Sanjay Gupta, Obama’s reported choice for surgeon general, is no stranger to the ethically sticky situation physicians often find themselves in with drug companies. Speaking with Paula Zahn in 2005, he noted that “there is a lot of nudge, nudge, wink, wink going on, as far as some of these freebies, giveaways, trips to Aspen for performing a certain number of procedures or prescribing these medications. … It becomes a slippery slope.” As Paul Krugman and other critics have pointed out, but not yet fully explored, Gupta has treaded the ethical line in several instances.

For over six years, Gupta has been co-hosting “AccentHealth”—a CNN television segment beamed straight into doctors’ waiting rooms, sponsored in part by many of the major pharmaceutical companies. Touted on its website as an “integrated marketing opportunity” that allows companies to deliver their message “in a trusted environment,” the show has been underwritten by drug industry leaders Aventis, Pfizer, Procter & Gamble, Merck, and Warner Lambert.

At the same time, Gupta has been appearing on CNN’s primary broadcasts as an ostensibly objective medical authority, discussing the drugs produced by the very same pharmaceutical companies. In a November 2003 broadcast of CNN’s “American Morning,” Gupta described the benefits of the cholesterol-reducing drug Lipitor, which is produced by Pfizer:

I actually talked to the doctor who did this study and I asked him the same question. I asked him about myself, I said, “Should I be on this medication?” And he sort of laughed, and said, “I'm not ready to do that over the phone,” as a good doctor would. But he said, for the most part, it's a pretty good drug and there's very few reasons not to be on it.

Later, in a 2005 “Accent Health” broadcast, Gupta took up his promotional mantle and advised viewers how to buy discounted Lipitor online. These weren’t the only times that Gupta’s news coverage involved medications manufactured by the companies that have sponsored the quasi-infomercial he co-hosts. Gupta has also name-dropped Allegra, a popular allergy medication manufactured by Aventis, as an allergy remedy on “AccentHealth” in 2005 and repeated on CNN’s “House Call With Dr. Sanjay Gupta” in 2006. And in 2006, he began reporting extensively on Gardasil, the HPV vaccine produced by Merck.

A representative for AccentHealth says there is no relationship between Gupta and the show’s sponsors, and even if there were, it wouldn’t necessarily disqualify Gupta to be the next Surgeon General. But the sometimes thin line between his CNN and AccentHealth work--and his public support for pharmaceutical products that have helped pay his salary--raise a host of questions yet to be answered about how he’ll perform as the Obama administration’s leading public health advocate. A growing body of evidence, chronicled in books like Shannon Brownlee's Overtreated, suggests American medicine is far too aggressive, which leads to higher costs and, all too frequently, actual harm for patients. If Obama wants to reform the health care system, his surgeon general will have to push back against both the pharmaceutical companies that promote ineffective treatments and the doctors who prescribe them. Assuming he does turn out the be the nominee, the Senate would be wise to press Gupta on these issues during confirmation hearings.

Update: A CNN spokesperson e-mailed us this morning to emphasize that AccentHealth is responsible only for distribution and sales of the program, while CNN maintains full editorial control of its content.

 --Marin Cogan and Suzy Khimm