Surgeon general's powers are limited

More of a cheerleader than a quarterback

WASHINGTON, D.C. - America has done without a surgeon general for 17 months, a situation remedied Monday when the Senate confirmed Dr. Vivek Murthy to the job among a flurry of lame duck nominees cleared.

But just what have we been missing with the job vacant since July 2013, when Surgeon General Regina Benjamin left the post?

Not so much. As far as federal health care turf goes, the surgeon general functions more as cheerleader than quarterback. The post may be nicknamed “America’s doctor,” but its powers have been limited with the growth of the federal health care bureaucracy and the heightened public health profiles of the Centers for Disease Control and Prevention and the National Institutes of Health.

Historically, the surgeon general has often taken point during public health emergencies, along with administering the 6,500-strong uniformed Commissioned Corps of the U.S. Public Health Service.

But when public anxiety over the prospect of an imported Ebola outbreak soared this fall, officials at CDC and NIH took the lead, followed by hastily-appointed czar Ron Klain. The acting surgeon general, Rear Admiral Boris Lushniak, merely had cameo roles at a few hearings and press conferences.

Murthy, the 18th surgeon general since the job was created in 1871, will presumably have a bit higher profile on Ebola and other topics. President Obama said as much in praising the confirmation this week.

But Murthy is unlikely to be a public health maverick like some of his predecessors. The youngest to ever hold the job at 37, he holds an MD and MBA from Harvard, specializes in internal medicine and teaches at Harvard Medical School. He also founded Doctors for Obama during the 2008 campaign, a group later renamed Doctors for America to support health care reform.

As president of that group, he had joined in urging new gun control measures after the Newtown, Connecticut, shootings, a position that drew strong opposition to his nomination from the National Rifle Association. Murthy has insisted his focus as surgeon general will be battling obesity, not guns.

The first “supervising surgeon” was Dr. John Woodworth, who served as Gen. William Sherman’s top medical officer during the Civil War. He was appointed to clean up a corrupt and crumbling network of hospitals for mariners, which he did by setting up the public health service corps with a military organization. He and his successor, John Hamilton, expanded the corps role in battling disease outbreaks, including enforcement of quarantines.

Although the exact duties and agencies have changed over the years, the more notable surgeon generals of modern times have pushed against political, social and scientific norms to advance public health. Dr. Thomas Parran shocked Americans with a plain-spoken campaign against venereal diseases in the 1930s, but also allowed ethically-flawed syphilis studies in Alabama and Guatemala.

Dr. Luther Terry, in a landmark report, tied smoking to lung cancer and chronic bronchitis in 1964, the first official government recognition of such a link.

In the 1970s, Dr. Julius Richmond set the first national goals for health and disease prevention and helped establish a new network of community health centers.

As the AIDS epidemic developed in the 1980s, Dr. C. Everett Koop pushed a reluctant Reagan administration to address the problem and spoke candidly about transmission and prevention, including a brochure mailed to every household in the country.

More recently, surgeon generals have had to more closely toe White House lines or be frozen out. Dr. Jocelyn Elders helped promote health reform early in the Clinton years, but was shown the door for plain talk on masturbation, sex education and drug use. Her successor, Dr. David Satcher, pressed ahead on tobacco and helped respond to the 2001 anthrax attacks, but was forced out by the Bush administration after issuing a controversial report calling for expanded sex education in schools.

[Also by Lee Bowman: Obamacare complicates 2014 tax returns]

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