Acting Surgeon General Confident in the Battle Against Tobacco, Ebola, and Preventable Diseases

Not many health care leaders can transition smoothly from discussing the importance of walking 30 minutes per day to the need to send PHS officers to help control the Ebola epidemic in West Africa. The Surgeon General has to. As the most prominent public health official, the Surgeon General must offer a reassuring voice on health care issues big and small. With over 26 years at the PHS, Rear Admiral (RADM) Boris D. Lushniak, MD, MPH, is well equipped to handle the challenging role.

A year after assuming the role and just before delivering a plenary address at the 2014 AMSUS meeting, RADM Lushniak agreed to a wide-ranging conversation with Federal Practitioner. The following is condensed and edited, but the complete interview can be found at http://www.fedprac.com.

Rear Admiral (RADM) Boris D. Lushniak, MD, MPH, is the Acting United States Surgeon General and oversees the operations of the U.S. Public Health Service Commissioned Corps. He served as Deputy Surgeon General from November 2010 until July 17, 2013, when he assumed the duties of Acting Surgeon General. RADM Lushniak brings 26 years of experience in the PHS to the position. He has served with the Epidemic Intelligence Service and the National Institute for Occupational Safety and Health, both at the CDC. He also served at the FDA as the Chief Medical Officer of the Office of Counterterrorism and later the Assistant Commissioner, Counterterrorism Policy and Director of the Office of Counterterrorism and emerging Threats within the Office of the Commissioner. After Hurricane Katrina, RADM Lushniak served as the HHS representative in San Antonio, Texas.

---

The 50th anniversary of the Surgeon General’s report on smoking

RADM Boris D. Lushniak, Acting Surgeon General. Go back to January 1964 and realize what a different world we lived in back then. In fact, that report, which came out after a year and a half of scientific deliberations, of looking at facts, of searching through the literature, came up with a very important conclusion. That conclusion, simply put was: Smoking is bad for you.

Now it really was a landmark report from that perspective, but when we look back 50 years, what did it prove? It proved that cigarette smoking was directly associated with only 1 cancer at that point, specifically lung cancer in men. The report had a very simple but beautiful conclusion. It said that cigarette smoking is a health hazard of significant importance in the U.S. to warrant appropriate remedial action....

A half-century later, the social norms of our society have changed. We don’t have ashtrays all around. We don’t smoke on airplanes anymore. We oftentimes can’t smoke in bars and restaurants and establishments like that. We’ve moved from 43% of our population that smoked in 1964 to 18% currently.

We’ve had 32 Surgeons’ General reports since that first one....We brought up the issue of secondhand smoke 25 years ago. We talked about the successes and failures over these years, but 50 years later smoking remains a major public health problem in this country....

When we look to the future, what’s the goal? Well we really want to get to a zero point. We reannounced with the 50th anniversary report, which was released in January 2014, that this is an endgame strategy. At some point we have to realize that it’s not good enough to get down to 18% because of the health impact. Cigarettes and tobacco use in this country bring no good; no good to the individual, no good to the individual who has to deal with secondhand smoke, and no good for the future of our nation. So we’re really talking about an endgame strategy....

Our 50th anniversary report wasn’t just looking backward....It contains current data that now show us that we’re up to 13 different cancers caused by tobacco use. We know the impact on the whole human body. In essence, it affects almost every single system of the human body now. Brand-new diseases, formerly not associated with smoking, are still being discovered.

Most recently, we’ve seen diabetes and colon and rectal cancers as some of those diseases. We’re talking about blindness associated with smoking. We’re talking about diseases such as erectile dysfunction, which are associated with smoking. This product has brought nothing but grief and sorrow into our society and continues to do so.

Now it’s not only an impact on the United States for the Office of the Surgeon General’s to speak, but also in essence we know that internationally people look at the Surgeon General reports that come out of this office as that stellar scientific information that then can be translated worldwide.