Gun lobby blocks crucial federal appointment

When the Ebola challenge became a national issue, it would have been nice to have a United States surgeon general in place to help educate the public and work with patients and providers to implement health care reform.

It would have been especially nice to have Dr. Vivek Murthy on the job because of his infectious energy and organizing skill, his knowledge of primary care and of health information technology, and his ability to mobilize young people.

But President Obama’s nomination of Dr. Murthy to be surgeon general has never been confirmed by Congress; and when the Republicans take control of the Senate in January, the confirmation mess is likely to become even more of a quagmire. It’s quite possible that we’ll be stuck with key vacant positions throughout the executive branch and the federal judiciary. That makes this lame-duck session of Congress even more important.

I know Dr. Murthy well well because of our work in Doctors for America, which he co-founded. (Dr. Murthy also helped my own father address a scary cancer. I guess that makes me biased.) It is unclear which of his entrepreneurial and professional accomplishments, which of his fancy academic degrees fail to pass muster. This is, after all, a political process that failed to confirm Nobel Prize winning economist Peter Diamond to the Federal Reserve’s board of governors and pioneering physician Donald Berwick to run Medicare.

Whatever Murthy’s shortcomings, these didn’t trouble many other organizations within the medical and public health community that endorsed him, including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, American College of Osteopathic Family Physicians, American Osteopathic Association, American Public Health Association, American Cancer Society, American Diabetes Association, American Heart Association, and many more.

Despite his qualifications, Dr. Murthy’s nomination ran into trouble for three reasons — the president’s poll numbers are down. Our confirmation process has become a partisan mess. And Dr. Murthy had the temerity to identify gun violence as a major public health concern after the Sandy Hook tragedy when President Obama and Senators from both parties sought bipartisan legislation to pursue evidence-based gun safety policies.

Sen. Rand Paul (R-Ky.) placed a hold on Murthy’s nomination earlier this year. Sen. Paul doesn’t like the Affordable Care Act. Dr. Murthy fought hard for ACA’s passage. Sen. Paul is especially offended by Murthy’s views on gun policy. In Paul’s own words: Murthy “continually referred to guns as a public health issue on par with heart disease.” Paul and the National Rifle Association were particularly aggrieved by this Doctors for America letter to Congress sent just after the Sandy Hook school massacre. The letter called for stronger background checks, closer regulations of semi-automatic rifles, funding for epidemiological policy research law enforcement efforts against gun trafficking, suicide prevention efforts in clinical settings.

One can argue the merits of these recommendations. What’s unarguable is that these are standard among almost every medical or public health professional who treats victims of gun violence. Here, for example, is a congressional letter from the American Psychiatric Association. Here’s another from the American Academy of Pediatrics. Here’s the American College of Emergency Physicians. The surgeon general has little power to shape gun policy. Dr. Murthy made clear that gun policy would not be a prominent focus of his work as surgeon general.

The NRA’s real target is not Dr. Murthy, but the larger medical and public health community. Its real purpose is to lay down a marker. As one sympathetic account observed, the NRA is flexing its “election-year clout.” It wants public health leaders to quietly calculate that it’s too politically risky and difficult to take on gun violence and gun safety concerns. We can’t allow that to stand. Gun homicides, suicides, and accidents account for 30,000 deaths annually. America ranks well below average among industrialized nations in overall crime. Yet our homicide rate is almost three times higher than in Canada, almost four times higher than in the United Kingdom or France, and about five times the reported rate of Germany or Italy. Gun violence is the dominant reason for these disparities.

It is entirely appropriate — indeed necessary — that the surgeon general, our nation’s chief medical officer, have the freedom to speak out on these issues. Vivek Murthy should be expeditiously confirmed. For the Senate to block him would send the depressing signal that ambitious medical leaders should confine their activities to the lab and avoid controversial subjects such as HIV prevention, alcohol and prescription drug abuse, dubious nutritional supplements, or (not so long ago) tobacco control.

Both of our Illinois senators deserve great credit for supporting Dr. Murthy’s nomination. Particularly for Senator Mark Kirk, this could not have been an easy vote. But it was the right one. His Senate colleagues should follow suit.

Harold Pollack is Helen Ross Professor at the School of Social Service Administration. He is also Co-Director of The University of Chicago Crime Lab and an Executive Committee member of the Center for Health Administration Studies (CHAS) at the University of Chicago.