Benjamin is no Gupta (and that's a very good thing)

By Michael J.W. Stickings

President Obama today introduced Dr. Regina Benjamin as the new U.S. surgeon general (pending confirmation, of course). I don't know anything about her -- in fact, I'd never heard of her until today. Looking over her career accomplishments, though -- notably: family physician, founder of the Bayou La Batre Rural Health Clinic (which was destroyed by Hurricane Katrina), government appointee (both federally and in Alabama), current president of the Alabama Medical Association -- she seems like a deserving choice.

Is she up for the largely symbolic role of U.S. surgeon general, a job that is more public relations than medicine? Hopefully yes.

At the very least, she's no Sanjay Gupta, the CNN celebrity doctor who shills for Big Pharma and promotes the interests of the profit-driven medical establishment, a flack whom I wrote about here, here, and here, back when it looked like, as Obama's first choice, he was poised to become surgeon general.

Suffice it here to say that I don't much care for him.

While Benjamin may lack Gupta's star power and telegenic splendor (though, to be fair, I haven't yet seen her on TV), she has not, from what I can tell, compromised herself or her principles in pursuit of the god-almighty dollar. Yes, it's important to have someone in the position who is a good communicator, and (who knows?) she may very well be one, but I'll take the family physician who specializes in rural health over the media darling with the corporate connections regardless.

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Interestingly, Obama prefaced his introduction of Dr. Benjamin with a re-statement of his commitment to health-care reform. He didn't utter the words "public" and "option" together, nor did he say anything about government-run care, preferring instead to emphasize expanding coverage and ensuring choice, which could be telling.

I must admit, I'm worried. What does expanding coverage mean? Not universal coverage, to be sure, and not guaranteed coverage. And what does choice mean? More private options?

Still, Obama was admirably adamant about the need for reform:

I know there are those who believe we should wait to solve this problem, or take a more incremental approach, or simply do nothing. But this is the kind of criticism we heard when the country tried to pass Medicare, a program that is now providing quality care to generations of American seniors. It's the kind of criticism we heard when we tried to pass the Children's Health Insurance Program, which has provided quality care and coverage to millions of kids. It's the same Washington thinking that has ignored big challenges and put off tough decisions for decades. And it is precisely that kind of small thinking that has led us into the current predicament.

So make no mistake: The status quo on health care is no longer an option for the United States of America.

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This is no longer a problem we can wait to fix. This is about who we are as a country. Health care reform is about every family's health, but it's also about the health of the economy.

So I just want to put everybody on notice, because there was a lot of chatter during the week that I was gone: We are going to get this done. Inaction is not an option. And for those nay-sayers and cynics who think that this is not going to happen, don't bet against us. We are going to make this thing happen, because the American people desperately need it.

Big talk. I just hope he backs it up not with some tinkering of the status quo but with wholesale change, with big thinking that includes a robust public option.

Anything less would be not just a disappointment but a failure.

Gupta turns down surgeon general post

By Michael J.W. Stickings

Some of you may remember that I opposed CNN celebrity-doctor Sanjay Gupta's never-announced nomination for surgeon general from the very start. Let's just say, I'm not a fan. Here's what I said back in January:

[Gupta] seems to be very much a part of, as well as a defender of, the status quo, namely, the corporatized health care system controlled by Big Pharma and the HMOs.

And here's what I added a couple of days later:

The problem is that Big Pharma and the HMOs control health care in the U.S. -- and many doctors just buy into the marketing machine. Gupta may not be your basic GP -- he is surely more aware of the big picture than most -- but what he is instead is a significant contributor to the problem, a telegenic broadcaster with the credibility that comes from being on television. It would be one thing if he simply reported on the pharmaceutical industry and its products from a perspective of balanced detachment. But he doesn't. He actively tries to sell those products, and, in so doing -- and without being open about his connections to Big Pharma -- he's part of the marketing machine at the core of the problem.

And then the following day:

I do not oppose Gupta because he lacks experience -- indeed, what is needed in the position is not so much bureaucratic competence as the ability to lead public relations efforts on public health issues, and, in this sense, Gupta, with his extensive experience in broadcasting, could do well -- but rather because of his flacking for the pharmaceutical industry, that is, because he is part of the problem, a celebrity cog in the marketing machine for Big Pharma and the very system that so badly needs to be overhauled or, preferably, replaced.

Well, it looks like Gupta will continue being a cog in the machine, a flack for Big Pharma. According to The Washington Post, he has announced that he will not be accepting Obama's offer. He didn't issue a statement explaining why, but:

[O]ne source close to him said he was very disheartened by Daschle's fate and fearful he was not going to get a prominent role in the health reform process. Gupta has built a lucrative media empire that includes appearances on CBS as well as CNN and book deals. He had expressed concern to friends about the financial impact on his wife and children.

Uh-huh: "a lucrative media empire." It's not just the "appearances" and "book deals," though, it's Big Pharma payola.

As surgeon general, after all, he wouldn't have been able to push drugs through supposedly neutral, professional reporting, profiting off the credibility that comes with being a supposedly trusted, and trustworthy, TV celebrity, presenting himself as an unbiased medical man while neglecting to disclose his pharma-friendly financial interests.

In a way, it's worse that he won't be surgeon general. He'll continue to avoid accountability, and people will buy what he's selling, as they do now, just because he is who he is, because Gupta said so.

Just remember how lucrative his career has become. And then follow the money.

Conyers contra Gupta

By Michael J.W. Stickings

Needless to say, I'm not alone in my opposition to Sanjay Gupta for surgeon general (though it is evident that it is hardly Obama's most controversial move thus far, generating comparatively little criticism).

As HuffPo reports, Rep. John Conyers has sent a letter to his Democratic colleagues arguing against Gupta:

I join in opposition with respected Noble Peace Prize award wining economist Paul Krugman, who has very serious concerns with having Dr. Gupta be the nation's Surgeon General. [...]

Also, there are highly experienced medical professionals who question whether Dr. Gupta has the necessary experience or even the medical background to be in charge of some 6,000 physicians or more who work in the United States Public Health Service. Gerard M. Farrel, Executive Director of the Commissioned Officers Association, stated in the January 7, 2008 Washington Post that Dr. Gupta will certainly face a "credibility gap" because he never served in the National Health Service Corp, and furthermore, does not have the "experience or qualifications to be the leader of the nation's public health service." Clearly, it is not in the best interests of the nation to have someone like this who lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance to some of the poorest and most underserved communities in America.

I do not oppose Gupta because he lacks experience -- indeed, what is needed in the position is not so much bureaucratic competence as the ability to lead public relations efforts on public health issues, and, in this sense, Gupta, with his extensive experience in broadcasting, could do well -- but rather because of his flacking for the pharmaceutical industry, that is, because he is part of the problem, a celebrity cog in the marketing machine for Big Pharma and the very system that so badly needs to be overhauled or, preferably, replaced.

Still, Conyers makes a good point, adding to the growing case against Gupta.

Sanjay Gupta, Big Pharma flack

By Michael J.W. Stickings

I'm still not sold on Sanjay Gupta for surgeon general. In fact, the more I think about it, the more I dislike the very idea of putting Gupta in charge of public health.

As I wrote on Tuesday, when the story broke, Dr. Gupta "seems to be very much a part of, as well as a defender of, the status quo, namely, the corporatized health care system controlled by Big Pharma and the HMOs."

And, indeed, more is coming out about his seemingly unethical (or at least questionable) dealings. For example, at TNR's The Plank today, Marin Cogan and Suzy Khimm add that he is "no stranger to the ethically sticky situation physicians often find themselves in with drug companies":

For over six years, Gupta has been co-hosting "AccentHealth" -- a CNN television segment beamed straight into doctors' waiting rooms, sponsored in part by many of the major pharmaceutical companies. Touted on its website as an "integrated marketing opportunity" that allows companies to deliver their message "in a trusted environment," the show has been underwritten by drug industry leaders Aventis, Pfizer, Procter & Gamble, Merck, and Warner Lambert.

At the same time, Gupta has been appearing on CNN's primary broadcasts as an ostensibly objective medical authority, discussing the drugs produced by the very same pharmaceutical companies.

In other words, Gupta takes money from Big Pharma and then promotes their products both directly to patients and more broadly (and untransparently) in his capacity as a celebrity doctor on television. And he has done this, no doubt much to his profit, for drugs like Lipitor (cholesterol), Aventis (allergies), and Gardasil (HPV).

I realize that the world of health care ethics, not least where Big Pharma is concerned, is rather murky. The fact is, like it or not, these companies, and others like them, do manufacture and market drugs that work -- and that we would not want to do without. I do not necessarily fault them for wanting to sell their products, and to target both practitioners and patients. I would not want a doctor to prescribe a drug simply because he or she accepts what he or she is told unthinkingly, but if a doctor, like Gupta, thinks a drug is effective, then he or she should be able to speak positively to it.

As Cogan and Khimm point out, though, "[a] growing body of evidence... suggests American medicine is far too aggressive, which leads to higher costs and, all too frequently, actual harm for patients. If Obama wants to reform the health care system, his surgeon general will have to push back against both the pharmaceutical companies that promote ineffective treatments and the doctors who prescribe them."

The problem is that Big Pharma and the HMOs control health care in the U.S. -- and many doctors just buy into the marketing machine. Gupta may not be your basic GP -- he is surely more aware of the big picture than most -- but what he is instead is a significant contributor to the problem, a telegenic broadcaster with the credibility that comes from being on television. It would be one thing if he simply reported on the pharmaceutical industry and its products from a perspective of balanced detachment. But he doesn't. He actively tries to sell those products, and, in so doing -- and without being open about his connections to Big Pharma -- he's part of the marketing machine at the core of the problem.

Gupta has a lot going for him -- not least that he's an engaging communicator. But surely there is someone else -- a public health advocate, a leading researcher, an expert from the CDC -- who is qualified for the job and who hasn't been shilling for, and profiting off, Big Pharma. At the very least, if his nomination does go forward, Gupta should be required to answer for what he has been doing.

Sanjay Gupta for surgeon general?

By Michael J.W. Stickings

The WaPo's Howard Kurtz is reporting that Obama has asked celebrity tele-Dr. Sanjay Gupta, he of CNN and CBS fame, to be the new surgeon general.

Now, I'm in no position to question Gupta's abilities as a neurosurgeon or otherwise his medical qualifications. He may very well be an excellent doctor, as he seems to be (he performed brain surgery during the Iraq invasion in 2003). Furthermore, there is no doubt that he is telegenic and that he would make an excellent spokesman for public health issues. And, indeed, what's needed in that position is not so much expertise in medicine as the ability to communicate effectively with the broader public, that is, to inform and teach through the media. (Think C. Everett Koop and his anti-smoking campaign in the '80s.) In this regard, the media-friendly Gupta, a man who is clearly comfortable in front of the camera, seems to be an excellent pick for the job.

And yet.

It seems to me that what is needed in a surgeon general is also someone who can make the case for, or at least someone who is supportive of, a reformed public health care system, given that this seems to be, as many of us hope it genuinely is, one of Obama's main policy priorities. But is Gupta an advocate of such reform? I have my doubts. As he exposed in his critique of Michael Moore's movie Sicko back in July 2007, he seems to be very much a part of, as well as a defender of, the status quo, namely, the corporatized health care system controlled by Big Pharma and the HMOs. As I put it then, he picked apart Moore's movie, avoided subjecting the existing system and/or Moore's critics to similar evaluation, and failed to address the most serious flaws of the American system, namely, the enormous costs even to those with insurance and the utter lack of insurance for millions." So is this really the man who should be the spokesman for public health in the United States?

I see that my friend Steve Benen, while acknowledging (but not making much of) the Moore incident (which occurred on CNN, no less), thinks that Gupta "seems like a strong choice," given that he "would likely be the highest-profile official since Koop, and could conceivably play a valuable role in advancing a reform campaign." Well, maybe. And -- yet again, yet again -- I'm wondering if I should -- yet again, yet again -- give Obama the benefit of the doubt and trust that he knows what he's doing, that all will work out. Like Krugman, though, I just can't quite get past Gupta's "mugging" of Moore -- and that he got it wrong.

Should one ugly high-profile incident like this disqualify him? Maybe not, and, like I said, he undeniably has a lot going for him. For example, as Kurtz notes -- and this I did not know -- "[h]e was a White House fellow in the late 1990s, writing speeches and crafting policy for Hillary Clinton." That certainly inspires greater confidence, but I need to know more about his position on health care reform, as well as on the existing system that has left millions of Americans uninsured, and about his willingness to work with and in support of soon-to-be health czar and HHS Secretary Tom Daschle, before giving Obama the benefit of the doubt and approving this questionable appointment.

It would be good for the U.S. to have a prominent, highly visible, charismatic, and telegenic surgeon general at a time of reform, not to mention in case of public health emergencies. It's just not clear to me that Gupta is the right choice.

Yet.