The surgeon general is shirking his job

Like any top-level White House appointee, Surgeon General Jerome Adams serves at the pleasure of President Donald Trump and owes him some measure of political and institutional loyalty.

But one thing makes Adams different from the yes men and women orbiting the Oval Office. He is a doctor, bound by strict ethical standards and codes of professional conduct. In his role as America’s top public-health official, his primary obligation is not to Trump. His job is to promote the general health and well-being of everyone in the United States.

As Trump has pursued policies toxic to health and public safety — on issues including gun massacres, pollution and the systematic abuse and endangerment of migrant children at the border — Adams has stayed bafflingly silent.

He should stand up and speak out against what his boss is doing. Or he should quit.

That’s the best way the Surgeon General can help the country right now.

Indeed, the appointees in every last cranny of this administration must question the dysfunctional enterprise they are enabling.

For physicians like Adams, their professional ethical obligations are very clear, reaching back to the Hippocratic Oath. Doctors must put patients first. Why then is Adams putting the White House’s interests over the people’s? Adams has a record of simply ignoring many vital public health matters altogether. To be blunt, the Surgeon General is standing in front of the burning hellscape of this administration’s public health policies, smiling.

As mass shootings mount, the Surgeon General is silent, unlike other members of the medical profession. As migrants face major human rights violations in federal encampments, he is silent, unlike many other physicians. As access to health care is threatened or cut by administration policies, he is silent, unlike major medical groups.

Though spending extensive time on the opioid crisis, Adams attempts to deflect questions about supervised injection sites, where health professionals help addicts avoid overdosing when they take illegal drugs. The White House opposes the practice. When pressed on the matter by STAT News, Adams incorrectly claimed that there wasn’t enough evidence to support safe injection sites. He should know that isn’t true.

Vancouver’s supervised injection site alone has rescued people from more than 6,000 potential overdoses. Philadelphia-based Safehouse just won its court battle against a Trump-appointed United States attorney to open the first such site in the nation. Adams’ obfuscation serves an administration actively trying to block other cities from opening these sites.

What’s more, the entire federal government, most agencies of which are charged with protecting our health in some way, continues to rapidly shed its scientific credibility, as documented in a new report from NYU’s Brennan Center for Justice.

Science itself is under partisan assault, and not even the weather report is immune.

In the midst of this toxic stew of denialism and pseudoscience, what is the role of the Surgeon General?

Adams described the role succinctly last year at the Harvard T.H. Chan School of Public Health.

“… I’ve got three roles. Number one, the one that people are most familiar with, is that role as the nation’s doctor. And, in that capacity, it is my job to communicate the science around health to the American people very, very, very succinctly. Number two, I’m an advisor to folks within the administration and within other agencies, a content expert, if you will, at their leisure. Number three, and this is the only one that’s actually written in statute, I’m the head of the United States Public Health Service.”

The first two jobs — both in science communications — take up the bulk of the role. As for the USPHS, its 6,500 uniformed officers, led by the Surgeon General, constitute just 0.3% of the federal workforce of 2.1 million.

At the outset, Adams signaled that he would be a different kind of Surgeon General, choosing a business-minded approach to public health. Besides the opioid crisis, he hoped to promote healthy citizens as essential to the economy and national security.

Last December, the Surgeon General began highlighting vaping as an epidemic among the nation’s youth. Kudos.

Yet he is inexcusably avoiding many other pressing topics that just happen to be targets of ire from the bombastic, fact-free President who appointed him.

As this administration’s threats to the public’s health have mounted — from sabotaging the Affordable Care Act, to eviscerating environmental policies that our health depends on, to the recent reports that the President asked for alligator-stocked border moats and shooting undocumented immigrant families in their legs to stop them (Trump denies he said this) — where is the Surgeon General’s voice? Why does he continue to serve?

We asked him recently, on Twitter. And he responded. As it turns out, Adams would like to distance himself from this administration. He wrote on Twitter in response to a query from one of us (Vox): “My job isn’t to judge/ politicize. It’s to help people be the healthiest they can.” But we don’t see how that kind of distancing is possible when Adams is lending credibility to the most anti-science administration in history.

In our Twitter conversation, Adams described the nation itself as his patient. He feels duty-bound to treat this patient “regardless of their choices/circumstances (and the people/ patient made a choice).”

He likened serving as Surgeon General to a doctor showing up to work in a hospital or clinic regardless of whether he agrees with how hospital administrators are running the place.

The American “patient,” by any measure, is reeling. But Adams is carefully avoiding matters he thinks his “hospital” or “clinic” considers politically sensitive. If Adams sees himself as there to pick up the pieces, he shouldn’t tiptoe around the disaster scene before him.

Such intentional avoidance is precisely his modus operandi when he refuses to engage on guns, on family planning, on workplace safety, on pollution, on food stamps, on access to health care and on the government’s shoddy treatment of the most vulnerable, including migrants.

So why does Adams continue to work in this administration? In our Twitter exchange, he analogized himself to the duty-bound doctor again, trying to save folks who’ve made (and keep making) terrible health choices. “Every patient has a variety of issues and circumstances. You do the best you can where you can. But docs who care for their patients don’t give up on them.”

This is the hallowed sentiment of good-hearted doctors everywhere, for example when they save alcoholics with failing livers from yet another gastric bleed. “Once we discharge him home, he’ll probably keep drinking. But we’re doctors, damn it, we save lives!” they say. Cue the St. Elsewhere theme song.

Holding onto this attitude is a vital part of professional medical ethics.

But somehow the sentiment isn’t so reassuring when the doctor is the Surgeon General, we’re all the patient, and the Trump administration is bringing the diseases.

One statement the Surgeon General made to us on Twitter really stuck out for us. “Our job” [doctors] “is to stay out of the politics and help the patients.”

But in 2019 the two are inseparable for any doctor, particularly for the Surgeon General.

Adams should have shown up in border control camps when the crisis became apparent, and he can still do so now.

He should declare that the opioid crisis will never be solved if we scuttle every attempt to provide comprehensive health care for all Americans.

He should meet with Greta Thunberg and cheer on the nation’s youth as they protest for environmental policies that will save their very lives.

And given his own economics-focused mission statement, Adams should advise the administration to defend, rather than attack, the right of LGBT people to live productive and healthy lives.

And Adams should stand with all the health-care organizations that have declared the gun violence epidemic to be a public health crisis.

Adams can redeem his time in office if he stops taking cues from this administration. Otherwise, Surgeon General is a position better left unfilled when the officeholder’s studied silence is what the White House really wants.