Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
Acting Assistant Secretary for Health
United States Surgeon General
U.S. Department of Health and Human Services

Remarks to the American Medical Associationís National Advocacy Conference

Washington Hilton and Towers, Washington, D.C.
March 5, 2003

Thank you for that kind introduction, Yank (Coble, President of the AMA).

It is a real pleasure to be here among friends, and colleagues. Thank you for the invitation to speak at your advocacy conference. As Albert Einstein once said, "It is the duty of every citizen according to his best capacities to give validity to his convictions in political affairs."

Participating in the political process, making your views known, is what America is all about.

Congress is made up of lawyers, for the most part. You have an important role as doctors in educating Congress about the health issues they are looking at.

The last six months, since I was sworn in as Surgeon General, has been a whirlwind. I feel like Iíve aged in dog years. In fact, when I started this job, I had a full head of hair!

Iíve crisscrossed the country countless times already, and even represented the United States at an international conference.

And a day doesnít go by where I donít feel the enormity of the job that I have had the privilege to come into, the responsibility that I have.

President Bush has asked me to focus on several priorities as Surgeon General. Later, Iíll outline those for you. But first Iíd like to tell you a little about myself, how I came to be Surgeon General, the values I bring to the job.

  • Growing up in barrio in Manhattan - we were poor
  • I dropped out of high school and I ran the streets, getting into things I shouldnít have.
  • Then I went into the Army, and learned about accountability, responsibility and leadership. I got my GED. Served as SF medic. At age 19, delivered babies, saw my friends die, was wounded myself.
  • I enrolled in Bronx Community College in an open enrollment program.
  • My uncle had arranged for me to get a job in the electrical union, but I said I wanted to be a doctor. He thought I was crazy, because it just wasnít done.
  • But I was determined to be a doctor, so I went to medical school in San Francisco. Iíve been a nurse, a paramedic, a doctor, a professor, and a surgeon.
  • Then, I was thrilled to be asked by the President to be the 17th Surgeon General of the United States.
  • President Bush and HHS Secretary Thompson have charged me with three priorities: prevention, public health preparedness, and closing the gap of health disparities for minorities. Today I would like to focus on disease prevention, and what you can do in your own practices, and lives, to help.


    The life experiences I have described have shaped my approach and passion about prevention. Everything I do will focus on prevention first. Our nationís biggest health problems are smoking-related illnesses and illnesses related to obesity and overweight, what I call Ďthe terror within.í These are largely preventable through individual choices and healthy behavior.

    As we look at the broad picture of health care in this country, there are perverse incentives in our nationís health care system.

    We are a treatment-oriented society. We wait for people to get sick and then we spend top dollar to make them healthy again. I am grateful for what science has brought to the public in the form of miracle interventions. But we shouldnít have to rely on good science to undo peopleís bad choices.

    We reward caretakers for doing extraordinary things that are very costly, to save somebody who largely could have made decisions years before, or even that very day, that would have prevented the disease or injury from occurring.

    The incentives are perverse. And the pendulum has to swing to the other side.

    Do you know the fastest-growing cause of illness and death in America today?

    It is not smoking, drug abuse, or alcoholism, as terrible as those things are. It is not AIDS, or suicide, or motor vehicle injury.

    The fastest-growing cause of illness and death in America today is being overweight or obese. When I speak to people around the country, many are stunned by that fact. 300,000 Americans a year die from its complications. Thatís nearly 1,000 every day, one every 90 seconds.

    If we donít do anything about it, we will have a morbidly obese dysfunctional population that we cannot afford to care for. Obesity leads to hypertension, heart disease, type 2 diabetes and other problems.

    Did you know that we spend $117 billion a year on medical costs related to overweight and obesity . . . And an additional $132 billion on the costs associated with type 2 diabetes?

    Think of the loss of productivity, the pain and suffering caused by obesity, diabetes, and stress! What if we had that $250 billion available for other things?

    We canít afford the disease and economic burden we have today. . . what will our kids and grandkids do in the future?

    One of the first things Iím going to work on is teaching Americans, especially children about the importance of healthy choices, not when they are adults, but now.

    We are seeing a generation of kids who have been raised ON the Playstation and OFF the playground. More than a third of high school-age kids donít engage in vigorous physical activity. Ever!

    But it is so important, because the choices kids make now, the behaviors they learn, will last for a lifetime. As adults we must lead by example.

    I take leadership by example very seriously, and I know you do, too. I work out every day and make healthy choices in my life. President Bush is probably one of the busiest men in the world, yet he finds time to exercise almost every day.

    And Secretary Thompson has put HHS on a diet and has led by example by losing 15 pounds.

    The Secretary has his entire staff wearing pedometers. And heís always asking them how many steps they have taken.

    And, every time the President or Secretary see me, the first thing they ask is "Rich, have you worked out yet today?" and I always answer "Yes, Sir!"

    Government can be a partner in our prevention efforts. President Bushís fiscal year 2004 budget proposal includes $125 million to prevent diabetes, obesity and asthma through community-based healthier lifestyles. Local programs will be designed to promote healthy behavior Ė particularly those focused on youth and older Americans.

    This is part of "Steps to a Healthier U.S.," which is the Secretaryís prevention initiative.

    Our goals for next year include preventing diabetes for at least 75,000 Americans; preventing obesity for at least 100,000 Americans, and prevent asthma-related hospitalizations for at least 50,000 Americans.


    Despite years of advice from the medical community to their patients, smoking is still one of Americaís top public health problems. We have made a lot of progress in recent years. But when 400,000 Americans still die each year from their habit, that tells us we still have a long way to go. Smoking is still the number one cause of preventable mortality.

    Treating smoking related diseases costs us $50-73 billion a year.

    Just today, 3,000 kids in the U.S. will start to smoke. Weíve got to get them to stop starting. And once they start, weíve got to get them to quit, before the health consequences are irreversible.

    What are we doing about this problem?

    1. Our National Tobacco Control Program gives funds to states to prevent youth smoking and promote smoking cessation programs.
    2. HHS has also established a partnership with the Robert Wood Johnson Foundation and the National Cancer Institute to help youth quit smoking.
    3. Weíre providing funding to states to support Tobacco-Free Sports activities, like the Tobacco-Free Sports Playbook.

    These are all good efforts, but much more needs to be done.

    This year we will issue a Surgeon Generalís Report on The Health Consequences of Tobacco Use. This is the first comprehensive look at the evidence of the health effects on active smoking among Americans since the 1989 Surgeon Generalís report, and it will include some information about adolescent smoking, and how to prevent teens from smoking and stop them once they start.

    Treatment Oriented vs. Prevention Oriented

    As I see it, we can no longer, as a society, afford to tolerate the poor choices that have given us this huge disease burden and huge costs. We have a health care crisis now, in terms of cost.

    How do we bridge the cultural divide from a treatment society to a prevention society?

    The medical community can lead by example, in my view. Put in practice the behavioral guidelines that we know work. All of your patients can benefit from the Ďprevention message.í Encourage your patients to

  • eat smartly,
  • exercise,
  • stop smoking and drink in moderation,
  • reduce risks
  • And do it yourselves!

    Value of Scientific Research in Disease Prevention

    Scientific research is also very important to our shift to a prevention-oriented society. Advances in science mean we are quickly moving into another major evolutionary development in public health: that of health promotion.

    Public health for the past 150 years has been largely concerned with keeping people alive and alleviating suffering. But recent scientific discoveries will translate into our ability to help people avoid illness entirely and get the most out of life.

    For instance, in the next decade, we will likely be able to screen populations for genetic information that will enable doctors to target interventions to individual patients to avoid adult-onset illnesses, years before their first symptoms would have appeared. Specific diets could be prescribed based on your genetic profile.

    But thanks to biomedical research and the great imaginations of scientists in academic, private, and federal laboratories, treatments are being developed that will make some surgery a thing of the past.

    And thatís a good thing. I often call myself a Ďrecovering surgeon.í

    As a recent issue of Time magazine points out, "Drugs like Herceptin for breast cancer and Gleevec for leukemia work by blocking the chemical signal that tells the cancer to grow. They herald the day when we can look back on the traditional slashing and burning of cancer patients as having been as primitive as bloodletting."

    Molecular computers and hybrid bio-nano systems will push medical technology very quickly, allowing us to live longer and healthier lives.

    Rather than looking at health as a state of being Ďdisease free,í the new health promotion paradigm will look at health as maximizing our abilities and feeling as good as possible during a larger part of our longer life span. The opportunities are limitless.

    But, while biotechnology gives us the ability to improve and enhance life, it can also be deliberately used to spread contagious diseases and destroy human flesh, as we are now discovering in our fight against terrorism.

    This is the great paradox of scientific discovery: As we learn more about creating and improving life, so too do we learn how to destroy it. 

    Science has the potential now to outpace human understanding of the ramifications of what we are undertaking. We need to move carefully but deliberately. There could be huge unintended consequences.

    I have faith that most scientists care a great deal about the applications of their discoveries, and will not step over lines drawn by societal conscience.

    And it is incumbent on those of you who are experts in the fields of medicine and science, to protect science.  To prevent thoughtless science from prevailing in the name of scientific progress.

    With your expertise comes a great responsibility to understand the intended and unintended consequences of new medical discoveries, and to relate them to the governmental leaders and to the general population.

    Most people have a general sense and expectation that science continues to progress, however they donít know what the implications are for themselves, or for their families.

    While we, as a nation, will reap the benefits of medical research, medical research must take its time with the nation.

    As we move forward in science and medical research, we must also take care not to leave the public behind.

    There is a wide diversity of opinion in America from condemnation of some of the new technologies to unqualified endorsement.

    While industry, government and academia are now engaged, the risk is to leave the public out of the debate, which will cause even greater disharmony and divisiveness.

    As doctors, you will play an important role in communicating information about new medical discoveries to your patients.

    We must ensure that Americans are informed, that they understand the context of scientific advancements, that they know that policies are based on knowledge and science, not ignorance and hype.

    But by taking the necessary precautions and time required by society, we can assure safe and reliable scientific progress.

    In closing, Iíd like to leave you on this personal note. After almost 6 months, I am still profoundly humbled by this extraordinary opportunity and responsibility that President Bush afforded me.

    I will dedicate myself to creating a legacy of positive change for our country. I am thrilled to serve as your United States Surgeon General and with your help we can make a difference. Thank you.


    Last revised: January 9, 2007