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There are some real problems with the possible selection of Dr. Sanjay Gupta as Obama's nominee for Surgeon General.  And it goes way beyond his being factually wrong in his dust-up with Michael Moore.

Let me start by saying that he is a qualified neurosurgeon and obviously has media skill and connections beyond those of the typical nominee.

However, he has no professional background or training in public health, preventive medicine, and has shown de facto disdain for the basic precepts of evidence based medicine, all of which would be the underlying scientific basis of a Surgeon General.

And he has huge conflicts of interest as a bought-and-paid-for shill for Pharma, that should actually be disqualifying as a so-called journalist, to say nothing of being "Americas Family Physician" or the leader of the Public Health Service.

Here is a completely dishonest and disengenuous version of what is going on:

In a 2005 segment on CNN's "Paula Zahn Now" on health problems that were surfacing with widely used prescription drugs such as Vioxx, Gupta talked about drug companies' efforts to woo physicians by offering everything from free pens to free trips. He admitted that he had accepted pens from time to time.

"If you take a pen, are you going to prescribe that drug more often? I haven't seen a situation where the drug company says, listen, we'll only give you X if you prescribe the drug so many times. I haven't seen that, that transparent a sort of thing," Gupta told Zahn. "But there is a sort of more implicit sort of understanding between the pharmaceutical companies and doctors, I think. It is not so clear that they'll say, OK, you got to do X number of procedures and we'll give you a trip to Aspen, or you got to prescribe the drug so many times and we'll give a free lunch. You don't see that. But there is a sort of, again, nudge, nudge, wink, wink."

Really? Just took a few pens, huh.

I call total b.s. on that! Let check the actual record, shall we:

--------------------------------------------------

BIG CORRECTION FROM GOOZ:

My source for some of the critique has now withdrawn and corrected his posting:

http://www.gooznews.com/...

I made a major error this morning in claiming that the Sanjay Gupta on the American Psychiatric Association disclosure website from 2007 was the Sanjay Gupta of CNN. Different people. My apologies to CNN's Sanjay Gupta for making the earlier post, which is now withdrawn.

The list of connections to specific pharmaceutical companies cited in a CME program is now reported to be for a different Sanjay Gupta.

I have deleted that part of the this diary, and will update accordingly.

h/t to Ezra Klein

HOWEVER: There is still a need for full disclosure, just as is supposed to be done for biomedical journal publications and CME speakers and hopefully all senior political appointments, all of the speaker fees, corporate sponsors, payments, salaries and sources of income, stocks and sector mutual funds etc. that this Dr. Sanjay Gupta has.  I believe all appointments at this level (Civil Service GS-15 or uniform service 06 and up, SES, political appointments requiring congressional approval etc.) have to do this.

The criticism's based on Accent Health, Vioxx, Michael Moore & Sicko, and other items etc. per below, still apply.

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Those interested in the Gupta appointment may also want to check out this Health News blog item by Gary Schwitzer, a journalism professor at the University of Minnesota, last November 20 (actually via an article in the Brtish Medical Journal). It discusses a new show launched by CNN for broadcast in hospital and physician waiting rooms:

A powerful contemporary example of entanglement involves a television network called Accent Health (whose logo includes the words "Your target is waiting"), said to be watched monthly by more than 10 million viewers in US medical waiting rooms. The network, which is produced by CNN, overtly offers sponsors, including drug companies, the chance to boost sales of their products, by, for example, putting "your brand in front of the valuable Baby Boomer population just before they discuss their health conditions with their doctor." One of the hosts is Sanjay Gupta, CNN’s chief medical correspondent and host of at least one other CNN health programme that is funded partly through drug company advertising. ...

Just to be clear: Accent Health is a little bit of programming sponsered by drug ads and more drugs ads and pretty much only drug ads.  According to Pharmaceutical Executive Magazine:

"Just as it's vital to reach your target at the right time, you've got to reach them at the right place, and in the proper state of mind.  In the trusted environment of their doctor's office, our viewers are watching our health-related programming -- and absorbing your health-related advertising."

As Pam Martens reported:

The overarching issue in all of this is the dangerous and growing tentacles of a corporate agenda that seeks to control every message pertaining to its corporate brands in every venue visited or medium viewed by a consumer. That includes TV and cable news. Increasingly, corporations demand "integration" for their advertising dollars.

Dr. Gupta is part of this new wave of "integration" as co-host of a program called AccentHealth. Here's how the AccentHealth website explains itself:

"AccentHealth is America 's #1 integrated health media company offering advertisers multiple consumer touch points in the place where health matters most ­ the doctors office. AccentHealth's waiting room TV network produced by CNN and hosted by CNN's Dr. Sanjay Gupta and Robin Meade, reaches 132 million viewers annually in 185 Nielsen Markets...To complement your broadcast message, and the consumer focused product information you can provide in our 10,800 offices, AccentHealth offers another channel into the physician's office -- a unique fax program that can help you strengthen your physician relationships...Reinforce product credibility through the "Halo Effect..." How would you like to see your product on our show? AccentHealth runs frequent on-air promotions to engage viewers and ensure more focused viewing...Our healthy mascot "Abby Apple" has been reminding our viewers to lead a healthy lifestyle for 4 years! Abby can appear on-air using your product... AccentHealth is committed to meeting your campaign expectations. With an audience of receptive, health conscious consumers and a direct line into the physician's office we will customize your AccentHealth initiative to meet your specific brand goals...Use our production facilities to create a custom message for our unique environment...Let us organize a consumer event to coincide with your AccentHealth on-air campaign...."

In a January 17, 2007 interview with TV Week, Greg D'Alba, Chief Operating Officer of CNN ad sales and marketing, explained what's driving "integration." "What's interesting is it's not about what's new anymore, but what's becoming the norm...For every fully integrated package that we present there is an advertiser. We're batting 1,000 percent on that. And it's not because we're developing it and throwing it out there and we're finding sponsors, it's because our advertisers and our partners are requesting it, they're demanding it." (12)

Given the incestuous nature of "integration," should Dr. Sanjay Gupta have revealed to his CNN viewers during his extolling of the virtues of Gardasil that its manufacturer, Merck, was a financial sponsor of this integrated marketing scheme he co-hosts at AccentHealth? And exactly who prepared and vetted the First Lady's whopper on Gardasil? Should the First Lady have been commenting at all on a product from a company under criminal investigation by the U.S. Department of Justice? Inquiring minds not yet "integrated" want to know.

...and Dr. Gupta is the smiling face of this.

What else...?

Well he apparently initially blew off the reports of Vioxx's dangers... based on say-so of manufacturer:

Here's how he responded to Miles O'Brien on CNN's "American Morning" on October 30, 2003:

"Miles O'Brien: Let's talk about Vioxx. Some indication it might increase the risk of heart attack?

"Gupta: This stat has been around since August of 2001. They talked about the increase of heart attack with Vioxx. The numbers are very small. Perhaps a small percentage increase in the overall risk of heart attacks with Vioxx. They say 37 percent to 39 percent but that's of a very small number. After 90 days, no increased risk."

It's difficult to imagine a statement more riddled with factual inaccuracies. And where did Dr. Gupta get his information? He tells us in the interview: "We've talked to the makers of Vioxx, the Merck company."

This not how we do evidenced-based medicine, nor how we should be doing journalism.

As the authors of that BMJ article point out:

However, a surgeon general would "need to demonstrate skills that are too often missing in medical news on TV: skepticism about the science and a careful analysis of both the benefits and harms of medical care," said Drs. Lisa Schwartz and Steven Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice.  The pair raised questions about drug-company sponsorship of some programs Gupta hosted in a broader critique of medical media coverage last fall, and on Tuesday they urged careful examination of any potential conflicts of interest.

Now we can understand why Gupta went after Moore so hard. After all, it seemed at the time, way over-the-top and out-of-nowhere.

But in fact it was a rare case where we really document how the corporate media works at its worst. As Moore pointed out at the time, the segments attacking him and Sicko were full of advertisements by drug companies. The industries attacked by Moore and defended by CNN and Gupta were purchasing advertising time on the very same segment that led directly into the on camera debate.  Gupta’s views defended not only the status quo but the political views of those sponsors.  

And now we also know that the lead attacker was being paid both directly and indirectly (e.g. his pay for doing the Accent Health spots) by Pharama.

And in those false attack on Michael Moore and Sicko, Gupta used an expert whom he chose to identify as a "Professor at Vanderbilt University."  The "Professor" also just happened to be the head of a Big Pharma association.  Was that worth reporting? Apparently not according to Dr. Gupta. That is not journalism I can believe in.

But, being completely and totally wrong on every single point is okay, if as Paul Krugman points out, you do it nicely.

And it helps if you are paid well by the other side.

An actual advocates for public health would not run around pushing Pharma and conservative talking points about why real universal healthcare would be bad.

As Gary Schwitzer the journalism professor says:

As researchers and writers acting to improve medical journalism, we encourage journalists, educators, and professional associations to scrutinise their own relations with the industry as intensely as they do those between doctors and drug companies and to develop workable solutions. And, if they are to be good watchdogs, journalists need to mark their territory and clearly establish boundaries between themselves and the industry to avoid unhealthy entanglements.

Marcia Angell just wrote a scathing condemnation of the corruption of medicine in the latest New York Review of Books. Sanjay Gupta, it wouuld appear, is part of that problem, both as a practicing physician and as a medical journalist. Before he becomes Surgeon General, he ought to publicly state whether he thinks those kinds of financial entanglements for working physicians, and, for that matter, working journalists, are appropriate.


As a closing note, this little side-light also suggest that he just does not seem to have the temperment I want as the face of public health and preventive medicine:

People said Gupta lived dangerously by sometimes driving his Jaguar XK8 too fast


Yeah, yeah I know... now Gupta will be working for Obama and Obama's agenda.  But this disengenuous dishonest Pharma-lobbyist-by-proxy is who and what Gupta has chosen to be up until now.  This potential appointment is not just a terrible telling choice -- media glam, dishonesty and corporate-conflict-of-interest, over expertise, experience and professionalism.  It is also a marked contrast to the relatively progressive actual experts Obama tapped for energy, environment and other science posts. Very disappointing.


May I suggest Dr. Marcia Angell or Dr. Tom Frieden for Surgeon General.

Update:

To those saying it is "just" being the media front-person, I guess I have a couple of replies:

  1. The surgeon general can be serious and important position, with some policy input and departmnetal and administrative decision making. And I don't like the idea of somebody who has been so disengenuous and dishonest in his conflict-of-interest up-to-now being rewarded. There are other media-savvy doctors, to say nothing of actual professionals who are more qualified and deserving and honest.
  1. According to yesterday's Washington Post piece, "Obama told Gupta he could be the highest-profile surgeon general in history and would have an expanded role in giving healthcare policy advice."
  1. The main reason Gupta seems to be hesitating, according to the general media reports, is the cut in his income that would be involved.  Again, this relates to full disclosure of all of his conflicts of interest and also to his relative interest in public service, versus wealthy stardom.

UPDATE 3:

As noted in the diary, the Dartmouth authors of the original BMJ piece that noted the deceptive targeted marketing of the "Accent Heatlh" progrming, were quoted YESTERDAY in the AP as being concerned about CNN's Sanjay Gupta's Pharma connections. This was prior to and independent of the Booz that was retracted today.  So, yeah, I still want to know more about all his potential conflicts of interest up to now, and what was behind the big false attack on Moore & Sicko?

Update 4:

From comments... Dr. Gupta has apparently gone out of his way to downlay concern with lead paint in toys (it is a legit concern) and to suggest that cooking beef at regular cooking-for-eating temperatures will prevent the prion based "Mad Cow" disease (even well done does not do it). In other words, when push comes to shove his instinct is to go with the industry line not the public health line.

Similarly with diet and excercise, it really is important to recognize the structural issues (why population as a whole has gotten more  obese, more diabetes, etc) and not reduce it only to personal individual responsibilty.

On the one hand, I suppose it is good to have a surgeon general who will have a much higher media and public profile pushing a public health agenda. On the other hand, I have concerns what that message will be with this guy.

Originally posted to DrSteveB on Wed Jan 07, 2009 at 09:15 AM PST.

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