THE GREEN SHEET

Balt. Suns 11-29-82

Doctor
Koop’s -
Bad Idea

HE surgeon geneftal of the
TT tnited States, Dr C. Everett
Koop, recently made 1ews at a
meeting of pediatricians by main-
taining that violence was a treat-
able public health problem.

The idea is strategically un-
sound and clinically preposterous.

Doctors have never wanted any-
thing to do with violence and still

 

By John R. Lion

TSS

don’t. Few pediatricians wish to see
violent children and even psychia-
trists avoid violent adults.

The American Psychiatric As-
sociation report on “Clinical
Aspects of the Violent Individual”
came out in 1974 and is now out of
print; violence is not as popular as
the study of depression or schizo-
phrenia.

Child: abuse was practically ig-
nored by the medical. profession
until such time as laws came into
existence requiring doctors to re-
port incidents of child abuse; doc-
tors would much have preferred to
look the other way. Even now, once
a case of child abuse is recognized,
the management of the case is as-
sumed by social welfare and crimi-
nal justice institutions.

Outside of training hospitals or
specialized facilities, it is an ex-
ceedingly rare: practitioner who
elects to diagnose and treat violent
patients and their families.

A pediatrician faced with a vio-
lent youngster will almost inevita-
bly shunt that patient somewhere
else. He hasn’t the skills or the time
to spend with the patient and his
family. That’s the kind of thing
Marcus Welby might be able to
spend a fanciful day doing.

Speaking of television, the sur-
geon general also suggested that
doctors watch the entertainment
“menus” of their patients. He waa
referring to television violence.

Dr. Koop ought to be aware of
other public health aspects of tele-
vision, not just violence. For exam-
ple, studies have shown that heavy
aleohol drinking is depicted in 40

percent of prime-time programs,
yet only 1 percent of the characters
on the programs are shown to have
a drinking problem or to be alco-
holics. :

Nor does anyone ever seem to
get seriously hurt driving, despite
the perverse frequency of car
smashups on these shows. ~

Analyses of adult programs indi-
cate that a mere 7 percent of major
characters have injuries or ilinesses
requiring treatment. Victims of in-
juries are hardly even shown.

All in all, television’s effect far-

transcends the simple display of
aggression. The TV menu Dr. Koop
speaks of is hardly to be changed
by the medical profession. If the
surgeon general wants to do battle
with the industry, that’s quite an-
other matter with a potentially ef-
fective outcome.

The most distressing thing
about Dr. Koop’s comments is their
epidemiological fuzziness. His re-
marks indicate that clinicians
should focus on signs and symp-
toms of childhood violence such as

ychomotor epilepsy.

Psychomotor epilepsy has been
linked with violence, but the link is

tenuous. The disease is very rare
anyway. About 15 percent of all
epilepsies are of the psychomotor
type and the coexistence of vio-
lence epilepsy is even rarer. Trying
to diagnose a violent child on the
basis of brain dysfunction is cru-
cial, but it contributes as much to
the reduction of crime and violence
in America as the swatting of a sin-
gle mosquito contributes to the
control of i

If the surgeon general really
wants to have an effect on health
and violence as they relate to one
another, he ought to go to work on
alcohol-related: highway deaths..
That's where the numbers are.

The other day we memorialized
the nearly 58,000 people killed in
the Vietnam War. An equal num-
ber of people are killed every single
year in this country in highway ac-
cidents and over half of them are
alcohol-related. They are prevent-
able. Physicians play the tiniest
role in such prevention. Politicians,
legislators and judges are responsi-
ble.

The surgeon general's office has
‘influence. It battled the tobacco in-
dustry and won major victories. In-
stead of doctors, Dr. Koop should
start working with the Mothers
Against Drunk Drivers (MADD).

. That would reduce a lot of carnage.

Dr. Lion is professor of psychia-
try at the University of Maryland
Medical School.

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