COMMENCEMENT ADDRESS
BY
C, Everett Koop, M.D., Sc.D,
SURGEON GENERAL
OF THE
U.S, PuBLic HEALTH SERVICE
U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PRESENTED AT THE COMMENCEMENT EXERCISES
OF THE F. EDWARD HEBERT SCHOOL OF MEDICINE OF THE
UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES

WASHINGTON, D.C,
May 20, 1989
1
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I AM DEEPLY TOUCHED BY YOUR INVITATION TO BE YOUR COMMENCE-
MENT SPEAKER THIS YEAR ... FOR THE SECOND YEAR IN A ROW... A
UNIQUE HONOR FOR ME,

YOU'VE GIVEN ME THIS HONOR, AND I SINCERELY APPRECIATE IT.

BUT THAT IS NOT THE ONLY GIFT I’VE RECEIVED AT THE HEBERT
SCHOOL OF MEDICINE HERE AT U.S.U.H.S. DESPITE MY BUREAUCRATIC
RESPONSIBILITIES, YOU'VE NEVERTHELESS ACCEPTED ME AS YOUR
COLLEAGUE IN THE HEALING ARTS.
2
U.S.U.H.S. STUDENTS AND FACULTY HAVE GATHERED ME IN AS A

FELLOW PHYSICIAN WHO IS STILL STRUGGLING -- ALONG WITH THE REST
OF YOU -- TO UNDERSTAND AND TO FULFILL BOTH THE SCOPE AND THE
DEPTH OF OUR OATH OF SERVICE TO COUNTRY ... AND TO MANKIND.

I'VE ALSO FOUND GREAT UNDERSTANDING AND COMFORT FROM AMONG
MY PEERS IN THE OTHER UNIFORMED SERVICES, MY FELLOW SURGEONS
GENERAL IN PARTICULAR AND THE CHIEFS OF MEDICAL SERVICES.

THEY‘VE COUNSELED ME WHEN I WAS TROUBLED ABOUT THE COURSE OF
HEALTH CARE IN THE SERVICES, AND THEY IN TURN LISTENED TO MY
COUNSEL WITH PATIENCE, GREAT GOOD GRACE, AND A MEASURE OF CHARITY
AS WELL. FOR ALL THAT, I THANK THEM MOST SINCERELY,
3
KNOWING WHAT I KNOW TODAY, I WANT TO TELL THE AMERICAN

PEOPLE THAT OUR COUNTRY IS IN GOOD HANDS ... THAT WE AMERICANS
ARE DEFENDED BY MEN AND WOMEN WHO WILL MEET AND DEFEAT ANY ENEMY
-- WHETHER IT BE AN ARMY FROM WITHOUT ... OR A DISEASE FROM
WITHIN,

T LOVE YOU ALL ... BUT THERE’S A SPECIAL SPOT IN MY HEART
FOR THOSE IN THE UNIFORM OF THE U.S. PUBLIC HEALTH SERVICE. YOU
ARE “MY PEOPLE.” THERE ARE JUST A FEW OF YOU... BUT YOU’RE A
PRECIOUS FEW ... PRECIOUS TO ME ... TO THE P.H.S. ITSELF ...
AND PRECIOUS TO OUR NATION,
4
IF I SOUND A LITTLE SENTIMENTAL, I GUESS IT’S BECAUSE I FEEL

SENTIMENTAL. IN 6 WEEKS IT WILL GO ON LEAVE AND BECOME “INACTIVE”
»++ AND THAT WILL CERTAINLY BE A NEW EXPERIENCE FOR ME. THEN, ON
OCTOBER 1 ] WILL SAY “FAREWELL” TO ONE OF THE MOST EXCITING
PERIODS OF MY LIFE.

OVER THE NEXT SEVERAL MONTHS I WANT TO CLEAN OUT A FEW
FILES, TIE UP SOME LOOSE ENDS, AND PUT SOME THOUGHTS DOWN ON
PAPER REGARDING MY FORMER INCARNATION AS A PEDIATRIC SURGEON AND
MY MORE RECENT EXPERTENCES OF THESE PAST 8 YEARS AS YOUR SURGEON
GENERAL,

AND, WITH YOUR INDULGENCE, I’D LIKE TO DO JUST A LITTLE
REMINISCING WITH YOU TODAY,
5
FIRST, LET ME SAY I REMAIN TOTALLY GRATEFUL TO PRESIDENT

REAGAN FOR HAVING NOMINATED ME IN 1981 AND FOR RE-NOMINATING ME
IN 1985,

IN 1981 I WASN’T A VERY POPULAR CHOICE. I HAD A REPUTATION
AS AN OUTSPOKEN PERSON WITH VERY STRONG OPINIONS ON IMPORTANT
ISSUES. AND THOSE OPINIONS -- AND MY AGE, WHICH WAS 65 WAY BACK
THEN -- WERE RAISED AS ARGUMENTS AGAINST MY BEING THE COUNTRY’S
SURGEON GENERAL,
6
THE DEBATE WENT ON FOR ABOUT 8 MONTHS UNTIL AT LAST THE

SENATE GRUDGINGLY CONFIRMED ME. I GUESS SOME OF YOU WERE STILL
IN HIGH SCHOOL THEN AND PROBABLY DIDN'T GIVE THIS MATTER MUCH
THOUGHT ... IF, IN FACT, YOU WERE DOING ANY THINKING AT ALL AT
THAT TIME,

BUT I KNOW I WAS DOING A GREAT DEAL OF THINKING. I WAS
WONDERING IF I COULD -- OR EVEN IF I SHOULD -- BECOME A WHOLE NEW
PERSON IN ORDER TO GAIN THE APPROVAL OF THE UNITED STATES
SENATE.
/
SHOULD I, FOR EXAMPLE, DEPOSIT MY RELIGIOUS BELIEFS IN A

BLIND TRUST AND LEAVE THEM THERE FOR THE DURATION??

SHOULD 1 DONATE MY MORAL VALUES TO A WORTHY CHARITY?

SHOULD I PACK MY ETHICAL PRINCIPLES IN AN OLD ATTIC TRUNK
AND FORGET ABOUT THEM UNTIL MY TERM WAS OVER?

TO ALL OF THOSE OPTIONS I SAID, “NO... NONE OF THE ABOVE.”

T BELIEVED THEN -- AND I CERTAINLY BELIEVE NOW -- THAT ONE'S

BEST APPROACH TO PUBLIC SERVICE IS TO PROMISE TO GIVE IT EVERY-
THING YOU HAVE ... OF WHATEVER IT IS YOU DO HAVE,
8
YOU MUST BE WILLING AND EVEN EAGER TO DRAW HEAVILY FROM YOUR

OWN STOREHOUSE OF KNOWLEDGE AND LIFE EXPERIENCE ... FROM THE
IDEAS AND SENTIMENTS YOU'VE ABSORBED FROM FRIENDS AND FROM
FAMILY,

_ AND FROM ALL THAT ACCUMULATED KNOWLEDGE AND EXPERIENCE, YOU
MUST SQUEEZE OUT EVERY OUNCE OF GOOD JUDGMENT, OF DEEP FELLOW
FEELING, AND OF LOVE OF COUNTRY.

SO I DECIDED NOT TO CHANGE C. EVERETT KOOP. RATHER, I
DECIDED 1 WOULD TRY TO BECOME THE BEST C. EVERETT KOOP THAT I
COULD POSSIBLY BE.
9
I THINK I MADE THE RIGHT CHOICE. BUT IT DIDN'T MAKE MY

ASSIGNMENT ANY EASTER. INSTEAD, I WAS FORCED TO DISCOVER THINGS
ABOUT MYSELF AND ABOUT MY COUNTRY THAT I DID NOT FULLY UNDERSTAND
UNTIL 1 EMBARKED ON THIS NEW EXPERIENCE AS SURGEON GENERAL.

_ AND I WOULD GUESS THAT EACH OF YOU IS ABOUT TO CROSS THAT
SAME THRESHOLD AS WELL. AND WHEN YOU DO, YOU WILL LEAVE BEHIND
THE SIMPLER QUESTIONS OF MEDICAL SUBSTANCE AND TAKE ON THE FAR
TOUGHER QUESTION OF YOUR OWN PROFESSIONAL AND PERSONAL CHARACTER.
10
I WILL CONFESS TO YOU THAT, IN THE HEADY EXCITEMENT OF BEING

CALLED UP BY THE PRESIDENT ... OF BEING FOLLOWED AROUND BY THE
PRESS ... OF LATE-NIGHT CONVERSATIONS WITH POWERFUL SENATORS AND
CONGRESSMEN ... WHEN ALL THIS WAS HAPPENING, I DID NOT -- AT THE
SAME TIME -- TRULY UNDERSTAND WHAT MY JOB AND MY LIFE WERE REALLY
GOING TO BE LIKE,

AND I BELIEVE THE CLASS OF ‘89 MAY BE GOING THROUGH A
SIMILAR PHASE, THERE’S SO MUCH EXCITEMENT IN THE AIR TODAY THAT
IT'S DIFFICULT TO THINK CLEARLY ABOUT LIES AHEAD. AND IN ANY
CASE, YOU CAN'T REALLY KNOW,

AND YOU DON’T DARE ASK. |
11
THE BEST YOU CAN DO IS TO KNOW YOURSELF AS WELL AS YOU CAN,

SO THAT YOU CAN ABSORB WHATEVER FATE -- AND YOUR COMMANDERS --
MAY SEND YOUR WAY,

ESSENTIALLY, THAT WAS MY EXPERIENCE, AFTER BEING IN GOVERN-
MENT LESS THAN 6 MONTHS. IT WAS APRIL OF 1982 AND A LITTLE BOY
~- TO BE KNOWN FOREVER IN THE HISTORY BOOKS AS “BABY DOE” -- WAS
BORN IN BLOOMINGTON, INDIANA.

“BABY DOE” WAS BORN WITH MULTIPLE CONGENITAL DEFECTS,
INCLUDING AN ESOPHAGEAL OBSTRUCTION AND DOWN SYNDROME.
12
AN ATTENDING SURGEON TOLD “BABY DOE’S” PARENTS THAT THEIR

SON HAD ABOUT A 50-50 CHANCE OF SURVIVING AN OPERATION TO CLEAR
UP THE OBSTRUCTION. AND AN ATTENDING PEDIATRICIAN TOLD THEM
THAT, EVEN IF “BABY DOE” DID SURVIVE, HE WOULD PROBABLY GROW UP
SEVERELY RETARDED AND ENDURE A POOR “QUALITY OF LIFE.”

BOTH THOSE PHYSICIANS WERE WRONG.
NEVERTHELESS, ON THE BASIS OF SUCH INFORMATION, THE PARENTS

OF “BABY DOE” ASKED THAT THEIR SON BE GIVEN NO FURTHER MEDICAL
ASSISTANCE OR NOURISHMENT OF ANY KIND.
13
THAT WAS “BABY DOE’S” DEATH SENTENCE.

THE CASE WAS IMMEDIATELY TAKEN TO COURT BY SOME OF THE
HOSPITAL STAFF ACTING ON “BABY DOE’S” BEHALF. BUT IT DIDN‘T
HELP, ON APRIL 15, ONE WEEK AFTER HIS BIRTH, “BABY DOE” DIED.
AND ALL THE COURT ARGUMENTS BECAME MOOT.

FRANKLY, THOUGH I WAS NOT A PARTY TO ANY OF THOSE PROCEED-
INGS, 1 WAS STUNNED BY WHAT HAD HAPPENED. AFTER ALL, I HAD JUST
COMPLETED 36 YEARS AS A PEDIATRIC SURGEON, DURING THAT TIME, I
HAD SUCCESSFULLY CORRECTED ESOPHAGEAL ATRESIA ON HUNDREDS OF
INFANTS. MY SUCCESS RATE WAS FAR HIGHER THAN 50-50: IN FACT, |
HAD NOT LOST A FULL-TERM BABY IN MY LAST 8 YEARS IN SURGERY AND I
HAD AN 88 PERCENT SURVIVAL RATE FOR PREMATURE BABIES.

MANY OF MY COLLEAGUES WERE DOING JUST AS WELL.
14
YET, AS THE NATION’S “SURGEON GENERAL,” NO LESS, I COULD NOT

DO FOR “BABY DOE” WHAT I HAD DONE FOR HUNDREDS OF OTHER BABIES
WITH THE SAME CONDITION,

ALSO, I WOULD NEVER HAVE DARED TO PREDICT WHAT THE “QUALITY
OF LIFE” MIGHT BE FOR AN INFANT WITH DOWN SYNDROME. PEOPLE WHO
PREDICT THE “QUALITY OF LIFE” FOR HANDICAPPED CHILDREN ARE THE
SAME PEOPLE WHO PREDICT THE WINNING NUMBERS IN ALL THE STATE
LOTTERIES.
15
MY FIRST INSTINCT WAS TO SPEAK OUT LOUD AND CLEAR ON BEHALF

OF “BABY DOE.” BUT I QUICKLY REALIZED THAT I WAS NOT ONLY “BABY
DOE'S” SURGEON GENERAL ... I WAS ALSO SURGEON GENERAL FOR HIS
PARENTS AND FOR THOSE TWO PHYSICIANS AS WELL.

“BABY DOE” NEEDED HELP ... BUT SO DID HIS PARENTS. LIKE
MANY OTHER PARENTS, THEY MAY HAVE SIMPLY LACKED THE RESOURCES --
BE THEY MATERIAL, SOCIAL, OR ECONOMIC ... OR EMOTIONAL, MORAL, OR
PSYCHOLOGICAL -- TO CARE FOR A DISABLED CHILD IN THEIR OWN
FAMILY,
16
YOU CAN’T URGE PARENTS TO FIGHT FOR THE LIVES OF THEIR

DISABLED OR HANDICAPPED CHILDREN ... AND THEN JUST WALK AWAY WHEN
THE FIGHT IS WON,

AS EVERY GRADUATE HERE WILL SURELY DISCOVER IN HIS OR HER
OWN PROFESSIONAL LIFE, EVERY OUTCOME -- SUCCESSFUL OR NOT --
GENERATES ITS OWN TRAJECTORY OF CONSEQUENCES.

I BELIEVE YOU MUST DO WHAT YOU THINK IS RIGHT ... PERIOD,
THAT’S FUNDAMENTAL.
17
BUT I ALSO BELIEVE YOU MUST PREPARE YOURSELF FOR THE

OUTCOME, AND ~~ TO THE EXTENT POSSIBLE AND PERMISSIBLE -- YOU
SHOULD HELP YOUR PATIENTS AND THEIR FAMILIES PREPARE THEMSELVES
AS WELL.

I BELIEVE THIS IS TRUE FOR EVERY PRACTICING HEALTH
PROFESSIONAL. BUT IT’S ESPECIALLY TRUE FOR THOSE PROFESSIONALS
IN UNIFORM IN PUBLIC SERVICE,
18
NEEDLESS TO SAY, THERE WERE MANY PHYSICIANS WHO AGREED WITH

“BABY DOE'S” PARENTS AND DID NOT AGREE WITH ME. I LISTENED TO
THEIR ARGUMENTS AND THEN SOMEHOW MANAGED TO HELP THEM MODIFY
THEIR OWN THINKING ENOUGH SO THAT ALL OF US ~~ PARENTS,
PHYSICIANS, CHILD ADVOCATES .. ALL OF US TOGETHER -- COULD COME
UP WITH A MORE RATIONAL AND MORE HUMANE WAY OF DEALING WITH
HANDICAPPED NEONATES THAN MERELY LETTING THEM STARVE TO DEATH,

I WON'T BORE YOU WITH ALL THE DETAILS. INSTEAD, LET ME
JUST SAY THAT WE NOW HAVE A LAW ON THE BOOKS THAT PROTECTS THE
LIVES OF FUTURE “BABY DOES,” WHILE STILL RECOGNIZING THE ROLE OF
PARENTS AND ATTENDING PHYSICIANS.
19
WHAT TRULY SURPRISED ME, HOWEVER, WAS THE ATTITUDE OF MY

MANY FRIENDS IN THE PRO-LIFE MOVEMENT. TO THEM, I HAD BECOME A
TURNCOAT, THEY SAID I WAS TEMPORIZING AND EVEN ABANDONING THE
ABSOLUTIST POSITIONS I HAD TAKEN -- SIDE-BY-SIDE WITH THEM -- FOR
MANY YEARS.

THEIR CRITICISMS WERE UNFAIR. MY PERSONAL IDEOLOGY HAD NOT
CHANGED ONE IOTA, IT IS ESSENTIALLY UNCHANGED TODAY. BUT MY
PUBLIC POSITION DID REQUIRE SOME ADDITIONAL THOUGHT.
20
I LEARNED THAT IN PUBLIC HEALTH MATTERS, IDEOLOGY CAN BE

HELPFUL ... BUT IDEOLOGY IS NOT ENOUGH. AS A PUBLIC PHYSICIAN IN
A UNIFORMED SERVICE ... SOMEONE WHO CAN’T ALWAYS PICK AND CHOOSE
WHERE I WILL PRACTICE AND WHOM I WILL SERVE, I HAD A RESPONSI-
BILITY TO BE TRUE TO MY OWN BELIEFS AND IDEALS ... BUT NEVER AT
THE EXPENSE OF THE PEOPLE WHOM I HAD TAKEN A SOLEMN OATH TO
SERVE.

FOLLOWING THE YEAR-LONG “BABY DOE” DIALOGUE, I CONVENED A
SERIES OF “SURGEON GENERAL'S WORKSHOPS” THAT FOCUSED ON THE NEEDS
OF THE HANDICAPPED CHILD AND HIS OR HER FAMILY. WHAT EVOLVED
WAS A CONCEPT OF “FAMILY-CENTERED, COMMUNITY-BASED, COMPREHENSIVE
CARE FOR CHILDREN WITH SPECIAL NEEDS.”
21
IT’S NEW,

AND IT WORKS,

AND IT'S BEING ADOPTED MORE AND MORE ALL ACROSS THE
COUNTRY.

IVE RECEIVED MUCH PRAISE FOR MY INVOLVEMENT WITH SMOKING
AND WITH AIDS. YET, I MUST CONFESS THAT I COUNT AS ONE OF MY
MAJOR ACHIEVEMENTS OF THESE PAST 8 YEARS THIS EVOLUTION OF A MORE
WIDESPREAD, MORE EFFECTIVE, AND MORE COMPASSIONATE APPROACH TO
CHILDREN WHO ARE BORN WITH A NON-FATAL HANDICAP.
22
AT ABOUT THIS SAME TIME SEVERAL OTHER ISSUES WERE

GERMINATING AT THE HIGHEST LEVELS OF PUBLIC HEALTH POLICY:
SMOKING, FAMILY VIOLENCE, THE HEALTH OF THE AGED, INFANT
MORTALITY, AND SO ON. BUT ONE WAS TO CONSUME MOST OF MY WAKING
HOURS FOR MY LAST THREE YEARS IN OFFICE.

THAT ISSUE, OF COURSE, HAS BEEN AIDS.

THE SUBJECT OF AIDS HAS BEEN COVERED SO EXTENSIVELY AND IN

SUCH DEPTH THAT [’LL JUST OFFER A COUPLE OF PERSONAL PERCEPTIONS
THIS MORNING,
23
FIRST, YOU MAY RECALL THAT, ON JUNE 5, 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 CARINII PNEUMONIA, A VERY RARE FORM OF PNEUMONIA.

THESE AND SUBSEQUENT PATIENTS ALSO PRESENTED EVIDENCE OF
CYTOMEGALOVIRUS AND CANDIDA INFECTIONS ... PLUS KAPOSI’S SARCOMA,
A HIGHLY UNCOMMON FORM OF CANCER ... ALSO, HERPES SIMPLEX,
CRYPTOCOCCAL MENINGITIS, SPLENOMEGALY, GENERALIZED
LYMPHADENOPATHY, TOXOPLASMOSIS, DISSEMINATED MYCOBACTERIUM

AVIUM-INTRACELLULARE, AND SO ON,
24
I’M SURE YOU’VE HEARD OF SOME OF THESE DISEASES. I’M ALSO

SURE YOU'VE SEEN VERY FEW OF THEM. AND THE TRUTH OF THE MATTER
IS THAT FROM THE VERY BEGINNING OF THIS EPIDEMIC, WE’VE BEEN

DEALING WITH MYSTERIES COMPOUNDED BY MYSTERIES.

OUR COUNTRY DID NOT HAVE MANY TRAINED CLINICIANS AND
RESEARCHERS FAMILIAR WITH THE RARE DISEASES ASSOCIATED WITH AIDS.
AND IN ANY CASE, WE HAD NO CURES FOR THEM.

IN ADDITION, HOMOSEXUAL MEN, AMONG WHOM THE AIDS SYMPTOMS
WERE BEING PRESENTED, HAD CHOSEN TO PATRONIZE PHYSICIANS AND
CLINICS WHO WERE MORE UNDERSTANDING OF THE SO-CALLED “GAY
LIFESTYLE.”
25
THIS CHOICE EFFECTIVELY PLACED A GREAT MANY HOMOSEXUALS

OUTSIDE MAINSTREAM CLINICAL MEDICINE AND, THEREFORE, MORE
DIFFICULT TO KNOW ... TO REACH ... AND TO HELP.

THIS ALSO OCCURRED -- NOT COINCIDENTALLY -- AT THE TIME OF
THE “GAY REVOLUTION,” WHEN HOMOSEXUAL AND BISEXUAL MEN WERE
“COMING OUT OF THE CLOSET” AND ASSERTING THEIR CIVIL RIGHTS.

UNFORTUNATELY, THE GAY ACTIVISTS COMBINED THE SEPARATE
HEALTH AND POLITICAL ISSUES INTO A SINGLE PACKAGE OF GRIEVANCES,
FOR WHICH THEY SOUGHT PUBLIC REDRESS. BUT THE PUBLIC HAS NEITHER
THE PATIENCE NOR THE SKILL TO SORT OUT THESE ISSUES. HENCE, THE
STRATEGY OF THE “GAY COMMUNITY” AROUSED MORE PUBLIC CONFUSION
AND ANGER THAN PUBLIC SYMPATHY.
26
AS A RESULT, OUR FIRST PUBLIC HEALTH PRIORITY -- THAT IS, TO

STOP FURTHER TRANSMISSION OF THE AIDS VIRUS -- BECAME HOPELESSLY
AND NEEDLESSLY MIRED IN THE SEXUAL POLITICS OF THE EARLY 1980s,

WE LOST SOME PRECIOUS TIME BECAUSE OF THIS ... AND I SUSPECT
WE LOST SOME LIVES AS WELL.

YET, DESPITE THE CONFUSION AND FRUSTRATION, THE ANGER AND
THE IGNORANCE, THE TERROR AND THE DEATH, BIOMEDICAL SCIENCE AND
RESEARCH DID PRESS FORWARD AND A RELIABLE BLOOD TEST WAS
DISCOVERED AND MADE GENERALLY AVAILABLE IN THE FALL OF 1985,
2/7
THAT REMAINS -- IN MY BOOK, ANYWAY -- ONE OF THE RESEARCH

MIRACLES OF THIS CENTURY.

I'D LOVE TO TAKE CREDIT FOR THE EARLY LEADERSHIP SHOWN BY
THE U.S. PUBLIC HEALTH SERVICE -- BUT I CAN’T. I WAS NOT
INVOLVED AT ALL IN THE EARLY DAYS OF THE AIDS EPIDEMIC. BUT FOR
A VERY MUNDANE REASON.

IN CASE YOU DON’T KNOW IT BY NOW, THE POSITION OF SURGEON
GENERAL IS SUPPORTED BY A HALF-DOZEN STAFF AND ENOUGH MONEY TO
BUY PAPER CLIPS AND NAME-TAGS. AND THAT'S ABOUT IT.
28
THE AIDS RESEARCH HAS BEEN CARRIED OUT AT THE NATIONAL

INSTITUTES OF HEALTH, THE CENTERS FOR DISEASE CONTROL, AND THE
FOOD AND DRUG ADMINISTRATION. THE SURGEON GENERAL RUNS NONE OF

THESE,

THE CASE REPORTING IS DONE BY STATE AND LOCAL PUBLIC HEALTH
AGENCIES. THEY'VE BEEN EXTRAORDINARY THROUGHOUT THE YEARS OF
THE AIDS EPIDEMIC. BUT I DON’T RUN THEM EITHER.

AND SO, THERE WAS LITTLE REASON TO GET THE SURGEON GENERAL
INVOLVED IN THE EARLY YEARS OF THE EPIDEMIC.
29
BUT SOMETHING WAS GOING ON IN 1985 AND 1986 THAT BROUGHT ME

INTO THE AIDS ISSUE. BY THAT TIME THE PUBLIC HAD BEEN RECEIVING
A GREAT MANY MIXED AND CONFUSING MESSAGES ABOUT THE DISEASE OF
AIDS.

HENCE, THE TIME HAD COME FOR THE GOVERNMENT TO INVEST ITS
CREDIBILITY IN ONE PERSON WHOSE TASK IT WOULD BE TO TELL THE
AMERICAN PEOPLE WHAT WE KNEW TO BE TRUE ABOUT THE AIDS EPIDEMIC
11. WHAT WE KNEW TO BE EALSE ABOUT THE EPIDEMIC ... AND WHAT WE
STILL DID NOT KNOW ABOUT THE AIDS EPIDEMIC.
30
IN FEBRUARY 1986, PRESIDENT REAGAN DIRECTED THAT I BE THAT

PERSON AND THAT I PREPARE A REPORT TO THE AMERICAN PEOPLE ON
AIDS. THE REPORT HAD TO GIVE THE FACTS ABOUT AIDS AND HOW PEOPLE
COULD PROTECT THEMSELVES FROM GETTING IT,

THE REPORT ALSO HAD TO EXPOSE THE FALSE MYTHOLOGIES THAT HAD
BEGUN TO APPEAR CONCERNING AIDS ... MYTHOLOGIES PERPETUATED BY
MEAN-SPIRITED PEOPLE WITH A MACABRE VIEW OF THE HUMAN CONDITION,

T MENTIONED THAT THE HOMOSEXUAL COMMUNITY HAD HOPELESSLY AND
NEEDLESSLY POLITICIZED THE AIDS ISSUE IN THE BEGINNING. IN ALL
FAIRNESS, I MUST RECALL THAT THE ISSUE WAS EURTHER POLITICIZED --
AGAIN, NEEDLESSLY AND CALLOUSLY -- BY EXTREME CONSERVATIVES,
PEOPLE FOR WHOM IDEOLOGY WAS EVERYTHING,

 
31
THEY CHEERED THE PRESIDENT’S DECISION. BUT MANY OF THEM

MISTAKENLY PREDICTED THAT I WOULD PRODUCE THE “RIGHT” KIND OF
REPORT, APPROPRIATELY LAUNDERED TO THEIR LIKING.

AFTER 8 MONTHS OF LISTENING TO ALL SHADES OF OPINION --
LEFT, RIGHT, AND CENTER -- FROM A BROAD CROSS-SECTION OF AMERICAN
PUBLIC LIFE, I RELEASED MY REPORT DIRECTLY TO THE PUBLIC AT AN
OCTOBER 1986 PRESS CONFERENCE,

I CONFESS THAT I KNEW WELL IN ADVANCE THAT MY FRIENDS IN
CONSERVATIVE PROTESTANT SECTS AND IN THE CATHOLIC CHURCH --
FRIENDS AND ALLIES IN MANY PAST BATTLES AGAINST ABORTION -- I
KNEW THAT THEY WEREN’T GOING TO LIKE MY REPORT.
32
THEY VIEW ANAL INTERCOURSE -- OR SODOMY -- AS A VIOLATION

OF LAWS BOTH SPIRITUAL AND TEMPORAL. SO DO 1,

BUT THAT WAS HARDLY THE ISSUE IN 1986, THE ISSUE THEN WAS
THAT ANAL INTERCOURSE WAS THE PRIME METHOD OF TRANSMISSION OF THE
VIRUS. WE HAD TO RECOGNIZE THAT FACT AND THEN WE HAD TO
CONVINCE MEN TO STOP DOING IT,

BUT WHAT IF THEY DID NOT STOP? WHAT THEN? AND THAT LED ME
TO A SECOND CONCLUSION THAT FURTHER IRRITATED MANY OF MY OLD
FRIENDS AND ALLIES.
33
IF HOMOSEXUALS AND BISEXUAL MEN PERSISTED IN ENGAGING IN

ANAL INTERCOURSE, ESPECIALLY WITH ANONYMOUS OR CASUAL SEX
PARTNERS, THEN THEY HAD TO PROTECT THEMSELVES WITH SOME KIND OF
IMPERMEABLE BARRIER TO TRANSMISSION.

SUCH BARRIERS ARE COMMONLY KNOWN AS CONDOMS, AND I'M AFRAID
THAT I MADE CONDOMS THE “C-WORD” OF 1986 AND ‘87,

BUT I NEVER CONSIDERED THEM TO BE OUR FIRST LINE OF DEFENSE
-- AND I STILL DON’T. I ALWAYS TOLD MY AUDIENCES THAT ABSTINENCE
WAS FIRST ... FAILING THAT, THE NEXT BEST DEFENSE WAS A MUTUALLY
FAITHFUL, MONOGAMOUS RELATIONSHIP ... AND FAILING THAT, THEN
YOU'D BETTER USE CONDOMS,

 
34
BUT THAT WAS HARDLY THE END OF IT. FROM THE DATA GIVEN 10

ME BY THE CENTERS FOR DISEASE CONTROL, I LEARNED THAT THE MEDIAN
AGE OF AIDS VICTIMS WAS QUITE LOW, YOUNG MEN IN THEIR EARLY 20s.

AND BY THEN WE ALSO KNEW THAT A PERSON COULD CARRY THE AIDS
VIRUS FOR AS LONG AS 7 YEARS -- POSSIBLY LONGER -- BEFORE SHOWING
SIGNS OF AN OPPORTUNISTIC INFECTION ... KAPOSI’S SARCOMA,
PNEUMOCYSTIC CARINIT PNEUMONIA, CYTOMEGALOVIRUS, AND SO ON.

WHAT DID THAT MEAN? THAT MEANT THAT THOSE YOUNG MEN WHO
WERE REPORTED AS AN AIDS-RELATED DISEASE HAD VERY POSSIBLY BECOME
INFECTED WITH THE AIDS VIRUS WHEN THEY WERE STILL IN THEIR TEENS,
35
AND THAT MEANT THAT THE WHOLE AIDS ISSUE -~ COMPLETE WITH

EDUCATION PRECEDING THE ONSET OF SEXUAL EXPERIMENTATION AND --
YES -- INCLUDING DISCUSSIONS ABOUT CONDOMS -- ALL THAT WOULD
SOMEHOW HAVE TO BE INTRODUCED INTO OUR SECONDARY SCHOOLS, WITH
SOME PREPARATION NECESSARY IN OUR ELEMENTARY SCHOOLS AS WELL.

PLEASE REMEMBER THAT WE DID NOT HAVE THEN -- AND WE DO NOT
YET HAVE -- AN EFFECTIVE AND GENERALLY AVAILABLE VACCINE. THAT’S
STILL YEARS AWAY. THEREFORE, OUR SINGLE WEAPON AGAINST AIDS --
IN 1986 AND 1987 AND FOR MANY MORE YEARS TO COME -- WAS AND WILL
CONTINUE TO BE EDUCATION ... EDUCATION ... AND MORE EDUCATION.

I WAS PROMPTLY AND WITLESSLY ACCUSED OF TEACHING SODOMY TO
THIRD-GRADERS AND PASSING OUT CONDOMS TO 8-YEAR-OLDS. AND THERE
HAS BEEN MORE OF THAT.
36
I WAS VERY ANNOYED AT ALL THIS, BUT NOT BECAUSE OF THE

PERSONAL ATTACKS. I KNEW THOSE WOULD HAVE NO LASTING EFFECT ON
ME. THEY NEVER HAVE.

RATHER, I WAS ANNOYED AT THOSE FEW CRITICS WHO -- BY
ATTACKING ME -- WERE HOPING TO COMPROMISE THE GOVERNMENT’S
ABILITY TO DELIVER THE FACTS ABOUT AIDS TO THE AMERICAN PEOPLE.
THEY WERE PLAYING WITH FIRE. AND I THINK THEY KNEW IT.

YOU MUST ALSO REMEMBER THAT MY PREDECESSORS HAD SO CONDUCTED
THEMSELVES AS SURGEONS GENERAL SUCH THAT THIS OFFICE WAS AMONG
THE MOST CREDIBLE AND RELIABLE IN THE GOVERNMENT ... THE ENVY OF
SOME PRESIDENTS, I MIGHT ADD.
3/7
NOW IT WAS MY JOB TO SAY WHAT WAS NECESSARY IN THIS VERY

COMPLEX AND EMOTIONALLY CHARGED ISSUE OF AIDS -- BUT I ALSO HAD
TO MAINTAIN THE CREDIBILITY OF THIS OFFICE FOR MY SUCCESSORS AND
FOR THE NATION. I'D LIKE 10 THINK THAT I DID BOTH,

IN ANY CASE, WHEN MY SUCCESSOR ARRIVES, I HOPE THAT HE OR
SHE WILL FIND THE OFFICE AS STRONG -- IF NOT STRONGER -- THAN IT
WAS WHEN I ARRIVED SOME 8 YEARS AGO,

OBVIOUSLY, AS I INDICATED AT THE BEGINNING OF THESE REMARKS,
I DID NOT LOCK AWAY MY PERSONAL BELIEFS AND PERSONAL ETHICS
BEFORE COMING TO WASHINGTON. I DREW UPON THEM CONTINUOUSLY TO
GIVE ME MY DIRECTION AND MY STRENGTH,
38
THE RESULTS WERE NOT ALWAYS PREDICTABLE. SOMETIMES I WAS AS

SURPRISED AS EVERYONE ELSE BY THE CONCLUSIONS I REACHED IN THE
COURSE OF DOING MY JOB FOR THE PEOPLE OF THIS COUNTRY.

BUT SO BE IT.

AND 1 GUESS THAT’S THE SUM AND SUBSTANCE OF MY MESSAGE TO
THE CLASS OF 1989, IT’S NOT VERY ORIGINAL ... EVEN THOUGH EACH
PERSON HAS TO DISCOVER IT IN HIS OR HER OWN GOOD TIME. BUT THE
MESSAGE IS SIMPLY THIS:
39
KNOW YOURSELF ... AND BE TRUE TO YOURSELF ... AND

EVERYTHING ELSE WILL FOLLOW,

I’D RECOMMEND THAT MOTTO TO EVERY GRADUATE. BUT I BELIEVE
IT HAS SPECIAL RELEVANCE TO PEOPLE LIKE YOU AND ME, WHO HAVE
CHOSEN TO SERVE OUR COUNTRY.

TO EACH OF YOU... TO YOUR FAMILIES .., AND TO YOUR FRIENDS
. I WISH YOU GODSPEED.

THANK YOU.
HHH #