ORIGINAL
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ADDRESS.

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

PRESENTED BEFORE THE INTERNATIONAL PLATFORM ASSOCIATION
WASHINGTON, D.C,
Aucust 3, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC. )

THANK YOU VERY MUCH FOR THIS HONOR,

DR, GEORGE CRILE HAS ALWAYS BEEN TO ME ONE OF THOSE MAGIC NAMES
OF MEDICINE, SO THIS HONOR HAS SPECIAL SIGNIFICANCE FOR ME. HE WAS AN
INFLUENTIAL CONTEMPORARY OF MY MENTORS IN SURGERY. I KNOW THAT MANY
OF THE PRECEPTS DEVELOPED AND HELD BY DR. CRILE WERE HANDED DOWN TO ME
DURING MY FORMATIVE YEARS AS A SURGEON.

I WOULD LIKE TO THINK THAT THE MEMBERS OF THE AWARD JURY, IN THE
COURSE OF THEIR DELIBERATIONS, DID NOT PAY AS MUCH ATTENTION TO ME
PERSONALLY AS THEY PAID TO THE ISSUE OF AIDS ITSELF AND TO ITS
SIGNIFICANCE FOR THE HEALTH AND WELL-BEING OF ALL OUR CITIZENS,

FOR OVER A YEAR, NOW -- EVER SINCE PRESIDENT REAGAN ASKED ME TO
DO SO -- I'VE BEEN GIVING THE AMERICAN PEOPLE THE FACTS ABOUT AIDS.
AND THE FACTS ARE NOT VERY NICE, THE AIDS VIRUS IS STILL
RELATIVELY MYSTERIOUS. WERE STILL FINDING OUT THINGS ABOUT IT. AND
THEREFORE, WE HAVE NO VACCINE YET TO PREVENT AIDS FROM SPREADING,

BUT WE DO KNOW A FEW THINGS WITH RELATIVE CERTAINTY. WE KNOW
THAT AIDS IS VIRTUALLY FATAL: 91 PERCENT OF THE PEOPLE WHO WERE
DIAGNOSED AS HAVING AIDS BACK IN 1981,,.HAVE SINCE DIED OF THE
DISEASE, NINETY-ONE PERCENT.

THERE ARE VERY FEW CONTAGIOUS DISEASES THAT HAVE THAT KIND OF
MORTALITY RATE. IN FACT, ANYTHING WITH THAT KIND OF KILLING POWER
MUST BE TREATED WITH GREAT CIRCUMSPECTION,
WE ALSO KNOW WHERE TO LOOK FOR THIS DISEASE. THE AIDS VIRUS
FEEDS ON -- AND DESTROYS -- THOSE SPECIAL WHITE BLOOD CELLS THAT ARE
AT THE HEART OF OUR IMMUNE SYSTEM, HENCE, THE VIRUS GOES RIGHT FOR
THOSE CELLS...AND YOU FIND THEM IN HIGH CONCENTRATIONS IN TWO BODY
FLUIDS: BLOOD AND SEMEN,

SINCE 1985, WE'VE HAD A VERY GOOD BLOOD TEST TO DETECT THE
PRESENCE OF ANTIBODIES TO THE VIRUS AND, THEREFORE, THE PRESENCE OF
THE AIDS VIRUS ITSELF.

IT’S A LITTLE LIKE THOSE OLD DETECTIVE MOVIES, WHERE THE HERO
KNEW THE VILLAIN WAS JUST AROUND THE CORNER,..BECAUSE HE SAW HIS
SHADOW.
THE BLOOD TEST DOESN'T REVEAL THE VIRUS ITSELF, BUT WE SEE ITS
UNMISTAKABLE SHADOW,

AND WITH THAT KNOWLEDGE WE KNOW HOW THIS VIRUS IS SPREAD. IT IS
SPREAD WHEN THE AIDS-INFECTED BLOOD AND/OR SEMEN FROM ONE PERSON IS
PASSED ON TO ANOTHER PERSON,

THAT RARELY HAPPENS BY ACCIDENT, SO LET’S BE CLEAR ON THIS
IMPORTANT PIECE OF INFORMATION:

YOU TRANSMIT -- OR CATCH -- AIDS ONLY IF YOU DO SOMETHING THAT
INVOLVES PASSING AIDS-INFECTED BLOOD AND/OR SEMEN BETWEEN YOU AND
YOUR PARTNER,
ANYTHING ELSE YOU’VE HEARD IS EITHER GUESS-WORK OR HYSTERIA,

AS THE PHILOSOPHER WILLIAM JAMES ONCE SAID...

"THERE IS NO WORSE LIE THAN A TRUTH MISUNDERSTOOD BY THOSE WHO
HEAR IT.”

LET’S HAVE NO SUCH LIES AND NO SUCH MISUNDERSTANDINGS ABOUT THE
DISEASE OF AIDS, LET’S IMPLANT THE TRUTH OF THE MATTER FIRMLY IN OUR
MINDS,
YOU CAN SHARE WATER GLASSES, BATH TOWELS, TOILET SEATS, SWEAT-
SHIRTS, AND HOUSEHOLD PETS WITH OTHER PEOPLE...AND YOU WON’T GET
AIDS,

YOU MAY GET A COLD OR YOU MAY GET THE FLU. BUT THOSE ARE NOT THE
WAYS YOU GET AIDS.

THEN PRECISELY HOW 1S THE VIRUS SPREAD?

THE MOST COMMON WAY IS THROUGH THE ACT OF SEXUAL INTERCOURSE.
AND, IN FACT, CERTAIN SEX PRACTICES NOT ONLY PRODUCE SEMEN BUT ALSO
CAN CAUSE BLEEDING, PARTICULARLY ANORECTAL BLEEDING. SUCH PRACTICES
HAVE BEEN ENGAGED IN BY SOME HOMOSEXUALS AND BISEXUAL MALES,
AND THAT ACCOUNTS FOR THE FACT THAT 2 OUT OF EVERY 3 VICTIMS OF
AIDS ARE EITHER HOMOSEXUALS OR BISEXUAL MALES,

BUT LET'S BE ABSOLUTELY CLEAR ABOUT THIS: IT’S NOT THEIR
HOMOSEXUALITY BY ITSELF THAT’S THE CAUSE OF AIDS. SAYING THAT MAKES
AS MUCH SENSE AS SAYING YOU GET AIDS IF YOU HAVE BLUE EYES OR BIG
FEET, IT JUST ISN’T SO,

MANY HOMOSEXUALS -- MAYBE MOST, THAT'S SOMETHING WE DON’T KNOW --
BUT CERTAINLY A GREAT NUMBER OF HOMOSEXUALS AND BISEXUAL MALES HAVE
MONOGAMOUS RELATIONSHIPS AND HAVE NOT ENGAGED IN THESE ROUGHER SEX
ACTS. AND SO, THEY DON'T HAVE AIDS AND THEY’RE AS FRIGHTENED OF THE
DISEASE AS THE REST OF US ARE,
WHAT IT COMES DOWN TO IS THIS: WE’RE FIGHTING A DEADLY DISEASE...
WERE NOT FIGHTING THE PEOPLE WHO HAVE IT. THE AMERICAN SYSTEM OF
PUBLIC HEALTH HAS WAGED WARS AGAINST SMALLPOX, POLIO, MEASLES,
SYPHYLIS AND MANY OTHER CONTAGIOUS DISEASES. WE NEVER WAGED WAR
AGAINST THE PEOPLE WHO HAD THEM,

AS YOUR SURGEON GENERAL, I CAN ASSURE YOU THAT WE’RE NOT GOING T0
CHANGE NOW.,.AIDS OR NO AIDS.

NEARLY 40,000 INDIVIDUALS HAVE CONTRACTED AIDS SINCE THE FIRST 5
CASES WERE REPORTED BACK IN JUNE, 1981, AS 1 INDICATED A MOMENT AGO,
ABOUT TWO-THIRDS OF ALL THOSE VICTIMS HAVE BEEN HOMOSEXUALS AND
BISEXUAL MALES.
BUT ANOTHER 25 PERCENT ARE INDIVIDUALS WHO “SHOOT” DANGEROUS
DRUGS INTO THEIR BLOODSTREAMS, USING OTHER PEOPLE’S NEEDLES AND
SYRINGES ALREADY CONTAMINATED WITH THE AIDS VIRUS.

BETWEEN THEM, THESE TWO GROUPS -- SOME DRUG ADDICTS AND SOME
HOMOSEXUALS AND BISEXUAL MALES -- ACCOUNT FOR 90 PERCENT OF ALL AIDS
VICTIMS IN THE UNITED STATES.

SO FAR, YOU HAVE TO SAY THAT THE DISEASE OF AIDS IS SIMPLY NOT
THE DISEASE OF THE MAJORITY OF AMERICANS. I REPEAT: NOT SO FAR,

MOST AMERICANS ARE HETEROSEXUAL AND MONOGAMOUS: THAT IS, THEY
HAVE ONE SEX PARTNER AND THEY’RE FAITHFUL,
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SOME OF YOU MAY FIND THAT HARD TO BELIEVE...ESPECIALLY IF YOU
ENJOY GRADE "B” MOVIES AND WATCH DAYTIME T.V. ACCORDING TO THOSE
PRODUCTIONS, THE ONLY REASON AN AMERICAN GETS OUT OF BED IN THE
MORNING IS TO GET INTO SOMEONE ELSE’S BED THAT AFTERNOON,

THAT MAY BE ENTERTAINING, ..BUT FORTUNATELY IT’S JUST NOT TRUE.
AND 1 SAY THAT AS YOUR SURGEON GENERAL, NOT AS YOUR CHAPLAIN.

IF IT WERE TRUE, BELIEVE ME, I’D BE TALKING TO AN EMPTY BALLROOM
RIGHT NOW. MOST OF YOU WOULD NOT BE HERE, YOU'D BE IN A HOSPITAL OR
A CLINIC SOMEWHERE, BEING TREATED FOR SYPHILIS, GONORRHEA, OR
HERPES,

OR YOU'D BE IN A HOSPICE DYING OF AIDS,
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BUT YOU AREN’T ANY OF THOSE THINGS. YOU'RE HERE. AND I°D GUESS
THAT THE WORST HEALTH PROBLEM MOST OF YOU HAVE HAD TODAY IS A TEMPO-
RARY DISAGREEMENT WITH YOUR LUNCH,

THAT’S NOT VERY ROMANTIC,..AND YOU CAN’T GET A NICKEL FOR THE
MOVIE RIGHTS TO A CASE OF INDIGESTION.

BUT THERE IT IS,

OUR EPIDEMIOLOGISTS ESTIMATE THAT ABOUT A MILLION AND A HALF
AMERICANS ARE NOW INFECTED WITH THE AIDS VIRUS.,.BUT, FOR ONE REASON
OR ANOTHER, THEY HAVE NOT YET CONTRACTED AN AIDS-RELATED DISEASE.
THEREFORE, WE DON’T KNOW WHO THEY ARE...AND THEY DON’T KNOW EITHER.
12

BUT THERE ARE CLUES, DRAWN FROM LIFESTYLE AND FROM GEOGRAPHY,

FOR EXAMPLE, IF YOU‘RE A HOMOSEXUAL OR BISEXUAL MALE BETWEEN THE
AGES OF 30 AND 39, AND YOU LIVE IN ONE OF THE NATION’S FIVE METRO-
POLITAN AREAS WITH HIGH AIDS INFECTION RATES -- NEW YORK CITY, FOR
INSTANCE, OR SAN FRANCISCO -- THE CHANCES ARE 1_IN 15 THAT YOU ALSO
ARE NOW CARRYING THE AIDS VIRUS IN YOUR BLOODSTREAM,

BUT IF YOU'RE A HETEROSEXUAL MALE BETWEEN 30 AND 39 YEARS OLD AND
YOU LIVE IN NASHUA, NEW HAMPSHIRE, OR OMAHA, NEBRASKA, OR SOME OTHER
LOW-INCIDENCE AREA, YOUR CHANCES OF BEING AN AIDS CARRIER ARE 1 IN

1,400,
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AND IF YOU'RE A WOMAN THAT AGE...LIVING IN THOSE SAME LOW-
INCIDENCE AREAS,..YOUR CHANCES OF BEING AN AIDS CARRIER ARE | IN

14,000,

BUT IF YOU DON’T ENGAGE IN HIGH-RISK SEXUAL BEHAVIOR AND YOU
DON'T “SHOOT” DRUGS,,,REGARDLESS OF WHERE YOU LIVE AND REGARDLESS OF
HOW OLD YOU ARE,..YOUR CHANCES OF BEING AN AIDS CARRIER ARE...ZERQ,

NOW, BEFORE YOU BREATHE A BIG SIGH OF RELIEF, LET ME TELL YOU A
SECRET: THOSE ARE MARVELOUS ODDS...BUT WHETHER OR NOT THEY STAY THAT
WAY DEPENDS ON YOU,

AND THAT’S MY GREATEST CONCERN, AS YOUR SURGEON GENERAL.
14

YES, IT’S TRUE THAT MOST PEOPLE IN AMERICA TODAY WILL NOT GET
AIDS BECAUSE THEY SIMPLY DON’T BEHAVE IN WAYS THAT PUT THEM AT RISK,

BUT BEHAVIOR CAN CHANGE...AND NOT ALWAYS FOR THE BETTER. AND
SOME PEOPLE JUST NEVER GET THE MESSAGE STRAIGHT:

SOME PEOPLE STILL SMOKE CIGARETTES...EVEN THOUGH THE VERY PACKAGE
ITSELF HAS A LABEL SAYING THAT SMOKING CIGARETTES CAUSES A VARIETY
OF TERRIBLE DISEASE CONDITIONS. BUT THEY’RE ADDICTED AND THEY

CONTINUE TO SMOKE.
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AND SOME PEOPLE STILL DRIVE TOO FAST AND WON’T WEAR SEAT-BELTS,

AND SOME PEOPLE DRINK TOO MUCH,

AND SOME PARENTS STILL THINK THEY HAVE A RIGHT. IN THE PRIVACY OF

THEIR OWN HOMES, TO ABUSE THEIR CHILDREN...AND EACH OTHER.

THEY’RE WRONG, OF COURSE.

ALL THOSE PEOPLE ARE WRONG. AND WE'RE OBLIGED 10 TELL THEM SO,
lo6—A

WE HOPE THAT AT LEAST A FEW -- IF NOT ALL OF THEM -- WILL MEND
THEIR WAYS AND NO LONGER DO THOSE LIFE-THREATENING THINGS,

AND WE HOPE THAT THE REST OF OUR CITIZENS WILL ALSO GET THE
MESSAGE, AND WE HOPE THAT SUCH A MESSAGE WILL ENCOURAGE THEM TO KEEP
ON BEING THE GENERALLY HEALTHY, SENSIBLE, LIFE-PROTECTING PEOPLE THAT
THEY ARE,

SOQ I HAVE T0 SAY, YES, THE RISKS OF BEING INFECTED BY AIDS MAY
NOW BE LOW... BUT THEY COULD RISE, IF WE DON’T TAKE EVERY PRECAUTION,
THEREFORE, WE’RE OBLIGED TO HAMMER AWAY WITH THE FACTS ABOUT AIDS IN
ORDER TO CONVINCE A FEW PEOPLE TO CHANGE THEIR BEHAVIOR AS WELL AS
CONVINCE MANY PEOPLE NOT TO CHANGE THEIRS,
16-8

1 SAID EARLIER THAT 90 PERCENT OF ALL 40,000 AIDS VICTIMS HAVE
EITHER BEEN INTRAVENOUS DRUG ABUSERS OR HOMOSEXUALS AND BISEXUAL
MALES,

BUT ANOTHER 4 PERCENT ARE NONE OF THE ABOVE. THEY ARE MEN AND
WOMEN WHO HAVE HAD A HETEROSEXUAL RELATIONSHIP WITH AN AIDS CARRIER
AND THAT’S HOW THEY GOT THE DISEASE.

FOR EXAMPLE, THE WIFE OF AN INFECTED BISEXUAL MAN BECOMES HERSELF
INFECTED WITH THE VIRUS,..CONTRACTS AN AIDS-RELATED DISEASE... AND
DIES,

 
R

OR CONSIDER THE SPOUSE OF A PROMISCUOUS, AIDS-INFECTED
INDIVIDUAL, APPARENTLY IT’S POSSIBLE FOR HER TO ABSORB HIS VIRUS INTO
HER OWN BLOODSTREAM, LOSE HER IMMUNITY TO A FATAL DISEASE,..AND DIE.

THIS IS VERY OMINOUS-SOUNDING INFORMATION, BUT I’M NOT TELLING
IT TO YOU IN ORDER TO STRIKE FEAR INTO YOUR HEARTS, I’VE LIVED LONG
ENOUGH TO KNOW THAT THERE’S A VERY THIN LINE BETWEEN FEAR...AND
HATE, SO 1 DON’T WANT YOU TO BE FEARFUL OF THIS DISEASE, RATHER, 1
WANT YOU TO KEEP YOUR WITS ABOUT YOU AND GIVE THIS PROBLEM YOUR
COMPLETE AND MOST THOUGHTFUL ATTENTION,
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OTHER PEOPLE, 17M SORRY TO REPORT. HAVE GONE ABOUT THE COUNTRY
PREACHING THE FEAR OF AIDS, AND IN THEIR WAKE THEY LEAVE BEHIND BOTH
FEAR OF THE DISEASE,..AND HATE FOR THOSE WHO HAVE IT,

BUT I WON’T HAVE ANY PART OF THAT.

I SAID EARLIER THAT WE HAD NO CURE FOR AIDS...NO VACCINE...NO
SILVER BULLET. THE BEST WEAPON WE NOW HAVE IS EDUCATION... EDUCATION

1 AND MORE EDUCATION,
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WE NEED ESPECIALLY TO TEACH OUR CHILDREN AND YOUNG PEOPLE ABOUT
THIS DISEASE, THE DISEASE WILL STILL BE AMONG US WITH ITS SAME DREAD
POTENTIAL OF DEATH, WHEN TODAY’S 10-YEAR-OLD TURNS 21,

IT IS ABSOLUTELY ESSENTIAL THAT WE BEGIN NOW TO RAISE A GENERA-
TION OF PEOPLE KNOWLEDGEABLE AND AWARE OF THE DISEASE OF AIDS...A
GENERATION THAT RESPECTS ITSELF...ONE THAT WILL NOT FRIVOLOUSLY
ENDANGER HUMAN LIFE...A GENERATION THAT WILL KEEP THE HUMAN RACE
GOING, DESPITE THE POOR EXAMPLE SET BY SO MANY OF THEIR ELDERS,
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HISTORY TELLS US THAT THE PHILOSOPHER DIOGENES PUNISHED THE
FATHER WHOSE SON WAS CAUGHT SWEARING. THAT’S NOT A BAD IDEA.

IN REGARD TO AIDS, I THINK WE WILL DESERVE TO BE SEVERELY
PUNISHED, IF WE LIVE TO SEE OUR CHILDREN INFECTED WITH THE AIDS VIRUS
BECAUSE WE NEGLECTED TO TEACH THEM THE FACTS OF LIFE...AND OF DEATH,

AND NOW, I WANT TO SAY AGAIN HOW MUCH I APPRECIATE THE HONOR
YOU'VE AFFORDED TO ME...AND NOW MUCH I RESPECT THE MEMBERS OF THE JURY
FOR BRINGING THIS ISSUE OF AIDS OUT INTO THE OPEN AT THIS MEETING,
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THE KOOP FAMILY CAME HERE FROM HOLLAND MANY YEARS AGO AND IN
THEIR LUGGAGE THEY CARRIED MANY WISE SAYINGS FROM THE OLD COUNTRY.
ONE OF THEM, TRANSLATED FROM THE DUTCH, GOES LIKE THIS:

"VISITORS ALWAYS GIVE PLEASURE...IF NOT AT THEIR ARRIVAL, THEN AT
THEIR DEPARTURE.”

I WILL TAKE MY OWN HINT,..SAY “THANK YOU” ONCE AGAIN...AND ALSO “GOOD

NIGHT,”
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