ORIGINAL

STATEMENT.

By
C. Everett Koop, M.D.
SURGEON GENERAL
U.S. PuBLic HEALTH SERVICE
AND
DEPUTY ASSISTANT SECRETARY FOR HEALTH
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

eS Ss

To THE ATTORNEY GENERAL’S COMMISSION ON PORNOGRAPHY

WASHINGTON, D,C,
June 20, 1985
MR. CHAIRMAN AND MEMBERS OF THE COMMISSION:

MY NAME IS C, EVERETT KOOP, 1 HAVE BEEN A PRACTICING PHYSICIAN
FOR 44 YEARS. SINCE NOVEMBER 1981, HOWEVER, I HAVE BEEN THE SURGEON
GENERAL OF THE U.S. PUBLIC HEALTH SERVICE.

1 AM APPEARING THIS MORNING BEFORE THIS COMMISSION IN MY OFFICIAL
CAPACITY AS SURGEON GENERAL. BUT LET ME EMPHASIZE THAT MY APPEARANCE
HERE MEANS A GOOD DEAL MORE TO ME AND TO THE PUBLIC HEALTH SERVICE
THAN JUST ANOTHER OFFICIAL DUTY. I CONSIDER THIS TO BE AN ESPECIALLY
IMPORTANT OPPORTUNITY TO SHARE WITH THE DISTINGUISHED MEMBERS OF THIS
COMMISSION -- AND WITH THE PUBLIC AT LARGE -- SOME OF OUR CONCERNS
REGARDING THE POTENTIAL RELATIONSHIP BETWEEN PORNOGRAPHY AND THE
PHYSICAL AND MENTAL HEALTH OF OUR CITIZENS AND OF OUR SOCIETY IN
GENERAL.
FIRST, MR. CHAIRMAN, LET ME SAY THAT WE ARE NOT OPERATING IN THE
DARK IN THIS MATTER, AS MAY HAVE BEEN THE CASE A DECADE OR TWO AGO,
RESEARCHERS IN THE BEHAVIORAL SCIENCES HAVE BEEN GENERATING A
PROFESSIONALLY RESPECTABLE LITERATURE ON MANY ASPECTS OF PORNOGRAPHY
IN THE YEARS SINCE THE REPORT OF THE NATIONAL COMMISSION ON OBSCENITY
AND PORNOGRAPHY APPEARED IN 1970,

YOU WILL RECALL, MR, CHAIRMAN, THAT THE MEMBERS OF THAT
COMMISSION SAID THAT THEY’D SEEN “NO EVIDENCE THAT EXPOSURE TO OR USE
OF EXPLICIT SEXUAL MATERIALS PLAYS A SIGNIFICANT ROLE IN THE CAUSATION
OF SOCIAL AND INDIVIDUAL HARMS, SUCH AS CRIME, DELINQUENCY, SEXUAL OR
NONSEXUAL DEVIANCY, OR SEVERE EMOTIONAL DISTURBANCE.”

THEIR CONCLUSION SATISFIED SOME PEOPLE BUT UPSET MANY OTHERS.
BUT I THINK WE SHOULD SAY THAT THE 1970 REPORT WAS BASED UPON A VERY
LIMITED UNIVERSE OF SCIENTIFIC LITERATURE AND EXPERIENCE REGARDING
PORNOGRAPHY, IN THAT RESPECT, THE SOMEWHAT EQUIVOCAL JUDGMENT OF THE
COMMISSION MAY HAVE BEEN AN ACCURATE REFLECTION OF THE EQUIVOCAL
NATURE OF THE STATE OF OUR KNOWLEDGE AT THAT TIME.
BUT 15 YEARS HAVE GONE BY AND WE ARE NOW QUITE A BIT MORE
KNOWLEDGEABLE ABOUT PORNOGRAPHY AND ITS POTENTIAL EFFECTS UPON
HEALTH, AND DURING THOSE INTERVENING YEARS SOCIETY HAS ALSO BECOME
MUCH MORE CONCERNED ABOUT THE WAY PORNOGRAPHY HAS BEGUN TO INVADE BOTH
OUR PUBLIC AND OUR PRIVATE LIVES.

AT ONE TIME, THE PUBLIC’S CONCERN WAS FOCUSED ALMOST EXCLUSIVELY
UPON BOOK STORES AND MOVIE THEATERS THAT SPECIALIZED IN PORNOGRAPHY,
BUT TODAY'S HUCKSTERS OF PORNOGRAPHY HAVE INVADED CABLE TELEVISION,
THE WORLD OF POPULAR MUSIC, TELEPHONE COMMUNICATIONS. AND THE WHOLE
NEW FIELD OF HOME VIDEO RECORDERS. THROUGH THESE NEW TECHNOLOGIES
THEY’ VE EXPANDED THEIR MARKETS OF SLEAZE AND TRASH,

AS A CITIZEN AND AS YOUR SURGEON GENERAL, I SHARE THE SAME
ANXIETIES AS THE REST OF MY COUNTRYMEN AND, LIKE YOURSELVES AND LIKE
THE ATTORNEY GENERAL, I ALSO WANT TO DO WHAT I CAN TO HELP ALLEVIATE
OUR FEARS AND MISGIVINGS ABOUT THE PRESENCE OF PORNOGRAPHY IN AMERICAN
LIFE.
I MUST SAY THAT, HOWEVER, WITH THE GREATEST OF CAUTION. THE
MEMBERS OF THIS COMMISSION ARE AWARE, I AM SURE. OF THE WAY IN WHICH
OUR COUNTRY TENDS TO "MEDICALIZE” ALL OUR WORST SOCIAL PROBLEMS. AS A
RESULT, THE PUBLIC HEALTH COMMUNITY HAS BEEN HANDED SUCH ISSUES AS
DIVORCE. DRUNK DRIVING, AND TEEN-AGE PREGNANCY AND IT’S BEEN ASKED TO
"DO SOMETHING” ABOUT THEM.

I THINK PUBLIC HEALTH PEOPLE ARE DOING THE BEST THEY CAN WITH THE
BROAD AGENDA OF CONCERNS THEY’VE BEEN GIVEN, EVEN THOUGH SOME OF THE
PROBLEMS ARE NOT PARTICULARLY -- OR EVEN PECULIARLY -- HEALTH OR
MEDICAL PROBLEMS,

BUT, AS WE’VE SEEN HAPPEN WITH DRUNK DRIVING, FOR EXAMPLE, AND
WITH ENVIRONMENTAL POLLUTION, SOCIETY IS ABLE TO GENERATE REAL
SOLUTIONS ONLY WHEN ALL THE AFFECTED INTEREST GROUPS -- INCLUDING
PUBLIC HEALTH -- SHARE A SENSE OF PROPRIETORSHIP FOR THOSE PROBLEMS,
THAT’S THE POINT AT WHICH A SOCIAL PROBLEM IS NO LONGER YOURS OR YOURS
OR YOURS...IT HAS BECOMES OURS.
THIS IS A PLEA, THEREFORE, THAT WE NOT IDENTIFY PORNOGRAPHY AS
BEING ESSENTIALLY OR PRIMARILY A PROBLEM AFFECTING THE PUBLIC
HEALTH, PORNOGRAPHY IS, RATHER, A GENERAL SOCIAL PROBLEM IN WHICH
PUBLIC HEALTH CAN IDENTIFY A VITAL YET A PARTICULAR INTEREST AND FOR
WHICH PUBLIC HEALTH MAY BE ABLE TO OFFER SOME SPECIFIC RELIEF.

IF THAT SOUNDS TOO THEORETICAL, I DON’T MEAN IT TO BE SO. I
BELIEVE WE HAVE ENOUGH EVIDENCE TO IMPLICATE PORNOGRAPHY AS A SERIOUS
CONTRIBUTING FACTOR TO CERTAIN DISORDERS OF HUMAN HEALTH AND AS A KIND

OF “ACCESSORY” TO CERTAIN ANTI-SOCIAL ACTIONS THAT PRODUCE GRAVE AND
PROFOUNDLY HARMFUL OUTCOMES,

THIS SEEMS TO BE ESPECIALLY CLEAR IN TWO AREAS:

* — EIRST, THERE IS MOUNTING EVIDENCE THAT SEXUALLY VIOLENT
MATERIAL DOES HAVE A NEGATIVE EFFECT ON ATTITUDES. FOR EXAMPLE,
SUCH MATERIAL CLEARLY AND VICIOUSLY DEGRADES WOMEN. MEN WHO SEE
OR READ SUCH MATERIAL OVER A PERIOD OF TIME TEND TO HAVE A HIGHER
DEGREE OF TOLERANCE FOR SEXUAL VIOLENCE AND ACTS OF SEXUAL
DEGRADATION, AND WE SUSPECT THAT FOR MEN WHO ARE EVEN SLIGHTLY
PREDISPOSED TO SUCH BEHAVIOR, THIS MATERIAL MAY PROVIDE THE

IMPETUS THAT PROPELS THEM FROM THE UNREAL WORLD OF FANTASY TO THE
REAL WORLD OF OVERT ACTION,
IT’S IMPORTANT TO KNOW HOW THAT HAPPENS, IN ORDER TO DEVELOP
EFFECTIVE WAYS TO INTERVENE AND, THUS, PREVENT SUCH ACTION FROM
TAKING PLACE,

* A SECOND AREA INVOLVES CHILDREN, BOTH THE USE OF CHILDREN AS
SUBJECTS IN PORNOGRAPHY AND THE USE OF SUCH CHILD PORNOGRAPHY T0
AROUSE CHILDREN AND ADULTS TO ENGAGE IN ILLICIT AND OFTEN VIOLENT
SEXUAL ACTS. THIS IS, UNFORTUNATELY, NOT A NEW PROBLEM FOR
MANKIND. HOWEVER, WE ARE JUST NOW BECOMING ACUTELY AWARE OF THE
DEVASTATING LONG-TERM EFFECTS OF THESE KINDS OF PORNOGRAPHY MAY
HAVE UPON BOTH THE PHYSICAL AND MENTAL HEALTH OF THE VICTIMIZED
CHILDREN. WE ALSO KNOW THAT MANY CHILDREN EXPLOITED BY THE
PORNOGRAPHER SOON BECOME VICTIMS OF THE EVEN MORE FRIGHTENING
WORLD OF CHILD PROSTITUTION,

THERE IS ALSO A GROWING BODY OF EVIDENCE THAT POINTS TO THE
IMPORTANCE OF THIS KIND OF PORNOGRAPHIC STIMULUS FOR THE ADULT WHO
THEN SEXUALLY ABUSES CHILDREN. IN MY TERMS, I CALL CHILD
PORNOGRAPHY IN SUCH CASES AN “ACCESSORY” TO THE CRIME OF CHILD
ABUSE.
THIS IS AN AREA THAT HAS BEEN RECEIVING MORE AND MORE ATTENTION
SINCE THE MID-1970s, BUT WHILE THE PUBLIC’S DISGUST AND ANGER HAS
BEEN TURNED INTO NEW AND HARSHER FEDERAL AND STATE LAW, THE PUBLIC
HEALTH RESEARCH COMMUNITY HAS LAGGED BEHIND IN DEVELOPING THE KIND
OF DATA THAT PUBLIC AUTHORITIES NEED TO PREVENT THE SPREAD OF
CHILD PORNOGRAPHY, AS WELL AS TO HELP RECLAIM CHILDREN WHO HAVE
BEEN VICTIMIZED BY PORNOGRAPHERS,

THERE IS A BITTER IRONY HERE, HOWEVER: WE KNOW THAT PROFESSIONALS
ENGAGING IN BEHAVIORAL RESEARCH HAVE NOT BEEN ACTIVE IN CHILD
PORNOGRAPHY BECAUSE OF THEIR RESPECT FOR CERTAIN OBVIOUS ETHICAL
RESTRAINTS -- THE VERY SAME ETHICAL RESTRAINTS THAT THE
PORNOGRAPHER BRAZENLY VIOLATES,
BUT FOR WHATEVER REASON, WE'VE BEEN GIVING PORNOGRAPHY A LOW
PRIORITY IN THE OVERALL SCHEME OF PUBLIC HEALTH CONCERNS. BUT AT THIS
STAGE OF OUR UNDERSTANDING, TO IGNORE THE EVIDENCE WOULD BE TO MAKE A
CONSCIOUS DECISION NOT TO SEE PORNOGRAPHY AS A CLEAR AND PRESENT
DANGER TO AMERICAN PUBLIC HEALTH. AND IT OBVIOUSLY IS,

HENCE, MANY PROFESSIONALS IN PUBLIC HEALTH ARE NOW BEGINNING TO
LOOK UPON PORNOGRAPHY WITH THE SAME DEGREE OF SERIOUS STUDY THAT
THEY'VE GIVEN EVERY OTHER MANIFESTATION OF MAJOR SOCIAL STRESS AND
DISORDER. I’M GREATLY ENCOURAGED BY THAT. THE PUBLIC HEALTH
COMMUNITY, AFTER ALL. HAS EMPLOYED THE SCIENTIFIC METHOD TO UNDERSTAND
AND VANQUISH SUCH PHENOMENA AS “LEGIONNAIRE’S DISEASE” AND “TOXIC
SHOCK SYNDROME.” GOOD SCIENCE HAS BEEN OUR BEST WEAPON IN THOSE AND
MANY OTHER DIFFICULT CASES.
AND GOOD SCIENCE IS ALSO THE KEY TO OUR ULTIMATE VICTORY OVER
CIGARETTE SMOKING, WHICH, AS YOU KNOW, IS THE MAJOR CONTRIBUTOR TO THE
THREE LEADING KILLERS OF OUR PEOPLE: CANCER, STROKE, AND HEART
DISEASE,

WHILE PEOPLE OFTEN SPEAK OF PORNOGRAPHY AS A "DISEASE" OF OUR
SOCIETY, I’M AFRAID THAT’S MORE POETRY THAN SCIENCE. PORNOGRAPHY DOES
NOT. OF COURSE, LITERALLY ACT LIKE A BACTERIUM OR A VIRUS. AS MUCH AS
WE MIGHT WISH FOR IT, WE WILL NEVER COME UP WITH A VACCINE OR A
MEDICATION THAT WILL CURE ANYONE OF ENGAGING IN PORNOGRAPHY, IN THAT
SENSE, YOU MIGHT SAY THAT OUR TASK IS ALL THE MORE DIFFICULT. SINCE
THERE IS NO CLEAR END-POINT AT WHICH WE MIGHT UNFURL THE BANNER OF
"SUCCESS,"

BUT THAT SHOULD NOT BE A REASON -- OR AN EXCUSE -- FOR INDECISION
OR INACTIVITY. WE MAY NOT KNOW EVERYTHING WE’D LIKE TO KNOW OR NEED
TO KNOW ABOUT THE RELATIONSHIP BETWEEN PORNOGRAPHY AND PUBLIC HEALTH,
NEVERTHELESS, WE KNOW ENOUGH TO IDENTIFY THE DIRECTION IN WHICH WE
OUGHT TO BE GOING IN THIS ISSUE,
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AND I FEEL CONFIDENT THAT THE MEDICAL AND PUBLIC HEALTH
COMMUNITIES ARE PREPARED TO MOVE AHEAD IN THAT FRAME OF MIND. ALSO. I
BASE THAT FEELING ON MY EXPERIENCE OVER THE PAST SEVERAL YEARS WITH A
SIMILAR ISSUE AFFECTING THE PUBLIC HEALTH: INTERPERSONAL VIOLENCE.

THREE YEARS AGO I BEGAN TO VOICE MY CONCERN OVER THE LEVEL OF
VIOLENCE IN AMERICAN SOCIETY. I SAID THAT ACTS OF ASSAULT, RAPE,
MARITAL RAPE, CHILD ABUSE, CHILD SEXUAL ABUSE, AND HOMICIDE ARE
OCCURRING IN NUMBERS FAR BEYOND WHAT WE MIGHT EXPECT EVEN IN A BIG
COUNTRY LIKE OURS WITH ITS MINORITY OF CLINICALLY DISTURBED MEN AND
WOMEN,

THE OUTCOMES OF SUCH VIOLENCE ARE CATASTROPHIC NOT JUST FOR ITS
VICTIMS BUT FOR THE COUNTRY AT LARGE. WE ARE SPENDING YEARS IN TIME
AND MILLIONS IN DOLLARS TRYING TO PIECE BACK TOGETHER AGAIN THE BODIES
AND MINDS AND LIVES OF VICTIMS OF VIOLENCE.
Il

FOR THE PAST 3 YEARS I’VE BEEN DELIVERING THIS MESSAGE TO
PROFESSIONAL ASSOCIATIONS, TO THE MEDIA -- IN PARTICULAR THE
LEADERSHIP OF THE THREE MAJOR NETWORKS -- AND TO CONCERNED CITIZENS’
GROUPS,

THIS YEAR THE TIME SEEMS TO BE RIPE FOR PEOPLE IN MEDICINE AND
PUBLIC HEALTH TO FOCUS ON WAYS TO IMPROVE THE DIAGNOSIS AND TREATMENT
OF VICTIMS AND ALSO TO PREVENT VIOLENCE FROM HAPPENING IN THE FIRST
PLACE. WITH THAT GOAL IN MIND, I’VE ISSUED INVITATIONS TO A “SURGEON
GENERAL’S WORKSHOP ON VIOLENCE AND PUBLIC HEALTH” TO BE HELD THIS
OCTOBER IN LEESBURG, VIRGINIA. THE DEPARTMENT OF JUSTICE IS AN ACTIVE
CO-SPONSOR OF THE WORKSHOP, I AM PLEASED TO REPORT.

AS OF TODAY, NEARLY 150 LEADING PHYSICIANS, NURSES, EMERGENCY
MEDICINE SPECIALISTS, VICTIMS ADVOCATES, PSYCHOLOGISTS, AND MANY
OTHERS HAVE QUICKLY ACCEPTED MY CHALLENGE AND PLAN TO TAKE PART IN
THAT WORKSHOP,
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AND FROM THE LITTLE NOTES THAT MANY HAVE ATTACHED TO THEIR
RESPONSE FORMS, IT SEEMS CLEAR ENOUGH THAT THESE COLLEAGUES IN
MEDICINE, NURSING, PUBLIC HEALTH, AND SOCIAL SERVICES CAN BE STRONG
AND WILLING ALLIES OF THE GENERAL PUBLIC IN ANY SERIOUS EFFORT TO TURN
BACK THE TIDES OF VIOLENCE.

WE WILL NOT BE DEALING WITH PORNOGRAPHY AS SUCH AT THE LEESBURG
WORKSHOP, BUT I DON’T DOUBT THAT IT WILL COME UP IN OUR DISCUSSIONS
OF THE CAUSES AND OUTCOMES OF ACTS OF SEXUAL VIOLENCE AGAINST CHILDREN
AND ADULTS.

AND I BELIEVE THAT, AS THE PUBLIC SHARES ITS GROWING UNEASINESS
REGARDING PORNOGRAPHY, THE SAME KINDS OF PROFESSIONALS WHO WILL BE
WITH US AT LEESBURG -- MAYBE MANY OF THE SAME INDIVIDUALS -- WILL STEP
FORWARD. READY TO HELP.

WHAT IS IT THAT NEEDS TO BE DONE? 1I’D SAY THERE ARE 3 GENERAL
TASKS TO BE ACCOMPLISHED:

FIRST, WE NEED TO SORT THROUGH THE THINGS WE’VE LEARNED OVER THE
PAST 10 OR 15 YEARS ABOUT THE RELATIONSHIP BETWEEN PORNOGRAPHY AND
PUBLIC HEALTH.
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SECOND, WE NEED TO IDENTIFY THOSE AREAS IN WHICH WE HAVE A GOOD
DEAL OF INFORMATION AND THOSE AREAS IN WHICH WE HAVE LITTLE OR NO
INFORMATION AT ALL,

AND FINALLY, WE NEED TO WORK OUT A PUBLIC HEALTH STRATEGY FOR
GATHERING THE IMPORTANT INFORMATION THAT WE LACK,

I BELIEVE SUCH AN EFFORT WOULD GO FAR TOWARD HELPING OUR PUBLIC
OFFICIALS IN HEALTH, SOCIAL SERVICES, AND LAW ENFORCEMENT DO A MORE
EFFECTIVE JOB...

DEALING WITH THE ISSUE OF PORNOGRAPHY...

DEALING WITH THE PURVEYORS OF PORNOGRAPHY...

AND DEALING WITH THOSE INDIVIDUALS FOR WHOM PORNOGRAPHY IS THE
STIMULUS TO ANTI-SOCIAL AND VIOLENT ACTION.
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IN OTHER WORDS, WHILE WE MAY NOT LEARN EVERYTHING ABOUT PORNOGRAPHY
WITHIN THE NEXT FEW MONTHS OR EVEN WITHIN THE YEAR, I’M SURE WE CAN AT
LEAST LEARN ENOUGH TO HELP SOCIETY ACT,

MR. CHAIRMAN, I WANT TO CONGRATULATE YOU AND THE MEMBERS AND
STAFF OF THE COMMISSION ON PORNOGRAPHY FOR MOVING QUICKLY AND
DECISIVELY TO CARRY OUT THE CHARGE GIVEN YOU BY ATTORNEY GENERAL
MEESE. THE U.S, PUBLIC HEALTH SERVICE SHARES WITH EACH OF YOU THE
SAME GRAVE CONCERN FOR THE WELL-BEING OF MILLIONS OF MEN, WOMEN, AND
CHILDREN, WHOSE PHYSICAL, EMOTIONAL, AND MENTAL HEALTH IS PLACED AT
RISK BY THE LOATHESOME MERCHANTS OF PORNOGRAPHY,
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I WOULD FURTHER LIKE TO PLEDGE TO YOU THAT THE OFFICE OF THE
SURGEON GENERAL AND THE U.S. PUBLIC HEALTH SERVICE ITSELF STANDS READY
TO HELP YOU IN ANY WAY POSSIBLE,

AND NOW, IF YOU WISH, I WOULD BE PLEASED TO RESPOND TO YOUR
QUESTIONS,

THANK YOU.

HEH # #