Despite his work on the harmful effects of secondhand smoke and healthcare disparities, Richard Carmona will likely be remembered as the U.S. surgeon general who served when America sharpened its focus on national security, bioterrorism and emergency preparedness. Experts suggest Carmona's successor should address issues related to both the nation's public health and healthcare.
After four years as America's chief health educator, Carmona stepped down when his term expired July 29. As surgeon general, Carmona led the office that oversees the 6,000-member U.S Public Health Service Commissioned Corps and reported to the assistant secretary for health. He was not available for an interview, but a spokeswomen in HHS' Office of Public Health and Science said Carmona, 56, plans to return to civilian life.
Deputy Surgeon General Kenneth Moritsugu, 61, will serve as interim surgeon general. Carmona's efforts to educate the public about secondhand smoke and inequalities in healthcare were somewhat lost amid the nation's priority of preparing for terrorism and pandemics.
Georges Benjamin, executive director of the American Public Health Association, said the nation's agenda has not focused on chronic diseases such as diabetes and tobacco use because "we have been engrossed in security work and defense work." He also said Americans own their thanks to Carmona for his work on disparities in healthcare.
"He criss-crossed the country and talked about healthcare quality and equity," Benjamin said. "And despite the bully pulpit he had, it didn't get the traction the issue deserved," he said, adding that Carmona will likely be remembered for his report on secondhand smoke. Released in late June, The Health Consequences of Involuntary Exposure to Tobacco Smoke found that even brief secondhand smoke exposure can cause immediate harm.
According to Philip Lee, who served as the assistant secretary for health in both the Clinton and Johnson administrations, the new surgeon general should be an intelligent, highly regarded professional either within or outside the health service who understands the role and is able to communicate clearly, effectively and independently to the media. He also said that the position requires a person of integrity, which he said Carmona exemplified.
"You want an independent voice," Lee said. "The assistant secretary for health represents the administration. The surgeon general should be nonpartisan."
A previous post, which reproduces an article from the United Methodist Daily News, discusses some concerns about James Holsinger, the new nominee for Surgeon General.
Holsinger has been a consistent Republican donor, having donated to Bush and Cheney as candidates, as well as to the larger party. This we could overlook, as we could overlook the fact that he hasn't kept up with his cardiology boards, except that the article also says that Holsinger seems not to be very successful, professionally. And the article quotes a court case where a foundation under his control sold a hospital and took control of the proceeds for charitable causes, except that the court ruled that the hospital belonged to the local Methodist conference, not the foundation. And the article makes it clear that he supports reparative therapy, which professional medical and psychological organizations consider to be harmful and unnecessary.
To put it bluntly, President Bush is nominating a fellow quack with possibly questionable ethics to the office of Surgeon General. We should not be surprised, but we should ask our elected officials to turn this nomination down.
I wasn't in public health in Carmona's era, so I'll have to take Modern Healthcare's word that Carmona was involved in research and education about healthcare disparities. However, I do know that the Agency for Healthcare Quality and Research released the first copy of the National Healthcare Disparities Report in 2003, and does so annually. The first NHDR was a good summary of the disparities that the nation faced in healthcare. It made clear the disparities within certain priority populations, like racial/ethnic minorities, women, the elderly, children, and rural populations (those were off the top of my head, I think there were a couple more categories). It used 140 measures of quality and 100 measures of access, applying them to each population subgroup. Finally, it made clear that the research was incomplete, especially for smaller minority groups like Native Americans. If Carmona was involved with that, then hats off to him.
I also know that Tommy Thompson, then head of the Department of Health and Human Services, probably ordered the first report to be doctored. It eliminated many mentions of disparities, preferring the word "differences" instead. It downplayed the horrible state of healthcare in this country, and the striking disparities between racial and socioeconomic groups.
If you're willing to plough through about 10 pages, Representative Henry Waxman released a report detailing how the document's final relase in November was cooked from the July draft version.
I also know that Tommy Thompson, facing severe criticism over what essentially amounts to cooking the books like they did at Enron, released the original, July draft version instead of the cooked November version. Dr. Carolyn Clancy, director of the AHRQ, also released this statement, in which she said that "changes, with which I concurred" were made to the draft document by "a broad array of staff," and that, at the request of Tommy Thompson, she was "now making available as the final report the July draft as it was sent to HHS for clearance."
Basically, Tommy Thompson either cooked the books, or the books were cooked under his watch. The buck stops with the director. Republicans should seriously consider whether they want this man, who obviously lacks integrity, to be their Presidential nominee.
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