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The new surgeon general's 4 rules for health

Over the past year, Vivek Murthy has unexpectedly become one of the most controversial figures in American politics.

President Obama nominated him for the post of US surgeon general, the nation's top spokesperson for public health, back in November 2013. The Senate then promptly blocked his nomination for more than a year, particularly after the National Rifle Association criticized a letter Murthy had co-signed in support of gun control measures. Murthy only got confirmed in December 2014 after some red-state Democrats who were losing their seats anyway decided to switch course and back him.


Vivek Murthy, U.S. surgeon general, at Howard University on April 7, 2015. (Andrew Harrer-Pool/Getty Images)

In person, however, it's harder to see how the mild-tempered Murthy became such a lightning rod. He meditates daily, he told me, to "center myself, a chance for me to remember who I want to be every day." And he's starting his tenure with a listening tour that took him across America — rather than a push for any particular policies. Indeed, he has already said he wasn't interested in using his post "as a bully pulpit for gun control."

Before his swearing-in ceremony today, I spoke with Murthy at length about what he sees as the biggest public health issues facing the country, what he hopes to achieve as surgeon general, and why the best ways to boost health may have nothing to do with medicine.

Murthy's big idea about public health: institutions outside medicine often have the biggest impact

The surgeon general is essentially the nation's top spokesperson on health matters. Past officeholders have often used the position to call attention to pressing public health issues such as smoking or obesity. Murthy plans to do the same. But though he's a physician by training, he argues that institutions outside of medicine often have the biggest impact on public health.

"I first started thinking about that when I was practicing medicine," Murthy says, "and I realized that I would sit in the clinic with patients or sit at their bedside, and talk to them about changing their diet, about improving their physical activity. I would question how much of an impact I was having on their ultimate decisions about their lifestyle. If you ask any doctor or nurse who has cared for patients, they will often tell you they have had similar experiences."

He elaborated: "If we think about ourselves, it’s often our family and friends who can impact the choices we make around food. It’s the food options that are available at work or in the cafeteria that might impact the choices we make during the third of our lives we spend at work. It can be what we hear in church Sunday morning that impacts how we think about important issues in our society.

"That’s why I have come to believe if we are going to overcome the great health challenges our country faces right now, we have to do so with a coalition of leaders. This includes not only doctors, nurses, and health professionals but also our employers, schools, faith-based organizations, civic institutions, and the various people and institutions in our country that actually impact decisions people make day to day."

For example, employers and churches could play a bigger role in tackling obesity

Obesity GIF map CDC

Americans have become more obese over time. (CDC)

Take, for instance, the obesity crisis, which Murthy has called one of his top priorities. He argues that it's not enough to engage doctors on this issue — employers, faith-based organizations, and other institutions need to play a role, too.

"I want to make sure I’m working with employers to make physical activity a greater part of work culture — recognizing that this not only has benefits for the physical health of employees but also positive effects on emotional well-being and mental function," he says.

The same goes for mental health, which needs to be addressed by institutions outside of medicine. "I want to work with faith-based leaders to address the negative attitudes associated with mental illness," he explains.

This, in general, fits with Murthy's broader approach to public health: "We have to do more than build hospitals and more clinics. We have to invest in prevention and community prevention, and recognize that institutions that don’t have the word health in their name — faith-based groups, employers, schools — have a massive impact on the health decisions people make every day. That's why we have to engage these institutions in doing their part to improve health."

The surgeon general's top four rules for health

So how does Murthy focus on staying healthy? "I have four rules I follow for myself," he says.

"One is to eat healthy. I tend to avoid salt, added sugar, and processed foods whenever possible, and try to eat fresh fruits and vegetables as part of all my meals whenever possible.

"Second is to stay physically active. That means not just going to gym but incorporating activity into whatever I do, whether that’s taking the stairs or converting sitting meetings to walking meetings whenever possible.

"Third is making sure I’m focusing on my emotional and mental well-being. For me, an important part of that is the meditation practice that I do every morning. It’s a chance for me to center myself, a chance for me to remember who I want to be every day.

"The fourth thing is I remind myself to stay away from toxic substances like tobacco and drugs."

Murthy will also have to combat misinformation about public health


Dr. Oz, who has been under fire for promoting health misinformation. (Brad Barket/Getty Images Entertainment)

The surgeon general doesn't just promote public health. From his perch, Murthy will also likely have to play a role in combating misinformation. I asked him about Dr. Oz, arguably the most famous health proselytizer in America, who has come under fire for his use of pseudoscience. "I have never actually watched Dr. Oz on TV so I can’t really comment," Murthy says.

"Too often, doctors and nurses don’t speak out when it’s needed the most"

But Murthy does agree that the public often faces a problem in sorting through all the health information out there: "In general, when people think about diet and physical activity, there’s a lot of information out there, and it can be very confusing for people. That's why I think it’s very important for us to understand the science behind the recommendations we make around diet and physical activity."

He adds, "I have been on the road a lot these last few months. One of the things that came up time and again was the pervasive misinformation that exists around certain hot-button issues. Diet is one of them. In recent months, in light of the measles outbreak, there has also been some confusion around vaccinations. That was an issue I spoke about a lot on the road, helping people understand that when it comes to the measles vaccine it's both safe and effective, and there's no link to autism."

So what's Murthy's role in all this? "I will continue to make sure we are getting scientifically grounded messages out there to the public about questions that concern them the most," he says. "But it's not just the responsibility of the surgeon general but of every public health professional who understands science, who is trained to evaluate evidence, and who knows the cost we incur when patients are misinformed about the treatments they need.

"Too often, doctors and nurses don’t speak out when it’s needed the most — when there are controversies around issues, whether it be vaccines or e-cigarettes or other health topics. They can not only answer questions that the public may have but also push our institutions and policymakers and leaders to find answers when we don’t have them."

Why Murthy wouldn't want his future kids to use e-cigarettes

Murthy's mention of e-cigarettes brought up a related question. E-cigarettes are one of the biggest puzzles facing the medical community right now, since the science behind them is still so nascent. So how does he think about the issue?

"Our scientific understanding of e-cigarettes has been far outpaced by the actual use of e-cigarettes"

"Our scientific understanding of e-cigarettes has been far outpaced by the actual use of e-cigarettes," Murthy says. "This means people are asking questions we don’t always know the answers to. Some of those questions are: Do e-cigarettes have adverse effects on health? Do they lead children to be more open to smoking regular cigarettes? And do they help with cessation for people who are current smokers? These are questions we haven’t adequately answered yet through research — but we have to do so because, as a recent CDC report showed, e-cigarettes use tripled over the last year among youth. That to me is very concerning when we don’t fully understand the potential adverse impacts of e-cigarettes."

He continues, "Should we promote or allow the use of e-cigarettes by minors and by people who don’t smoke at all? This is where I'm concerned. We know nicotine is not a benign substance. We know it has potential harmful effects on the body including the development of the adolescent brain. Speaking as a regular person, I would not want my children — if I were blessed enough to have children — to be exposed to nicotine unnecessarily, whether that’s through their smoking of e-cigarettes or traditional cigarettes or whether that was through secondhand vapor or smoke."

Why Murthy appeared on Sesame Street to talk about vaccines

(Sesame Workshop/PBS via Daily Dot)

In April, Murthy did a public service announcement on Sesame Street to remind kids to get vaccinated. Can we expect more of that in the future?

"The public service announcement we did with Elmo around vaccines was just one example of the different types of communication tools we want to use to make sure we’re getting the right message to kids and adults about health," Murthy said. "But to make sure we’re reaching everybody — to use a variety of messengers, messages, channels. We have to be creative about how we do it.

"When it comes to obesity, thinking about nutrition, I want to work closely with our entertainment leaders and our leaders in sports to make sure we’re setting positive role models for kids in particular when it comes to choices around physical activity and nutrition. "

Editor: Brad Plumer
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