REMARKS

BY
C, EVERETT KOOP, M.D., SC.D,
SURGEON GENERAL
OF THE
U. S, PUBLIC HEALTH SERVICE

PRESENTED TO THE REPUBLICANS ASSOCIATED FOR MUTUAL SUPPORT
WASHINGTON, D. C,
NOVEMBER 19, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I WANT TO THANK YOU ALL VERY MUCH FOR INVITING ME TO SPEAK TO
YOU THIS MORNINGS ent PlE ASE Det Oe PARTICILPATE..LNA-CONFERENCE ON
B RESPONSE TO THE EPIDEMIC OF AIDS,

 
   
  
  
        

80 SAY THAT 1 RECOGNIZE AND APPRECIATE. THE LEADERSHIP
» SAN FRANCISCO DEPARTMENT OF PUBLIC” HEALTH ON THIS VERY

DIFFICULT/ISSUE.

f WAR AGAINST AIDS BEGAN HERE AND THE CONTRIBUTIONS OF,
FIRST/ DR. MERVYN SILVERMAN NO NOW DR. DAVID WERTIGER ARE SHINING
EXAMPLES OF WHAT PUBLIC, HEALTH LEADERSHIP CAN ACCOMPLISH,

YOU WILL sof scussIG AIDS EDUCATION, IN-GENERAL AND FOR
TARGET GROUPS“AND SO ON, AND THAT'S FINE WITH ME. BUT 1 WOULD LIKE

BE JST A LITTLE MORE PHILOSOPHICAL, SINCE MOST OF YOUARE. HIGHLY
WACIFIED EXPERTS ON THE ISSUES TO BE DISCUSSSED THIS MORNING,

    
  

Q

I'D LIKE TO LOOK AT THIS PANDEMIC OF AIDS FROM A LITTLE
DIFFERENT POINT OF VIEW. I WANT TO TALK ABOUT WHAT IT’S DOING TO
SOME OF OUR PEOPLE...WHAT IT CAN DO TO ALL OF OUR PEOPLE.,.AND WHAT
WE MUST DO TO HELP PEOPLE CONQUER AIDS, THE MOST VICIOUS OF
INFECTIOUS DISEA....° IN THE HISTORY OF THE HUMAN RACE.
2

LET ME CONFESS THAT, IN THE BATTLE AGAINST THIS DISEASE,
MEDICINE AND SCIENCE ARE MAKING VERY SMALL HEADWAY, RELATIVE TO WHAT
HAS YET TO BE ACCOMPLISHED.

IN FACT. I‘LL GO EVEN FURTHER AND SAY THAT THE FINAL VICTORY
OVER THIS DISEASE WILL NOT FOLLOW THE PATTERNS OF OTHER SUCH
VICTORIES -- THE ONE OVER SMALLPOX. FOR EXAMPLE, OR POLIO.

NO, THIS TIME, THE VICTORY WILL PROBABLY NOT BE THE EXCLUSIVE
VICTORY OF SCIENTIFIC RESEARCH AND CLINICAL PRACTICE.

THE FINAL VICTORY OVER THE DISEASE OF AIDS WILL MUCH MORE
LIKELY SPRING FROM THE IMPELLING FORCE OF COMPASSIONATELY COMMITTED,
ETHICALLY MOTIVATED, AND COURAGEOUS MEN AND WONEN WITH LITTLE OR NO
MEDICAL BACKGROUND AT ALL.

LET ME TAKE A LITTLE TIME TO EXPLAIN THAT OBSERVATION,

EVERYTHING THE PUBLIC THINKS AND DOES ABOUT AIDS SEEMS TO BE
RELATED TO THE THREE BASIC ASPECTS OF THE DISEASE:
FIRST OF ALL, IN SPITE OF ALL WE’VE LEARNED ABOUT THIS VIRUS IN
THE PAST 6 YEARS, AIDS IS. STILL PRETTY MUCH OF A MYSTERY,
ESPECIALLY TO THE PUBLIC. WE KNOW HOW IT’S TRANSMITTED, FOR
EXAMPLE. AND WE ALSO KNOW HOU IT ATTACKS AND DESTROYS THE HUMAN
IMMUNE SYSTEM. BUT WE DON’T KNOW WHY IT DOES THAT AND WE STILL
CAN‘T PREDICT WHEN THE AIDS VIRUS WILL -- OR WILL NOT -- PROCEED
ON ITS DESTRUCTIVE PATH. SO, FIRST ON OUR LIST IS MYSTERY,

BUT MEDICAL SCIENCE DOES NOT THRIVE ON MYSTERY.,.1IT THRIVES ON
DISCOVERY. AND DISCOVERY STILL SEEMS TO BE SOME DISTANCE AWAY FROM
US.

AIDS IS A MYSTERY...BUT IT’S NOT ONLY A MYSTERY. IT’S AN
ENORMOUS HUMAN CATASTROPHE,..A DISEASE THAT HAS AFFLICTED MORE THAN
44,000 AMERICANS,..OF WHOM NEARLY 26,000 HAVE ALREADY DIED.

MANY PEOPLE DENY THAT THEY ARE NOW -- OR COULD EVER BE --
INFECTED WITH THE AIDS VIRUS, EVEN THOUGH THEY MAY ENGAGE IN HIGH-
RISK BEHAVIOR,..ANAL INTERCOURSE, FOR EXAMPLE, OR NEEDLE-SHARING

AMONG I,V, DRUG ABUSERS,
BUT MORE IMPORTANT. MANY PEOPLE WHO DO NOT ENGAGE IN ANY HIGH-
RISK BEHAVIOR AT ALL AND ARE WILL PROBABLY NEVER CATCH AIDS, ARE
READY TO GIVE UP ON PEOPLE WHO DO HAVE AIDS,

BUT THAT’S EXACTLY WHAT WE CANNOT DO,..WE CANNOT GIVE UP ON
PEOPLE...WE HAVE NO MORAL RIGHT TO ABANDON ANOTHER PERSON,

AND THAT’S THE THREAT FROM THIS ASPECT OF AIDS... THE THREAT
RAISED BY ITS MYSTERY. Qo aiesrnenmaem ene

    

WE WITTSSACCEPT THE CONTINUING CATASTROPHE OF LOSS OF HUMAN
LIFE... -

WE WILL DENY THAT MANKIND IS SUPERIOR TO THIS DISEASE...

BUT IN THIS TERRIBLE AND FEARSOME PERIOD. I MAINTAIN -- AS A’
PHYSICIAN, AS A SCIENTIST, BUT ALSO AS A HUMAN BEING -- THAT MAN

CANNOT BE DENIED.
AIDS -- BY JTSELF -- WOULD MAKE US ‘DO THAT.
PEOPLE WHO LIVE IN TOTAL FEAR OF AIDS WOULD HAVE US DO THAT,

AND SOME PEOPLE WEAKENED BY THE DESPAIR OF AIDS, SEEING
PATIENTS DIE OF IT, WOULD HAVE US DO THAT.

BUT WE CANNOT,

AND THAT’S WHY WE MUST RECOGNIZE THIS ASPECT OF MYSTERY FOR
WHAT IT IS,..AND OVERCOME IT, |

THE SECOND FACT ABOUT AIDS THAT COLORS ALL WE SAY AND DO IS
THAT THE DISEASE IS VIRTUALLY 100 PERCENT FATAL.

I MENTIONED A MOMENT AGO THAT THE DISEASE HAS ATTACKED MORE
THAN 44,000 PEOPLE SINCE JUNE OF 1981 AND THAT ALMOST 26,000 OF
THOSE PEOPLE HAVE ALREADY DIED.

THAT’S THE TRUTH...BUT THERE’S MORE, THE TRUTH ALSO INCLUDES
THE FACT THAT, OF THOSE PEOPLE WHO HAD AIDS IN 1981, AT LEAST 91

PERCENT OF THEM HAVE ALREADY DIED.
OF THOSE WHO HAD THE DISEASE IN 1982, SOME 87 PERCENT HAVE
ALREADY DIED.

OF THOSE IN 1983, 89 PERCENT OF THEM HAVE ALREADY DIED OF AIDS.

AND -SO ON.

AEDS IS THE CLOSEST THING IN OUR ENVIRONMENT TODAY TO BEING A
"VIRTUALLY 100 PERCENT FATAL DISEASE.”

 

—i: HAVE NOTHING AT ALL...NOTHING...THAT WILL SAFELY AND

EFFECTIVELY STOP THE DISEASE OF AIDS IN ITS TRACKS.

WE HAVE NO DRUGS.,.NO VACCINES...NO MAGIC BULLETS... NOTHING
THAT CAN ACCOMPLISH THAT LIFE-SAVING JOB.

WHAT DQ WE HAVE? ONLY EDUCATION,

 
 

IT IS IMPERATIVE THAT WE TELL THE PUBLIC, WHOSE SYMPATHY AND
COOPERATION ARE SORELY NEEDED. THAT -- AT THE MOMENT -- DEATH IS THE
PARTNER OF PEOPLE WITH AIDS.

IT’S A GREAT MISTAKE TO UNDERESTIMATE THE SIGNIFICANCE OF THIS
SECOND ASPECT OF AIDS -- ITS VIRTUALLY 100 PERCENT MORTALITY RATE --
BECAUSE THIS FACT IS ALREADY RAISING THE POSSIBILITY OF ABANDONMENT
IN THE MINDS OF OTHERWISE RESPONSIBLE PEOPLE.

I’VE BEEN HEARING STORIES OF SOME PHYSICIANS AND NURSES -- VERY
FEW, THANK GOODNESS, BUT EVEN ONE IS ONE TOO MANY -- PHYSICIANS AND
NURSES WHO DON’T WANT TO TREAT AIDS PATIENTS BECAUSE OF THE DANGER
OF BECOMING INFECTED WITH THE VIRUS THEMSELVES.

epumimey 1 KNOW...AND THEY KNOW THAT SUCH A DANGER IS
MINUSCULE...AT THE VERY MOST.
8

YET WE ALL WATCHED THE TELEVISION NEWS COVERAGE OF THE TRAGEDY
OF THE RAY FAMILY IN ARCADIA, FLORIDA...REJECTED AND EXPELLED NOT
ONLY BY PLAIN TOWNSPEOPLE BUT ALSO BY EDUCATORS AND COMMUNITY
LEADERS.

I. THINK THEY MAY BE TRYING TO TELL US SOMETHING ELSE... SOME-
THING SO CONTRARY TO WESTERN ETHICAL TRADITIONS THAT THEY SIMPLY
CANNOT BRING THEMSELVES TO SAY IT STRAIGHT OUT, BUT I THINK THEY
MIGHT BE TRYING TO SAY WHAT SOME HAVE ALREADY SAID TO ME...

"WE DON’T CARE, BECAUSE THESE PEOPLE WITH AIDS ARE AS GOOD AS
DEAD ANYWAY.”

THAT'S A HORRIBLE STATEMENT, AND THE FIRST MOMENT IT IS SAID IT MUST
STIMULATE- US TO EXTEND EVEN FURTHER OUR CALL FOR COMPASSION FOR
PEOPLE WITH AIDS, |

THERE IS A MESSAGE THAT EACH OF US MUST DELIVER TO THE WORLD
EVERY DAY. THE INEVITABLY OF DEATH FROM THE DISEASE OF AIDS SHOULD
NOT -- BY ITSELF -- CAUSE THE VICTIMS OF AIDS TO BE ABANDONED AND,
IN THE WORDS OF THE PHILOSOPHER MARTIN BUBER, GIVEN THE EORETASTE.
OF DEATH.”
WE HAVE NO REASON TO LET THAT HAPPEN,

SO THERE IS THE MYSTERY OF AIDS.

AND THERE IS THE CERTAINTY OF DEATH FROM AIDS,

AND FINALLY, THERE IS THE THIRD ASPECT OF THE DISEASE OF AIDS
THAT IS*POSED TO ME IN JUST ABOUT EVERY QUESTION-AND-ANSWER PERIOD

WHEREVER I SPEAK, AND IT’S THAT PEOPLE GET AIDS BECAUSE THEY DO
HINGS MOS CR PEOPLE DON’ "T_APPROVE OF ,

BUT THIS THIRD ASPECT OF THE ISSUE OF AIDS IS EVEN MORE |
COMPLICATED THAN IT SEEMS,

IN ADDITION TO THE 28,000 HOMOSEXUALS AND BISEXUAL MALES WHO
HAVE HAD AIDS. WE MUST ADD THE 10,000 DRUG ADDICTS WHO HAVE SHARED
DIRTY NEEDLES AND OTHER PARAPHERNALIA AND, BY SUCH ACTIONS, SPREAD
THE DISEASE OF AIDS EVEN FURTHER,

THE VAST MAJORITY OF AMERICANS DON’T “SHOOT” DRUGS, BELIEVE
ME, NOR DO THEY APPROVE OF PEOPLE WHO DO.
10

IN ADDITION, OF THOSE DRUG ADDICTS WITH AIDS, THERE ARE 4
BLACKS AND LATINOS FOR EACH WHITE PERSON, SO THERE IS YET ANOTHER
ELEMENT OF SOCIAL RANCOR AND DIVISION THAT FILLS OUT THIS THIRD
ASPECT OF AIDS.

IN OTHER WORDS, 90 PERCENT OF THE PEOPLE WHO HAVE THE DISEASE |
OF AIDS CONTRACTED IT WHILE THEY WERE ENGAGING IN HIGH-RISK
BEHAVIOR, OF WHICH THE MAJORITY OF THE PUBLIC DISAPPROVE,

NOW THAT THEY HAVE THE DISEASE, IT 1S A VIRTUAL CERTAINTY THAT
THEY WILL DIE.

AND THE REST OF US WILL BE WITNESS TO THEIR DEATHS. YET WE WILL
HAVE NOTHING AT HAND TO PREVENT THOSE DEATHS.

SOME DAY, WE MAY WELL HAVE A BIOMEDICAL CURE FOR AIDS...A
VACCINE THAT IS BOTH SAFE AND EFFECTIVE AND GENERALLY AVAILABLE,

BUT WHO SHOULD BE THE FIRST PEOPLE TO GET IT? MY GUESS WOULD
BE THOSE VERY SAME PEOPLE WHO PRACTICE HIGH-RISK BEHAVIOR

WILL THE AMERICAN PEOPLE BE ABLE TO UNDERSTAND THAT? 1. HOPE
SO,..BUT I’M NOT REALLY SURE THEY’RE READY YET,
ll

LIKE IT OR NOT, WE ARE IN THE MIDST OF AN EPIDEMIC THAT IS
TESTING NOT ONLY OUR CAPABILITIES IN BIOMEDICAL RESEARCH AND
CLINICAL PRACTICE...BUT IT’S ALSO TESTING OUR CAPABILITIES AS HUMAN
BEINGS WHO HAVE BEEN RAISED IN -- AND -WHO ARE PRESUMABLY STILL
COMMITTED TO -- THE AFFIRMATIVE ETHICAL, MORAL. AND RELIGIOUS

IR OUR COUNTRY,(SOmE Wee Yiees Pus 45 vawon )
Afé Wh(lur ME Poe (SE CAMGAFL Ww Prow WHE Te ute. 7.

THOSE TRADITIONS HAVE BEEN LIVED BY MILLIONS OF PEOPLE WHOSE
NAMES WE WILL NEVER KNOW, BUT WHO MUST HAVE LIVED THAT WAY FOR US 10
HAVE ARRIVED AT THIS POINT AT ALL; | —

“> THIS IS NOT AN EASY TIME FOR US, EVEN FOR THOSE OF US WHO HAVE
HAD THE TRAINING AND THE EDUCATION AND THE PROFESSIONAL COMMITMENT
AND SO ON.

HOW MUCH HARDER, THEN. IS IT FOR OUR NEIGHBORS TO BE COURAGEOUS
11.70 BE WISE...AND TO BE INVOLVED?
12

SOMETIMES THOSE OF US IN PUBLIC HEALTH WILL RECOGNIZE A DISEASE
FOR WHICH MEDICINE ITSELF CAN OFFER ONLY A PARTIAL CURE, WHILE THE
SOCIAL AND SPIRITUAL STRENGTH OF SOCIETY MUST COME UP WITH THE REST.

1 BELIEVE THAT AIDS IS SUCH A DISEASE AND. THEREFORE -- YOU AND
1 AND AS MANY OTHERS AS WILL JOIN WITH US -- WE HAVE MUCH WORK TO
DO... TOGETHER. |

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