One Surgeon’s Battles Against Big Tobacco and Our Ballot Box

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When Dr. John Maa went to bed on June 4, 2012, he thought he was finishing the last leg of the most important journey of his life.  Years of preparation, millions of dollars, and months of grueling campaigning had led Dr. Maa to the day when Californians would have the chance to pass Prop 29, which would both reduce smoking and fund cancer research.  Little did he know that upon waking the next day that a new journey would begin; one that would take him beyond challenging tobacco and questioning the integrity of our entire system of voting.

June elections typically have a lower voter turnout than November elections and June 2012 proved no exception with only a 31% turnout and only two statewide initiatives to excite voters:  Prop 28 which limited Legislators’ terms in office and Prop 29 which would have imposed a $1 per pack additional tax on cigarettes for cancer research.  Polling throughout the months before the election showed that Prop 29 would pass easily so it was a surprise to many people that the vote was so close on election night. In the end, Prop 29 lost on June 5, 2012 by 24,076 votes out of 5,161,506 votes cast on this initiative. So unbelievably close that Dr. John Maa has put $250,000 of his own money into a recount.   Supporters are gathering signatures, as we speak, to put a new $1 per pack cigarette tax initiative on the November 2014 ballot this time to expand financial aid for California residents enrolled at public universities.

Dr. John Maa.

Dr. John Maa

As a first year student at Harvard Medical School studying for final exams, Operation Desert Storm began. Maa realized that as a doctor in training, there were many useful skills he would obtain that could be used to care for our men and women in the Armed Forces.  He joined the US Army shortly thereafter, as a second lieutenant, and would remain in the Reserves for eight years, before being discharged as a captain.  Today, Dr. Maa is a national leader in education and understanding the negative impacts of smoking. He has written many medical papers and is a sought out lecturer around the country. got the chance to sit down with Dr. Maa to talk about his profession and thoughts on the political process.


What got you involved in the Prop 29 campaign?

After finishing my general surgery residency, I completed a two year health care policy fellowship at UCSF.  My mentor was Dr. Stan Glantz and a strength of the fellowship program is the exposure to tobacco control strategies and advocates. Another national leader in tobacco control at UCSF is Steve Schroeder…also a mentor of mine.   In 2011, I was nominated by the American Heart Association to be their representative to the UC Office of the President Tobacco Related Disease Research Program (TRDRP). I am now the Vice- Chair of the Scientific Advisory Committee for the program, which administers the research dollars raised by Prop 99 (passed in 1988) which raised the price of a pack of cigarettes by 25 cents. Current State Senator Jerry Hill nominated me to serve on the Board of Directors of the American Heart Association in 2003, when he was a member of the San Mateo Board of Supervisors, and I was working at San Mateo Medical Center. As an advocate in the policy arena and as a surgeon, I have seen the harm caused by tobacco which led me to participate in the Prop 29 campaign and even appear in a TV commercial.  I believed that Prop 29 is about saving lives by funding cancer research.


You spent $250,000 on the recount and the outcome didn’t change enough to reverse the results.  Do you regret it and what did you learn? 

I chalk that money up as ensuring integrity in the election process and I believe it will yield much more in the future; elections will be better. I learned a lot and I believe that one of the “exciting public policy” projects is to reform the handling and reporting of absentee, provisional and damaged ballots during the canvass in the 29 days after Election Day. The events in Sacramento County ( highlight the vulnerabilities in the “chain of custody” of these ballots, which can be misplaced or miscounted. More importantly, there is a 36-hour window the morning after Election Day and before the first report of “unprocessed ballots” remaining to be added is due, where each of the counties handles the tallying and reporting differently. It is this 36-hour window that accounts for the 300,000 vote discrepancy between what the counties reported as left to count, and what appeared in the final SOS report for the June 2012 election.


Were you destined to be a doctor from a young age? 

When I entered UC Berkeley, I originally wanted to be an engineer, which was a better return on investment. However growing up I watched “Mash” and “Marcus Welby” so I had a strong interest in being a doctor and transitioned into medicine so I could help society.  I decided to go into surgery because I wanted to be the “US Surgeon General” some day and it was eye opening that the “Surgeon General” doesn’t have to be surgeon; Jocelyn Elders is a pediatrician and the current one, Regina Benjamin is a primary care physician.  However one of my heroes was C. Everett Koop, a pediatric surgeon, known as “America’s Family Doctor” during his tenure as Surgeon General (1981 to 1989), who just died on February 23rd at the age of 96.  He was so outspoken about his crusade to end smoking and is the reason we have the warning labels on cigarettes.


What do you like about your job?

Solving different challenges and preparing for difficult operations and having them go well.


What do you dislike about your job?

The exact opposite as above… when things don’t go well. There are also time pressures so sometimes doctors overlook key clues when trying to make decisions.  Another problem is the intrusion of business principles into the practice of medicine.


What happens when you make the wrong decision?

You need to have the fortitude to continue.  You need to focus on what you do and continue to care for your other patients.


Healthcare is one of the number one concerns for individuals and families yet “Obama Care” has been criticized by some.  As a doctor, what is your opinion of the healthcare reforms happening today?

I think people supported the intent but were somewhat displeased with the process. Everyone comes to the table with different assumptions. I believe we need a 28th Amendment to define what the rights and responsibilities are of healthcare:   we need to define “entitlement” first; then we have to agree on what everyone is entitled to and therefore responsible for.   I personally have seen a difference.


Do you think we’ll ever have Universal Healthcare?

“Yes” to basic and affordable healthcare but “no” to emergency healthcare.


Would you advise young people to go into medicine?

Yes.  Being a doctor is rewarding and enriching however the increasing cost of education is discouraging students and the choice of a specialty is becoming a business decision.  It’s unfortunate and understandable but correctable.


What is your next project? 

I’m working on a book and trying to fix our emergency care system crisis.  My goal is to provide equal access to the emergency care system by fixing the misallocation of manpower and resources; the mismatch between doctors’ availability and human need.


What do you do in your free time?

I like to sail and would someday like to sail a spinnaker around the south coast of France and Italy. And I’m still working on the Prop 29 recount.

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