Is the Surgeon General up to the Task?

In August of this year, Jerome Adams, MD, was sworn in as the 20^th Surgeon General in U.S. history. This office has a long history dating back to 1871 when Dr. John Woodworth became the country’s first "Supervising Surgeon."

Historically, the surgeon general has always been a doctor and is sometimes referred to as "The Doctor of the US." His role is to prevent illness and offer the best evidence-based recommendations to keep the public healthy. The surgeon general is the spokesperson of the U.S. government on all public health-related issues.

Adams vowed to take on the opioid crisis when he was recently appointed. But, is that where doctors think he should be spending his time? According to a recent survey conducted by Platform Q Health, the answer seems to be yes. Of the choices provided, approximately 45 percent of respondents felt the top priority of the surgeon general should be addiction recovery and mental health.

Statistics from several sources reveal the opioid epidemic continues to grow and is a main contributor to drug related overdose deaths. The CDC estimates that 91 Americans die every day due to opioids (both prescription medications and IV heroin). In a data analysis conducted by The New York Times, it was revealed that drug overdose deaths rose 19 percent from 2015 to 2016 and it is expected to rise even more in 2017.

The previous Surgeon General, Vivek Murthy, MD addressed drug and alcohol addiction in his landmark study. It was the first time in U.S. history that the topic was addressed and resulted in a 400-page report. He concluded that approximately 20.8 million Americans suffer from a substance abuse disorder. Of these, only 10 percent are receiving any treatment for it. In August 2016, Dr. Murthy sent a letter to every physician in the U.S., citing the fact that two million Americans suffer a prescription opioid abuse disorder.

Despite all of this attention, the opioid crisis continues to expand and drug overdoses climb. Can the new surgeon general reverse this trend?

Mental healthcare is another area that needs reform and attention from the Surgeon General. It is estimated by Mental Health America, a non-profit community, that around 57 percent of patients with mental health disorders receive any treatment.  Of those receiving treatment, 20.1 percent state that they do not receive the treatment that they need. The access for mental health care seems to be even more dismal for youths. Of those suffering major depression, over 60 percent (age not specified by Mental Health America) are not receiving any treatment.

The reasons for this lack of treatment for mental health disorders is a multitude. For one, people often face many barriers to care, even from people within the system itself. Health insurances cover mental disorders differently than physical diseases. Society places many stigmas on mental diseases and it is very difficult for a patient to fight these from all corners. According to the poll results, finding evidence based patient education was a top priority for 20 percent of the respondents. We see the term "fake news" floating around these days and it is often surprising how gullible some people may be. But when it comes to medical information, "fake news" becomes downright dangerous. Anyone can post any medical or health information online that they want. A clear job of the Surgeon General is bringing the best evidence into the hands of the patients making decisions.

Another 18 percent of those answering the poll said that antibiotic stewardship should be the top priority. Through the inappropriate use of antibiotics, we are increasing drug resistance and giving rise to superbugs. Infections that previously only originated in hospitals, such as MRSA, are now more frequently seen in community settings. It is becoming difficult to find antibiotics that are effective to treat these bacterial infections. If we continue down this path without addressing it, we will soon find that we no longer have effective tools to treat even common bacterial infections.

Similarly, 17 percent answered that the top priority should be readdressing vaccines. To tie in an earlier priority, here is a good example of how non-evidence based medical information can be harmful by preventing children getting needed vaccines. Over the past few years, we witnessed the carnage that newly emerging diseases such as Ebola and Zika virus can produce. It has never been more apparent that we need to be prepared to produce new vaccines in short amounts of time. When these new infections were wide-spread, it was clear just how ill-prepared we are. A job of the new Surgeon General should not only be in readdressing vaccines but in developing the means of rapidly manufacturing new ones.

The Surgeon General has huge shoes to fill. While we can share our opinions and answer polls, he must take action to address all these health threats as well as prioritize those that are most imminent.

Is he up to that task?