ST. LOUIS — Anesthesiologist and former U.S. surgeon general Jerome Adams has emerged as a leading voice on public health and issues of equity in medicine from his new position as executive director of health equity initiatives at Purdue University, in his home state of Indiana.
He recently was a keynote speaker at the Association for Health Care Journalists annual meeting in St. Louis, where he criticized some of the reporting on him while he was surgeon general for being overly politicized and taking some of his comments out of context.
STAT sat down with him to discuss the challenges of communicating about science and health in these politically divisive times, how he’s battling to escape the long shadow of former President Donald Trump, in whose administration he served, and the struggles his family faces as his wife battles advanced cancer.
This interview has been edited for clarity and length.
You have a history of bridging political divides; when you were Indiana’s health commissioner, you convinced the governor and state legislature in a red state to legalize needle exchanges to combat HIV. What’s your secret?
I really do believe people have to relate to you. One of my guiding principles is that people need to know that you care before they care what you know. I try to figure out what I have in common with people as opposed to focusing on what separates us. Are you a parent? Are you someone who grew up in a rural community? Are you a person of color? Are you someone who has an experience with chronic diseases? Once you can create that link, that opens the door to having even difficult conversations about things we may not agree on.
The world of Twitter and TikTok, and headlines, and three-minute CNN and Fox stories doesn’t lend itself to complicated health discussions, so I’ve been doing more podcasts, where you can have a longer conversation with people and more op-eds of my own where I’m not forced to answer a question that’s been asked in a particular way that may have an agenda behind it. I can tell you directly: Here’s what I think about CDC data, about Covid origins, about the latest vaccine misinformation that’s come out.
I’ve noticed that on Twitter, with your massive following, you don’t tend to walk away from a fight or from misinformation. You get downright feisty sometimes. How and why do you decide to engage, even when it can get uncomfortable?
Nuance is important. And with nuance comes disagreement and discomfort, and we need to be OK with that. When I’m on social media and I go back and forth with someone, I’m not necessarily going back and forth with that individual as much as I’m going back and forth with the concept. Sometimes I’ll think, “OK I’ve heard that bit of misinformation enough that it’s important enough for me to respond.”
What’s interesting is when you look at communication science, one of the challenges of having a big platform is that other people will use you to lift themselves up. So sometimes when you respond you can do more harm than good by lifting up their misinformation to your 80,000 Twitter followers vs. their 800. Sometimes it makes sense to respond when you might not think it does, and other times it makes sense to be quiet.
You shared a powerful story with STAT shortly after you were appointed about your brother Phillip and his struggles with addiction and incarceration, showing how this issue hits so many families, even yours. What’s his status now?
He’s been released. He actually got released early, in 2020 because of Covid, which was both a blessing and a curse. It was a blessing because we know many people who were incarcerated developed Covid. Prisons were a perfect storm for superspreading. But the flip side is he and many others were released without the support and resources and ability to get into treatment and recovery programs. So the honest truth is he’s out, he’s still alive, he’s still struggling to keep his head above water, and it’s scary.
Literally every time my parents call, I have to prepare for the fact it could be incredibly bad news. He also lives in a rural community where it’s hard to access resources. The justice system confines you when you are released to your local area. So if you’re on parole, you have to report in and that confines you to a small area where everyone knows you’ve been incarcerated, and the people who got you in trouble before are still there. It just sets people up for recidivism.
Something I’ve always pushed for is to try to get people Medicaid while they are in jail and get them treatment while they are in jail. You literally and figuratively have a captive audience, and there’s no better time to give people services — you have their attention, you have them on a regular schedule. It’s a missed opportunity to treat substance use disorder.
I also want to ask about your wife, Lacey, who is in treatment for stage 4 melanoma and about a Washington Post article that you thought would be about her cancer but turned out to be a far more political piece about Trump – and really angered you. First, how is Lacey doing, and second, why was that piece so upsetting to you both?
She’s in a stable place right now. When you have stage 4 cancer, you live PET scan to PET scan. Right now, we’re waiting for the next scan to see if things are getting better or worse. Right now we just pray and thank God for each day we have. It’s scary, we have three kids and we’re trying to figure out, are they going to have their mom when they graduate? But we just think day-to-day and are thankful for the time we have. We are lucky treatments for melanoma have been advancing so rapidly; there is treatment there wouldn’t have been 10 years ago.
What was interesting about that article was my wife faced what I had to face in terms of a backlash and your story being distorted. My wife was trying to use her story to help other people and it was turned into a largely political story about Trump. So she’s now gun-shy about wanting to advocate about melanoma because of that experience.
That’s happened to me throughout the pandemic, that I’ve been attacked for trying to advocate for different issues, and it’s made me less likely or willing to want to put my neck out again. I got more death threats and more hate mail about my wife’s cancer than for any media piece I’ve done since I left office as surgeon general. And it wasn’t even supposed to be about me. It was supposed to be about my wife’s cancer.
You mentioned your difficulty in finding a job after you left office, when many former surgeon generals end up in very cushy posts once they leave. How is that going now that you are at Purdue? Have you outrun this thing you call the Trump hangover?
I don’t think anyone will outrun the shadow because the last administration was so polarizing. What I will say is I feel like I’m in a good spot. I am a Christian, so I do believe that things happen for a reason. We need to be around family and friends because of my wife’s cancer, and that’s in Indiana. I was able to get a really good job, doing what I love, at Purdue University. Maybe if a different offer had come along earlier that would have required us to move halfway across the country, it wouldn’t have been as good of a fit for my family.
You’re an extremely successful Black male physician in a field, anesthesiology, where just about 5% of physicians are Black. Can you talk about some of the challenges you’ve faced?
A lot of people just see me as being Trump’s surgeon general and don’t realize I was the chair of the professional diversity committee for the American Society of Anesthesiologists, helping mentor and support people trying to enter a very white, male profession. One problem is that we’re focused on admittance, on affirmative action, and who should get scholarships and that’s important — it’s necessary but not sufficient. Often people get admitted, then they are left hanging high and dry.
I was a Meyerhoff Scholar at the University of Maryland, Baltimore County, which is one of the most successful programs in producing Ph.D.s and M.D.s of color outside the HBCUs. It wasn’t just “we brought you here,” it had programs to help you get summer internships, and learn how to study, support like that. We need to do more of that to get more people into these professions that have been dominated by white males for centuries.
In terms of the issues you hear about, like doctors being mistaken for valets, yes, you experience it, and what is really concerning to me is the research that is now coming out that shows the physiological impact of these daily microaggressions. What happens is, if that’s part of your normal life, you can’t go around being angry or upset, especially externally, all the time, so you internalize it. We’re just now starting to realize that when you internalize over time, that results in higher levels of diabetes, high blood pressure, even cancer. That’s what scares me.
It’s everything from having to fight harder to get a mortgage for your house to having to work harder than the people around you, and find workarounds for your Blackness. You’re always wondering when you are sitting around with other people who don’t look like you, why everything seems easier for them, and you’re having to fight for everything, even something like negotiating to get a low interest rate for a car.
You’re incredibly busy and in demand. Your bio at Purdue even has a “request speech” link on it. Why did you think it was important to take time to speak to health care journalists?
I think it’s really important that we recognize we need health care-oriented journalism and that much of the health reporting we have out there is really political reporting in sheep’s clothing. We need to support health care journalism and we need more stories about equity. When I say equity, it’s another one of those loaded words. People always think it’s about race. But equity is about urban vs. rural, it’s about people with differing abilities, it’s about people who speak different languages, it’s about the LGBTQ+ community.
We need to pay attention to the inequities that exist or we’re going to continue to have workforce issues, we’re going to continue to have larger societal issues that impact all of us. A lot of people think these stories are about morality and yes, there’s a moral aspect to it, but this is really about us having a thriving society. And we can’t have a thriving society if we’re leaving people behind.