'Surgeon General's Warning' Provides a Fascinating History on a Controversial Position

Written in vivid detail and expertly researched, Mike Stobbe's chronicle of the office of the Surgeon General parts the curtains on some surprising heroes and brings us to a surprising conclusion.

Surgeon General's Warning: How Politics Crippled the Nation's Doctor

Publisher: University of California Press
Length: 394 pages
Author: Mike Stobbe
Price: $34.95
Format: Hardcover
Publication date: 2014-06

In this new and engaging volume, Mike Stobbe writes about the unique role that the Surgeon General has long held. As he writes in the introduction, the office has always been "a bit of an anomaly", which provided those who held the position to "speak more candidly and powerfully about the nation's problems than other health officials."

That power, however, only came to fruition on certain occasions, mostly when a series of factors aligned and allowed the Surgeon General the chance to speak candidly and (mostly) free of political influence. Stobbe ably chronicles the downward trajectory of that office, engaging the reader with biographical shards on each of the men and women who have held the office, but also with an uncommon ability to distill complex historical and political factors into a language that makes Surgeon General's Warning invaluable to scholars and highly engaging for general audiences.

John Woolworth was the first to take the office and when he did in 1871 the Marine Hospital Service, which he was to rebuild, was in a terrible state. The hospitals were overcrowded or in deep disrepair. He was swift in developing and executing a plan that lifted the system out of debt and despair. He, along with his successors, John Hamilton and Walter Wyman, became the architects of the U.S. Department of Health and Human Services. Although there were assumptions that the Surgeon General would be unlikely to make shrewd political maneuvers or would always act in the most benevolent fashion, neither was especially true. Hamilton was known for being outspoken and Wyman for his often brusque nature.

The office also concerned itself with social problems that impacted health, especially in the years leading up to World War I. Rupert Blue, who had been appointed by William Taft, was concerned that workers often did not earn enough money to lead a healthy lifestyle, including to afford a proper diet. He welcomed compulsory health insurance, which the American Medical Association supported, even though labor leaders did not; they would have rather seen an increase in wages. Private physicians were concerned that insurance companies would set payments at rates that were too low for profit. Though Blue's career was initially built on solid promise, it began to fall apart as World War I took hold.

The war caused Blue to scatter resources more thinly than he had initially hoped, and care for veterans became a serious problem as the war continued to unfold. But equally troubling was the arrival of the Spanish flu. Because his office was spread thin by the war effort, Blue was slow to investigate the arrival of the flu and only became fully engaged in the fight against it as a second wave hit the US and death tolls began to rise.

Despite being slow to act at the outset his actions during that second wave were instrumental in introducing tactics that remain in use to this day: he empowered the public through the dissemination of information on what they could do to prevent the illness, and he spoke in measured tones that helped assuage panic. Although there were great casualties from the outbreak, in the end the country was more distracted by the war than by this threat to public health.

In subsequent years the battles for public health took on familiar topics. Hugh S. Cumming warned of the dangers of smoking and issued warnings about leaded gasoline; the former continues to concern public health officials and the latter took an alarming amount of time to correct.

Even in the early part of the last century, the Surgeon General was concerned with sexual health, something that came to the fore with the figure who is clearly, in Stobbe's estimation, the best and brightest figure to hold the office, C. Everett Koop. Described as "a social conservative's dream", Koop doubted the theory of evolution and was concerned that abortion would eventually lead to the elderly being euthanized in large numbers.

If Ronald Reagan and Jesse Helms were convinced that Koop would advance an agenda that was anti-gay, anti-feminist, and anti-civil rights, they were gravely disappointed when Koop began to tackle the big issues of the Reagan years. He denied that AIDS was a "gay disease", took on smoking as a major health risk, and refused to undertake a study that would examine the long term impact of abortion. He was predictably anti-drug and was an early figure in the concern about how violent images in media might harm youth.

His work on AIDS, under a president who barely uttered the word, was remarkable, if late. (He didn't release his report until late 1986.) He called for sex education (to begin in elementary school), the distribution of condoms, and stood against compulsory blood testing for infected people. He argued that he did not see his advocating the use of condoms as standing in opposition to his anti-abortion beliefs.

Despite his growing cache with the public, the White House was increasingly dismayed with his actions. Although he was friendly with then Vice President George Bush, by the early days of Bush's own term in the oval office, the tide had changed and Koop left the White House by the end of the year, though he was never far from the public eye. He is the most clearly drawn character in these pages and the one we feel the heaviest loss for, both when he leaves his post and when he passes.

From there the Surgeon Generals are alternately more colorful and less interesting. Jocelyn Elders is certainly firmly within the former camp, while Regina Benjamin's position is almost tragic-comic. Elders is certainly firmly within the former camp with her frank discussions of masturbation, Benjamin's position is almost tragic-comic, as concerns about her weight and the general standing of her office almost became more central to her tenure than her policies.

Stobbe ultimately argues that it's time to do away with the office, noting that although the title has built-in prestige, it has very little power. The battle for the office to regain its former glory and power would be too long and too costly to be worthwhile. Whether one agrees or disagrees with this statement, Stobbe's research and portraits of the men and women who have held the post of Surgeon General are remarkable in their vividness and insights.


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