The Surreal Surgeon General and Public Health

“The nation” is not a big biological organism but is made of a large number of individuals, all different and unique, with each his or her own preferences, values, and circumstances. Economics is a science that studies the social consequences of individual choices. Ultimately, all choices are individual, even the decisions made by politicians and bureaucrats. A political majority is made of individuals. If somebody were “the nation’s doctor,” you would thus expect him to be proficient in economics, whether he studied the social consequences of the Second Amendment, or the First, or the Fourth, or any of them.

The US Surgeon General officially defines himself, presumably on the basis of some law or regulation, as “the Nation’s Doctor.” His office is a strange creature (as its history also reveals):

As Vice Admiral of the U.S. Public Health Service Commissioned Corps, the Surgeon General oversees the operations of the U.S. Public Health Service Commissioned Corps (USPHS), an elite group of over 6,000 uniformed officers working throughout the federal government whose mission is to protect, promote, and advance the health of our nation.

Like most public health bureaucrats, he and his office are not exactly proficient in economics. His latest “advisory” is titled Firearm Violence: A Public Health Crisis in America. Although surgeons general have opines on many topics and lifestyles, they never discussed the social consequences of free speech or due process. (The current Surgeon General did however publish advisories on social media and health misinformation.) His advisory on firearms violence contains no mention of the word “economics” and seems to reference no more than two limited economic studies. Could I have missed something in the report’s 110 footnotes (there is no separate bibliography)? It does look as if the Surgeon General believes he is the physician of a big organism of which ordinary individuals are the organs or the cells.

Economics and other rational choice approaches to society have deflated the pre-scientific idea that society can be studied as a biological organism. Émile Faguet, the great French literary critic, historian of political ideas, essayist, and Academician was not an economist, but he knew enough to mock the sort of “zoological politics” implied by social organicism: “You think you are a man,” he wrote; “in fact, you are a foot”—“Vous vous croyez un homme; vous êtes un pied” (Le Libéralisme, Paris, 1902/1903). My Independent Review article “The Impossibility of Populism” illustrates the danger of this error.

Of course, we can hope that individuals will make informed choices on their trade-offs between risk and happiness–especially when children could be indirect victims. Minimal government intervention in the form of unbiased information, assuming it is possible, could probably be justified. But unbiased information and the protection of children are not what public health is about. An article in the current issue of The Economist, “Research into Trans Medicine Has Been Manipulated,” reviews an instance of what public health activists typically mean by information and research.

What we now call “public health” originated around the beginning of the 20th century, a bit earlier in Germany. It is not a scientific endeavor but an ideological and political movement. (I have developed this idea in a Regulation article, “The Dangers of Public Health,” and a Reason Foundation article, “Public Health Models and Related Government Interventions.”) During the Progressive Era, the public health movement and at least one Surgeon General were supportive of eugenics and compulsory sterilization. In an article on “UVA and the History of Race: Eugenics, the Racial Integrity Act, Health Disparities,” P. Preston Renolds, a professor of medicine and nursing at the University of Virginia, mentions how the fifth Surgeon General of the United States, Hugh Smith Cumming, with two assistant surgeon generals,

took eugenic racism into the rural tobacco fields of Alabama. Here they implemented the infamous Tuskegee Syphilis Study, where nearly 400 black men were followed for 40 years in an effort to document how the disease manifested in black individuals left untreated. The tragedy is that with the discovery of penicillin as a cure for syphilis after World War II, these men were never informed of their disease, nor offered curative therapy.

In many ways, “public health” is the label for faddish lifestyles encouraged, if not coercively imposed, by government. Think about the decades-long persecution of smokers by prohibiting restaurants, bars, and other private venues from freely welcoming them. Public health is government coercion with a human face. It is a surreal experience to see the Surgeon General, dressed in his authoritative vice admiral’s uniform, opining on what lifestyle choices his national patients should make (see “U.S. Gun Violence Is a Public-Health Crisis, Surgeon General Warns,” Wall Street Journal, June 26, 2024).

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