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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC. )

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BUT, THANKS TO ‘QBS ano a HANDFUL OF PEOPLE LIKE HIM, WE

BEGAN THIS NEW SPECIALTY OF PEDIATRIC SURGERY WITH THE CONCEPTS OF

QUALITY MEDICINE AND COMPASSIONATE PATIENT CARE BUILT RIGHT IN.

NEVER ONCE HAVE I EVER REGRETTED HAVING CHOSEN THIS PARTICULAR

ROAD IN MEDICINE. Sage eS
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IF I SOUND A LITTLE ON THE MUSHY, SENTIMENTAL SIDE, I GUESS

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IT’S BECAUSE I FEEL MUSHY AND SENTIMENTAL.

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I ON ALEAVE , a

 

THEN, ON OCTOBER 1 I WILL SAY "FAREWELL" TO ONE OF THE MOST

EXCITING PERIODS OF MY LIFE.

OVER THE NEXT SEVERAL MONTHS I WANT TO CLEAN OUT A FEW FILES,
TIE UP SOME LOOSE ENDS, AND PUT SOME THOUGHTS DOWN ON PAPER
REGARDING MY FORMER INCARNATION AS A PEDIATRIC SURGEON AND MY MORE

RECENT EXPERIENCES OF THESE PAST 8 YEARS AS YOUR:SURGEON GENERAL.
12
AND, WITH YOUR INDULGENCE, I’D LIKE TO EXPLOIT THIS PARTICULAR
OPPORTUNITY TO DO A LITTLE REMINISCING AND THINK OUT LOUD ABOUT MY

. +
LIFE AS THE NATION'S S.G, ,

FIRST, LET ME SAY I REMAIN TOTALLY GRATEFUL TO PRESIDENT

REAGAN FOR HAVING NOMINATED ME IN 1981 AND FOR RE-NOMINATING ME IN

1985.

IN 1981 I WASN’T A VERY POPULAR CHOICE. I HAD A REPUTATION
AS AN OUTSPOKEN PERSON WITH VERY STRONG OPINIONS ON IMPORTANT
ISSUES. AND THOSE OPINIONS -- AND MY AGE, WHICH WAS 65 WAY BACK
THEN -- WERE RAISED AS ARGUMENTS AGAINST MY BEING THE COUNTRY’S

SURGEON GENERAL.
13

THE DEBATE WENT ON FOR ABOUT 10 MONTHS, DURING WHICH TIME I

DID A LOT OF THINKING ABOUT THE CHALLENGE I HAD BEEN OFFERED.

FRANKLY, I WONDERED IF I COULD -- OR EVEN IF I SHOULD --
BECOME A WHOLE NEW PERSON IN ORDER TO GAIN THE APPROVAL OF THE
UNITED STATES SENATE. I DECIDED I COULDN’T AND I SHOULDN'T. ‘THE
PRESIDENT HAD INVITED ME TO WASHINGTON FOR THE PERSON I HAD BEEN

SO FAR ... NOT FOR SOME PERSON I MIGHT BECOME.
14

I ALSO DECIDED THAT MY RELIGIOUS BELIEFS WERE NOT NEGOTIABLE
COMMODITIES AND, THEREFORE, I WOULD NOT DEPOSIT THEM IN A BLIND

TRUST AND LEAVE THEM THERE FOR THE DURATION OF MY GOVERNMENT

SERVICE.

MY PERSONAL MORAL CODE WAS MINE AND I WOULD KEEP IT. I
DECIDED THAT I WOULD NOT DONATE MY CODE TO SOME WORTHY CHARITY

PRIOR TO BEING SWORN IN AS SURGEON GENERAL.

I HAD SOME ETHICAL PRINCIPLES, ALSO. AND I HAD ADVERTISED
THEM FAIRLY WIDELY. AND I DECIDED NOT TO LEAVE THEM IN A TRUNK IN

PHILADELPHIA, WHILE I SERVED MY COUNTRY IN WASHINGTON, D.C.
15
I DON’T REPORT ALL THIS WITH ANY SMUGNESS, BY THE WAY. I CAME
TO THESE DECISIONS AFTER MUCH DELIBERATION ABOUT THE NATURE OF
GOVERNMENT SERVICE ... WHAT IT MIGHT DO FOR ME ... AND WHAT I MIGHT
DO FOR IT. I REALLY WANTED TO LEAVE MANY TIMES IN 1981. IT WAS

BETTY WHO CONTINUED TO REMIND ME I HAD NO JOB IN PHILADELPHIA.

I CAME TO BELIEVE THEN -- AND I CERTAINLY BELIEVE NOW -- THAT
AN INDIVIDUAL’S BEST APPROACH TO PUBLIC SERVICE IS TO PROMISE TO

GIVE IT EVERYTHING YOU HAVE ... OF WHATEVER IT IS YOU DO HAVE.
16

YOU MUST BE WILLING AND EVEN EAGER TO DRAW HEAVILY FROM YOUR

OWN STOREHOUSE OF KNOWLEDGE AND LIFE EXPERIENCE ... FROM THE IDEAS
AND SENTIMENTS YOU'VE ABSORBED FROM YOUR FRIENDS ... FROM YOUR
FAMILY ... AND FROM YOUR FAITH.

AND I WOULD HOPE YOU WOULD HAVE SOME OF EACH.

AND FROM ALL THAT ACCUMULATED KNOWLEDGE AND EXPERIENCE, YOU

MUST SQUEEZE OUT EVERY OUNCE OF GOOD JUDGMENT, OF DEEP FELLOW

FEELING, AND OF LOVE OF COUNTRY. I THINK THAT’S WHAT EVERY
PRESIDENT WANTS -- BUT I KNOW THAT’S WHAT EVERY TAXPAYER WANTS.

AND I WAS ONE OF THOSE BEFORE I WAS SURGEON GENERAL.
17

SO I DECIDED NOT TO CHANGE C. EVERETT KOOP. RATHER, I DECIDED

I WOULD TRY TO BECOME THE BEST C. EVERETT KOOP THAT I COULD

POSSIBLY BE.

HISTORY WILL DECIDE WHETHER OR NOT I SUCCEEDED. NEVERTHE-

LESS, FOR MYSELF ... I BELIEVE I MADE THE RIGHT CHOICE.

BUT IT DIDN’T MAKE MY ASSIGNMENT ANY EASIER. INSTEAD, I WAS
FORCED TO DISCOVER THINGS ABOUT MYSELF AND ABOUT MY COUNTRY THAT
I DID NOT FULLY UNDERSTAND UNTIL I EMBARKED ON THIS NEW EXPERIENCE

AS SURGEON GENERAL.
18

I WILL CONFESS TO YOU THAT IT’S HARD TO AVOID THE HEADY
EXCITEMENT THAT COMES WITH THE CALL FROM YOUR PRESIDENT ... THE
INQUIRIES FROM THE PRESS ... AND THE LATE-NIGHT CONVERSATIONS WITH

POWERFUL SENATORS AND CONGRESSMEN.

WHILE ALL THIS IS HAPPENING, YOU’RE ALSO TALKING THINGS OVER
WITH YOUR FAMILY, SINCERELY TRYING TO BE FAIR TO THEM AS WELL --

AND NOT DOING A VERY GOOD JOB OF IT.

YET, DESPITE ALL THIS DEBATE AND RUMINATION, I DID NOT TRULY
UNDERSTAND WHAT MY JOB AND MY LIFE WERE REALLY GOING TO BE LIKE.
I KNOW THAT NOW. I DID NOT KNOW IT THEN. AND IN ANY CASE, I

DIDN'T DARE ASK.
19

THE FIRST REAL INKLING I HAD THAT LIFE WAS GOING TO BE VERY

SE
DIFFERENT CAME AFTER I HAD BEEN IN-GOVERNMENT LESS THAN 6 MONTHS.

BY THEN IT WAS APRIL 1982, AND A LITTLE BOY -- TO BE KNOWN
FOREVER IN THE HISTORY BOOKS AS “BABY DOE" -- WAS BORN IN

BLOOMINGTON, INDIANA.

“BABY DOE" WAS BORN WITH MULTIPLE CONGENITAL DEFECTS,
INCLUDING AN ESOPHAGEAL ATRESIA AND DOWN SYNDROME. MANY OF YOU

I‘M SURE REMEMBER THE CASE.
20

AN ATTENDING SURGEON TOLD "BABY DOE’S" PARENTS THAT THEIR SON
HAD ABOUT A 50-50 CHANCE OF SURVIVING AN OPERATION TO CLEAR UP THE
OBSTRUCTION. AND AN ATTENDING PEDIATRICIAN TOLD THEM THAT, EVEN
IF "BABY DOE" DID SURVIVE, HE WOULD PROBABLY GROW UP SEVERELY

RETARDED AND ENDURE A POOR "QUALITY OF LIFE."
BOTH THOSE PHYSICIANS WERE WRONG.
NEVERTHELESS, ON THE BASIS OF SUCH INFORMATION, THE PARENTS

OF "BABY DOE" ASKED THAT THEIR SON BE GIVEN NO FURTHER MEDICAL

ASSISTANCE OR NOURISHMENT OF ANY KIND.
21

IN EFFECT, THEY SENTENCED THEIR SON TO DEATH.

THE GOVERNMENT WAS NOT IMMEDIATELY INVOLVED. THERE WAS, AS

THEY SAY IN THE LEGAL TRADE, "NO COMPELLING FEDERAL INTEREST. "

BUT A CHALLENGE WAS NEVERTHELESS MOUNTED AGAINST THE PARENTS
INSTRUCTIONS. SOME MEMBERS OF THE HOSPITAL STAFF WENT TO COURT ON

THEIR OWN, ACTING ON "BABY DOE'S" BEHALF. BUT IT DIDN'T HELP.

ON APRIL 15, ONE WEEK AFTER HIS BIRTH, "BABY DOE" DIED. AND

ALL THE COURT ARGUMENTS BECAME MOOT.
22
AS I SAY, I WAS NOT A PARTY TO ANY OF THOSE PROCEEDINGS, BUT

I WAS STUNNED BY WHAT HAD HAPPENED. AFTER ALL, I HAD JUST
COMPLETED 35 YEARS AS A PEDIATRIC SURGEON. I HAD DEVOTED My
PROFESSIONAL LIFE TO DOING SUCH THINGS AS CORRECTING ESOPHAGEAL

ATRESIA ON HUNDREDS OF INFANTS.

AND I MIGHT ADD THAT MY SUCCESS RATE WAS FAR HIGHER THAN 50-
50: IN FACT, I HAD NOT LOST A FULL-TERM BABY IN MY LAST 8 YEARS IN

SURGERY AND. I HAD AN 88 PERCENT SURVIVAL RATE FOR PREMATURE BABIES.

a Corl? feces

AND MANY OF Y@& WERE DOING JUST AS WELL.
23

YET, AS THE NATION’S “SURGEON GENERAL," NO LESS, I COULD NOT
DO FOR "BABY DOE" WHAT I HAD DONE FOR HUNDREDS OF OTHER BABIES WITH

THE SAME CONDITION. IT WAS VERY FRUSTRATING.

ALSO, I HAD NEVER DARED TO PREDICT THE "QUALITY OF LIFE" FOR
AN INFANT WITH DOWN SYNDROME. CERTAINLY ONE OF OUR LIMITATIONS Is

THE ABILITY TO PREDICT THE FUTURE "QUALITY OF LIFE" FOR HANDICAPPED

CHILDREN.
24

MY FIRST INSTINCT WAS TO SPEAK OUT LOUD AND CLEAR ON BEHALF
OF "BABY DOE." THIS WAS PRECISELY THE KIND OF FIGHT I WAS USED TO

AND I WAS READY FOR.

BUT I ALSO REALIZED THAT I WAS NOT ONLY "BABY DOE’S" SURGEON
GENERAL ... I WAS ALSO SURGEON GENERAL FOR HIS PARENTS ... AND,
LIKE IT OR NOT, I WAS SURGEON GENERAL FOR THOSE TWO PHYSICIANS AS

WELL.

“BABY DOE" NEEDED HELP ... BUT SO DID HIS PARENTS. LIKE MANY
OTHER PARENTS, THEY MAY HAVE SIMPLY LACKED THE RESOURCES -- BE THEY
MATERIAL, SOCIAL, OR ECONOMIC ... OR EMOTIONAL, MORAL, OR
PSYCHOLOGICAL -- TO CARE FOR A DISABLED CHILD IN THEIR OWN FAMILY.

I DIDN’T KNOW ... AND I HAD NO RIGHT TO JUDGE.
25

YOU CAN’T URGE PARENTS TO FIGHT FOR THE LIVES OF THEIR

DISABLED OR HANDICAPPED CHILDREN ... AND THEN JUST WALK AWAY WHEN
RIGHT
THE FIGHT IS WON. I HAD LEARNED THAT LESSON MANY TIMES OVER wap

tere IV GttS HOSPITAL
BUT SUDDENLY, IT HAD A GREAT DEAL MORE

MEANING FOR ME.

AS FOR THE ATTENDING PHYSICIANS, I DID NOT AGREE WITH THEM,
BUT I KNEW THERE WERE MANY IN THE PROFESSION WHO DID AND THAT,
SOMEHOW, I WOULD HAVE TO COUNSEL WITH THEM AS WELL ... THAT IS 1 IF
I REALLY WANTED TO PREVENT THE DEATHS OF ANY MORE "BABY DOES."

AND I DID.
26

THERE WERE TWO SETS OF REGULATIONS PROMULGATED BY HHS BUT I
HAD NOTHING TO DO WITH WRITING THEM. BUT I TOOK ALL THE FLACK --

I WAS THE LIGHTNING ROD.

I CONVINCED MARGARET HECKLER THEN SECRETARY OF HHS THAT IF I
WERE TO TAKE ALL THE CRITICISM I SHOULD AT LEAST WRITE THE THIRD
CMe Ben
¢ a MAL fe
SET OF REGULATIONS. SHE AGREED. Some roe tt Yor
) Stew? wr DAT 4H BCE TALK Ine 17 oof Ww
ALTHOUGH WHAT I WROTE WAS EVENTUALLY STRUCK DOWN IN COURT, THE

REGULATIONS I WROTE WOULD HAVE WORKED.
27

I BROUGHT TOGETHER HANDICAPPED ADVOCATES, PEDIATRICIANS, PRO~
LIFE PEOPLE AND AFTER THEY OVERCAME THEIR INITIAL HOSTILITY THEY
PUT TOGETHER A DOCUMENT ON THE RIGHTS OF A HANDICAPPED NEONATE --

ONE OF THE BEST MANIFESTOS OF THIS CENTURY.

MADELINE WILL OF THE DEPARTMENT OF EDUCATION WAS OF GREAT HELP —

IN WRITING THE REGULATIONS -- I USED POSITIVE AND NOT NEGATIVE
BuT

STATEMENTS -~ 48% I USED THEIR LANGUAGE. THAT’S WHY IT WOULD HAVE

WORKED.
28

I WON’T BORE YOU WITH ALL THE DETAILS. INSTEAD, LET ME JUST
SAY THAT WE NOW HAVE STILL ANOTHER LAW ON THE BOOKS THAT PROTECTS
THE LIVES OF FUTURE "BABY DOES," WHILE STILL RECOGNIZING THE ROLE
OF PARENTS AND THE ROLE OF ATTENDING PHYSICIANS. THE LAW IS NOT

PERFECT. BUT IT WORKS.
29

IT ALL SOUNDS RATHER SMOOTH, BUT IT WASN’T THAT WAY AT ALL.
I WAS QUITE RUDELY SURPRISED BY THE ATTITUDE OF MY MANY FRIENDS IN
THE PRO-LIFE MOVEMENT. TO THEM, I HAD BECOME A TURNCOAT. THEY
SAID I WAS TEMPORIZING AND EVEN ABANDONING THE ABSOLUTIST POSITIONS
I HAD TAKEN -- FOR MANY YEARS. AND IT’S TRUE ... I HAD.

.BUT THEIR CRITICISMS WERE UNFAIR. MY PERSONAL IDEOLOGY HAD
NOT CHANGED ONE IOTA. I DON’T BELIEVED IT IS ESSENTIALLY ACHANGED

TODAY. BUT MY PUBLIC POSITION DID REQUIRE SOME ADDITIONAL THOUGHT.
30
I LEARNED THAT IN PUBLIC HEALTH MATTERS, IDEOLOGY CAN BE

HELPFUL ... BUT IDEOLOGY IS NOT ENOUGH.

AS A PUBLIC PHYSICIAN IN THE SERVICE OF MY COUNTRY, I COULD

NOT PICK AND CHOOSE HOW I WOULD PRACTICE AND WHOM I WOULD SERVE.
I HAD A RESPONSIBILITY TO BE TRUE TO MY OWN BELIEFS AND IDEALS ...
THERE’S NO QUESTION ABOUT THAT ... BUT NEVER AT THE EXPENSE OF THE

PEOPLE WHOM I HAD TAKEN A SOLEMN OATH TO SERVE.

FOLLOWING THE YEAR-LONG “BABY DOE" DIALOGUE , I CONVENED A
SERIES OF "SURGEON GENERAL’S WORKSHOPS" THAT FOCUSED ON THE NEEDS
OF THE HANDICAPPED CHILD AND HIS OR HER FAMILY. * WHAT EVOLVED WAS
A CONCEPT OF "FAMILY-CENTERED, COMMUNITY-BASED, COMPREHENSIVE CARE

FOR CHILDREN WITH SPECIAL NEEDS. "
31
IT’S NEW.

AND IT WORKS.

AND IT’S BEING ADOPTED MORE AND MORE ALL ACROSS THE COUNTRY.

a

MY SCRAPBOOK IS FILLED WITH PRAISE FOR WHAT I'VE MANAGED TO
DO IN REGARD TO SMOKING AND WITH AIDS. AND I FEEL GOOD ABOUT THAT.
HOWEVER, I’D HAVE TO SAY THAT I COUNT AS ONE OF MY MAJOR
ACHIEVEMENTS OF THESE PAST 8 YEARS THIS EVOLUTION OF A MORE

WIDESPREAD, MORE EFFECTIVE, AND MORE COMPASSIONATE APPROACH TO

CHILDREN WHO ARE BORN WITH A NON-FATAL HANDICAP.
32
AS I SAY, THE "BABY DOE" ISSUE AROSE EARLY IN MY FIRST TERM

AS SURGEON GENERAL. BUT IT WAS NOT THE ONLY ISSUE PERCOLATING AT
THE TIME IN THE HIGHER REACHES OF GOVERNMENT HEALTH POLICY. THERE

WERE SEVERAL OTHERS: GERMINATING AT THE HIGHEST LEVELS OF PUBLIC

HEALTH POLICY:

* THERE WAS SMOKING, OF. COURSE, I’VE MENTIONED THAT.

* THERE WAS ALSO FAMILY VIOLENCE, AND I’M ESPECIALLY
PLEASED WITH THE SUCCESS WE’VE HAD IN PUTTING THIS HIGH UP ON

THE PUBLIC HEALTH AGENDA OF THIS COUNTRY FOR THE FIRST TIME.
33
* THERE WAS ALSO THE HEALTH OF THE AGED AND THE NEED FOR

ALL OF US IN MEDICINE TO FOCUS UPON THE REALITIES OF THE
HEALTH OF AGING PEOPLE ... AND NOT UPON THE MYTHOLOGIES AND

MISCONCEPTIONS REGARDING THE ILLNESSES OF AGING PEOPLE.

* THERE WAS THE ISSUE OF INFANT MORTALITY, IN PARTICULAR
THE ALARMINGLY HIGH RATES THAT PERSIST AMONG THE BLACK
COMMUNITY. FOR REASONS THAT STILL BAFFLE MOST OF US, THE
BLACK RATE REMAINS AT ABOUT TWICE THE WHITE RATE ... AND WE'VE

HAD VERY LITTLE LUCK REDUCING THIS FACTOR OF 2.
34
BUT ONE ISSUE WAS TO CONSUME MOST OF MY WAKING HOURS FOR THE

LAST THREE YEARS OF MY SECOND TERM IN OFFICE.
THAT ISSUE, OF COURSE, IS AIDS.

THE SUBJECT OF AIDS HAS BEEN COVERED SO EXTENSIVELY AND IN
SUCH DEPTH THAT I’LL JUST OFFER A COUPLE OF PERSONAL PERCEPTIONS

FOR YOU THIS AFTERNOON.

FIRST OF ALL, I THINK IT’S TIME TO LOOK AT THE HISTORY OF THIS
EPIDEMIC THROUGH A LENS CLEARED OF BIAS AND POLITICS. FOR EXAMPLE,
MANY CRITICS HAVE TAKEN THE GOVERNMENT TO TASK FOR TAKING "SO MUCH

TIME" IN THE EARLY DAYS OF THE EPIDEMIC.
35

SUCH CRITICS CONVENIENTLY OVERLOOK THE NATURE OF THE EPIDEMIC
IN THE EARLY DAYS OF 1981 AND 1982. WE WERE SEEING MEN COME INTO

CLINICS AND HOSPITALS PRESENTING THE SYMPTOMS OF THE VERY RARE

PNEUMOCYSTIS CARINIZT PNEUMONIA ... OR EVIDENCE OF CYTOMEGALOVIRUS
AND CANDIDA INFECTIONS ... PLUS THE HIGHLY UNCOMMON KAPOSI’S

SARCOMA ... ALSO, HERPES SIMPLEX ... CRYPTOCOCCAL MENINGITIS ...

TOXOPLASMOSIS ... DISSEMINATED MYCOBACTERIUM AVIUM-INTRACELLULARE,

AND SO ON.

MAYBE YOU'VE HEARD OF THESE DISEASES. I'M SURE YOU’VE SEEN

VERY FEW OF THEM. AND YOU’RE NOT ALONE.
36
IN 1981 AND 1982 THE UNITED STATES HAD EVEN FEWER TRAINED

 

CLINICIANS AND RESEARCHERS THAN NOW FAMILIAR WITH THESE RARE
DISEASES THAT WERE CROPPING UP IN LOS ANGELES, SAN FRANCISCO, AND

NEW YORK. AND IN ANY CASE, WE HAD NO CURES FOR THEM.

ALSO, THE PATIENTS WITH THOSE CONDITIONS WERE IN EVERY CASE
HOMOSEXUAL MEN. HOWEVER, BY THE 1970s AND EARLY '80s, A GREAT MANY
HOMOSEXUAL AND BISEXUAL MEN HAD CHOSEN TO PATRONIZE PHYSICIANS AND
CLINICS WHO WERE MORE UNDERSTANDING OF THE SO-CALLED "GAY

LIFESTYLE. "
37

IN MAKING THAT CHOICE, THESE MEN EFFECTIVELY PLACED THEMSELVES
OUTSIDE MAINSTREAM CLINICAL MEDICINE AND, THEREFORE, THEY WERE MORE

DIFFICULT TO KNOW ... TO REACH ... AND TO HELP.

THIS CHOICE WAS PART OF WHAT WAS KNOWN AT THE TIME AS THE "GAY
REVOLUTION,“ WHEN HOMOSEXUAL AND BISEXUAL MEN WERE "COMING OUT OF

THE CLOSET" AND ASSERTING THEIR CIVIL RIGHTS.

UNFORTUNATELY, MOST "GAY ACTIVISTS" COMBINED THE OTHERWISE
SEPARATE ISSUES OF HEALTH AND POLITICS. THEY THEN PLACED THIS

SINGLE PACKAGE OF GRIEVANCES BEFORE THE GENERAL PUBLIC FOR REDRESS.
38

BUT THE AMERICAN PEOPLE HAD NEITHER THE SKILL NOR THE PATIENCE
TO SORT OUT THESE ISSUES. HENCE, THIS STRATEGY OF THE "GAY
COMMUNITY" GENERATED MORE PUBLIC CONFUSION AND ANGER THAN IT DID

PUBLIC UNDERSTANDING AND SYMPATHY.

AS A RESULT, OUR FIRST PUBLIC HEALTH PRIORITY -- THAT IS, TO
STOP FURTHER TRANSMISSION OF THE AIDS VIRUS -- BECAME HOPELESSLY

AND NEEDLESSLY MIRED IN THE SEXUAL POLITICS OF THE EARLY 1980s.

WE LOST A GREAT DEAL OF PRECIOUS TIME BECAUSE OF THIS ... AND

I SUSPECT WE LOST SOME LIVES AS WELL.
39

YET, DESPITE THE CONFUSION AND FRUSTRATION, THE ANGER AND THE
IGNORANCE, THE TERROR AND THE DEATH, THE GOVERNMENT DID PRESS
FORWARD IN BIOMEDICAL SCIENCE AND RESEARCH. AND, BY THE FALL OF

1985, A RELIABLE BLOOD TEST WAS DISCOVERED AND MADE GENERALLY

AVAILABLE.

IN MY BOOK, ANYWAY, THAT IS ONE OF THE RESEARCH MIRACLES OF
THIS CENTURY BECAUSE, AT THAT POINT, WE WERE ABLE TO TEST THE HUMAN
BLOOD SUPPLY FOR THE PRESENCE OF A LETHAL VIRUS ... ABOUT WHICH WE

OTHERWISE KNEW NEXT TO NOTHING.
40
SO I THINK THE HISTORICAL RECORD ACTUALLY SHOWS THAT --

DESPITE THE COMPOUNDING OF MEDICAL MYSTERIES THAT WAS OCCURRING
AND DESPITE THE POLITICAL CONFUSION THAT WAS GENERATED --- THE

GOVERNMENT PERSEVERED AND MADE ASTONISHING PROGRESS.

I’D LOVE TO TAKE CREDIT FOR THAT EARLY LEADERSHIP BY THE U.S.
PUBLIC HEALTH SERVICE. BUT I CAN'T. JI WAS NOT INVOLVED AT ALL IN
THE EARLY DAYS OF THE AIDS EPIDEMIC. AND THE REASON IS QUITE

MUNDANE ... HARDLY THE STUFF OF SCANDAL.

IN CASE YOU DON’T KNOW IT BY NOW, THE POSITION OF SURGEON
GENERAL IS SUPPORTED BY A HALF-~DOZEN STAFF AND ENQUGH MONEY TO BUY

PAPER CLIPS AND NAME-TAGS. AND THAT’S ABOUT IT.
41

THE AIDS RESEARCH, HOWEVER, HAS BEEN CARRIED OUT AT THE
NATIONAL INSTITUTES OF HEALTH, THE CENTERS FOR DISEASE CONTROL,

AND THE FOOD AND DRUG ADMINISTRATION.
THE SURGEON GENERAL RUNS NONE OF THESE ORGANIZATIONS.

THE BASIC EPIDEMIOLOGY AND CASE REPORTING ARE TASKS PERFORMED
BY STATE AND LOCAL PUBLIC HEALTH AGENCIES. AND THEY'VE BEEN

EXTRAORDINARY THROUGHOUT THE AIDS EPIDEMIC.

BUT I DON’T RUN THEM EITHER.
42
SO THERE WAS LITTLE REASON TO GET THE SURGEON GENERAL INVOLVED

IN THE EARLY YEARS OF THE EPIDEMIC.

BUT THEN -- ALONG ABOUT 1985 AND 1986 -- IT BECAME CLEAR THAT
THE PUBLIC WAS RECEIVING A GREAT MANY MIXED, CONFUSING, AND PLAIN

WRONG MESSAGES ABOUT THE DISEASE OF AIDS.

THE TIME HAD COME FOR THE GOVERNMENT TO TROT OUT SOMEBODY WHO

HAD THE CREDIBILITY TO TELL THE AMERICAN PEOPLE WHAT WE KNEW TO BE

 

TRUE ABOUT THE AIDS EPIDEMIC ... WHAT WE KNEW TO BE FALSE ABOUT THE
EPIDEMIC ... AND WHAT WE STILL DIDN’T KNOW AT ALL ABOUT THE AIDS

EPIDEMIC.
43

IN FEBRUARY 1986, PRESIDENT REAGAN -- LIKE MANY PRESIDENTS
BEFORE HIM -- TURNED FOR HELP TO HIS SURGEON GENERAL. THE

PRESIDENT DIRECTED THAT I PREPARE A REPORT TO THE AMERICAN PEOPLE

ON AIDS.

THE REPORT HAD TO GIVE THE FACTS ABOUT AIDS AND TELL PEOPLE

HOW TO PROTECT THEMSELVES FROM GETTING IT.

THE REPORT ALSO HAD TO EXPOSE THE FALSE MYTHOLOGIES THAT HAD
BEGUN TO APPEAR CONCERNING AIDS ... MYTHOLOGIES PRANKLY PERPETUATED

BY MEAN-SPIRITED PEOPLE WITH A MACABRE VIEW OF THE HUMAN CONDITION.
44

I MENTIONED THAT THE HOMOSEXUAL COMMUNITY HAD CARELESSLY
POLITICIZED THE AIDS ISSUE IN THE BEGINNING. IN ALL FAIRNESS, I

MUST ADD THAT THE ISSUE WAS FURTHER POLITICIZED BY EXTREME

 

CONSERVATIVES, PEOPLE FOR WHOM IDEOLOGY WAS EVERYTHING.

CONSERVATIVES -- MY LONG-TIME FRIENDS AND SUPPORTERS --

CHEERED THE PRESIDENT’S DECISION. MANY OF THEM PREDICTED THAT I

WOULD PRODUCE THE "RIGHT" KIND OF REPORT 1 APPROPRIATELY LAUNDERED

TO THEIR LIKING.

THEY WERE MISTAKEN.
45

AFTER 8 MONTHS OF LISTENING TO ALL SHADES OF OPINION -- LEFT,
RIGHT, AND CENTER -- FROM A BROAD CROSS-SECTION OF OUR SOCIETY, I
RELEASED MY REPORT DIRECTLY TO THE AMERICAN PEOPLE AT AN OCTOBER

1986 PRESS CONFERENCE.

I MUST TELL YOU THAT IT WAS A DIFFICULT TIME FOR ME. I KNEW,
FOR EXAMPLE, THAT MANY OF MY FRIENDS IN CONSERVATIVE PROTESTANT
SECTS AND IN THE CATHOLIC CHURCH -~ FRIENDS AND ALLIES IN MANY PAST
BATTLES AGAINST ABORTION -~ I KNEW THAT THEY WEREN'T GOING TO LIKE

MY REPORT.
46
THEY VIEW ANAL INTERCOURSE -~ OR SODOMY -- AS A VIOLATION OF

LAWS BOTH SPIRITUAL AND TEMPORAL. WELL ... SO DO I.

BUT THAT WAS HARDLY THE COMPELLING PUBLIC HEALTH ISSUE IN
1986. THE ISSUE THEN WAS THAT ANAT, INTERCOURSE WAS THE PRIME
METHOD OF TRANSMISSION OF THE.AIDS VIRUS. WE HAD TO RECOGNIZE THAT

THAT WAS THE CASE ... AND THEN WE HAD TO CONVINCE MEN TO STOP DOING

It.

OF COURSE, THAT MEANT WE HAD TO ESTABLISH A WORKING
RELATIONSHIP OF TRUST WITH PEOPLE WHOSE LIFESTYLES WE DIDN’T
ESPECIALLY LIKE. BUT -- AS I'VE SAID OVER AND OVER AGAIN -- WE’RE
IN A FIGHT AGAINST A DEADLY DISEASE, NOT AGAINST THE PEOPLE WHO

HAVE IT.
47
I BELIEVE I WAS RIGHT. I THINK MY VERY CONSERVATIVE FRIENDS

SECRETLY KNEW I WAS RIGHT. AND NATURALLY THEY FOUND THAT TO BE

VERY IRRITATING.

BUT WHAT IF HOMOSEXUAL AND BISEXUAL MEN DID NOT STOP THOSE

HIGH-RISK SEXUAL PRACTICES? THEN WHAT?

THAT LED ME TO A SECOND CONCLUSION THAT FURTHER IRRITATED MANY

OF MY OLD FRIENDS AND ALLIES.
48

IF THOSE MEN PERSISTED IN ENGAGING IN ANAL INTERCOURSE,
ESPECIALLY WITH ANONYMOUS OR CASUAL SEX PARTNERS, THEN THEY HAD TO
PROTECT THEMSELVES -- AND THEIR PARTNERS -- WITH SOME KIND OF

IMPERMEABLE BARRIER TO PREVENT TRANSMISSION OF THE VIRUS.

SUCH BARRIERS ARE KNOWN AS “CONDOMS. " AND I’M AFRAID THAT I

MADE CONDOMS THE "C-WORD" OF 1986 AND ‘87.

BUT LET ME BE CLEAR ABOUT THIS. NEVER ONCE DID I CONSIDER
CONDOMS TO BE SOCIETY'S FIRST LINE OF DEFENSE AGAINST AIDS -- AND

I STILL DON’T.

 
49

I ALWAYS TELL MY AUDIENCES -- AND I’LL TELL YOU TODAY -- THAT

ABSTINENCE IS YOUR BEST DEFENSE AGAINST AIDS OR ANY OTHER SEXUALLY

 

TRANSMITTED DISEASE FOR THAT MATTER.

HOWEVER, FAILING THAT, YOUR NEXT BEST DEFENSE IS A MUTUALLY

' FAITHFUL, MONOGAMOUS RELATIONSHIP.

AND FAILING THAT, THEN YOU OR YOUR PARTNER HAD BETTER USE A

CONDOM.

fevVR.

AND THAT’S BEEN MY BASIC MESSAGE FOR THE PAST THREE YEARS.
50
I CAN TELL YOU THAT, BACK IN 1981, I HAD NO IDEA I’D EVER BE

CALLED UPON TO DELIVER SUCH A MESSAGE.

BUT IN 1986 -- AND EVER SINCE THEN -- I DON’T BELIEVE I'VE
HAD THE LUXURY TO CHOOSE A MORE COMFORTABLE OR MORE GENTEEL MESSAGE

FOR THE AMERICAN PEOPLE. THE TRUTH IS WHAT THEY NEEDED, SO THAT

 

THEY COULD SAVE THEIR OWN LIVES AND THE LIVES OF PEOPLE THEY LOVED.

ANYTHING LESS THAN THE TRUTH, THEREFORE, WOULD BE LIFE-~

THREATENING. SO I DON’T THINK I HAD A CHOICE IN THIS MATTER.
51
I WISH THE ANGER ABOUT CONDOMS COULD HAVE BEEN THE END OF THE

MATTER. BUT IT WASN'T.

FROM THE DATA GIVEN TO ME BY THE CENTERS FOR DISEASE CONTROL,
I WAS STARTLED TO LEARN THAT THE MEDIAN AGE OF AIDS VICTIMS WAS

QUITE LOW. THEY WERE MOSTLY YOUNG MEN IN THEIR EARLY 20s.

C.D.C. ALSO LEARNED BY THEN THAT AN INFECTED INDIVIDUAL COULD
CARRY THE AIDS VIRUS WITHIN HIS OR HER BLOODSTREAM FOR AS LONG AS
7 YEARS -- AND MAYBE EVEN LONGER -- BEFORE SHOWING SIGNS OF AN
OPPORTUNISTIC INFECTION ... KAPOSI‘’S SARCOMA, PNEUMOCYSTIC CARINII

PNEUMONIA, CYTOMEGALOVIRUS, AND SO ON.
52
WHAT DID THAT MEAN? I’LL TELL YOU WHAT THAT MEANT. IT MEANT

THAT MANY THOUSANDS OF THOSE YOUNG MEN WHO WERE REPORTED AS
PRESENTING AN AIDS-RELATED DISEASE HAD PROBABLY BECOME INFECTED

WITH THE AIDS VIRUS WHEN THEY WERE STILL IN THEIR TEENS.

AND THAT MEANT THAT THE WHOLE AIDS ISSUE -~ COMPLETE WITH

 

EDUCATION PRECEDING THE ONSET OF SEXUAL EXPERIMENTATION AND -- YES
-~- AND DISCUSSIONS ABOUT CONDOMS -- ALL THAT WOULD SOMEHOW HAVE TO
BE INTRODUCED INTO OUR SECONDARY SCHOOLS ... AND SOME PREPARATION

WAS NO DOUBT NECESSARY IN OUR ELEMENTARY SCHOOLS AS WELL.
53
PLEASE REMEMBER THAT WE DID NOT HAVE THEN -- AND WE STILL DO

NOT HAVE TODAY -- AN EFFECTIVE AND GENERALLY AVAILABLE ANTI-AIDS

VACCINE. SUCH A VACCINE IS STILL YEARS AWAY. THEREFORE, OUR

 

SINGLE WEAPON AGAINST AIDS -- IN 1986 AND 1987 AND FOR MANY MORE
YEARS TO COME -- WAS AND WILL CONTINUE TO BE ... EDUCATION ...
EDUCATION ... AND MORE EDUCATION.

 

THE T.V. LIGHTS HAD BARELY BEEN SWITCHED OFF AT MY OCTOBER
1986 PRESS CONFERENCE, WHEN I WAS IMMEDIATELY AND WITLESSLY ACCUSED

OF ADVOCATING THE TEACHING OF SODOMY TO THIRD-GRADERS.
54

SHORTLY THEREAFTER IT WAS REPORTED THAT I HAD PASSED ouT

CONDOMS TO 8-YEAR-OLDS.

AND MUCH MORE. IT WAS A VERY PAINFUL TIME, PERSONALLY.

BUT THOSE PERSONAL ATTACKS WERE NOT MY CHIEF WORRY. I KNEW

THEY WOULD HAVE NO LASTING EFFECT ON ME. SUCH ATTACKS NEVER HAVE.

RATHER, I WAS ANNOYED AT THOSE FEW CRITICS WHO ~- BY ATTACKING

ME -- WERE HOPING TO COMPROMISE THE GOVERNMENT'S ABILITY TO DELIVER

THE FACTS ABOUT AIDS TO THE AMERICAN PEOPLE.
55

THEY HATED THE MESSAGE ... SO THEY DECIDED TO DISCREDIT THE

MESSENGER.

THOSE CRITICS WERE PLAYING WITH FIRE. AND -- WORSE YET -- I

THINK THEY KNEW IT.

SO MY COURSE OF ACTION BECAME CLEARER EVERY DAY. I WOULD HAVE
TO CONDUCT MYSELF IN THE SAME MANNER AS MY PREDECESSORS HAD

CONDUCTED THEMSELVES AS SURGEONS GENERAL. AND THEY HAD DONE SUCH

 

A GOOD JOB THAT THE OFFICE I HELD WAS AMONG THE MOST CREDIBLE AND

RELIABLE IN THE GOVERNMENT ... THE ENVY OF PRESIDENTS, I MIGHT ADD.
56

NOW IT WAS MY JOB TO MAINTAIN THAT TRADITION, THAT’S ALL THERE
WAS TO IT. DESPITE THE COMPLEXITY AND THE EMOTION IN THE AIDS
ISSUE, MY TASK WAS CLEAR: I HAD TO DO WHATEVER WAS NECESSARY TO

PROTECT THE CREDIBILITY OF THIS OFFICE FOR MYSELF ... MY SUCCESSORS

+.» AND MY COUNTRY.
AND I HOPE AND PRAY THAT THAT’S WHAT I HAVE DONE.
WHEN MY SUCCESSOR ARRIVES -- LATER THIS YEAR -- I HOPE THAT

HE OR SHE WILL FIND THE OFFICE AS STRONG AS IT WAS WHEN I ARRIVED

SOME 8 YEARS AGO. OR EVEN STRONGER.
Looking back on my last years
in government, some might think
that I was a glutton for
punishment. I had another
encounter with the public and the
conservative/liberal split in the
early months of 1989.

Otis Bowen, then Secretary of
Health and Human Services, had
fired a member of his department
who happened to be very -strongly
pro-life.
In the ensuing concern over that
dismissal, the President became
embroiled in a situation where he
had to mollify pro-life leaders. In
the process, he was misled by
some of his staffers into believing
that if the Surgeon General were
to write a report on the health
effects of abortion on women, it
would be so devastating, that the
Supreme Court decision Roe v.
Wade could be reversed.
The President, therefore, told the
pro lifers that he was asking the
Surgeon General to write a report
on the health effects of abortion
on women.

I felt from the beginning that
the President was on the wrong
track. The whole pro-life
movement had been built around
the effects of abortion on the
fetus, not the health effects of the
abortion on women who were
having abortions.
[ sA10 7Y4AT A
y 1 t#AO uo clh
T [A0VE Diwwt (2

I accepted the assignment) age were, -

proceeded as I had with preparing

the report on AIDS. I called in
representatives of 27 groups of

people who had an interest in

abortion and the possible health

effects on women. After spending

many months in investigation, and

after reading the literature on the
subject, I came to a conclusion.
Anecdotal evidence on the
dditorious effects of abortion on
women was abundent. Indeed, in
my former incarnation I had
counseled women who were in the
midst of deep depressions over
guilt. But I also have encountered
women who felt that the health
effects of abortion on them was
positive because it either saved a
marriage, enabled the individual
to finish an education, or kept her
from being thrown out on the
street by an irate father.
All of the literature that my —
staff and I read seemed to carry

the bias4socially or sociologically ee
(f the author) did not rely on
myself in this regard, but used
Statisticians who were as free

from ideology on the subject of
abortion as it was possible to find.

My conclusion was that it was
not possible, either scientifically
or statistically, to write a report -
that would stand up to scrutiny in
the scientific community-fone
way or the other.

  
 
  

 

 

 

 
Therefore, I wrote the
President stating I could not write
WV

him a report, the reasons why,
T sed made it clear that there was
not sufficient statistical and
scientific evidence to produce the
kind of a report that he had been

led to believe I could make.
I did not say that there was no
evidence of délaterious effects of
abortion on women, however, one
United Press misinterpretation of
what I had said was published
and picked up by all the major
networks. ad @vernight I was
accused of having changed a
position I have held on abortion
for the previous 20 years.
The worst thing I could have
done for the pro-life movement
would have been to write a report
that could have been torn apart
scientifically.

This time the attacks were
rather personal. I admit I have
been stung by some of these
personal attacks. I have been
outraged to see my words
distorted, my beliefs doubted and
my integrity questioned.
My position on gol, 74S °
@@umm subject realigned those who

had supported me and those who
had opposed me. Once praised by
conservatives and condemned by
liberals, I suddenly found myself
attacked by former friends and
praised by former foes.
Many of the conservatives who
now Oppose me were against me
merely because liberals spoke in
my favor. You have all heard
about knee-jerk liberals. Let me
tell you, conservative knees jerk
just as readily.
57

AS I INDICATED AT THE BEGINNING OF THESE REMARKS, I DID NOT
LOCK AWAY MY PERSONAL BELIEFS AND PERSONAL ETHICS BEFORE COMING TO
WASHINGTON. I DREW UPON THEM CONTINUOUSLY TO GIVE ME MY DIRECTION

AND MY STRENGTH.
THE RESULTS WERE NOT ALWAYS PREDICTABLE. AND SOMETIMES I WAS

EVERY BIT AS SURPRISED AS THE NEXT PERSON BY THE CONCLUSIONS I

REACHED IN THE COURSE OF DOING MY JOB.

SO BE IT.
58

THE EXPERIENCE HAS BEEN A REVELATION TO ME ... AND YET, IT
HAS BEEN A REVELATION OF AN OLD AND NOT A NEW TRUTH. I HAVE RE-

DISCOVERED ... THE HARD WAY, I GUESS ... THIS SIMPLE TRUTH:

WHEN YOU'RE BEING TESTED, YOU HAVE TO KNOW YOURSELF ... AND
YOU HAVE TO BE TRUE TO YOURSELF ... AND ALL THE IMPORTANT

THINGS WILL FOLLOW.
voy em

THE MEMONG OF 4° OCnEAT

59 PHD Cy w Avo A CtwIte ms,

THIS AFTERNOON, AT THIS GENEROUS CEREMONY, THAT SIMPLE TRUTH

COMES HOME TO ME AGAIN, OVER THE PAST 8 YEARS, I LEARNED QUITE
A BIT ABOUT WHO C. EVERETT KOOP REALLY IS ... AND I’VE TRIED TO BE
THE VERY BEST C. EVERETT KOOP I COULD BE ... AND AN IMPORTANT THING

HAS FOLLOWED: I’M STILL CREDIBLE. I’M STILL BELIEVED. I HOPE TO
CONTINUE IN THE MONTHS AHEAD ON THIS BASIS, TO DELIVER MESSAGES TO

THE AMERICAN PEOPLE.

TO EACH ONE OF YOU, LET ME SAY, "THANK YOU ... AND GOD BLESS

You."

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