Surgeon General's Warning

Surgeon General's Warning: How Politics Crippled the Nation's Doctor

Mike Stobbe
Copyright Date: 2014
Edition: 1
Pages: 394
https://www.jstor.org/stable/10.1525/j.ctt6wqb8w
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  • Book Info
    Surgeon General's Warning
    Book Description:

    What does it mean to be the nation's doctor? In this engaging narrative, journalist Mike Stobbe examines the Office of the U.S. Surgeon General, emphasizing that it has always been unique within the federal government in its ability to influence public health. But now, in their efforts to provide leadership in public health policy, surgeons general compete with other high-profile figures such as the secretary of the Department of Health and Human Services and the director of the Centers for Disease Control and Prevention (CDC). Furthermore, in an era of declining budgets, when public health departments have eliminated tens of thousands of jobs, some argue that a lower-profile and ineffective surgeon general is a waste of money. By tracing stories of how surgeons general like Luther Terry, C. Everett Koop, and Joycelyn Elders created policies and confronted controversy in response to issues like smoking, AIDS, and masturbation, Stobbe highlights how this office is key to shaping the nation’s health and explailns why its decline is harming our national well-being.

    eISBN: 978-0-520-95839-5
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. CHAPTER 1 The Monarch of Public Health
    (pp. 1-12)

    Regina Benjamin took her place in front of dark velvet curtains, set her smile, and waited.

    The scene was a bit like “Pictures with Santa” at a busy shopping mall on the Saturday before Christmas. More than 150 people patiently stood in line to have their photo taken with Benjamin, some with emotions akin to the awe of a child about to meet St. Nicholas. They craned their necks to see her up ahead; some were even a little giggly. Benjamin’s helpers, wearing uniforms like hers, managed the crowd.

    But the similarities stopped there. This was weeks after the holiday...

  5. PART ONE. RISE, 1871–1948
    • CHAPTER 2 Coming to Power
      (pp. 15-40)

      John Woodworth was disgusted.

      A year earlier, the thirty-three-year-old Woodworth had won a plum assignment—a newly created job to rebuild the Marine Hospital Service, the U.S. government’s hospital system for seamen. Created in 1798, it was a pioneering federal venture into providing health care, embodied in grand structures across the young nation.

      But now it was 1872, and as the young doctor from Chicago surveyed his new domain, he saw calamity nearly everywhere. Of thirty-one government-built marine hospitals, only ten were still used, some just barely. The hospitals in Detroit, Cleveland, Louisville, and Portland needed extensive repairs. The one...

    • CHAPTER 3 War and Prominence
      (pp. 41-66)

      When Walter Wyman died, the Office of the Surgeon General was forty years old, and an informal tradition regarding succession was already in place. Each surgeon general had chosen his replacement. Woodworth, on his deathbed, advocated for Hamilton. Hamilton engineered the selection of Wyman. But Wyman—that old controlling bachelor—made no arrangement for an heir.

      President Taft was left to choose between two men. One was Rupert Blue, the forty-six-year-old hero of the San Francisco plague outbreaks. The other was Joseph H. White, an older veteran of the Service (he was fifty-three at the time) who had distinguished himself...

    • CHAPTER 4 The Best Seller
      (pp. 67-88)

      Thomas Parran grew up shy, with a tendency to stutter that he had to suppress, and as an adult was an unimposing five feet, eight inches and 150 pounds. But he was a giant in the surgeon general’s bully pulpit, and raised the job to a level of national and international influence never seen before.

      Parran bullied prudish journalists to carry frank discussions about venereal disease, and spoke forcefully about mental illness in an age when psychiatric disorders were still kept in the closet. He used newspapers, magazines, radio, and even motion pictures to push messages about a range of...

  6. PART TWO. DECLINE, 1949–1980
    • CHAPTER 5 The Quicksand Bureaucracy
      (pp. 91-116)

      It was once said that Leonard Scheele was the last happy surgeon general.¹

      Scheele did have more reason to be chipper than any of his successors. He reigned when the office was still steeped in prestige and significant power, and he was not fazed by the lobbyists, congressmen, or executive branch political appointees who would have growing influence over the Public Health Service through the 1950s and beyond. They were only just beginning to push in when Scheele became surgeon general.

      The tall and jowly Scheele served eight years as America’s doctor, some of them tumultuous and involving the assimilation...

    • CHAPTER 6 “They Are Giving the Public Health Service Away!”
      (pp. 117-139)

      Life for surgeons general had been pretty good in the 1950s. As the new decade began, there was reason to believe that would continue. President John F. Kennedy, elected in 1960, appointed two HEW secretaries—Abraham Ribicoff and, later, Anthony Celebrezze. Both had other things to do than monkey with the surgeon general. The department was growing larger and harder to manage and was saddled with controversial issues ranging from Social Security reform to school desegregation. (HEW was sometimes called “the Department of Headaches,” theNew York Timesnoted at the time.)¹

      But though the secretary was occupied with other...

    • CHAPTER 7 Bossed Around
      (pp. 140-166)

      Richard Nixon’s surgeon general was going to face a new kind of challenge—competition from his immediate boss.

      In the Johnson years, Assistant Secretary of Health and Scientific Affairs Phil Lee took over the surgeon general’s place on the organization chart, but was not much for the media spotlight. He was content to let Stewart remain the government’s expert voice on federal public health matters.

      Lee’s replacement was not as happy to stand behind the curtain. Roger Egeberg, once General Douglas MacArthur’s personal physician, was a tall military veteran with a take-no-guff attitude—which he sometimes emphasized by wearing a...

    • Plates
      (pp. None)
  7. PART THREE. STRUGGLE, 1981–2001
    • CHAPTER 8 Resurrection
      (pp. 169-189)

      “Senator No.” That was the nickname for Jesse Helms, a powerful North Carolina politician famous for his opposition to civil rights, gay rights, disability rights, feminism, and affirmative action. But as 1981 began, the famously sour Helms was downright giddy.

      Fellow Republican Ronald Reagan had been elected president in November, and all of Carter’s HHS political appointments were packing up and moving out. The anti-smoking crusader Joseph Califano was already gone, and his scientific sidekick Julius Richmond was preparing to head back to Harvard. The new HHS secretary, Richard Schweiker, was a conservative who supported a constitutional amendment prohibiting abortion,...

    • CHAPTER 9 Drawn as Villains
      (pp. 190-213)

      It was perhaps inevitable that there would be a comic book character named the Surgeon General. Crime fighters with quasi-military and quasi-medical names were common sights in newsstand racks, including Captain Marvel and Doctor Strange. Some comic book writer was bound to create a Surgeon General, especially in the wake of the uniformed, larger-than-life C. Everett Koop.

      In the spring of 1992, it happened. The Surgeon General debuted in Marvel Comics, showcased in a two-issue story line with two of Marvel’s most popular heroes—Spider-Man and Daredevil.

      But for those who saw the real surgeon general as a heroic public...

    • CHAPTER 10 “You’re on Your Own”
      (pp. 214-236)

      Less than three weeks after David Satcher was sworn in as the sixteenth surgeon general, a U.S. senator tried to shutter his office.

      It was nothing personal, according to Conrad Burns, the Montana Republican who introduced the bill. “This legislation is not about Dr. Satcher, or about any previous Surgeon General,” Burns said when he submitted the bill on March 6, 1998.¹ Rather, he said, the office had become too politicized and distracting in recent years, under both Republican and Democratic presidents. Other government officials spoke out on health issues, making the surgeon general redundant. “This legislation will sunset an...

  8. PART FOUR. PLUMMET, 2002–PRESENT
    • CHAPTER 11 MIA
      (pp. 239-261)

      If ever there was a candidate who seemed likely to restore the Office of the Surgeon General to Koop-like prominence, it was Richard Carmona. Here was an outspoken trauma surgeon who had grown up in Harlem, shined as a Green Beret in Vietnam, and won media attention for a heroic cliffside rescue. A combination SWAT team member and university professor, he had the respect of both Republicans and Democrats. He sounded like a hero from a dime novel.

      But once he was in office, Carmona proved to be the lowest-profile surgeon general the nation had seen. He was a “do-nothing...

    • CHAPTER 12 “America’s Doctor”
      (pp. 262-281)

      In April 2010, Anne Schuchat glimpsed something in theNew York Timesthat made her excited about Regina Benjamin’s potential impact as surgeon general. It was a short promotional blurb for an article in the newspaper’s coming Sunday edition, about “America’s doctor.” “I thought ‘Finally,’” said Schuchat, a high-ranking CDC flu expert who is also an assistant surgeon general.¹ Finally, she meant, a major media spotlight on Benjamin. The blurb’s phrasing seemed a sure giveaway; “America’s doctor” had long been the unofficial title for the surgeon general, and that was how Benjamin referred to herself in speeches.

      But when the...

    • CHAPTER 13 The Surgeon General’s Demise
      (pp. 282-292)

      In his novel 2030, comedian Albert Brooks envisioned a future America incapacitated by debt, devastated by a giant California earthquake, and shaken by violent conflict between the elderly and the younger generations. Much of it sounded fairly plausible, actually, except for one detail: Brooks imagined that the government would still have a surgeon general and that the character would be an influential figure.¹

      Judging from how things stand now, that seems extremely unlikely. The Office of the Surgeon General has been sinking for more than half a century. In the 1960s, William Stewart was stripped of his oversight of 150...

  9. Notes
    (pp. 293-358)
  10. Index
    (pp. 359-375)