The California Cure: Primary Prescription

Christie Hefner goes one-on-one with former surgeon general Rich Carmona


I had heard of Dr. Rich Carmona before I met him. When he left office as the 17th surgeon general of the United States—having been appointed by President George W. Bush in 2002—he and other surgeons general were critical of the administration for interfering with and suppressing scientific findings that conflicted with its ideological agenda. Carmona and former surgeons general C. Everett Koop and David Satcher testified about that interference before the House Com­mit­tee on Oversight and Government Reform.

Despite the political pressure, Carmona had many successes while surgeon general, including releasing a landmark report on the effects of secondhand smoke and encouraging the adoption of smoking bans.

We met three years ago, when Carmona became vice chairman of Canyon Ranch, a resort and residential company with a nonprofit arm that provides health information and services to underserved communities. Although I was introduced to Canyon Ranch 14 years ago as a potential spa partner when I was working on location-based entertainment opportunities for Playboy, I became drawn to what founders Mel and Enid Zuckerman and Jerry Cohen were trying to do: lead lives dedicated to the belief that individuals can transform themselves to attain health and wellness.

I had already led the effort to raise $30 million to build a health facility in Chicago that was a national model combining education, prevention and holistic treatment for people with HIV/AIDS and other infectious diseases, and I’ve seen the positive effects of integrating Western care and healthy lifestyle choices. A few years after meeting him, Mel asked me to join the CR advisory board.

Carmona’s personal story is fascinating. Of Puerto Rican descent, he grew up in Harlem, where he experienced firsthand not only health disparities but homelessness and hunger. He enlisted in the army after dropping out of high school, became a combat-decorated Vietnam veteran and, while in the service, earned his GED. As he tells it, his mom repeatedly said she only wanted to live long enough to see one of her kids graduate—from high school!

With no other means of getting there, he “sneaked” into college through an open-enrollment program for vets and eventually made it to UC San Francisco School of Medicine, where he was top of his class and was awarded the coveted Gold-Headed Cane—given by classmates to graduates who exemplify the traits of a true physician. A stint in Tucson resulted in his heading the region’s first trauma center and serving on the Pima County SWAT team. To this day, he isn’t sure why he was nominated as the country’s top doc. He didn’t know President Bush or have the political pedigree that is usually required.

Consistently throughout his career, Carmona has focused on shifting the paradigm of health from treatment to prevention. With all of the debate and discussion going on around health-care reform, now seems like a good time to check in, though I learn Carmona has just had major reconstructive neck surgery.

Christie Hefner: How are you doing?
Rich Carmona: I’m progressing well, thanks. Paying the price in midlife for all the “hard landings” of my youth! I needed to correct a multitude of chronic injuries.

CH: Thanks so much for doing this in pain! It seems our timing couldn’t be better, as the country is so completely focused on health care. I’ve been talking about it on American Morning, Campbell Brown, Morning Joe and Sean Hannity. And I’m finding that whether it’s the debate over the “public option” or how to pay for the uninsured, the elephant in the room seems to be individual responsibility. What do you think we as a country need to do to shift from a focus on illness to promoting health?
RC: Currently the nation spends $2.5 trillion on “sick care.” That’s nearly 17 percent of our GDP. And 75 percent of this expenditure is for chronic diseases—most of which are preventable! Make no mistake, we have a perversely incentivized sick-care system. We must improve the health literacy of our citizens so they understand the personal and economic value of pursuing optimal health and wellness.

CH: What should we do to live longer, besides not smoking, limiting alco­hol, eating healthy foods in smaller portions and adding physical activity?
RC: Social determinants of health are often overlooked, but when you examine communities globally that spawn 100-year-plus citizens, they share variables beyond eating well and exercising—family and community and networks that validate their lives and work. In many countries, elders are revered—and interestingly, in those societies, when it is time to pass, comfort care is given in a very dignified manner, but extraordinary amounts of money and resources are not spent on prolonging life beyond the reasonable, as they are here. Rather, the passing of the elder is celebrated in a bittersweet way.

CH: The President recently nominated a new surgeon general, Dr. Regina Benjamin. What advice would you give her?
RC: I’d like to see the surgeon general give an annual open report to Congress regarding the state of the nation’s (and global) health. This would both improve the health literacy of the public and drive appropriate policy. If she’s confirmed, I would advise her to remember she is the doctor of the nation and not of either political party. The currency that we trade on is based on the integrity of the office. In fact, my predecessors and I have a short mantra: “Once a surgeon general, always a surgeon general.” When we leave office, a piece of that bully pulpit comes with us.

CH: How would you advise President Obama on this?
RC: Continue to take the high road, and stay away from declaring “bad guys” in your health rhetoric. Yes, there are some who are partisan, and even malicious, in their intent, but don’t be distracted. The focus should be on articulating that our goal is access to preventive services for all citizens. And we have to recognize that health is inextricably linked to socioeconomics. Educated working people have much better health outcomes and cost less to care for. Lastly, prepare the public for the fact that this complex health-care transformation will be an incremental process, not done in a single piece of legislation.

CH: I spoke at an ideas conference in Toronto, and scientists talked about advances in life expectancy. What breakthroughs are on the horizon?
RC: There are daily ones nationally and internationally in treatments and procedures. But paradoxically, most of this emerging science and its attendant cost is directed at diseases that can be prevented through good lifestyle choices.

CH: Approximately 20 years ago, my father had a stroke. He was extraordinarily lucky in that he had a primary-care physician who knew him well enough to treat him without immediately moving him to a hospital and, as I recall, to recommend a then somewhat experimental massive dose of steroids to reduce the swelling—he fully recovered. What should people look for in a PCP?
RC: In addition to the requisite training and certification, I believe the ideal PCP should be a compassionate, user-friendly advocate who also embraces scientifically grounded complementary and alternative approaches to health, wellness and care.

CH: What do you do to stay in shape?
RC: I work out one to one and a half hours daily. I cross train for strength, balance and agility—daily cardio on an elliptical, step, stationary bike and/or swimming, weight circuit every other day and daily stretch and ab/back workouts. I also watch my diet.

CH: Any indulgences?
RC: Ice cream...once in a while! Everything in moderation, not deprivation!