ORIGINAL

# 7
SS Mops

ADDRESS

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

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PRESENTED TO THE NINTH ANNUAL NATIONAL MEDIA CONFERENCE
New York, NEw York
NovemBer 30, 1987
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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I WANT TO THANK YOU ALL VERY MUCH FOR INVITING ME TO SPEAK 10
YOU THIS MORNING. I’M PLEASED TO PARTICIPATE IN A CONFERENCE OF
COMMUNICATORS BECAUSE OUR ABILTY TO COMMUNICATE THE FACTS ABOUT AIDS
TO THE AMERICAN PEOPLE 1S THE ONLY THING THAT STANDS BETWEEN OUR
SOCIETY AND AN OVERWHELMING NATIONAL TRAGEDY.

I’D GUESS THAT EVERYONE HERE HAS A REASONABLY GOOD BASIS OF
KNOWLEDGE ABOUT THE DISEASE, SO I WON’T GIVE YOU A LOT OF “BOILER-
PLATE” THIS MORNING,
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BUT IF I’VE GUESSED WRONG ABOUT YOU, THEN -- PLEASE -- CALL
THIS NUMBER: 1-800-342-AIDS, AND ASK FOR YOUR FREE COPY OF THE
"SURGEON GENERAL'S REPORT ON AIDS.”

AND LET ME ADD A FOOTNOTE RIGHT HERE. REGARDING THAT REPORT.

IT TOOK ME 8 MONTHS TO PREPARE THAT REPORT, FROM FEBRUARY T0
SEPTEMBER OF 1986, AND I THINK IT’S A GOOD ONE. BUT IF IT HAD BEEN
LEFT TO GOVERNMENT ALONE TO GET THE PUBLISHED REPORT INTO THE HANDS
OF THE AMERICAN PEOPLE, I’M AFRAID WE MIGHT STILL BE WAITING.
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THAT'S AN OBSERVATION, NOT A CRITICISM, OUR SOCIETY HAS BEEN
CAREFUL TO KEEP GOVERNMENT RELATIVELY INEFFICIENT AS A COMMUNICATOR,
SINCE WE BELIEVE THE ALTERNATIVE -- THE TOTALITARIAN APPROACH OF
BEING ABLE TO REACH EVERYWHERE -- HAS NO PLACE IN OUR KIND OF
DEMOCRACY

SO, I’M JUST YOUR SURGEON GENERAL,..1°M NOT YOUR “BIG BROTHER.”

AND LET’S KEEP IT THAT WAY,..FOR ME AND FOR WHOMEVER COMES
ALONG NEXT,

BUT THE REPORT HAS BEEN READ BY MILLIONS OF AMERICANS, AND FOR
THAT WE HAVE TO THANK PEOPLE LIKE YOURSELVES...THE PROFESSIONALS WHO
PROVIDE OUR CITIZENS WITH INFORMATION DAY IN AND DAY OUT,
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COMMUNICATING TO THE PUBLIC IS MORE THAN A JUST A JOB,
RELATIVE TO WHAT YOUR INDUSTRY HAS ACCOMPLISHED WITH AIDS, I‘D SAY
IT’S A VITAL PUBLIC SERVICE,

THEREFORE. AS I INDICATED A MOMENT AGO, YOU'VE BEEN SO TERRIFIC
IN GETTING OUT THE FACTS CONCERNING AIDS -- AND MAYBE READING THAT
MATERTAL IN THE PROCESS -- THAT I WANT TO TAKE THIS OPPORTUNITY TO
TEST SOME IDEAS AND TO ASK SOME QUESTIONS FOR WHICH WE, AS YET, HAVE
NO GOOD ANSWERS,

I WANT TO TALK ABOUT WHAT THE AIDS VIRUS IS DOING TO SOME OF
OUR PEOPLE...WHAT IT COULD DO TO ALL OF OUR PEOPLE...AND WHAT WE
MUST DO TO HELP PEOPLE FIGHT BACK AND CONQUER AIDS, WHICH COULD WELL
PROVE TO BE THE MOST VICIOUS OF INFECTIOUS DISEASES IN THE HISTORY
OF THE HUMAN RACE,
LET ME CONFESS THAT, IN THE BATTLE AGAINST AIDS, MEDICINE AND
SCIENCE HAVE BEEN MAKING VERY SMALL HEADWAY. YES, THERE HAVE BEEN
SEVERAL ACHIEVEMENTS -- THE IDENTIFICATION OF THE VIRUS, THE BLOOD-
TEST, THE DEVELOPMENT OF A.Z.T., AND SO ON -- BUT, RELATIVE TO WHAT
WE STILL MUST ACCOMPLISH, WE'VE NOT MOVED THAT FAR FORWARD,

IN FACT, I’LL GO EVEN FURTHER AND SAY THAT THE FINAL VICTORY
OVER THIS DISEASE MIGHT NOT BE THE EXCLUSIVE VICTORY OF SCIENTIFIC
RESEARCH AND CLINICAL PRACTICE.

RESEARCH AND PRACTICE WERE THE ALLIES THAT CONQUERED SMALLPOX,
FOR EXAMPLE, AND POLIO,
BUT THIS TIME, THE VICTORY WILL MORE LIKELY SPRING FROM THE
IMPELLING FORCE OF COMPASSIONATELY COMMITTED AND ETHICALLY MOTIVATED
MEN AND WOMEN WHO HAVE LITTLE OR NO MEDICAL BACKGROUND AT ALL,

AND NOT JUST A FEW OF THEM. I MEAN MILLIONS OF THEM,
LET ME EXPLAIN THAT OBSERVATION,

RIGHT NOW, EVERYTHING THE PUBLIC THINKS AND DOES ABOUT AIDS
SEEMS TO BE RELATED TO THE THREE BASIC ASPECTS OF THE DISEASE:

ITS MYSTERY.,..WE’RE STILL NOT SURE EXACTLY WHAT IT 1S AND DOES,

ITS VIRTUALLLY 100 PERCENT MORTALITY RATE.
AND THE WAY MOST PEOPLE GET AIDS IS BY DOING THINGS THEY OUGHT
NOT TO DO... ENGAGING IN UNPROTECTED ANAL INTERCOURSE... BEING
SEXUALLY PROMISCUOUS,..AND “SHOOTING” ILLEGAL DRUGS WITH
BORROWED NEEDLES,

- EACH OF THESE ASPECTS TENDS TO CONFOUND THE INHERENTLY GOOD
INSTINCTS THAT MOST PEOPLE HAVE TOWARD ONE ANOTHER.

FOR EXAMPLE, CONSIDER THE MYSTERY OF THIS DISEASE.

 

WE MAY KNOW HOW THE VIRUS IS TRANSMITTED AND HOW IT ATTACKS
AND DESTROYS THE HUMAN IMMUNE SYSTEM -- BUT WE DON’T KNOW WHY IT
DOES THAT AND WE CAN’T PREDICT WHEN IT WILL DO THAT.

THE GENERAL PUBLIC DOESN’T LIKE MEDICAL MYSTERIES AND
DOESN’T TOLERATE THEM VERY WELL.
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THAT’S ONE OF THE REASONS THAT MEDICAL QUACKERY STILL
SURVIVES IN OUR SOCIETY. FAKE CANCER CURES,..FAKE AIDS
CURES,..FAKE DIETS...FAKE TONICS FOR BALDNESS AND ALL THE REST.

MOST OF THESE SCAMS WOULD BE HUMOROUS, IF THEY DIDN’T CAUSE
SO MANY PEOPLE TO LOSE SO MUCH OF THEIR MONEY AND IF THEY DIDN’T
PROLONG PAIN AND AGONY WITH THE FALSE HOPES OF QUACK MAGIC,

IN AN UPSIDE-DOWN WAY, MY COLLEAGUES IN SCIENCE AND
MEDICINE ARE PARTLY RESPONSIBLE.
IF WE HADN'T BEEN SO SUCCESSFUL OVER THE PAST 25 YEARS IN
DEFEATING OR CONTROLLING DOZENS OF SERIOUS MENACES TO THE PUBLIC
HEALTH -- SMALLPOX, POLIO, SICKLE CELL ANEMIA, HYPERTENSION,
LEAD POISONING, GERMAN MEASLES, AND SO ON -- THEN PEOPLE
WOULDN’T SEEN SO CONVINCED THAT SCIENCE IS MAGIC AND MAGIC IS
SCIENCE AND TOGETHER THEY CAN DO ANYTHING,

WHEN THEY LEARN THAT'S NOT THE CASE AT ALL, MANY PEOPLE
TEND TO LOSE THEIR PATIENCE... THEY LOSE THEIR TOLERANCE...OR
THEY LOSE THEIR FAITH,

AND SOME PEOPLE LOSE ALL THREE.
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WE NEED TO BE PREPARED FOR THIS VERY HUMAN -- ALBEIT
UNPLEASANT -- RESPONSE AND TRY TO DEAL WITH IT,

AS THE DAYS WIND ON, WE‘RE GOING TO SEE THE NUMBER OF
PEOPLE WITH AIDS CONTINUE TO GO UP,

WE ESTIMATE THAT ABOUT A MILLION TO A MILLION AND A HALF
PEOPLE ARE WALKING AROUND TODAY WITH THE AIDS VIRUS IN THEIR
BLOODSTREAMS, EVENTUALLY, EACH ONE WILL SHOW SIGNS OF AN AIDS-
RELATED DISEASE OF ONE KIND OR ANOTHER.

AND THEY WILL DIE OF THOSE OPPORTUNISTIC DISEASES,
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AND SO THE NUMBER OF ALDS-RELATED DEATHS WILL CONTINUE TO
CLIMB AS WELL,

WHILE THOSE NUMBERS CLIMB, THE PUBLIC WILL BE MORE FEAR-
FUL AND LOOK FOR QUICK ANSWERS AND QUICK SOLUTIONS. BUT WE HAVE
NONE TODAY AND WE WON’T HAVE ANY TOMORROW EITHER.

AND “TOMORROW” CAN STRETCH INTO THE 1990’s AND BEYOND,

SO FAR, OUR SOCIETY HAS BEEN ABLE TO HANDLE THIS FEAR OF
THE UNKNOWN WITH A MINIMUM OF IRRATIONALITY.

WE'VE HAD ARCADIA, FLORIDA, WHERE THREE HEMOPHILIAC BOYS
AND THEIR FAMILY WERE LITERALLY DRIVEN OUT OF TOWN. BUT THANK
GOODNESS... THE EXPERIENCE IN ARCADIA IS NOT THE RULE IN AMERICA,
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‘AND WE HAVE TO DO OUR VERY BEST TO MAKE SURE THAT THAT’S
THE CASE FOR THE LONG, HARD YEARS AHEAD.

WE MUST NOT PANDER TO FEAR AND IGNORANCE AND PREJUDICE IN
THE FACE OF THE MYSTERY OF AIDS. WE MUST, INSTEAD, COUNTER WITH
FACTS AND PATIENCE AND FAITH IN THE FUTURE OF THE HUMAN RACE,

] SAID THAT THE SECOND FACT ABOUT AIDS IS ITS FATALITY
RATE: THE DISEASE IS VIRTUALLY 100 PERCENT FATAL.

AIDS HAS ATTACKED MORE THAN 44,000 PEOPLE SINCE JUNE OF
1981 AND ALMOST 26,000 OF THEM HAVE ALREADY DIED,
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THAT’S THE TRUTH,..BUT THERE’S MORE. THE TRUTH ALSO
INCLUDES THE FACT THAT, OF THOSE PEOPLE WHO HAD AIDS IN 1981, AT
LEAST 91 PERCENT OF THEM HAVE ALREADY DIED,

OF THOSE WHO HAD THE DISEASE IN 1982, SOME 87 PERCENT HAVE
ALREADY DIED.

OF THOSE IN 1983, 89 PERCENT OF THEM HAVE ALREADY DIED OF
AIDS,

AND SO ON,

AIDS IS THE CLOSEST THING IN OUR ENVIRONMENT TODAY TO BEING
A "VIRTUALLY 100 PERCENT FATAL DISEASE.”
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WE HAVE ONLY A FEW DRUGS COMING INTO THE MARKETPLACE --
A.Z.T. MOST PROMINENT AMONG THEM -- AND THESE DRUGS HELP PROLONG
LIFE A LITTLE BIT,..A FEW MONTHS.,.MAYBE A YEAR OR SO,

BUT WE HAVE NOTHING AT ALL...NOTHING...THAT WILL SAFELY AND
EFFECTIVELY STOP THE DISEASE OF AIDS IN ITS TRACKS,

 

WE HAVE NO DRUGS...NO VACCINES,..NO MAGIC BULLETS,..NOTHING
THAT CAN ACCOMPLISH THAT LIFE-SAVING JOB,

SO THE AIDS EPIDEMIC PROVIDES A DANGEROUSLY FERTILE
ENVIRONMENT FOR HOPELESSNESS,
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PEOPLE ASK ME."WHAT’S THE POINT OF SPENDING GREAT SUMS OF
MONEY ON THESE PEOPLE WITH AIDS... WHEN THEY’RE GOING TO DIE
ANYWAY 2"

OR, ON A MORE PERSONAL LEVEL, “WHY SHOULD I DO ANYTHING FOR
A PERSON WITH AIDS, WHEN DEATH IS RIGHT AROUND THE CORNER?”

MAYBE EVERYONE DOESN’T PUT IT QUITE SO BLUNTLY. BUT THAT'S
WHAT THEY‘RE THINKING, WHEN THEY REFUSE TO ADMIT AIDS PATIENTS
TO HOSPITALS OR TURN THEM AWAY FROM CLINICS AND SCHOOLS.

THIS SECOND ASPECT OF AIDS -- ITS VIRTUALLY 100 PERCENT
MORTALITY RATE -- IS AT THE SOURCE OF THIS TURN TOWARD
ABANDONING PEOPLE WITH THE AIDS VIRUS,
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AND ABANDONMENT OF THE SICK -- EVEN OF THE MORTALLY AND
FATALLY ILL -- IS TOTALLY CONTRARY TO WESTERN ETHICAL
TRADITIONS.

WE MUST NOT LET THIS DISEASE INFECT AND CORRUPT OUR VALUES.
WHILE IT DESTROYS THE BODIES AND MINDS OF MANY OF OUR
CITIZENS, WE SIMPLY MUST NOT ALLOW THAT TO HAPPEN.

PREVENTING THAT IT FROM HAPPENING IS A TASK ALL OF US MUST
SHARE,
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SO THERE IS THE MYSTERY OF AIDS,

 

AND THERE IS THE CERTAINTY OF DEATH FROM AIDS,

AND FINALLY, THERE 1S THE THIRD ASPECT OF THE DISEASE
WHICH, IN MANY WAYS, IS THE MOST DIFFICULT ASPECT: THE FACT THAT

PEOPLE GET AIDS BECAUSE THEY DO THINGS MOST OTHER PEOPLE DON'T
DON'T APPROVE OF DOING.

APPROXIMATELY 29,000 HOMOSEXUALS AND BISEXUAL MALES HAVE
BEEN REPORTED AS HAVING AIDS SINCE JUNE 1981, THEY MOST LIKELY

BECAME INFECTED WITH THE AIDS VIRUS DURING ANAL INTERCOURSE,
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TO THAT FIGURE OF 28,000 WE MUST ADD THE 11,000 DRUG
ADDICTS WHO HAVE SHARED DIRTY NEEDLES AND OTHER DRUG “WORKS”
AND, HENCE, SPREAD THE DISEASE EVEN FURTHER.

 

THE VAST MAJORITY OF AMERICANS ARE HETEROSEXUALS AND THEY
GENERALLY DO NOT ENGAGE IN THE SEX PRACTICES COMMONLY FOUND IN
THE HOMOSEXUAL COMMUNITY. AND THEY DON’T “SHOOT” DRUGS EITHER,
NOR DO THEY APPROVE OF PEOPLE WHO DO.

IN OTHER WORDS, 95 PERCENT OF THE PEOPLE WHO HAVE THE
DISEASE OF AIDS CONTRACTED IT WHILE THEY WERE ENGAGING IN HIGH-
RISK BEHAVIOR, ..THE KIND OF BEHAVIOR WHICH THE MAJORITY OF THE
PUBLIC DOESN’T LIKE.
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NOW THEY HAVE A DISEASE THAT NOBODY UNDERSTANDS AND
EVERYONE FEARS. IN ADDITION, IT 1S A VIRTUAL CERTAINTY THAT
THEY WILL DIE. AND MEDICALLY THERE’S NOTHING WE CAN DO ABOUT IT.

IN OTHER WORDS, THIS DISEASE IS SHAPING UP NOT ONLY AS ONE
OF ‘THE MOST COMPLEX SCIENTIFIC CHALLENGES WE'VE EVER HAD. IT IS
ALSO PRESENTING US WITH ONE OF THE MOST PROFOUND ETHICAL AND
MORAL CHALLENGES WE’VE EVER HAD.

ARE WE PREPARED TO MAKE AVAILABLE EVERY SOCIAL, LEGAL, AND
MEDICAL RESOURCE FOR PEOPLE WITH AIDS?
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MY ANSWER, AS SURGEON GENERAL, IS CLEAR ENOUGH: YES, WE
MUST. I’M NOT PREPARED TO COMPROMISE A 5000-YEAR-OLD JUDEO-
CHRISTIAN TRADITION OF COMPASSION IN HUMAN RELATIONSHIPS NOR AM
I READY TO ABANDON THE BASIC PRINCIPLES OF OUR 200-YEAR-OLD
AMERICAN SOCIETY.

BUT I THINK THAT'S THE KIND OF ISSUE WE HAVE BEFORE US,
LET ME OFFER AN EXAMPLE OF THIS ISUSE.

WE DO NOT NOW HAVE A SAFE AND EFFECTIVE VACCINE TO PREVENT
ADIS, BUT WE’RE SEARCHING FOR ONE...AT A COST OF $30 MILLION
LAST YEAR...$60 MILLION THIS YEAR...AND APPRECIABLY MORE THAN
THAT NEXT YEAR, I’M SURE.
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EACH ONE OF YOU. AS A TAXPAYER, IS CONTRIBUTING YOUR SHARE
TO PAYING THAT RESEARCH COST,

BUT WHEN A VACCINE COMES ALONG...1 DOUBT THAT ANYONE IN
THIS AUDIENCE WOULD BE FIRST ON THE LIST TO RECEIVE A SHOT, ON
THE CONTRARY, HERE IN NEW YORK CITY THERE ARE ABOUT 50,000-
60,000 DRUG ADDICTS AND THEIR SEXUAL PARTNERS WHO SHOULD BE
GIVEN THE SHOTS FIRST,

AND TO BE PERFECTLY HONEST WITH YOU, I DON’T KNOW HOW THAT
KIND OF OBVIOUS PUBLIC HEALTH DECISION WILL BE RECEIVED.
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I‘D LIKE TO THINK THAT IT WOULD BE APPLAUDED AND
UNIVERSALLY SUPPORTED,

BUT I JUST DON’T KNOW,

AND THAT UNCERTAINTY IS AS GREAT A BURDEN TO CARRY AS THE
WEEKLY CASE REPORT HAS BEEN SINCE JUNE OF 1981,

THIS IS NOT AN EASY TIME FOR US, EVEN FOR THOSE OF US WHO
HAVE THE TRAINING OR THE EDUCATION OR THE PROFESSIONAL AND
WORLDLY UNDERSTANDING TO KNOW WHAT’S GOING ON,..AND WHAT’S AT
STAKE,

HOW MUCH HARDER. THEN, IS IT FOR OUR NEIGHBORS -- FOR
AVERAGE CITIZENS ALL ACROSS OUR COUNTRY -- TO BE WISE...T0 BE
COMPASSIONATE...AND TO BE FAIR,
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I] THINK YOU AND I MUST BE ALL THOSE THINGS...AND WE MUST DO
WHAT WE CAN TO HELP OTHERS BE, ALSO. THAT'S A MAJOR TASK FOR
COMMUNICATIONS. ..A MAJOR ASSIGNMENT FOR THE MEDIA,

THE HUMAN RACE HAS FALLEN VICTIM TO A DISEASE FOR WHICH
SCIENCE AND MEDICINE CAN OFFER ONLY A PARTIAL CURE...0OR MAYBE NO
CURE AT ALL. RATHER, WE MUST SUMMON THE SOCIAL AND SPIRITUAL
STRENGTH OF SOCIETY ITSELF, IF WE HOPE TO PREVAIL.

AIDS 1S THAT KIND OF A DISEASE AND THEREFORE -- YOU AND I
AND AS MANY OTHERS AS WILL JOIN WITH US -- WE HAVE MUCH WORK TO
DO... TOGETHER.

THANK YOU,

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