Why the NRA Is Blocking Obama's Surgeon General Nominee

The post of the surgeon general has been vacant since July, and it looks likely to remain that way for some time thanks to a strident campaign led by the National Rifle Association and libertarian Senator Rand Paul against President Obama's nominee, Dr. Vivek Murthy.

The post of the surgeon general has been vacant since July, and it looks likely to remain that way for some time thanks to a strident campaign led by the National Rifle Association and libertarian Senator Rand Paul against President Obama's nominee, Dr. Vivek Murthy.

Murthy has medical and business degrees from Yale, works as an attending physician and instructor at Brigham and Women's Hospital at Harvard Medical School and has founded several health businesses and nonprofits. He has also expressed support for limited gun safety measures like a ban on assault weapons, mandatory safety training and limits on ammunition, and so the NRA has declared it will "score" his confirmation vote, putting pressure on Senate Democrats running tight re-election races in red states to block Murthy's confirmation. As The New York Timesreported on Saturday, the White House is "recalibrating" its strategy towards Murthy's nomination, meaning the Senate vote will either be delayed or never happen.

This isn't the first time the NRA has held up a nominee: the Bureau of Alcohol, Tobacco, Firearms and Explosives went without a director for seven years because of opposition from the gun lobby. But never before has the group set itself so strongly against a surgeon general nominee. So why now? The NRA said Murthy's "blatant activism on behalf of gun control" attracted their attention.

But the gun lobby's campaign against Murthy isn't really about his record, or him at all. His positions on guns are hardly radical or even activist, and his views are consistent with those of the majority of Americans. Polling indicates that the public is far more supportive of new gun control laws than members of Congress or, certainly, the NRA.

Furthermore, Murthy's views represent a consensus among medical professionals that gun violence is a major public health issue. Gun violence, including suicide, kills some 30,000 Americans every year, about the same number as car accidents. Cars are highly regulated for health and safety; guns, barely. Accordingly, the American Medical Association, the American Psychiatric Association and the American Academy of Pediatrics, among many others, have called for stronger gun safety laws. It would be surprising if, as a doctor, Murthy did not have concerns about gun violence and the strength of current regulations.

With public health professionals engaging more forcefully on the gun issue, the NRA has a pressing interest in muting their calls for stronger policy. Really, the campaign against Murthy is the continuation of a longstanding effort to make discussion of gun violence taboo. For years the NRA has worked to bury information about gun violence and its public health implications. The NRA has campaigned successfully to ban registries that collect data on guns used in crimes, and in 1996 the group fought for and won legislation that froze federal funding for research on gun violence. Although Obama lifted the restriction last year in the wake of the Sandy Hook shootings, there's still very little money--federal and private--for gun research and not enough data, said David Hemenway, an expert on injury at the Harvard School of Public Health.

On the local level, the NRA has tried to bar pediatricians from counseling parents about the risks of keeping guns at home. The American Association of Pediatrics recommends that doctors begin to talk to parents about gun safety even before their baby is born, and continue the conversation yearly, just as doctors talk to parents about the dangers of swimming pools and the importance of bicycle helmets. Florida passed a gag law in 2011; crafted by an NRA lobbyist, the bill forbids doctors from "making written inquiry or asking questions concerning the ownership of a firearm or ammunition by the patient or by a family member of the patient." A district court ruled the following year that the law restricted physicians' rights to free speech, and the case is now in the appeals process. Murthy's opposition to pediatrician gag laws was one of the reasons cited by the NRA and Rand Paul in their attempt to disqualify him.

When she ordered a permanent injunction against the Florida law in 2012, District Judge Marcia Cooke wrote that the law "in no way affects [Second Ammendment] rights" and instead "aims to restrict a practitioner's ability to provide truthful, non-misleading information to a patient." The same can be said of the NRA's objection to the Surgeon General nominee, who won't be involved in crafting gun policy. The threat to the NRA is that the surgeon general will merely talk about gun violence, in fulfilling his or her duty to provide the public with "the best scientific information available on how to improve their health and reduce their risk of illness and injury."

While the NRA's political clout comes from its individual members, the group serves the agenda of gun industry. What's really going on with Murthy's confirmation is that an industry group is trying to keep the government from regulating its products. This isn't a new battle: the tobacco industry fought it, as have many other industries with financial interests in evading health and safety regulations.

"Most industries try to protect themselves--the less regulation the better, the less oversight the better. They want to pursue their sales," said Hemenway. "I think it's almost time for a surgeon general statement about guns, like we had with cigarettes and cancer, particularly about guns and suicide."

While the industry's goals aren't exceptional, its success at evading regulation is, said Kristen Rand, legislative director at the Violence Policy Center. "Guns are a consumer product. We've taken a public health approach to reducing product-related injury for every other product, from automobiles, to toys, to airplanes. Every product is regulated from a health and safety perspective with the goal of reducing accident and injury. The only exception is guns," Rand said.

Murthy's assurance that he does not intend to use the surgeon general's office "as a bully pulpit on gun control" failed to appease the NRA. Perhaps appeasement is the wrong tack. The only way to curb the gun industry's outsized influence is if people like the surgeon general do talk about gun violence, and advocate for more research and data, not less.

"The surgeon general's role is to educate the public about how to live healthier, safer lives and one of biggest injury-producing mechanisms in America today are guns. It's obviously an area where he should be involved," said Rand. "What the NRA fears is having someone with a bully pulpit who has solid information and is giving people the facts. The NRA fears information."

Democrats also need to stand up for freedom of speech and information. The midterm map presents a real challenge, as the Senate races most important to Democrats are in deep red states--Louisiana, Arkansas, Montana, Alaska--where public opinion on gun control is far more conservative than it is nationally. Still, it's far from clear that the NRA's endorsement is worth groveling for. The NRA can easily whip up hundreds of gun owners to flood Senate offices with calls expressing outrage over Murthy's nomination, but there is some evidence that the group's electoral influence is much less significant than its effect on policymaking and nominations. According to a statistical analysis conducted by Paul Waldman in 2012, "The NRA has virtually no impact on congressional elections. The NRA endorsement, so coveted by so many politicians, is almost meaningless. Nor does the money the organization spends have any demonstrable impact on the outcome of races." [Emphasis his.]

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