The invisible surgeon general

Although some of the nation’s healthcare issues are abstruse and vexing, others are relatively approachable. Many in this latter category fall within the province of the U.S. surgeon general. But the incumbent is nowhere to be found.

The position of surgeon general is unusual in that it is considered prestigious but lacks virtually any budget, staff or programs of its own. The incumbent’s achievements are the result of moral suasion and the careful selection of issues — and sometimes a willingness to butt heads with the pols. C. Everett Koop, who served during the Reagan administration, is unquestionably the best-known surgeon general in modern times. He has said he was strongly discouraged by senior officials in the administration from publicly discussing the accelerating AIDS crisis. But he ignored the pressure and became known as a champion of AIDS funding and research.

The current surgeon general, Regina M. Benjamin, has focused her attention almost exclusively on a single issue: obesity. And how, exactly, does Benjamin intend to address the problem? “Help Americans lead healthier lives through better nutrition, regular physical activity and encouraging communities to support healthy choices.”

That reminds me of a cartoon that was popular when I was an undergraduate at MIT. A math professor and his student are standing in front of a blackboard that the student has almost completely covered with a mathematical proof, in the middle of which is written “Then a miracle occurs.” The professor points to that and says, “I think you should be more explicit here in step two.”

The surgeon general also warned — in a 700-page report released in December — that smoking cigarettes causes cancer and cardiovascular disease. What a surprise. Her other contribution has been a “Call to Action to Support Breastfeeding,” released on Jan. 20. Another public health breakthrough.

So what should Benjamin focus on? Well, plenty of Americans lack accurate perspective on many important health threats that are both more immediate and more easily addressed than obesity. (The dangers of obesity are hardly obscure; most people know that they’re healthier if they’re close to their ideal weight, but they lack the motivation or willpower to act on that knowledge.)

Consider, for example, some of these shockingly common self-destructive behaviors:

• One-third of mothers answering a survey released in October said they did not plan to have their children vaccinated against the flu. Worse, more than a quarter of healthcare workers polled also said they intended to avoid immunization. Flu not only causes misery and economic losses, but it is a killer — of 36,000 on average annually in the United States.

• Forty percent of American parents have delayed or refused one or more vaccines for their young children, according to 2010 data from the Centers for Disease Control and Prevention.

• An astonishing 40% of women who regularly take medicine that is considered by the FDA to be “contraindicated in women who are or may become pregnant” fail to practice birth control as prescribed. They are, therefore, at high risk of having babies with birth defects.

• Women who have a high risk of breast cancer can reduce their risk substantially by taking either of two types of drugs — selective estrogen receptor modulators (such as tamoxifen) and aromatase inhibitors (such as anastrozole and exemestane) — yet only one-fifth or fewer of eligible women take one of the effective drugs.

• Hypertension, or high blood pressure, is a common but symptom-free illness that is a major cause of heart attacks, strokes and kidney disease, yet only 10% of patients take their blood- pressure-lowering medications as prescribed for more than one year.

• Asthmatics, diabetics and even AIDS patients all have been shown to arbitrarily reduce the dose or frequency of their therapy, or skip it altogether.

At the same time that they indulge in such harmful behavior, many of these same people have hysterics over various negligible threats to their health. For example, many people eschew drugs that prevent heart attacks or cancer, or choose to expose their children to the very real dangers of childhood viral and bacterial diseases, while at the same time “protecting” them from imaginary hobgoblins such as plasticizers in toys and shower curtains and pesticide residues in foods. (Not only are the permissible levels of chemical pesticides in food extremely low — and seldom exceeded — but 99.99% of pesticidal substances in food occur naturally.)

Benjamin should use the bully pulpit that her position offers, such as doing public service announcements on TV and radio to educate consumers about simple ways to minimize significant health risks. But she has been invisible. She is virtually unknown even among the public health community. In an informal poll that I conducted recently, only nine of 39 experts in public health could identify the current surgeon general. Many thought the post had been abolished or was vacant.

A previous surgeon general characterized the office as “a shining example of a great America.” It’s now more like an example of a tarnished, ineffective government.

Henry Miller, a physician and fellow at Stanford University’s Hoover Institution, was the founding director of the Office of Biotechnology at the FDA. He is the author of “To America’s Health: A Proposal to Reform the Food and Drug Administration.”