New Surgeon General promises science, not political ideology, drives his policies

He joined a Republican administration last month that's often accused of downplaying or disregarding science, but the new surgeon general says he's "nonpartisan" and will let science and data drive his approach to the opioid epidemic. 

"It's more important than ever to have that objective voice," physician Jerome Adams said in his first sit-down interview since taking office. "Everyone's got their own opinion (but) make no mistake, the science does matter." 

Adams says his first “Surgeon General’s Report” will be on health and the economy, due in large part to the importance of jobs for people in recovery and because addiction is the main impediment to solving unemployment in many states.

After President Trump declared the opioid epidemic a public health emergency on Thursday, Adams issued a statement underscoring his passion for partnerships that include employers: "We must ... fully leverage all of our public health, business, law enforcement, and community resources to address these issues head on," he said.  

The epidemic's economic connection is embraced by even Virginia's Democratic Gov. Terry McAuliffe. He said at a panel discussion that included Adams recently that employers tell him up to seven out of 10 of job candidates in his state can't pass the drug test. 

In Indiana, where Adams was health commissioner under then-Gov. Mike Pence, the state had one of the lowest unemployment rates in the country but employers would often say "we can't find enough healthy employees," he says. 

Working for Pence not only got him his new job, it prepared him for the kinds of ideological battles he avoids but will likely have to face. He convinced the conservative Pence to fund needle exchanges for intravenous drug users after one county faced the biggest HIV outbreak ever in the U.S. 

The first anesthesiologist to hold his new job, Adams insists he's not a Republican and doesn't even say he's “bipartisan” anymore as that would suggest political ideology influences him at all. 

Adams would have far more reason than most to let emotion rule his response: He has a brother who had untreated mental health issues that led to substance abuse disorder and landed him in prison. Family members also have HIV and Hepatitis C. 

The rest "suffer from about every chronic disease you can think of," he says. His grandfather developed lung cancer from smoking, and died of a heart attack due to complications of cancer surgery. His mother used to be obese, lost considerable weight but still has Type II diabetes, as does a sister. His father has suffered from heart disease, hypertension and high cholesterol. 

"It tells him we have these problems in every family in one way or another," says Freeman Hrabowski, who has been president of University of Maryland, Baltimore County, since before Adams was there as a student in the mid-'90s. "He’s seen it up close." 

Hrabowski remembers Adams so well because of his intense focus and because he was one of the first "Meyerhoff Scholars," then about 40 of the most promising among 1,000 or so African American male students nominated by their high schools. It was part of an experiment to see if the students could excel at math and science at a predominantly white college. The goal was for them all to go on and get doctorates or medical degrees and doctorates. Hrabowski acknowledges Adams hasn't exactly disappointed with his medical degree from Indiana University and master's in public health from University of California, Berkeley. 

Adams volunteered during another recent panel discussion that the drugmaker Eli Lilly paid for his medical school education. 

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Adams' list of things healthy communities have to have may run counter to the administration's plans. Along with parks and grocery stores, it includes "clean air laws." In some asthmatics, air pollution triggers asthma, which Adams himself suffers from. The Trump administration has been rolling back clear air rules issued by former President Obama, arguing that regulation stunts economic growth.

That puts Adams in a tougher spot than most.

"There is a certainly a tradition in surgeon generals speaking truth to power," says Josh Sharfstein, who has served as the top health official for both the city of Baltimore and the state of Maryland. "Some of what Dr. Adams will have to do will be behind closed doors."

People may not cite health when asked what issues are most important to them, but they cite jobs, safety and security, says Adams. 

"The communities that are suffering from the opioid epidemic in many cases are communities that have suffered from a poor economy in which you've seen a vicious downward spiral and they're also communities where you've seen crime increase," says Adams.

Koop's big shoes

Surgeons general are typically primary care doctors and those physicians tend to be more liberal, while higher-paid specialists lean more conservative, says physician Adams Dudley, who heads the University of San Francisco's Center for Healthcare Value. That and the fact he was appointed by Pence and then Trump has led some —including Democratic senators at his confirmation hearing — to question his commitment to public health. 

Adams is prepared for the questions. 

After working as an anesthesiologist treating patients from "six months to 96" and prescribing painkillers including fentanyl and morphine on a daily basis, Adams says he has "a very unique skill set that's well suited to the problems our country is facing right now."

"I think in many ways, God put me in this place at this time for a very specific reason," he says. 

The opioid epidemic is considered the biggest public health crisis since AIDS in the 1980s. That occurred during the tenure of the nation's best-known surgeon general: The late C. Everett Koop. 

Koop sent letters to every home in the country warning about HIV/AIDS and how it was transmitted. That wasn't exactly President Ronald Reagan's idea. 

Koop is the surgeon general "everyone brings up because he was a giant," says Adams.

But unlike Koop, who was a pediatric surgeon, Adams says he will not focus on a "particular disease or problem du jour." 

The opioid epidemic is the top priority for everyone at the Department of Health and Human Services Adams says, and he shares the agency's two other top concerns: Mental health and obesity. 

No matter what ails Americans, however, Adams says he believes community partnerships will help everyone's health. 

Along with the needle exchange in Indiana, Adams stood out for his efforts to "look at the circumstances that led to the HIV outbreak," says former Massachusetts health commissioner John Auerbach, citing unemployment, poverty and a "lack of hope."   

Helping people find work, getting them into counseling and dealing with their other "social determinants of health" were part of the "cutting edge public health" Adams practiced, says Auerbach, who now heads the non-profit Trust for America’s Health.