Surgeon General or America’s Nanny?

SACRAMENTO, Calif. — I’m doubtful average Americans know what modern surgeons general actually do, as these uniformed “generals” — appointed by the president and confirmed by the U.S. Senate — issue proclamations designed to improve our health. Yet the latest attention-grabbing idea by surgeon general Vivek Murthy is so foolhardy that it undermines the authority of this position. Not surprisingly, many media outlets are taking the proposal seriously.

In a guest essay this week in the New York Times, Murthy advocates a new idea to reduce what he views as a mental health crisis among young people. He learned in medical school that in an emergency, “you don’t have the luxury to wait for perfect information.” Instead, “you assess the available facts, you use your best judgment, and you act quickly.” His best judgment suggests that Congress target the supposed source of this crisis: social media.

“It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents,” he wrote. This label “would regularly remind parents and adolescents that social media has not been proved safe.” He argues that warning labels on tobacco products boosted “awareness” of the dangers of smoking and caused people to change their behavior.

Comparing social media with tobacco use is bizarre. Smoking cigarettes is a known danger, whereas social media is a generally positive development that has troubling side effects for some young people who spend too much time on the platforms. It’s more like watching television or reading magazines. It’s “safe” for some people and tricky for others. Most people’s lives are enriched by their access to information, but teens without enough supervision can turn on spigots of troubling information.

Public health advocates tout surveys showing that warning labels increase people’s awareness (although not necessarily their behavior) of the ill effects of tobacco use, but the impact of such labels is not entirely clear even for tobacco let alone for more nebulous products and services.

“Studies have found the current text-only warnings on cigarettes do not attract attention and do not provide sufficient information about the harmful health effects of smoking,” according to an American Cancer Society article promoting the use of graphic anti-smoking images (photos of sick people, of bloody urine, of surgery scars). In other words, the text warnings don’t work very well, so we need scary images, too.

Even if such labels do work for well-defined dangers related to cigarettes, it’s highly questionable whether they would work on ill-defined risks involving social media. Anyone who doesn’t know about the dangers of smoking combustible cigarettes has surely been living under a rock, but I can see how reading or seeing a warning might bring the matter into sharper focus. The goal of the warning is clear: don’t use these products.

What exactly would a social media warning label attempt to accomplish? In fact, the proliferation of warning labels on every manner of product has caused people to shrug off the attempted warnings. California’s Proposition 65 warnings — “This product contains a chemical known to the State of California to cause cancer” — are so ubiquitous even on ordinary and generally healthy products that no one pays them any mind at all.

“Warning labels are everywhere,” notes a 2016 article in Harvard Business Review. “But are our current warnings effective? Do they convey sufficient information for individuals to balance the risks and benefits? Our answer is a resounding ‘no.’ Our reasoning is that the present system fails miserably at distinguishing between large and small risks.” As a result, most labels “are of little value.” The writers argue that people are so used to being scared about “puppies” that they don’t pay attention when they actually face “wolves.”

Murthy’s idea would simply lead to label proliferation and likely have the opposite result of what’s intended — causing people to shrug off or even mock the warning, just as people laugh off the general Prop. 65 warnings one sees when entering a business or visiting a theme park. Such warnings provide no guide on what to do about the potential (and almost certainly infinitesimal risk). Often, they serve merely as tools for litigation.

Murthy and his allies also have other ideas in mind. His essay promotes legislative remedies. He’s not specific, but Congress is considering age-verification rules, prior restraint mechanisms, the creation of new bureaucracies, and other measures to exert government control over private platforms. These also include European–style antitrust rules that won’t improve internet safety, but will hobble our innovative industry, as I reported recently for The American Spectator.

I can understand a surgeon general weighing in on clear public health risks, but Murthy’s essay veers into uncharted ideological waters. The surgeon general position dates back to 1870, when the Marine Hospital Service needed a supervising surgeon to oversee the care of merchant marines. The role evolved over time, including handling personnel matters at the Commissioned Corps — a team of 6,000 commissioned officers who work in the public health field.

Now, as the National Cancer Institute describes it, the surgeon general serves mainly as “the chief medical doctor and health educator for the United States” with the mission of giving “the public the best scientific information available on how to improve health and lower the risk of illness and injury.” Yet if this is the best scientific advice a surgeon general can come up with, it’s hard to see the continue value of the position.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

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