Around 1900, a doctor with a twirled handlebar mustache — the nation's third surgeon general — tried to quarantine California. The California citizenry howled for his bristly head.
Rats had infested San Francisco's Chinatown with plague. Californians stood in denial, opposing all assistance, so Surgeon General Walter Wyman sought to stop them all from traveling outside their state. He was overruled by President McKinley, but hung on to his job and eventually forced California to accept an eradication campaign.
Wyman stands as a hero to the country's last full-fledged surgeon general, Richard Carmona. He served four years under George W. Bush before getting into a war with the White House over second-hand smoke. When Carmona's term expired, he wasn't invited back, and Bush never nominated another. His next two appointments were "acting" surgeons general.
That's how things stand as Barack Obama takes office. The next surgeon general, Carmona says, had better be ready to walk. Someone in the next four years will howl for his or her head. It has happened to almost every surgeon general since the first was named in 1871. (Of the country's 24 surgeons general, seven have been "acting.")
In fact, this go-round, the blows have begun even before anyone has been formally nominated.
The head most recently howled for belongs to Sanjay Gupta. He's a neurosurgeon at Grady Memorial Hospital in Atlanta, a former White House Fellow, by all accounts distinguished. But he is also 39. He is also a correspondent for CNN. He was also one of the Sexiest Men Alive in 2003, according to People magazine.
Obama's transition team ran into a fair amount of ridicule when it floated Gupta's name as a possible nominee for surgeon general. David Letterman compared him with Drs. Phil and Laura.
Two previous occupants of the post say all this is good job training for whoever is eventually nominated.
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Joycelyn Elders is the most famously axed surgeon general alive.
Hers was an inspiring story — an Arkansas sharecropper's daughter who rose to be the first African-American surgeon general. She was appointed by President Clinton in 1993.
She was fired in 1994. Her specialty was pediatric endocrinology — sexual health of teenagers. She knew the minefields there, but she did not expect so short a tenure.
"I thought Arkansas was a little behind," she said last week from her home state, "but it never occurred to me that the rest of the country was even more sexually conservative."
Elders first got in trouble by advocating the distribution of condoms in schools. Clinton initially defended her. Then in 1994, she attended a U.N. conference on HIV. She was asked if masturbation might sway teenagers from riskier kinds of sex. She answered that masturbation was a part of human sexuality, "and perhaps it should be taught."
Out she went.
"I thought I was the right person, at the right time, under the right president," Elders says. "I was a black woman; I thought I could say things a white man couldn't say."
She now thinks she could have been more diplomatic, but only a little more. "I still love aggravating people," she says. She remains certain that she stood up for the integrity of the office.
"The next surgeon general must protect the office," she says. "That's what Carmona did."
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Richard Carmona's story was also inspiring. He was a high school dropout from Harlem whose salvation was the Army. He served in Vietnam, was combat-decorated, and began medical studies afterward.
His tenure as surgeon general under Bush soured in 2006 with his condemnation of second-hand smoke as "a serious health hazard." He advocated a ban on smoking in restaurants. When his term expired that July, he wasn't reappointed.
But the battle continued. Carmona said the Bush administration had tried for years to rewrite his smoking report and to dilute its impact.
He and former Surgeons General C. Everett Koop and David Satcher complained to Congress. All three cited political interference by different presidential administrations.
Carmona is a student of surgeon general history. It's not an unblemished record. The notorious Tuskegee syphilis study of unwitting black men was launched under the watch of Surgeon General Hugh Cumming in 1930 and lasted more than 40 years.
But Carmona felt inspired by the likes of predecessor Thomas Parran Jr., 1936-48, who fought for national health insurance, was attacked by the American Medical Association, and was not reappointed by President Truman. He was further inspired by Leonard Scheele, 1948-56, who fought for fluoridation of drinking water, once considered a Communist plot.
But the standard for independence, in Carmona's view, was set by C. Everett Koop, 1982-89, who fought for some of the most contested causes in the history of the office and came out as a folk hero.
It might have been the bushy seaman's beard, the brass buttons and the chestful of medals, but the public loved Koop, enabling him to survive virulent criticism on multiple public health fronts.
He was the first surgeon general to call AIDS a public health threat, to criticize gays for risky sexual behavior, and to send frank prevention information to every household. He also advocated sex education in schools and the use of condoms. In 1984, he released a report that damned nicotine as being as addictive as heroin.
But Koop's folk hero status was cemented when he dryly disavowed a report on abortion that the Reagan administration had published under his name, saying he never wrote it, read it or believed it.
He's 92, still working at Dartmouth Medical School, and not answering questions about the next surgeon general.
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Carmona, who now teaches at the University of Arizona, notes that most of the unpopular stands by surgeons general have been vindicated by history. The indoor smoking bans he advocated are now widely enforced. He also thinks that Joycelyn Elders' straight talk on sex education was ahead of its time and still mourns her dismissal.
As for the next surgeon general, Carmona says the perils grow larger. Every public health threat today is a global one — from biological terrorism to international pollution to mutating viruses.
He would like to see a surgeon general with a few gray hairs and global stature. But he would most like to see someone unafraid to take a stand.
"The legacy of integrity is paramount," he says.
John Barry can be reached at firstname.lastname@example.org or (727) 892-2258.