ORIGINAL
k fi : 7
35, NAIC

ADDRESS

 

By
C. Everett Koop, MD, ScD
SURGEON GENERAL
OF THE
U. S, PupLic HEALTH SERVICE
U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

aye

PRESENTED TO THE NATIONAL ASSOCIATION OF GOVERNMENT COMMUNICATORS
ARLINGTON, VIRGINIA
NovemMBer 20, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)
THANK YOU VERY MUCH FOR YOUR RECOGNITION AND YOUR HONOR.

AND CONGRATULATIONS FOR DISCOVERING ONE OF THE BEST-KEPT
SECRETS IN GOVERNMENT SERVICE:

THE SURGEON GENERAL OF THE U.S PUBLIC HEALTH SERVICE IS NOT NOW
A SURGEON -- I WAS ONE ONCE AND A PRETTY GOOD ONE, TOO -- BUT 1
HAVEN'T PRACTICED AS A SURGEON SINCE MY APPOINTMENT IN 1981,

AND 17M CERTAINLY NOT A GENERAL, ACTUALLY MY EQUIVALENT
MILITARY RANK IS THAT OF A VICE-ADMIRAL. BUT WHO EVER HEARD OF
A "SURGEON ADMIRAL"?
2

NO, I AM NEITHER "SURGEON" NOR “GENERAL”. WHAT THIS JOB IS --
HAS BEEN -- AND CERTAINLY WILL CONTINUE TO BE LONG AFTER 1’VE
FINISHED MY OWN TOUR OF DUTY IN 17...1S THAT OF COMMUNICATOR,

I’M SUPPOSED TO TELL PEOPLE THINGS ABOUT THEIR HEALTH. BUT I’M
NOT SUPPOSED TO DO ANYTHING ELSE ABOUT IT,

AND FOR AN EX-SURGEON... BELIEVE ME, THAT’S NOT EASY.

ALSO, AS A NEWCOMER TO THIS FIELD, I’M STILL WORRIED ABOUT
WHETHER I’M COMMUNICATING EFFECTIVELY OR NOT. IN OTHER WORDS, DO
PEOPLE REALLY UNDERSTAND ME?
3

CAN YOU IMAGINE DR. RUTH OR PEEWEE HERMAN OR EVANS AND NOVAK OR
TAMMY BAKKER ASKING THEMSELVES SUCH A QUESTION?

OBVIOUSLY NOT.

NOW, I HOPE -- DESPITE MY CONFESSION HERE -- THAT YOU WON'T
TAKE YOUR AWARD BACK, I’M DELIGHTED WITH BEING NAMED “COMMUNICATOR
OF THE YEAR.”

FOR ME, IT’S ANOTHER RUNG UP THE CAREER LADDER...AND I NEED
THAT KIND OF HELP...AS A NON-SURGEON, NON-GENERAL,
AND NOW, WITH THAT CLARIFICATION OUT OF THE WAY, LET ME GET
DOWN TO BUSINESS AND TALK ABOUT A COUPLE OF IMPORTANT LESSONS I'VE
LEARNED ALONG THE 6-YEAR TRAIL THAT HAS LED TO TODAY'S LUNCHEON,

THE FIRST LESSON HAS TO DO WITH ALLIES.

YOU MAY RECALL THAT, ALMOST TWO YEARS AGO, IN FEBRUARY 1986,
PRESIDENT REAGAN ANNOUNCED THAT HE WANTED ME TO PUT TOGETHER A
REPORT TO THE AMERICAN PEOPLE THAT TOLD THEM THE PLAIN FACTS ABOUT
AIDS,

THE AIDS EPIDEMIC HAD BEEN ON THE RECORD BOOKS FOR NEARLY 5
YEARS BY THEN AND A GREAT MANY THINGS HAD HAPPENED:
5

* FOR EXAMPLE, WE HAD IDENTIFIED THE ROUTES OF TRANSMISSION
OF THE AIDS VIRUS FROM ONE HUMAN BEING TO ANOTHER...

* AND WE ALSO HAD A GOOD TEST TO DETECT THE PRESENCE IN THE
BLOODSTREAM OF ANTIBODIES TO THE AIDS VIRUS.

BUT MANY THINGS HAD NOT HAPPENED:

* WE STILL HAD NO VACCINE TO PREVENT THE VIRUS FROM
SPREADING...

* WE HAD NO DRUGS THAT STOPPED THE AIDS-RELATED ILLNESSES ~
FROM INVADING AND TAKING OVER THE BODY -- AND THE MIND -- OF A
PERSON WITH AIDS.
6

* AND WHILE WE TOLD THE PUBLIC HOW THE AIDS VIRUS WAS
TRANSMITTED, WE HAD’T SUCCEEDED IN TELLING THEM WHAT TO DO TO
AVOID GETTING AIDS. IN OTHER WORDS, WE TALKED A LOT ABOUT
"HIGH-RISK" BEHAVIOR, BUT WE NEGLECTED TO DESCRIBE “LOW-RISK” OR
"NO-RISK” BEHAVIOR.

THERE WAS MUCH CONFUSION, FRUSTRATION. ANGER, AND FEAR AT THAT
TIME. AND THAT’S WHEN THE PRESIDENT ASKED ME TO SPEND A FEW MONTHS
AND SET THE RECORD STRAIGHT FOR THE AMERICAN PEOPLE.

BUT I REALIZED THAT I, ALSO, HAD SOME CONCERNS ABOUT SOME
ASPECTS OF THE AIDS EPIDEMIC AND I NEEDED TO BE EDUCATED -- AND FAST
-- IF 1 WERE TO DO WHAT THE PRESIDENT WANTED,

FOR THE NEXT 8 MONTHS, THEREFORE, I INVITED A WIDE RANGE OF
ORGANI ZATIONS AND INDIVIDUALS TO MEET WITH ME PRIVATELY AND TELL ME
WHAT THEY KNEW ABOUT THIS DISEASE AND WHAT THEY THOUGHT THEIR
CONSTITUENCIES OUGHT TO KNOW, ALSO,
7

I LISTENED TO VIRTUALLY EVERY POINT OF VIEW ON THE SUBJECT,
BROUGHT TO ME BY SINCERE PEOPLE REPRESENTING...

THE NATIONAL EDUCATION ASSOCIATION AND THE NATIONAL P.T.A....

THE NATIONAL COUNCIL OF CHURCHES AND THE CHRISTIAN LIFE
COMMISSION OF THE SOUTHERN BAPTIST CONVENTION...

THE SYNAGOGUE COUNCIL OF AMERICA AND THE NATIONAL CONFERENCE OF
CATHOLIC BISHOPS...

T TALKED WITH THE NATIONAL COALITION OF BLACK LESBIANS AND GAYS
AND WITH THE WASHINGTON BUSINESS GROUP ON HEALTH,
8

I MET WITH REPRESENTATIVES OF LOCAL, COUNTY, STATE, AND
TERRITORIAL HEALTH OFFICIALS, ALL IN ALL, 1 TALKED WITH
REPRESENTATIVES OF 26 ORGANIZATIONS.

THEY WERE ALL CONCERNED...AND THEY ALL PLEDGED TO HELP ME GET
THE FINAL REPORT INTO THE HANDS OF THE AMERICAN PEOPLE.

AND THAT'S THE PART I WANT TO EMPHASIZE TO YOU TODAY,

THE EXPERIENCE OF LISTENING...LEARNING...AND THEN WRITING THAT
REPORT WAS -- QUITE COINCIDENTALLY -- A MINI-COURSE IN HOW THIS
SOCIETY WORKS,

WE OPERATE ON THE PRINCIPLE OF MAXIMUM PARTICIPATION BY THE
PEOPLE IN THE PROCESSES OF OUR NATIONAL LIFE.
9

WHEN THAT OCCURS, I BELIEVE THE PEOPLE FEEL A GENUINE SENSE OF
PROPRIETORSHIP ABOUT THE PROCESS,..AND ABOUT ITS OUTCOME...EVEN IF
IT’S AN OUTCOME WITH WHICH THEY DON’T COMPLETELY AGREE.

THE AMERICAN PEOPLE ARE BASICALLY FAIR...AND I THINK THEIR
FAIRNESS HAS NEVER BEEN MORE EVIDENT THAN DURING THE GROWTH OF THE
AIDS EPIDEMIC,

I EMPHASIZE THIS BECAUSE, AS I’M SURE YOU KNOW, MY REPORT ON
AIDS WASN'T EXACTLY WHAT MANY PEOPLE HAD EXPECTED, YET, IT DID
CONTAIN THE KIND OF INFORMATION THAT CAME UP OVER AND OVER AGAIN
DURING MY CONVERSATIONS WITH PEOPLE AND GROUPS FROM ACROSS THE
SPECTRUM OF AMERICAN LIFE.
10

THE REPORT SPOKE OF THE NEED TO TELL OUR CHILDREN ABOUT AIDS...
AND ABOUT THE PRIMARY WAY AIDS WAS BEING TRANSMITTED: THAT IS.
THROUGH SEXUAL INTERCOURSE. SO, WE HAD TO FOCUS ON THE NEED 10 TELL
OUR CHILDREN ABOUT HUMAN REPRODUCTION, HUMAN SEXUALITY, AND -- MOST
IMPORTANT OF ALL -- THE NATURE OF HUMAN RELATIONSHIPS:

WHAT YOU THINK ABOUT YOURSELF...AND WHAT YOU THINK ABOUT
OTHER PEOPLE,

IT SEEMED TO ME THAT THE PUBLIC HAD ALREADY BEEN GIVEN MORE THAN
ENOUGH MISINFORMATION ABOUT THIS DISEASE AND THE PEOPLE WHO HAD IT.
BUT THE PUBLIC HAD NOT YET BEEN GIVEN NEARLY ENOUGH INFORMATION TO
HELP THEM UNDERSTAND THAT SCIENCE AND MORALITY HAD TO WALK HAND-IN-
HAND, IN ORDER FOR US TO CONTAIN THE EPIDEMIC OF AIDS.
1]

AND IT TURNED OUT THAT I HAD TREMENDOUS ALLIES FOR THIS POINT
OF VIEW,

AND THAT HAS MADE ALL THE DIFFERENCE,

WE RELEASED THE “SURGEON GENERAL’S REPORT ON AIDS” ON OCTOBER
22, 1986. AND FROM THAT MOMENT ON, THE SCHOOLS. ..CHURCHES,.,
SYNAGOGUES, . HOSPITALS, ..CITY HALLS...STATE HOUSES...AND CIVIC
ASSOCIATIONS OF AMERICA HAVE HELPED TO DISTRIBUTE THE REPORT.

WE'VE MADE CAMERA-READY COPIES OF THE REPORT AVAILABLE TO ANY
GROUP SO THEY COULD REPRODUCE IT AND EVEN ADD THEIR OWN LOGO. AND
DOZENS OF GROUPS HAVE DONE JUST THAT.

SINCE THEY WERE PART OF THE WRITING PROCESS ITSELF AND, THUS,
HAVE A SENSE OF OWNERSHIP OF THE REPORT, THESE GROUPS HAVE ALSO GONE
TO LOCAL NEWSPAPERS AND RADIO AND T.V, STATIONS... THEY’VE HELD
PUBLIC MEETINGS... THEY’VE DONE A TREMENDOUS EDUCATION JOB RIGHT AT
THE COMMUNITY AND NEIGHBORHOOD LEVEL.
12

THE NUMBER OF PERSONS WITH AIDS HAS CLIMBED STEADILY SINCE
1981, BUT 1 AM ABSOLUTELY CERTAIN THAT, WITHOUT THE PRO-ACTIVE
INVOLVEMENT OF SO MANY SOLID AMERICAN GROUPS -- OF EVERY PERSUASION
-- THE NUMBER OF AIDS VICTIMS WOULD BE FAR HIGHER THAN IT IS,

I GAN’T PROVE IT. NO ONE CAN, BUT 1 BELIEVE IT’S TRUE,

NOW. I PERSONALLY GET A LOT OF CREDIT FOR DOING SUCH A
MARVELOUS JOB IN COMMUNICATING THE AIDS MESSAGE. AND I SUPPOSE I
HAVE, OR 1 WOULDN’T BE HONORED BY YOU AT THIS ANNUAL MEETING,

BUT I -- JUST LIKE EVERY ONE OF YOU -- I ALSO AM JUST ONE
PERSON. ..A GOVERNMENT EMPLOYE,...AND I MAINTAIN THAT THE SUCCESS I
MAY HAVE HAD SO FAR IS, YOU MIGHT SAY, JUST “THE TIP OF THE
ICEBERG,”
13

WHAT YOU DON'T SEE -- BUT WHICH I KNOW IS THERE -- IS THE BROAD
BASE OF UNDERSTANDING AND SUPPORT AND CONSTANT REITERATION OF THE
ANTI-AIDS MESSAGE BY TENS OF THOUSANDS OF ENGAGED AND INVOLVED AND
FAIR-MINDED CITIZENS,

I ‘ENCOURAGE YOU ALL TO BENEFIT FROM MY EXPERIENCE. IN YOUR OWN
WORK, IN REFERENCE TO ONE OR ANOTHER INFORMATION EFFORT FOR WHICH
YOU'RE RESPONSIBLE, I URGE YOU TO TAKE A MOMENT AND SEE 10 WHAT

EXTENT YOU CAN LEARN FROM -- AND LEARN WITH -- THE CITIZENS YOU
SERVE.

IN THAT WAY, YOU, TOO, CAN BUILD YOUR OWN ICEBERG,
14

MY OTHER MESSAGE FOR YOU TODAY IS A LITTLE DIFFERENT, BUT IT’S
STILL ROOTED IN MY OWN EXPERIENCE OVER THE PAST FEW YEARS.

IT’S PROMPTED BY MY FAMILIARITY WITH A GREAT DEAL OF THE CRITI-
CISM THAT HAS BEEN LEVELED AT THE GOVERNMENT -- AND THE PUBLIC
HEALTH ‘SERVICE IN PARTICULAR -- THROUGHOUT THIS TRAGIC PERIOD.

THE CRITICISMS GENERALLY HAVE TO DO WITH MONEY -- WE WEREN’T
SPENDING ENOUGH, THE CRITICS HAVE SAID -- OR WITH OUR ABILITY T0
COMMUNICATE THE FULL NATURE OF THIS DISEASE TO THE AMERICAN PEOPLE.

I BELIEVE IT HAS TO BE SAID THAT, FROM THE VERY BEGINNING --
GOING BACK TO JUNE OF 1981 -- THE GOVERNMENT TOOK SERIOUSLY THE
PRESENCE AND THE SPREAD OF AIDS,
15

BUT OUR VERY FIRST TASK, AS A RESPONSIBLE SCIENTIFIC ORGANI -
ZATION, WAS TO IDENTIFY THE BEAST AND UNDERSTAND HOW IT WORKED,

WE DID NOT SOUND A GENERAL ALARM ABOUT “AIDS” IN 1981 BECAUSE
THE TERM SIMPLY DIDN’T EXIST, IN FACT, FOR OVER A YEAR, THE DISEASE
WAS REFERRED TO AS "KAPOSI’S SARCOMA IN PREVIOUSLY HEALTHY PERSONS”
OR “PNEUMOCYSTIS CARINIT PNEUMONIA IN PREVIOUSLY HEALTHY PERSONS,”

THE TERM "ACQUIRED IMMUNE DEFICIENCY SYNDROME” -- AND ITS
ACRONYM "AIDS" -- DIDN’T GAIN CURRENCY UNTIL THE FALL OF 1982, SOME
14 MONTHS AFTER THE FIRST REPORTS OF THIS STRANGE DISEASE,
16

BUT GIVING IT A NAME DIDN'T SOLVE MUCH EITHER, BECAUSE AIDS HAS
PROVED TO BE A VERY STUBBORN PHENOMENON, IT BEGAN IN MYSTERY. AND
TODAY, MORE THAN 6 YEARS AND OVER A BILLION DOLLARS LATER, IT IS
STILL SOMETHING OF A MYSTERY.

 

BY. MID-1983 WE BEGAN TO SEE THE DIM OUTLINES OF WHAT THIS
DISEASE REALLY MIGHT BE, AND AT THAT POINT, THE PUBLIC HEALTH
SERVICE PUT IT ON THE TOP OF ITS AGENDA FOR RESEARCH AND ACTION,

WITH THE ADVICE AND COUNSEL OF THE NATIONAL GAY TASK FORCE, THE
PUBLIC HEALTH SERVICE INSTALLED A TOLL-FREE HOTLINE AND THE
ASSISTANT SECRETARY FOR HEALTH AT THAT TIME, DR. EDWARD BRANDT, SAID
THAT AIDS WAS NOW THE COUNTRY’S “NUMBER ONE HEALTH PROBLEM, ”
17

MOST AMERICANS HEARD THAT STATEMENT IN DISBELIEF, IN 1983
ALMOST ANYONE COULD TICK OFF A DOZEN OTHER CONCERNS THAT SEEMED TO
MERIT THAT TOP SPOT:

TEEN-AGE PREGNANCY, ALZHEIMER'S DISEASE, DRUG ABUSE, HEART
DISEASE, ALCOHOLISM, OBESITY...AND FOR ME, AT THAT TIME, THE
MAJOR PUBLIC HEALTH CONCERN WAS SMOKING,

AND I MUST BE VERY CANDID WITH YOU, CIGARETTES KILL IN ONE
MONTH AS MANY AMERICANS AS HAVE DIED OF AIDS IN THE PAST 6 YEARS.
18

1 THINK A CLOSER READING OF THE HISTORY OF THIS EPIDEMIC SO FAR
WILL LEAD TO THE CONCLUSION THAT THE GOVERNMENT DID, IN FACT,
MOBILIZE ITS EXTENSIVE RESOURCES IN A MANNER WHICH WAS CONSISTENT
WITH THE EVOLVING BODY OF INFORMATION WE HAD AT ANY ONE TIME,

AS THE INFORMATION CHANGED, PEOPLE IN GOVERNMENT MADE THE
NECESSARY ADJUSTMENTS IN POLICY AND ADMINISTRATION.

IN FACT, AS I INDICATED A MOMENT AGO, THERE WAS EVEN A QUESTION
AS TO WHETHER SOME GOVERNMENT DECISION-MAKERS WEREN’T GETTING AHEAD
OF WHAT THE SCIENTIFIC DATA SEEMED TO INDICATE.
19

PEOPLE IN GOVERNMENT -- ESPECIALLY THOSE OF US WHOSE
PROFESSIONAL TASK IT IS TO COMMUNICATE TO THE PUBLIC -- WE'RE
CONSTANTLY FACED BY THE REQUIREMENT TO TELL WHAT WE KNOW...BUT NOT
TO TELL THINGS THAT ARE BEYOND WHAT WE KNOW,

MANY OF OUR CRITICS WANTED US TO DO THAT. BUT WE WOULD NOT,
AND WE WILL NOT,

AND THE SAME IS TRUE OF THE BUDGET. WE’VE BEEN ROUNDLY
CRITICIZED FOR NOT ASKING FOR HUGE SUMS OF MONEY RIGHT FROM THE
BEGINNING. BUT, AS ANY GOVERNMENT PERSONS KNOWS, WE’RE SUPPOSED TO
ASK FOR MONEY WE KNOW WE CAN SPEND RESPONSIBLY, IF WE ASK FOR MORE
THAN THAT, THEN WE’RE BEING IRRESPONSIBLE.
20

HENCE, THE CHALLENGE FOR THE PUBLIC HEALTH SERVICE IN THE EARLY
YEARS OF THE AIDS EPIDEMIC WAS TO SPEAK AND TO SPEND WITHIN THE
BOUNDARIES OF WHAT WE KNEW OR COULD REASONABLY SUSPECT,

IT BELIEVE WE DID THAT. AND WE STILL ARE DOING THAT.

i

FROM THAT PERSPECTIVE, I BELIEVE THE AIDS EXPERIENCE HAS PROVED
TO BE A POSITIVE EXAMPLE OF THE WAY THE GOVERNMENT IN GENERAL -- AND
THE PUBLIC HEALTH SERVICE IN PARTICULAR -- OUGHT TO CONDUCT ITS
BUSINESS:

WE STAYED CLOSE TO OUR AIDS INFORMATION BASE, AND DID NOT OVER-
REACT IN GROUNDLESS HYSTERICS NOR UNDER-REACT IN CALLOUS
INDIFFERENCE.
21

I HOPE NOTHING LIKE THE AIDS VIRUS EVER APPEARS AMONG US AGAIN,
BUT. AS HUMAN HISTORY AMPLY ILLUSTRATES, SUCH THINGS APPEAR WITH
VERY TROUBLING FREQUENCY. AND I SUPPOSE WE’LL BE IN FOR SOMETHING
ELSE, BEFORE T00 LONG,

MY BEST ADVICE TO MY SUCCESSOR WOULD BE TO ACT PRETTY MUCH AS
WE ACTED OVER THE PAST 6 YEARS: MOVE AHEAD AS QUICKLY AS YOU CAN TO
DEVELOP THE INFORMATION BASE -- THE SCIENCE, THE DEMOGRAPHY. THE
ECONOMICS, OR WHATEVER IS REQUIRED -- AND THEN COMMUNICATE THAT
INFORMATION TO THE BEST OF YOUR ABILITY, LEAVING NOTHING OUT... BUT
NOT PUTTING A LOT OF UNSUBSTANTIATED THINGS IN EITHER,
22

] WOULD ADVISE THAT MY SUCCESSOR DO THAT...AND THEN HUNKER DOWN
TO TAKE THE HEAT.

AND NOW, LET ME CLOSE WITH A LITTLE BIT OF WISDOM THAT HAS
STAYED WITH ME FOR MANY YEARS, IT IS ESPECIALLY APPROPRIATE WHEN
DISCUSSING THE PHENOMENON OF AIDS, IT WAS WRITTEN BY ONE OF THE
GREAT PIONEERS OF MODERN SCIENCE, SIR FRANCIS BACON, AND IT GOES
LIKE THIS:

"NATURE IS A LABYRINTH IN WHICH
THE VERY HASTE YOU MOVE WITH
WILL MAKE YOU LOSE YOUR WAY.”
— 23

COME TO THINK OF IT, THAT’S NOT A BAD MOTTO FOR THE GOVERNMENT
COMMUNICATOR EITHER.

ONCE AGAIN, THANK YOU FOR YOUR INVITATION AND FOR YOUR AWARD.
1 DO APPRECIATE IT VERY MUCH.

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