Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Wednesday, July 10, 2002

    Dr. Davey Crockett: The Bush nominee for surgeon general, Richard Carmona, is coming under attack. He certainly is colorful, to say the least. Like Davey Crockett, he's had many bold adventures, and like Davey Crockett, he likes to embroider them in the telling. People say he's abrasive and egotistical (well, he is a surgeon), that he's difficult (he is a surgeon), and that he lacks people skills (he is a surgeon), but his patients like him (he is a surgeon?). Not surprisingly, he's made a lot of enemies. One of them, Dr. Charles W. Putnam, has been busy writing disparaging letters about his nemesis:

    Charles W. Putnam, a University of Arizona surgery professor who has worked with Carmona, told Kennedy in the letter that he did not want as his surgeon general someone "who was removed from his two previous administrative appointments ... because he could not work in an effective or even a civil manner with health professionals and other constituencies of those positions."

    Dr Putnam didn’t stop there. He also brought up a shoot-out that Dr. Carmona had and won, with a man who was threatening another driver after an auto accident. Dr. Carmona, at the time, was acting in his capacity as a sheriff’s deputy. The other man died from his wounds. It was discovered later that he was insane and had just murdered his parents. Dr. Putnam thinks that Carmona should have had more compassion for the victim:

    "It is patently clear that Sheriff Carmona ... not Dr. Carmona, was at center stage," Putnam said of the shootout in his letter to Kennedy. "Could not a physician have recognized the behavior of a mentally ill individual and responded in kind?"

    Well, no. You can’t tell the difference between mental illness and plain old out of control rage when someone is on a rip. Dr. Putnam is being much too hard on Dr. Carmona. Others have criticized him because he didn’t rush to help the man after he shot him, as initial media reports had indicated, but instead went back to his car and reloaded his revolver first. Still others interpret his killing of a homicidal lunatic as a violation of his Hippocratic oath.

    As Donald Rumsfeld would say, “Oh my goodness.” First of all, you can’t tell if someone’s dead unless you are right up on them. You have to hear their breath, feel their pulse, and see their chest move. To do this, you have to touch them. Who among us is brave enough (or dumb enough) to go up to a homicidal lunatic on the ground and touch them without re-arming himself? Presumably, Dr. Putnam would be. I’d sure as hell make sure I was protected before I went within striking distance.

    As for the bit about the incident violating the Hippocratic oath, that’s just ludicrous. The Hippocratic oath is intended to set guidelines for a doctor’s behavior with his patients, not his day to day personal interactions, or his relationship with society at large. That “do no harm” phrase refers to treating patients. It doesn’t mean a doctor can’t defend himself or those around him with deadly force if necessary. It does mean he can’t give his patients a lethal dose of a drug or perform abortions, both of which are mentioned immediately after the “do no harm” phrase in the oath. Oops! I guess we don’t take that part of the oath seriously anymore, do we?

    And About Those Board Exams: The other complaint that the LA Times article makes against Dr. Carmona is that he had to take his general surgery boards three times before passing them. They imply that this makes him unsuitable for the job. Well, not so fast. Here are the minimal requirements for the job:

    -A medical degree from an accredited medical school
    -At least one year of postgraduate medical training
    -Licensure to practice medicine in 1 of the 50 states

    Dr. Carmona exceeds them. You don’t need to be board certified to be surgeon general. David Satcher doesn’t appear to have been. He isn’t listed in the diplomate directory of the American Board of Family Practice, and he doesn’t mention his board certification status in his resume. Joycelyn Elders isn’t listed in the directory for the American Board of Pediatrics, although her resume claims that she was “certified” in pediatric endocrinology. Antonia Novella, (appointed by Bush pere), however, is board certified in pediatrics.

    You certainly don’t have to be a good doctor to be surgeon general, presuming board certification makes you one, which it doesn’t. Surgeon generals never touch patients. Dr. Carmona does seem to be wanting in administrative and management skills, but is that even necessary anymore for a surgeon general? According to the office’s own website, the surgeon general has been demoted from being in charge of public health affairs to being a spokesperson for public health policies. It’s hard to imagine how anyone could mess that up. (Well, OK, Joycelyn Elders did.)

    UPDATE: The buzz is that Carmona will be confirmed. But, the most interesting tidbit was this:

    Further complicating Carmona's role is that Bush has asked Congress to shift all bioterrorism issues from HHS to a new Homeland Security Department. Asked how that would affect Carmona's vow to work on the issue, Pierce said, "I'm not going to speculate on that."

    I guess the CDC will pretty much be out of the loop on bioterrorism prevention.

    posted by Sydney on 7/10/2002 01:34:00 AM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006