Physicians

Dr. George Lundberg for Surgeon General

The report that Mr. Obama’s Surgeon General choice might be neurosurgeon and CNN medical  correspondent Dr. Sanjay Gupta produced an upwelling of strong opinion, particularly in the medical community. Some argued that Dr. Gupta has clearly demonstrated his abilities as an able communicator.

But others said that Gupta lacks the experience, seriousness and focus on public health. (I can’t help thinking that anyone who has achieved working neurosurgeon and national TV commentator status is pretty capable and serious, demeanor notwithstanding.)

And so it is that on Facebook, that Dr. Richard Lippin, a longtime Preventive Medicine physician based in Pennsylvania, has posted a letter he sent to President Obama and Secretary Daschle, urging the consideration of Dr. George Lundberg for Surgeon General.

The header reads: “We need a physician with the gravitas and the moral credentials and authority to use this bully pulpit position to speak for science and values based priority public health issues for all Americans. Dr. George Lundberg fits the bill.”Picture 1

The letter provides a brief bio of Dr. Lundberg, the brilliantly eclectic, progressive, Alabama-born, down-to-earth physician who has been a visible mainstay of American medicine for decades. Dr. Lippin doesn’t mention Dr. Lundberg’s landmark 2002 book on American health care and reform, Severed Trust. (The title alone provides a lot of insight into Dr. Lundberg’s view of the world.)

But Dr. Lippin does believe the Surgeon General choice is about healing both America and American medicine, He writes, “we have a genuine crisis on many levels in US Medicine. Also 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.

I agree with Dr. Lippin that those are the tasks, and I agree that Dr. Lundberg is a terrifically suitable candidate. Over many years, I have developed a warm friendship with him. It is impossible to not be bowled over by his range and grasp of issues, and by his unswerving willingness to stand clearly and openly for approaches that are tied to evidence and reason. The ultimate critical thinker, his judgments are founded most closely to merit, possibility and an unshakable belief in the correctness of the pursuit of excellence in health.

He is also bold and politically savvy. You don’t become the longest running Editor-in-Chief of the Journal of the American Medical Association (until he got politically at odds with them) and then build Medscape into the most widely read Web resource for clinicians worldwide unless you can continuously strike the delicate balances between science, sensibility and moral imperatives among your peers.

I can’t say whether Dr. Lundberg would be the best candidate for the job ahead. He has a huge following in the medical community, nationally and worldwide, the result of many, many years of consistently high performance infused with unassailable integrity. Whether he’s the right person for this moment is another issue, though, fraught with the complexities of political consideration, a vision consistent with the larger plan of the Obama team, fluency with the bewildering array of new technologies that are changing the face of medicine and the patient-physician relationship, and so on.

But Dr. Lippin makes an important point. American medicine is demoralized in the field. Overt, rampant financial conflict has caused many to believe that the profession has lost its compass. With that loss, the trust of patients and the authority that trust conveys have also diminished.

Restoring that trust and authority isn’t simply a matter of leadership or preaching, but will depend on fundamentally changing the business of medicine, a much larger task indeed that will require an orchestrated effort by all of us, not just physicians.

But the new Surgeon General, whoever he or she is, should be grounded first in science, evidence and best practice, in tirelessly advocating and maneuvering for a care delivery system that is as advanced and nuanced as the diagnostic and treatment approaches we’ve developed, and on advancing the health of ALL our people in ways that leverage rather than squander increasingly precious resources.

While there is no question that Dr. Lundberg is worthy, I’d be surprised if the call for his consideration is heard in the din of this transition. Even so, it is deeply gratifying to see an outpouring of support by his peers, the result of successfully dedicating his life to advancing medical knowledge and its best application.

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18 replies »

  1. Dr. Lundberg gets my vote.
    While Gupta is perhaps okay as a TV personality, he does not have the qualifications to serve in the role of Surgeon General of the US. There are major concerns.
    1. As a media figure, Gupta has been disturbingly cozy with Big Pharma. He co-hosts Turner Private Networks’ monthly show “Accent Health,” which airs in doctors’ offices around the country and which serves as a major conduit for targeted ads from the drug companies.
    2. He has openly opposed progressive health reform, and cited false information in an effort to discredit Michael Moore’s film “Sicko”. Ultimately, it was found that Gupta distorted the facts.
    3. In 2003, despite mounting evidence to the contrary, he publicly downplayed concerns about the dangers of Vioxx. It was removed from the market a year later by its manufacturer, Merck.
    4. Media watchdog groups have also expressed concern about lack of objectivity in his reporting: http://www.fair.org/index.php?page=3135 and
    http://mediamatters.org/items/200707120001

  2. I trained under Dr. Lundberg, have observed his career over the years, and kept in touch with him as well. Quite frankly for the critical need of reform in American medicine, I think he is the best qualified candidate by far, and he does have other qualifications to recommend him as well, which others have covered well here. But I wish to point out his accessibility, his military experience, and his seniority in the medical profession- all of which render him, in my opinion, more acceptable and qualified for the position than any other candidate. We all know there may be major changes in the works with respect to the military/civilian medical sector interface. Who better qualified to deal with that sort of thing than one who has actually seen honorable and distinguished military service in the past? And who better to address the growing medical needs of senior citizens that one who is from their ranks? I’m sure Dr. Gupta is a fine choice, too. I just think Dr. Lundberg is a better one, especially for this administration. Paul Corrao, M.D.

  3. I also know and admire Dr. Lundberg. I authored at article for JAMA while he was there and found his integrity to be beyond repute, as well as his smarts. He is definitely down-to-earth, yet so smart that he can handle the agencies as well as the potential crises we face, such as a potential flu pandemic. He gets my vote. As a footnote, I also worked for two other Surgeons General, Koop and Novello. I have a little experience knowing which are good, independent and right for the job and which are not. Spolarich.

  4. “Everything should be made as simple as possible, but not simpler.” Albert Einstein
    Our next surgeon general will need to understand medicine in all of its complexities and translate the knowledge into practical decisions, not simplistic ones.
    I know who I would choose, by George!

  5. John Irvine-
    I understand the consraints of a blog like yours widely endorsing candidates for leadership roles.
    Respectfully though, Sanjay Gupta is not at all the “out of the box” candidate for US Surgeon General
    In fact Gupta is intimately tied to much of what is wrong with the status quo in contemporary mainstream US organized medicine.
    He is the wrong choice for our times which desperately calls for a return to integrity and distancing ourselves from the excesses of the influence of the profit motive on the “former” profession of Medicine
    Sincerely,
    Dr. Rick Lippin
    Southampton,Pa

  6. I had the opportunity to work for Dr. Lundberg at Medscape. He is a thoughtful, pragmatic leader who is vastly more qualified for Surgeon General that Dr. Gupta. While Dr. Gupta is a clearly an intelligent charismatic communicator this country needs a leader with a deep commitment to the integrity of America’s health care delivery system. Dr. Lundberg’s thoughtfulness, deep understanding, and lifetime of experience makes him the clear choice for Surgeon General. In addition to voicing your support online at http://www.whitehouse.gov/contact/ you can also join the “George Lundberg for Surgeon General” group on facebook at http://www.facebook.com/home.php?#/group.php?gid=45444711924&ref=mf. 179 members and climbing. If the White House isn’t reading THCB, perhaps they’re trolling facebook…

  7. I think Dr Sanjay Gupta is perfect for the job of Surgeon General..He is smart and has been before the public in many areanas…and has spoken up on maintaining good health before the Public…Look around your Medical Community…let’s be fair some of you are biased and we know why…Let the Groundswell for Dr Sanjay Gupta as Surgeon General fill the air…Hold on to your hats…..
    Janice S. Wong R.N

  8. George –
    You’d be surprised to know how large the cave you’re standing in actually is. And who is standing in the dark with you in it at this very moment.
    We haven’t set up a auto-email bombing because we have not officially endorsed Dr. Lundberg as a candidate. Brian’s piece reflects his personal view.
    I tend to agree with Bill Crounse MD. Both candidates have appealing qualities that recommend them for the post. Dr. Lundberg clearly passes the gravitas test. Dr. Gupta is an outside of the box selection, but I’m not sure that should necessarily disqualify him for the role.
    If you want your voice to be heard on this issue, I’d recommend leaving a comment on the new whitehouse.gov site.
    http://www.whitehouse.gov/contact/
    This administration says it is committed to transparency and dialogue. Is it? I’m more inclined to be optimistic than some. This may be a chance for us to find out.
    John Irvine

  9. Why hasn’t THCB set up an auto-generating letter site or link to send letters to our senators or provided easy information for us quickly email them on this important issue.
    It’s clear that Dr. Lundberg, or someone of equal stature, is vital to our individual and collective health in myriad ways.
    Blogging here is like screaming into a small cave.

  10. I am on the fence with this one. As a CRNA with a PhD in Biology, I am a huge fan of Dr. Gupta. In the world that we live in today, embracing our first African American President, I believe that Dr. Gupta stands the unity of races. I will agree that Dr. George Lundberg would make an excellent Surgeon General, however the personality of Dr. Sanjay Gupta is extrodinary. He manages to catch even the modest physicians attention and locks us in with his charm, knowledge and demeanor. He speaks to us and not at us. We are living in a modern world with modern thinking. Dr. Gupta’s presence, knowledge and personality far exceeds Dr. Lundberg’s expertise. Sometimes it is the key to getting the attention healthcare deserves and needs.
    Dr. Elena Katazkos, CRNA, PhD.

  11. Dr. George Lundberg would be a terrific Surgeon General. He is not only an icon of our industry, but a very nice man. It was my pleasure to work with him from time to time during years of anchoring television programs and specials for Lifetime Medical Television and also for the AMA. He’s a class act. I can also say that, having been a physician broadcaster for much of my career, Dr. Sanjay Gupta has managed to do a first-rate job balancing journalistic integrity with the ratings-driven demands of television. Each candidate would bring unique strengths to the position of Surgeon General. The big question in my mind is why either George or Sanjay would want the job. With the exception of Dr. Koop (who was also a master of media) most SG’s have been pretty much irrelevant and largely forgettable. Maybe that makes the case for why we need a Surgeon General of George’s or Sanjay’s caliber. Perhaps the best idea would be to extract the DNA of each and clone the perfect candidate; highly intelligent, unflappable, scientific, academic, convincing, uncompromising, and totally savvy with media old and new.

  12. Disclosure: I am Dr. Lundberg’s stepdaughter.
    I have watched my stepfather’s career from the inside for over twenty-five years, and can say that everything that has been said about his professional life carries over to his personal life (not that I will say more about his personal life. I still want to be invited to dinner.). He is, bar none, the best role model for anyone who cares about the nation’s health care, or for their own. He has integrity, a very long view, an infallible moral compass, and an ability to look at matters objectively and see a solution that simply staggers.
    He is acutely aware of what’s wrong with the health care system (oxymoron?) and bore frustrated witness to my being unable to obtain health insurance when the company I worked for shut down and ceased COBRA premiums. For nearly a year, I struggled to pay for care as a single (unemployed) mother of three while searching for coverage, which was ultimately granted through HIPPA via an absurdly circuitous route. If this can happen to me, with my knowledge and resources and contacts, it can happen to ANYONE. Just a case in point.
    As a family member I may be biased, but I can assure you that there is pure transparency to this man. What you see is what you get, and that is quite a lot and not to be overlooked at this particular time, with this particular administration.
    Read Severed Trust. Google his career. Do what you must, but do not let this one get away.

  13. 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.”
    Go to this link http://blog.lib.umn.edu/schwitz/healthnews/161649.html
    and you will find links to all of the
    posts listed below which discuss:
    • 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 sponsorhip 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 (form Gary Switzer)
    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.
    Posted by schwitz at January 12, 2009 10:53 AM
    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 fame reserach) 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–mm. 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 schiophrenia and depression. It seems that he’s just not into medical evidence. And this is not a very progressive stance. Meanhwile legalizing marijuana for medical use is just the sort of issue where a Surgeon General could use his bully pulpit to have an impact.

  14. Dr. Pandey,
    This post was in no way intended to be critical of Dr. Gupta. While I don’t know him personally, he certainly appears to be an extremely capable and well-intentioned individual.
    Instead, I was trying to frame my understanding of the circumstance within the context of support for Dr. Lundberg, who has been a good friend for many years.
    There is no reason to read anything beyond that into the column.
    Thanks.

  15. Thanks for bringing this up at THCB. I really like the idea. I would very much prefer Dr. Lundberg to Dr. Gupta as our next SG.
    Dan Hoch
    Neurologist
    Boston

  16. Brian Klepper- Thanks for your piece
    A agree with most of what you are saying
    I hope our effort to promote Dr. Lundberg is heard above the din of all the transition noise
    After all the health of all Americans and the costs of US health care is a central issue from many standpoints.
    The Presidential transition team would do well to read your piece today
    How can I help get their attention!
    Thanks Again,
    Dr. Rick Lippin
    Southampton,Pa

  17. I am amazed to see so many critique of Dr. Gupta. I thought capability matters. The guy is smart, articulate, and cares.
    Is it an attempt by the heavily lobbied AMA to lobby against him out of fear?
    By the way I heard him on CNN, I personally felt that he is still very much supported of his profession.
    I wonder what is the cause of opinion against him?
    rgds
    ravi
    http://www.biproinc.com

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