NRA Opposes Surgeon General Nominee Vivek Murthy

March 11, 2014

President Barack Obama's pick for surgeon general — Vivek Murthy, MD — could face a tougher confirmation vote in the Senate now that the National Rifle Association (NRA) has come out against him as a supporter of "radical gun control measures."

"Confirmation of Dr. Murthy is a prescription for disaster for America's gun owners," Chris Cox, the executive director of the NRA's Institute for Legislation Action (NRA-ILA), wrote Senate leaders last month.

Such pronouncements can turn Congressional ayes into nays, given many politicians' fear of crossing the NRA and losing the gun-rights vote when they are up for election or re-election.

The nomination of Dr. Murthy to be the nation's top doctor, supported by much of organized medicine, was controversial enough to begin with. Dr. Murthy struck some Senate Republicans as too partisan for the job. He headed a group called Doctors for Obama in 2008 as well as its successor organization, Doctors for America, which supported passage of the Affordable Care Act (ACA).

Doctors for America also lobbied Congress to ban military-style assault weapons in the wake of the Sandy Hook Elementary School shooting in December 2012. "We are unwavering in our belief that strong measures to reduce gun violence must be taken immediately," Dr. Murthy stated in a letter to Congress in January 2013. He called gun violence "an important public health issue," not an unusual stance for a physician, given how medical societies such as the American Academy of Pediatrics (AAP) have said the same thing.

In his letter, Dr. Murthy also advocated for:

  • Limiting purchases of ammunition

  • Regulating private sales and transfers of guns

  • Reinstating federal funding for research on preventing firearms injury and death

  • Prohibiting laws that forbid physicians from discussing gun safety with patients

  • Removing the ACA provision that prohibits physicians from documenting that a patient owns a gun

Dr. Murthy has taken on the NRA as well, evidenced by this tweet: "Tired of politicians playing politics w/guns b/c they're scared of NRA. Guns are a healthcare issue."

In the face of pointed questions from Senate Republicans, Dr. Murthy backpedalled on this issue during his confirmation hearing before the US Senate Committee on Health, Education, Labor, and Pensions (HELP) on February 4. He promised not to use the surgeon general's office as a "bully pulpit" to advocate for gun control. He said that he would instead focus on preventing obesity, and function as a health educator rather than a politico.

On February 27, the HELP committee voted 13 to 9 along party lines to send Dr. Murthy's nomination to the Senate floor for a vote. Sen. Mark Kirk (R-IL) broke ranks with the committee's 10 Republicans to support Dr. Murthy. One of the "no" votes belonged to Sen. Rand Paul (R-KY), who notified Senate Majority Leader Harry Reid (D-NV) that he was placing a procedural hold on Dr. Murthy's nomination because of his gun-control views. Such a senatorial hold, like a filibuster, prevents the Senate from voting on a nominee.

In the past, supporters of a presidential nominee had to muster 60 votes to overcome either a senatorial hold or a filibuster. However, Senate Democrats, who control that chamber, voted last year to change the rules on presidential nominations to drop the threshold to 51 votes to surmount such obstacles. The lower bar, which Senate Democrats justified as an antidote to constant GOP stonewalling of Obama nominees, does not apply to Supreme Court nominations.

Some Politicians Fear Poor Grade From the NRA

By all accounts, Senate Democrats have not scheduled a vote on Dr. Murthy's nomination. Harry Reid's press office did not respond to repeated queries on the vote's timing.

Then again, Reid still may be working to round up the 51 votes needed to confirm Dr. Murthy. Although the Democrats command 55 votes in the Senate, including those of 2 independents, they could lose the votes of Democratic senators in otherwise "red" states who do not want to appear sympathetic to gun control. Seven such senators — Sen. Mark Begich (D-AL), Sen. Mark Pryor (D-AR), Sen. Mary Landrieu (D-LA), Sen. John Walsh (D- MT), Sen. Kay Hagan (D-NC), Sen, Tim Johnson (D-SD), and Sen. Jay Rockefeller (D-WV) — are up for re-election this November.

That's where the NRA comes into play. The letter from NRA-ILA Executive Director Chris Cox, which spoke of "Dr. Murthy's lengthy history of hostility toward the right to keep and bear arms," essentially put senators on notice that the group would be watching how they vote. An NRA-ILA spokesperson told Medscape Medical News that the group will "score" the confirmation vote for its rankings and endorsements of political candidates.

The rankings, published on the NRA Web site, are based on a candidate's overall track record on gun control and gun-owner rights. The NRA awards an A+ to candidates who have "not only an excellent voting record on all critical NRA issues, but who has also made a vigorous effort to promote and defend the Second Amendment." An F goes to "true enemy of gun owners' rights." There are 5 more grades between the 2 extremes.

Lobbyists for organized medicine say the prospect of a lower grade on the NRA report card could dissuade some Democrat senators up for re-election this fall from voting for Dr. Murthy's confirmation. To avoid that scenario, it's thought, Harry Reid may choose to hold the vote in the lame-duck session of Congress after November 4, when political pressure lessens for election-day winners and losers alike. Or, President Obama may decide to sidestep a Senate vote and put Dr. Murthy into office with a recess appointment while the Senate is on vacation later this year.

One person who predicts that the Senate will confirm Dr. Murthy as surgeon general despite the shadow cast by the NRA is Brian Malte, senior national policy director for the Brady Campaign to Prevent Gun Violence. Malte told Medscape Medical News that his group is throwing its support behind Obama's nominee.

"We think that no one is more uniquely qualified than Dr. Murthy with his extensive background in public health," said Malte. "We always say that we trust doctors about matters of public health, not the gun lobby."

The Brady Campaign joins a long list of groups that have endorsed Dr. Murthy. They include 6 medical societies: The AAP, the American College of Physicians, the American Academy of Family Physicians, the American College of Sports Medicine, the American Medical Women's Association, and the American Association of Physicians of Indian Origin. Other marquis supporters are the American Hospital Association, the Federation of America Hospitals, the American Cancer Society, and the American Public Health Association.

Dr. Murthy is a hospitalist at Brigham and Women's Hospital in Boston, Massachusetts, and an instructor in medicine at Harvard Medical School. He sits on the Prevention Advisory Group in the surgeon general's office, a body created by the ACA. One of his public health credentials is cofounding VISIONS Worldwide, a nonprofit organization promoting HIV/AIDS education in India and the United States. He is also cofounder and board chairman of TrialNetworks, a company that offers cloud-based software applications to streamline and improve clinical trials.

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