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A Surgeon General’s Advice to Me

Posted by John McDonough  March 3, 2013 10:24 PM

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Way back in 1993, I met Dr. C. Everett Koop MD, the nation's most recognized and respected Surgeon General (he served in the 1980s under President Reagan). We met at an event at the Federal Reserve Bank in Boston where he and I both received awards from Health Care for All.

Reading about me in the event program, he noticed that I was the product of a Jesuit Koop.jpgeducation (B.C. High and Boston College). With that knowledge, he felt safe tossing me a phrase in Latin: "Illegitimi non carborundum." I didn't have the nerve to tell him I didn't have a clue what the phrase meant, so I just shook his hand and said: "Thank you, sir!"

In 1993 there was no Web to find out translations instantly, so it took a little time for me to find out what it meant. I finally did: "Don't let the bastards grind you down."

I thought of that encounter last week at the sad moment of learning of Dr. Koop's passing. But I had also thought of it a few days before when I read a New York Times column by Mark Bittman raking our current Surgeon General, Dr. Regina Benjamin, over the coals for her near-invisible public profile and other sins:

"No one I asked (including a member of Congress) could name the current one. She’s Regina Benjamin — and no, I didn’t know, either. In theory, the surgeon general is the nation’s doctor, an independent practitioner whose major concern is our health. In reality, the position has been eviscerated..."

It is true -- compared with some of our prior U.S. Surgeons General, Dr. Benjamin lacks public recognition. Dr. Luther Terry, LBJ's SG, secured a place in public health history for publishing his courageous "Smoking and Health" report in 1964. Dr. Julius Richmond in 1978 launched the "Healthy People" series, elevating health promotion and disease prevention to unprecedented recognition. In the 1980s, Dr. Koop became America's most trusted physician with his high profile work on AIDS/HIV and smoking. In 1998, Dr. David Satcher established racial and ethnic disparities in health and health care as a compelling national policy priority.

Benjamin.jpgAnd, we've had more than a few forgettable SGs who would not rate a Jeopardy question. We even had a four-year period between 1973 and 1977 (Presidents Nixon & Ford) when the nation had no SG. Ups and downs have been normal.

Surgeon General Regina Benjamin has led on one highly important policy initiative which Mark Bittman failed to notice. Title IV of the Affordable Care Act directed the SG to develop a "National Prevention Strategy" involving not just the U.S. Department of Health & Human Services, but all the other cabinet departments including Housing, Education, Transportation, Revenue, Defense, EPA and more. The Strategy was released in June 2011.  It's a strong document, a blueprint not just for the federal government, but for states, localities, non-governmental stakeholders, and more. Some entities -- notably the City of Chicago -- have adopted the Strategy as a key part of their own health promotion and disease prevention work.

Here's the disappointment -- almost no one has heard of the Strategy beyond those who pay close attention to prevention and public health. SG Benjamin, a smart and talented lady, has been unable to use her office to draw public notice to the critical issues in the Strategy. More than 18 months after the Strategy's release, it can't even be called forgotten because so few knew of it in the first place. That is a tragedy.

Bittman correctly observes a hesitancy to offend on the part of Dr. Benjamin, a reticence to confront vested interests. So confronting obesity is about getting consumers to change their behaviors and not at all about the food industry that feeds America a diet designed to produce epidemics of chronic disease. We don't need a pundit SG -- we do need a Surgeon General willing to produce scientific evidence to move America to confront uncomfortable truths. SG Terry in 1964 produced no new evidence on smoking and health; instead, he assembled in one place the best scientific evidence in existence at the time. And he made history.

That's the kind of leadership America needs to face up to our current public health threats. In President Obama's second term, here's hoping that Dr. Regina Benjamin will find her platform and voice. And here's a bit of advice someone once told me:

Illegitimi non carborundum.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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