Former Surgeons General Recount Political Pressure on the Job

As astrophysicist Dr. Neil deGrasse Tyson has said, "The good thing about science is that it's true whether or not you believe in it." Add decency, humanity, compassion, dedication and true patriotism — and you have those discussed in this timely article (together with others mentioned in several readers' comments).

Except for these four stand-out Surgeons General, I am not aware of any elected or politically appointed physician, with an MD or DO after his/her name, who was an advocate for the public health of this nation - or was an advocate for Americans as patients...

I'll never forget Dr. Elders and the cruel and shameful way she was treated in the media, by the public, and the shabby dismissal by Bill Clinton Had the policies she proposed been implemented then, our world would be completely different today. -- 'Things Trump Did While You Weren’t Looking' https://wp.me/p2KJ3H-2ZW

What a cool group of people. Thank you, each of you, for your service to science and to our country. A quick peek at https://www.surgeongeneral.gov/ show you just how influential the SG is today. Sad.

“though time proved them right.” Not time. Generalizable facts! During operating conditions which enabled personally unaccountable, agendaed, individual and systemic stakeholders to be stopped. Temporarily. In a specific area. As principles of faith, profit motivation, and power games, amongst other factors, enabled viable well being, for the many, to become a toxic mantra misused by a few. President Nixon and his racist War on Drugs; a losing battle, and not a war, against selected people and selected “drugs.” The ongoing process of medicalizing an increased number and types of human behaviors-“disease mongering”- by creating consensualized diagnoses. Which are not constrained by generalizable empirical evidence. A faux-as-if scientific trajectory which profits pockets of… and not people’s state of health. Daily achievable and sustainable wellbeing. Levels, types and qualities of coping. Adapting. Functioning with non-stigmatized identities and a range of diverse behaviors. The politicalization of states of achievable and sustainable health and wellbeing. By, and with, personally unaccountable policymakers. “Immune” to feeling and being shamed. About their harmful words and deeds. Continues, daily. Currently worsened during an era of alt-facts. Bald lies. Hairy-assertions. Toxic complacency by many. Complicity by many others. This documented meeting, and others which were noted, are important if they can contribute to needed changes.Not as historical showcases.

Sad commentary on our government.

Issues involving public health ought to be resolved in an arena completely free from the influences of capitalism and of politics. When profits for corporations are placed above health of Americans, we have a system which is destructive. Market forces cannot self regulate this sector of the economy. From cars that are unsafe, to foods and products which cause obesity, to drugs which should be very cautiously prescribed, independent oversight is an absolute necessity. The world is full of charlatans. Dangerous foods and drugs are often sold under false pretenses. The lives of children are at stake. Obviously, regulation needs to be applied carefully, and with strict limits, or economic growth is in peril. But the evidence here is that government too often protects the interests of its donors over those of the public. This is impermissible in any just society.

I recall with considerable admiration the public relations skills of Dr. Ronny Jackson, Trump’s previous White House physician, in pronouncing him mentally fit-as-a-fiddle on the basis of his 100% score on the Montreal Cognitive Assessment, a diagnosis which at the time was greatly ridiculed, but is now widely recognized in medical circles as proof-positive that it is not-only possible, but extremely easy to fool all of Trump’s supporters all-of-the-time.

Clinton should have just let Dr. Satcher be the Surgeon General in the first place. He had no desire or interest in being CDC Director. Then he should have let George H.W. Bush appointee Dr. William Roper ( who was the best director CDC has had in 30 years), stay. Dr. Roper wanted to stay.

Dr Koop is my hero. He was one of the bravest public servants and physicians I have ever been exposed to. When was a fairly new HHS employee I was riding an elevator filled with politicos who were discussing how AIDS would eliminate deviant and outlier populations (e.g, hemophiliacs and gays). The Act Up protests were a common occurrence near HHS facilities - the face of AIDS was on full display for all, To listen to those folks so callously discussing this dreadful disease was beyond my ability to comprehend them as human beings. Dr. Koop openly defied the political pressure to provide a response that was necessary for the health of the nation - his service to the nation cannot be underestimated. How many lives were saved we will never know.

The truth always hurts -- too bad these former surgeon generals were muzzled by Presidents who viewed the truth as a political liability.

“If we had responded to the crack cocaine epidemic as we should have, we wouldn’t have had the opioid epidemic,” Dr. Satcher said. How so? Why no elaboration of this statement?

Thoughts: The arrogance of politicians who tell Surgeons how to do their jobs, and control their statements. Life would be better if we put the experts in positions of actual power and policy-making.

The firing of Dr Elders was a tragic example of hypocrisy, injustice, and cowardice. Many pediatricians -- including me-- still look upon it with regret and dismay.

Thank you. A wonderful report. I am pushing 70 - to me, Dr. Koop - will always be America's Surgeon General. What do they say the doctors solemn oath is "First, do no harm." It seems for the modern Surgeon General - it is "First, watch your back."

How well I remember the Puritan pillorying of Dr. Elders--I remember all four, and I how I wish we'd listened to them. http://www.thecriticalmom.blogspot.com

Thank you to these public health leaders for your service. Public health professionals perform daily in the background -- preventing disasters -- without much acknowledgment. But a special shout out to Dr. Elders. She was not treated fairly for giving brilliant advice.

Thank you for writing this article. I’m a physician and applaud these brave truthful physician surgeon generals. But I’m afraid that instead of politicians influencing and silencing physicians it is the large hospital employers and investment groups who are doing the same. It takes the form of production goals, time with each patient and compensation tied to Press-Gainey scores. As one physician remarked to me, if my bonus is tied to the Press-Gainey score, I might have to write prescriptions for all the narcotic and medical marijuana requests. The incentives for good medicine have been perverted.

Seems to me the politicians and not the professionals always won. Kind of sad. I agree that if the surgeon general can’t be independent, and be able to state the facts in there educated opinion, why bother with the position.

The government should take a lesson from the Federal Reserve--real independence is essential to do its work effectively. Money and our health are too important to leave exposed to politicians' influence.

This is indeed a sad commentary on our current state. If the Surgeon General of the United States is not free to state his or her considered opinion without political interference, then it would seem that the office holds no meaning, and future candidates might consider demurring appointment. A rubber stamp on the current administrations policies does not advance the health of the nation.

Most physicians have a very strong science background, or at least are educated in sciences, which represents truth as best we know it at the time. To have some politician decide what you can say and impose that upon you is not only wrong, but deflating to smart people who accept the SG's position in Washington.

I applaud all efforts such as this piece to pull back the curtain on forces that work against the best interests of citizens. This piece gives us revelations about political influences at the top levels of government agencies related to health. We could use similar exposes regarding lobbyists working for industries such as food, drink, pharmaceuticals, and medical devices. And also regarding the ways in which religious zealotry on such issues as abortion use political clout to impose its dictates where it is unwanted. This effort is one of the great services the media can provide. I hope that the high-powered political reporting in The Times can find parallels in reporting about health issues.

The recent SG discussed the public health issue of alcohol....outrage, yet as a healthcare provider I see more violence and vulnerable children hurt by this disease than any other....once again not discussed but it will be.....

These comments are so well thought out. I agree with the reader who hopes "that the high-powered political reporting in The Times can find parallels in reporting about health issues." It's partly news consumers fault for not paying attention to articles that seem boring or not relevant. Is there some way you could make health and science issues "sexy"? I read this because of some memorable stands taken by some memorable surgeon generals. Maybe it's their uniforms. Maybe you could have votes on the most informative, significant articles or topics. We can't read thousands of comments, but we could read vote totals... I don't know, would that dumb down the news?

"All four lamented that the surgeon general’s job has faded in stature". Case in point, when I saw the headline I realized I don't really know what the Surgeon General does.

As a former medical reporter, I actually had the privilege of interviewing both Dr. Koop and Dr. Satcher. They were wonderful men who truly cared about the health of the nation. It is a shame the office of Surgeon General has no meaning anymore.

I would like to actually hear this discussion. I remember some of the reasons these Surgeons General were booted but I looked each of them up on the net and found impressive biographies for them. Then I looked up Dr. Lewis-Hall. I found out a lot of information about her tenure as a Veep for Pfizer but nothing at all about her medical background or if she has one.

Public Health information should not be stifled by political pressures. A healthy population is extremely important for all Americans, regardless of political affiliation. Also, they current aministratuon is trying to cut the United States Public Health Service by 40%. This is not good, considering these officers have been the ones responding to disease outbreaks such as Ebola and the many hurricane disasters that have happened these past couple of months.

Dr. Elders's remarks on masturbation were always taken out of context by the media and by the right. Similar to how the Rev. Wright's "God D... America" sermon was taken out of context. The same way Shirley Sherrod's comments on farmers were taken out of context. Regardless, each person was quickly thrown overboard by their respective president at the command of conservatives, only to cause more humiliation for those presidents when the full context of their remarks showed they spoke with great wisdom and knowledge.

Yet again politics trumps science and informed policy. Why not make the CDC an independent agency that reports to The Congress, and not to the President or any of her/his vassals?

As a physician and public health researcher, I thank the NY Times for this article. Over the years, I have often wondered -- especially during Republican administrations -- why the SG's stances either contradicted or were not/ less supportive of ideas I knew to be true through my medical practice and research. So I'm glad to hear many of these stances were politically coerced. The SG's office has so much untapped power. I was a teenager when I received Dr. Koop's HIV message in the mail but I still remember it. I hope -- as one reader suggested -- that the NY Times will permit these retired SG's to write the occasional column. We need to hear the truth.

Without a doubt, former SG Vivek Murthy was fired by the current occupant of the WH for views not in synch with that which passes for science in this upside down administration. https://www.nytimes.com/2017/04/21/us/politics/surgeon-general-trump-adm... Dr. Murthy's concerns regarding E-cigarettes and guns apparently were framed as yet another example of burdensome and onerous regulation, rather than the thoughtful and appropriate consideration of our chief medical officer. In almost any other circumstance, it is quite clear that allowing politics and politicians, rather than medically qualified people, to make medical decisions would be seen as tantamount to practicing medicine without a license. BTW, can anyone name the newest SG? I know that I could not, but apparently he is a protege of Mike Pence, and we know how resistant he was to institute a needle exchange program in Indiana. https://www.surgeongeneral.gov/about/biographies/bio-sg.html

Maybe the NY Times should make room for a regular column penned by *former* top public health personnel where they can speak truth amidst rampant partisan and corporate obfuscation. Promotion of and funding for sound public health advice and policy (not just health care and medical advice/policy) support the physical and mental vitality of our citizenry. The phrase "If you haven't got your health, you haven't got anything." applies to countries just as it does to individuals, and Americans are not, on average, a healthy people despite our national wealth and resources.

Dr. Koop was one of the rare surprises: an honest conservative. The politicization of the SG office by subordinating it to HHS and publicity-seeking HHS secretaries, is a sad indicator of the condition of our government. It exemplifies the trend most notably forwarded by Nixon to consolidate power in the political level of the Executive and especially in the office of the President. People may not realize that was not the practice for most of the lifetime of this country.

This is proof that having the office of Surgeon General is only to give the public the illusion that someone at the top of government is dedicated to public health causes. with powerful politicians muzzling them, the public has no advocate and has only industry marketing programs masquerading as good medicine.

Great article about great people.

I've always wondered how politically appointed Surgeons General, who never seem to be lifers from the Public Health Service, manage to accumulate so many ribbons in their decorations racks. Dr. Novello looks like a combat veteran!

Making medicine a partisan affair, or bowing to corporate profits costs lives. How many lives could have been saved had these honest people been permitted to speak the scientific truths? The role is political in that it influences “poli”-cy. Politics is not partisanship. Partisanship, not politics, kills our own citizens.

Dr. Koop also annoyed the alcohol industry with his SG Workshop on Drunk Driving, which called for environmental approaches to reducing the problem of heavy drinking, like higher excise taxes, reduced availability, and constrained marketing. Big shift in thinking!

Making everything "political" means that any opinion is equal to, and often greater than, the scientific facts. What a wonderful idea.

Unless a politician has a degree and experience in medical practice, they should not interfere with the performance of a surgeon general's duties. Period.