AG
THERE ARE MANY MYTHS ABOUT AGING. ONE OF THE WORST IS
THAT YOU CLING TO YOUR HEALTH UNTIL YOUR 65TH BIRTHDAY,
AND THEN YOU SUDDENLY SLIDE DOWNHILL ON THE OTHER
SIDE.
THAT SIMPLY IS NOT TRUE.
YOU CAN LIVE IN GOOD HEALTH ON A PLATEAU, NOT GOING

DOWNHILL UNTIL THE VERY END.

191
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NOW WE UNDERSTAND THAT THERE IS SOMETHING, MEDICALLY
SPEAKING, AS A DISEASE-FREE AGING PROCESS.
YOU DON'T HAVE TO GIVE UP ON LIVING AT 65, AND SNOOZE IN A
ROCKING CHAIR.
TODAY THE AVERAGE 65 YEAR-OLD CAN LOOK FORWARD TO

LIVING ANOTHER 17 YEARS.

192
ag
YET AS INDIVIDUALS AND A SOCIETY WE TOO OFTEN ROB THE
YEARS AFTER 65 OF THEIR VALUE.

TOO MANY OLDER AMERICANS WITHDRAW INTO INACTIVITY,
THEN THEY FIND THEMSELVES DEPRESSED, AND PLAGUED WITH
POOR HEALTH.

GROWING OLD DOES NOT NECESSARILY MEAN GETTING SICK.

193
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AGING HAS SPECIAL MEANING FOR ME. YOU MAY RECALL THAT,
WHEN PRESIDENT REAGAN FIRST NOMINATED ME TO BE HIS
SURGEON GENERAL, BACK IN 1981, A GREAT HUE AND CRY WENT

UP THAT I WAS TOO OLD.

195
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I WAS JUST A YOUNGSTER OF 65.
BUT ALL MY CRITICS SAID THAT 65 WAS THE AGE AT WHICH
SURGEONS GENERAL WERE SUPPOSED TO LEAVE THE PUBLIC
HEALTH SERVICE ... NOT ENTER IT FOR THE FIRST TIME.
OF COURSE, THIS DID NOT SIT VERY WELL WITH THE MAN WHO
NOMINATED ME. PRESIDENT REAGAN HAD JUST CELEBRATED
HIS 70TH BIRTHDAY AND DID NOT TAKE KINDLY TO THE IDEA
THAT SOMEONE 5 YEARS HIS JUNIOR WAS TOO OLD FOR PUBLIC

SERVICE.

196
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NOW, IN MY 75TH YEAR, I AM SURELY QUALIFIED TO BE
COUNTED AS ONE OF AMERICA'S SENIOR CITIZENS. AND I'M

VERY PROUD TO BE AMONG THAT COMPANY.

THERE ARE MORE OF US EVERY DAY. IN, SAY, 15 OR 20 YEARS -- A

SUBSTANTIAL PORTION OF THE AMERICAN POPULATION, CLOSE

TO 20 PERCENT, WILL BE OVER THE AGE OF 65.

197
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AND WITHIN THAT GROUP, THE FASTEST-GROWING SEGMENT

WILL BE THAT OF PERSONS WHO ARE AGE 85 OR ABOVE.

 

OLDER AMERICANS ARE A GREAT NATURAL RESOURCE. THEY

OFFER SOCIETY WHAT IT SO OFTEN NEEDS THE MOST: COMMON

SENSE AND WISDOM.

198
ag
SO, WHETHER YOU'RE 20 OR 30 OR 40 OR 50 OR 60, IF YOU DON'T
WANT TO WAIT IN LINE IN THER FUTURE FOR RATIONED
HEALTHCARE, TAKE CARE OF YOURSELF NOW.

THE PRESCRIPTION IS SIMPLE:

203
NO SMOKING,

ALCOHOL ONLY IN MODERATION,

EXERCISE AND DIET APPROPRIATE TO AGE,

CHECK BLOOD PRESSURE AND CHOLESTEROL, AND SEE THE
DOCTOR IF THEY ARE ABNORMAL; FOLLOW YOUR DOCTORS

ADVICE.

204

ag
ag
FORTUNATELY SOME OF US OLDER FOLKS MUST HAVE GOOD
GENES, BECAUSE WE'VE LIVED SO MANY YEARS BEFORE THESE
HELPFUL HEALTH WARNINGS. WE'VE EATEN FAR TOO MUCH
LARD, NEVER JOGGED UNLESS WE WERE LATE FOR A TRAIN,
THOUGHT FIBER WAS PART OF CLOTHING NOT DIET, AND WE'VE

MADE IT TO OLD-AGE.

205
ag

OF COURSE, IF WE'D KNOWN WE'D LIVE SO LONG, WE'D HAVE

TAKEN BETTER CARE OF OURSELVES.

BUT I'VE DECIDED THAT BIRTHDAYS ARE GOOD FOR YOU.

THE PEOPLE WHO HAVE THE MOST OF THEM LIVE LONGEST.

[COUPLE WHO WENT TO HEAVEN......... OAT BRAN]

206
ag
BUT AGE PREJUDICE IS STILL FAR TOO COMMON IN AMERICA.
FORTUNATELY THERE ARE MORE AND MORE PEOPLE WHO ARE
DEFYING THE STEREOTYPE OF THE IDLE ELDERLY, AND THEY

CONTINUE TO LIVE LIFE FULLY UNTIL THE DAY THEY DIE.

AND YES, WE SHOULD TALK ABOUT THAT, THE DAY WE DIE.

207
ag
SOMETIMES I THINK AMERICANS HAVE FORGOTTEN THEY HAVE
TO DIE OF SOMETHING.
THE MIRACLES OF MODERN MEDICINE MAY TEMPT US TO
WORSHIP AT THE ALTAR OF "LIFE AT ALL COST."
BUT NOW, I BELIEVE THE PUBLIC WONDERS IF MEDICAL

TECHNOLOGY MIGHT BE A MIXED BLESSING.

208
ag
BOTH THE LAY PUBLIC AND THE MEDICAL PROFESSION ARE EVEN
NOW DEBATING THE WISDOM OF USING SO-CALLED
"EXTRAORDINARY" MEASURES TO SAVE OR PROLONG THE LIVES

OF PERSONS PROFOUNDLY TRAUMATIZED OR TERMINALLY ILL.

209
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FOR MANY PEOPLE WHO MUST DECIDE THE FATE OF LOVED
ONES, HIGH-TECH MEDICINE SOMETIMES ACTS LIKE A FRIEND ...

AND SOMETIMES IT ACTS LIKE AN ENEMY.

HENCE, SOME PEOPLE ARE TURNING TO LEGAL INSTRUMENTS
LIKE THE SO-CALLED "LIVING WILL" AND THE "DURABLE POWER
OF ATTORNEY" TO PROTECT THEMSELVES FROM RUNAWAY
MEDICAL TECHNOLOGY, IN THE EVENT THEY ONE DAY HAVE A

TERMINAL ILLNESS OR INJURY.

210
ag
ON THE OTHER HAND, WE MUST BE WARY OF THOSE WHO ARE
TOO WILLING TO END THE LIVES OF THE ELDERLY AND THE ILL.
IF WE EVER DECIDE THAT A POOR QUALITY OF LIFE JUSTIFIES
ENDING THAT LIFE, WE HAVE TAKEN A STEP DOWN A SLIPPERY
SLOPE THAT PLACES ALL OF US IN DANGER. THERE IS A
DIFFERENCE BETWEEN ALLOWING NATURE TO TAKE IT COURSE,
AND ACTIVELY ASSISTING DEATH.

MEDICINE CANNOT BE OUR HEALER AND OUR KILLER.

211
IN OUR SOCIETY WE SHY AWAY EVEN FROM TALKING ABOUT
DEATH.

WE NEED TO BE MORE REALISTIC.

PART OF LIVING IS PREPARING FOR DEATH.

AS THE WRITER OF ECCLESIASTES WROTE, "THERE IS A TIME TO

BE BORN; THERE IS A TIME TO DIE."

212

ag
ag
AS DR. TIM JOHNSON HAS WRITTEN, THERE HAS ALWAYS BEEN
AN ELEMENT OF TENSION OR PARADOX IN OUR VIEW OF LIFE,
CONDITIONED BY OUR JUDEO-CHRISTIAN HERITAGE.
WE CHERISH LIFE, AND DO ALL WE CAN TO SUSTAIN IT, BUT
THEN THERE COMES THE TIME TO DIE....AND OUR SPIRITUAL
HERITAGE REMINDS US THAT WE SHOULD NOT EQUATE BEING

TERMINALLY ILL WITH BEING HOPELESSLY ILL.

213
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FOR ME, MY CHRISTIAN FAITH ALLOWS ME TO FACE DEATH WITH
REALISM AND EVEN OPTIMISM. RESOURCES OF THE SPIRIT DO
THE SAME FOR OTHERS.
MANY PEOPLE HAVE FOUND STRENGTH AND AN OUTLET FOR

SERVICE IN THE GROWING HOSPICE MOVEMENT.

214
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AS THE AMERICAN POPULATION AGES, THESE ISSUES WILL GROW
IN IMPORTANCE.

WE MUST KEEP OUR ELDERLY FOLK LIVING AS WELL AS THEY
CAN UNTIL THEY DIE, AND THEN ASSURE THEM --AND
OURSELVES-- OF A DEATH AS FREE OF PAIN AS POSSIBLE, AMONG

FRIENDS, A DEATH WITH SERENITY.

215
ag
BUT MAYBE SOME OF YOU HAVE THOUGHT ABOUT AGING.
I'M SURE THAT SOME OF YOU HAVE THOUGHT ABOUT YOUR
PARENTS, AND YOU WONDER WHO WILL LOOK AFTER THEM

WHEN THEY ARE OLD AND SICK. —

YOU CAN'T STOP THEIR AGING, BUT YOU CAN HELP THEIR

HEALTH.

190
ag
NOW WE KNOW HOW TO PREVENT MANY DISEASES AND

DISABILITIES THAT DENY OLDER PEOPLE THEIR INDEPENDENCE.

FOR EXAMPLE, THERE ARE THREE COMMON ONE-WAY TICKETS
TO A NURSING HOME:
BROKEN HIPS, URINARY INCONTINENCE, AND A DIABETIC

FOOT.
EACH OF THESE CAN BE EASILY PREVENTED, GIVING OLDER

PEOPLE MORE YEARS OF INDEPENDENT LIVING. °

194
ag

SO LET'S GET A FEW THINGS STRAIGHT:

GRAY OR WHITE HAIR IS NOT A SIGN OF DISEASE.

NEVER HAS BEEN. NEVER WILL BE.

DRY SKIN IS A NATURAL PHENOMENON OF AGING. WE DON'T

KNOW WHY IT HAPPENS ... BUT IT'S NOT THE RESULT OF DISEASE.

199
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TAKING THINGS A LITTLE EASIER IS NOT A DISEASE CONDITION.

IT'S MORE LIKE A SIGN OF MATURITY.

AND GETTING A STRONGER PRESCRIPTION FOR YOUR

EYEGLASSES OR BEING FITTED FOR A HEARING AID IS NOT

EVIDENCE THAT YOU HAVE ONE FOOT IN THE GRAVE.

IT JUST ISN'T.

200
ag
AFTER SEVERAL YEARS IN WASHINGTON I WAS BEGINNING TO
FEEL MORE COMFORTABLE WITH THE JOB. I BEGAN TO LIKE
MORE PEOPLE IN THE CONGRESS, AND ACTUALLY ENJOYED
COMMITTEE MEETINGS AT THE WHITE HOUSE.

SUDDENLY I REALTZED WHY: I WAS LOSING MY HEARING.

201
SERIOUSLY, THOUGH, I REALIZED THAT I WAS MISSING A LOT.
AND I WAS MAKING INAPPROPRIATE RESPONSES.

SO I GOT TWO HEARING AIDS.

GETTING A HEARING AID SHOULD BE JUST LIKE GETTING

EYEGLASSES.

202

ag
I'M SURE AIDS IS NOT A NEW TOPIC FOR ANYONE IN THIS ROOM.
AFTER ALL I WROTE EACH OF YOU A LETTER ABOUT AIDS TWO
YEARS AGO. AT LEAST I SENT THE AIDS MAILER TO 107 MILLION
HOUSEHOLDS. I HOPE YOU RECEIVED YOURS.

AND YET I'M SURE THERE ARE STILL MANY PEOPLE RIGHT HERE
IN THIS AUDIENCE WHO ARE STILL UNCLEAR ABOUT THE NATURE

OF THE DISEASE OF AIDS.

216
YOU MAY RECALL THAT, IN 1981, THE U.S. PUBLIC HEALTH
SERVICE PUBLISHED THE FIRST REPORTS OF WHAT WAS TO
BECOME THE AIDS EPIDEMIC. THEY CONCERNED 5 "PREVIOUSLY
HEALTHY" HOMOSEXUALS WHO WERE ADMITTED TO LOS
ANGELES HOSPITALS WITH PNEUMOCYSTIS CARINI PNEUMONIA,

A VERY RARE FORM OF PNEUMONIA.

BY THE TIME THE REPORT HAD BEEN PUBLISHED, 2 OF THE MEN

HAD DIED. THE OTHER 3 DIED SHORTLY THEREAFTER.

217
THEN, A MONTH LATER, THE PUBLIC HEALTH SERVICE
PUBLISHED A REPORT THAT 26 YOUNG MEN HAD BEEN RECENTLY
DIAGNOSED AS HAVING KAPOSI'S SARCOMA, "AN UNCOMMONLY
REPORTED" CANCEROUS CONDITION USUALLY FOUND IF AT ALL

AMONG ELDERLY MEN.

FROM THAT SMALL BEGINNING THE CASES MUSHROOMED INTO

THE EPIDEMIC OF THE LATE 1980S.

218
THE FIRST THING TO KNOW IS THAT THE AIDS VIRUS IS STILL
SPREADING, BOTH IN OUR COUNTRY AND WORLDWIDE.

THAT'S THE PREMISE FOR EVERYTHING WE DO. WE'VE GOT A
KILLER DISEASE ON OUR HANDS AND IT'S REACHING FARTHER

AND DEEPER INTO OUR SOCIETY EVERY DAY.

OUR STATISTICIANS PREDICTED TWO YEARS AGO THAT THE AIDS

EPIDEMIC WOULD CONTINUE TO GROW AND SPREAD WELL INTO

THE 1990S ... AND I'M AFRAID THEY WERE RIGHT. |

219
ag
AS OF LAST YEAR WE HAD -117,000 CASES WITH 70,000 DEATHS.
AND 1 MILLION CARRYING THE VIRUS. SOME OF THEM KNOW
THEY HAVE IT AND SOME DON'T, BUT THEY ARE ALL INFECTIOUS
TO OTHER PEOPLE THROUGH INTIMATE SEXUAL CONTACT OR

SHARING PARAPHANALIA WHEN THEY SHOOT DRUGS.

220
THAT'S WHY I PREFER TO SPEAK OF HIV INFECTION --NOT AIDS--

BECAUSE IT HELPS FOCUS ON THE ENORMITY OF THE PROBLEM.

ALMOST HALF THE NUMBER OF PEOPLE WHO WERE REPORTED

AS NEW CASES OF AIDS JUST LAST YEAR HAVE ALREADY DIED.

221
SO, EVEN THOUGH WE DON'T KNOW EVERYTHING ABOUT THIS

DISEASE, WE DO KNOW ONE THING FOR CERTAIN:

IF YOU HAVE AIDS, YOUR CHANCES OF SURVIVING THE NEXT TWO

OR THREE YEARS ARE NOT VERY GOOD. BUT YOUR CHANCES OF

SURVIVING ANY LONGER THAN THAT ARE ALMOST NIL.

222
IN FEBRUARY 1986, PRESIDENT REAGAN ASKED THE SURGEON
GENERAL TO 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.
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.

223
AIDS IS TRANSMITTED IN FOUR WAYS ... AND IN ONLY FOUR

WAYS:

* THE FIRST WAY IS MOST COMMON ROUTE OF
TRANSMISSION IS SEXUAL INTERCOURSE ... MOSTLY BUT NOT
EXCLUSIVELY ANAL INTERCOURSE, WHICH OCCURS MOST
FREQUENTLY AMONG HOMOSEXUALS AND BISEXUAL MALES.
THIS ACCOUNTS FOR ABOUT TWO-THIRDS OF ALL CASES OF AIDS.
HOWEVER, AIDS IS TRANSMITTED THROUGH HETEROSEXUAL
INTERCOURSE. AND EVEN THOUGH THE STATISTICAL INCIDENCE

OF HETEROSEXUAL TRANSMISSION IS LOWER, IT IS JUST AS

FATAL. DON'T FOOL AROUND.

224
* AIDS IS ALSO TRANSMITTED INTO THE BLOOD OF
INTRAVENOUS DRUG ADDICTS WHO USE THE NEEDLES AND

SYRINGES OF OTHER ADDICTS ALREADY INFECTED WITH AIDS

 

VIRUS.

* THE VIRUS CAN ALSO BE TRANSMITTED FROM AN AIDS-
INFECTED MOTHER TO HER INFANT DURING PREGNANCY OR AT

THE TIME OF DELIVERY.

7 AND FINALLY, AIDS CAN BE TRANSMITTED THROUGH
TRANSFUSED BLOOD OR BLOOD PRODUCTS. BUT THIS DANGER IS

NOW ALMOST STATISTICALLY INSIGNIFICANT.

225
AND, THERE ARE FOUR KEY ASPECTS OF THE DISEASE OF AIDS:
ONE, THAT IT'S SPREADING ...
TWO, THAT IT'S FATAL...
THREE, THAT WE DON'T HAVE A CURE YET ...
AND FOUR, THAT IT'S SPREAD MAINLY BY CERTAIN SPECIFIC

BEHAVIORS INVOLVING SEX AND/OR DRUGS.

226
THESE FOUR ASPECTS MAKE THE AMERICAN PEOPLE VERY EDGY
ABOUT AIDS. AND THAT'S CERTAINLY UNDERSTANDABLE.

BUT THE FACT REMAINS THAT YOU HAVE TO MAKE A CONSCIOUS
DECISION TO CARRY OUT A SPECIFIC FORM OF PERSONAL
BEHAVIOR BEFORE YOU EXPOSE YOURSELF TO THE AIDS VIRUS.

DON'T DO IT.

THE ONLY WEAPON WE HAVE AGAINST THIS DISEASE IS

EDUCATION, EDUCATION, AND MORE EDUCATION.

227
AND TO DEAL WITH THE GROWING NUMBER OF AMERICANS
DYING OF AIDS, WE WILL NEED COMPASSION, COMPASSION, AND

MORE COMPASSION.

228
AIDS MAY BE THE MOST DEADLY DISEASE ON THE HORIZON, THE
MOST UNIQUE CHALLENGE TO US, BUT IT IS NOT THE GREATEST
KILLER OR THE GREATEST BURDEN ON THE HEALTH CARE
SYSTEM. THAT NOTORIETY GOES TO SMOKING-RELATED

DISEASE.

229
I'VE SAID IT MANY TIMES BEFORE: "SMOKING IS THE CHIEF,
SINGLE, AVOIDABLE CAUSE OF DEATH IN OUR SOCIETY AND THE

MOST IMPORTANT PUBLIC HEALTH ISSUE OF OUR TIME" (CEK)

230
THE EVIDENCE AGAINST SMOKING BUILDS EVERY YEAR, AND THE
AMERICAN PEOPLE ARE BELIEVING IT.

AS YOUR SURGEON GENERAL I RELEASED 8 ANNUAL REPORTS ON
SMOKING. THEY HAVE DEALT WITH CANCER, CARDIOVASCULAR
DISEASE, CANCER IN WOMEN, SMOKING IN THE WORKPLACE,
CHRONIC OBSTRUCTIVE LUNG DISEASE, INVOLUNTARY SMOKING
OR WHAT IS SOMETIMES CALLED "PASSIVE SMOKING," AND THE

ADDICTIVE QUALITIES OF NICOTINE.

231
EACH ONE HAS ITS OWN SPECIFIC AND IMPRESSIVE DATA BASE.

TODAY, THE SMOKING-AND-HEALTH RESEARCH BASE IS STILL
GROWING. IT IS COMPRISED OF MORE THAN 60,000 PUBLISHED
ARTICLES. AGAIN, THE VAST MAJORITY QUITE CLEARLY
REINFORCES THE FACT THAT CIGARETTE SMOKING IS THE
SINGLE MOST IMPORTANT FACTOR BEHIND ACUTE AND CHRONIC

MORBIDITY AND PREMATURE MORTALITY AMONG ADULTS.

232
AS THIS RESEARCH BASE EXPANDED, SO DID OUR EFFORTS TO
EDUCATE THE PUBLIC ... TO GET THOSE WHO SMOKE, TO STOP ...

AND THOSE WHO DON'T SMOKE, TO NEVER START.

IN 1984, I WAS PERSONALLY SO CONVINCED BY THE DATA
ACCUMULATED THUS FAR THAT I CALLED UPON MY FELLOW
CITIZENS TO MAKE THE UNITED STATES A "SMOKE-FREE SOCIETY

BY THE YEAR 2000."

233
WE'LL ACHIEVE THAT SMOKE-FREE SOCIETY BECAUSE WE WILL
GRADUATE A CLASS FROM HIGH SCHOOL IN 2000 THAT WILL
HAVE HAD 12 YEARS OF ANTI-SMOKING HEALTH MESSAGES. IT
STARTED THE YEAR BEFORE LAST, IN THE FIRST GRADE.

TEACHING THAT YOUNG WILL WIN.
FEW THINGS BRINGS ME AS MUCH SATISFACTION AS THE

DRAMATIC DECREASE IN SMOKERS DURING THE LAST 8 YEARS,

FROM 33 PERCENT TO 26 PERCENT.

234
BUT THERE IS MORE TO DO.

SMOKING IS STILL THE SINGLE MOST DEADLY "HABIT" ...
ASSOCIATED WITH HIGHER MORTALITY AND ILLNESS THAN
DRUGS, AUTOMOBILES, AND AIDS COMBINED. ALL THE AIDS
PATIENTS WHO HAVE DIED SINCE WE KNEW ABOUT THE DISEASE,

8 YEARS, EQUALS THE SMOKING DEATHS OF ONLY 4 MONTHS.

235
SMOKING IS THE ROOT CAUSE OR THE MOST SIGNIFICANT CAUSE
FOR ABOUT 1,000 DEATHS A DAY OF HEART DISEASE, CANCER,
AND STROKE, THE 3 LEADING KILLERS OF AMERICANS.

RECENT STUDIES DEMONSTRATE A DEFINITE INCREASE IN YOUR

HEART ATTACK RISK, EVEN IF YOU SMOKE VERY LITTLE.

SOME 50 MILLION AMERICANS STILL SMOKE, MAKING A MAJOR

IMPACT ON THE NATIONAL HEALTH BUDGET ... AND THEIR OWN

PERSONAL AND FAMILY HEALTH BUDGETS.

236
BUT THE TOBACCO INDUSTRY HAS NOT GIVEN UP
I DOUBT THAT YOU CAN FIND A MORE HEAVY-HANDED, OBTUSE,

IMPOLITIC, AND UNTRUTHFUL GROUP OF CORPORATIONS

ANYWHERE.

237
ALMOST FROM MY FIRST DAY IN OFFICE, THE INDUSTRY
REMINDED ME AGAIN AND AGAIN -- AND NOT VERY SUBTLY
EITHER -- THAT I OUGHT TO GET OFF MY ANTI-SMOKING "HOBBY-
HORSE," AS ONE TOBACCO LOBBYIST CALLED IT, AND PAY
ATTENTION TO OTHER, ALLEGEDLY MORE IMPORTANT PUBLIC

HEALTH MATTERS.

ECHOES OF THEIR COMPLAINTS WERE RELAYED TO ME FROM
THE WHITE HOUSE, THE CONGRESS, AND EVEN FROM MEMBERS
OF THE PRESS, WHO HAVE OFTEN BEEN THE GULLIBLE CARRIERS

OF THE INDUSTRY'S DISASTROUS MESSAGE.

238
I ALSO READ THEIR DECEPTIVE, FULL-PAGE ADVERTISEMENTS
THAT LIFTED MENDACITY AND HALF-TRUTHS TO A NEW AND

HIGHER LEVEL OF FAUSTIAN ART.

TO BE PERFECTLY HONEST, I DID NOT ASSUME THE POSITION OF

SURGEON GENERAL WITH THE CLEAR INTENTION OF BEING SUCH
AN ACTIVE OPPONENT OF TOBACCO AS I HAVE BEEN. BUT THEN I
BEGAN TO STUDY IN SOME DEPTH THE INCONTROVERTIBLE

TRUTHS ABOUT THE HEALTH HAZARDS OF SMOKING.

239
AND I MUST TELL YOU THAT I WAS AT FIRST DUMBFOUNDED AND
THEN PLAINLY FURIOUS AT THE TOBACCO INDUSTRY FOR
ATTEMPTING TO OBFUSCATE AND TRIVIALIZE THIS

EXTRAORDINARILY IMPORTANT PUBLIC HEALTH INFORMATION.

240
HOW COULD THE TOBACCO INDUSTRY DARE TO DISMISS AS
UNFOUNDED AND UNPROVEN THE ABSOLUTELY CLEAR
CONNECTION BETWEEN SMOKING AND HEART DISEASE ...
BETWEEN SMOKING AND DEATHS FROM STROKE ... BETWEEN
SMOKING AND CANCER OF THE LUNG, THE MOUTH, THE
ESOPHAGUS, AND OF THE STOMACH ... AND BETWEEN SMOKING
AND A DOZEN OR MORE SERIOUS, DEBILITATING, EXHAUSTING,

EXPENSIVE, AND HUMILIATING DISEASES?

241
HOW COULD THEY DARE TO DO THAT? I WONDERED. THE
ANSWER WAS ... THEY JUST DID. AND THEY FLAUNTED THEIR
ABILITY TO BUY THEIR WAY INTO THE MARKETPLACE OF IDEAS

AND POLLUTE IT WITH THEIR FALSE AND DEADLY INFORMATION.

SO OUR EDUCATION CAMPAIGNS, OUR SELF-HELP GROUPS MUST
CONTINUE THEIR GOOD WORK. WE MUST GUARD AGAINST
COMPLACENCY, AND INTENSIFY OUR EFFORTS TO ELIMINATE
THE GREATEST CAUSE OF PREVENTABLE DISEASE AND DEATH

AFFLICTING OUR SOCIETY.

242
YOU ALL CAN DO SOMETHING.

IF YOU SMOKE, OF COURSE, STOP.

AND GET THE HELP YOU NEED TO STOP. THERE ARE MANY GOOD
AND PROVEN CESSATION PROGRAMS.

IF YOU DON'T SMOKE --THANK YOU-- BUT SOMEONE CLOSE TO

YOU DOES, HELP HER OR HIM TO STOP.

243
AND THEN TAKE ON THE TOBACCO COMPANIES IN YOUR OWN
COMMUNITY.
A GOOD PLACE TO START IS THE VENDING MACHINES THAT

HOOK OUR KIDS ON CIGARETTES.

HERE IS ANOTHER EXAMPLE OF THE CODDLED CIGARETTE

COMPANIES.

244
IT IS ILLEGAL TO SELL BOTH ALCOHOL AND CIGARETTES TO
MINORS. THAT IS BECAUSE ALCOHOL AND NICOTINE ARE THE
TWO MAJOR LEGAL ADDICTING DRUGS IN OUR SOCIETY.

WE WOULD NEVER TOLERATE SELLING ALCOHOLIC BEVERAGES
IN VENDING MACHINES, BUT SOMEHOW WE TOLERATE

CIGARETTE VENDING MACHINES.

245
LOOK AT THE LAWS DEALING WITH SELLING CIGARETTES TO
MINORS.

OUR NATION'S CAPITAL, WITH ALL THE HOOPLA ABOUT FIGHTING
DRUGS, CAN FINE AN OFFENDING MERCHANT WHO SELLS
CIGARETTES TO A MINOR ONLY $2. ACROSS THE POTOMAC, IN
VIRGINIA, THE FINE GOES ALL THE WAY TO $25. IT'S A PITIFUL
TESTIMONY TO OUR CRIMINAL TOLERATION OF SELLING

CIGARETTES TO MINORS.

246
YET, GETTING A KID ADDICTED TO NICOTINE SEEMS TO BE ONE

OF THE MOST CERTAIN WAYS TO CUT SHORT A PROMISING LIFE.

THE CIGARETTE VENDING MACHINES SHOULD BE THE NEXT

TARGET IN THE CRUSADE AGAINST SMOKING.

247
THERE IS ANOTHER ISSUE CONCERNING TOBACCO.

OUR SOCIETY IS NOT THE ONLY ONE AFFECTED.

THE BATTLE AGAINST SMOKING WORLDWIDE IS OUR BUSINESS

TOO.

IT IS OUR CONCERN NOT ONLY BECAUSE OF A GENERAL

INTEREST IN COMBATING DISEASE AND DEATH, BUT ALSO

BECAUSE IT AFFECTS OUR ABILITY TO COUNTER THE PLOYS OF

THE TOBACCO INDUSTRY, AND IT IS PART OF OUR WAR ON

DRUGS.

248
THE DECLINE IN TOBACCO COMPANY EARNINGS FROM THE SALE
OF CIGARETTES TO AMERICANS IS BEING OFFSET BECAUSE

CIGARETTE COMPANIES ARE EXPLOITING MARKETS OVERSEAS.

IN ONE OF THE MOST DISGRACEFUL EXAMPLES OF PRIVATE
ENTERPRISE GONE AMOK, THE CIGARETTE INDUSTRY IS
FOCUSING ITS HIGH-POWERED MARKETING ATTENTION ON THE
UNPROTECTED CITIZENS OF THIRD-WORLD NATIONS IN ASIA,

AFRICA, AND SOUTH AMERICA.

249
AS A RESULT, THOSE NATIONS ARE NOW BEGINNING TO
EXPERIENCE THE SAME RISE IN SMOKING-RELATED DISEASES
THAT WE EXPERIENCED A GENERATION AGO ... HEART DISEASE,
STROKE, AND CANCER OF THE LUNG, MOUTH, ESOPHAGUS, AND

STOMACH.

AND AS AN AMERICAN CITIZEN, I AM APPALLED BY THIS
CORPORATE BEHAVIOR OF AMERICAN COMPANIES AND,
FURTHER, I AM SHOCKED BY THE OUR OWN GOVERNMENT'S

SUPPORT OF SUCH BEHAVIOR.

250
THE ALARMING THING ABOUT THIS HABIT IS THAT, WHEN IT
INVADES A NEW MARKET, IT DOES SO WITH IMMENSE SPEED AND
IMPACT. ACCORDING TO THE WORLD HEALTH ORGANIZATION,
BETWEEN 1971 AND 1981 CIGARETTE CONSUMPTION INCREASED
IN ASIA AND LATIN AMERICA AT A RATE 30 PERCENT AHEAD OF
THE RATE OF POPULATION INCREASE ... IN AFRICA, IT ROSE 77

PERCENT AHEAD OF THE RISE IN POPULATION.

251
IN 10 OF 15 ASIAN COUNTRIES, AMERICAN CIGARETTES WERE THE

MOST COMMON KIND IMPORTED.

BUT THOSE AMERICAN CIGARETTES ARE A LITTLE DIFFERENT
OVERSEAS: FOR ONE THING, THEY DON'T CARRY THE SURGEON
GENERAL'S WARNING. AND FOR ANOTHER, MANY AMERICAN
CIGARETTES MANUFACTURED FOR EXPORT HAVE A HIGHER TAR
CONTENT AND ARE, THEREFORE, EVEN MORE DANGEROUS THAN
THE LOWER-TAR, FULLY-LABELLED PRODUCTS SOLD HERE IN

THE UNITED STATES.

252
NOW, LET ME MAKE SURE YOU UNDERSTAND WHAT I JUST SAID.
I SAID THAT SOME AMERICAN CIGARETTE MANUFACTURERS -- AS
KNOWLEDGEABLE AS I AM, CONCERNING THE HEALTH RISKS OF
SMOKING -- KNOWINGLY PRODUCE A MORE HARMFUL
CIGARETTE FOR EXPORT THAN THEY PRODUCE FOR DOMESTIC

CONSUMPTION.

253
JUST A LITTLE MORE THAN A YEAR AGO, 15 ASIAN 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.

254
OUR EXPORT OF TOBACCO PRODUCTS IS A MORAL OUTRAGE.
AND IT IS ALSO FOOLISH.

WE MUST CONVINCE OUR GOVERNMENT THAT THERE IS NO
SENSE IN PLANNING FOR THE LONG-TERM ECONOMIC HEALTH
OF A FOREIGN SOCIETY AND PROVIDING THAT SOCIETY WITH
FOREIGN AID ON THE ONE HAND, IF THE PHYSICAL HEALTH OF
THE PEOPLE OF THAT SOCIETY IS FUNDAMENTALLY

ENDANGERED DURING THAT SAME LONG TERM.

255
I DO NOT BELIEVE THE UNITED STATES WILL EVER AGAIN BE A
GOOD MARKET FOR TOBACCO PRODUCTS.

THE CURVE IS GOING DOWN AND ACCELERATING.

AND I FEEL QUITE GOOD ABOUT THE ROLE I BELIEVE I PLAYED

IN BRINGING ABOUT THIS MARKET CHANGE.

256
WE HAVE BEATEN THE CIGARETTE INDUSTRY ON ITS OWN HOME
TURE ... BUT WE'VE DRIVEN THEM TO SCOUR THE REST OF THE

EARTH FOR NEW VICTIMS.

IT IS THE HEIGHT OF HYPOCRISY FOR THE UNITED STATES, IN
OUR WAR AGAINST DRUGS, TO DEMAND THAT FOREIGN NATIONS
TAKE STEPS TO STOP THE EXPORT OF COCAINE TO OUR
COUNTRY WHILE AT THE SAME TIME WE EXPORT NICOTINE, A
DRUG JUST AS ADDICTIVE AS COCAINE, TO THE REST OF THE

WORLD.

257
THE PROBLEM OF DRUGS IN AMERICA IS SO LARGE AND SO
OFTEN DISCUSSED THAT I DON'T NEED TO ADD MY VOICE TO ALL
THOSE WHO POINT OUT THE URGENCY ABOUT DOING
SOMETHING ABOUT THE DRUG CRISIS.

IT IS A COMPLICATED PROBLEM, TOUCHING NOT ONLY UPON
PUBLIC HEALTH, BUT ALSO INVOLVING LAW, POLITICS, AND EVEN

THE MILITARY.

258
MY ONE COMMENT ON THIS ISSUE WILL MAKE A MEDICAL
COMPARISON.

NOT TOO LONG AGO THE MEDICAL COMMUNITY SPENT A GOOD
DEAL OF TIME AND EFFORT TRYING TO DECIDE WHICH WAS THE
BEST TREATMENT FOR CANCER: SURGERY, RADIATION,
CHEMOTHERAPY, ETC.

PEOPLE DIVIDED THEMSELVES INTO CAMPS, EACH PLUGGING ITS

OWN SOLUTION.

259
EVENTUALLY IT BECAME CLEAR THAT THE SMARTEST STRATEGY
WAS A MULTIPLE STRATEGY, EMPLOYING ALL OF THEM,
EMPHASIZING ONE OR THE OTHER FOR CERTAIN PROBLEMS.

IN THE SAME WAY, PERHAPS TO MUCH TIME HAS BEEN SPENT
TRYING TO FIND THE BEST WAY TO FIGHT DRUGS: ELIMINATE
THE SUPPLY, REDUCE THE DEMAND, INTERDICTION,
INCARCERATION, SOLVING BASIC SOCIAL PROBLEMS. WE NEED
ALL THESE, IN A MULTIPLE STRATEGY, AND THE WISDOM TO

DECIDE WHICH TO EMPHASIZE WHEN.

260
AND TO RAISE THE MONEY TO PAY FOR THE WAR ON DRUGS, WE
COULD RAISE THE EXCISE TAX ON THE TWO LEGAL DRUGS,
NICOTINE AND ALCOHOL.

THE HIGHER PRICE MIGHT PUT CIGARETTES OUT OF THE RANGE
OF THOUSANDS OF TEENAGE PURCHASERS, SAVING THEM FROM

A LIFE OF NICOTINE ADDICTION.

261
I HAVE FOCUSED MY ATTENTION ON THE WORKSITE SINCE
LEAVING GOVERNMENT. ONE QUARTER OF THE 20-40 YEAR OLDS
IN THE AMERICAN WORK FORCE TOOK DRUGS IN THE LAST YEAR.
ONE OF 8 TOOK DRUGS IN THE LAST MONTH. YET THESE MEN
AND WOMEN HAVE JOBS, SPOUSES, FAMILY AND I THINK A
BETTER BASE FOR CHANGE WHEN GIVEN AMNESTY AND A WAY

OUT THEN TO DECLARE WAR ON A CITY LIKE WASHINGTON, D.C.

262
AL

MY FINAL APPEARANCE BEFORE CONGRESS AS SURGEON
GENERAL FOCUSED ON A DRUG TOPIC THAT FIGURED LARGELY
IN MY FINAL YEAR IN OFFICE,

ONE THAT IS HIGH ON THE AMERICAN LIST OF CONCERNS:

ALCOHOL ABUSE, ESPECIALLY ALCOHOL-IMPAIRED DRIVING.

263
ALCOHOL IS A TOXIC, POTENTIALLY ADDICTIVE DRUG, THE
GREATEST KILLER OF AMERICAN YOUNG PEOPLE BETWEEN 16

AND 24.

ALCOHOL ABUSE COSTS ANNUALLY 100,000 DEATHS AND $136

BILLION IN ECONOMIC LOSSES.

AN ESTIMATED 18 MILLION ADULT AMERICANS HAVE MEDICAL,
SOCIAL AND PERSONAL PROBLEMS RELATED TO THE USE OF
ALCOHOL, AS DO SEVERAL MILLION ADOLESCENTS FOR WHOM

ALCOHOL IS AN ILLEGAL DRUG.

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264
TENS OF MILLIONS OF OTHER ADULTS AND YOUTHS ARE
AFFECTED BY THE ALCOHOL PROBLEMS OF FAMILY MEMBERS,

FRIENDS, AND WORK ASSOCIATES.

THESE FIGURES DO NOT INCLUDE THE COSTS OF GRIEF AND

HUMAN SUFFERING. HOW MANY DEFICITS OF THIS KIND CAN

THE COUNTRY AFFORD?

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265
I WAS LED TO TACKLE THE ISSUE OF DRUNK DRIVING BECAUSE

OF THE URGENCY OF THE CRISIS.

I COULD SEE THE URGENCY IN THE MANY LETTERS THAT CAME
IN TO MY OFFICE FROM STATE AND LOCAL OFFICIALS OF EVERY
AREA OF THE COUNTRY. I ALSO RECEIVED THOUSANDS OF
CARDS, LETTERS, AND TELEGRAMS FROM SURVIVING FAMILY
MEMBERS GRIEVING OVER THE LOSS OF A LOVED ONE ...

SOMEONE KILLED BY A DRUNK DRIVER.

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266
THE URGENCY WAS CLEAR FROM THE SENTIMENT EXPRESSED BY
99 UNITED STATES SENATORS AND FROM A UNANIMOUS HOUSE
OF REPRESENTATIVES, WHO ASKED ME TO TAKE ON THIS ISSUE
AND DO WHATEVER I COULD TO BRING IT UNDER CONTROL.

TIME IS NOT ON OUR SIDE.

AL

267
HENCE, WE CAN EXPECT THAT 1990 -- LIKE 1989 AND 1988 BEFORE

IT --WILL BE A YEAR IN WHICH 24,000 MORE AMERICANS WILL

 

HAVE DIED ON OUR HIGHWAYS IN ALCOHOL-RELATED

ACCIDENTS.

AND MANY THOUSANDS MORE WILL HAVE BEEN KILLED IN

ACCIDENTS THAT ARE DRUG-RELATED.

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268
DURING MY TIME AT THIS MICROPHONE THREE OF OUR
CITIZENS WILL BE KILLED BY A DRUNK DRIVER. 534,000 PEOPLE
ARE INJURED IN ALCOHOL-RELATED TRAFFIC CRASHES EACH

YEAR.

WHEN THE VEHICULAR WRECKAGE IS TOWED AWAY, THE HUMAN
WRECKAGE IS LEFT BEHIND -- THE PERMANENT BRAIN DAMAGE,
THE SPINAL CORD INJURIES, THE LOST OR PERMANENTLY
DEFORMED LIMBS, THE BLINDNESS AND THE IMPOTENCE ... THE
LIFETIMES CRIPPLED WITH DISABILITY AND HAUNTED BY

RECURRENT NIGHTMARES OF HOW IT ALL HAPPENED.

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269
TENS OF THOUSANDS OF DEATHS ... HUNDREDS OF THOUSANDS

OF INJURIES ... THOSE ARE NUMBING STATISTICS. BUT THEY ARE

ALSO MORE THAN JUST STATISTICS.

THEY ARE REAL PEOPLE ... REAL HUMAN LIVES.

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270
UNFORTUNATELY, A DISPROPORTIONATE NUMBER OF HIGHWAY
VICTIMS ARE YOUNG PEOPLE ... YOUNG MEN AND WOMEN
BETWEEN THE AGES OF 15 AND 24. NO OTHER COMPARABLE AGE
COHORT HAS SUCH A RECORD OF DEATH AND INJURY ON THE
HIGHWAY.

AND THIS AGE GROUP, BY ITSELF, ACCOUNTS FOR OVER 8,000
ALCOHOL-RELATED FATALITIES, OR ABOUT A THIRD OF ALL

FATALITIES EACH YEAR IN WHICH ALCOHOL IS IMPLICATED.

AL

271
WITH ALCOHOL-IMPAIRED DRIVING, AS WITH SMOKING, THE
ISSUES ARE MANY AND COMPLICATED, AND EVEN SMALL STEPS
TOWARD ALLEVIATING THE PROBLEM TRIGGER STRONG
EMOTIONS AND VEHEMENT CONTROVERSY.

FOR EXAMPLE, DURING MY FINAL YEAR AS SURGEON GENERAL I
INVITED TO A WORKSHOP ON DRUNK DRIVING REPRESENTATIVES
FROM THE NATIONAL ASSOCIATION OF BROADCASTERS, THE
AMERICAN ASSOCIATION OF ADVERTISING AGENCIES, AND THE
ASSOCIATION OF NATIONAL ADVERTISERS.

al

272
THEY ALL DECLINED, YET CRITICIZED STRONGLY THE
WORKSHOP AND ITS RECOMMENDATIONS.

THE NATIONAL BEER WHOLESALERS ASSOCIATION WENT SO FAR
AS TO FILE A LAWSUIT FOR A RESTRAINING ORDER FOR THE

WORKSHOP.

AL

273
ALCOHOL-IMPAIRED DRIVING MUST BE SEEN AS A PUBLIC

HEALTH AND SAFETY PROBLEM, RATHER THAN AS AN ECONOMIC

AND MORAL ISSUE, AND OUR PRIMARY CONCERN MUST BE WITH

PRESERVING HUMAN LIVES.

OUR GOAL MUST BE THE NATIONAL TOTAL UNACCEPTABILITY OF

DRIVING AFTER USING ALCOHOL OR OTHER DRUGS, THE VERY

ENORMITY OF OUR LOSSES DEMANDS NO LESS OF A RESPONSE.

AL

274
AFTER THE WORKSHOP I INFORMED THE CONGRESS,
MANUFACTURERS, THE VOLUNTARY AGENCIES, ADVERTISERS,
AND LAW ENFORCEMENT AGENCIES WHAT EACH COULD DO TO

STOP THE CARNAGE. LET ME HIGHLIGHT ONE MESSAGE.

AL

275
AD

WE NEED TO PAY SPECIAL ATTENTION TO THE PERNICIOUS

MESSAGES OF ALCOHOL ADVERTISING.

OUR CONCERN SHOULD ALSO INCLUDE TOBACCO ADVERTISING.

AS WE MOUNT OUR NATIONAL WAR ON DRUGS,

THERE IS SOMETHING PERVERSE ABOUT OUR CONDONING

ADVERTISEMENTS FOR THE GREATEST KILLER-DRUGS: NICOTINE

 

AND ALCOHOL.

276
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INDEED, IT IS STRANGE THAT WE SHOULD EVEN NEED TO
ADDRESS THIS SUBJECT.
IT IS STRANGE TO ATTEMPT TO HAVE A RATIONAL DISCOURSE

ABOUT AN IRRATIONAL FLUKE OF HISTORY.

WITHOUT THE UNHAPPY BURDEN OF HISTORY ALL REASONABLE
PEOPLE WOULD DENOUNCE ANY ATTEMPT TO ENCOURAGE
AMERICANS TO CONSUME SUBSTANCES LIKE TOBACCO OR
ALCOHOL, BECAUSE THEY ARE CLEARLY ASSOCIATED WITH

DISEASE, DISABILITY AND DEATH.

277
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IF TOBACCO AND ALCOHOL WERE NOW FOR THE FIRST TIME
BEING TESTED FOR POPULAR CONSUMPTION, THE REGULATORY
AGENCIES WE ENTRUST WITH WATCHING OUT FOR OUR HEALTH

WOULD DISALLOW THEIR USE.

BUT FROM THE BEGINNING, AMERICAN TOBACCO HAS ENJOYED
GOVERNMENT PROTECTION AND CODDLING, DESPITE ITS
SINISTER ASSOCIATIONS, FIRST WITH SLAVERY, AND LATER WITH
CANCER AND HEART DISEASE. ONLY THE GROTESQUE
ECONOMIC POWER OF THE INTERNATIONAL TOBACCO
COMPANIES CAN SUSTAIN THIS OUTRAGE, AS THEY USE
ECONOMIC BLACKMAIL TO INTIMIDATE PUBLISHERS,

GOVERNMENTS, AND BROADCASTERS.

278
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SIMILARLY, THE FAILURE OF PROHIBITION IN THE 1920S HAS
MADE AMERICANS SHRINK FROM TAKING THE STEPS ANY
RATIONAL SOCIETY WOULD TAKE TO REDUCE OR ELIMINATE THE

INCALCULABLE PERSONAL AND SOCIAL COST OF ALCOHOL

ABUSE.

279
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IT IS UNCONTESTABLE: UNDENIABLE HARM TO INDIVIDUALS AND

TO OUR NATION COMES FROM ALCOHOL AND TOBACCO.

ALTHOUGH NO ONE CLAIMS THAT ADVERTISING ALONE IS THE

CAUSE FOR DRINKING AND SMOKING, IT DOES NOT MAKE SENSE

_ THAT TOBACCO AND ALCOHOL ADVERTISERS WOULD SPEND

BILLIONS ON SLICK, GLAMOROUS, SEXY ADVERTISING IF IT DID

NOT PAY OFF.

280
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CURRENT ALCOHOLIC BEVERAGE ADVERTISING IS INCREASINGLY
TARGETED AT YOUNG PEOPLE AND MINORITIES, AND OFTEN
DEPICTS ALCOHOL CONSUMPTION AS A NORMAL AND
GLAMOROUS ACTIVITY WITHOUT NEGATIVE CONSEQUENCES.
DRINKING IS FREQUENTLY SHOWN IN ASSOCIATION WITH HIGH-
RISK ACTIVITIES AND LINKED TO ATHLETIC, SOCIAL, AND SEXUAL

SUCCESS. THAT'S THE WRONG MESSAGE.

281
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AND STUDIES MAKE CLEAR THE RELATIONSHIP AMONG
TEENAGERS BETWEEN HEAVY EXPOSURE TO ALCOHOL ADS,
HEAVY DRINKING, AND ENGAGING IN RISKY ACTIVITIES, LIKE

DRIVING WHILE UNDER THE INFLUENCE OF ALCOHOL.

282
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AND IT IS YOUNG PEOPLE WHO HEAR THIS MESSAGE.
AMERICAN CHILDREN SEE ABOUT 100,000 BEER COMMERCIALS
BETWEEN THE TIME THEY ARE TODDLERS UNTIL 18.
56% OF U.S. HIGH SCHOOL STUDENTS BEGIN DRINKING IN THE

9TH GRADE OR EARLIER. MANY DRINK HEAVILY.

HALF OF 10TH GRADERS AND ONE THIRD OF 8TH GRADERS
SURVEYED SAID THEY HAD RIDDEN AT LEAST ONCE IN LAST
MONTH WITH DRIVER WHO HAD USED ALCOHOL OR DRUGS

BEFORE DRIVING.

283
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DRUNK-DRIVING IS NOT THE ONLY PROBLEM.
ALCOHOL ABUSE IS A CULPRIT ASSOCIATED WITH CHILD AND

SPOUSE ABUSE, WITH DROWNINGS, WITH FETAL ALCOHOL

SYNDROMES, WITH CANCER, WITH HEART DISEASE.

284
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BUT THE ALCOHOL INDUSTRY FORCES ITS TENTACLES OF
CORRUPTION AND INFLUENCE INTO THE VERY AGENCIES THAT
SHOULD BE PROTECTING US. DURING RECENT HEARINGS ABOUT
A BILL THAT WOULD REQUIRE ROTATING HEALTH WARNINGS ON
BEER WINE AND LIQUOR ADS, MUCH LIKE THOSE ON
CIGARETTES, THE FEDERAL TRADE COMMISSION CHAIRWOMAN,
JANET D. STEIGER, SAID THAT THE F.T.C. WOULD NOT BACK THE

WARNINGS BECAUSE THE "EVIDENCE" WAS INCONCLUSIVE.

285
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THE WOMAN WAS OBVIOUSLY BOUGHT OFF, SINCE THE EVIDENCE
IS CONCLUSIVE.
TEENAGERS TESTIFYING BEFORE NATIONAL COMMISSION ON
ALCOHOL SAID REPEATEDLY THAT A HIGH PERCENT OF TEENS

BEGIN TO DRINK BEER BECAUSE OF THE ADS.

286
ad
IF YOU THINK THERE IS NO ADVERTISING OF CIGARETTES ON
TELEVISION, LISTEN TO THIS. CIGARETTE ADS ON MOST SPORTS
STADIUMS GET FULL PLAY ON TV, AS THE CAMERAS SEEM TO
PAN AROUND THE FIELD JUST TO FIND THEM. ON NBC'S 1989
GRAND PRIX IN 93 MINUTES OF TV THERE WERE 4997 IMAGES OF
MARLBORO SIGNS, 519 OF MARLBORO BILLBOARDS, 249 OF THE
MARLBORO CAR. FOR 49% OF THE WHOLE TIME OR 46 MINUTES

THE BRAND NAME MARLBORO WAS ON THE SCREEN.

287
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ALTHOUGH ONE OF THE MOST GRATIFYING CHANGES DURING
MY TENURE AS SURGEON GENERAL WAS THE DECLINE IN
CIGARETTE SMOKING IN GENERAL, I AM ALARMED BY THE
CONTINUED RISE OF SMOKING IN CERTAIN GROUPS: YOUNG

PEOPLE, WOMEN, AND MINORITIES.

NOT COINCIDENTALLY, THESE THREE GROUPS HAVE BEEN THE

TARGETS OF SPECIAL ADVERTISING BY THE TOBACCO

COMPANIES.

288
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ADVOCATES FOR WOMEN, CHILDREN, AND MINORITIES ARE
INCENSED BY THIS PATRONIZING AND MANIPULATIVE

MARKETING.

CIGARETTE FIRMS MANIPULATE MINORITIES, WOMEN, AND
YOUNG PEOPLE BECAUSE THESE PEOPLE HAVE THE STRONGEST
ASPIRATIONS TO CHANGE THEIR STATUS.

SO THESE ADS ASSOCIATE SMOKING WITH MAKING IT...

IN THE WHITE, OR ANGLO, OR MALE, OR ADULT WORLD.

289
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THEY ASSOCIATE SMOKING WITH A HIGHER ECONOMIC STATUS

(WHEN REALLY HIGHER INCOME GROUPS ARE NOW SMOKING

LESS).

TOBACCO ADVERTISERS ASSOCIATE SMOKING --CONTRARY TO
ALL EVIDENCE-- WITH ROBUST ACTIVITY, ATHLETICS, SOCIAL
ACCEPTABILITY, SUCCESS, OUTDOOR LEISURE, AND EVEN GOOD
HEALTH.

TOBACCO-SPONSORED SPORT EVENTS IMPROPERLY LINK
SMOKING WITH ATHLETIC SUCCESS, INSTEAD OF WITH ITS

HEALTH-CRIPPLING RESULTS.

290
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AT THIS POINT THE CIGARETTE COMPANIES, ALCOHOLIC
BEVERAGE COMPANIES--AND SOME BROADCASTERS-- TROT OUT
THE OLD LINE THAT THEIR ADVERTISING IS INTENDED ONLY TO
ENFORCE BRAND LOYALTY, AND TO GET CONSUMERS TO SWITCH
TO THEIR BRAND.
NO ONE REALLY BELIEVES THAT.
BRAND CHANGERS FORM ONLY 10% OF THE MARKET.
THE REAL PURPOSE OF CIGARETTE ADVERTISING TO IS HOLD ON
TO THOSE SMOKERS ALREADY HOOKED --ADDICTED-- AND TO

ATTRACT NEW ONES.

291
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IT WORKS.
RECENT STUDIES CONFIRM THAT INCREASED ADVERTISING
BRINGS ABOUT A HIGHER DEMAND FOR CIGARETTES IN
GENERAL, NOT JUST FOR THE BRANDS ADVERTISED.

THE STORY FOR ALCOHOL ADVERTISING IS MUCH THE SAME.

292
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LIKE TOBACCO ADVERTISERS, ALCOHOL ADVERTISERS ARE
ALWAYS ATTEMPTING TO INCREASE THEIR TOTAL MARKET, TO
LURE NEW CONSUMERS TO THEIR PRODUCTS.
THIS MEANS COMPETING, NOT JUST WITH OTHER ALCOHOLIC
BEVERAGES, BUT WITH ALL BEVERAGES, INCLUDING SODA,

JUICES, AND THE LIKE.

THAT'S WHAT IS BEHIND THE TREND TOWARD WINE COOLERS,
LITE BEER, CREAMY LIQUEURS, ETC.AND, SURE ENOUGH, WINE
AND BEER CONSUMPTION HAS MOVED UP STEADILY SINCE THIS

NEW HEAVY ADVERTISING BEGAN ON TV AND RADIO.

293
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THE TIME HAS COME FOR THE AMERICAN PEOPLE TO PROTECT
THEIR CHILDREN --AND THEMSELVES-- FROM THE THREAT TO

THEIR HEALTH IN THE GUISE OF ADVERTISING.

A BUSINESS WEEK/LOUIS HARRIS POLL INDICATED THAT 57% OF
THE PUBLIC FAVORS TOTAL BAN ON BROADCAST ALCOHOL
ADVERTISING.

IF VOLUNTARY RESTRICTIONS ARE NOT SOON ADOPTED,
ADVERTISING BANS WILL BE MANDATED BY CONGRESS IN

RESPONSE TO PUBLIC DEMAND.

294
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A BAN ON ADVERTISING FOR BOTH ALCOHOL AND TOBACCO WILL
HAVE ALMOST IMMEDIATE POSITIVE RESULTS FOR THE HEALTH
OF THE AMERICAN PEOPLE.
OR, IF WE DON'T HAVE A BAN, WE'LL USE COUNTER-ADVERTISING,
WITH HEALTH MESSAGES. COUNTER-ADVERTISING IS SO
SUCCESSFUL, THAT IN THE PAST TOBACCO ADVERTISERS HAVE
PULLED THEIR ADS OFF TV, RATHER THAN HAVE COUNTER-ADS
INFORM AMERICANS ABOUT THE REAL CONSEQUENCES OF

SMOKING.

295
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WHEN TOBACCO ADVERTISING HAS BEEN RESTRICTED, HERE AND
ABROAD, SMOKING HAS DECLINED, THEREFORE AFFECTING
POSITIVELY THE HEALTH OF THE SOCIETY.
WE HAVE SEEN THE STEADY DECLINE IN SMOKING SINCE TV ADS
WERE BANNED.

WE CAN SEE SIMILAR RESULTS IN OTHER COUNTRIES.

296
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NEW ZEALAND DISCOVERED THAT BANS ON TOBACCO
PROMOTION ARE FOLLOWED BY A SMOKING DECLINE, AND THAT
TOTAL BANS CAUSE A SMOKING DECLINE 4 TIMES FASTER THAN

IN COUNTRIES WITH PARTIAL BANS.

SIMILARLY A MULTI-FACETED CAMPAIGN AGAINST ALCOHOL ADS

IN SCANDINAVIAN COUNTRIES LED TO A 20% DECLINE IN

DRINKING, AND A 30% DECLINE IN HIGH SCHOOL DRINKING.

297
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IN CALLING FOR RESTRICTIONS ON TOBACCO AND ALCOHOL
ADVERTISING
I STAND ON COMMON SENSE AND PROVEN HEALTH STUDIES.
I DON'T NEED TO HIDE BEHIND THE FIRST AMENDMENT.
I DON'T NEED TO USE OUR CONSTITUTION AS A SMOKE SCREEN.
AND THE "FREE SPEECH" ARGUMENT USED BY TOBACCO AND
ALCOHOL ADVERTISERS IS A SMOKE SCREEN.
YOU DON'T SEE THESE PEOPLE OUT IN FRONT ON OTHER FIRST

AMENDMENT ISSUES.

298
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FREE SPEECH HAS NEVER BEEN AN UNLIMITED RIGHT:

WE ALL KNOW YOU CAN'T YELL "FIRE" IN A CROWDED THEATRE.

THE FIRST AMENDMENT WAS NOT INTENDED TO ALLOW LIES TO
BE FOISTED ON THE PUBLIC.

MOST CIGARETTE AND ALCOHOL ADVERTISING IS LIES.

IT ASSOCIATES WITH ROMANCE, GLAMOUR, ATHLETICS, SUCCESS

SUBSTANCES WHICH INSTEAD LEAD TO DISABILITY AND DEATH.

299
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FIRST AMENDMENT PROTECTION IS NOT EXTENDED TO SPEECH
ENCOURAGING ILLEGAL ACTIVITY.
TOBACCO AND ALCOHOL ADVERTISERS DEPEND UPON REACHING
YOUNG PEOPLE.
MOST OF THOSE WHO SMOKE OR DRINK, BEGAN BEFORE THEY
WERE TWENTY, OR EVEN 15.
IN OTHER WORDS, THE CONTINUED STRENGTH OF THE TOBACCO
AND ALCOHOL MARKET DEPENDS ON THOSE TO WHOM THE

PRODUCTS CANNOT BE LEGALLY SOLD.

300
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THEREFORE, RESTRICTIONS ON TOBACCO AND ALCOHOL
ADVERTISING MEET THE CONSTITUTIONAL TEST IN AT LEAST

TWO WAYS:

1. IT IS APPROPRIATE TO BAN COMMERCIAL SPEECH THAT IS

MISLEADING OR FRAUDULENT.

AND

2. IT IS APPROPRIATE TO BAN COMMERCIAL SPEECH

RELATED TO ILLEGAL ACTIVITY.

301
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FOR ALL THEIR TALK ABOUT "FREEDOM", TOBACCO AND

ALCOHOL INTERESTS ARE GREAT ENEMIES OF FREEDOM.

FAR FROM BELIEVING IN FREE SPEECH, TOBACCO AND ALCOHOL
ADVERTISERS USE THEIR ECONOMIC CLOUT TO FORCE
PUBLISHERS NOT TO PRINT ARTICLES ABOUT THE REAL
CONSEQUENCES OF SMOKING AND DRINKING.

CIGARETTE AND ALCOHOL ADVERTISING, FAR FROM ALLOWING
FREE CHOICE, ACTUALLY UNDERMINE FREE CHOICE. NICOTINE

ADDICTS AND ALCOHOLICS DO NOT ENJOY FREE CHOICE.

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FINALLY, LET'S BE UP-FRONT ABOUT THE SPECIAL CHALLENGE
FACING TOBACCO ADVERTISERS:
MOST TOBACCO USERS WOULD RATHER NOT SMOKE.
AS MANY AS 90% WISH TO QUIT.
MANY TOUGH IT OUT, BREAK THEIR ADDICTION, AND SUCCEED IN
QUITTING.
THE ADVERTISERS NEED TO REPLENISH THE DIMINISHING

SUPPLY OF TOBACCO USERS.

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AND, --REMEMBER THIS-- 1,000 SMOKERS WILL GIVE UP SMOKING
TODAY.

eases THEIR FUNERALS WILL BE HELD IN THE NEXT THREE DAYS.

ANOTHER 5000 QUIT EACH DAY BECAUSE THEY KNOW BETTER.

SO, JUST TO KEEP RUNNING IN PLACE THE CIGARETTE

COMPANIES MUST HOOK 6000 NEW SMOKERS PER DAY.

304
WE ARE A VIOLENT SOCIETY.

IN 1870 THE UNITED STATES CONGRESS PASSED A LAW CREATING

AN ORGANIZATION TO PREVENT CRUELTY TO ANIMALS.

VERY QUICKLY, EVEN IN RELATIVELY SMALL TOWNS,
ORGANIZATIONS BEGAN TO PROTECT ALL MANNER OF FURRY OR
FEATHERED CREATURES.

IT Is A SAD COMMENTARY ON OUR SOCIETY TO ADMIT THAT IT
TOOK AN ADDITIONAL 100 YEARS TO CREATE OUR FIRST SHELTER

FOR BATTERED WOMEN.

305
VIOLENCE IS NOT ONLY A PROBLEM FOR AMERICAN SOCIETY,
BUT ALSO IT HAS BECOME A PLAGUE, A RAPIDLY EXPANDING

HEALTH PROBLEM.

MY INTEREST IN THIS ISSUE BEGAN IN A CURIOUS WAY.
IN 1984, I WAS ASKED TO ADDRESS A MEETING ON TELEVISION

VIOLENCE.
THE GOVERNMENT HAD BEEN FUNDING RESEARCH IN T.V.

VIOLENCE FOR THE PAST 20 YEARS AND SPEECHES ON THE

SUBJECT BY THE SURGEON GENERAL WERE RATHER ROUTINE ...

306
BUT I BEGAN TO WONDER IF SOMEHOW OUR PREOCCUPATION
WITH T.V. VIOLENCE MIGHT ACTUALLY BE PREVENTING US FROM
SEEING THE LARGER AND MUCH MORE SERIOUS PROBLEM OF

REAL VIOLENCE IN OUR SOCIETY.

EVEN A QUICK GLANCE AT THE PROBLEM REVEALED ITS

STAGGERING DIMENSIONS.

307
REPORTS FROM AROUND THE NATION INDICATED THAT AS MANY

AS 4 MILLION CHILDREN WERE VICTIMS OF ABUSE AND NEGLECT.

TO OUR SHAME WE HAD HIDDEN THIS NATIONAL TRAGEDY.

MANY OF THOSE YOUNG VICTIMS HAVE BEEN PUNCHED ...

SLAPPED ... THROWN ... AND BEATEN WITH FISTS, CLUBS, AND

OTHER WEAPONS.

ADULTS DO THAT TO CHILDREN.

308
FOR CENTURIES ADULTS HAVE INJURED CHILDREN ... AND HAVE
LIED ABOUT IT ...
AND OTHER ADULTS HAVE HEARD THOSE LIES AND THEN

MERELY TURNED AWAY.

THE STATISTICS FOR WOMEN ARE EQUALLY ALARMING.
ESTIMATES VARY, BUT WE KNOW THAT FROM 1 TO 3 MILLION
WOMEN IN THE UNITED STATES ARE BATTERED AND ASSAULTED
EACH YEAR BY THEIR HUSBANDS OR PARTNERS. MANY ARE

RAPED.

309
THESE WOMEN VICTIMS OF ASSAULT ARE PERMANENTLY

INJURED -- NOT JUST PHYSICALLY BUT ALSO MENTALLY --- WHILE

SOME OF THEM LOSE THEIR LIVES.

BATTERY IS THE SINGLE MOST SIGNIFICANT CAUSE OF INJURY

TO WOMEN IN THIS COUNTRY.

310
ONE IN EVERY FIVE WOMEN SEEN IN HOSPITAL EMERGENCY
ROOMS IS A VICTIM OF PERSONAL INJURY CAUSED BY SPOUSE

ABUSE.

REMEMBER, BEHIND THESE COLD NUMBERS, PERCENTAGES, AND

STATISTICS ARE REAL PEOPLE, OUR NEIGHBORS, OUR FAMILY

MEMBERS, OUR FELLOW CITIZENS.

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311
THE CONSEQUENCES ARE ENORMOUS:

LOSS OF SELF-ESTEEM,

INABILITY TO WORK PRODUCTIVELY AND TO CARE FOR
CHILDREN, PSYCHIATRIC PROBLEMS, ALCOHOL AND DRUG

DEPENDENCE.
STUDIES HAVE SHOWN THAT BATTERED WOMEN ARE FOUR TO
FIVE TIMES MORE LIKELY THAN NON-BATTERED WOMEN TO

REQUIRE PSYCHIATRIC TREATMENT.

V

312
MANY SUFFER FROM ANXIETY, INCREASED LEVELS OF HOSTILITY,
OBSESSIVE-COMPULSIVE SYMPTOMS, AND AGORAPHOBIA - FEAR

OF OPEN SPACES. SOME COMMIT SUICIDE.

MOREOVER, STUDIES HAVE SHOWN THAT WOMEN WHO ARE

ABUSED ARE EIGHT TIMES MORE LIKELY TO ABUSE THEIR

 

CHILDREN THAN WOMEN WHO ARE NOT ABUSED. THESE ABUSED

CHILDREN THEN OFTEN BECOME ABUSERS THEMSELVES.

V

313
WE REALIZE THAT WE DON'T HAVE GOOD STATISTICS IN THIS
DIFFICULT AREA. BUT, IF ANYTHING, THESE NUMBERS ARE MUCH

TOO LOW.

WE ESTIMATE, FOR EXAMPLE, THAT FOR EVERY ADULT VICTIM
OF VIOLENCE COUNTED BY THE POLICE AND THE F.B.1., AS MANY
AS THREE ADDITIONAL ADULT VICTIMS PASS THROUGH
HOSPITAL EMERGENCY ROOMS OR COMMUNITY CLINICS AND

ARE MISSED BY THE POLICE ALTOGETHER.

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314
INTERPERSONAL FAMILY VIOLENCE IS AN OVERWHELMING
MORAL, ECONOMIC, AND PUBLIC HEALTH BURDEN THAT OUR
SOCIETY CAN NO LONGER BEAR. IN THIS COUNTRY, NO MAN HAS
A LICENSE TO BEAT A WOMAN ... AND GET AWAY WITH IT. AND
NO WOMAN IS OBLIGED TO ACCEPT A BEATING ... AND SUFFER

BECAUSE OF IT.

315
I WON'T GO INTO ALL THE DETAILS OF HOW WE FACED THIS
PROBLEM, BUT MUCH HAS BEEN ACCOMPLISHED. NOT ENOUGH.
THERE IS STILL MUCH TO DO.

WE SAY WE ARE A CIVILIZED SOCIETY.

ALL RIGHT, LET'S ACT LIKE ONE.

V

316
WE AMERICANS CAN GET SLIGHTLY ZANY ABOUT FOOD --
LIKE DURING THE APPLE SCARE OF '89: SCHOOLS BANNED

"APPLES FOR THE TEACHERS'--AND FOR THE STUDENTS,

HOUSEWIVES PITCHED OUT JARS OF APPLESAUCE,

AND THEN THERE WAS THAT FRANTIC MOTHER IN UPSTATE NEW
YORK

WHO INSISTED THAT THE STATE POLICE INTERCEPT HER
DAUGHTER'S SCHOOL BUS, BECAUSE SHE HAD PACKED AN APPLE
IN THE LITTLE GIRL'S LUNCH BOX BEFORE HEARING NEWS

REPORTS ABOUT ALAR.

317
SOME PEOPLE THINK THAT ALL MAN-MADE SUBSTANCES SHOULD
BE REMOVED FROM OUR FOOD SUPPLY, AND THAT EVERYTHING
OCCURRING IN NATURE IN BENEFICIAL. THEY INSIST ON
BANNING ALL PESTICIDES. FORTUNATELY THE LARGE CHAIN
STORES HAVE NOT JUMPED ON THIS BANDWAGON, ALTHOUGH
SOME SMALL STORES HAVE PLEDGED TO SELL NOTHING EXCEPT
FOODS UNTREATED BY PESTICIDES. NOT ONLY WILL THIS LEAVE
THEM WITH ROTTEN FOOD, BUT ALSO THEY WILL FAIL TO

PROTECT THE CONSUMER AGAINST MOLD SUCH AS APHATOXIN

(??) WHICH IS LETHAL, AND OCCURS, FOR EXAMPLE, ON CORN.

318
PEOPLE WHO ARE SO WORRIED ABOUT PESTICIDES FAIL TO
REALIZE THAT THE CANCER RATES HAVE DROPPED OVER THE
LAST 40 YEARS: STOMACH CANCER HAS DROPPED MORE THAN
75%, WHILE RECTAL CANCER DROPPED MORE THAN 65%.

THE ONLY CANCER RATE THAT IS GOING UP IS AN
ENVIRONMENTAL CANCER, CIGARETTE- INDUCED LUNG CANCER.
MUCH OF THE PUBLIC CONCERN ABOUT CARCINOGENS IN

PESTICIDES IS MISPLACED.

319
THE CHAIRMAN OF THE DEPARTMENT OF BIOCHEMISTRY AT
BERKELEY, AND AUTHOR OF IMPORTANT ADVANCES IN
ONCOLOGY BELIEVES THAT THE FDA IS CORRECT IN SAYING
THAT AVERAGE AMERICAN CONSUMES 45 MICROGRAMS OF
POSSIBLE CARCINOGENIC MAN-MADE PESTICIDE RESIDUES
EVERY DAY. BUT HE POINTS OUT THAT THERE ARE 500
MICROGRAMS OF NATURALLY OCCURRING CARCINOGENS IN 1
CUP OF COFFEE, 185 MICROGRAMS OF NATURAL CARCINOGENS IN
A SLICE OF BREAD, 2000 MICROGRAMS OF NATURE'S

CARCINOGENS IN COCA-COLA.

320
UNTIL RECENTLY, AMERICANS THOUGHT ABOUT FOOD IN TERMS
OF TASTE AND COST.

NOW THEIR CHIEF CONCERNS ARE HEALTH AND SAFETY.

AMERICANS ENJOY THE SAFEST FOOD SUPPLY IN THE WORLD,
BUT IT TAKES ONLY AN ISOLATED INCIDENT OR RUMOR TO MAKE
THIS NATION PANIC ABOUT THE SAFETY OF OUR ENTIRE FOOD

SUPPLY.

321
THE AMERICAN PEOPLE WANT ASSURANCE THAT EVERYTHING

THEY EAT IS "SAFE".
THE QUESTION ABOUT THE FOOD SUPPLY IS NOT "IS IT SAFE?"

--FEW THINGS IN LIFE CAN BE GUARANTEED "SAFE' --

BUT "IS IT SAFE ENOUGH?"

322
IN THE FOOD SUPPLY --AS IN ALL OTHER PUBLIC HEALTH
QUESTIONS-- WE NEED BETTER UNDERSTANDING OF RISK AND

HAZARD --AND THE DIFFERENCE BETWEEN RISK AND HAZARD.

THERE IS RISK IN ALMOST EVERYTHING WE DO,

SO WE NEED TO CONCENTRATE ON THE DIFFERENCE BETWEEN

EXPOSURE TO A HAZARD AND TRUE RISK.

323
SOME INSIST THAT NO AMOUNT OF CHEMICALS OR PESTICIDE
RESIDUE IN FOOD IS ACCEPTABLE. PUBLIC HEALTH OFFICIALS,
HOWEVER, OPERATE ON THE PRINCIPLE THAT MERE EXPOSURE

TO A SUBSTANCE DOES NOT NECESSARILY CREATE A HAZARD.

IT IS THE COMBINATION OF TOXICITY AND EXPOSURE THAT
CREATES THE RISK. WE STILL HAVE A LONG WAY TO GO IN
EDUCATING THE AMERICAN PEOPLE ABOUT THIS DIFFERENCE

BETWEEN EXPOSURE AND RISK.

324
ONE OF OUR PROBLEMS IN STRIKING THE RIGHT BALANCE
BETWEEN MANAGING RISK AND MANAGING FEAR IS NOT A
SCIENTIFIC OR HEALTH PROBLEM, BUT A LEGISLATIVE ONE:
A WELL-INTENDED MEASURE --THE DELANEY CLAUSE-- WITH

UNFORESEEN NEGATIVE CONSEQUENCES.

325
WHEN CONCERN FIRST SURFACED ABOUT THE PRESENCE OF
CARCINOGENS IN FOODS AND DRUGS, CONGRESS PASSED THE
DELANEY CLAUSE TO PROTECT THE AMERICAN PEOPLE FROM
UNKNOWN DANGERS.

JUST TO BE ON THE SAFE SIDE, THE LAW STIPULATED THAT IF
ANY SUBSTANCE CAUSED ANY CANCER IN ANY ANIMAL, IT WOULD

BE BANNED FOR HUMAN CONSUMPTION.

326
THE LAW DID NOT BOTHER TO DISTINGUISH THE SIZE OF THE
DOSE, THE TOXICITY OF THE SUBSTANCE, THE FORM OF CANCER,
THE KIND OF ANIMAL, ETC.

SINCE THEN, THE RESEARCH COMMUNITY HAS BECOME MORE
SOPHISTICATED, DETERMINING THAT SOME CARCINOGENS IN
ANIMALS DO NOT HAVE THAT EFFECT IN HUMANS.

ALSO, SOME CARCINOGENS PEOPLE WOULD LIKE TO BAN IN

ADDITIVES ARE FOUND NATURALLY IN FOODS.

327
FURTHER STUDIES HAVE INDICATED THAT THE DAMAGE DONE TO
CELLS IN SOME ANIMALS IN SOME TESTS IS DUE, NOT TO
CARCINOGENIC SUBSTANCE, BUT TO THE SHEER TOXICITY OF
THE SIZE OF THE DOSE.

GIVING A LABORATORY RAT A DOSE THE EQUIVALENT TO MY
DRINKING A BATHTUB FULL OF THE SAME SUBSTANCE HAS BEEN

QUESTIONED AS A VALID SCIENTIFIC EXPERIMENT.

I THINK THE DELANEY CLAUSE NEEDS TO BE AMENDED TO

REFLECT CURRENT SCIENCE.

328
A NUMBER OF RECENT SCARES SHOWED US HOW QUICKLY

CONCERN TURNS TO PANIC.

AS A PUBLIC HEALTH OFFICIAL, I APPLAUD THE AMERICAN
CONCERN FOR A HEALTHFUL DIET. SUSTAINED PUBLIC INTEREST
IN DIET AND HEALTH IS BOUND TO MAKE A DIFFERENCE,
BECAUSE DIET IS FUNDAMENTAL TO THE HEALTH OF THE

AMERICAN PEOPLE.

329
INDEED, THE AMERICAN COUNCIL ON SCIENCE AND HEALTH
INDICATSS THAT TWO-THIRDS OF ALL DEATHS IN AMERICA ARE

DIRECTLY OR INDIRECTLY RELATED TO DIET.
BUT PUBLIC HEALTH OFFICIALS BECOME FRUSTRATED WHEN

CONCER!! ABOUT DIET LEADS TO CONFUSION ABOUT THE SAFETY

OF THE *OOD SUPPLY.

330
SOMETIMES BEING TOO CONCERNED ABOUT DIET CAN BE
COUNTE?.-PRODUCTIVE.

WORRYING ABOUT TRACES OF CHEMICALS IN A FEW FOODS MAY
BE KEEPING MANY AMERICANS FROM EATING THE WELL-

ROUNDED AND NUTRITIONAL DIETS THEY NEED.

331
WHILE WE ARE TALKING ABOUT FOOD, A FEW WORDS ABOUT THE

CHOLESTEROL ISSUE.

THE CHOLESTEROL BALLOON HAS BEEN PRICKED AND IS
DEFLATING.
LET'S BE VERY CLEAR ABOUT CHOLESTEROL.

IT IS A RISK FACTOR FOR CORONARY HEART DISEASE.

332
IT IS HOWEVER, ONLY ONE OF SEVERAL RISK FACTORS, AND
MOST SCIENTISTS THINK THE OTHERS, SUCH AS SMOKING AND
HIGH BLOOD PRESSURE ARE MORE IMPORTANT AND EASIER TO
CONTROL. BECAUSE CHOLESTEROL IS MANUFACTURED IN THE
BODY NATURALLY, DIET DOES NOT HAVE THE DIRECT
RELATIC?OiP TO BLOOD LEVELS THAT MANY MISLED LAYMEN

ASSUME.

333
THEN TOO, THE STATED RELATIONSHIP BETWEEN CORONARY
HEART DISEASE AND CHOLESTEROL BLOOD LEVELS FALLS OFF
FOR WOMEN WHEN THEY GET OVER 55 AND MEN WHEN THEY
GET OVER 60. HEREDITY IS A PROMINENT FACTOR. IN SUMMARY
IT SEEMS THAT ADVICE CONCERNING CHOLESTEROL DIET IN
RELATIC iC P TO CORONARY HEART DISEASE HAS BEEN GIVEN
TO MOR: PiiOPLE THAN THOSE TO WHOM THE INFORMATION IS
PERTINENT. A SEGMENT OF THE POPULATION MAY HAVE BEEN
MISLED INTO THINKING DIETARY CHANGES CAN ACCOMPLISH

MORE THAN LS POSSIBLE.

334
THE NUM®ERS ARE INTERESTING. WHILE MANY STUDIES SHOW
THAT THERE IS A REDUCTION IN THE NUMBER OF HEART
ATTACKS ASSOCIATED WITH THE LOWERING OF CHOLESTEROL,
THERE 15 NO EVIDENCE THAT THERE IS AN ACCOMPANYING
REDUCT:ON IN THE DEATH RATE FROM CORONARY HEART
DISEASE. SO, ALTHOUGH THE QUALITY OF LIFE MIGHT BE
IMPROY "2, HE DEATH RATE IS STILL THE SAME.

THERE 15 1:0 DOUBT THAT SOME HAVE BENEFITTED FROM THE
CHOLESTEROL HEALTH INITIATIVE, BUT GREATER NUMBERS

HAVE PEM FREATED THAN NECESSARY OR PRUDENT.

335
(A FEW FACTS ON CHOLESTEROL:)

IF YOU'RE OVER 50 AND A FEMALE; OR OVER 60 AND A MALE, AND
YOUR ©" OLESTEROL 1S 200 MILLIGRAMS OR LESS, CHECK WITH
YOUR DOCTOR IN 5 YEARS, AND EAT A NORMAL DIET. IF YOUR
CHOLESTEROL IS BETWEEN 200 AND 240, IF OTHER RISK FACTORS
ARE NOT un DER CONTROL, THEN YOU SHOULD CONTROL THEM,
AND Pio..t.’5 REDUCE YOUR CHOLESTEROL. IF YOU HAVE MORE
THAN 240 CiiOLESTEROL, THEN YOU OUGHT TO TALK TO YOUR
DOCTC® “OUT TAKING YOU TOTALLY IN HAND, AND ALTHOUGH
HE MAY PU YOU ON A LOWERED CHOLESTEROL DIET, HE
SHOUL:. | ‘ot DO SO WITHOUT CUTTING DOWN ON OTHER RISK
FACTO®®. 2S §S CRAZY TO GO ON A LOW CHOLESTEROL DIET

AND C...00.:.JUiE TO SMOKE,

336
INT

(some of this material same as in smoking part of speech)

NOW, Po LIE TO TAKE A FEW MINUTES TO TALK ABOUT

INTERNA! ONAL HEALTH,

FOR MOST CF MY SURGICAL CAREER, I WAS INVOLVED IN
INTER iA.) GHAL HEALTH WORK. BUT IT WAS ONLY DURING MY
TENUS& 3) SURGEON GENERAL OF THE U.S. PUBLIC HEALTH
SERVICE, THAT I HAD THE OPPORTUNITY TO WORK CLOSELY

WITH 7) LiiADERSHIP AND STAFF OF THE WORLD HEALTH

aw,

ORGAR SON,

337
int
THE EXP eS ENCE HAS REINFORCED MANY TIMES OVER MY
BELIEF 721.5
W.H.O. 18 NOT ONLY AN AGENCY WHOSE EXISTENCE IS ESSENTIAL
TO WORLD HEALTH, BUT IS ALSO AN ORGANIZATION WHOSE
ACCOM. LOSI MENTS OVER THE PAST 40 YEARS HAVE EVEN
EXCEED > "SHE GREAT HOPES THAT ATTENDED ITS BIRTH.
AND If 2240 B2EN DRIVEN BY A POWERFUL CONCEPT ... "THAT
HEALT?:. SOCD OR ILL, COULD NEVER AGAIN BE PURELY A

NATIOM+. 2. 2 ENOMENON."

338
int
THE HEALTH STATUS OF ALL THE PEOPLE OF THE WORLD --
WHETE! WS Y LIVE IN DEVELOPED OR DEVELOPING
COUNT? 05 -- AFFECTS ALL OTHERS. IT WAS THEREFORE IN THE
INTEREST CF ALL NATIONS TO WORK TOGETHER TO ADDRESS

THE TC?T*.iTY OF WORLD HEALTH PROBLEMS.

339
int:
AS WE LOOK AT OUR WORLD TODAY, WE SEE THAT ENORMOUS
PROGRESS NAS BEEN MADE IN THE FOUR DECADES DURING
WHICH *"07.0, EVOLVED FROM A TECHNICAL ASSISTANCE
AGENCY, PRIMARILY CONCERNED WITH COMMUNICABLE
DISEASES CONTROL, TO A PARTNER OF ALL NATIONS IN THE

SUPPC™ © MATIONAL GOALS FOR HEALTH FOR ALL.

340
int
O WE 'S IMPROVED OUR HEALTH CARE SYSTEMS AND
M.A" S MALTH SERVICES AVAILABLE TO A DEGREE

UNV NO VWN 40 YEARS AGO.

O TODAY, THANKS TO A VERY ACTIVE AND SUCCESSFUL W.H.O. |
EXPAN... 00° | SOGRAM ON IMMUNIZATION, THERE IS EXCELLENT .
VACCIM #0. Gi COVERAGE AGAINST POLIOMYELITIS, DIPHTHERIA,

TETANUS, WHOOPING COUGH, MEASLES, AND TUBERCULOSIS.

341
int
AS WE LOO AT OUR WORLD TODAY, WE SEE THAT ENORMOUS
PROGRESS =IAS BEEN MADE IN THE FOUR DECADES DURING
WHICH! "01,0, EVOLVED FROM A TECHNICAL ASSISTANCE
| AGENCY, PPIMARILY CONCERNED WITH COMMUNICABLE
DISEASES CONTROL, TO A PARTNER OF ALL NATIONS IN THE

SUPPC'. © NATIONAL GOALS FOR HEALTH FOR ALL.

340
int
AND, AT THE REQUEST OF MEMBER NATIONS, W.H.O. HAS NOW
LAUNCHED A SPECIAL EFFORT TO ELIMINATE POLIO
EVERYWHERE. POLIO MAY WELL BECOME THE SECOND DISEASE
TO BE ERADICATED THROUGH THE EFFORTS OF MANKIND,

FOLLOWING SMALLPOX ON THE ROAD TO EXTINCTION.

ORAL REHYDRATION THERAPY IS WELL ON ITS WAY TO
BECOMING ANOTHER SUCCESS STORY. IT IS BECOMING SO
EFFECTIVE THAT THE LIVES OF COUNTLESS INFANTS AND
CHILDREN ARE BEING SPARED. THE THERAPY, OF COURSE, IS
BASED ON A SIMPLE SOLUTION OF WATER, SUGAR, AND SALTS ...

A FORMULA DEVISED BY W.H.O. SCIENTISTS.

343
int
THE WORK ON MALARIA ALSO CONTINUES TO HOLD PROMISE
THAT THIS DISEASE, TOO, WILL ONE DAY BE CONQUERED. FROM
ITS CREATION, W.H.O. HAS TARGETED THIS DISEASE. AND
DESPITE THE DIFFICULTIES OF MALARIA CONTROL, WE CAN

REMAIN OPTIMISTIC ABOUT THE FUTURE.

THESE SUCCESS STORIES ARE IMPRESSIVE. BUT IF ANYTHING,
THEY SHOULD SERVE AS A STIMULUS TO US TO DO BETTER.

THEY MUST NOT BE AN EXCUSE FOR COMPLACENCY.

344
int
WE KNOW ALL TOO WELL THAT VICTORY OVER DISEASE IS OFTEN
COUNTER-BALANCED BY THE APPEARANCE OF NEW THREATS AND

NEW DISEASES.

WE ARE NOW EXPERIENCING THIS WITH AIDS AS A WORLDWIDE

EPIDEMIC.

WORLDWIDE, 8 TO 10 MILLION PEOPLE ARE ALREADY INFECTED
WITH AIDS, CONSISTENT WITH THE GRIM PREDICTION MADE BY
W.H.O. THAT BY THE YEAR 2000, 25 TO 20 MILLION PEOPLE WOULD
BE INFECTED BY THE HIV VIRUS. IN SOME PLACES --SUB-

SAHARAN AFRICA, ASIA, AND LATIN AMERICA-- THE EPIDEMIC IS

SPREADING EVEN MORE RAPIDLY THAN FORECAST, REFLECTING

THE CONTINUING INCREASES IN HETEROSEXUAL TRANSMISSION.

345
int

AIDS THREATENS EVERY NATION AND PRESENTS AN

UNPRECEDENTED CHALLENGE TO INTERNATIONAL PUBLIC

HEALTH. EACH COUNTRY AFFECTED THAT CONFRONTS THIS NEW

HEALTH PROBLEM MAY DISCOVER IT MAY NEED TO RESPOND

WITH RESOURCES OF SO GREAT A MAGNITUDE THAT IT CAN

DEVASTATE THE VERY HEALTH SYSTEM IT IS TRYING TO

STRENGTHEN.

346
int
IN DEVELOPING NATIONS, AIDS TENDS TO IMPACT MOST OFTEN
ON THE MOST PRODUCTIVE MEMBERS OF SOCIETY: THE
BREADWINNERS IN THE PRIME OF THEIR LIVES HENCE,
DEVELOPING NATIONS HIT BY AIDS COULD LOSE AN
IRREPLACEABLE GENERATION OF ENGINEERS, HEALTH
WORKERS, TEACHERS, AND GOVERNMENT OFFICIALS, AS WELL AS

WORKERS IN AGRICULTURE, INDUSTRY, AND TRADE.

AIDS HAS THE POTENTIAL TO DEVASTATE A DEVELOPING

COUNTRY'S PLANS FOR DEVELOPMENT.

347
int
A TOP PRIORITY FOR W.H.O. AND THE NATIONS OF THE WORLD IS

TO MAKE THE WORLD'S BLOOD SUPPLY SAFE FOR TRANSFUSION.

THE GLOBAL FIGHT AGAINST AIDS WILL TAKE MANY YEARS, AND
IT WILL REQUIRE POLITICAL AND HEALTH LEADERS ALIKE TO
HAVE THE STRENGTH OF COMMITMENT NECESSARY TO MAKE
DIFFICULT DECISIONS, TO STAND FIRM AGAINST UNREASONABLE
FEAR, AND TO MAINTAIN THE CONSISTENCY AND UNITY OF
ACTION THAT ARE ABSOLUTELY VITAL FOR A GLOBAL FIGHT

AGAINST THIS GLOBAL THREAT.

348
int
LIKE AIDS, THE HEALTH CONSEQUENCES OF SMOKING HAVE
BECOME AN INTERNATIONAL PROBLEM. AND, I'M SORRY TO
ADMIT, THE UNITED STATES HAS PLAYED A SINISTER ROLE IN

THIS TRAGEDY.

THE FACT OF THE MATTER IS THAT THE CIGARETTE COMPANIES -
- AMERICAN COMPANIES AND THEIR EUROPEAN COUNTERPARTS -
- ARE EXPLOITING THE UNPROTECTED MARKETS OF THE THIRD
WORLD: ASIA, SOUTHEAST ASIA, AFRICA, AND CENTRAL AND

SOUTH AMERICA.

349
int
AND THEY ARE VERY EFFECTIVE, I MIGHT ADD. THEY HAVE
INUNDATED THOSE UNDEVELOPED AND DEVELOPING COUNTRIES
WITH CIGARETTE ADVERTISING AND PROMOTION TO SUCH AN
EXTENT THAT CIGARETTE CONSUMPTION IN THOSE COUNTRIES

IS ON THE RISE.

AND ALSO ON THE RISE ARE THE MORBIDITY AND MORTALITY
RATES FOR SUCH SMOKING-RELATED DISEASES AS STROKE,
HEART DISEASE, AND CANCERS OF THE LUNG, MOUTH,

ESOPHAGUS, AND STOMACH.

350
int
AND I MUST ADD THAT THIS EXPORT OF DEATH AND DISEASE HAS
BEEN CARRIED OUT WITH THE SUPPORT OF THE UNITED STATES
GOVERNMENT -- OUR TRADE REPRESENTATIVES, OUR STATE
DEPARTMENT, OUR COMMERCE DEPARTMENT, AND OUR
AGRICULTURE DEPARTMENT.

IT'S NOT A VERY PRETTY STORY. BUT THERE IT IS.

351
int
THE ALARMING THING ABOUT THIS HABIT IS THAT, WHEN IT
INVADES A NEW MARKET, IT DOES SO WITH IMMENSE SPEED AND
IMPACT. ACCORDING TO THE WORLD HEALTH ORGANIZATION,
BETWEEN 1971 AND 1981 CIGARETTE CONSUMPTION INCREASED
IN ASIA AND LATIN AMERICA AT A RATE 30 PERCENT AHEAD OF
THE RATE OF POPULATION INCREASE ... IN AFRICA, IT ROSE 77

PERCENT AHEAD OF THE RISE IN POPULATION.

352
int
BUT THOSE AMERICAN CIGARETTES ARE A LITTLE DIFFERENT
OVERSEAS: FOR ONE THING, THEY DON'T CARRY THE SURGEON
GENERAL'S WARNING. AND FOR ANOTHER, MANY AMERICAN

CIGARETTES MANUFACTURED FOR EXPORT HAVE A HIGHER TAR

 

CONTENT AND ARE, THEREFORE, EVEN MORE DANGEROUS THAN
THE LOWER-TAR, FULLY-LABELLED PRODUCTS SOLD HERE IN

THE UNITED STATES.

353
int
NOW, LET ME MAKE SURE YOU UNDERSTAND WHAT I JUST SAID.
I SAID THAT SOME AMERICAN CIGARETTE MANUFACTURERS -- AS
KNOWLEDGEABLE AS I AM, CONCERNING THE HEALTH RISKS OF
SMOKING -- KNOWINGLY PRODUCE A MORE HARMFUL
CIGARETTE FOR EXPORT THAN THEY PRODUCE FOR DOMESTIC

CONSUMPTION.

354
int
JUST A LITTLE MORE THAN A YEAR AGO, 15 ASIAN 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.

355
int
IN OTHER WORDS, THE TOBACCO EPIDEMIC AND ITS LETHAL
CONSEQUENCES HAVE HIT ASIA ... AND -- THANKS TO OUR OWN
CIGARETTE INDUSTRY AND THAT OF THE UNITED KINGDOM--

HAVE HIT ASIA HARD.

356
int
I DO NOT BELIEVE THE UNITED STATES WILL EVER AGAIN BE A
GOOD MARKET FOR TOBACCO PRODUCTS. THE CURVE IS GOING
DOWN AND ACCELERATING. AND I FEEL QUITE GOOD ABOUT THE
ROLE I BELIEVE I PLAYED IN BRINGING ABOUT THIS MARKET

CHANGE.

I THINK THAT WE HAVE BEATEN THE CIGARETTE INDUSTRY ON

ITS OWN HOME TURF ... BUT WE'VE DRIVEN THEM TO SCOUR THE

REST OF THE EARTH FOR NEW VICTIMS.

357
int
IT IS A TERRIBLE BURDEN FOR THE CONSCIENCE OF THE UNITED
STATES. BUT WE WILL HAVE TO BEAR IT UNTIL WE FIND A WAY
TO END, ONCE AND FOR ALL, THE PUBLIC HEALTH HAVOC

CREATED BY TOBACCO EVERYWHERE IN THE WORLD.

MY ONE REGRET IS THAT I LEFT OFFICE JUST AS THE FIGHT IS
BEGINNING TO RID THE REST OF THE WORLD OF THE SCOURGE
OF TOBACCO AS WELL. IT'S A SHAME, BECAUSE I REALLY FEEL

UP TOIT.

358
int
OUR EFFORTS TO HELP THE ENTIRE WORLD ABOUT THE THREATS
POSED BY AIDS AND SMOKING DEPEND ONLY ON EDUCATION

AND PREVENTION.

THAT'S THE NEW --AND OLD-- HEALTH MESSAGE OF THE 1990S.

359
FORTUNATELY SOME OF US OLDER FOLKS MUST HAVE GOOD
GENES, BECAUSE WE'VE LIVED SO MANY YEARS BEFORE THESE
HELPFUL HEALTH WARNINGS. WE'VE EATEN FAR TOO MUCH
LARD, NEVER JOGGED UNLESS WE WERE LATE FOR A TRAIN,
THOUGHT FIBER WAS PART OF CLOTHING NOT DIET, AND WE'VE
MADE IT TO OLD-AGE. OF COURSE, IF WE'D KNOWN WE'D LIVE

SO LONG, WE'D HAVE TAKEN BETTER CARE OF OURSELVES.

361
I'VE DECIDED THAT BIRTHDAYS ARE GOOD FOR YOU.

THE PEOPLE WHO HAVE THE MOST OF THEM LIVE LONGEST.

362
[COUPLE WHO WENT TO HEAVEN......... OAT BRAN]

363
EXTRA NOTES:

dont be fooled by the statistics war. When you read that, say, the
japanese are healthier than we are because only 7.5% Of the
japanese population is hospitalized each year, compared to 14.7% Of
the us population, remember that the reason for that is the
unavailability of hospital beds in japan, where the average stay is 52

days, vs. 6.6 Days in us
ERRAKKKEREKEERRRERRREERKEEE

humana's budget for artificial heart equal to what society spent on
eradicating small pox

numbers of doctors and lawyers. We have 2/3 or worlds lawyers.
40% Of americanrhodes scholars become lawyers. Japan trains 1,000
engineers for every 100 lawyers. We train 1000 lawyers for every 100
engineers.

By 2000, there may be 145,000 excess physicians. These will add
costs to the medical practice, by $300,000 per doctor per yr.

There has to be a limit on these two cancerous professions.
KREKRERERKRERRRERRERERREERE

Family
need to strengthen family in order to meet health needs of children

[from sullivan speech]:

of the more than 3.5 Million children who enter our schools each
year, 14 percent are children of unmarried parents; 40 percent will
live in a home torn by divorce before they reach 18; between 25 and
35 percent are "latchkey” children, with no one to greet them when
they come home from school.

Breakup of american family has severe health consequences seen in
alcohol abuse, illegal drugs, teenage pregnancy, hiv infection, low
birth weight,

family structure is biggest difference between black middle class and
black underclass.

We need to buttress family,
deter teenage sexual activity and teenage pregnancy

364
attack poverty, to break vicious circle of poverty, family breakdown,

more poverty
KKEKKEREKEKEKERERREKREKEEK

future hospitals must be efficient hubs of care for people brought in
over great distances (but, cek: patient transport by ‘copter costs
$35,000 +}

REKREEKERERERERERERERIKE

limits to healthcare are not like other limits; no one talks about
running out or healthcare like environmentalists warn about running
out of oil.

REKKEKEEREKERERERRKKRE

Tobacco price supports: refer to absurdity of many farm programs,
born in a different age, now perpetuated without reason, offering
price supports that benefit mainly the big farms and agribusiness, not
the mythic small farm. And the un-supported commodities somehow
make it to market, and the farmers who grow them make a living as
well as those who milk the public for price supports.

BRREKERERERREREREREERERERERERKE

_ Limits-to-medicine people may have given up before the battle has
started. Many cost-cutting techniques not tried yet. There's a lot of
untapped wealth in this, the richest country in the world.

Is 11% of gnp(where we are now) the limit? Or 12% ? If we were
spending 8%, would 9% be the limit? We are not near the limit.
KREKKKEREREKREEREKRERE

Although, barring economic recession, foreign policy crises or war,
healthcare costs will form the basic issue of the 1990s, health is not
the only expense facing us. American industry, the american
industrial and transportation infrastructure is living on borrowed time,
and also clamors for funds. Meanwhile, the reshaping of our age
demography into an hourglass means more young and old

dependents, and fewer working americans to foot the bill.
KKEREKRRRRKREREKEEKREREREEEE

Roper poll of fortune 500 execs
95% against national health service,

instead, wanted better application of free-market
AREKKEKKEKKEKEKRE KK

365
foreign health services like gb, canada, w. Germany grew in accord
with societies that had a much stronger tradition of government social
leadership, greater traditional deference to society rather than to
individual. Temperamentally and culturally not suited to usa.
KRRERRERKRERREERKKRRKEKE

Should age be a factor in determing allocation of health care?

(Now elderly consume far more medical resources than children)

KREKKERKEEKKEE

technology

chronic conditions cause 87% or all deaths.
Technology keeps people alive, but a family going through the death
of a loved one can look at medical treatment as the enemy

we should not spend our money on things like artificial hearts. We
need to spend it to treat heart disease. We would never have
conquered polio by spending money on artificial lungs.

KEEKKRKEKKRKKKRKKRRE
Research

budget cuts are curtailing federal support for bio-d=medical research,
and only fed. Govt can afford research. But the paydff for govt is
highest. As percentage of fed. Expenditures for healthcare, support
for research has continued to decline for two decades.

Nih: approved but funded nih grants went from 61% in 1975 to 25% In
1990. Low federal salaries drive away scientists from nih.

In last 2 years dod r&d has spent more taxpayer money than nih has
spent in its entire history.

Nih senior scientists are paid 50% of what they might make in private
sector in universities or industry. 28% Fewer senior researchers than
a decade ago. Rep. Conte, (ma r) says that soon nih will mean
*nobody is here.”

Nih research spending: cancer, $1.45 Billion; hiv $1.3 Billion; heart
disease $1 billion; diabetes $.30 Billion; strokes/hypertension $.20
Billion

366