Why Does the Surgeon General Have to Clean Up Our Mess?

In testimony before the Senate health committee, James Holsinger, President Bush‘s nominee for Surgeon General, listed his three top priorities if approved. According to the New York Times, these priorities would be: “tackling childhood obesity, ‘making America a tobacco-free nation’ and improving the ability of the Public Health Service to respond to emergencies.”

While these priorities are certainly in sync with the current Surgeon General guidelines, it is striking to me that two of Holsinger’s three priorities are essentially self-inflicted conditions. Tobacco use is optional (if addictive); obesity is self-generated (if, for some, unavoidable). What does it say about us, our habits, and our government that the nation’s top doctor must put such energy into these kinds of problems? What would you focus on if you were Surgeon General? (Other than, as former Surgeon General Richard Carmona testified the other day, dodging political demands and singing the praises of President Bush.)


"obesity is self-generated (if, for some, unavoidable)"

You left out the word "childhood".

What kid can control (and thereby "self generate" his or her obesity) the nutritionless sh@t that is shoveled down his or her fat little gullet by
first: affordable food manufacturers (and their godless advertisers),
second: their schools, and
third: their parents who lack the education to know that lucky charms for breakfast, ramen noodles for lunch, and hot dogs for dinner accompanied by fun fruits in between is not great for the kid, or who simply lack the income to do a f@cking thing about it.

Would you argue that we should let HIV/AIDS victims wither away in obscurity because a great deal of them chose to have gay sex thereby "self generating" their condition?

Ask Roland Fryer how important the childhood obesity epidemic is and what his new baby, NYC public schools are doing about it.

I dislike a fat adult slob as much as the next guy, but please leave kids out of it.


Ike Pigott

Ironically, childhood obesity is an issue that the federal government can tackle. But only if the Surgeon General wants to lobby Congress to change certain subsidies. The law of unintended consequences strikes again...


I think our health system is in a crisis because there's no incentives for prevention programs- all the payments/kickbacks revolve around treatment and drugs- so the health care costs spiral upward- thus I disagree with the post's implication- it should be the SG's duty to foster prevention
ps- snubgodtoh- I love ur critique! holy indignation :)


Both obesity (childhood & adult) and tobacco use create health conditions that put an enormous strain on the health systems in the US. Getting rid of the problems caused by them, from lung cancer to cardiovascular disease, diabetes, etc... could potentially seriously reduce some of the financial and capacity-related strain. Sure, they are paternalistic goals, but so is requiring seatbelt usage in cars, which was done for similar reasons. It's not about the individual or suffering on a personal level, but more of a utilitarian, population-based approach.

That said, I would like to see the reintroduction of meaningful sex education in public schools.


I would focus on increasing breastfeeding rates, especially among the poor.


I would focus on increased breastfeeding, lead paint abatement, and childhood nutrition. All three are proven to have positive health outcomes and are cheap and easy to implement. Well, lead paint abatement isn't that easy, or Baltimore would have done a better job at it, but with political will, it can be done.


I tend to believe the government should be in the business of promoting the welfare of the governed, rather than "gettin' all up in the business of the governed." As such, our government has done a pisspoor job at promoting our welfare, unless by "governed" you mean "those entities with strong financial and political will."

In the wake of Sicko, we should not necessarily look to socialized medicine as the answer as much as politicizing good nutrition and exercise at the expense of the food- and entertainment-industrial complexes. It's like both parties just accept that we have to live with those complexes because they carry so much money and thus so much power. What happened to the citizenry? Don't we matter?

Frontline ran a sobering piece on health care and the elderly that pushed the idea that doctors need to adjust to more holistic approaches. Doctors interviewed admitted the typical approach is diagnose-then-treat, but with expanded life expectancy, they need to treat the patient in a broader sense. I know that I will refuse to be a pill-guzzling old man. Eating in a sensible manner and exercising have to be stressed to the populace. Subsidies and incentives need to be shifted to benefit the governed, not the complexes.



I'm all for the SG's goals, as long as they don't manifest into ridiculous Big Brother-type regulations and restrictions (which they will). I think education and cultural pressure are what will make a difference. It's already made a big difference in smoking rates, and will continue to do so. And I agree that more focus needs to be placed on preventative medicine. If I had any other wishes, it would be to put more efforts into mental health issues. I think any findings in mental health research could be very useful for the obesity and addiction issues, since both are so closely tied with mental health.


I believe the Surgeon General of the United States of America should take some fertilized embryos hostage, go on TV, and threaten to shoot them (the embryos) if the god-d*mned religious conservative Republican nincompoops don't let them (the embryos) go free...to the labs of America where they (the embryos) will do the most good.

Barring that, the SG should personally see to it that all hospital staff in these United States and any countries that I visit are washing their hands properly.

Oh...and lastly...how about the SG work to divert some Iraq money to anti-bacterial research labs before we all die from some otherwise seemingly innocuous little bug.


I would suggest he concentrate on limiting the transmission of infectious diseases, esp in our food and by immigrants, legal and illegal.

Ike Pigott

@giromide - look at my link again. The idea is to reduce childhood obesity by slashing government subsidies for foods that make people fat.


I would focus on solving this problem of erectile dysfunction. Everyday there is a new product meant to solve this chronic and debilitating problem, yet none seem to cure this plague. I would try to get the CDC right on this before it gets worse! Maybe have a road race....


What does it say about us that you don't expect leadership from your government officials?


"President Bush's surgeon general nominee, Dr. James Holsinger, said Thursday he would resign rather than allow politics over-rule science."

A communist socialist pig if there ever was one. Not one mention of god it that statement.

double d

Wow Dubner! The posters aren't exactly taking up the torch of Personal Responsibility. Snubgodtoh didn't even get around to mentioning parents until #3. I hate it when people sneak into my house a force junk food on my kids. Great post. Very disappointing response.


@9... I won't say it as colorfully, but yeah, stem cell research would be my answer.


Here is a very apropos study on this topic -headlined today in Arts & Letters Daily:

The author chooses to make the point about obesity, but clearly each potential public vs private health conflict would be different. I think this epidemic of people sneaking into innocent houses and forcing thin children to eat junk food, for instance, is a definite public health issue, and the Surgeon General ought to check with the President and see if he can say anything about it.


I am really surprised by the comments on this post. Wow. Not what I was expecting. I was just going to comment that even the other goal of the Surgeon General candidate might be considered self-inflicted due to lack of proper preparation.


Does the Surgeon General have a real job, or is he just the barker for the Federal medicine show? Assuming that it's all a scam, I'd have to say that the tobacco theme is tired and probably doesn't have much box-office anymore. The fear-mongering about emergencies is horribly overdone, and, after Hurricane Katrina, no one will believe a word of it. Who are they trying to kid? And haven't they been in the childhood obesity business since the Seventies? It's not a bad scam -- if things get worse, they can demand more money, and if they get better, they can take all the credit. But I don't see why anyone takes any of this seriously. Do government officials have unusually long lifespans? If not, why would anyone pay attention to them?


As Surgeon General, I would:

1) champion a TRUE physical education program for all schools -- I am talking something closer to a combination of martial arts and military-style physical training (none of this doge-ball nonsense that doesn't actually teach people how to have healthy exercise habits)

2) champion more holistic health, encouraging hospitals and clinics to teach their patients how to live healthy lives, including good nutrition (also to be taught -- and practiced -- in schools)

3) come up with a set of recommendations to eliminate as much insurance (private and government)-created bureaucracy, which only work to create a barrier between doctors and patients, while driving up health care cost (estimates are that the very existence of insurance drives up the prices doctors have to charge by 300% -- they have to charge enough to ensure they get paid half that, then they have to use half of what they get paid to get the money they do get from the insurance companies)