But Can He Talk About Sex?

Since the Obama administration announced that CNN's Sanjay Gupta, one of People magazine's "sexiest men alive" in 2003, might be the next surgeon general, reactions have ranged from indifferent to outraged. Although Gupta is a neurosurgeon and has been in the public eye for years - he started his "House Call" show on CNN in 2004 - many have been scrambling to figure out what this man stands for. 

Two separate controversies have already arisen since Gupta's name has publicly been floated as the next surgeon general. First, New York Times columnist Paul Krugman lambasted Gupta's critique of Michael Moore's 2007 film Sicko, saying that Gupta's accusation that Moore "fudged the facts" was, well, just plain wrong. Then Rep. John Conyers (D-MI) wrote a letter to his fellow Democrats urging them to oppose Gupta as surgeon general. Conyers claimed that Gupta would face a "credibility problem," given his lack of experience in the National Health Service Corp and that "it is not in the best interests of the nation to have someone ... who lacks the requisite experience needed to oversee the federal agency that provides crucial health care assistance to some of the poorest and most underserved communities in America." 

Many bloggers have already written about Gupta's lack of administrative experience, his opposition to marijuana reforms, and some of his biggest medical reporting mistakes. But little is known about where Gupta stands on reproductive health. (RH Reality Check attempted to contact Gupta for an interview, but was told he isn't available for interviews at this time.) 

The biggest source on Gupta's public record, the transcript archives from "House Call," reveals little; Gupta's show has largely avoided the issue. In a 2004 special on the worldwide HIV/AIDS epidemic, Gupta discussed "prevention" abstractly without ever mentioning condoms or even sex. In another episode on the spread of HIV a few months later, he quotes an HIV-positive man, Peter Staley, saying, "You can't stop the spread of HIV unless you talk about sex." But Gupta's show doesn't talk about sex. Instead, it cuts to an interview with former basketball star Magic Johnson. But the show's ability to deal with HIV/AIDS improves over the years, and in 2007 "House Call" addressed the problems of transactional sex in African countries that presents challenges to stopping the spread of HIV. 

Still, reproductive issues specifically rarely grace the screen. An entire episode devoted to "women's health issues" covered only the topics of breast cancer, smoking, and heart disease. In a 2004 special on multiple births, he headed up the top of the news program with the news that pregnancies among girls ages 10-14 were on the decline, which he attributed to "abstinence programs and birth control," a fairly ambiguous and tentative statement. Some have suggested that his ties to pharmaceutical companies are too tight, and that he supported Gardasil while the jury was out on its safety. 

But when Gupta was consulted about emergency contraception's then potential over-the-counter sale, he confirmed that Plan B was a "high dose birth control pill" and said that there wasn't much controversy from the mainstream anti-choice community because "they think it actually acts before - actually prevents the insemination part of this and the creation of life," thus quashing any claims that emergency contraception causes abortion. 

What a Bold Surgeon General Can Do

The public most commonly knows the surgeon general as the person responsible for putting warnings on cigarette packages. Yet the surgeon general really serves as a public health advocate in a broad sense; his or her job is to relate accurate scientific and medical information to the public to improve public health. Sticking to that job description, however, might land a surgeon general in trouble. President Ronald Reagan's surgeon general, C. Everett Koop, learned that lesson the hard way.  

Koop discovered that much of the information put forth by anti-choice groups claiming abortion had negative psychological implications for women wasn't backed up by science. He then released a statement that "the available scientific evidence about the psychological sequelae of abortion simply cannot support either the preconceived notions of those pro-life or those pro-choice." His position, viewed by many as an open rebuke to the religious right, cost him the position of Secretary of Health and Human Services under President George H.W. Bush. 

Dr. Jocelyn Elders, the surgeon general under President Bill Clinton and only the second women to ever hold the position, only served for 18 months. She resigned after a statement she made before the United Nations about masturbation; she said it is "part of human sexuality, and perhaps it should be taught." Today Elders realizes that many of the challenges she faced have remained the same. (The full transcript is available here.) 

Part of the job of surgeon general for her, as it would be for Gupta, was  to sell health care reform to the public. "You have to remember that we were trying to get through the Clinton health plan at the same time," she said. And in this respect, she thinks Gupta would excel: "I think Dr. Gupta has been out there working very hard trying to communicate with the American people. I think he would be an excellent communicator." 

Elders had a very different public perception when she was appointed than Gupta does. "Everybody knew when I came to Washington that I was interested in reducing teenage pregnancy, that I was very into reproductive health," she said. She doesn't know where Gupta stands on reproductive health, but "he has 6,000 public health people who will be working for him who are the best in the world."  

Still, Elders expects that many of the reproductive battles ahead will be on the list of battles she faced: combating thfe spread of HIV/AIDS, advocating for fully funding Title X to ensure comprehensive family planning, and calling for public funding of abortion for women on Medicaid. "I think we need to get over our ideas about how condoms will break. We know condoms will break, but the vows of abstinence break far more frequently than latex condoms," Elders said. Gupta, if confirmed, might do well to remember that.