On Obama’s Choice of Sanjay Gupta for Surgeon General

[Time for change]

There are several choices that President-Elect Obama has made since his election victory that I have not been happy about. I single out this one to post about because it involves an area of work – public health – that I have trained and worked in for more than 30 years and because, as a medical officer in the Food and Drug administration, my work is likely to be significantly affected by the policies of our next Surgeon General.


Gupta’s qualifications for the job

According to the Office of the Surgeon General’s website:

The Surgeon General serves as America's chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury…

As such, the Surgeon General is considered to be the chief public health officer of the United States, which is quite a major responsibility because, as I note in my book, “The purpose of public health is to preserve and improve the health of the population to whom it is responsible”.

Public Health is a sub-specialty of medicine that requires four years of additional training after completing the requirements for a doctorate of medicine degree. Of the six jobs that I’ve held since I received my Public Health certification in 1980, I think it’s fair to say that I would have been hired for not a single one of them without my Public Health training and certification.

Yet Dr. Gupta is being nominated for the most important public health position in our nation, though he has received no training in public health. He is a neurologist. He may be an excellent neurologist for all I know. But without training in public health, I don’t see what qualifies him to be the nation’s chief public health officer.

John Conyers made a similar point, urging fellow Democrats to sign a letter to Obama stating that:

It is not in the best interests of the nation to have someone like this who lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance to some of the poorest and most underserved communities in America.

Disparaging of one of the most important public health films in our country

Michael Moore’s film “Sicko” is one of the most important public health films available in our country, in my opinion. I say that because it demonstrates, in a way that makes it easy for ordinary people to understand, some of the major problems with the health care system (or lack thereof) in our country. These include the extremely high and largely unnecessary cost of health care, and a for-profit insurance industry, which together have led to 47 million uninsured American citizens.

What makes Moore’s film so important is that it helps to provide the political impetus for the creation of the first universal national health care system our country has ever had.

Yet Dr. Gupta, in his role as medical correspondent and consultant for CNN, led the effort to disparage that film in ways that were unfair and inaccurate. The gist of his hit piece can be seen by looking at the beginning and the end of it. He starts off:

Moore presents a lot of facts throughout the movie. But do they all check out? "Keeping Them Honest," we did some digging…

Then he commences to throw a bunch of criticisms at Moore’s film which are trivial at best, and worse yet, misleading and inaccurate. And he ends with:

But no matter how much Moore fudged the facts, and he did fudge some facts, there's one everyone agrees on. The system here should be far better.

I do have to give him credit for at least acknowledging that our health care system should be far better. But that does not begin to justify his unjustly critical and inaccurate portrayal of Moore’s film. Michael Moore did NOT fudge facts in his film. Gupta, on behalf of CNN was the only one doing the fudging… or making honest mistakes. In either case, the whole critique was petty and inaccurate and not at all worthy of a Surgeon General of our country. Here are the major examples:

Cuba has worse health care than the United States
Gupta said the following during his “fact check” of “Sicko”:

(Moore says) the United States slipped to number 37 in the world's health care systems. It's true. ... Moore brings a group of patients, including 9/11 workers, to Cuba and marvels at their free treatment and quality of care. But hold on – that WHO list puts Cuba's health care system even lower than the United States, coming in at #39.

That is a terribly misleading statement on two accounts. First of all, it implies that Moore tried to hide the fact that the health care system of the United States is rated by the World Health Organization (marginally) better than that of Cuba. But in fact, Cuba’s ranking of #39 was prominently displayed in “Sicko’, as noted here:


And secondly, Cuba is a poor country. Consequently, their citizens spend on a per capita basis less than twenty times what U.S. citizens spend. And yet, their health care system is rated only marginally worse than ours, and all of their citizens have access to health care.

Grossly misquoting “Sicko” on the cost of health care in Cuba
Here’s another one. Gupta said:

Moore asserts that the American health care system spends $7,000 per person on health. Cuba spends $25 dollars per person. Not true. But not too far off. The United States spends $6,096 per person, versus $229 per person in Cuba.

That statement is also misleading on two accounts. First, “Sicko” did not say that Cuba spends $25 per person. It said $251 per person. Gupta later had to admit to that mistake (blaming it on a transcription error). And secondly, Moore’s figure of $7,000 per person for costs in the U.S. was based on U.S. government projections for 2006. And even if Moore had chosen to go with Gupta’s older figure of $6,096 per person, that would have hardly changed the basic point of Moore’s message, which is that health care per person in the U.S. is tremendously more expensive than in Cuba.

Inaccurate statement about longevity
Gupta claimed that Americans live longer than Cubans.

But according to the 2006 United Nations Human Development Report's human development index, life expectancy in the United States was 77.5 years, compared to 77.6 years in Cuba.

Misleading statement about waiting times
Gupta said:

Americans have shorter wait times than everyone but Germans when seeking non-emergency elective procedures, like hip replacement, cataract surgery, or knee repair.

That was true of the six countries surveyed in the study that Gupta referred to, but also very misleading. First, Gupta’s statement applies only to elective procedures. When it comes to patients who are actually sick, the United States is near the top of the list with regard to waiting times.

Furthermore, one of main reasons why the United States is able to prevent waiting times from becoming longer than they are is that tens of millions of Americans don’t receive the health care that they need. That applies not only to the 47 million uninsured Americans, but also to tens of millions of other Americans who don’t seek the health care they need because of insufficient coverage by their insurance companies.

Saying that Moore implied that citizens of other countries don’t pay for health care with their taxes
Gupta and his guest “expert” made a big point out of claiming that “Sicko” implied that health care is “free” in other countries, in that taxpayer money isn’t used to pay for it. In his televised debate with Michael Moore, Gupta said:

I mean France is drowning in taxes. They're running a $15.6 billion debt. I mean it's very hard to pay for this sort of thing. And to just call it free and say it's free, I think, makes it very – it's murky, Michael, at best. And I think that's what I have difficulty with when you're trying to really advance a scenario here where we can get health care for everybody.

The idea that “Sicko” tried to imply that taxpayer money isn’t used to pay for health care is rather absurd on the face of it. But any possible question on that account was dispelled when Moore responded to Gupta by pointing out that Gupta’s “France is drowning in taxes” line was right out of “Sicko” itself. Then he asked Gupta, “Don’t you agree?” And Gupta just avoided the question:

No. Let me – you would have to agree that people would walk away from your film with the perception that health care is free in Canada.

False information about Gupta’s guest “expert”
An article in Media Matters for America demonstrates how Gupta misrepresented the affiliations of his guest “expert” who helped him “debunk” Moore’s film: Here is a summary:

After “Sicko” director Michael Moore said that CNN's “Sicko” fact-check "healthcare expert" Paul Keckley is "a person from a think tank group who is a big Republican contributor," CNN's Dr. Sanjay Gupta asserted that Keckley's "only affiliation" is with Vanderbilt University.” Gupta continued, "We checked it, Michael. We checked his conflict of interest. We do ask those questions."

Gupta was wrong again. Keckley has contributed $8,500 to Republican candidates for Congress, and he is indeed associated with a think tank – He is the executive director of the Deloitte Center for Health Solution, of which Tommy Thompson is a chairman.


Some final words about Gupta’s fitness to be Surgeon General

The many errors that Gupta made in his criticism of Michael Moore’s great film, as well as the pettiness and trivialness of those criticisms, cast serious doubt on his fitness to be our next Surgeon General, in my opinion. Yes, anyone can make mistakes. But Gupta was highly reluctant to admit to his mistakes, as demonstrated in his debate with Moore on CNN. And furthermore, subsequent identification of e-mails shows that CNN and Gupta had the correct information in their hands prior to airing the false information.

What’s even more important than the misleading nature and inaccuracy of Gupta’s criticisms is the nature of the film that CNN and Gupta chose to disparage. Why should CNN and Gupta attack a film that exposed the greed of the insurance industry and the effect that greed has had on the health of the American people? There was nothing there to attack.

The great importance of an independent press stems mainly from our need to have them expose the crimes of our government, not films that shine a light on our social problems. Where was CNN when the Bush administration’s obviously false claims of weapons of mass destruction in Iraq led us into a disastrous war? If Sanjay Gupta is so interested in exposing the truth, why doesn’t he do a piece on the hundreds of thousands of Iraqis we’ve killed and wounded during the course of our invasion and occupation?

President Obama will presumably be leading an effort to enact the first national health care plan in U.S. history that makes health care available to all Americans. Why should he pick as one of his major spokespersons for that plan someone who did a hatchet job on a film that could serve as an invaluable tool in explaining to the American people why we need such a plan?

Dr. Gupta is a medical doctor who specialized as a neurosurgeon, and he is a smooth talking television personality. But he is not qualified, either by his medical training, his carelessness with crucial facts, or his ties to the corporate news media to be our next Surgeon General. What good is all the smooth talking in the world if the content of the message is all wrong?