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January 10, 2009


Ronald Hoffman, MD

13 Things I’d Do as Surgeon General of the United States

Paging Dr. Gupta! CNN health and medical correspondent Sanjay Gupta got the call from the Obama administration to become Surgeon General. (I kind of suspected I wouldn’t get it after all my criticism of America’s medical establishment and the pharmaceutical industry). Oprah has dibs on Mehmet Oz, so Sanjay Gupta became the next logical choice

Gupta is an adroit media communicator and a brain surgeon, so he’s certainly well-equipped to occupy a position that is essentially a bully pulpit for exhorting Americans to be healthy.

Previous Surgeons General haven’t fared so well in recent times. Dr. Richard Carmona, an avid fitness buff, blasted the Bush administration that appointed him for muzzling him on crucial health issues. And Jocelyn Elders, MD, the first African-American woman to occupy the post, left in ignominy after opining that teenagers should be taught masturbation techniques as a way of curbing pre-marital sex.

What would I do if I were Surgeon General? Here’s a list of 13 initiatives I would champion:

Using current technology, we could equip Americans with pedometers to award them tax credits for mileage logged. Electronic transmitters installed on scales could relay your weight and body composition to IRS servers to incentive optimum fat/lean ratios.

2) NO MORE FOOD STAMPS FOR JUNK FOOD. If you want to use your own money to buy poor-quality, calorie-dense food, fine, it’s a free country. But using government support to cultivate health problems for which the public health system is responsible—enough already!
3) CHECK THE VITAMIN D LEVEL OF EVERY AMERICAN MAN, WOMAN AND CHILD. Then, for those who are deficient, provide free supplements which would cost pennies a day. The savings, in terms of cardiovascular disease, cancer, autoimmune and infectious diseases, and osteoporosis, would pay many times over for testing and the free D.
4) ESTABLISH A CHILDHOOD HEALTH CORPS. We are witnessing a crisis of obesity and premature degenerative diseases among our kids. Early intervention to promote optimal weight, fitness, and healthy eating habits is just as important as literacy and math. Healthy children are a prerequisite to a healthy adult citizenry. The Corps would be empowered to ban junk food ads targeting kids during children’s programming, and to apply warning labels to kids’foods.
5) QUINTUPLE THE BUDGET FOR THE NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE. Some Washington pols are calling for the dismantling of NCCAM, which does research on alternative therapies, as a cost-saving measure. They decry NCCAM as an enabler of “quackery.” Actually, initiatives like NCCAM are the last best hope for American medicine, which threatens to collapse due to its expense, inefficacy, and toxicity.
6) ERADICATE END-OF-LIFE INTERVENTIONS THAT MERELY PROLONG SUFFERING AND DRIVE UP HEALTH-CARE COSTS. It’s estimated that 80% of Medicare dollars are expended on patients’ 12 months of life. A special commission needs to be convened to investigate futile medical procedures that cause terminal patients to languish in intensive care units with little prospect of recovery, costly unnecessary surgeries, or aggressive cancer treatments with no proven efficacy for elderly patients. Patients and families must be given the resources to make ethical and humanitarian end-of-life decisions (and we’re NOT talking about euthanasia, just rational compassionate care!)
7) ESTABLISH A TASK FORCE ON CHRONIC DISEASES. Our current medical system prides itself on quick fixes. But decades in-the-making conditions like heart disease, diabetes, hypertension, prostate cancer, breast cancer, asthma and obesity account for over 75% of health care costs. All of these maladies are amenable to diet, lifestyle, and nutritional intervention. An intensive initiative needs to be mounted to come up with ways to forestall these illnesses which are sapping our nation’s productivity and resources.
8) CONVENE A SPECIAL, EMERGENCY SUMMIT ON DRUGS THAT DON’T WORK. Especially egregious examples include anti-psychotic drugs used as chemical straight-jackets for elderly demented patients in nursing homes, excess use of antibiotics for simple ear infections, sinusitis and bronchitis, and futile chemo regimens in many advanced cancers. The drug industry spends billions of dollars to get doctors and the public to use more drugs, and the government even subsidizes their overuse—a counterforce needs to be empowered immediately to stem the tide of dangerous and unnecessary prescribing.
9) LEAD THE CABINET IN DAILY EXERCISE, NUTRITIOUS EATING, AND HEALTH PRACTICES LIKE YOGA AND TAI CHI. Government officials need to exemplify healthy lifestyles—the culture of the White House and Federal Government should reflect positive values. How about a morning staff meeting conducted while jogging—or a press conference featuring healthy fare instead of the usual coffee and Danish for the White House press corps? Morning Tai Chi on the White House lawn, or a yoga break in the White House gym might inspire Americans to incorporate similar practices in their homes and workplaces.
10) BRING BACK “VICTORY GARDENS”. They helped our grandparents support the war effort in WWII. Amidst the current economic recession, more people are eschewing expensive fresh fruits and vegetables in favor of cheap processed foods. The Surgeon General should collaborate with the Agriculture Department to encourage individual and local community gardens and food co-ops to provide abundant, fresh and inexpensive seasonal produce.
11) And while we’re at it ELIMINATE GOVERNMENT SUBSIDIES FOR SUGAR, CORN, AND WHEAT. These price supports artificially drive down the cost of processed foods laden in carbohydrates and fat and give them an unfair competitive advantage relative to healthier food choices. Instead, why not tax breaks for farmers who raise broccoli, blueberries, and arugula?
12) FLIP THE SCRIPT ON DOCTOR’S SALARIES. We’re currently experiencing a critical shortage of primary care docs—internists, family practitioners, and pediatricians—because their salaries lag behind those of ultra-specialists. Plastic surgeons, cosmetic dermatologists, and other niched practitioners work less hours and make bigger bucks recommending costly medicines, surgeries and procedures. Guaranteeing better salaries for doctors working “in the trenches” could help turn our bloated system around. And,
13) REIN IN THE AMBULANCE CHASERS. Easing the current malpractice crisis could help keep our “best and brightest” doctors from leaving the field, and from practicing wasteful and ultimately dangerous defensive medicine.

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