Prevention, Preparedness Are Top Priorities
By Carla Garnett
Photos by Ernie Branson
On the Front Page...
Just a week or so following his emergency appendectomy at Tripler Army Medical Center in Honolulu, Surgeon General Richard Carmona wanted to make a couple of things crystal clear during his Dec. 19 all-hands meeting at NIH with commissioned officers: First, he did not intentionally set out to test uniformed services' urgent-care facilities and contrary to humorous, but untrue accounts he did not remove his own appendix, although he did confess to diagnosing himself and perhaps offering treatment suggestions to his care providers. Secondly, and most importantly, he intends to use hearty endorsements of the Public Health Service from both the Secretary of Health and Human Services and the President to transform the Commissioned Corps as well as the entire PHS.
Accompanied by NIH director Dr. Elias Zerhouni, Carmona looked hail and hearty as he met for an hour with members of the corps most in uniform and other staff in Masur Auditorium. In his second official visit to NIH, the surgeon general a former Special Forces medic in Vietnam who earned the Bronze Star, the Purple Heart and a combat service medal, and later held posts as a paramedic, registered nurse, surgeon and deputy sheriff was given a hero's introduction by NIDCR deputy director and corps rear admiral Dr. Dushanka Kleinman.
"It's clear that Vice Admiral Carmona has led a non-traditional career path," she said, "and by so doing he has melted down the walls between the many sectors that society requires to maintain the nation's health."
Accepting the introduction with humor and humility, Carmona said his "many careers, which were viewed as somewhat schizophrenic prior to 9/11, all of a sudden emerged and became very desirable traits after that time. It's allowed me entrée into many areas that people always somewhat disparaged, but are now obviously mutually dependent upon one another law enforcement, EMS and so on. It's really served me well to be able to move now as your surgeon general into many of these areas and have some credibility already established."
Led by the surgeon general, the PHS Commissioned Corps one of the seven U.S. uniformed services that include the Army, Navy, Air Force and Marines is an all-officer organization consisting of about 6,000 health professionals, including dentists, scientists, physicians, nurses, engineers, veterinarians and dietitians. In a national emergency, the corps may be designated as a military service.
Currently, the nation's top doctor said, he is acquainting himself with the people and agencies he will work with in the PHS and elsewhere, as evidenced by his recent meetings with Pacific commanders in Hawaii, and corps groups at FDA and NIH. In addition, Carmona has in the last few months visited the U.S. naval base in Guantanamo Bay, Cuba, and represented the U.S. in meetings of public health officials in Santiago, Chile. He said that during such travel he witnessed an incredible global need for resources and information the U.S. can provide to help advance public health.
"I'm desperately looking for ways to have my office and NIH work together on a lot of different things," Carmona said, noting that even a bout with acute appendicitis could not prevent his recent visit to NIH, which originally had been scheduled to include sessions with institute and center directors. A briefing with the HHS Secretary postponed his meeting with IC heads.
"Secretary Thompson is very passionate about strengthening the corps and overhauling the structure," Carmona emphasized, noting that one of the mandates of his new position is "to build and strengthen the corps to create parity with the other services. That's going to take a while. It's a big cultural change, but that's where we want to go."
In recent talks, he said he has heard an "overarching theme" from the administration. "The President and the Secretary are very supportive of the U.S. Public Health Service and all of the agencies we work in NIH, CDC, FDA and so on," he explained. "There are a lot of opportunities to enhance our corps to be able to serve the agencies and to meet the Secretary's mandate that we act as one company with a single vision for the public health and well-being of the nation. The President as well wants us to act as a seamless system."
Briefly recalling the rich history of the PHS and proud tradition of corps service prior to the Vietnam war, Carmona offered a broad outline for revitalizing the 21st century corps, parts of which he said may require legislation to restructure.
"The idea now is to bring us back to our core mission," he explained, "having a unified corps that still serves all of the agencies, but first and foremost presents our commissioned officers in the uniformed services with a distinct and unique mission that does not subtract, but adds to the value of NIH, CDC and every place else. We want to strengthen corps values and bring it back to the way it was," which means establishing equivalence across the board pay, benefits, professional stature with all uniformed services. In addition, Carmona wants to create mechanisms for leadership training for corps officers akin to war colleges offered by military branches, and to offer young people entering the corps well-defined career pathways.
He admitted that his plan is ambitious, but also acknowledged that the public health problems facing the world require bold innovation, and that the administration expects nothing less.
"Every time I meet with the President, I'm more inspired," Carmona confided. "He said to me, 'Rich, I'm relying on you guys to think outside the box, to challenge the norms, to really push the envelope.' Secretary Thompson too says, 'If you're not pushing the envelope, then you're taking up too much space.' He's challenging all of us to do great things. They're both saying, 'You're here for a limited amount of time. Create a legacy that we can all be proud of when we leave.' Once we leave here, there must be a sustainable legacy that has transformed our public health culture and made it better. I know I can't do it without all of you.
"My agenda is prevention," Carmona continued. "I see the same data that you do, as far as the economic and disease burden on our society. It is unsustainable. It's really a sin that we are spending so many resources on things that are largely preventable. In spite of the wonderful clinical research and basic science research both are necessary and we need to do them the other part of the equation is prevention. That's everything, including the obesity epidemic that we have now, with its tangential negatives of diabetes and cardiovascular disease. We're looking at about half a dozen items that, if we were truly able to prevent, we wouldn't have a healthcare crisis. We need to become a prevention-oriented society one that accepts social responsibility, makes good decisions. Things like not smoking, increasing physical activity and eliminating risky behaviors are very simple, cost-effective measures that can have a huge impact on our society. After all, the lifestyles that we are creating today are what our children and grandchildren will inherit."
For their part, NIH'ers took the gathering as an opportunity to pose questions about a wide range of topics, including whether the corps would be called upon to lead the way in smallpox vaccination, and the possibility of PHS participation in war efforts.
"The other thing that I've been tasked with is preparedness," Carmona responded, reminding the audience about the corps' role as back-ups to the military during conflicts and to provide humanitarian assistance in war-torn regions. "We're all interested to see how the new agency [Department of Homeland Security] takes shape, and I've been told that I need to be very involved in that, in educating the public and interfacing with local and state agencies regarding preparedness activities for all hazards...bioterrorism being one small part of a much larger hazard that we all face."
Addressing queries about research's place in his agenda, Carmona said he highly prizes the research components of the PHS and will rely on NIH and other science-based agencies to help him prioritize areas for emphasis.
"I am still a bit dismayed by the fact that much of the work that is done here and around the world by our Commissioned Corps and civil servants goes on anonymously," Carmona said, noting that one of the most effective roles a surgeon general plays is as chief global health advocate. "The public doesn't realize the huge unparalleled asset it has. From turning on clean drinking water every day to the advances your doctor provides when you have an illness or disease that was incurable a decade ago it's taken for granted. One of the things I want to do is make sure the public does understand the enormous contributions that all of you make."
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