Surgeons General at Dartmouth

To say that the last few years have been difficult from a public-health perspective would be an understatement. For the past decade, the nation has faced a succession of crises. Longstanding challenges like the opioid epidemic have continued to build, while shocks like the COVID-19 pandemic have rocked the economy and society as a whole. During the pandemic, Dartmouth in particular drew the attention of national media for its unhealthy climate for mental health.

Such challenges have promoted a heightened focus on health, both mental and physical, as the nation’s most prominent leaders all offer their own opinions on how best to address the problems that ail us. In light of Dartmouth’s recent, ignominious history, President Beilock sought to take to the foreground of this nationwide seminar of solutions, successfully assembling a brain trust of U.S. Surgeon General Vivik Murphy alongside his six living predecessors.

Dartmouth convened this panel on September 28, and presented as moderators Sanjay Gupta, CNN’s chief medical correspondent, and Duane Compton, Dean of the Geisel School of Medicine. The panel was introduced by President Beilock, our resident sociologist turned administrator. In her remarks, the president emphasized the severity of the mental-health crisis, especially as it pertains to young people. Dr. Gupta then delivered his own opening remarks, emphasizing the significance of the occasion. So, for the first twenty minutes of the hour-and-a-half talk, the Surgeons General themselves were quiet. 

When they did speak, they covered a broad range of topics. The first, Antonia Novello—the first woman to serve in the position—focused on how our medical system mistreats female doctors. Her comments ranged from the gap in pay between male and female doctors to the conscious and unconscious discrimination that she said women face daily in the medical profession. Her successors voiced similar concerns, interestingly continuing to focus on their side of the doctor-patient equation. We who lack medical degrees do not often think about how doctors too can suffer from increased stress, and how their own mental-health problems affect not just them but their patients. 

One notable standout to the trend of the remarks was Jerome Adams, who served as Surgeon General under President Trump. When it was his turn to speak, Adams attempted to justify his tenure under the 44th President, explaining that he had to work with Trump in order to ensure medical progress. While he did not directly attack his former boss, Adams’ words were hardly an endorsement. The former Surgeon General seemed to want the approval of his colleagues, and he hinted that some have criticized him for even having worked under the former president. 

Former Surgeon General Kenneth Moritsugu brought the conversation to the topic of public health, belting out the standard line about young people being the future of health and calling on Congress to listen “twice as much as it talks.” Perhaps, given how grating it can be to listen to what is said in contemporary discourse, Members of Congress simply want to crowd out everyone else. For their part, the Surgeons General did seem to want to jockey for the most appealing tagline, and in this vein Regina Benjamin said that young people are not merely the future of health but that we are health. She called on young people to speak up for patients and “make their own authority.” Interestingly, I note, RFK Jr. has similar talking points. Then, Novello told a story of how she solved the issue of infection risk due to circumcisions in New York City’s Hasidic community. While undoubtedly an important achievement, this parable, and others told by the Surgeons General which I will not relay here, seemed to consist of a great deal of talking down to people, an element perhaps inconsistent with the supposed core theme of self-representation in health.

To wrap up the conversation, Dean Comptom asked Former Surgeon General Adams about the future of healthcare. Adams emphasized that technological advances must be distributed evenly, while Novello chimed back in to suggest that technology is making us lose touch with our emotions. She warned of the danger of AI working with poor data that doesn’t include minorities, which she said lacks ethics. Instead, she argued, the results produced by AI must be interpreted by an expert. She offered no word on what to do if these experts are themselves biased. Next, former Surgeon General Jocelyn Elders called for doctors to take greater responsibility in their patients’ care. Whether this conflicts with the call for patients to advocate for themselves is up for interpretation. Novello then made his own contribution, proclaiming that, rather than follow the money to specialized practices, doctors should go where their hearts take them. To this end, Novello blamed avarice and career pressure for the decreased portion of doctors who become general practitioners. Far be it for me, a lowly econ major, to tell the esteemed former Surgeon General about incentives, but perhaps telling people not to do the job that pays them more is not the best way to achieve your desired outcome. 

After the Surgeons General finished pontificating, the moderators opened up the room to the audience, with students especially encouraged to ask questions. The first question was from a future general practitioner, who asked Novello how she would be supported in her career. Novello responded that there was a program which would pay her way through medical school and would then send her someplace to work as a condition of that payment. She also spoke of laws that are geared to reduce the stress from which GPs suffer when bargaining with insurance companies. While that stress may be a problem for some GPs, the questioner seemed rather more concerned with equal pay, which Novello did not address. Adams chimed in with the excellent assertion that Dartmouth should reign in its tuition costs (one could hear Geisel administrators shuddering at the thought of reducing their budgets). Other panelists offered promises of gradual salary increases, and Moritsugu emphasized the potential role of nurse practitioners. Navarro ended the talk with yet more focus on racism, further perpetuating the progressive idea that racism is a fundamental problem to public health. She noted that 47% of Americans don’t believe there is any racism in this country, and thus she stressed the importance of “education.” Perhaps, given current public distrust in the medical industry, our focus should not be on re-educating people for the purpose of “public health.”

Medical students and premeds may have found the Surgeon General event to be insightful and interesting. Certainly, the speakers attempted to speak to future doctors in particular with their emotional appeals and retellings of personal experiences. However, for those of us not shell-shocked by organic chemistry and the MCAT, there was little valuable information to be learned. Most of the actual policies discussed were generic and well-known applications of progressive ideology to the field of medicine. The discourse on mental health could have been taken straight out of a publication by the Brookings Institution. Maybe the Surgeons General simply suffered from their ideas being so popular to have become banal. Yet, one wishes that some of the greatest living doctors, with manifold accomplishments among them, could have offered more in the way of profound commentary, if not revolutionary conclusions, than they did.