Why he wears a spiffy uniform -- and more

With former Surgeon General Richard H. Carmona’s testimony to a House committee about the influence of politics on public health messages, and Dr. James W. Holsinger Jr. currently being interviewed for the position, some may be wondering who is this person who places warnings on cigarette packs.

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Who is the surgeon general?

“The surgeon general is considered the nation’s top public health doctor and top health communicator,” says the acting surgeon general, Rear Adm. Kenneth Moritsugu, M.D. The job is to protect the public’s health. He or she (two of the 15 surgeons general have been women) commands the 6,000-member Public Health Service Commissioned Corps, a group of health professionals who respond to emergencies.

The PHS encompasses eight agencies in the Department of Health and Human Services, including the Food and Drug Administration, National Institutes of Health and Centers for Disease Control and Prevention. Originally, the surgeon general headed the PHS, but several bureaucratic reorganizations bumped him down a notch. Now heads of the different PHS agencies report to the secretary of Health and Human Services, not the surgeon general.

Besides running the PHS Commissioned Corps, the surgeon general communicates health information -- through reports, or warning labels on cigarette packs, for example. “He takes dense scientific information and translates it so the American public can understand it and put it into action,” Moritsugu says. For example, Dr. C. Everett Koop, surgeon general during the Reagan administration, raised awareness of AIDS, then a new disease, and campaigned against smoking.

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Are political clashes common?

Communicating health information seems as if it would be uncontroversial, but time and again surgeons general have had to face public or political opposition to their reports. Between the world wars, Surgeon General Thomas Parran led a campaign against venereal diseases. His crusade began when radio executives wouldn’t let him say “syphilis control” on the air. More recently, President Clinton fired Surgeon General M. Jocelyn Elders when she appeared to support teaching about masturbation in school sex education. And then there’s Joe Camel. Surgeon General Antonia Novello repeatedly attacked the tobacco industry as using the camel character to market cigarettes to adolescents.

The surgeon general also handles medical emergencies. This too can sometimes mire him or her in politics. In 1892, Surgeon General Walter Wyman quarantined ships carrying immigrants to prevent a cholera epidemic at a time when immigrant labor was much in demand. When bubonic plague broke out in San Francisco after the 1906 earthquake, Surgeon General Rupert Blue faced uncooperative state officials and businesspeople who worried that public health measures such as quarantines would hurt California’s economy.

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Why the spiffy uniform?

The surgeon general heads a uniformed service. “Most people don’t realize that there are seven uniformed services in the United States,” Moritsugu says. Five are military: the Navy, Air Force, Marines, Army and Coast Guard. Two are scientific: the National Oceanic and Atmospheric Administration and the PHS Commissioned Corps.

The Commissioned Corps has ranks similar to the Navy -- hence Moritsugu’s two-star rear admiral rank -- but instead of being full of sailors, it has doctors, pharmacists, scientists and other public health professionals who can be deployed at any time anywhere there is a public health emergency. For example, 2,500 of the 6,000 members were called in to help after Hurricane Katrina, the corps’ largest deployment ever.

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When was the position created?

The first surgeon general was appointed in 1871. The PHS Commissioned Corps began in 1889. (Several attempts have been made over the years to dismantle it.) Early in the 20th century, its responsibilities included quarantines, medical inspection of immigrants and regulation of vaccines.

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How does one get the job?

The surgeon general is nominated by the president and confirmed by the Senate. Surgeons general used to come from the ranks of the Commissioned Corps, but since the late 1970s, most have come from outside it.