By Maggie Mahar

Editor's note: Maggie wrote this originally as a comment to Brian Klepper's post, but we thought it worthy of its own headline.

I vote for Dr. Lundberg–who I know, admire and trust.

I am troubled by Dr. Gupta's nomination because I have heard him
promote products or treatments on television while ignoring the best
medical evidence. In other words, he misinforms the public–without hinting that he is contradicting current best practice guidelines.

There are disturbing ties to Pharma which suggest conflict of interest.

Professor Gary Schwitzer of the University of Minnesots's
Journalism school documents many of these incidents on his excellent
blog "Health News Review."

• Gupta recommending non-evidence-based screening test for men

• Gupta's “unquestioning – almost cheerleading – approach to health news”

• Gupta's involvement in a doctor’s office waiting room video
program that “overtly offers sponsors, including drug companies, the
chance to boost sales of their products.” (This from a journal article)

• the political newsletter CounterPunch and the Chicago Tribune asking readers: "Do you trust CNN's Dr. Sanjay Gupta?"

• Trudy Lieberman’s article describing ineptitude by CNN and Gupta in coverage of health policy news.

• Gupta vs. Michael Moore regarding “Sicko”

• the waste of air time speculating over the cause of death of Anna Nicole Smith.

• a one-sided view of the controversy over mammography for women in their 40s.

• a Pfizer ad for Pfizer’s sponsorship of the “Paging Dr. Gupta” program.

• some laughable, some dangerous coverage on Gupta’s “Housecall” program

• bad judgment employed in his live TV news coverage of Raelian cloning news conference.

Schwitzer notes that two of his stories were reviewed on HealthNewsReview.org:

• about disease-mongering of wrinkles on CNN

• a review of his CBS story about a treatment for addiction to painkillers that got one of our lowest scores.

One of the smartest pieces I saw was by Sandy Szwarc on her Junkfood Science blog.

My summary (from Gary Switzer posted on January 12, 2009)

What does the President want from a Surgeon General? Is it just PR
& glitz? Then let's stop the charade and abandon the position. . .

The prevention & wellness messages that Gupta so often promoted
on CNN can go too far – pushing screening tests outside the boundaries
of evidence and ignoring that such screening may cause more harm than
good. If that is the message that he would promote as Surgeon General,
I would consider that a non-evidence-based abuse of the bully pulpit.
And a huge mistake by the Obama administration.

The industry conflict of interest questions that have arisen are cause for concern. Usually where there's smoke, there's fire.

Presumably Surgeon General Gupta would work closely with new HHS
secretary Tom Daschle. Several passages from Daschle's book, "Critical:
What We Can Do About the Health Care Crisis," raise questions in my
mind about the Gupta appointment. Daschle wrote about "using
evidence-based guidelines and cutting down on inappropriate care" as
effective ways to control rising health-care costs. But Gupta's
reporting, as noted in the entries above, often didn't reflect a great
appreciation for evidence-based health care. Daschle also wrote, "It is
relatively easy to misinform the public and stoke fears, no matter how
strong the desire for reform." Promoting screening outside the
boundaries of evidence is fear-mongering. These are potentially
troublesome disconnects for an Obama health care team.

My view (mm)–I would add that what we need most in a Surgeon
General–and in all cabinet posts–is integrity. After 8 years of lies,
corruption and blatant conflict of interest, the public is hungry for
honesty.

In addition, we need a surgeon-general who is committed to public
health. Lundberg is. Gupta seems more interested in advancing the cause
of diagnostic-imaging equipment makers and drug-makers producing
unproven, over-priced drugs.

And Schwitzer is not alone.

Kevin M.D. asks: "Is this a case of style over substance? And
suggests that Gupta might be better suited to "do PR for the
government" rather than serve as Surgeon General

On Global Health Report, Christine Gorman writes about Gupta's links to Pfizer:

"We all know that advertising and corporate sponsorship make
mainstream media possible. That is why you need to look at the
firewalls between the sponsors/advertisers and editorial side in any
specialized field, but especially in health, to make sure they are
solid.

"This is especially true when there is a single sponsor for a
television program or print column. Anyone who cared to flip through
the pages of TIME Magazine from a few years ago would see that Gupta's
column always ran next to ads from Pfizer. The New Republic has written
about the pharmaceutical industry's sponsorship of CNN's AccentHealth.

"In addition, the practice of accepting speaking fees from
pharmaceutical companies is very controversial, to say the least, among
health journalists. I have written about why I do not do it. .. . .
So, I would also like to know a lot more about the speaking fees that
Gupta has received over the years from pharmaceutical companies."

On Jan. 13, she also writes that "Opposition to the possible nomination of Sanjay Gupta as Surgeon General is building.

"CNN journalist lacks independent voice to be surgeon general," says
Peter Canellos today in the Boston Globe. Representative John Conyers
of Michigan is pushing a different candidate, Dr. Herb Smitherman, a
public health advocate from Detroit."

Note also that the Drs. Lisa Schwartz and Steven Woloshin of the
Dartmouth Institute for Health Policy and Clinical Practice (and home
to Jack Wennberg's famed research) observe that a surgeon general
would "need to demonstrate skills that are too often missing in medical
news on TV: skepticism about the science and a careful analysis of both
the benefits and harms of medical care.."

Woloshin and Schwartz "raised questions about drug-company
sponsorship of some programs Gupta hosted in a broader critique of
medical media coverage last fall, and on Tuesday they urged careful
examination of any potential conflicts of interest" (from the Baltimore
Sun)

Paul Krugman talks about how Gupta plays fast and loose with facts: "You don’t have to like Moore or his film; but Gupta specifically
claimed that Moore “fudged his facts”, when the truth was that on every
one of the allegedly fudged facts, Moore was actually right and CNN was
wrong.

"What bothered me about the incident," Krugman continues "was that
it was what Digby would call Village behavior: Moore is an outsider,
he’s uncouth, so he gets smeared as unreliable even though he actually
got it right. It’s sort of a minor-league version of the way people who
pointed out in real time that Bush was misleading us into war are to
this day considered less “serious” than people who waited until it was
fashionable to reach that conclusion. And appointing Gupta now,
although it’s a small thing, is just another example of the lack of
accountability that always seems to be the rule when you get things
wrong in a socially acceptable way.

Update from Krugman: "Many commenters don’t seem to get the point.
Gupta didn’t say “Michael Moore is an annoying blowhard”; he didn’t say
“We question his interpretation of the evidence”; he said he “fudged
the facts”. In other words, he accused Moore of lying. That’s a very
strong accusation, which had better be backed by solid evidence.
Instead, we had CNN misreading a number from Moore; CNN objecting to
Moore using a projected health care spending number for 2007 instead of
an actual number for 2005 (and the projection was right, by the way);
CNN accusing Moore of not showing a number that was in fact right there
in the movie. And Gupta did not apologize, except for the misread
number."

This is not "best practice" of journalism. Rather, Gupta is
exhibiting the type of "Great Communicator" skills that Ronald Reagan
made famous: look like a celebrity and don't worry about the facts.

Finally, Gupta is against legalizing marijuana use because
"marijuana isn't very good for you." (Unless you're constantly
nauseous,and it's the only rememdy that helps you. Gupta has also make
the claim (debunked by medical evidence that marijuana use leads to schizophrenia and depression. It seems that he's just not into medical
evidence. And this is not a very progressive stance. Meanwhile,
legalizing marijuana for medical use is just the sort of issue where a
Surgeon General could use his bully pulpit to have an impact.