The Controversy about Dr. Gupta as Surgeon General Takes a New Turn – Part 1

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As you no doubt have heard, the healthcare blogosphere has been seriously divided on President Obama's nomination of CNN chief medical correspondent Dr. Sanja Gupta as our next surgeon general.

Over at The American Prospect, Ezra Klein liked the pick. Klein sees the surgeon general as "the country's leading medical and lifestyle educator," and it's that role " Klein wrote, that  "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." Klein  also expects that Gupta will be an effective  advocate for the President' s health care plan."Sanjay Gupta, arguably the nation's most trusted health care authority, will be back on TV screens arguing for Obama's universal health care plan, lending it his credibility as a doctor, a trusted media presence, and the nation's surgeon general."

Not everyone sees the charismatic 39-year-old as the country's "most trusted health care authority." Indeed, the question of "trust" is central to the debate.  Gary Schwitzer,  a professor at the University of Minnesota School of Journalism and Mass Communications and the mind  behind the excellent  Schwitzer health news blog, said he was "shocked" when he heard that Gupta has been tapped.  Schwitzer has written frequently about Gupta, citing his "entanglement" with drugmakers; his "unquestioning – almost cheerleading – approach to health news coverage" ; and "some laughable, some dangerous coverage on Gupta's 'Housecall' program;" .  (This  last post ran under the headline "Molly Ivins would have loved this one.")

Schwitzer is not alone. Drs. Lisa Schwartz and Steven Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice (and home to Jack Wennberg's famed research on overtreatment) economist Paul Krugman, respected  bloggers Kevin M.D. Dr. Val,  Christine Gorman and Joe Paduda as well as  Boston Post columnist Peter Canellos  and Chicago Tribune columnist Judy Deardoff  all have raised questions about whether Gupta has the "substance," the "independent voice"  the "freedom from conflict of interest," the "qualifications" the respect for "facts" and  medical "evidence" that we need in a Surgeon General.

Now, the debate has taken a new turn:  Earlier this week, HealthBeat reader Dr. Rick Lippin posted an open letter to President Obama and Secretary Tom Daschle on Facebook, urging them to seriously consider Secretary Dr. George Lundberg  as the nation's next Surgeon General. Today, Lippin's letter became the subject of a post  by Brian Klepper on The Healthcare Blog (THCB. The Gupta controversy may be heating up.

First, Lippin's letter: in it he argues that the Surgeon General should be "a physician with the gravitas and the moral credentials and authority to use this bully pulpit position to speak for science and values based public health issues for all Americans. Dr. George Lundberg fits the bill." Lippin then outlines Lundberg's credentials:

  • As Editor- in-Chief of the Journal of the American Medical Association's journal, commonly known as JAMA, between 1982-1999, he made it most widely read medical journal in the world,
  • In 1999 he then went onto becoming Editor-in-Chief of MEDSCAPE, the leading source of online health information and education for physicians thus establishing himself as a genuine pioneer in e-medicine.
  • Before joining Jama, Lundberg was an expert in o tropical medicine and served in the US Army during the Vietnam War leaving as a Lieutenant Colonel after 11years of service. His major professional interests are toxicology, violence, communication, physician behavior, strategic management and health system reform" –intellectual interests that would stand him in good stead as this country's Surgeon General.
  • Finally, Lundberg is an inspiring, persuasive  speaker who,  Lippin notes, "has used his  well honed communication skills in addressing both professional and public audiences live and in all categories of the electronic media.

Lippin concludes: "we have a genuine crisis on many levels in US Medicine.  We need desperately for the medical profession to regain its moral and ethical foundations and furthermore we also need medical leaders who must regain the trust of the American Public which has been dangerously eroded.
Let me add that I know Dr. Lundberg. I have read his fine book, Severed Trust; I quote him in Money-Driven Medicine. I have met him and have the greatest respect for his courage, integrity and deep intelligence.

Meanwhile, I am troubled by Dr. Gupta's nomination because I have heard him offer medical advice on CNN that contradicts the best medical evidence and evidence-based guidelines available.  Perhaps he is right, and the guidelines are wrong. But he should at least disclose what the National Services Preventive Task Force is saying.  Too often, Gupta seems to be promoting the products or treatments he recommends, while dismissing safety concerns.   As I have written before, we need a health care system that is designed to serve the interests of patients-ahead of the interests of those who profit from our bloated $2.3 trillion healthcare system.

In the past, the U.S. Surgeon General has stood up to a U.S. President to insist that we take AIDS seriously; he has stood up to the cigarette industry to proclaim the dangers of tobacco. As we move toward health care reform, we need a surgeon general who is more than a "lifestyle counselor."  The Obama administration will need a Surgeon General able and willing to take on the many vested interests who will fight reform as they try, with all of the resources at their disposal, to protect their pot of gold.  A Surgeon General could help rally the American public, and in so doing, force Congress to stand up to the lobbyists.

But how can the Surgeon General do that if he has already known as the TV counselor who has close ties to  Merck-and , who, in 2003, dismissed the risk that Merck's block-buster drug Vioxx increased the chances of heart attacks?

Less than a year later the drug would be withdrawn from the market, and Merck would be accused of concealing the thousands of heart attacks and strokes caused by the drug.

In part 2 of the this post, I will tell you more about Professor Gary Schwitzer and why he was "shocked" by Gupta's appointment –as well what Gupta's other critics have to say about him.  I'll also quote those who support Gupta, tell you a little more about Lundberg, and leave it to you to decide who you would prefer as  Surgeon General: Sanjay Gupta or George Lundberg?

13 thoughts on “The Controversy about Dr. Gupta as Surgeon General Takes a New Turn – Part 1”

  1. I’m looking forward to Part 2. My vote is for Lundberg, of course. I reported directly to him when I worked at the Medscape Journal of Medicine. He is fair, balanced, open-minded, and highly ethical. He has the courage to take unpopular positions when necessary, and is a defender of science-based medicine. He’s the sort of person we need in the office of Surgeon General.

  2. Thanks Maggie
    Your blog piece and revelations about Dr. Gupta are noteworty.
    We need health care leaders, more so that ever, that are free of the taint of the excesses of the profit motive in US Medicine
    THAT IS NOT DR SANJAY GUPTA
    Dr. Rick Lippin
    Southampton,Pa

  3. WE NEED A MD WITH A PUBLIC HEALTH DEGREE. WE DO NOT NEED A TV DOCTOR WHO IS GIVING SUPERFICIAL MEDICAL INFO ON A DAILY BASIS. WE NEED A DEDICATED SCHOLARLY PERSON WITH A BROAD OVERVIEW.

  4. Dr Val, D Rick and
    Sylvia–
    Thank you very much for your comments.
    I agree we need a Surgeon-General free of conflict of
    interests.
    Moreover, we need a Surgeon General who undertands –and has a real commitment to –public health.
    That is major part of the Surgeon General’s job.
    Dr. Gupta does not have great experience in this area–which makes him a very odd choice.
    Part 2 of this post will come soon.

  5. Does Dr. Lundberg WANT this job? His qualifications are not in dispute but I DO find quite an alarming amount of jealousy from many of you regarding Dr. Gupta. And I also wonder if his detractors are anxious to ride the wake of Dr. Lundberg’s reputation to media popularity? I never hear anyone recall Gupta’s bravery when, while embedded with a forward deployed Marine expeditionary unit in a hot zone near Baghdad he performed more than a few neurosurgical cases which he was NOT required on that assignment to. In each case the pt. would have perished for lack of neurosurgical skill. Have any of you done this? No, I didn’t think so. Dr. Gupta is remarkably well rounded considering what is required to excell in Neurosurgery and given his youth. His amazing good looks and ability to engage the masses is NOT a handicap. It IS rare in medicine, however. Nor does Dr. Gupta slam his expertise or opinions down the public’s throat knowing that patients today DON’T trust doctors anymore. In fact – too often we have become enemy. His powerful forum on CNN gives him more access to Joe Q. Public us than any other doctor in the nation. He’s in bed with Merck you say? Would you mind documenting that? He touted Vioxx? So did most of the cardiologists in my service area to the tune of taking it themselves directly from to sample closet when they had pain. Is there anything of real substance to the anti-Gupta movement here? He’s not qualified? In what way? His academic and surgical credentials are impeccable. The eminent Dr. Lundburg and HIS Vitae notwithstanding – Dr. Gupta gets MY vote and the nods of LOTS of others whose opinions are astonishingly absent from this blog. That this discussion is slanted away from Dr. Gupta is hardly subtle so I will stand on his side for a moment. Dr. Gupta does not treat from the newsdesk on CNN. So kindly tell us exactly how his comments flew in the face of current medical practice? Did he espouse a heliocentric solar system? As men and women of science, we should be very careful NOT to make proclamations about Dr. Gupta which are tantamount to gossip and cannot be verified. Shame on all of you who are transparently jealous of Dr. Gupta’s career, good looks, surgical acumen and esteemed role in academia. It’s the career most of us could never lay claim to. And while Dr. Lundberg is certainly revered and rightly so – this does NOT an endorsement make. Will Sanjay take the job if it’s offered to him? I hope he does, but won’t be surprised if he turns it down since I feel that he values personal freedoms which would be compromised were to to become the senior admiral in the US Public Health Service. Finally, Dr. Gupta could take on the media toe to toe in the event of a public health care snafu. It’s a skill Dr. Lundberg is NOT in possession of. Such a skill is highly desirable today when medical quackery and associated propaganda is disseminated at light speed with the potential to cause increased M&M. Jocelyn Elders and C. Everett were both eviscerated by the media because although both were good and well intentioned Surgeons General, were sadly media retards. Lastly, I am reading a most profound dislike of Dr. Gupta by some of you and it is coming across as a desire to get even with him or to see him fail. Is there more here than meets the eye? There are far too many negative sentiments expressed about Dr. Gupta which are blatantly nasty and are disproportionately vehement. This is NOT not at all in keeping with balanced reporting and I daresay Dr. Lundberg would not appreciate such tactics launched supposedly in his behalf.

  6. Last of the Zucchni Flowers–
    You’ll notice this post is headlined part 1 More
    dcoumentation of Gupta’s entanglement with Merck, etc., will come in Part 2.
    Perhaps you know many doctors who brushed off the problems with Vioxx.
    I don’t. Many doctors were concerned. More than a year before Merck was forced to withdraw Vioxx from the market, Kaiser, the VA, and the Mayo Clini–as well as many other doctors– were no longer prescribing Vioxx for any patients unless those patients could not tolerate older, equally effective and far less expensive painkiller). (For a few patients, those older painkillers caused
    gastrointestinal bleeding.)
    But those docs were not taking money from Merck. Gupta was while doing “infomercials” in televisoin in Doctors’ waiting rooms, promoting various drugs. Merck wa a sponosor.
    When Gupta publiclly brushed off the concerns about Vioxx on televison, he was asked where he got his information. (There was already good medical reserach indicating problems.)
    ‘
    His reply? From the compnay.
    Great. You hear that a medication might be hurting patients, and who do you go to for info? The company– a company that would later be charged with covering up evidence that Vioxx caused heart attacks and strokes.
    Yes, I knwo Dr Gupta performed surgery while emberedded with the troops. I think that’s great–but why wouldn’t he?
    If a soldier needed surgery, and Gupta knew who to do it, why wouldn’t he take the opporutnity to help?
    Meanwhile, I’m sure CNN was very glad he did it. Virtually everyone knows about the surgery because it generated a huge amount of favorable publicity.
    This is fine too–but I don’t find it remarkabe that Gutpa did it. It’s what any doctor would do in a similar situation.
    I personally don’t know of anyone who is jealous of Gupta. Nor can I agree that his “amazing good looks” are “rare” in medicine. Gutpa is nice-looking–though I have to say I find Obama better-looking (far more intelligence in his eyes.)
    More importantly, why would looks matter??
    Do you think Americans are so incredibly foolish that they would only take advice from a suregeon general who is AMAXINGLY GOOD LOOKING? Okay, some 14-17 year old girls would probably be bowled over . . . .but the rest of us???
    Personal integrity, honesty and courage go a long way toward making a difference.
    Do you rememer the surgeon general who publicly stood up to Reagan and insisted that we start paying attention to AIDS?
    (Reagan wasn’t terribly concerned that Gay people were dying.)
    Do you remember the surgeon general persuading the nation that cigarettes are indeed hazardous to our health–and beginning the war against tobacco?
    Finally, there are great many U.S. phsyicians who are much better speakers (or, if you prefer “communicators”) than Gupta.
    I just returned from a conference were both Atul
    Gawande and Uwe Reinhardt spoke. They leave Gupta in the shade.

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  10. DR GUPTA DID NOT HAVE THE PROPER CREDENTIALS OR EXPERIENCE TO HEAD OUR HELATH CARE SYSTEM. WE NEED A MD
    WITH PUBLIC HEALTH CREDENTIALS. WHY DOES WASHINGTON GO FOR POPULARITY OVER QUALITY?

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