[°° Vet o- let A SPEECH & PM 1ad-24-d7 AMERICAN RED CROSS/ROCHESTER-MONROE COUNTY CHAPTER ROCHESTER, NY CE. KOOP, MD Cl hn ke Sante Stl — — 100 ye — Po kini A Wn Botany Plage Hao IT'S A LITTLE HARD TO GET USED TO THESE CLOTHES, FOR IT'S BEEN rw PSESSEESMGRESAHEN ONE MONTHSSINCE I HUNG IN MY CLOSET THE UNIFORM OF THE SURGEON GENERAL, NEVER TO PUT IT ON AGAIN, 1 AM, OF COURSE, GRATEFUL TO RONALD REAGAN FOR NOMINATING ME AND THEN RENOMINATING ME TO THE OFFICE OF SURGEON GENERAL. BEFORE THEN, I HAD ENJOVED, FOR 40 YEARS A WONDERFUL CAREER AS SURGEON-IN-CHIEF AT THE CHILDRENS ' HOSPITAL OF PHILADELPHIA, AS WELL AS TWO PROFESSORSHIPS AT THE UNIVERSITY OF PENNSYLVANIA, 1 THOUGHT THAT NOTHING COULD EVER COMPARE WITH THAT, BUT THE JOB OF SURGEON GENERAL DID. I LOVED EVERY MINUTE OF IT. . . . WELL, ALMOST EVERY MINUTE. NOW I ENTER THE PRIVATE SECTOR, FEELING THAT PUBLIC SERVICE IS TTS OWN REWARD, ESPECIALLY WHEN IT IS APPRECIATED, T INTEND TO CONTINUE TO SPEAK OUT WHEN I CAN TO IMPROVE THE HEALTH OF THE AMERICAN PEOPLE. I DON'T HAVE THE POWER OF A PUBLIC OFFICE NOW, BUT I DON'T HAVE ITS CONSTRAINTS EITHER. EVEN AS SURGEON GENERAL I USED TO SAY SOMEWHAT FACETIOUSLY THAT | HAD NO POWER AND NO BUDGET. THAT IS CORRECT. BUT T ACCOMPLISHED MUCH BY SPENDING OTHER PEOPLE'S MONEY. AND I HAD THE POWER OF MORAL SUASION TO CHANGE PUBLIC POLICY. I MAY HAVE HAD THE REPUTATION FOR STRAIGHT AND FRANK TALK, BUT BELIEVE ME I NEVER SHOT FROM THE HIP. T WOULD NOT HAVE HAD THE POWER OF MORAL SUASION IF MY PREDECESSORS HAD NOT JEALOUSLY GUARDED THE OFFICE OF THE SURGEON GENERAL TO MAKE IT PERHAPS THE MOST CREDIBLE IN GOVERNMENT. AT TIMES, THE ENVY OF PRESIDENTS, I MIGHT ADD. MY APPOINTMENT BY RONALD REAGAN DID NOT MEET WITH UNQUALIFIED ENTHUSIASM. TO CALL MY APPOINTMENT AS SURGEON GENERAL "CONTROVERSIAL" IS A GROSS UNDERSTATEMENT. I WAS ATTACKED BY THE PRESS AS BEING UNQUALIFIED, AN IDEOLOGUE, AND THE WORST APPOINTMENT AS SURGEON GENERAL IN THE HISTORY OF THE OFFICE, IN THE SHORT TIME WE HAVE TOGETHER TODAY, I'D LIKE TO HIT SOME OF - Witt 16 tA MCR THE HIGH SPOTS OF MY 8 YEARS AS SURGEON GENERAL, ANDSEHENSEBER TO THE FUTURE. THAT SHOULD PROVIDE A BASIS FOR YOUR QUESTIONS, ALTHOUGH YOU DON'T NEED TO CONFINE YOUR QUESTIONS TO THE SUBJECTS I MENTION, I'M SURE AIDS 1S NOT A NEW TOPIC FOR ANYONE IN THIS ROOM. AFTER ALL I WROTE EACH OF VOU A LETTER ABOUT AIDS A YEAR AGO. AT LEAST. ~T SENT THE AIDS MAILER TO 107 MILLION HOUSEHOLDS. 1 HOPE vou | RECEIVED YOURS. — AND YET I'M SURE THERE ARE STILL MANY PEOPLE RIGHT HERE IN THIS AUDIENCE WHO ARE STILL UNCLEAR ABOUT THE NATURE OF THE DISEASE OF AIDS. VOU MAY RECALL THAT, IN 1981, THE U8. PUBLIC HEALTH SERVICE PUBL ISHED THE FIRST REPORTS OF WHAT WAS TO BECOME THE AIDS EPIDEMIC. THEY CONCERNED 5 "PREVIQUSLY HEALTHY" HOMOSEXUALS WHO WERE ADMITTED TO LOS ANGELES HOSPITALS WITH PNEUMOCYSTIS CARINII Aen Ae cee etm ey ee te eI ce ine mm ee es Gere my ate ree PNEUMONIA, A VERY RARE FORM OF PNEUMONIA, BY THE TIME THE REPORT HAD BEEN PUBLISHED, 2 OF THE MEN HAD DIED, THE OTHER 3 DIED SHORTLY THEREAFTER. THEN, A MONTH LATER, THE PUBLIC HEALTH SERVICE PUBLISHED A REPORT © THAT 26 YOUNG MEN HAD BEEN RECENTLY DIAGNOSED AS HAVING KAPOSI'S SARCOMA, "AN UNCOMMONLY REPORTED" CANCEROUS CONDITION USUALLY FOUND IF AT ALL AMONG ELDERLY MEN, FROM THAT SMALL BEGINNING THE CASES MUSHROOMED INTO THE EPIDEMIC OF THE LATE 19805, THE FIRST THING TO KNOW IS THAT THE AIDS VIRUS 1 STILL THAT'S THE PREMISE FOR EVERYTHING WE DO. WE'VE GOT A KILLER DISEASE ON OUR HANDS AND IT'S REACHING FARTHER AND DEEPER INTO OUR SOCIETY EVERY DAY, OUR STATISTICIANS PREDICTED TWO YEARS AGO THAT THE AIDS EPIDEMIC WOULD CONTINUE TO GROW AND SPREAD WELL INTO THE 1990'S ... AND I'M AFRAID. THEY WERE RIGHT. ~ AS OF LAST WEEK WE HAD 109 THOUSAND CASES WITH ne ae cee ee ee ee ee ee ee ee ee ee ee ee AND 1 1/c 10 3 MILLION CARRYING THE VIRUS. SOME OF THEM KNOW THEY HAVE IT AND SOME DON'T, BUT THEY ARE ALL INFECTIOUS TO OTHER PEOPLE THROUGH INTIMATE SEXUAL CONTACT OR SHARING PARAPHANAL IA WHEN THEY SHOOT DRUGS. THAT'S WHY I PREFER TO SPEAK OF HIV INFECTION --NOT AIDS-- BECAUSE IT HELPS FOCUS ON THE ENORMITY OF THE PROBLEM. ALMOST HALF THE NUMBER OF PEOPLE WHO WERE REPORTED WITH AIDS JUST aU, EVEN THOUGH WE DON'T KNOW EVERYTHING ABOUT THIS DISEASE, WE DO KNOW ONE THING FOR CERTAIN: IF YOU HAVE AIDS, YOUR CHANCES OF SURVIVING THE NEXT TWO OR THREE YEARS ARE NOT VERY GOOD. BUT YOUR CHANCES OF SURVIVING ANY IN FEBRUARY 1986, PRESIDENT REAGAN ASKED THE SURGEON GENERAL TO PREPARE A REPORT TO THE AMERICAN PEOPLE ON AIDS. THE REPORT HAD 10 GIVE THE FACTS ABOUT AIDS AND TELL PEOPLE HOW TO PROTECT THENSEL ES FROM GETTING IT. AFTER 8 MONTHS OF LISTENING TO ALL SHADES OF QPINION -- LEFT, RIGHT, AND CENTER -- FROM A BROAD CROSS-SECTION OF OUR SOCIETY, 1 RELEASED MY REPORT DIRECTLY TO THE ANERICAN PEOPLE AT AN OCTOBER 1984 PRESS CONFERENCE. AIDS 1S TRANSMITTED IN FOUR WAYS ... AND IN ONLY FOUR WAYS: * JHE FIRST WAY IS MOST COMMON ROUTE OF TRANSMISSION IS SEYUAL INTERCOURSE ... MOSTLY BUT NOT EXCLUSIVELY ANAL INTERCOURSE, | WHICH OCCURS MOST FREQUENTLY AMONG HOMOSEXUALS AND BISEXUAL MALES. THIS ACCOUNTS FOR ABOUT TWO-THIRDS OF :ALL CASES OF AIDS, HOWEVER, AIDS IS TRANSMITTED THROUGH HETEROSEXUAL INTERCOURSE. AND EVEN THOUGH THE STATISTICAL INCIDENCE OF HETEROSEXUAL ~ TRANSMISSION IS LOWER, IT IS JUST AS FATAL. DON'T FOOL AROUND. * AIDS 15 ALSO TRANSMITTED INTO THE BLOOD OF INTRAVENOUS DRUG ADDICTS WHO USE THE NEEDLES AND SYRINGES OF OTHER ADDICTS ALREADY INFECTED WITH AIDS VIRUS. * THE VIRUS CAN ALSO BE TRANSMITTED FROM AN AIDS-INFECTED MOTHER TO HER INFANT DURING PREGNANCY OR AT THE TIME OF DELIVERY, * — AND FINALLY, AIDS CAN BE TRANSMITTED THROUGH TRANSFUSED BLOOD OR BLOOD PRODUCTS. BUT, AS MOST OF YOU KNOW, THIS DANGER IS NOW ALMOST STATISTICALLY INSIGNIFICANT. —Beruc |! bo AM Ftp / wing wa Ri aw7- FuARD eH APTA With? WE eRe Lo 1 O87 Kan MERE Wo BE iy HE Franz Biome We sey Eo THE VR) We sew LTS Phat Ena? - ARE eT bopey- fw PRFecaeg A 1837. TR AT. MabE 17 POSS hE oe Sched Bled Fon Pawspsun We RED CHS did ae BST awh VE me TE Suet Blew TL THAT 17 3 POSSE hkuce- NATAL dD A S7ER DD framict «am AND, THERE ARE FOUR KEY ASPECTS OF THE DISEASE OF nis: ONE, THAT IT'S SPREADING ... TWO, THAT IT'S FATAL... THREE, THAT WE DON'T HAVE A CURE YET ... AND FOUR, THAT IT'S SPREAD MAINLY BY CERTAIN SPECIFIC BEHAVIORS INVOLVING SEX AND/OR DRUGS. THESE FOUR ASPECTS MAKE THE AMERICAN PEOPLE VERY EDGY ABOUT AIDS. AND rea CERTAINLY UNDERSTANDABLE. BUT THE FACT REMAINS THAT YOU HAVE TO MAKE A CONSCIOUS DECISION TO CARRY QUT A SPECIFIC FORM OF PERSONAL BEHAVIOR BEFORE YOU EXPOSE YOURSELF TQ THE AIDS VIRUS. DON'T DO IT. THE ONLY WEAPON WE HAVE AGAINST THIS DISEASE IS EDUCATION, EDUCATION, AND MORE EDUCATION. AIDS MAY BE THE MOST DEADLY DISEASE ON THE HORIZON, THE MOST UNIQUE CHALLENGE TO US, BUT IT IS NOT THE GREATEST KILLER OR THE GREATEST BURDEN ON THE HEALTH CARE SYSTEM. THAT NOTORIETY GOES TO SMOKING-RELATED DISEASE, THE EVIDENCE AGAINGT SMOKING BUILDS EVERY YEAR, AND THE ANERICAN PEOPLE ARE BELIEVING IT, AS YOUR SURGEON GENERAL I RELEASED 8 ANNUAL REPORTS ON SMOKING. THEY HAVE DEALT WITH CANCER, CARDIOVASCULAR DISEASE, CANCER IN WOMEN, SMOKING IN THE WORKPLACE, CHRONIC OBSTRUCTIVE LUNG DISEASE, INVOLUNTARY SMOKING OR WHAT IS SOMETIMES CALLED "PASSIVE SMOKING," AND THE ADDICTIVE QUALITIES OF NICOTINE, EACH ONE HAS ITS OWN SPECIFIC AND IMPRESSIVE DATA BASE. ro0AV, THE SMOKING-AND-HEALTH RESEARC! BASE IS STILL GROWING. IT IS COMPRISED OF MORE THAN 60,000 PUBLISHED ARTICLES. AGAIN, THE | VAST MAJORITY QUITE CLEARLY REINFORCES THE FACT THAT CIGARETTE SMOKING 1S THE SINGLE MOST IMPORTANT FACTOR BEHIND ACUTE AND CHRONIC MORBIDITY AND PREMATURE MORTALITY AMONG ADULTS. AS THIS RESEARCH BASE EXPANDED, SO DID OUR EFFORTS TO EDUCATE THE PUBLIC ... T0 GET THOSE WHO SMOKE, TO STOP ... AND THOSE WHO DON'T SMOKE, TO NEVER START. IN 1984, | WAS PERSONALLY SO CONVINCED BY THE DATA ACCUMULATED THUS FAR THAT I CALLED UPON MY FELLOW CITIZENS TO MAKE THE UNITED STATES A "SMOKE-FREE SOCIETY BY THE YEAR 2000." WE'LL ACHIEVE THAT SMOKE-FREE SOCIETY BECAUSE WE WILL GRADUATE A CLASS FROM HIGH SCHOOL IN 2000 THAT WILL HAVE HAD 12 YEARS oF ANTISMOKING HEALTH MESSAGES. 1T STARTED THE YEAR BEFORE LAST, IN THE FIRST GRADE. TEACHING THAT YOUNG WILL WIN. FEW THINGS BRINGS ME AS MUCH SATISFACTION AS THE DRAMATIC DECREASE IN SMOKERS DURING THE LAST 8 YEARS, FROM 33. PERCENT 10 26 PERCENT. BUT THERE IS MORE TO DO. SMOKING IS STILL THE SINGLE MOST DEADLY "HABIT" ... WITH HIGHER MORTALITY AND MORBIDITY THAN DRUGS, AUTOMOBILES, AND AIDS ABOUT THE DISEASE, 8 YEARS, EQUALS THE SMOKING DEATHS OF ONLY 4 MONTHS. SMOKING IS THE ROOT CAUSE OR THE MOST SIGNIFICANT CAUSE FOR ABOUT LEADING KILLERS OF AMERICANS. SOME 50 MILLION AMERICANS STILL SMOKE, MAKING A MAJOR IMPACT ON THE NATIONAL HEALTH BUDGET ... AND THEIR OWN PERSONAL AND FAMILY ee ee cee ts ee oe ee oe HEALTH BUDGETS. BUT THE TOBACCO INDUSTRY HAS NOT GIVEN UP T DOUBT THAT YOU CAN FIND A MORE HEAVY-HANDED, OBTUSE, IMPOLITIC, AND UNTRUTHFUL GROUP OF CORPORATIONS ANYWHERE IN THE GREAT PANOPLY OF AMERICAN PRIVATE ENTERPRISE. ALMOST FROM MY FIRST 7 IN OFFICE, THE INDUSTRY REMINDED ME AGAIN AND AGAIN -- AND NOT VERY SUBTLY EITHER -- THAT I OUGHT TO GET OFF MY ANTI-SMOKING "HOBBY-HORSE," AS ONE TOBACCO LOBBYIST CALLED IT, AND PAV ATTENTION TO OTHER, ALLEGEDLY MORE IMPORTANT PUBLIC HEALTH MATTERS, ECHOES OF THEIR COMPLAINTS WERE RELAYED TO ME FROM THE WHITE HOUSE, THE CONGRESS, AND EVEN FROM MEMBERS OF THE PRESS, WHO HAVE OFTEN BEEN THE GULLIBLE CARRIERS OF THE INDUSTRY'S DISASTROUS MESSAGE. . T ALSO READ THEIR DECEPTIVE, FULL-PAGE ADVERTISEMENTS THAT LIFTED NENDACITY AND HALF-TRUTHS TO A NEW AND HIGHER LEVEL OF FAUSTIAN ART. ‘TO BE PERFECTLY HONEST, I DID NOT ASSUME THE POSITION OF SURGEON GENERAL WITH THE CLEAR INTENTION OF BEING SO PRO-ACTIVE AN OPPONENT OF TOBACCO AS T HAVE BEEN. BUT THEN T-BEGAN TO STUDY IN SOME DEPTH THE INCONTROVERT IBLE TRUTHS ABOUT tHe HEALTH HAZARDS © OF SMOKING. AND I MUST TELL YOU THAT 1 WAS AT FIRST DUMBFOUNDED AND THEN PLAINLY FURIOUS AT THE TOBACCO INDUSTRY FOR ATTEMPTING TO OBFUSCATE AND TRIVIALIZE THIS EXTRAORDINARILY IMPORTANT PUBLIC HEALTH INFORMATION, HOW COULD THE TOBACCO INDUSTRY DARE TO DISMISS AS UNFOUNDED AND UNPROVEN THE ABSOLUTELY CLEAR CONNECTION BETWEEN SMOKING AND HEART DISEASE ... BETWEEN SMOKING AND DEATHS FROM STROKE ... BETWEEN SMOKING AND CANCER OF THE LUNG, THE MOUTH, THE ESOPHAGUS, — AND OF THE STOMACH ... AND BETWEEN SMOKING AND A mnzen OR MORE SERIOUS, DEBILITATING, EXHAUSTING, EXPENSIVE, AND HUMTLIATING DISEASES? HOW COULD THEY DARE TO DO THAT? I WONDERED. THE ANSWER WAS ... THEY JUST DID. AND THEY FLAUNTED THEIR ABILITY TO BUY THEIR WAV INTO THE MARKETPLACE QF IDEAS AND POLLUTE IT WITH THEIR FALSE AND DEADLY INEORMATION. SQ OUR EDUCATION CAMPAIGNS, QUR SELF-HELP GROUPS MUST CONTINUE THETR GOOD WORK. WE MUST GUARD AGAINST COMPLACENCY, AND INTENSIFY QUR EFFORTS TO ELIMINATE THE GREATEST CAUSE OF PREVENTABLE DISEASE AND DEATH AFFLICTING QUR SOCIETY. THERE IS ANOTHER ISSUE CONCERNING TOBACCO, QUR SOCIETY IS NOT THE ONLY ONE AFFECTED, THE BATTLE AGAINST SMOKING WORLDWIDE IS OUR BUSINESS TOO. IT IS OUR CONCERN NOT ONLY BECAUSE OF A GENERAL INTEREST IN COMBATING DISEASE AND DEATH, BUT ALSO BECAUSE IT AFFECTS oF ABILITY TO COUNTER THE PLOYS OF THE TOBACCO INDUSTRY, AND IT 1S PART GF QUR WAR ON DRUGS. THE DECLINE IN TOBACCO COMPANY EARNINGS FROM THE SALE OF CIGARETTES TO AMERICANS IS BEING OFFSET BECAUSE CIGARETTE COMPANIES ARE EXPLOITING MARKETS OVERSEAS, IN ONE OF THE MOST DISGRACEFUL EXAMPLES OF PRIVATE ENTERPRISE GONE AMOK, THE CIGARETTE INDUSTRY IS FOCUSING:ITS HIGH-POWERED MARKETING ATTENTION ON THE UNPROTECTED CITIZENS OF THIRD-WORLD NATIONS IN ASIA, AFRICA, AND SOUTH ANERICA. AS A RESULT, THOSE NATIONS ARE NOW BEGINNING TO EXPERIENCE THE GAME RISE IN OMOKING-RELATED DISEASES THAT WE EXPERIENCED A GENERATION AGO ... HEART DISEASE, STROKE, AND CANCER OF THE LUNG, MOUTH, ESOPHAGUS, AND STOMACH. AND AS AN AMERICAN CITIZEN, I AM APPALLED BY THIS CORPORATE BEHAVIOR OF AMERICAN COMPANIES AND, FURTHER, I AM SHOCKED BY THE OUR OWN GOVERNMENT'S SUPPORT OF SUCH BEHAVIOR. IN 1987 IN TOKYO, REPRESENTATIVES OF 15 ASIAN COUNTRIES ATTENDED A WORLD HEALTH ORGANIZATION "REGIONAL WORKING GROUP ON TOBACCO OR HEALTH." HERE ARE SOME OF THE THINGS REPORTED AT THAT MEETING BY THE TOP HEALTH EXPERTS FROM THOSE 15 ASIAN COUNTRIES: SAYING SOMETHING IN ITSELF. THE ALARMING THING ABOUT THIS HABIT IS THAT, WHEN IT INVADES A NEW MARKET, IT DOES SO WITH IMMENSE SPEED AND IMPACT. ACCORDING TO THE WORLD HEALTH ORGANIZATION, BETWEEN 1971 AND 1981 CIGARETTE CONSUMPTION INCREASED IN ASIA AND LATIN AMERICA AT A RATE 30 AND LISTEN CAREFULLY TO THIS: IN CHINA, WHERE COUPLES ARE SUPPOSED TO HAVE ONLY 1 CHILD PER FAMILY, THERE ARE AT THIS MOMENT AN ESTIMATED 50,000,000 CHILDREN RUNNING AROUND TODAY WHO WILL EVENTUALLY DIE PREMATURELY FROM SMOKING. SECOND -- AND HERE'S WHERE WE DESERVE TO GQUIRM IN SHAME -- IN 10 OF THOSE 15 ASIAN COUNTRIES, AMERICAN CIGARETTES WERE THE MOST COMMON KIND IMPORTED. BUT THOSE AMERICAN CIGARETTES ARE A LITTLE DIFFERENT OVERSEAS: FOR ONE THING, THEY DON'T CARRY THE SURGEON GENERAL'S WARNING. AND FOR ANOTHER, MANY AMERICAN CIGARETTES MANUFACTURED FOR EXPORT eee ae et ree te aoe es ee ee ce ss ae Ge oni eee THAN THE LOWER-TAR, FULLY-LABELLED PRODUCTS SOLD HERE IN THE UNITED STATES. AND NOT SURPRISINGLY, THESE SAME 15 COUNTRIES REPORTED THAT COMMUNICABLE DISEASE WAS NO LONGER THE NUMBER ONE PUBLIC HEALTH MENACE IN ASIA. TODAY, THE TOP THREE CAUSES OF DEATH IN ASIA ARE -~ CAN YOU GUESS? -- THE SAME THREE SMOKING-RELATED CAUSES OF DEATH THAT PREVAIL HERE IN THE UNITED STATES: HEART DISEASE, CANCER, AND STROKE, T SHOULD ADD THAT MR. J.T. BUNN, THE TOBACCO EXPORTER, WARNED ME LAST FEBRUARY THAT IF I CONTINUE TO PROMOTE ANTI-SMOKING CAMPAIGNS WORLDWIDE -- WHICH I HAVE SURELY DONE -- I WOULD BE "TELLING OUR FOREIGN FRIENDS HO TO CONDUCT TRADE AND HOW TO CHANGE THEIR HABITS. IT PROJECTS FOR THE U.S. AN IMAGE OF ‘THE UGLY AMERICAN, '" SAID MR. BUNN IN ONE OF THE BEST DEMONSTRATIONS OF BARE-FACED CYNICISM I HAVE HAD THE PRIVILEGE TO ENCOUNTER. TAIWAN PEDUCED SMOKING IN '85 AND "84 BY 5% AND dt RESPECTIVELY. BUT WHEN. THE AMERICAN THREAT TO IMPOSE TRADE SANCTIONS FORCED THEM TO OPEN THEIR DOORS TO AMERICAN CIGARETTE ADVERTISING, SMOKING INCREASED BY 10 PERCENT. THE COSTS oF THE RESULTING DISABILITY AND DEATH WILL EXCEED THE ABILITY OF TAIWAN TO PAY. I DO NOT BELIEVE THE UNITED STATES WILL EVER AGAIN BE A GOOD MARKET FOR TOBACCO PRODUCTS. THE CURVE IS GOING DOWN AND ACCELERATING. AND I FEEL QUITE GOOD ABOUT THE ROLE I BELIEVE I PLAYED IN BRINGING ABOUT THIS MARKET CHANGE. WE HAVE BEATEN THE CIGARETTE INDUSTRY ON ITS OWN HOME TURF ... BUT WE'VE DRIVEN THEM TO SCOUR THE REST OF THE EARTH FOR NEW VICTIMS. IT 1S THE HEIGHT OF HYPOCRISY FOR THE UNITED STATES, IN OUR WAR AGAINST DRUGS, TO DEMAND THAT FOREIGN NATIONS: TAKE STEPS TO STOP THE EXPORT OF COCAINE TO OUR COUNTRY WHILE AT THE SAME TIME WE EXPORT NICOTINE, A DRUG JUST AS ADDICTIVE AS COCAINE, TO. THE REST OF THE WORLD. [ MUST CONFESS THAT, WHILE I RECEIVE MUCH PUBLIC PRAISE FOR MY INVOLVEMENT WITH SMOKING AND WITH AIDS, I COUNT AS ONE OF MY MAJOR ACHIEVEMENTS OF THESE PAST 8 YEARS THE EVOLUTION OF A MORE winespatan, MORE EFFECTIVE, AND NORE COMPASSIONATE APPROACH TO. CHILDREN WHO ARE BORN WITH A NON-FATAL HANDICAP. FOLLOWING THE YEAR-LONG "BABY DOE" DIALOGUE IN 1982, I CONVENED A SERIES OF “SURGEON GENERAL'S WORKSHOPS” THAT FOCUSED ON THE NEEDS QF THE HANDICAPPED CHILD AND HIS OR HER FAMILY. I INVITED PHYSICIANS, NURSES, SOCIAL WORKERS, HOSPITAL PERSONNEL , COMMUNITY ACTIVISTS, CHILD ADVOCATES, AND OTHERS. WHAT HAS EVOLVED IS “FAMILY-CENTERED, COMMUNITY-BASED, COMPREHENSIVE CARE FOR CHILDREN WITH SPECIAL NEEDS." IT'S A NEW CONCEPT. IT WORKS, AND IT'S BEING ADOPTED MORE AND MORE ALL ACROSS THE COUNTRY. ONE OF THE MOST DIFFICULT TIMES IN THE LIVES OF A HANDICAPPED CHILD AND HIS OR HER FAMILY COMES WHEN THAT CHILD QUTGROWS THE KIND OF CARE PROVIDED BY THE PEDIATRICIAN AND NEEDS TO BE HANDED ON TO THE WAITING AND CAPABLE 1000s OF A PRACTITIONER OF ADULT OR FAMILY MEDICINE. SOMETIMES THAT TRANSITION WORKS VERY WELL. BUT MOST OF THE TIME IT DOESN'T, I THINK WE ALL KNOW THAT. AND I THINK WE ALL WANT TO DO SOMETHING ABOUT IT. THE GUARANTEE OF CONTINUITY OF CARE FOR CHILDREN WITH SPECIAL THIS 1S THE SITUATION TODAY: A CHILD WITH DOWN SYNDROME IS IN THE CARE OF A PEDIATRICIAN FROM BIRTH ... THE CHILD GROWS UP... THROUGH ADOLESCENCE ... AND ON INTO THE LATE TEENS... AT THAT POINT THE PEDIATRICIAN SUGGESTS TO THE FAMILY THAT THEIR CHILD'S HEALTH NEEDS WOULD RECEIVE A MORE APPROPRIATE RESPONSE FROM AN INTERNIST mR FAMILY PHYSICIAN ... THEY ALL AGREE AND THE CHILD IS TAKEN TO AN INTERNIST ... WHO HAS NO CLEAR IDEA AS TO WHAT TO:DO NEXT. IF THERE IS ANY "POINT OF DISJUNCTION" IN THE HEALTH SYSTEM FOR CHILDREN WITH DOWN SYNDROME OR ANY OTHER DEVELOPNENTAL PROBLEM, THAT'S THE POINT RIGHT THERE, WHEN THE CHILD PASSES FROM THE CARE OF A PEDIATRICIAN AND INTO THE CARE OF ANOTHER SPECIALTY. MOST PEDIATRICIANS DO NOT FEEL THE NEED TO PASS ALONG ANY MORE THAN VAGUE, GENERALIZED INFORMATION ABOUT THE CHILD AND HIS OR HER SPECIAL NEEDS, ASSUMING -- I WOULD GUESS -- THAT THE NEXT PHYSICIAN WILL KNOW WHAT THE PROBLEMS ARE ANYWAY, BUT MOST NON-PEDIATRIC PHYSICIANS DO NOT KNOW THE PROBLEMS ASSOCTATED WITH DOWN SYNDROME »+« MOST HAVE HAD NO TRAINING GR EXPERIENCE WITH THE SYNDROME ... AND FEW HAVE. WORKED CLOSELY WITH FAMILIES OR WITH COMMUNITY ORGANIZATIONS SERVING CHILDREN OR ADULTS WITH DOWN SYNDROME. WHICH MEANS THAT, EITHER BOTH PATIENT AND PHYSICIAN MUST GO THROUGH A LUNG ORIENTATION PERIOD TOGETHER, OR -- WORSE YET -- BOTH PHYSICIAN AND PATIENT WILL SEE LESS OF EACH OTHER THAN THEY SHOULD. WE STILL HAVE A LONG WAY TO GO WITH THIS ISSUE, BUT I THINK WE HAVE TURNED THE CORNER, AND WE SEE WHAT NEEDS 7O BE DONE. THE PROBLEM QF DRUGS IN ANERICA IS SQ LARGE AND SO OFTEN DISCUSSED THAT I DON'T NEED TO ADD MY VOICE TO ALL THOSE WHO POINT QUT THE URGENCY ABOUT DOING SOMETHING ABOUT THE DRUG CRISIS. IT 15 A COMPLICATED PROBLEM, TOUCHING NOT ONLY UPON PUBLIC HEALTH, BUT ALSO INVOLVING LAW, POLITICS, AND.EVEN THE MILITARY, MY ONE COMMENT ON THIS ISSUE WILL MAKE A MEDICAL COMPARISON. NOT TOO LONG AGO THE MEDICAL COMMUNITY SPENT A GOOD DEAL OF TIME AND EFFORT TRYING TO DECIDE WHICH WAS THE BEST TREATMENT FOR CANCER: SURGERY, RADIATION, CHEMOTHERAPY, ETC. PEOPLE DIVIDED THEMSELVES INTO CAMPS, EACH PLUGGING ITS OWN SOLUTION. EVENTUALLY IT BECAME CLEAR THAT THE SMARTEST STRATEGY WAS A MULTIPLE STRATEGY, EMPLOYING ALL OF THEM, EMPHASIZING ONE OR THE OTHER FOR CERTAIN PROBLEMS, IN THE SAME WAY, PERHAPS TO MUCH TIME HAS BEEN SPENT TRYING TO FIND THE BEST WAY TO FIGHT DRUGS: ELIMINATE THE SUPPLY, REDUCE THE DEMAND, INTERDICTION, INCARCERATION, SOLVING BASIC SOCIAL PROBLEMS. WE NEED ALL THESE, IN A MULTIPLE STRATEGY, AND THE WISDOM TO DECIDE WHICH TO EMPHASIZE WHEN. MY FINAL APPEARANCE BEFORE CONGRESS AS SURGEON GENERAL FOCUSED ON A DRUG TOPIC THAT FIGURED LARGELY IN MY FINAL YEAR IN OFFICE, ONE THAT IS HIGH ON THE AMERICAN LIST OF CONCERNS: ALCOHOL ABUSE, ESPECIALLY ALCOHOL-IMPATRED DRIVING. AN ESTIMATED 18 MILLION ADULT AMERICANS HAVE MEDICAL, SOCIAL AND PERSONAL PROBLEMS 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, FRIENDS, AND WORK ASSOCIATES. BY 1990 ALCOHOL ABUSE AND ALCOHOLISM ARE EXPECTED TO COST THE AMERICAN SOCIETY $136 BILLION A YEAR, INCLUDING BETHEEN $10 TO $13 BILLION FOR ALCOHOL RELATED CRASHES. THESE FIGURES DO NOT INCLUDE THE COSTS OF GRIEF AND HUMAN SUFFERING. HOW MANY DEFICITS OF THIS KIND CAN THE COUNTRY AFFORD? T WAS LED TO TACKLE THE ISSUE OF DRUNK DRIVING BECAUSE OF THE URGENCY OF THE CRISIS. T COULD SEE THE URGENCY IN THE MANY LETTERS THAT CAME IN TO MY OFFICE FROM STATE AND LOCAL OFFICIALS OF EVERY AREA OF THE COUNTRY. I ALSO RECEIVED THOUSANDS OF CARDS,:LETTERS, AND TELE- GRAMS FROM SURVIVING FAMILY MEMBERS GRIEVING OVER THE LOSS OF A LOVED ONE ... SOMEONE KILLED BY A DRUNK DRIVER. THE URGENCY WAS CLEAR FROM THE SENTIMENT EXPRESSED BY 99 UNITED STATES SENATORS AND FROM A UNANIMOUS HOUSE OF REPRESENTATIVES, WHO ASKED ME TO TAKE ON THIS ISSUE AND DO WHATEVER I COULD To BRING IT UNDER CONTROL. TIME IS NOT ON QUR SIDE. HENCE, WE CAN EXPECT THAT 1990 -- LIKE 1989 AND 1998 BEFORE IT -- WILL BE A YEAR IN WHICH 24,000 MORE AMERICANS WILL HAVE DIED ON OUR HIGHWAYS IN ALCOHOL-RELATED ACCIDENTS. AND MANY THOUSANDS MORE WILL HAVE BEEN KILLED IN ACCIDENTS THAT ARE DRUG-RELATED. DURING MY TIME AT THIS MICROPHONE THREE OF OUR CITIZENS WILL BE KILLED BY A DRUNK DRIVER. 594,000 PEOPLE ARE INJURED IN ALCOHOL - RELATED TRAFFIC CRASHES EACH YEAR, LEFT BEHIND -- THE PERMANENT BRAIN DAMAGE, THE SPINAL CORD INJURIES, THE LOST OR PERMANENTLY DEFORMED LIMBS, THE BLINDNESS AND THE IMPOTENCE ... THE LIFETIMES CRIPPLED WITH DISABILITY AND HAUNTED BY RECURRENT NIGHTMARES OF HOW IT ALL HAPPENED, TENS OF THOUSANDS OF DEATHS ... HUNDREDS OF THOUSANDS OF INJURIES ... THOSE ARE NUMBING STATISTICS. BUT THEY ARE ALSO MORE THAN JUST STATISTICS. THEY ARE REAL PEOPLE ... REAL HUMAN LIVES, THIS IS A TOPIC THAT AFFECTS EACH OF YOU. IT IS A PROBLEM ALL TOO COMMON AMONG UNIVERSITY STUDENTS. UNFORTUNATELY, A DISPROPORTIONATE NUMBER OF HIGHWAY VICTIMS ARE 24, NO OTHER COMPARABLE AGE COHORT HAS SUCH A RECORD OF DEATH AND INJURY ON THE HIGHWAY, AND THIS AGE GROUP, BY ITSELF, ACCOUNTS FOR OVER 8,000 ALCOHOL- RELATED FATALITIES, OR ABOUT A THIRD OF ALL FATALITIES EACH YEAR IN WHICH ALCOHOL 1S IMPLICATED. WITH ALCOHOL-IMPATRED DRIVING, AS WITH SMOKING, THE ISSUES ARE MANY AND COMPLICATED, AND EVEN SMALL STEPS TOWARD ALLEVIATING THE PROBLEM TRIGGER STRONG EMOTIONS OND VEHEMENT CONTROVERSY, FOR EXAMPLE, LAST DECEMBER I INVITED TO A WORKSHOP ON DRUNK DRIVING REPRESENTATIVES FROM THE NATIONAL ASSOCIATION OF BROADCASTERS, THE AMERICAN ASSOCIATION OF ADVERTISING AGENCIES, | AND THE ASSOCIATION OF NATIONAL ADVERTISERS. THEY ALL DECLINED, YET CRITICIZED STRONGLY THE WORKSHOP AND ITS RECOMMENDATIONS. THE NATIONAL BEER WHOLESALERS ASSULTATION WENT SO FAR AS TO FILE A LAWSUIT FOR A RESTRAINING ORDER FOR THE WORKSHOP, ALCOHOL-IMPAIRED DRIVING MUST BE SEEN AS A PUBLIC HEALTH AND SAFETY PROBLEM, RATHER THAN AS AN ECONOMIC AND MORAL ISSUE, AND QUR PRIMARY CONCERN MUST BE WITH PRESERVING HUMAN LIVES, AFTER THE WORKSHOP I INFORMED CONGRESS, MANUFACTURERS, THE VOLUNTARY AGENCIES, ADVERTISERS, AND LAW ENFORCEMENT AGENCIES WHAT EACH COULD DO TO STOP THE CARNAGE. LET ME HIGHLIGHT ONE MESSAGE. WE NEED TO PAY SPECIAL ATTENTION TO THE PERNICIOUS MESSAGES OF ALCOHOL ADVERTISING. CURRENT ALCOHOLIC BEVERAGE ADVERTISING IS INCREASINGLY TARGETED AT YOUNG PEOPLE AND 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, SUCTAL, AND SEXUAL SUCCESS. THAT'S THE WRONG MESSAGE. QUR GOAL MUST BE THE NATIONAL TOTAL UNACCEPTABILITY OF DRIVING AFTER USING ALCOHOL OR OTHER DRUGS. THE VERY ENORMITY OF OUR LOSSES DEMANDS NO LESS OF @ RESPONSE. OTHER ISSUES CALL FOR OUR RESPONSE. IN 1970 THE UNITED STATES CONGRESS PASSED A LAW CREATING AN ORGANIZATION TO PREVENT CRUEL TY TO ANIMALS. VERY QUICKLY, EVEN IN RELATIVELY SMALL TOWNS, ORGANIZATIONS BEGAN TO PROTECT ALL MANNER OF FURRY OR FEATHERED CREATURES. IT 15 A SAD COMMENTARY ON OUR SOCIETY TO ADMIT THAT IT TOOK AN ADDITIONAL 100 YEARS TO CREATE OUR FIRST SHELTER FOR BATTERED WOMEN, VIOLENCE 15 NOT ONLY A PROBLEM FOR AMERICAN SOCIETY meen ; PROBLEM. MY INTEREST IN THIS ISSUE BEGAN IN A CURIOUS WAY, IN 1984, I WAS ASKED TO ADDRESS A MEETING ON FELEVISION VIOLENCE, THE GOVERNMENT HAD BEEN FUNDING RESEARCH IN T.V. VIOLENCE FOR THE PAST cO YEARS AND SPEECHES ON THE SUBJECT BY THE SURGEON GENERAL WERE RATHER ROUTINE ... BUT I BEGAN TO WONDER IF SOMEHOW OUR PREOCCUPATION WITH T.V, VIOLENCE MIGHT ACTUALLY BE PREVENTING US FROM SEEING THE LARGER AND MUCH MORE SERIOUS PROBLEM OF REAL VIOLENCE IN OUR SOCIETY. EVEN A QUICK GLANCE AT THE PROBLEM REVEALED ITS STAGGERING DIMENSIONS. REPORTS FROM AROUND THE NATION INDICATED THAT AS MANY AS 4 MILLION CHILDREN WERE VICTIMS OF ABUSE AND NEGLECT. TO OUR SHAME WE HAD HIDDEN THIS NATIONAL TRAGEDY. MANY OF THOSE YOUNG VICTIMS HAVE BEEN PUNCHED:... SLAPPED .., THROWN ... AND BEATEN WITH FISTS, CLUBS, AND OTHER WEAPONS. ADULTS DO THAT TO CHILDREN, FOR CENTURIES ADULTS HAVE INJURED CHILDREN ... AND HAVE LIED ABOUT IT ... AND OTHER ADULTS HAVE HEARD THOSE LIES AND THEN MERELY TURNED AWAY. THE STATISTICS FOR WOMEN ARE EQUALLY ALARMING, ESTIMATES VARY, BUT WE KNOW THAT FROM 1 TO 3 MILLION WOMEN IN THE UNITED STATES ARE BATTERED AND ASSAULTED EACH YEAR BY THEIR HUSBANDS OR PARTNERS. MANY ARE RAPED. THESE WOMEN VICTIMS OF ASSAULT ARE PERMANENTLY INJURED -- NOT JUST PHYSICALLY BUT ALSO MENTALLY --- WHILE SOME OF THEM LOSE THEIR LIVES, BATTERY 15 THE SINGLE MOST SIGNIFICANT CAUSE OF INJURY TO WOMEN IN THIS COUNTRY. UNE IN EVERY FIVE WOMEN SEEN IN HOSPITAL EMERGENCY ROOMS IS A VICTIM OF PERSONAL INJURY CAUSED BY SPOUSE ABUSE. REMEMBER, BEHIND THESE COLD NUMBERS, PERCENTAGES, AND STATISTICS ARE REAL PEOPLE, QUR NEIGHBORS, OUR FAMILY MEMBERS, OUR FELLOW CITIZENS, THE CONSEQUENCES ARE ENORMOUS: LOSS OF SELF-ESTEEM, INABILITY TO WORK PRODUCTIVELY AND TO CARE FOR CHILDREN, PSYCHIATRIC PROBLEMS, ALCOHOL AND DRUG DEPENDENCE. STUDIES HAVE SHOWN THAT BATTERED WOMEN ARE FOUR TO FIVE TIMES MORE LIKELY THAN NON-BATTERED WOMEN TO REQUIRE POYCHIATRIC TREATMENT. MANY SUFFER FROM ANXIETY, INCREASED LEVELS oF HOSTILITY, OBSESSIVE-COMPULSIVE SYMPTOMS, AND AGORAPHOBIA - FEAR OF OPEN SPACES. SOME COMMIT SUICIDE, MOREOVER, STUDIES HAVE SHOWN THAT WOMEN WHO ARE ABUSED ARE EIGHT ABUSED. THESE ABUSED CHILDREN THEN OFTEN BECOME ABUSERS THEMSELVES, WE REALIZE THAT WE DON'T HAVE GOOD STATISTICS IN THIS DIFFICULT AREA, BUT, IF ANYTHING, THESE NUMBERS ARE MUCH TOO LOW. WE ESTIMATE, FOR EXAMPLE, THAT FOR EVERY ADULT VICTIM OF VIOLENCE COUNTED BY THE POLICE AND THE F.B.I., AS MANY AS THREE ADDITIONAL ADULT VICTIMS PASS THROUGH HOSPITAL EMERGENCY: ROOMS OR COMMUNITY CLINICS AND ARE MISSED BY THE POLICE ALTOGETHER. INTERPERSONAL FAMILY VIOLENCE 1S AN OVERWHELMING MORAL, ECONOMIC, AND PUBLIC HEALTH BURDEN THAT OUR SOCIETY CAN NO LONGER BEAR, IN THIS COUNTRY, NO MAN HAS A LICENSE TO BEAT A WOMAN ... AND GET AWAY WITH IT. AND NO WOMAN IS OBLIGED TO ACCEPT A BEATING ... AND SUFFER BECAUSE OF IT. [ WON'T GO INTO ALL THE DETAILS OF HOW WE FACED THIS PROBLEM, BUT MUCH HAS BEEN ACCOMPLISHED. NOT ENOUGH, “THERE IS STILL MUCH TO DO, WE SAY WE ARE A CIVILIZED SOCIETY. ALL RIGHT, LET'S ACT LIKE ONE, I KNOW T HAVE ALREADY CALLED YOU TO GIVE YOUR ATTENTION TO SEVERAL PRESSING TOPICS. THERE'S ONE HEALTH ISSUE PEOPLE ARE ALREADY TALKING ABOUT: FOOD. WE AMERICANS CAN GET SLIGHTLY ZANY ABOUT FOOD -- LIKE DURING THE APPLE SCARE OF '89: SCHOOLS BANNED "APPLES FOR THE TEACHERS"--AND FOR THE STUDENTS, HOUSEWIVES PITCHED OUT JARS OF APPLESAUCE, AND THEN THERE WAS THAT FRANTIC MOTHER IN UPSTATE NEW YORK WHO INSISTED THAT THE STATE POLICE INTERCEPT HER DAUGHTER'S SCHOOL BUS, BECAUSE SHE HAD PACKED AN APPLE IN THE LITTLE GIRL'S LUNCH BOX BEFORE HEARING NEWS REPORTS ABOUT ALAR. SOME PEOPLE THINK THAT ALL MAN-MADE SUBSTANCES SHOULD BE REMOVED FROM OUR FOOD SUPPLY, AND THAT EVERYTHING OCCURRING IN NATURE IN BENEFICIAL. THEY INSIST ON BANNING ALL PESTICIDES. FORTUNATELY THE LARGE CHAIN STORES HAVE NOT JUMPED ON THIS BANDWAGON, ALTHOUGH SOME SMALL STORES HAVE PLEDGED TO SELL NOTHING EXCEPT FOODS UNTREATED BY PESTICIDES. NOT ONLY WILL:THIS LEAVE THEM WITH ROTTEN FOOD, BUT ALSO THEY WILL FAIL. TO PROTECT THE CONSUMER AGAINST MOLD SUCH AS AFFLATOXIN WHICH Is LETHAL , OND Occurs, FOR EXAMPLE, ON CORN, PEOPLE WHO ARE SQ WORRIED ABOUT PESTICIDES FAIL TO REALIZE THAT THE CANCER RATES HAVE DROPPED OVER THE LAST 40 YEARS: STOMACH CANCER HAS DROPPED MORE THAN 75%, WHILE RECTAL CANCER DROPPED MORE THAN 454. THE ONLY CANCER RATE THAT IS GOING UP IS AN ENVIRONMENTAL CANCER, CIGARETTE- INDUCED LUNG CANCER. MUCH OF THE PUBLIC CONCERN ABQUT CARCINOGENS IN PESTICIDES IS MISPLACED. THE CHAIRMAN OF THE DEPARTMENT OF BIOCHEMISTRY AT BERKELEY, AND CORRECT IN SAVING THAT AVERAGE AMERICAN CONSUMES 45 MICROGRAMS OF | POSSIBLE CARCINOGENIC MAN-MADE PESTICIDE RESIDUES EVERY DAY. BUT HE POINTS QUT THAT THERE ARE 500 MICROGRAMS OF NATURALLY OCCURRING CARCINOGENS IN 1 CUP OF COFFEE, 185:MICROGRAMS OF NATURAL CARCINOGENS IN A SLICE OF BREAD, 2000 MICROGRAMS OF NATURE'S CARCINOGENS IN COCA-COLA, UNTIL RECENTLY, AMERICANS THOUGHT ABOUT FOOD IN TERMS OF TASTE AND COST. NOW THEIR CHIEF CONCERNS ARE HEALTH AND SAFETY, AMERICANS ENJOY THE SAFEST FOOD SUPPLY IN THE WORLD, BUT IT TAKES ONLY AN ISOLATED INCIDENT OR RUMOR TO MAKE THIS NATION PANIC ABOUT THE SAFETY OF OUR ENTIRE FOOD SUPPLY, THE AMERICAN PEOPLE WANT ASSURANCE THAT EVERYTHING THEY EAT IS "SAFE". THE QUESTION ABOUT THE FOOD SUPPLY IS NOT "IS IT SAFE?" “FEW THINGS IN LIFE CAN BE GUARANTEED "SAFE" -- BUT "IS IT SAFE ENOUGH?" IN THE FOOD SUPPLY --AS IN ALL OTHER PUBLIC HEALTH QUESTIONS-- WE BETWEEN RISK AND HAZARD. THERE IS HAZARD IN ALMOST EVERYTHING WE DO, oU We NEED TO CONCENTRATE ON THE DIFFERENCE BETWEEN EXPOSURE TO A HAZARD AND TRUE RISK, SOME INSIST THAT NO AMOUNT OF CHEMICALS OR PESTICIDE RESIDUE IN FOOD IS ACCEPTABLE. PUBLIC HEALTH OFFICIALS, HOWEVER, OPERATE ON THE PRINCIPLE THAT MERE EXPOSURE TO A SUBSTANCE DOES NOT NECESSARILY CREATE A TRUE RISK, RISK. WE STILL HAVE A LONG WAY TO GO IN EDUCATING THE AMERICAN PEOPLE ABOUT THIS DIFFERENCE BETWEEN EXPOSURE AND RISK. A NUMBER OF RECENT SCARES SHOWED US HOW QUICKLY CONCERN TURNS TG AS A PUBLIC HEALTH OFFICIAL, I APPLAUD THE AMERICAN CONCERN FOR A HEALTHFUL DIET. SUSTAINED PUBLIC INTEREST IN DIET AND HEALTH IS BOUND TO MAKE A DIFFERENCE, BECAUSE DIET IS FUNDAMENTAL TD THE HEALTH OF THE AMERICAN PEOPLE. INDEED, THE AMERICAN COUNCIL ON SCIENCE AND HEALTH INDICATES THAT TWO-THIRDS OF ALL DEATHS IN AMERICA ARE DIRECTLY OR INDIRECTLY RELATED TO DIET. BUT PUBLIC HEALTH OFFICIALS BECOME FRUSTRATED WHEN CONCERN ABOUT SOMETIMES BEING TOO CONCERNED ABOUT DIET CAN BE COUNTER- PRODUCTIVE, WORRYING ABOUT TRACES OF CHEMICALS IN A FEW FOODS MAY BE KEEPING MANY AMERICANS FROM EATING THE WELL-ROUNDED AND NUTRITIONAL DIETS THEY NEED, WHILE WE ARE TALKING ABOUT FOOD, A FEW WORDS ABOUT THE CHOLESTEROL ISSUE. THE CHOLESTEROL BALLOON HAS BEEN PRICKED AND IS DEFLATING. LET'S BE VERY CLEAR ABOUT CHOLESTEROL. IT 15 A RISK FACTOR FOR CORONARY HEART DISEASE. IT IS HOWEVER, ONLY ONE OF SEVERAL RISK FACTORS, AND MOST SCIENTISTS THINK THE OTHERS, SUCH AS SMOKING AND HIGH BLOOD PRESSURE ARE MORE IMPORTANT AND EASIER TO CONTROL. BECAUSE CHOLESTEROL IS MANUFACTURED IN THE BODY NATURALLY, DIET DOES NOT HAVE THE DIRECT RELATIONSHIP TO BLOOD LEVELS THAT MANY MISLED LAYMEN ASSUME. THEN TOO, THE STATED RELATIONSHIP BETWEEN CORONARY HEART DISEASE AND CHOLESTEROL BLOOD LEVELS FALLS OFF FOR WOMEN WHEN THEY GET OVER 35 AND MEN WHEN THEY GET OVER 40, HEREDITY 15 A PROMINENT FACTOR. IN SUMMARY IT SEEMS THAT ADVICE CONCERNING CHOLESTEROL DIET IN RELATIONSHIP TQ CORONARY HEART DISEASE HAS BEEN GIVEN TO MORE PEOPLE THAN THOSE TO WHOM THE INFORNAT IGN IS PERTINENT. A SEGMENT OF THE POPULATION MAY HAVE BEEN MISLED INTO THINKING DIETARY CHANGES CAN ACCOMPLISH MORE THAN IS POSSIBLE. THE NUMBERS ARE INTERESTING. WHILE MANY STUDIES SHOW THAT THERE IS A REDUCTION IN THE NUMBER OF HEART ATTACKS ASSOCIATED WITH THE LOWERING OF CHOLESTEROL, THERE IS NO EVIDENCE THAT THERE IS AN ACCOMPANYING REDUCTION IN THE DEATH RATE FROM CORONARY HEART DISEASE. SO, ALTHOUGH THE QUALITY OF LIFE MIGHT BE IMPROVED, THE DEATH RATE IS STILL THE SAME. THERE TS NO DOUBT THAT SOME HAVE BENEFITTED FROM THE CHOLESTEROL HEALTH INITIATIVE, BUT GREATER NUMBERS HAVE BEEN TREATED THAN NECESSARY OR PRUDENT, FRNAEEY LET ME SAV A WORD ABOUT A SUBJECT THAT GETS MORE IMPORTANT TO EACH OF US AS TIME GOES BY: AGING. OLDER PEOPLE THINK ABOUT IT ALL THE TIME, AND YOUNGER PEOPLE THINK ABOUT THEIR PARENTS. WE CAN'T STOP AGING, BUT WE CAN AGE IN HEALTH. "THE PRESCRIPTION IS SINPLE: NO SMOKING, ALCOHOL ONLY IN MODERATION, EXERCISE AND DIET APPROPRIATE TO AGE, CHECK BLOOD PRESSURE AND CHOLESTEROL, AND SEE THE DOCTOR IF THEY ARE ABNORMAL. 76 IF YOU --OR YOUR PARENTS-- DO THAT YOU COULD CLIMB THE HILL To AGE 65, BUT INSTEAD OF STARTING DOWNHILL AT 65, YOU COULD LIVE UP THERE ON THAT PLATEAU. AND ENJOY A QUALITY OF LIFE AS A SENIOR CITIZENS UNKNOWN TO PREVIOUS GENERATIONS. AGING HAS SPECIAL MEANING FOR ME. YOU MAY RECALL THAT, WHEN PRESIDENT REAGAN FIRST NOMINATED ME TO BE HIS SURGEON GENERAL, BACK IN 1981, A GREAT HUE AND CRY WENT UP THAT I WAS TOO OLD. I WAS JUST A YOUNGSTER OF 45, BUT ALL MY CRITICS SAID THAT 45 WAS THE AGE AT WHICH SURGEONS ENTER IT FOR THE FIRST TIME, OF COURSE, THIS DID NOT SIT VERY WELL WITH THE MAN WHO NOMINATED ME. PRESIDENT REAGAN HAD JUST CELEBRATED HIS 70TH BIRTHDAY AND DID NOT: TAKE KINDLY TO THE SERVICE. NOW, AT AGE 73, I AM SURELY QUALIFIED TO BE COUNTED as ONE OF AMERICA'S SENIOR CITIZENS. AND I'M VERY PROUD TO BE AMONG THAT COMPANY . THERE ARE MORE OF US EVERY DAY. IN, SAY, 15 OR 20 YEARS -- A SUBSTANTIAL PORTION OF THE AMERICAN POPULATION, CLOSE TO 20 PERCENT, WILL BE OVER THE AGE OF 45. AND WITHIN THAT GROUP, THE FASTEST-GROWING SEGMENT WILL BE THAT OF PERSONS WHO ARE AGE 85 OR ABOVE. o0 LET'S GET A FEW THINGS STRAIGHT: GRAY OR WHITE HAIR IS NOT A SIGN OF DISEASE. NEVER HAS BEEN. NEVER WILL BE, DRY SKIN IS A NATURAL PHENOMENON OF AGING. WE DON'T KNOW WHY IT HAPPENS ... BUT IT'S NOT THE RESULT OF DISEASE, TAKING THINGS A LITTLE EASIER IS NOT A DISEASE CONDITION. IT'S MORE LIKE A SIGN OF MATURITY. AND GETTING A STRONGER PRESCRIPTION FOR YOUR EYEGLASSES OR BEING FITTED FOR A HEARING AID IS NOT EVIDENCE THAT voy HAVE UNE FOOT IN THE GRAVE AND ANOTHER ON A BANANA-PEEL, IT JUST ISN'T. IN THE PAST YEAR OR SO, 1 HAD PERSONAL EXPERIENCE WITH HEARING LOSS. AFTER SEVERAL YEARS IN WASHINGTON I WAS BEGINNING TO FEEL MORE COMFORTABLE WITH THE 108. I BEGAN TO LIKE MORE PEOPLE IN THE CONGRESS, AND ACTUALLY ENJOYED COMMITTEE MEETINGS AT THE WHITE HOUSE. SUDDENLY I REALIZED WHY: I WAS LOSING MY HEARING. SERIOUSLY, THOUGH, I REALIZED THAT I WAS MISSING A LOT. AND I WAG MAKING INAPPROPRIATE RESPONSES. SO 1 GOT TWO HEARING AIDS. GETTING A HEARING AID SHOULD BE JUST LIKE GETTING EYEGLASSES. AGE PREJUDICE 1S STILL FAR TOO COMMON IN AMERICA, OLD AGE NEED NOT BE A TIME OF CHRONIC AND PROLONGED INCAPACITY, AND FOR MOST PEOPLE OVER THE AGE OF 45 IT IS NOT. WE NOW UNDERSTAND THAT -- MEDICALLY SPEAKING -- THERE TS.5UCH A THING AS SYSTEMS IN A PERSON'S BODY CONTINUE TO FUNCTIGN NORMALLY. AND THAT'S THE WAY IT'S GOING TO BE FOR MOST OLDER PEOPLE IN THE FUTURE, --MOST OF YOU, I HOPE -- BECAUSE TOMORROW'S ELDERLY ARE TODAY'S BIKERS, JOGGERS, AND SWIMMERS ... THEY'RE THE PEOPLE wHo SNACK ON SALAD AND YOGURT ... WHO'VE GIVEN UP CIGARETTES AND HARD LIQUOR ... WHO WEAR SEAT-BELTS AND SENSIBLE SHOES ... AND WHO DO MORE ABOUT MANAGING STRESS THAN JUST POP ANOTHER VALIUM. OTHER PERIOD IN ONE'S LIFE, IF WE TAKE THE RIGHT STEPS IN PREVENTIVE HEALTH CARE. (Mh Ley mE fl€pm? tv’ THERE HAS BEEN A REVOLUTION IN THE WAY WE LOOK AT HEALTH IN AMERICA. TWO CONCEPTS FORM THE BASIS FOR THIS REVOLUTION. AWAY THE GREATEST IMPROVEMENTS IN THE HEALTH STATUS OF AMERICANS, SOME ANALYSTS EVEN SAY THAT PREVENTION AND HEALTH PROMOTION CAN POSTPONE UP TO 70 PERCENT OF ALL PREMATURE DEATHS, WHEREAS THE TRADITIONAL CURATIVE AND REPARATIVE APPROACH OF MEDICINE CAN POSTPONE NO MORE THAN 10 TO 15 PERCENT OF SUCH DEATHS. EVEN IF THEY'RE ONLY HALF RIGHT, THAT'S QUITE A DIFFERENCE IN SOCIAL PAay- OFFS. SECOND IS THE RECOGNITION THAT THESE TWO APPROACHES TO HEALTH -- THAT [5, DISEASE PREVENTION AND HEALTH PROMOTION -- ARE THE PRIMARY RESPONSIBILITIES OF EACH INDIVIDUAL. PHYSICIANS AND THERAPISTS AND PHARMACISTS AND NURSES CAN PROVIDE INFORMATION AND ALL KINDS OF SERVICE. BUT THE CHOICES REST WITH THE INDIVIDUAL. AND THEY ARE FREE CHOICES IN NEARLY EVERY CASE, NOT MANDATED BY LAW -- AT LEAST NOT YET. THIS TWO-FOLD CHANGE IN THE WAY WE LOOK AT HEALTH IN AMERICA HAS NOT YET BEEN FULLY ABSORBED BY THE AMERICAN PEOPLE, ALTHOUGH THEY SEEM WILLING ENOUGH TO LEARN. NOW, IT'S TRUE THAT AMERICAN PUBLIC HEALTH HAS ALWAYS HAD A STRONG PREVENTIVE BASE: WE WERE BROUGHT UP ON VACCINATION PROGRAMS AND WATER FLUORIDATION AND BLOOD PRESSURE CHECK-UPS AND SO ON, NEVERTHELESS, I THINK THE OVERALL PERCEPTION AMONG THE AMERICAN: PEOPLE 15 STILL AN OLD-FASHIONED ONE: THAT IS, THAT PUBLIC HEALTH AND MEDICAL AND NURSING PERSONNEL ARE REALLY ON THE JOB TO PATCH YOU_UP IF YOU GET HURT OR TO CURE YOU IF YOU GET SICK. IN OTHER WORDS, THE PATIENT IS PASSIVE AND THE HEALTH SYSTEM IS THE ONLY ACTIVE PARTY. [ THINK THE PUBLIC STILL ADHERES TO THE IDEA THAT THE PATIENT IS SUPPOSED TO "FOLLOW THE DOCTOR'S ORDERS," A PHRASE WHICH HAS EVEN BECOME A CLICHE OF THE LANGUAGE. OF COURSE, BY "FOLLOWING THE DOCTOR'S ORDERS," THE PATIENT WILL DO THOSE THINGS THAT WILL HELP HIM OR HER REGAIN THE LOST STATUS ee ey ee OF FULL HEALTH. WE IN THE PUBLIC HEALTH PROFESSIONS HAVE BEEN DILIGENTLY TRYING TO TURN THAT CONVENTIONAL WISDOM AROUND. AND I THINK WE ARE! [ THINK WE'RE MAKING GREAT STRIDES IN THE ANTI-SMOKING AREA, 7 THE PERCENTAGE OF THE ADULT POPULATION WHO SMOKES IS STEADILY DECLINING AND THAT'S EXCELLENT. THERE'S ALSO BEEN A DROP IN THE CONSUMPTION OF HARD LIQUOR, WITH A SHIFT TQ BEER AND WINE -- OR SIMPLY WATER. AS A RESULT, THERE'S BEEN A DRAMATIC DROP IN CHRONIC LIVER DISEASE AND CIRRHOSIS MORTALITY IN GENERAL. — PEOPLE SEEM TO BE EATING LESS FAT, PARTICULAREY SATURATED FAT AND CHOLESTEROL. THE DROP IN CIGARETTE SMOKING AND THE REDUCTIONS IN FAT IN THE AVERAGE PERSON'S DIET HAVE COMBINED 10 CONTRIBUTE TO THE DECLINE IN HEART DISEASE AND STROKE DEATHS OVER THE PAST 10 10 19 YEARS AS WELL. THERE'S NO DOUBT ABOUT THAT. SQ I THINK We CAN FEEL ENCOURAGED ABOUT THE TRENDS SO FAR, THE BIG QUESTION REMAINS, HOWEVER: ARE THEY REALLY TRENDS ... OR ARE THEY TEMPORARY ARTIFACTS OF A DYNAMIC CULTURE? WE NEED TO MAKE THE RIGHT CHOICES ABOUT LIFESTYLE, ABOUT PHYSICAL EXERCISE, ABOUT DIET. WHEN WE CONVINCE QURSELVES TO EAT A PROPER DIET, TO AVOID FOODS HIGH IN FAT, SUGAR, AND SODIUM, TO SAY "NO!" TO DRUGS LIKE ALCOHOL AND NICOTINE, WE TAKE CHARGE OF OUR HEALTH. WHEN WE SAY THAT THE BEST WAY TQ BEAT HEART DISEASE IS THROUGH ROUTINE EXERCISE, NO SMOKING, AND A HEALTHFUL DIET, THAT'S JUST ANOTHER WAY OF TELLING PEOPLE, "DON'T RELY COMPLETELY ON HIGH-COST HIGH-TECH MEDICINE TO SAVE YOUR LIFE. YOU CAN AFFORD PREVENTION ... YOU CANNOT AFFORD A QUADRUPLE BY-PASS, " WE KNOW, HOWEVER, THAT HEART DISEASE IS PROGRESSIVE: THAT IS, IT'S BEGINNING TQ DEVELOP RIGHT NOW, EVEN IN SOME OF YOU, IF YOU ARE OVERWEIGHT NOW... IF YOUR CURRENT DIETARY INTAKE IS HIGH IN SODIUM, CHOLESTEROL, AND SATURATED FATS ... IF YOU LEAD A GENERALLY SEDENTARY EXISTENCE, IF YOU'RE A "COUCH-AND-ARMCHAIR POTATO" ... IT 1S HIGHLY LIKELY THAT THIS COULD BE YOUR LIFESTYLE AT AGE 30... AT AGE 40 .., AND AT AGE 50, AND THE ODDS OF YOUR REACHING AGE 40, MUCH LESS AGE 70 OR 80, WILL BE SMALL, BUT YOU CAN RAISE THOSE ODDS CONSIDERABLY BY GETTING CONTROL OF © YOUR DIET AND BY FITTING IN TIME FOR EXERCISE EVERY WEEK. DOES THAT MEAN YOU WILL BE IMMORTAL AND NEVER DIE? NO, T'M AFRAID NOT, EVERY LIVING THING IN THE PLANT AND ANIMAL KINGDOMS HAS A LIMIT OF SOME KIND TO THE LENGTH OF LIFE. We DON’T KNOW MUCH MORE ABOUT IT THAN THAT. WE KNOW THAT THE CALIFORNIA GIANT REDWOOD TREE LIVES TO A MAXIMUM OF ABOUT 2,000 TO 3,000 YEARS. AND THEN IT STOPS ... AND DIES. WHY? NQ ONE REALLY KNOWS, BUT THE MAPLE TREE IS DIFFERENT. A MAPLE HAS A LIFE-SPAN OF ABOUT 30 YEARS. AT THAT AGE, A MAPLE BEGINS TO "DIE BACK." IT [5 AN IRREVERSIBLE PROCESS. WE KNOW THAT HAPPENS, BUT -- AGAIN -- WE DON'T REALLY KNOW WHY. AND We DON'T KNOW WHY HUMAN BEINGS SEEM TO "RUN OUT OF TIME" BETWEEN THEIR 65TH AND 85TH YEARS. WE DO KNOW THAT THE PREMATURE DEATH OF TREES CAN BE PREVENTED, IF WE MAKE SURE THEY HAVE AMPLE SUPPLIES SUNLIGHT, CLEAN AIR, FRESH WATER, AND CERTAIN SOIL-BASED MINERALS. SIMILARLY, WE KNOW THAT THE PREMATURE DEATH OF HUMAN BEINGS CAN ALSO BE PREVENTED, IF THEY DON'T SMOKE ... DON'T ABUSE DRUGS ~~ INCLUDING ALCOHOL AND NICOTINE... MAINTAIN A REGULAR ROUTINE QF EXERCISE ... AND WATCH THEIR DIET. THERE DOESN'T SEEM TO BE ANY SPECIAL ORGAN THAT AFFECTS THE LIFE UF A TREE, BUT THERE CERTAINLY IS ONE THAT AFFECTS THE LIFE OF THE HUMAN BEING. AND IT'S THE HEART. AND THE FEW RULES I JUST MENTIONED -- DIET, EXERCISE, AND SO ON - - WILL ALLOW YOUR HEART TO DO ITS JOB "FOR AS LONG AS IT IS PREPARED TQ FUNCTION." THAT'S THE.BEST WAY I CAN PUT IT, SINCE NO ONE KNOWS HOW LONG THAT IS. IF YOU BELIEVE YOU CAN LIVE ANY WAY YOU PLEASE WHILE YOU'RE YOUNG AND THEN DEAL WITH YOUR HEART LATER ON... YOU ARE TRAGICALLY MISTAKEN. WHEN IT HAS BEEN ABUSED FOR ANY LENGTH OF TIME, THE HUMAN HEART HAS A TENDENCY TO THROW A FIT. AND STOP. [ HOPE VOU WON'T WAIT THAT LONG TO PAY ATTENTION TO THIS MYSTERIOUS BUT ABSOLUTELY VITAL ORGAN, SQ, YOU EACH HAVE AN INDIVIDUAL RESPONSIBILITY TO DO SOMETHING, TO DO MANY THINGS, TO MAINTAIN YOUR INDIVIDUAL HEALTH, THANK YOU.