First, Do No Harm — Gupta, Weed, Ethics, & Science

Guptas say vape. Are this his "patients"
Are these the “patients” Sanjay Gupta will help with his “non-science, non-evidence-based suggestion that vaping may be the way to consume weed? Source: Reuters/Kimberly White

Since CNN sensationalized his “Weed” reports, Sanjay Guptas has continued to erode his own credibility, for example, in his statements about vaporizing marijuana.

The biggest concern about Dr. Gupta is his relationship with science-based medicine. Being a medical correspondent is a tough job to have and still stay true to science and evidence-based medicine. The temptation to “sex up a story” or to do credulous puff pieces about the latest “alternative” medicine in order to drive ratings is strong, and it takes a strong commitment to be able to resist them.

It seems that Gupta’s weaknesses as a science-based or evidence-based professional were known even as he was being considered for surgeon general in 2009 (see article below). He didn’t make the cut then.

His carelessness in promoting marijuana to his broad TV public with no regard for the impact on public health and increasing abuse of marijuana bares out that skepticism about his professional judgement. His words on marijuana can easily be interpreted to suggest that he cares more about ratings and potential profit than he does about the impact of his comments on the drug’s use and abuse. His comments are being used as a defacto promotion of a broadly misunderstood and highly abused drug, and the result is an increase in use and abuse patterns in the unsuspecting American public.

While responsible public health officials are attempting to tamp down on the rapid increase in vaporizing drugs like tobacco and marijuana, Gupta uses his soap box to promote vaporizing drugs. The rest of the medical community knows the new conveniently concealed small vaping devices (e-cigs) are dramatically increasing drug abuse — especially among the young, Gupta voices unqualified support for the promise of vaping marijuana as “medicine”.

The foundation of ethics in the medical profession is “first, do no harm.”* Mr. Gupta needs to reflect on that very foundation of his espoused profession before he picks up a microphone again to essentially promote marijuana use to the masses.
*Primum non nocere is a Latin phrase that means “first, do no harm.”

Non-maleficence, which is derived from the maxim, is one of the principal precepts of bioethics that all healthcare students are taught in school and is a fundamental principle throughout the world.

Another way to state it is that, “given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.” It reminds the health care provider that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

Dr. Sanjay Gupta for Surgeon General? Yawn.

Posted by Orac on January 7, 2009

As I was sitting in the O.R. lounge yesterday afternoon between cases, the television in the lounge was tuned to CNN. One thing I noted was some rather fawning coverage of President Bush regarding the military that seemed as though it belonged on FOX News rather than CNN. Not long after that, Wolf Blitzer breathlessly reported that CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, had apparently been approached by the Obama Transition Team about becoming the new Surgeon General. I thought to myself, “Hmmm. That’s interesting.” And then I went back to the O.R. to finish up my schedule.

Later on, I just so happened to check my stats, and I noticed a Pharyngulanche. Apparently, P.Z. Myers was incredibly unimpressed by this pick because he seems to view Dr. Gupta as some sort of tool of the capitalist health care system. Oddly enough, he wondered what my opinion was referring to me as “that ol’ conservative.” Of course, these days I’m about as centrist as they come, perhaps slightly right of center, but compared to the predominate groupthink of the ScienceBlogs collective I might as well be a member of the John Birch Society compared to the flaming liberals that surround me. Or at least, so it seems. However, PZ is a the Big Kahuna among ScienceBloggers, and he was nice enough to boost my traffic for a day. So it would be churlish not to weigh in. Besides, everyone else and his grandmother around here appears to be doing the same, and, far be it from me as–gulp–a grand old man of the medical blogosphere (hey, four years is a really long time in terms of blog time)–to deny him or the rest of my readers my stunning insights, for which, no doubt, all wait anxiously with bated breath. (How’s that for a surgical ego?)

Suffice it to say that I, too, am unimpressed, but not for the same reason that PZ is. Indeed, it has little or nothing to do with politics. In this, I’m afraid I’ll be having a rare disagreement with blog buds PalMD, who thinks the appointment is pretty cool, and Abel Pharmboy, who admires Dr. Gupta’s communication skills. It’s pretty unusual for me to disagree with them, but, hey, it sometimes happens.

My reasons for not being too thrilled with Dr. Gupta as the new Surgeon General come down to two areas. First, like Val Jones, I think he lacks gravitas. He’s too young and has no experience as the administrator of a large organization, which is important. Although the Surgeon General is an important position, it is not a policy-making position but rather primarily an administrative position. Dr. Gupta’s academic rank is only Assistant Professor of Neurosurgery, and his other position, Associate Chief of the Neurosurgery Service at Grady Memorial Hospital, isn’t sufficient administrative experience to prepare him to administer the Public Health Service. In brief, the Surgeon General is the chief medical officer for the 6,000 strong Commissioned Corps of the US Public Health Service. It is also an advisory position, being the primary medical science advisor to the Assistant Secretary for Health, who in turn is the principal advisor to the Secretary of Health and Human Services on public health and scientific issues. Depending on what the President wants, the Surgeon General can be simply an administrator with little public role, but an unofficial role of the Surgeon General is to be “America’s chief doctor.”

It is that second role of the Surgeon General that makes me somewhat less than thrilled with the apparent selection of Dr. Gupta. A Surgeon General’s influence with the public and with policy makers derives primarily from his gravitas and his persuasiveness. If the Surgeon General is perceived as a lightweight, legislators and the U.S. public will pay him little mind.One reason that Dr. C. Everett Koop was so influential was because his long history as a pediatric surgeon and his manner led him to be respected throughout the medical community and by policy makers and the movers and shakers in HHS. I just can’t see Dr. Gupta commanding that sort of respect, given his history as a talking head.

However, what concerns me most about Dr. Gupta is his relationship with science-based medicine. Being a medical correspondent is a tough job to have and still stay true to science- and evidence-based medicine. The temptation to “sex a story up” or to do credulous puff pieces about the latest “alternative” medicine in order to drive ratings is strong, and it takes a strong commitment to be able to resist them. In this, Dr. Gupta has made some high profile stumbles. Chris Mooney points out how poorly he performed in the Clonaid fiasco. In actuality, this is something about Dr. Gupta that I had not heard about. I do remember the Raelians and their claim, presented without any evidence, that they had cloned a human being. But I either did not see or hear about Dr. Gupta’s credulous report on the Raelians. It was truly a low point for medical journalism in the last decade, and he was at the center of it. As Mooney points out, he may not have been a willing participant. He may have been inexperienced then. He may not have been confident enough in his position to say no. However, his involvement with that story does not give me confidence in his judgment.

What concerns me even more that that is that, when it comes to one of the most important threats to public health of our time, the antivaccine movement, specifically the movement that claims that vaccines cause autism, Dr. Gupta has shown a maddening tendency to straddle the fence and play both sides in his reporting. His coverage of the Hannah Poling case, in particular, was distressingly credulous, so much so that the crank blog Age of Autism approved of it heartily. Meanwhile, on his own blog, Dr. Gupta was disturbingly sympathetic to the antivaccine viewpoint:
I want to continue the discussion today. Couple of points. First of all, it seems as if parents bring up concerns about vaccines, they are automatically portrayed as anti-vaccine. Why is that? Is it possible to completely believe in the power and benefits of vaccines, but still have legitimate and credible concerns?
That’s not what we’re talking about. We are not talking about parents who worry about whether vaccines can cause harm, most of whom wouldn’t even think of prefacing their comments with “I’m not anti-vaccine,” because it wouldn’t even occur to them that anyone is anti-vaccine. I once passed on this pearl of wisdom. Whenever someone prefaces her argument with earnest and emphatic claim that she is not “antivaccine,” antivaccine pseudoscientific canards almost always follow shortly thereafter. I’m thinking of calling it the Jenny McCarthy Law of Pseudoscience because, heck, Jenny McCarthy and J.B. Handley insist over and over that they are not “antivaccine” before serving up the most outlandish antivaccine canards. It’s a ruse, because they know that if they admitted that they were in fact antivaccine no one outside of the antivaccine movement would take them seriously anymore. That’s where the whole “Green Our Vaccines” and “too many too soon” catchphrases came from.

Do I think Dr. Gupta is sympathetic to antivaccine views? Not at all. But he clearly does not recognize them when he sees them, and he seems tainted by the journalistic tendency to “tell both sides” even when there is no scientific support at all to one of the sides. Such a tendency may have served him well as a journalist (although arguably not as a science or medical journalist), but it would not serve the nation well in a Surgeon General, who must persuade the nation with clear, science-based arguments, gravitas, and moral authority.Again, the Surgeon General’s influence depends on his gravitas and ability to persuade, both of which he can undermine by even being perceived to give credence to cranks and quacks. Moreover, as Jake pointed out, the Surgeon General does not have the luxury of playing both sides of medical pseudodebates in which cranks are pitted against scientific medicine. He has to choose science- and evidence-based medicine, and he has to articulate firmly, using evidence and political persuasion, why he chose that way. He can’t afford to be perceived as lending credence to cranks, as former NIH Director Bernadine Healy has been doing so happily lately. Look at how much the antivaccine loons at AoA point to her as “proof” that scientists take their viewpoint seriously. If they do that when a former Director of the NIH says such things, imagine how much more they would do the same if an actual sitting Surgeon General said something that seemed to be sympathetic to their cause.

I’m not ignoring the considerable strengths that Dr. Gupta could bring to the job as Surgeon General. Again, a Surgeon General rises and falls by his ability to persuade, particularly when he is issuing health warnings to the nation, and Dr. Gupta’s experience and skill as a medical reporter could be most useful in that capacity. He is an excellent communicator and very telegenic. Also, from a personal perspective, I can’t help but think it would be cool to have a fellow graduate of the University of Michigan Medical School, as well as someone who grew up practically right next door to where I did (Novi, Michigan is very close to Livonia, Michigan, where my parents moved when I was 10). If Gupta can learn to dump his journalistic “tell both sides” mentality when it comes to dubious health claims, he might grow into being a formidable Surgeon General.

Unfortunately, that’s a big if.