SURGEON GENERAL, WHERE ART THOU?

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

Picture this: You’re a highly qualified, board-certified physician anesthesiologist with a Master’s Degree in Public Health from Berkeley. President Donald Trump appoints you to be the Surgeon General of the United States. Then the COVID-19 pandemic rears its head, and you can’t speak out regarding appropriate public health measures without crossing your President. Such is the plight of Dr. Jerome Adams, the 20th Surgeon General of the United States, stuck between supporting medical science or avoiding conflict the President he works for.

Dr. Adams is the first anesthesiologist to hold the office of Surgeon General when he was appointed in 2017. Dr. Adams’ area of public health expertise is the prevention and management of opioid abuse. In 2014 then-Governor of Indiana Mike Pence appointed Dr. Adams to be the Indiana Health Commissioner. Under Dr. Adams’ guidance, Indiana counties created syringe exchanges to contain the spread of AIDS throughout the state.

As an anesthesiologist, I’m a fan of Jerome Adams. We’re separated by only one degree: Dr. Adams is an acquaintance of Dr. Michael Champeau, who is the President of my anesthesia group in California. Dr. Adams is highly respected within the anesthesia world, and was a lead speaker at the 2019 American Society of Anesthesiologists National Meeting.

Dr. Adams was the subject of an article in The Washington Post on July 12, 2020, titled “Surgeon General Jerome Adams may be the nicest guy in the Trump Administration. But is that what America needs right now?” The article states, “Adams came to Washington three years ago to tackle another problem —  the raging opioid crisis — by drawing from a painful personal history with a brother who has struggled with substance abuse. Yet he has been thrust into the role of the pandemic surgeon general.” The article describes Jerome Adams as a fine man, experienced in tackling the opioid problem, but now confronted with the difficult public health reality of the coronavirus.

Most people don’t understand the office of the Surgeon General, a position often referred to as “The Nation’s Doctor.”The Surgeon General of the United States is the head of the United States Public Health Service Commissioned Corps, and is the leading spokesperson on matters of public health in the United States. In contrast, the Attorney General of the United States is the head of the United States Department of Justice, the chief lawyer of the United States government, and a member of the President’s Cabinet. Compared to the Attorney General, the Surgeon General has historically been an office with little power.

Dr. Adams’ legacy as Surgeon General will likely be clouded by our nation’s public health response to the COVID-19 virus. At the time of this writing, COVID case numbers and death rates are peaking in the United States, five months after the onset of the outbreak. Dr. Adams is in a precarious position: he was appointed to the office of Surgeon General by a President who has spent much of 2020 ignoring the advice of medical experts and advisors. If Dr. Adams publicly emphasizes the medical facts regarding battling the COVID pandemic (6-foot social distancing, wearing masks, avoiding crowded indoor settings) he risks contradicting the President who appointed him to the office. If Dr. Adams remains mute on the appropriate public health approach to battling the COVID pandemic, he risks marring his reputation as the lead public health officer in the United States.

Dr. Adams’ early response to the COVID pandemic in February 2020 included advice for the general public to not wear masks:

On Feb. 29, 2020, Adams tweeted: 

In an interview with “Fox & Friends” on March 2, 2020, Dr. Adams said: “One of the things (the general public) shouldn’t be doing is going out and buying masks. . . . It has not been proven to be effective in preventing the spread of coronavirus amongst the general public. . . . Folks who don’t know how to wear them properly tend to touch their faces a lot, and actually can increase the spread of coronavirus. You can increase your risk of getting it by wearing a mask if you are not a healthcare provider.”

This advice was contrary to the now-accepted public health strategy of requiring masks on everyone. The fact that the Surgeon General made the opposite recommendation in February 2020 was unfortunate. He meant well, as his advice was given at a time when there were inadequate amounts of PPE (personal protective equipment) for healthcare workers who were battling COVID on the hospital frontlines. Adams did not want an inadequate supply of masks to be redirected away from hospitals. When the public health recommendation later pivoted 180 degrees to wearing masks publicly, Adams’ February admonition seemed to have been bad advice.

In the spring of 2020, Adams appeared daily on television as part of President Trump’s Coronavirus Task Force, along with Dr. Anthony Fauci and Dr. Deborah Birx. When the Trump administration was facing criticisms about its COVID-19 response in hard-hit minority communities, Dr. Adams’ remarks at a April 10, 2020 daily press briefing were designed to address those concerns. Critics believed several comments made by Adams played into racial stereotypes. “Avoid alcohol, tobacco and drugs,” Adams said. He urged communities of color to “step up” to fight the disease. “We need you to do this, if not for yourself, then for your abuela. Do it for your granddaddy. Do it for your Big Mama. Do it for your Pop-Pop.” Representative Alexandria Ocasio-Cortez (Democrat-N.Y.) said the comments amplified claims about minority populations engaging in risky behaviors.

In the weeks following April 10th, 2020, Dr. Adams’ appearances with the Coronavirus Task Force became limited, and his role in COVID-19 public health policy was minimized.

The website of the Surgeon General (see above) has a paucity of information about the pandemic. There is one link for COVID-19 Updates. The website has general information about the Office of the Surgeon General (OSG), but very little medical information. There are links to Advisories on Marijuana and the Developing Brain, E-Cigarettes, and Naloxone and Opioid Overdose.

In the midst of the greatest public health crisis in one hundred years, the Surgeon General has remained—or the government has kept him—on the sidelines. At the current time the administration has distanced itself from both Dr. Fauci and Dr. Adams. The medical community sees this as unfortunate, as both physicians are respected and honest experts. 

Most Surgeons General have negligible legacies after their term is concluded. Notable past Surgeons General include:

Surgeon General Luther Terry MD (1961 – 1965), who was previously the Chief of General Medicine and Experimental Therapeutics at the National Heart Institute. Dr. Terry’s committee report issued on March 7, 1962 indicated that cigarette smoking was a cause of lung cancer and bronchitis, and probably a risk factor for cardiovascular disease as well.  

This report led to the familiar warning on all packages of cigarettes in the United States:

Surgeon General C. Everett Koop MD (1982-1989), was a pediatric surgeon from the University of Pennsylvania School of Medicine faculty. Dr. Koop released a paper which called for AIDS education in the early grades of elementary school, and he gave full support for using condoms for disease prevention. He also resisted pressure from the President Reagan to report that abortion was psychologically harmful to women. He believed abortion was a moral issue rather a public health issue.

Surgeon General Antonia Novello MD (1990-1993) was a pediatrician and the first female Surgeon General. She was a graduate of the University of Puerto Rico School of Medicine. 

Surgeon General Joycelyn Elders MD (1993-1994) is currently a professor emeritus of pediatrics at the University of Arkansas. Dr. Elders once spoke at a United Nations conference on AIDS, and when asked whether it would be appropriate to promote masturbation as a means of preventing young people from engaging in riskier forms of sexual activity she replied, “I think that it is part of human sexuality, and perhaps it should be taught.”  She was fired by President Bill Clinton that year.

What will Jerome Adams’ legacy be? We’ll only know after his term has ended and the chronicle of the COVID-19 pandemic is recorded into history books. As the top public health doctor in the United States at the time of our worst public health nightmare in a century, his feats, achievements, and non-achievements will be on the record for years to come. 

I support Dr. Jerome Adams, and urge him to use his platform, education, and experience to be a leader in America’s public health response to COVID-19.

Would President Trump fire his Surgeon General if Dr. Adams publicly disagreed with the President? Perhaps. But I believe Jerome Adams’ legacy will grow to the degree he speaks out on the side of medical science regarding the containment of the coronavirus, and to the degree the United States has a successful public health response to the COVID-19 pandemic.

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