Dr. George Lundberg for Surgeon General

The report that Mr. Obama’s Surgeon General choice might be neurosurgeon and CNN medicalĀ  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.

You can take your $15 fee and … ! by Paul Levy

In the past, I have sometimes used this blog to refer to articles
from medical journals when I felt they had broad public interest.
Sometimes, those articles have not been available to the general public
because they were only available by subscription. From time to time,
commentors to this blog have complained about this. I have let those
comments go by without reply.

But, finally, I have had enough. I
want to state this clearly and directly: When a respected medical
journal issues a press release about a given article that has important
public policy ramifications but does not make available the full text
of the article, it is a bad thing. It inhibits full public
understanding of the issue and makes us beholden to other people’s
interpretation of the article. It is inconsistent with the general
principle of academic discourse and also is counterproductive in
facilitating an informed debate on issues.Here is today’s example, from the Journal of the American Medical Association ("JAMA").  Last week, I received the following email from the AAMC (Association of American Medical Colleges):

Feb. 13 issue of JAMA will include an article on a new study examining
the status of institutional conflicts of interest policies at U.S.
medical schools. The study was undertaken by the AAMC and Massachusetts
General Hospital, and provides the first national data on medical
school policies and practices for dealing with institutional financial
conflicts of interest. Susan Ehringhaus, associate general counsel for
regulatory affairs in AAMC’s division of biomedical and health sciences
research, is the lead author on the artic

This topic
is clearly of great public interest and import, and so I asked the
question of whether the full article would be available for reading
upon publication. The answer I received today was, "No." Checking the
JAMA website, I confirmed this.  I can read the titles, the authors, and a short abstract.
But I can’t read the article and reach my own conclusions about the
methodology employed, the assumptions made, and the results.

Continue reading…


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