Surgeon General Nominee Breezes Through Senate Hearing

Alicia Ault

August 01, 2017

Republicans and Democrats on the Senate's Health, Education, Labor and Pensions (HELP) Committee seem unified in support of a slate of nominees for positions in the US Department of Health and Human Services, including Jerome Adams, MD, as the next surgeon general.

Jerome Adams, MD (Darron Cummings/AP)

Dr Adams, currently Indiana State Health Commissioner, was nominated by President Donald J. Trump in late June after he fired former Surgeon General Vivek Murthy, MD.

At the HELP committee hearing today, the senators also questioned Elinore McCance-Katz, MD, PhD, nominated as the assistant secretary for mental health and substance use, a new position that is being called the mental health "czar." In addition, they weighed the nominations of Lance Robertson for assistant secretary for aging, Brett Giroir, MD, for assistant secretary for health, and Robert Kadlec, MD, for assistant secretary for preparedness and response.

Senators on both sides of the aisle wanted to know how the nominees would address the opioid crisis, which legislators called a top priority. Democrats also asked nominees whether they would put science before politics.

Questions on Surgeon General's Independence

"President Trump's firing of the previous surgeon general just halfway into his term, shows to me a lack of respect for that office and for the independence of science," said Washington Democratic Senator Patty Murray. "I want to make clear today the next surgeon general must be an advocate for science and facts, and must be able to stand up and correct misinformation coming out of this administration," she said.

Dr Adams did not directly answer Murray's question, but repeatedly spoke during the hearing about the need to collaborate with many groups and advocates, and to be especially attentive to those with differing viewpoints — a lesson he says he learned in dealing with an opioid-related HIV epidemic in Scott County, Indiana.

"The biggest lesson I learned is that the science and the evidence is necessary, but not always sufficient to motivate change," he said. "I always want to lead with the science and represent the science, both as a physician, and if I'm confirmed as surgeon general," said Dr Adams. "But I also want to listen to what stakeholders are saying, and what my patients, if you will, the people of this country, are saying and speak to them in a way that resonates with what their goals are."

Dr Adams said the opioid epidemic would be a top priority. And, if confirmed, "I also hope to make wellness and community and employer engagement centerpieces of my agenda." 

The nation misses too many opportunities for prevention, he said, adding that he hoped to work with local communities to help them find ways to prevent obesity and addiction. He said, "American prosperity and competitiveness are being compromised by America's poor health," adding, "I truly hope to make America healthier."

Senator Elizabeth Warren (D-MA) lauded Dr Adams and said, "I hope very much that we are friends," adding, "You are an evidence-based, committed physician. Even if it is politically unpopular, I think that's what we need right now in addressing the opioid crisis."

Another Democrat, Senator Chris Murphy of Connecticut, asked Dr Adams — a gun owner — what he thought of gun violence, noting that organizations that were endorsing him for surgeon general — such as the American Medical Association and the American Public Health Association — have called it a public health crisis.

"What we have to do is separate the tool from the perpetrator," said Dr Adams. "Cars are not a public health problem. Car accidents are a public health problem. Guns and gun owners aren't inherently a public health problem, but the violence absolutely is," he said. "There are lots of partners out there if we're just willing to stop demonizing each other," said Dr Adams.

Murphy was skeptical, and urged Dr Adams to look at "the evidence that suggests that the propensity to commit a crime with a gun is directly connected to the likelihood that a gun is in close proximity to you."

Can Czar Right the SAMHSA Ship?

Both Republicans and Democrats wanted to know whether Dr McCance-Katz, a former chief medical officer at the Substance Abuse and Mental Health Services Administration (SAMHSA), thought she could bring together the various federal agencies to effectively address the opioid crisis.

Republican Senator Bill Cassidy of Louisiana said that SAMHSA had been a hugely dysfunctional agency, and that he hoped Dr McCance-Katz could bring some leadership to the federal effort to tackle the opioid crisis.

Dr McCance-Katz, currently chief medical officer of Rhode Island's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, said that one of her first moves would be to gather data from all the agencies that dispense federal grant money related to the opioid crisis.

"One of the things we're going to have to do is look at metrics and determine whether these programs really work," she said.

Dr McCance-Katz also said she would advocate for education for Americans on the safe and effective use of pain medications, and also education for healthcare practitioners on pain management and identification of substance use disorders and comorbid mental illness. Another priority will be helping the seriously mentally ill, she said.

She has received endorsements from the American Psychiatric Association (APA) and the National Alliance on Mental Illness, but her nomination was attacked by Rep. Tim Murphy, the Pennsylvania Republican who authored the law that created the new mental health czar position.

The APA issued another endorsement the morning of the HELP hearing. "I am confident that, as an APA member psychiatrist, she will be able to help our nation's government tackle pressing issues in mental health. The APA strongly supports her nomination," said APA President-Elect Altha J. Stewart, MD, in a statement.

The committee plans to vote on the nominations on August 2, and a Senate floor vote would follow soon after, said Chairman Lamar Alexander of Tennessee.

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