ORIGINAL
*S | ANAK

:

ADDRESS
BY
C, Everett Koop. M.D., Sc.D.
SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE ANNUAL MEETING OF THE A.M.A. AUXILIARY
CHICAGO, ILLINOIS
June 26, 1988
1
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I'M DELIGHTED TO BE HERE TO SHARE WITH YOU MY OBSERVATIONS
ABOUT TWO KEY ISSUES IN PUBLIC HEALTH TODAY.

BUT LET ME FIRST INVOKE THIS CAVEAT: PLEASE DON’T BE UPSET
IF I OVERLOOK YOUR FAVORITE DISEASE OR BIOMEDICAL BREAKTHROUGH,
FOR, WHILE I AM YOUR SURGEON GENERAL, I AM ALSO ONLY YOUR SURGEON
GENERAL, SEEING THE WORLD THROUGH THE SPECIAL PRISM OF MY_OWN
OFFICE AND WITH THE HELP OF MY_OWN ADVISORS AND GOOD FRIENDS.
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THAT'S WHY I AM PROBABLY THE ONLY HEALTH OFFICIAL IN

GOVERNMENT WHO WOULD BEGIN AN ADDRESS SUCH AS THIS WITH A FEW
WORDS ON SMOKING.

] SHOULD EXPLAIN THAT THE PUBLIC HEALTH ISSUE OF SMOKING
WAS ON MY DESK WHEN I ARRIVED IN WASHINGTON IN 1981 AND, I’M
SORRY TO SAY, IT WILL REMAIN ON MY DESK FOR MY SUCCESSOR, WHEN MY
SECOND TERM ENDS IN NOVEMBER OF 1989,

BUT I DON’T MEAN TO SOUND DISCOURAGED BECAUSE I‘M NOT.
WE’VE MADE A GREAT DEAL OF HEADWAY AGAINST THIS MOST SERIOUS
MENACE TO AMERICAN PUBLIC HEALTH.
3
IN THE COURSE OF THE PAST 7 YEARS, WE HAVE BROUGHT 10 THE

ATTENTION OF THE AMERICAN PEOPLE -- AND, INDEED, OF THE PEOPLE OF
THE WORLD, ALSO -- THE MOUNTING EVIDENCE AGAINST CIGARETTE
SMOKING,

DURING MY TENURE WE’VE ISSUED SEVERAL LANDMARK REPORTS. IN
1982, FOR EXAMPLE, WE BEGAN TO ISSUE ANNUAL REPORTS THAT LINKED
SMOKING WITH SPECIFIC DISEASE CONDITIONS. THAT YEAR IT WAS
CANCER, AND I DO NOT BELIEVE THE TOBACCO INDUSTRY HAS FULLY
RECOVERED FROM THAT REPORT. IT IS ALSO THE REPORT THAT HAS
CONTRIBUTED SUBSTANTIALLY TO THE HUNDREDS OF LIABILITY SUITS THAT
HAVE BEEN BROUGHT AGAINST SPECIFIC CIGARETTE MANUFACTURERS.
4
YOU WILL RECALL THAT THE MOST RECENT SUCH CASE, BROUGHT ON

BEHALF OF THE LATE ROSE CIPOLLONE OF NEW JERSEY, A JURY IN
FEDERAL COURT FOR THE FIRST TIME BROKE THROUGH THE ARMOR OF THE
INDUSTRY. THE JURY FOUND THAT CIGARETTE COMPANIES WERE
RESPONSIBLE FOR SOME OF THE BAD EFFECTS OF THEIR PRODUCT, IT
ASSIGNED A PORTION OF BLAME, AND LEVIED DAMAGES.

THAT WAS ONE OUTCOME OF THE HISTORIC 1982 REPORT. IN
SUBSEQUENT REPORTS WE DEALT WITH SMOKING AND HEART DISEASE,

STROKE, AND CHRONIC OBSTRUCTIVE LUNG DISEASE. AGAIN, THE EVIDENCE
HAS BEEN OVERWHELMING AND VERY DAMAGING TO TOBACCO.
5
T AM ESPECIALLY PLEASED, HOWEVER, TO HAVE RELEASED REPORTS

ON SMOKING AND THE WORKPLACE AND ON INVOLUNTARY SMOKING.
TOGETHER, THESE REPORTS BECAME THE BASIS FOR AN EXTRAORDINARY
NUMBER OF NEW ANTI-SMOKING LAWS AND POLICIES FOR RETAIL
ESTABLISHMENTS, MANUFACTURING, BUSINESS OFFICES, AND GOVERNMENT
BUILDINGS,

BUT THE MOST RECENT REPORT, WHICH I JUST RELEASED A MONTH
AGO, PRESENTS CONVINCING EVIDENCE THAT CIGARETTES AND OTHER
TOBACCO PRODUCTS ARE ADDICTING. IT IS THE NICOTINE IN TOBACCO
THAT CAUSES THE ADDICTION. AND WE FIND THAT THE PHARMACOLOGIC
AND BEHAVIORAL PROCESSES THAT DETERMINE TOBACCO ADDICTION ARE
SIMILAR TO THOSE PROCESSES THAT MAKE COCAINE AND HEROIN
ADDICTIVE.
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THE DEFINITIONS USED IN THAT REPORT ARE NOT MINE. THEY ARE

NOT IN ANY SENSE ARBITRARY. TOBACCO IS AN ADDICTIVE DRUG,
ACCORDING TO THE STANDARD DEFINITION OF DRUG ADDICTION ADOPTED
BY THE WORLD HEALTH ORGANIZATION, THE AMERICAN PSYCHIATRIC
ASSOCIATION, AND THE A.M.A. IN OTHER WORDS...

* —— TOBACCO IS A “MOOD-ALTERING” SUBSTANCE ...

* SMOKERS ARE COMPULSIVE IN THEIR USE OF TOBACCO...

* TOBACCO REWARDS THE USER -- IT IS, THEREFORE, A
“REINFORCING” SUBSTANCE ...

* SMOKERS BUILD UP A TOLERANCE TO NICOTINE AND, FROM TIME TO
TIME, WILL REQUIRE HIGHER DOSE LEVELS TO GET THEIR
NICOTINE “HIGH” ...
/
* PHYSICAL DEPENDENCE CAN OCCUR, WHICH MEANS A WITHDRAWAL

SYNDROME FOR THOSE WHO QUIT ...

* AND -- AS WITH HEROIN, COCAINE, AND OTHER ADDICTIVE DRUGS --
THE USER WILL VERY LIKELY RELAPSE AND RETURN TO THE USE
OF THE DRUG.

I FEEL VERY STRONGLY THAT YOUNG PEOPLE NEED TO BE WARNED
ABOUT THE ADDICTIVE NATURE OF TOBACCO,BECAUSE, RIGHT NOW, YOUNG
PEOPLE ARE THE PREFERRED TARGET OF TOBACCO ADVERTISING AND PUBLIC
RELATIONS.

I'VE SAID IT BEFORE AND I’LL SAY IT HERE AGAIN: I BELIEVE
THE DAYS OF THE TOBACCO INDUSTRY ARE NUMBERED ... AND THE SOONER
IT REALIZES AND ACCEPTS THAT FACT, THE HAPPIER WE‘LL ALL BE.
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PEOPLE OFTEN ASK ME HOW THE SMOKING ISSUE COMPARES IN

GRAVITY TO THE ISSUE OF AIDS. IT’S A LITTLE LIKE COMPARING
APPLES AND ORANGES, BUT OVER THE PAST SEVERAL MONTHS I’VE WORKED
OUT AN ANSWER, AND I WILL SHARE IT WITH YOU NOW,

FIRST OF ALL, WE’VE KNOWN ABOUT THE PUBLIC HEALTH CONSE-
QUENCES OF SMOKING FOR ABOUT 30 YEARS. AND DURING THAT TIME,
WE’VE GENERATED -- BOTH HERE IN THE UNITED STATES AND AROUND THE
WORLD -- AN ENORMOUS ARCHIVE OF SOLID SCIENTIFIC DATA THAT TIE
CIGARETTE SMOKING TO A LONG LIST OF DEBILITATING, DISABLING, AND
FATAL DISEASES.
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AIDS, ON THE OTHER HAND, HAS NOT YET PASSED ITS FIRST DECADE

AS AN IDENTIFIABLE DISEASE, AND ITS RESEARCH ARCHIVE, WHILE
LARGE, IS STILL MODEST BY COMPARISON TO THE 60,000 OR SO STUDIES
THAT HAVE BEEN DONE ON SMOKING,

AND -- SO FAR, AT LEAST -- THE MORTALITY AMONG SMOKERS STILL
FAR EXCEEDS THAT OF AIDS: WELL OVER 300,000 DEATHS A YEAR ARE
SMOKING-RELATED, BUT THERE WERE ONLY 8,500 AIDS-RELATED DEATHS
LAST YEAR,

T SHOULD ADD THAT THE MORTALITY RATE FOR AIDS IS VIRTUALLY
100 PERCENT, WHICH MAY BE HIGHER THAN THE MORTALITY RATE FOR
SMOKERS. THE KEY DIFFERENCE, OF COURSE, IS THAT YOU CAN’T
PREDICT WHICH SMOKERS ARE GOING TO DIE.
 

10
AND EVEN THAT NEEDS SOME EXPLANATION. LET’S LOOK, FOR

EXAMPLE, AT TWO YOUNG MEN, EACH 22 YEARS OF AGE. BOTH HAVE A
LIFE EXPECTANCY OF ABOUT 66 YEARS. ONE YOUNG MAN BECOMES
INFECTED TODAY WITH THE HUMAN IMMUNODEFICIENCY VIRUS, OR H.I.V.,
AND WILL VERY LIKELY DIE OF THE DISEASE OF AIDS AND ITS
COMPLICATIONS BEFORE HE TURNS 30. HE WILL DIE PREMATURELY, THEN,
BY ABOUT 36 YEARS.

THE SECOND YOUNG MAN OF 22 BEGINS TO SMOKE CIGARETTES TODAY
AND CONTINUES TO SMOKE THEM FOR THE REST OF HIS LIFE. HE WILL
VERY LIKELY DIE OF HEART DISEASE OR LUNG CANCER AROUND THE AGE OF
56, ALL OTHER THINGS BEING EQUAL. HE WILL DIE PREMATURELY BY
ABOUT 10 YEARS,
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YES, THE AIDS VIRUS, COMPARED TO CIGARETTE SMOKING, DOES

SHORTEN PEOPLE’S LIVES MORE QUICKLY THAN TOBACCO DOES. BUT THE
QUALITY OF LIFE FOR BOTH VICTIMS IS SADLY DIMINISHED. AND FOR

BOTH, PRE-MATURE DEATH IS PREMATURE DEATH. THE VICTIM DISAPPEARS
EARLY eee AND EQREVER.

SO, ESSENTIALLY, THE OUTCOME OF A LIFE OF CIGARETTE SMOKING
IS NO DIFFERENT FROM THE OUTCOME OF AN ADMITTEDLY SHORTER LIFE OF

SODOMY AND DRUG ADDICTION: YOU'RE DEAD TOO SOON.

AND BOTH CONDITIONS -- THAT IS, BEING A CIGARETTE SMOKER AND
BEING H.1.V.-POSITIVE -- ARE THE RESULTS OF WILLFUL PERSONAL
BEHAVIOR. YOU DON’T “CATCH” AN ADDICTION TO TOBACCO AS YOU DON’T
"CATCH” AIDS. YOU HAVE TO DO SOMETHING IN BOTH INSTANCES.

HENCE, THE VERY BEST WEAPON WE HAVE TO FIGHT BOTH DISEASE
CONDITIONS -- TOBACCO ADDICTION AND H.I.¥. INFECTION -- IS
EDUCATION ... EDUCATION ... AND MORE EDUCATION.
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THERE IS, HOWEVER, ONE KEY DIFFERENCE BETWEEN THE TWO:

CIGARETTE SMOKING IS ACTIVELY PROMOTED BY THE CIGARETTE INDUSTRY
ITSELF, WHICH IS THE PRINCIPLE AND COMMERCIAL BENEFICIARY OF THIS
ADDICTION. THEREFORE, THE GOVERNMENT’S ROLE IN TRYING TO REDUCE
AND EVEN ELIMINATE CIGARETTE SMOKING IS A ROLE MADE POSSIBLE BY
TWO CLAUSES IN ARTICLE I, SECTION 8 OF THE U.S. CONSTITUTION: THE
"GENERAL WELFARE” CLAUSE AND THE “COMMERCE CLAUSE.”

THESE TWO CLAUSES ARE THE BASIS FOR ALL GOVERNMENTAL
AGENCIES THAT REGULATE COMMERCE SO AS TO PROTECT THE HEALTH AND
SAFETY OF THE AMERICAN PEOPLE: THE ENVIRONMENTAL PROTECTION
AGENCY, FOR EXAMPLE, OR THE CONSUMER PRODUCT SAFETY COMMISSION OR
THE FOOD AND DRUG ADMINISTRATION, AND SO ON,
 

13
BUT AIDS IS A DIFFERENT MATTER. THERE IS NO H.I.V.

“INDUSTRY,” OF COURSE. THEREFORE, ANY GOVERNMENTAL ACTION
AGAINST AIDS MUST BE WITHIN THE SAME PUBLIC HEALTH FRAMEWORK AS
THE ACTIONS WE TAKE AGAINST INFLUENZA, HYPERTENSION, MEASLES, OR
TOOTH CAVITIES: THAT IS, WE BALANCE THE “GENERAL WELFARE” CLAUSE
AGAINST THE APPROPRIATE AMENDMENTS TO THE CONSTITUTION ...
BEGINNING, OF COURSE, WITH THE FIRST 10, THE “BILL OF RIGHTS,”

WE CAN, THEREFORE, PASS LAWS -- AND ENFORCE THEM -- TO
PROHIBIT THE SALE OF CIGARETTES TO YOUNG PEOPLE -- OR TO PERSONS
OF ANY AGE, IF WE WANTED TO -- AND LABEL CIGARETTE PACKAGES WITH
THE “SURGEON GENERAL’S WARNINGS” AND LEVY HIGH TAXES ON EVERY
SALE, AND SO FORTH,
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AND ONE DAY WE MAY EVEN FIGURE OUT HOW TO CLOSE DOWN THE

TOBACCO INDUSTRY ALTOGETHER, WITHOUT MASSIVE DISRUPTION TO THE
LIVES OF THOUSANDS OF FARMERS AND FACTORY WORKERS AND SHOP-
KEEPERS.

BUT WE HAVE A MUCH MORE DIFFICULT TIME PASSING LAWS -- AND
ENFORCING THEM -- THAT PROHIBIT CONSENSUAL SODOMY WITHOUT A
CONDOM OR PROMISCIOUS HETEREOSEXUAL INTERCOURSE OR THE USE OF
CONTAMINATED NEEDLES WHILE “SHOOTING UP” WITH DANGEROUS DRUGS.
NOR IS IT A SIMPLE MATTER TO KEEP RECORDS ON PEOPLE WITH AIDS, IF
THOSE RECORDS CAN BE USED AGAINST THEM IN SOME WAY,
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BUT BOTH CIGARETTE SMOKING AND AIDS HAVE SOMETHING ELSE IN

COMMON, AND THAT’S THEIR INTERNATIONAL CHARACTER. BOTH NOW SHARE
TOP BILLING AT THE WORLD HEALTH ORGANIZATION IN GENEVA. AND I’M
AFRAID THAT THE AMERICAN CIGARETTE MANUFACTURERS WORKED VERY HARD
TO EARN THAT TOP POSITION,

FOR EXAMPLE, EARLIER THIS YEAR MR. J.T. BUNN OF THE LEAF
TOBACCO EXPORTERS ASSOCIATION TOLD THE INTERAGENCY COMMITTEE ON
SMOKING AND HEALTH ~~ WHICH I CHAIR -- THAT IN 1987 “..,THE VALUE
OF U.S. EXPORTS OF LEAF TOBACCO AND TOBACCO PRODUCTS TOTALLED
$3.5 BILLION. THE VALUE OF U.S. TOBACCO IMPORTS TOTALLED ABOUT
$705 MILLION.”
16
MR. BUNN THEN PROUDLY POINTED OUT THAT “OUR NET FAVORABLE

BALANCE OF TOBACCO TRADE WAS $2.6 BILLION, THIS IS AN IMPORTANT
CONTRIBUTION TO OUR BALANCE OF PAYMENTS,” MR. BUNN CONCLUDED.

WELL, MAYBE IT IS. BUT OTHERS DON’T QUITE SEE IT THAT WAY,

IN 1987 IN TOKYO, REPRESENTATIVES OF 15 ASIAN COUNTRIES
ATTENDED A W.H.O. “REGIONAL WORKING GROUP ON TOBACCO OR HEALTH.”
HERE ARE SOME OF THE THINGS REPORTED AT THAT MEETING BY THE TOP
HEALTH EXPERTS FROM THOSE 15 ASIAN COUNTRIES:
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FIRST, THEY SAID THAT CIGARETTE CONSUMPTION EVERYWHERE IN

ASIA WAS RISING FASTER THAN THE OVERALL RISE IN POPULATION,
WHICH IS SAYING SOMETHING IN ITSELF, THE PEOPLE’S REPUBLIC
OF CHINA, FOR EXAMPLE, REPORTED THAT 90 PERCENT OF ITS MEN
SMOKE ... PAPUA NEW GUINEA REPORTED THAT 85 PERCENT OF ITS
MEN NOW SMOKE ... THE PHILIPPINES, 78 PERCENT ... AND SO
ON,

AND LISTEN CAREFULLY TO THIS: IN CHINA, WHERE COUPLES ARE
SUPPOSED TO HAVE ONLY 1 CHILD PER FAMILY, THERE ARE AT THIS
MOMENT AN ESTIMATED 50,000,000 CHILDREN WHO WILL DIE
PREMATURELY FROM SMOKING.

SECOND, IN 10 OF THOSE 15 ASIAN COUNTRIES, AMERICAN
CIGARETTES WERE THE MOST COMMON KIND IMPORTED. THEY DON’T
CARRY THE SURGEON GENERAL’S WARNING, EVEN THOUGH MANY ARE
MANUFACTURED WITH A HIGHER TAR CONTENT AND ARE, THEREFORE,
EVEN MORE DANGEROUS THAN THE LOWER-TAR, FULLY-LABELLED
PRODUCTS SOLD HERE IN THE STATES.
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THIRD, AND NOT SURPRISINGLY, THESE SAME 15 COUNTRIES

REPORTED THAT COMMUNICABLE DISEASE WAS NO LONGER THE NUMBER
ONE PUBLIC HEALTH MENACE IN ASIA. TODAY, THE TOP THREE
CAUSES OF DEATH IN ASIA ARE -- CAN YOU GUESS? --. THE SAME
THREE SMOKING-RELATED CAUSES OF DEATH THAT PREVAIL HERE IN
THE UNITED STATES: HEART DISEASE, CANCER, AND STROKE,

IN OTHER WORDS, THE TOBACCO EPIDEMIC AND ITS LETHAL CONSE-
QUENCES HAVE HIT ASIA ... AND -- THANKS TO OUR OWN CIGARETTE
INDUSTRY -- HAVE HIT ASIA HARD,
19
BUT THE CIGARETTE SMOKING EPIDEMIC BEING WHAT IT IS -- A

CROSS BETWEEN PUBLIC HEALTH AND INTERNATIONAL COMMERCE -- WE
FIND, COUNTRY-BY-COUNTRY, THAT THE STRONGEST OPPONENTS ARE OFTEN
CONSUMERS AS WELL AS PHYSICIANS. IN FACT, THE 1.0.C.U., OR
INTERNATIONAL ORGANIZATION OF CONSUMERS UNIONS -- NOT A U.N.
GROUP, BY THE WAY -- HAS A SEPARATE ANTI-SMOKING SUB-GROUP THAT
GOES BY THE NAME OF “ACTION GROUPS TO HALT THE ADVERTISING AND
SPONSORSHIP OF TOBACCO” -- OR “AGHAST.”

ONE OF “AGHAST’S” KEY ACTIVITIES IS TO SUPPORT THE WORLD
HEALTH ORGANIZATION’S ANNUAL “WORLD NO-TOBACCO DAY” ON APRIL 7.
AFFILIATED MEMBERS OF “AGHAST” -- MOSTLY NATIONAL CONSUMER
COUNCILS -- HAVE HAD ROUSING AND SUCCESSFUL “NO SMOKING DAYS” IN
PLACES LIKE FIJI, HONG KONG, INDIA, MALAYSIA, AND THAILAND.
20
IF THIS SOUNDS SUSPICIOUSLY LIKE OUR OWN “GREAT AMERICAN

SMOKE-OUT,” WHICH WE SPONSOR HERE EVERY YEAR IN NOVEMBER, THAT’S
BECAUSE IT IS. AND I’M PLEASED TO SAY THAT | AND OUR P.H.S.
OFFICE ON SMOKING AND HEALTH HAVE HAD SOMETHING TO DO WITH
SPREADING THE IDEA TO OUR FRIENDS OVERSEAS.

I SHOULD ADD THAT MR. J.T. BUNN, THE TOBACCO EXPORTER,
WARNED ME LAST FEBRUARY THAT IF I CONTINUE TO PROMOTE ANTI-
SMOKING CAMPAIGNS WORLDWIDE -- WHICH I HAVE SURELY DONE -- |
WOULD BE “TELLING OUR FOREIGN FRIENDS HOW TO CONDUCT TRADE AND
HOW TO CHANGE THEIR HABITS. IT PROJECTS FOR THE U.S. AN IMAGE OF
‘THE UGLY AMERICAN, ’” SAID MR. BUNN IN ONE OF THE BEST DEMON-
STRATIONS OF BARE-FACED CYNICISM I HAVE HAD THE PRIVILEGE TO
ENCOUNTER,
21
WELL, THEN, “UGLY AMERICAN” I AM... AND “UGLY AMERICAN” I

INTEND TO REMAIN, MR. J.T. BUNN,

SO MUCH FOR THE CIGARETTE EPIDEMIC.

THE AIDS EPIDEMIC IS A DIFFERENT MATTER, HOWEVER. THE
UNITED STATES HAS BEEN A WORLD LEADER IN THE EFFORT TO ISOLATE
AND IDENTIFY THE AIDS VIRUS AND IN THE BATTLE TO STOP THE
EPIDEMIC AND TURN IT AROUND. WE ESTABLISHED WHAT IS THE MODEL
SYSTEM SO FAR FOR REPORTING AIDS AND WE‘VE HELPED A NUMBER OF
COUNTRIES, ESPECIALLY THOSE IN SUB-SAHARA AFRICA, TO DO THE SAME,

WE’VE ALSO FINANCED MOST OF THE RESEARCH IN THE DISEASE,
BOTH HERE AND ABROAD, EITHER DIRECTLY OR THROUGH W.H.0.’s “GLOBAL
PROGRAMME ON AIDS.”
22
BUT DESPITE THESE GOOD WORKS, THE EPIDEMIC IS SPREADING

THROUGHOUT 135 COUNTRIES OF THE WORLD, AS IT IS SPREADING HERE IN
THE UNITED STATES,

WHILE OUR CASELOAD IS COMPRISED MAINLY OF HOMOSEXUALS,
BISEXUAL MEN, AND INTRAVENOUS DRUG ABUSERS, THE CASELOAD IN OTHER
COUNTRIES IS RISING MAINLY BECAUSE OF H.1.V.-INFECTED BLOOD AND
BLOOD PRODUCTS AND A VERY HIGH PROPORTION OF H.1.V.-INFECTED
PROSTITUTES ... IN SOME AREAS UP TO 90 PERCENT OF THE FEMALE
PROSTITUTES CARRY THE AIDS VIRUS.
23
BUT MANY COUNTRIES OF THE WORLD HAVE YET TO DEAL CANDIDLY

WITH THE UNSETTLING NATURE OF THE AIDS EPIDEMIOLOGICAL DATA, AS
WE HAD TO DO A FEW YEARS AGO. FOR EXAMPLE, IN HONG KONG IT IS
AGAINST THE LAW TO ENGAGE IN HOMOSEXUAL SEX. THEREFORE, SAY THE
AUTHORITIES OF HONG KONG, SEXUAL PROMISCUITY AMONG HOMOSEXUALS
DOES NOT OCCUR IN HONG KONG,

BUT IT DOES AND THE HONG KONG AIDS REPORTS ARE BEGINNING TO
OFFER PROOF THAT IT DOES. HOWEVER, THE OFFICIAL POSITION OF
DENIAL HAS PREVENTED THE LAUNCHING OF A USEFUL AIDS EDUCATION
PROGRAM DIRECTED TOWARD HOMOSEXUALS AND OTHER HIGH-RISK GROUPS.
24
FORTUNATELY, WE’VE ALREADY PASSED THROUGH THAT STAGE OF

SENSITIVITY TRAINING. FOR A WHILE IN 1986 AND 1987, I WAS THE
ONLY PUBLIC FIGURE USING SUCH WORDS AND PHRASES AS “CONDOM, “
"ANAL SEX,” “VAGINAL SEX," AND “SEMEN.”

I CAN'T SAY IT WAS EXACTLY A PRIVILEGE TO HAVE BEEN SO
CENTRALLY INVOLVED. NEVERTHELESS, I BELIEVE THAT THE AMERICAN
PEOPLE -- ASSISTED, I WOULD HOPE, BY THEIR SURGEON GENERAL --
HAVE PASSED THROUGH THAT PERIOD OF GREAT DISCOMFORT AND ARE
DEALING WITH THIS EPIDEMIC IN A RESPONSIBLE, MATURE WAY.
25
I WILL CONFESS TO YOU THAT IT WAS VERY DIFFICULT FOR THIS

70-YEAR-OLD HETEROSEXUAL MALE CELEBRATING HIS 49TH WEDDING
ANNIVERSARY TO TALK ABOUT SOME OF THESE THINGS. BUT I DID...
AND NOW THAT’S ALL BEHIND US.

I MAKE THE POINT, HOWEVER, TO ILLUSTRATE HOW FAR ALONG WE.
HAVE COME AS A SOCIETY, DEALING WITH THE DIFFICULT ISSUE OF AIDS,
COMPARED TO MANY OTHER SOCIETIES IN THE WORLD WHO ARE ALSO
EXPERIENCING THE FIRST EFFECTS OF THIS TERRIBLE EPIDEMIC,
26
THESE TWO PUBLIC HEALTH EPIDEMICS -- CIGARETTE SMOKING AND

AIDS -- ARE NOT THE ONLY THINGS THAT CONCERN ME ABOUT THE HEALTH
OF OUR NATION. 1 SPEND A GREAT DEAL OF TIME AND ENERGY ON
ALCOHOLISM AND DRUNK DRIVING ... ON DRUG ABUSE ... ON MATTERS
AFFECTING MATERNAL AND CHILD HEALTH ... AND ON THE STUDY OF THE
HEALTH EFFECTS OF ABORTION ON WOMEN, WHICH THE PRESIDENT ASKED ME
TO CARRY OUT.

BUT FOR SHEER NUMBERS OF HOURS, VOLUMES OF MAIL, AND LOGS OF
PHONE CALLS, AND PERSONAL VISITS TO MY OFFICE, THE TWO LEADING
ISSUES ARE AIDS AND CIGARETTES BY FAR.
 

2/7
I HOPE THIS HAS BEEN HELPFUL TO YOU IN SEEING THESE TWO

MAJOR HEALTH PROBLEMS IN A SLIGHTLY DIFFERENT PERSPECTIVE. AND
NOW, IF YOU WISH, I’D BE HAPPY TO ANSWER ONE OR TWO QUESTIONS.

THANK YOU,
Ht tH #