TESTIMONY OF C.  EVERETT KOOP, M.D., SURGEON GENERAL OF THE UNITED STATES ACCOMPANIED BY DR. LOREN ARCHER, DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE OF ALCOHOL ABUSE AND ALCOHOLISM IN THE ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION
Dr. Koop.  Thank you, Mr. Chairman.
Chairman Glenn.  Thank you, sir.
Dr. Koop.  Mr. Chairman and committee members, I want to thank you for inviting me to testify on the recommendations from the Surgeon General's Workshop on Drunk Driving. I would like to make it clear that I am not here representing the views of this Administration; rather the views that I am representing are my own personal views.  I am accompanied today by Mr. Loren Archer, Deputy Director of the National Institute of Alcohol Abuse and Alcoholism in the Alcohol, Drug Abuse and Mental Health Administration.
Mr. Archer is here at my request to answer scientific and technical questions relating to his Institute's programs. This will be, as several of you have mentioned, the last time that I testify before the United States Congress as Surgeon General.  I want to commend the committee for its's efforts to increase public awareness and to improve public policies relating to alcohol abuse and alcoholism.
And I applaud you, Mr. Chairman, for supporting Title III of Public Law 100-690 requiring warning labels on alcohol beverage containers.  Last year I received resolutions passed unanimously by the House of Representatives and the by the Senate urging me to address the problem of alcohol impaired driving.  In response to these congressional requests and increased public concern about alcohol impaired driving, I conducted a Surgeon General's Workshop on Drunk Driving in December of 1988.
On May 31 I released the Workshop Proceedings which contained the final workshop recommendations as well as a suggested implementation of strategies.  Since it was the Congress that asked me to focus national attention on alcohol impaired driving, I have sent the Proceedings to every member.  I hope that the Congress can provide leadership and resources to help various groups implement the workshop recommendations.  The groups I have in mind are Federal agencies, State legislatures, State and local Governments, education, professional and advocacy organizations, and of course, the private sector.
Working together the Congress and these groups can implement the 10 key summary recommendations that I endorsed. To-effectively reduce alcohol impaired driving and its life threatening consequences, I think you must pass legislation that aims at the following: require States to reduce the legal blood alcohol concentration or BAC from its present level of 0.10 percent to 0.08 percent immediately and to 0.04 percent by the year 2000.
Two, to require States to immediately establish a legal level of zero percent for drivers under 21 years of age. Three, to increase the Federal excise tax or user fee on alcoholic beverages and to equalize taxes by alcohol content for beer, wine, and distilled spirits.  Four, earmark the revenues generated from the Federal excise tax increase to fund impaired driving prevention programs. Five, provide incentives for States to make chemical testing for BAC mandatory for all drivers, passengers and pedestrians injured or killed in a crash involving a motorized vehicle.
Six, extend the warning label law to include warning labels on alcoholic beverage advertisements by November 1989.  Seven, authorize and fund Federal agencies to purchase advertising time for pro-health and pro-safety messages if substantially increased public service time and space do not become available.  Eight, eliminate tax deductions fox alcohol advertising and promotions that focus on lifestyle rather than price and product.  Nine, continue to encourage States to pass a law to confiscate drivers' licenses on the spot for those found to be above the legal BAC.  And finally, authorize and fund federal agencies to expand and evaluate their alcohol impaired driving programs as well as their research activities.
As the committee well knows, Mr. Chairman, every year nearly 24,000 people lose their lives and an additional 534,000 are injured in alcohol related traffic crashes. Many of the dead and injured are young.  The combination of drinking and driving is the number one killer of teenagers in this country.  Despite these alarming statistics, few Government officials have spoken out on alcohol impaired driving since Richard Schweiker testified before the Presi-dential Commission on Drunk Driving back in 1982. As then Secretary of the Department of Health and Human Services, Schweiker said the following, and I am quoting: "In the 1950's it was considered a national emergency when 200 young Americans a year aged 15 to 19 died from polio.  At the height of the polio epidemic in 1952, 3000 Americans in all succumbed to that disease, and we rushed to develop a vaccine."
Still quoting Mr. Schweiker, "The public health problem we are faced with today produces more than triple the number of those polio deaths for 16 to 25 year olds alone." Now one of Mr. Schweiker's successors, Dr. Otis Bowen, made alcohol abuse and alcoholism a major initiative during his tenure at DHHS and spoke at the workshop I have referred to.  I am sorry that the Bureau of Alcohol, Tobacco and Firearms and the Department of the Treasury is not testifying today because the Secretary of the Treasury is required to consult and coordinate the health awareness efforts of the alcohol warning labels with the Surgeon General.
In your invitational letter, Mr. Chairman, you asked me to identify obstacles to the implementation of the workshop recommendations.  One of the barriers is this reluctance by some public officials to take a firm stand against alcohol impaired driving.  I am not certain about the reasons for this silence. Certainly, speaking against alcohol-impaired driving should not label one as a prohibitionist, and I would hope that this silence is not from fear of offending the alcohol industry.
An estimated 18 million adult Americans have medical, social and personal problems directly related to the use of alcohol, as do several million adolescents for whom alcohol is an illegal drug.  Millions of other adults and youths are affected by the alcohol problems of family members or friends or work associates.  By 1990, alcohol abuse and alcoholism are expected to cost American society $136 billion a year, including between 10 to 15 billion for alcohol related crashes.  These figures, of course, do not include the cost of grief and human suffering.
How many deficits of this kind can the country afford? The workshop recommendations are not meant to punish the alcohol impaired driver or to bankrupt the alcoholic beverage industry.  They are designed to separate the act of drinking from the act of driving.  They are intended to help this Nation avoid tragedies like the May 14, 1988 bus collision and fire near Carrollton, Kentucky, which killed 27 people.
The National Transportation Safety Board recently released its report on the Kentucky crash.  The report lists 11 workshop recommendations that pertain to the issues in the crash and quotes the Expert Panel on Treatment for a prevention focus. A prevention focus will address the growing demands of many of your constituents for tougher measures to reduce the use of alcohol and other drugs in our society.
These tougher measures must include an increase in Federal and State taxes on alcoholic beverages and voluntary -- and I stress voluntary -- changes in alcohol advertising and marketing practices.  Why raise excise taxes? Well, the evidence strongly shows that an increase in product price brought about by an increase in excise taxes prevents or delays underage youth from drinking and also reduces the amount that heavier drinkers consume.
Why do we want alcohol advertising and marketing practices changed?  Current alcoholic beverage advertising is increasingly targeted at young people and at 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.
On June 8 and 9, the Entertainment Tonight television ran a story on celebrity alcohol advertisements and conducted a telephone poll asking viewers if they thought it was okay for celebrities to appear in alcohol advertisements. While 8,400 viewers said yes, over 28,000 said no.   Now this is not, Mr. Chairman, a scientific study, but it does indicate that almost 70 percent of the viewers of that program,  who were willing to pay 50 cents per call to express their opinion, think that it is wrong for stars to pitch beer and wine on television.
Is there compelling scientific evidence that advertising influences alcohol consumption, and the nature and level of alcohol related problems? No, there is not, and there may never be because of methodological difficulties in designing appropriate research studies. What we do have are observation, common sense and logic, and they have served us well with smoking since 1964 when members of this Congress, the public health and medical communities and citizen-groups embarked upon a systematic program to end America's high risk romance with tobacco.
It appears to me that we are now with alcohol impaired driving where we were 25 years ago with smoking.  That is bad news if the alcohol beverage industry follows in the tobacco industry's footsteps of denial and obfuscation.  It is good news if it represents the beginning of a new broad dedicated effort to prevent a major public health and safety problem, namely alcohol impaired driving.
A National Coalition to Prevent Impaired Driving is being established as a result of the workshop.  My hope is that this national coalition will help every State organize its own statewide coalition that will, in turn, empower local coalitions.  Already New Mexico and Michigan have developed statewide coalitions since the workshop to create positive social change.
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. The National Association of Broadcasters, the American Association of Advertising Agencies, and the Association of National Advertisers were offered a chance to participate in my workshop but declined.  Yet they have all been very vocal critics of the workshop and its recommendations.
The National Beer Wholesalers Association filed a lawsuit to have the workshop postponed or cancelled.  Under a settlement agreement, I accepted comments on the workshop until January 31, 1989.  These comments both pro and con were reviewed and considered by my staff.  Before I leave office, I will be recommending to the Assistant Secretary for Health that further research be continued and scientifically based responses be published for the many unresolved issues raised by the workshop and reflected in the comments.
This report will be an invaluable tool for States and local communities to use in developing programs and policies on alcohol impaired driving.  Alcohol impaired driving must be seen as a public health and safety problem rather than as an economic and moral problem, and our primary concern must be with preserving human lives.
This will take cooperation among public health, medical, law enforcement, and traffic safety experts as well as a change in individual and community attitudes about alcohol impaired driving.  It will also take courage and political clout. I conducted the workshop at the request of the Congress. I hope that the Congress will now provide strong leadership to help the Nation implement the workshop recommendations and adopt as a national standard the total unacceptability of driving after using alcohol or other drugs.
The very enormity our losses demands no less of a response.  Thank you.
Chairman Glenn.  Thank you very much, Dr. Koop.  We will be 5 minutes each on the round on this one.  You have recommended the blood alcohol level be lowered immediately from .1 to .08 percent for drivers 21 years and older and zero, of course, for drivers under 21.  What was the basis for the .08? Do we have statistical evidence that led us to hit that .08? Why not .06 or lower?
Dr. Koop.  Well, I will ask Mr. Archer to answer that, sir, because it is technical and he has the answers.
Chairman Glenn.  Doctor, good, fine.  Pull the mike up closer if you would, please.
Dr. Archer.  Mr. Chairman, the decision on the blood alcohol level is basically a political, not a scientific decision.  The evidence is that there is an increasing risk of an impairment from .04 on upward so it is a question of .08 has a lesser amount of impairment than .10, but of course, .06 would have even less.
Chairman Glenn.  What does that equate to in drinks, say, for 165 or 70 pound person, or can you equate that to us?  Would .08 be 2 martinis, 1 beer, what would it be? Do you have any --
Dr. Koop.  We can both take a crack at that, sir.   It is the first question that is always asked and the most difficult to answer.  It depends a little bit on the bodily habitus of that 165 pound man.  Is it all muscle or is it fat? It depends on what he had to eat just beforehand, how rapidly he consumed it, what his activity was just before and just after so that you cannot really answer it.
You can say that some people are impaired by 1 drink, and you can say that other people can drink several drinks and still have an alcohol level that comes under the legal limit.
Chairman Glenn.  Is there a big difference in tolerance from one person to another on what 1 or 2 beers or a martini will do to a person of about the same weight, a different alcohol tolerance?
Dr. Archer.  There can be differing alcohol tolerances, but the most important factor is body weight, and there also, of course, are differences by sex in that women because of lower total body water can be impaired with slightly less alcohol, which makes it difficult to give you a simple answer of 160 pound person because women are more impaired with the same amount of alcohol.
Chairman Glenn.  Are there enough differences there that we should have different standards for men and women?
Dr. Archer.  There are significant differences.   I think it would be difficult to administer.
Chairman Glenn.  I know it would be.  I am very aware, very aware of that.
Dr. Archer.  From a scientific standpoint, yes, there is evidence to support it.
Chairman Glenn.  But I just wondered if statistically and just from a clinical standpoint, are there major differences between men and women sufficient that, say, you could say for women it should be .6 or higher or lower or whatever the case would be?
Dr. Archer. No.  Because the blood alcohol level would be the same.  What we are talking of is differences that relate to produce a blood alcohol level in men and women.
Chairman Glenn.  I know, but what I am trying to relate to is what prevents impairment?  If women are more easily impaired by a certain amount of alcohol, then perhaps a lower blood level should be required, or is the same blood level that impairs both?
Dr. Archer.  The same blood level impairs both, Mr. Chairman.
Chairman Glenn.  Oh, okay.
Dr. Archer.  However, the standard --
Chairman Glenn.  It is just that it would take women less drinking to get to that blood impaired level?
Dr. Koop.  That is correct.
Dr. Archer.  A standard drink, whether it be a drink of distilled spirits, beer or wine would produce a different blood alcohol level in women than in men.
Chairman Glenn. Doctor, if the Congress were to -- let us just say we take 3 steps, how would you prioritize? What should we do this year?  Were your 10 steps were they prioritized or if we would take, be limited to, say, 3 or 4 steps, what would those be?
Dr. Koop.  Well, I think the immediate reduction of the blood alcohol from its present 0.1 to --
Chairman Glenn.   That was number 1.  Are these in priority?
Dr. Koop.  Well, in general in priority.  But they are not specifically.  I think that should be number 1 though, and coupled with it I would put number 2 to be certain that as far as those under 21 years of age that that level be zero.
Chairman Glenn.   Yes.  Well, now the legal drinking age now is 21, and so it would follow that if you have a driver that is under 21 and has any alcohol, I would presume that would be illegal from that standpoint, from just a general standpoint but not specifically for driving; is that correct?
Dr. Koop.   That is correct.
Chairman Glenn.  How many States have specific laws, then, that apply just to driving for drinkers under 21?
Dr. Archer.  We could provide that for the record, if you would like.
Chairman Glenn.  Okay.   That would be fine.   I would appreciate if you would.
[Information provided by Surgeon General follows:]
COMMITTEE INSERT
Chairman Glenn.  On page 78 of the Proceedings, the workshop recommends that the Government promote a "Don't Drink and Drive" message, and that other messages imply that some drinking with driving is acceptable such as "Know Your Limit" campaigns, and that those campaigns should be discouraged.  The alcoholic beverage industry and the advertising industry have each sponsored a number of advertisements to discourage drunk driving.
Do you believe those efforts are helpful, or do they send a very mixed message to the viewer that sort of cancels out the other more strict message?
Dr. Koop.  Well, I think they are certainly helpful, Mr. Chairman, but they are not as helpful as, they could be.  Remember that our target group here are the people we are most concerned about, those 15 to 25 years of age, our young people. I spent most my professional life working with adolescents, and I am sure you know, they have a sense of immortality. They like to take risks.  They think any admonition that begins with the word "don't" is for somebody else.  With those 3 personal characteristics of young people, I think we should take the firm stand that you do not drink and drive.
Chairman Glenn. Thank you. My time is up.  Senator Roth.
Senator Roth.  Thank you, Mr. Chairman.  As a number have indicated, it seems to me the primary problem is to change public attitude.  My concern has been that in the 1960's and 1970's we developed a very permissive style of life and suddenly we find that it is having very harmful impact on society, whether you are talking about drugs or AIDS or abuse of alcohol.
The one thing that gives me a little hope is the point you made in your opening statement is that we have made some progress with respect to smoking.  And it seems to me in some ways we have the same problem here.  I wonder has any effort been made to study what has brought about what I consider a very significant change with respect to smoking.  It has taken many years.  But are there some lessons from that for us to learn in the case of drunken driving?
Dr. Koop.  I think there are, Senator.  There is no doubt about the fact that you are on target when you talk about attitudes.  It would be very hard to measure what has happened in those 25 years that this Government has tried very sincerely to alter the smoking habits of Americans.
So many things have been done simultaneously by so many Federal and State authorities as well as the private sector  that it is hard to pick out whether it is a warning label or an educational campaign.  But I think that if you look at what we can measure from 1984 on, there have been changes about smoking which essentially come down to the fact that is becoming socially unacceptable.  That is attitudinal. And if we could get an attitudinal change that drinking and driving do not mix, then I think we would have achieved the same thing, and I would hope in less than the 25 years it took for smoking.
Senator Roth.  Again, I agree with you the difficulty of making the study.  But I wonder if it would not be worthwhile trying to establish to the extent we can scientifically what did we do in the past few years or 25 years as you state that that made a difference because it seems to me it is exactly the same thing we have to do here.
Let me ask you this question.  Now as I understand it, there is no hard liquor advertising on TV today; is that not correct?
Dr. Koop.   Correct.
Senator Roth.  But we do have, of course, advertising of beer.  Have any efforts been made or is there any difference, can we see where that has made a difference between alcohol and beer with respect to drunk driving?  Is beer more of a problem because of the advertising or is there any way we can analyze that difference?
Dr. Koop.  Well, we have the findings of the National Commission on Drunk Driving that were published just the week before my workshop. They visited several American cities and took testimony from teenagers who said with remarkable, almost unanimity, that they began to drink because of the advertising.
And I think one of the other things that is a misconception of youngsters is "Sure, I would not drink some hard liquor and drive, but beer has such a low alcohol that I do not have to worry about it."  When teenagers are involved in fatalities involving with drunk driving beer has usually been the beverage that they have consumed.
Senator Roth.  Well, I think one of your recommendations is to increase the excise tax so that the cost of beer and wine is equal to that of liquor.  Could that conceivably push young people into drinking hard liquor?
Dr. Koop. No, I do not think so because you would be taxing it proportionately on the alcohol content.   So that the tax would be higher per drink on hard liquor than it could be on beer and wine.  And we do have remarkable statistics on what a small increase in the price of cigarettes, for example, does to the smoking patterns of adolescents again.  Texas did a study that showed that if you increase the price of cigarettes by raising the total cost per pack only 10 percent, that 12 percent of teenagers stop smoking.
Senator Roth.  So you do feel cost is an effective deterrent?
Dr. Koop.  It is for adolescents.  I would not say across the board, but they have a much more limited source of funds for that particular activity.
Senator Roth.  Well, my time is up.  Thank you, Dr. Koop.
Chairman Glenn.  Senator Kohl.
Senator Kohl.  Dr. Koop, we talk a lot about drunk driving, but I think you would agree that the problem is not limited just to drunk driving.  It seems to me that the term "impaired driving" is a more apt description and goes well beyond just alcohol abuse.  What we are dealing with in our society today is not just a problem of alcohol abuse but of widespread and problematic drug use.
The disease of addiction to drugs of which alcoholism is just one manifestation is such a pervasive problem in our society that driving accidents are only the tip of the iceberg.  Do you see your program as being aimed more at the occasional binge user who decides to take the risk of drinking and driving, or do you consider the addict or alcoholic to be just as important an abuser?
Dr. Koop.  Well, I think that the real alcoholic tends to be an older age group, and they are not the ones that are involved in the problem we are addressing here today.   But such a statement cannot be taken as absolutely set in concrete.  Again, it is largely attitudinal.  As you confront youngsters who drink, they never think that they have stepped over the line, whereas a person who is an alcoholic, even though he may deny his alcoholism, he does admit freely to the fact that he is impaired.
And I hope that you understand that the reason we use the term "drunk driving" for the workshop is because the organizations that have been so helpful like MADD, and SADD and RID are all talking about drunk driving.  We much prefer the term "impaired" because you do not have to be drunk to be a danger on the road, and also the other statement you made is very much where we stand, and that is alcohol is not the only drug that we are concerned about.  There are many others, not just illegal drugs, but prescription drugs that many people feel because their doctor recommended them cannot possibly be something that would impair their ability to drive, but that is also true.
Senator Kohl.  Dr. Koop, you recommend that beer advertisements be balanced with equal time public service announcements.  Who would pay for these PSAs, and in your opinion who should pay for these PSAs?
Dr. Koop.  Well, I think that the private sector would do lot about them, and if you notice, what we did was to leave open the modus operandi hoping that the gap would be filled and the problem would be addressed.  But if not, then we would hope that money could be spent to construct proper, innovative, creative teaching public service announcements especially addressed at young people.
Senator Kohl.  I am not sure that I got that.   Who should pay for these PSAs?
Dr. Koop.  We would hope that Government funds would not be necessary but that voluntary agencies would take care of the problem and fill in the gap.   But if that does not take place, then our recommendation was that that would be a good expenditure of Government money.
Senator Kohl.  So you are not suggesting that these PSAs should be handled by the broadcast industry for free or anything else of that sort?
Dr. Koop.  I would be very happy if they did.
Senator Kohl.  Right.  Well, I would imagine that if they would, that they would somehow pass that on in some way, shape or fashion?  They would increase their rate to make that up with respect to the rest of their advertisers?
Dr. Koop.  Well, I think that that is a fact of life, and I would not object to that way of paying for it.  What I am interested in is getting the message out to young people and avoid the problem one always has when you have to spend government funds to do that.
Senator Kohl.  Okay. Dr. Koop, I have always wondered about the feasibility of actually keeping convicted drunk drivers off the road.  One of the local TV news stations recently completed a week long series about the ease with which convicted drunk drivers can get back behind the wheel.
Some of this is due to inadequate processing of drunk driving arrests and convictions, but even in cases where a person's license was revoked,  such an individual would sometimes leave the courtroom, get in a car, and drive away moments after the court had taken away their license for drunk driving.
Short of following these people around night and day, how can the police possibly ensure that people who have lost their licenses cannot get behind the wheel?
Dr. Koop.  Well, there are many cracks in the system, sir, and that is where we would hope that the coalitions that we have started at the Federal level would now move in the States and then get down to the grassroots. It is only when the grassroots people who are affected by the tragedies and the grief and the loss of the victims of drunk driving get into the act and say this cannot go on that the combination of transportation and law enforcement people will step in and do something about it.
I do not in any way minimize the problem, but I recognize as I have studied this that there are many ways that the cracks develop. There is great sympathy for the injured. I had a friend who knows he has an alcohol problem in one of the eastern States that has very tough drunk driving laws. He was arrested for drunk driving after an accident, had his license suspended for 6 months.  But on the second occasion, within 2 weeks after he had his license restored, he totaled his car by smashing into a tree.   No one was hurt and no property was damaged except his body and his car.   The action of the police was not to arrest him on a drunk driving charge because they felt that the accident already had punished him enough and would have a long period of recuperation.
That kind of sympathetic thinking for someone who is really in trouble has got to be altered because that person does not need punishment.  He needs rehabilitation. And that is when we would hope that the increase in excise taxes, both at the Federal level and the State level, would be channeled, into preventive programs so that a man like that recognizes his difficulty and is pushed by society into a system that takes him off the road until he is able to handle the problem of drinking without driving.
Chairman Glenn. Senator Lieberman.
Senator Lieberman.  Dr. Koop, one of the major missions of this committee is oversight of existing governmental structures and the work that they are doing.  In that regard, I was interested to note that one of your workshop's recommendations was that the responsibility for regulating the alcohol industry be removed from the Bureau of Alcohol, Tobacco and Firearms and placed into the Food and Drug Administration.  And I wonder if you could explain to the committee at this point why that recommendation was made, and how you feel personally about it?
Dr. Koop.  Well, I think the bottom line, sir, to give you a short answer, is that the bureau that now regulates alcohol does not really have a health component, and we believe that the reason that the Surgeon General is involved in this is because we are dealing very much with a health problem.  The Food and Drug Administration which is one of the agencies of the Public Health Service does have the expertise and the knowledge and the ability to work closely with a sister service like the Alcohol, Drug Abuse and Mental Health Administration in presenting the health aspects that should be used in regulation.
They are in the business of regulating foods, drugs and cosmetics for the protection of the American people, and they also are into devices such as those used for radiologic diagnosis or other things medical. I think therefore they are the best prepared to do so.
Senator Lieberman.  Could you describe then for the record what the -- and I understand the limits of time -- by way of overview what the functions of the BATF have been, the responsibilities of the BATF have been in regard to the alcohol industry?
Dr. Koop.  I do not think that I could answer that question, sir, in a satisfactory way to us at this moment, but I would be very glad to submit for the record.
[Information supplied by Dr. Koop follows:]
COMMITTEE INSERT
Senator Lieberman.  Okay.  But your major concern is you are not dealing for the moment with whether they have dispatched the responsibilities we have given them under law adequately but with the fact that they do not have a health component.
Dr. Koop.  That is exactly right.
Senator Lieberman.  And the FDA--
Dr. Koop.   Does.
Senator Lieberman.   --does.  Moving on then, could you assess the existing structure that we have at the Federal level in regard to education, prevention and treatment of alcoholism throughout the country?  Do you think the structure is adequate?
Dr. Koop.  I would like to ask Mr. Archer to do that because again it comes under his aegis.
Dr. Archer.  I would hesitate to answer from a scientific standpoint.  I think that clearly from an organizational standpoint the Department of Education, Department of Health and Human Services, Department of Transportation have all worked closely in this area, and appear to be functioning well, but that is more a political judgment.
Senator Lieberman.  I understand, but from your perspective, and I do not know whether you have a reaction to this based on your involvement so far, the Federal agencies with responsibility in this area, education, prevention and treatment, you think have been performing adequately?  That the structure, at least, is adequate to the task?
Dr. Koop.  I think the structure is adequate to the task.  I think there is a tendency for people in our position, who see the enormity of the problem, to compare the resources we have to prevent the carnage we are talking about now as opposed to the industry's resources that seem to be sending another message.  So to answer your question, we always could use more money, but I think the structure is adequate, sir.
Senator Lieberman.   Yes.  Do you have any sense of how much more money we could use?  In other words, I know we can always use more money, but what is the range of the problem? Did your workshops reach a point where you would make a recommendation to Congress about what our goals should be for adequate funding?
Dr. Koop. No.  We tried to avoid specific mention of dollar amounts, but rather send the general concerns back to Congress, thinking that it has a better understanding of the other concerns in reference to money and the demands made upon them.  The total amount now, Loren, is what, 30 million all put together.
Dr. Archer.  On prevention, yes.
Dr. Koop.  On all of the programs and all the Federal Government that are aimed at the prevention of the problem we are talking about, not just the driving, but of all alcoholism, the illnesses, the things you heard about, Veterans Hospital admissions and so forth is $30 million.
Senator Lieberman.  30 million which is a pretty small amount.  Let me go to the local level for a moment just for the final question.  Maybe I should ask you generically since time is running out.  Can you cite a few treatment programs or education programs that you came across in your work through the workshop that you think were particularly good success stories that we might use as models?
Dr. Koop.  I would be glad to provide you some of the details, sir, but I think the programs that I favor and that I think have the greatest impact not only upon the individual who has the problem of driving after he has been drinking but also on the community are those programs that are not aimed at a punitive action against the individual but recognize that here is a person who with proper rehabilitation can be made into a safe driver because he does not drink.
Senator Lieberman.  So that even though your recommendations have what look to be heavy punitive components to them, you certainly do not see that as the end of the problem?
Dr. Koop.  It does not matter, sir, whether you are talking about drunk driving or child abuse or battered wives, punitive measures tend to stop the program.  But the repeat offender is the person who has not been rehabilitated. So local or national or any other kind of punitive measures may stop the problem in its tracks for that one occasion.  But if you want to prevent the repetitive offender who is really the guy we are after, then he has to be rehabilitated, whether it is sex or drugs or whatever.
Senator Lieberman.  Thank you.
Chairman Glenn.  Senator Bingaman.
Senator Bingaman.  Thank you, Mr. Chairman.  Dr. Koop, one of the organizations which I gather is designed to deal with this problem you are describing here is the National Commission Against Drunk Driving.  My information is that they refused to participate in your December workshops. I would be interested if you would explain their thinking or why they would not welcome your leadership in this area?
Dr. Koop.  I would be very happy to explain the action, sir.  I do not think I can explain their thinking.  The National Commission on Drunk Driving was a natural and welcome outgrowth of the Presidential Commission on Drunk Driving several years ago.  And the way that things were organized in the early days of our planning for the workshop, they were part of the planning committee, and they moved along with us. As it got closer and closer to the date and certain people began to drop out and criticize the construction of our panels and the people we had invited to the workshop, the commission also dropped out.
We made an appeal to them.  The conversation took place between the chairman of their board and my chief of staff.  We pointed out the fact that we needed them more than we needed anybody else to make a solid front to the American people and our report back to you and Congress. I think we convinced the chairman of the board that by standing with me at the opening session by making some statements, it did not mean in any way that he was endorsing beforehand the conclusions of the workshop nor was he endorsing the manner in which I had set up the workshop.
And up until the day before the workshop itself, I was moving along with the understanding that no matter who else dropped out, at least the commission representative in the form of the chairman and I would stand with Otis Bowen and give the charge to those who had been invited.
He dropped out on that occasion after meeting with as he said, "some members of my board."  And that is where I cannot tell you what the thinking was, but he called back and said that he did not think that he could make the appearance that he promised but that he would send his deputy, chief executive officer. That person never did show up either.
So those are the facts that happened.  And I am not saying this, sir, in criticism of him or of the commission. I recognize that the people on that commission just like we who were in the workshop know the tremendously complex problem that we raise when we talk about drunk driving. You up there behind the platform are all men of goodwill. You are all concerned about this problem, but I think you would all have very different emphases about where you think you ought to go. When you heard one of your colleagues give you his program, you might be very critical of 10 or 15 percent of it.
What our concern was that we not let those differences keep a workshop of this importance from moving forward to have an impact upon the people of America and to report back to you a program on which you could act.
Senator Bingaman.  Could you state very differently the difference in emphasis that caused them not to participate? What was the emphasis that was reflected in the panels or the program that you had put forward that they did not feel comfortable with?
Dr. Koop.  What they did not feel comfortable with, they told us, was the manner in which we had constructed the panels.  Now my concern about that excuse was that they had been part of the planning committee all along, and I must say that I give great merit badge points to the staff of the National Commission because they worked with us all along and indeed were working with us on the very day that the commission pulled out.
Senator Bingaman.  But could you be more specific as to what was wrong with the panels or what was objectionable about the way, the people you had put on panels?
Dr. Koop.  Well, I think the way they stated it was that the people that we had chosen to be chairmen of panels took positions on issues, particularly advertising and taxes, that were not positions that were shared by the commission. Again I can tell you what they told me, but I cannot tell you what they thought.
Senator Bingaman. Let me ask in your testimony you indicate that some of those tougher measures that we must take in order to deal with this include voluntary changes in alcohol advertising and marketing practices.  Could you elaborate on that a little? What voluntary changes would you Iike to see adopted?
Dr. Koop.  I would like to see young people not targeted. I would like to see minorities not targeted.   I would like to see advertising not made part of a lifestyle that is very pleasant without any consequences on the individual if one abuses the privilege that he has.
I also would like to see the disassociation of alcohol advertising from role models that young people look up to or to activities that are very exciting for young people.  I do not think you ought to show race car drivers or racing or activities such as that with alcohol because it unites the 2 in the kid's mind when it should separate them. I have absolutely no concern about advertising that talks about the product, what the trade refers to as tombstone advertising.
I think anybody has the right to do that kind of and you will note in our recommendations in my testimony at the press conference, we did not call at any time for a ban on advertising. And the restrictions we called for, we asked that they be voluntary.
Senator Bingaman. My time is up, Mr. Chairman.
Chairman Glenn. Thank you.  I know Dr. Koop has to go before too long.  We will try to keep this next round to just a couple or three minutes a-piece here.  I know you have an 11 o'clock some place, Dr. Koop.  We will try to make this as rapidly as possible.
Dr. Koop.  I have a 10:30 some place, sir.
Chairman Glenn.  Oh, you do.  Well, okay.  Maybe we better end it now.  I hate to do that, but can you stay for one question each?
Dr. Koop. Go.
Chairman Glenn. All right.  We are talking about rehabilitation, where that fails.  We are trying to get the repeat offender off the highway.  They are the ones that cause a lot of the problem, the basic problem we are trying to deal with.  Now it would seem to me that if that is the cause a lot of the problem, the basic problem we are trying to deal with. Now it would seem to me that if that is problem, and we want to get abuser off the highway, and we want to really identify these people, it seems to me the Beer Institute, the Wine Institute, everybody should agree that we want to identify those people. If they are still going to be on the highway, I want to do defensive driving.
I would not mind seeing a scarlet dayglow paint put on both bumpers of any automobile owned by a person who has been convicted of drunk driving a second time, say, where rehabilitation has not worked.  So I know to look out for that car whether I am ahead of it or behind it.  That is somebody I better look out for.  Has anything like that been tried and do you think it would work?
Dr. Koop.  Well, of course, whenever you suggest something like that, there is a great scream that you are depriving people of their liberty, that you are discriminating against a certain class of people.
Chairman Glenn.  Absolutely.
Dr. Koop.  And many of us think that such people should be discriminated against.
Chairman Glenn.  That is exactly the purpose.  I may get killed if I do not discriminate against them.  I do not know of any program where that has been tried that has been deemed successful.  Do you, Loren?
Dr. Archer.  Perhaps the fellow from NHTSA might have some comment.
Dr. Koop.  I think the people in Transportation who funded things like that in the past could bring you an answer.  We would be happy to try to get that for you, sir.
Chairman Glenn.  Good.  I would like to have any comments you might make on that because I would not mind putting that in legislation myself.  Senator Kohl.
[Information supplied by Dr. Koop follows:]
COMMITTEE INSERT
Senator Kohl.  Dr. Koop, restrictions on where and when beer, wine and spirits can be purchased, and how these products can be marketed have not decreased alcohol abuse in a society like the USSR which has extensive restrictions. Why have these restrictions in your judgment not worked there and why do you believe that those kinds of availability and marketing restrictions might work here?
Dr. Koop.  Mr. Kohl, I am always leery in any health issue of trying to transfer the experience of one culture to another, whether it is the sale of vodka in the USSR or the exchange of needles for drug abusers in Amsterdam.   Our people are not quite the same.  I just go on the basis of what we know and what seems logical. Many more people are involved in drunk driving after they come from places where alcohol is sold on a retail basis than coming from parties in their own home or where they have purchased liquor in large quantities at a package store.
And I think that any time you see a number of instances out there that seem to be etiologic in causing the problem you are trying to fix, it seems reasonable to cut down on the numbers of those things or have other restrictions that do not have to limit personal freedoms.  Remember we are not trying to say to people you should not drink.  We are just saying if you are going to drink, do not drive.
Senator Lieberman.  Dr. Koop, Secretary Bennett in his work as the drug czar in putting together a program or recommendations for the country is apparently seriously considering the use of boot camps so-called for drug offenders.  How would you feel about that idea for first or second time drunk driving offenders as a way to make sure they are not repeat offenders?
Dr. Koop.  I would much rather see the money that would go into that for an alcohol offender go into a rehabilitation program rather than to a punitive program, and I think that you can carry out a rehabilitation program for a drunk driver without putting him behind barbed wire.
Senator Bingaman.  Dr. Koop, one of the recommendations in your report or out of your working group is recommendation B-2 on page 28.  It says eliminate alcohol advertising and promotion on college campuses where a high proportion of the audience reached is under the legal drinking age.  Do you support that recommendation, or do you think that is reasonable or not?
Dr. Koop.  I do support that recommendation, and I recognize all of the problems that go with such a complex issue as this.  But it seems to me that I read an insert by a beer advertiser that appeared in a tremendous number of college magazines and newspapers; and it was offensive to me in that it led the reader to believe that if on spring vacation you were not part of the beer drinking crowd, you just were not living up to the expectation of American youth that took a holiday in the spring.
And I do not remember exactly but it seemed to me that there was a comment in there that if you were not consuming a beer every hour, you were not in with the crowd.   I think that is reprehensible, sir.
Senator Bingaman.  That is all I had.  Thank you very much.
Chairman Glenn.  Thank you, doctor.  And we apologize to whoever it is you are supposed to be with at 10:30.
Dr. Koop.  I will tell them.
[Laughter.]
Chairman Glenn.  We appreciate it and we look forward to working with you.  It may be your being in a different capacity, but we look forward to keeping in touch with you for your suggestions.  Thank you very much for being here this morning.  Thank you.
[The statement of Dr. Koop follows:]