Outspoken A Conversation With Sanjay Gupta

Sunday, May 3, 2009

He was going to be President Obama's pick for U.S. surgeon general, the physician who would explain medical crises and mend the nation's bad health habits. But Dr. Gupta opted not to answer the page to Washington and to stay on in his current roles as a neurosurgeon and CNN reporter. Now, however, with swine flu upon us, there he is, on television, calmly explaining this crisis.

So maybe, in a sense, he took the job after all? While on assignment in Mexico, he spoke by phone with Outlook's Rachel Dry about why we shouldn't blame the pigs, how he might have to be quarantined when he gets home and the difficulty of talking pandemic without causing panic. Excerpts:

Many of the top public-health official jobs in this administration aren't filled yet, including the job you might have taken as surgeon general. It seems as though you basically are acting as our nation's surgeon general.

I think in some ways you're right. And I used to think about that in some ways before the possibility of my being surgeon general even came up. The media has a very unique role, I think, in situations like this. We have to report the news, obviously, but there is a public health role as well, especially for someone like me who is a doctor on the ground here. So that is a lot of what the surgeon general does in situations like this, and with media, we reach a lot of people very quickly, so there is a lot of overlap.

The vice president said in a television interview that he advised his family not to fly anywhere, not just to Mexico. What precautions should people be taking?

I think that most people who have been talking about this from the CDC have been pretty clear: If you're sick and if someone in your family is sick, you shouldn't fly. Now, if you're healthy, there are no specific restrictions. And in fact, the air on airplanes -- there have been a lot of studies and a lot of reporting on this -- is really not any more dangerous than the air anywhere else. People just need to exercise a lot of preventive precaution, more than ever before. This virus can spread pretty easily from inanimate surfaces to your eyes, your nose, your mouth. So I carry hand sanitizer with me and just wash my hands basically every time I think about it.

More cases continue to be reported and schools continue to close, but fatalities, luckily, so far seem limited. Can people relax?

We don't know what the severity of the disease is going to be ultimately, but the indicators now both in Mexico and the U.S. really have shown that in a lot of people it can be a mild illness. It can be like the seasonal flu, so you have a couple miserable days and you get over it.

If I did get swine flu and had those couple miserable days, would I then be better off during a more serious outbreak?

Yeah, you do develop some immunity to swine flu. I mean we're developing immunity every moment of our lives. And that's part of what's concerning about this for public health officials. When you have a brand new virus like this, we have no immunity to it so if it's something that's very virulent, we just can't fight it off naturally.

Do you have any regrets about not taking the job of surgeon general?

My friends will tell you that I'm just not a guy who's ever lived in the world of regrets or second guessing myself. I just don't.

Did you and your wife have your third child? When you withdrew as the possible surgeon general you mentioned that the arrival was "imminent."

Oh yeah. Five weeks old now. Here's the funny thing. So I'm down here in Mexico in the middle of covering this H1N1 flu, and the CDC calls me and says hey, um, we remember that you have a very young child at home. And I said yeah. And they said hmm, come see us before you go home. Obviously young children, because they have such weakened immune systems, may be particularly vulnerable. That was something I wasn't expecting to hear. But I guess I'll be going to get my blood tested before I go home.

A little quarantine?

I'd get some rest then, wouldn't I?

You referred to the virus just then as H1N1. Does saying swine flu make people too alarmed?

There's been a lot of people immediately assuming that pigs and pork and anything along those lines is dangerous. People are worried that if they eat pork they might get infected. [This virus] also does have a couple of components of swine flu, but with a lot of these viruses there's sort of a reassortment of several different strains, and in this case it includes avian flu and it includes human flu, so it's just trying to be as accurate as possible.

The president also referred to it as H1N1, at the same news conference where he urged people to wash their hands and cover their mouths when they cough. Is it strange to hear basic hygiene tips from the president?

I guess it shows the level of concern that he has about this. I don't think people are used to hearing those sorts of tips, but as it turns out they were the right sorts of tips. This is all about prevention and containment at this point.

Are there enough people getting the message out? Is the fact that many top public-health positions in the administration remain empty hampering anything important?

I don't think so. Obviously you want someone who's an official spokesperson from the administration on these things, but I think that they've been getting their message out.

The larger issues are going on away from the public eye. There are probably lots of discussions about whether or not they should contain this virus by closing off borders, restricting air travel. Those sorts of decisions obviously get made with the input of prominent health people within the administration.

How difficult is it to explain a complex public health situation and not have people panic?

It is complicated to explain some of these public health issues for two reasons, and they're sort of opposite reasons. On the one hand, there's some pretty hard-core science that you really can't shy away from when it comes to explaining these things, because it contextualizes what exactly is happening with an outbreak like this.

When the World Health Organization is saying this is an emergency, when you have a virus with unknown fatality rates suddenly make its way into several countries in the world pretty quickly, I think you can't shy away from delivering that news. But you have to contextualize it in a way that is useful for our viewers or readers or whoever. On the other hand, people are watching me constantly, they're following me on Twitter and on Facebook and you want to make sure that you're being very sensible in terms of how you report this and projecting knowledge as opposed to projecting fear. I think it's one of the hardest things that I do, quite frankly. Within journalism. Clipping an aneurysm is harder.

Wait, so what you're saying is it's hard, but it's not brain surgery?

Yeah. I teed that up for you.

If there were a surgeon general at this juncture, what should that person be doing?

The office and the person who holds it needs to have a high profile, someone who's out there communicating as the nation's doctor, often in situations like this but also on a regular basis. I think health and health reform is going to be a big part of this administration's agenda, and one of the things that the president will focus on is making sure that we're preventing as much disease as possible, you know, before disease ever strikes. And there are a lot of messages that need to constantly be reinforced to make that a reality. We are a disease-management society. We live in fireman mode, rushing from fire to fire putting things out. If you could prevent those fires in the first place, that would be better on all levels. How do you do it exactly? Well, that's something the surgeon general should be out there talking about.

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