MS Speaks

The Lancet (March 29), published in the UK, has an editorial strongly favoring the appointment of Dr. Vivek Murthy as US Surgeon General. The controversy surrounding this appointment is explained in the editorial.

Confirm Vivek Murthy for US Surgeon General

The first incarnation of the US Surgeon General was established in 1871 to oversee the administration of the US Marine Hospital System. In the intervening years, the role of the Surgeon General has evolved into “America's Doctor”—a spokesperson and advocate for the pressing public health issues of the day.

In 2013, Vivek Murthy was nominated by President Barack Obama as the next Surgeon General. A Harvard and Yale-educated internist and former emergency room physician who has served in a public health advisory capacity to the President, Murthy is a highly qualified candidate. The same passion for promoting and safeguarding the health of Americans that brought Murthy to the attention of the Obama Administration, however, has also put his confirmation in jeopardy.

At issue is a tweet that Murthy wrote after a mass shooting in December, 2012, that took the lives of 20 elementary schoolchildren and six staff in Sandy Hook, CT: “Tired of politicians playing politics w/ guns, putting lives at risk b/c they're scared of NRA. Guns are a health care issue. #debatehealth” and a January, 2013, letter on which he is a co-author that urges Congress to support an assault rifle ban and to require mandatory firearm safety training and waiting periods for those who wish to purchase guns. Seizing on this, the National Rifle Association (NRA) has charged that Murthy's fitness for the position is undermined by his support of “radical gun control measures” and has mounted an aggressive campaign to block his confirmation.

The NRA considers itself the largest and oldest civil rights organisation in America and has exerted that position in a long history of political advocacy. With a budget of around US$230 million and a membership of 5 million people, the NRA is a formidable opponent in numbers and in political sway. The simple senatorial majority required to confirm Murthy may well hinge on ten senators—all Democrats from conservative states such as Alaska and Louisiana where the influence of the NRA is most entrenched—who will be up for re-election this year. Under escalating pressure, there is a real concern that those ten senators may vote against Murthy, quashing his confirmation.

What is fascinating and chilling is the NRA's selective interest in the role of the Surgeon General. There is no precedent for a special interest group blocking a fully qualified candidate from the Surgeon General position. There is, however, a clear precedent for the Surgeon General to favour bold action, which may be counter to their brand of political advocacy.

As recently as the early 1990s, Surgeon General C. Everett Koop, appointed by President Ronald Reagan, was sufficiently concerned about the role of guns in escalating rates of interpersonal violence that he urged that gun violence must be discussed in the public health arena. It is also important to note that, like Koop's, Murthy's views are shared by the wider medical community, including the American Medical Association and the American Academy of Pediatrics. Furthermore, consensus across academic and governmental institutions exists that gun violence is a substantial and growing public health concern. Recent reports by Johns Hopkins, the Department of Justice, and the Institute of Medicine among others continue to document the link between gun ownership and increased rates of homicide, suicide, and accidents, and recommend the necessity of open communication between physicians and patients who are gun owners regarding safety.

It is troubling that a special interest group might block the confirmation of a well-qualified nominee by suggesting that he may be incapable of making decisions on the basis of “empirical and scientific evidence, rather than political or ideological motives”. The role of the Surgeon General is not legislative, but one of advocacy. In view of the existing empirical and scientific evidence, advocating for stronger gun control is a logical and justifiable conclusion.

The Lancet stands with Murthy and the sentiment that “Guns are a health care issue”. Suggesting, as countless medical professionals have, that public health policies should be updated to address the continuing surge of gun-related violence in the USA is not an assault on the Second Amendment right to bear arms. It is the protection of the First Amendment—the freedom of speech for all of America's doctors, from the Surgeon General to the family physician—and the necessity to openly communicate about the challenges to the safety, health, and wellbeing of American citizens. We strongly urge the US Senate to confirm the nomination of Vivek Murthy.

The editorial can be seen here.