend to live longer. And the longer we
live, the more healthcare resources we consume:

If we’re to get better at averting illness, we’re going
to have to spend more. The Tufts Medical Center Cost-Effectiveness
Analysis project tracks published data on the costs and benefits of
thousands of tests and treatments, including 279 preventive measures.
Fewer than 20 percent of these measures actually save money, the Tufts
group recently reported in the New England Journal of Medicine.
The rest raise medical spending, and that’s not even counting the extra
costs patients incur down the line, for illnesses they could have
avoided by dying.

That doesn’t mean that we shouldn’t spend money on preventative
medicine, Bloche says. We just have to think of prevention in terms of value,
not savings. In other words, prevention may be expensive, but it’s
worth it because it works better than treatment. Preventing diabetes
may turn out to be expensive in the long run, but someone who never
gets the disease will live a longer, healthier life compared to a
patient who depends on insulin and drugs.

In December, Obama sparked controversy when he picked conservative
mega-church Pastor Rick Warren to give the invocation at the
inauguration ceremony. As we’ve discussed before in the Weekly Pulse,
Warren’s worldly political agenda makes him a troubling pick. The
pastor opposes abortion, gay rights, and science-based sex education.
He favors the discredited
abstinence-only until hetero-marriage approach to preventing STDs and
unplanned pregnancies home and abroad. Warren is clearly positioning
himself for a prominent role in shaping the Obama administration policy
on healthcare and international development, especially AIDS in Africa.

Elsewhere on the reproductive health front, Mike Ervin, writing for the Progressive,
urges President Elect Obama and the new Democratic Congress to swiftly
repeal the eleventh hour regulations that raise out-of-pocket costs for
services. Erwin notes that higher Medicaid costs disproportionately
burden poor and disabled Americans and may discourage them from seeking

In Rewire, Sam Sedai outlines the key reproductive health policy decisions
facing the incoming administration. One of the most important questions
is the fate of Bush administration’s radical "conscience clause" rules,
which allow federal healthcare workers with religious qualms to opt out
of virtually any task connected to birth control or abortion.

Clearly, 2009 holds many challenges and a great deal of opportunity in store for advocates of progressive health policy.

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