Catching Up With Dr. Richard Carmona, 17th U.S. Surgeon General
Dr. Val: Dr. Carmona, I recently met you at the Partnership to Fight Chronic Disease conference in Washington, D.C., and now you’re here with the STOP Obesity Alliance. You are certainly one busy guy. What are you doing with your life these days?
Dr. Carmona: My life is certainly very full and very fulfilling. After completing my four-year term as surgeon general, many good people in the private sector offered me opportunities to continue my life’s work. All of my endeavors are geared toward improving the public’s health —that is, the health, safety and security of a person, a population, a nation —and sometimes even globally through partners that we work with.
As I surveyed the various opportunities to engage in public health service, I wanted to choose initiatives that gave me the biggest bang for my buck. In other words, I wanted to support programs that would have maximal impact in improving the lives of Americans. The chronic disease burden caused by a preventable condition —obesity — seemed like a really logical place to start.
We have to figure out how to reverse obesity in more than 9 million children, and we need to help the two out of three adults who are overweight or obese. Obesity has a huge impact on diseases across the board —asthma, cardiovascular disease, diabetes, cancers and a whole host of chronic diseases. Obesity either causes or is a comorbid [simultaneous and independent] factor in each of these.
In addition to my involvement in the Partnership to Fight Chronic Disease and in the STOP Obesity Alliance, I am involved in the National Foundation for Infectious Diseases, where I chair the Childhood Influenza Immunization Coalition — which endeavors to ensure that our children get their full complement of vaccines.
In a country where we spend more on health care than any other nation in the world, our metrics put us somewhere between 25th and 40th in terms of life expectancy, childhood vaccinations, maternal child mortality and things like that. We have to step back and ask: “Where are we missing the boat here?” I think part of the answer is that many of our children don’t complete their immunization series. In Arizona just recently, we had a measles outbreak. That shouldn’t happen in this country.
When I was a child, every mom worried about her son or daughter getting polio. We don’t have to worry about that any more because of vaccines. In a global economy where people move freely across geopolitical borders, vaccination has never been more important —both here in the U.S. and internationally.
Dr. Val: Tell me a little bit about what you’re doing at Canyon Ranch. People may have some misperceptions about the population that Canyon Ranch exists to serve (i.e., wealthy spa-goers). But I know there’s a lot more to it than that.
Dr. Carmona: I’m the vice chairman and CEO of Canyon Ranch [resorts in Arizona, Massachusetts and Florida], and I am always looking for opportunities for the organization to contribute to health policy issues. Our goal is to help the people who come to us to find a path to optimal health and wellness through prevention strategies based on a true integration of the mind, body and spirit.
The Canyon Ranch Institute is the nonprofit arm of our organization that takes our best practices at Canyon Ranch and translates them to underserved populations around the country. So we serve the upper echelons of society, but we also have a strong social responsibility to “give back” to underserved communities and to help eliminate health disparities. Through the institute, we partner with [for example] the Urban Health Plan in the South Bronx [in New York City] — which is in one of the poorest congressional districts in the United States. We’ve committed to helping some of the poorest Hispanic people in America because they struggle with disproportionate disease burden as a group.
Essentially, we’re building a Canyon Ranch Institute Life Enhancement Program in a federally qualified community health center to change the health metrics of that population. And we’re going to focus on disease prevention and an integrative approach to health and wellness. We’re going to measure our impact scientifically. We do everything in peer partnership in a way that honors the culture of the community, and we respect what they’re already doing to serve their population. With everything we do, we plan and act as consultants to the local community leaders. In this case, we took the local community physician and other health leaders and brought them to Canyon Ranch on a scholarship program. We trained them and then sent them back to the Bronx with a small team of staff to help them put together a life enhancement program. And now, we’re building a curriculum with them.
Dr. David Satcher and I are discussing a new initiative in Atlanta, perhaps through his institute — the Satcher Health Leadership Institute. We also have a partnership with the Lance Armstrong Foundation, in which we’ve come together with other surgeons general to bring forth a collective call to action on cancer prevention and survivorship — which we’ll announce this summer here at the National Press Club. This is the first initiative to include all the past surgeons general, so it’s really exciting.
We’re doing many innovative and entrepreneurial things that we can initiate quickly with a lot of smart and willing people. You can move a little more nimbly in the private sector than you can in the federal government, so it’s a joy to be able to pull all these people together to address the unmet needs of various populations at all levels of society.
Dr. Val: How do you incorporate the “mind, body, and spirit” approach to health without getting too far afield from science?
Dr. Carmona: At Canyon Ranch and the Canyon Ranch Institute, we believe that achieving optimal wellness involves taking an integrative and holistic approach to the many dimensions of health and well-being —enhancing the physical, mental, emotional, social, spiritual and environmental aspects. We’re also helping to translate this integrative approach to underserved communities through the Canyon Ranch Institute.
I have a small group of integrative health doctors and other health professionals who meet on a regular basis at Canyon Ranch. Their job is to read their scientific literature and meet periodically with me to present the new and emerging science in health and wellness. Then we review the science together and ask ourselves if there’s anything applicable that we could use as a product to improve the health of those we serve at Canyon Ranch or through the Canyon Ranch Institute’s nonprofit efforts.
So, for example, we’ve been taking a close look at the brain fitness movement in order to see what we could apply to older adults. When you and I went to medical school, we were taught that when you hit 60 or 70, you couldn’t really learn anything new and you need to be put out to pasture. The fact of the matter is that the science is now very clear that not only can you learn, but you can grow your knowledge and ability in many areas — even when you’re into your 90s and 100s. So at Canyon Ranch, we combine physical fitness with brain fitness, and we have holistic programs to develop cognitive skills through nutrition and mind exercises to increase intellectual capacity.
We have also been investigating whether or not touch can be healing. I believe it’s a gray area — some of it may be hocus-pocus, but some may also have scientific merit. So we’re working with Gary Schwartz, Ph.D., an expert in energy medicine, to take a closer look at this and to conduct some trials to see what works. I know this is pushing the envelope, but it’s not implausible that the comfort and stress reduction one experiences from gentle touch might improve immunity.
I recognize that holistic medicine is a very dynamic and challenging field to be in, but we vet everything and make sure that we have some scientific validity before we move forward with anything as a product. We try to stay open-minded as we study these so-called complementary and alternative medicine practices to see what works. And if we find a benefit, we incorporate it. If not, we reject it and move on.
Dr. Val: And do you practice what you preach? How are you taking care of yourself?
Dr. Carmona: I get about an hour to an hour and 15 minutes of exercise five to six times a week. I even have staff meetings while working out at the gym sometimes. I’ll say: “I have 24 hours a day, and you guys get 23. But I need one for exercise. If it’s so important that you need to see me during that hour, then you have to work out with me. We can swim or walk, and you can debrief me while we’re doing that.” Sometimes they’ll take me up on it, but not always. Last night we didn’t finish our business dinner until 11 pm. Everybody went to bed, but I went to the gym.
I do a lot of cross-training. I don’t run that much anymore because my knees are getting sore. I use elliptical machines and the StairMaster. I swim, and then I do a weight training circuit every other day.
Just keep moving. I think that’s the important thing.
Dr. Val: And what do you do nutritionally?
Dr. Carmona: I’m careful about what I eat. I eat a little bit of beef, but not much. I do eat a lot of chicken. I have fish allergies so, unfortunately, I can’t eat seafood. I eat a lot of whole grains, nuts and fruits, and I control my portions. My typical breakfast is oatmeal, fruit and a glass of skim milk. For lunch, I have a sandwich and some salad, and then I have a full but portion-controlled dinner. I allow myself some vices. I used to joke with my staff all the time about not being able to pass a Baskin-Robbins without stopping in to get a vanilla ice-cream cone.
Dr. Val: Baskin-Robbins has 31 flavors … and you pick vanilla?
Dr. Carmona: That’s right. I told them they’re wasting their time on the other 30. There’s only one flavor that I need: vanilla. Every once in a while, I’m really risqué and I’ll try French vanilla.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
, Dr. Rich explains that the major cause of rising costs in healthcare is an aging population that requires more resources. Though some have proposed that fraud and waste/inefficiencies are the primary sources of costs spiraling out of control, the truth is that they likely play a minor role compared to the tremendous costs of providing cutting edge treatments to an older and sicker US population. Dr. Rich argues that we don’t hear that much about the escalating cost of caring for older Americans because it makes us squeamish, so we instead focus on curbing costs due to fraud and waste. However, when fraud and waste are not the primary cause of increasing costs, enhanced attempts to quash them do not actually move the savings needle. Since certain groups are tasked with reducing escalating costs due to fraud (in particular), and their work does not result in savings, they must strive harder to find and punish those accused of fraud, perhaps even seeing fraud where it doesn’t exist.
