At first glance, Dr. Vivek Murthy, President Biden’s pick for surgeon general, seems very qualified for the job. As surgeon general under President Obama, Murthy helped lead the national response to health crises like Ebola, Zika, and opioid addiction. He was part of Biden’s public health advisory committee in Spring 2020 and was co-chair of the Biden’s Covid-19 advisory board during his transition to president. He is also a strong advocate for expanding health care access; before joining the Obama administration, he founded the nonprofit organization Doctors for America.
However, new information uncovered from ethics documents have revealed conflicts of interest that some experts say should disqualify Murthy from being the leading spokesperson on public health.
Covid consulting conflicts
The Washington Post reported that Murthy was paid $2.6 million by various private companies for speaking and consulting since January 2020, which is “the most financial entanglements of any surgeon general pick in recent history,” according to the Post. Most notably, Murthy was paid $400,000 by Carnival Cruises, $600,000 by Netflix, and $800,000 (including stock shares) from Airbnb, for assisting these companies on Covid-19 safety practices.
Why are these conflicts of interest? Because the size of some of these payments suggest that private companies were not just paying Murthy for advice. Most of this consulting work came after Biden had basically secured the Democratic nomination, when Murthy was being identified as a Biden advisor in speeches, the Post reports.
“These companies aren’t paying exorbitant fees for advice or services provided…They are payments for influence,” writes Dr. Vinay Prasad, hematologist-oncologist and associate professor of medicine at the University of California San Francisco, in an op-ed in MedPage Today. Carnival, Netflix, and Airbnb all have a stake in the policies that the Biden administration enacts, such as ventilation standards on cruise ships, requirements for reopening film and tv sets, travel restrictions, etc. If Murthy is going to be a part of deciding when and how the country reopens, it is problematic for him to have these financial relationships.
“Payments of this magnitude inherently compromise Murthy’s ability to think only about what is best for the public. These conflicts should disqualify him from the post of Surgeon General,” writes Prasad.
The problem of the “revolving door”
Relationships between public employees and private companies have been a long-standing problem in government ethics. The phenomenon of government agency workers leaving to work in the industry they once regulated is so common, it has its own nickname: The “revolving door.”
A particularly flagrant example was in April 2019 when Demetra Ashley, the former acting assistant administrator of the U.S. Drug Enforcement Administration, became a paid consultant for Purdue Pharma, one of the largest opioid-makers in the U.S.
The problem with the revolving door is that officials may regulate less strictly or “play nice” with industry, either because they plan to go back to the private sector, or to increase their chance of getting an industry job in the future. Similarly, public sector officials who have worked for industry in the past may find it more difficult to be impartial when making decisions that their former partners have a stake in.
Conflicts of interest go both ways
When Scott Gottlieb was nominated for commissioner of the Food and Drug Administration in 2017, we noted that he had more financial conflicts than any previous FDA commissioner, and some Democratic senators spoke out on this topic as well. However, Democrats have been conspicuously silent about Murthy’s conflicts. At Murthy’s Senate committee confirmation hearing in late February, he was not questioned about his conflicts by the committee members.
Back in 2017, Murthy was lauded by doctors for standing his ground on public health issues that went against then-President Trump’s views, even when it resulted in his removal. Murthy was praised for avoiding the conflict of interest that can happen when public health figures who are supposed to be independent come under intense political pressure (which we saw happen with leaders of the FDA in 2020).
“We are often at the intersection of politics, ethics, and health and, when confronted by a conflict of interest, should act like Murthy,” wrote assistant professor of medicine at University of Alberta Dr. Hakique Virani in an op-ed in STAT in 2017.
While Murthy’s decision to stand his ground in 2017 despite losing his job was brave, we still have to hold him to the same standard. Avoiding one conflict of interest does not excuse others, regardless of what political side you are on.