He applied the “Page 99 Test” to his new book, Surgeon General's Warning: How Politics Crippled the Nation’s Doctor, and reported the following:
My book is about the rise and fall of the surgeon general. Page 99 happens to mark one of the main turning points of my narrative, when the stage is set to allow the fall to begin.Learn more about Surgeon General's Warning at the University of California Press website.
The earlier part of the book speaks mainly about the surgeon general’s origin and ascension. The job was created after the Civil War to turn around a ruinous collection of federal hospitals for sailors. The ambitious men who first held the job went beyond that assignment, leading a growing government effort to manage disease outbreaks and safeguard the public health. By the early 1950s – where we are at page 99 – the surgeon general was the health officer of the nation, overseeing many thousands of employees organized in such agencies as the NIH and the CDC.
But this page lands in the middle of the tale of Leonard Scheele, known as “the last happy surgeon general.” Scheele was powerful too, but held office during creation of the Department of Health, Education, and Welfare (HEW). Suddenly, Scheele was placed under a cabinet-level HEW Secretary. His first boss, a lady newspaper publisher from Houston named Oveta Culp Hobby, was uncomfortable with many health issues and gave Scheele great leeway. But her successors (and their lieutenants) proved less interested in allowing surgeons general to speak for HEW on health matters and to rule such a large portion of the federal health bureaucracy. Within only about 15 years, the surgeon general was stripped of his administrative powers. He was turned into a health educator, dispatched to speak at functions other HEW officials chose not to attend.
The office would enjoy a resurgence in the 1980s when the remarkable C. Everett Koop held the post. But Koop managed to speak loudly from a weak pedestal. Denied real power and resources, it would take a combination of luck, allies and chutzpah for any surgeon general in recent decades to make an impact. Such a combination has been a rarity, and the surgeon general has largely disappeared.