52

THE SRTURDRY EVENING POST                    April `85

THE SURGEON GENERAZL
  IS DETERMZNED

C. Everett Koop, humanitarian and compassionate pediatric surgeon, is
exposing the hazards of smoking and fearlessly attacking the wrongfulness of
   addicting innocent young victims to the lethal drug nicotine.

by Gory SerKaas, M. D.

66 S moking is the No. 1
   public-health prob-

lem in the United States. It is
responsible for approxi-
mately 340,000 premature
deaths a year. In economic
terms, it costs the American
public about 39 billion dol-
lars anhU$lly," said Surgeon
General C. Everett Koop at
the opening of our interview.

Ser Vaas: What can the
public do to help?
Koop: Well, I think the
public has to become edu-
cated. They have to recog-
nize that smoking is not just
a nasty habit. Nicotine is an
addictive drug. In fact, the

tobacco allotments, every-
one would win. Do you
think that would be an op
portunity for us?
Koop: It certainly would.
And I am no expert on
high-lysine corn, but if you
are going to plant some-
thing, at least plant some-
thing from which you get
the greatest potential.
Ser Vaas: I just came back
from Ethiopia and was dis-
appointed to see they grow
tobacco in Ethiopia on the
tillable land where it does

The Surgeon General emphasizes to the Post editor that grass-
roots activity is helping curb our devastating, No. 1 health prob-
lem-smoking. "A lot of things start at township levels," be says.

rain. The No. 2 exporter of
tobacco is Zimbabwe while
there is starvation on their

borders.

National Institute on Drug Abuse has
said it is the most addictive drug in
our society. Smokers have to decide
whether or not their priorities of help
for themselves, for their families and
indeed for the nation are high enough
so that they are willing to do some-
thing about it. All the things that
have happened to cut down on smok-
ing in public places came about large-
ly through grass-roots action and
concern of citizens who then have ap-
pealed to local, regional, state and
federal legislators. Out of that has
come action. That is what we need
more of.
SerVuus: Do you see the possibility of
offering an allotment of some kind so
the tobacco farmers who choose not
to grow tobacco could get an equiva-
lent allotment, a lucrative allotment
for growing high-protein grains that
could save the starving Africans7
Koop: Well, that would certainly be
one way out of the dilemma. The diffi-
culty is that with the money they can
make from tobacco, it is very hard to
find another crop that will provide that
same kind of income, unless you pro-

vide supports. New Zealand has had a
marvelous opportunity-they have cut
back tremendously on their tobacco
growing, but they have a climate where
they can raise kiwi fruit. With what
you get for one kiwi fruit, you can see
why that is profitable for tobacco
farmers. If we could find something
like that, we would be way ahead.
Ser Vaas: You spent time as a physi-
cian in Africa, didn't you?
Koop: Yes, indeed.
Ser Vuas: And you saw kwashiorkor
when you were there?
Koop: Without a question.
Ser Vaas: And that is a disease caused
not by calorie deficiency but by pro-
tein deficiency.
Koop: Well, they both go together.
Ser Vaas: They go together, but
regular corn doesn't support the tod-
dlers and high-lysine corn would. If
we could get these products being
grown-if we could use the famine in
Africa as an opportunity-our people
might feel good about having the
government give a premium for plant-
ing high-protein foods to ship over to
Africa. If this could replace lucrative

Koop: Well, I am very concerned
about the use of tobacco for cash-
crop income and for excise taxes in
the Third World. The World Health
Organization has been exemplary in
its effort to educate developing coun-
tries not to get involved in the tobac-
co business. The difficulty is, the
cigarette conglomerates offer tobacco
plants to a country with a poor econ-
omy. It is a ready cash crop, and after
they have it for a while they say,
"How would you like to manufacture
cigarettes? We'll help you do that,
and then you can charge taxes for
them." But they never talk about the
health bill down the road. There is no
amount of money you can make on
tobacco for taxes that will ever pay
the health bills for what those coun-
tries are buying for themselves. It's
just terrible.            .I n
Ser Vuas: Could you tell us about the
U.S. tobacco industry in China?
Koop: I just came back from China.
One of the things that I was asked to
do was to take part in some discussion
with their very first private-sector
initiative in China against smoking.


THE SRTURDAY EVENING POST                              53

you won't get cancer of the lung from
chewing tobacco, but you can get
cancer of the mouth.

Ser Vuus: But you would not get em-
physema?
Koop: No, but you can get the addic-
tion to nicotine. Then when you find
that smoking is more socially accepta-
ble than chewing at your hostess' par-
ty, you'll eventually begin to smoke.
Then you'll be right down the line
we're talking about.
Ser Vuus: Luring children with shred-
ded bubble gum in the same color
packages looking exactly as if it is
chewing.tobacco in our drugstores is
a devastating practice.
Koop: Well, the thing is that the ad-
vertising uses role models that kids
love-sports figures or country-west-
ern singers.
SerVtwm Is there anything the sur-
geon general's office could do or that
the public could do to. help get ciga-
rettes under the.counter with the girlie
magazines and not make them avail-
able to the juvenile who can go in and
buy them? Could we get rid of vend-
ing machines so that lZyear-olds
cannot go in and buy cigarettes?
Couldn't we protect our children
from cigarette machines?
Koop: There is nothing my office can
do-1 try to hit the vending machines
by asking the Veterans Administra-

tion to cooperate by getting them out
of hospitals. They have, and I have
asked the army and navy to stop sub-
sidizing the cost of cigarettes in the
PX-no response to that as yet.
States could take it upon themselves
to enact legislation that would pro-
hibit children from buying cigarettes
or make it more difficult for them.
Ser Vuus: Should we write our con-
gressmen?
Koop: Congressmen are always very
susceptible to the way their constitu-
ents see this thinking. It doesn't mat-
ter what the issue is, so if your readers
are concerned about this issue their
congressmen should know it.
Ser Vaas: What else can the public
do?
Koop: I think a lot of these things
start at state and township levels. An
interesting thing took place over here
in Virginia. The police, firemen and
sheriff's departments in three coun-
ties will now not employ a smoker be
cause they cannot afford the health
package when he eventually has to go
on disability pension. This policy has
been tested in the courts and found to
be legal. Now, when you sign up in
those three counties for one of those
jobs, you promise not to smoke on or
off the job. If you do, you acknowl-

continued on page IOB

One of the largest cigarette-
manufacturing plants in the world
has just been built in China by an
American manufacturer.

Ser Vuus: What are your top priorities
for the next several years to eradicate
tobacco?
Koop: What's on the horizon is the
whole threat to young people of
smokeless tobacco-that's chewing
tobacco, snuff and moist snuff. We
will have to be directing some of our
attention to that in this coming year,
because in some cities in this country,
as many as 20 percent of high-school
students are chewing some form of
smokeless tobacco. We know that na-
tionwide the sales of moist snuff are
mounting very rapidly. This is not
covered by the same advertising ban
that cigarettes are covered by. You
will notice that smokeless tobacco is
advertised on television and in maga-
zines. The appeal is to young people.
I'm particularly concerned that the
advertisements imply a health benefit
when they say, "Instead of a puff
reach for a chew."
Ser Vaas: And once addicted, they are
for life.
Koop: Of course that is my main con-
cern. All the things that you don't
like in smoke are in chewing tobacco.
The nicotine is there, and all the car-
cinogenic things are there. It is true

"Tbeir'rpped is to young people. I'm par-
tkularly concerned tbat the advertisements
imply a bealtb benefit when they say,
`Instead of a puff, reach for a chew.' "

"The police, firemen and sheriff's depart-
ments in three Virginia counties wiIl not
employ a smoker because they can't af-
ford the eventual disability pension."

"We UC told not to kt anytbhg have the
ma8tery over us. If you are smow some-
thing containing an addictive .&II& yea
bave something tbat has mastered JOII."


108

The Surgeon General

continued from page 53
edge it's a cause for dismissal and
that there is no grievance procedure. I
think things like this have to happen
all over the country. As they do I
think my dream of a smokefree. socie-
ty in this country by the year 2000
becomes more and more of a reality.
SerVaas: What about passive smok-
ing? Do we have some good, hard
facts about the dangers of it?
Koop: We have always had good,
hard facts about the effects of passive
or side-stream smoking on children.
We know the children get
more respiratory infections,
more bronchitis, more bona
fide diagnoses of pneu-
monia; they miss more days
from school, they are in bed
more days and they are gen-
erally more frail. We have
only recently had good, hard
scientific evidence on side-
stream smoking in adults. It
is now possible to measure,
in the urine excretion of an
individual; one of the end
products of nicotine ab-
sorbed through the lung, so
that you can tell how much a
nonsmoker is absorbing on
the basis of urinary studies.
The bottom line is that if a
smoker and nonsmoker live
together, and the smoker is a
two-pack-a-day habit per-
son, the nonsmoker smokes
three cigarettes whether he
wants to or not. I think you
will find a rash of further
studies coming up of various parts of
the world relating this to the work-
place and to other types of social con-
tact we have with smoking.
Ser Vaas: Have there been any studies
on the health of stewardesses and
airline employees?
Koop: I've done one study-every
stewardess on every plane I fly on
who recognizes me says, "Won't you
do something so I don't have to go
back to the rear of this plane and ex-
pose myself to that health hazard?"
Ser Vaus: The health cost to all of us is
great. Since we have Medicare and we
take care of our people who are sick,
the smoker isn't just satisfying his
own habit-he is costing all the peo-
ple a lot of money, isn't he?
Koop: Well, I mentioned that the cost
to us is 39 billion dollars a year, and

THE SRTURDRY EVENING POST

13 billion of that is in direct medical
cost. That is astronomical, but the
rest of it is in time lost from work and
in illness that doesn't end in fatality.
If you added up the economic loss
and the misery that goes with smok-
ing, and then remember the end result
of 340,000 premature deaths that are
avoidable, you can see what a tremen-
dous public-health problem we have.
Ser V&as: What percentage of emphy-
sema, in your opinion, is caused by
smoking?
Koop: The experts in the National
Heart Blood Lung Institute tell us
that if there were not smoking, there

would be practically no emphysema.
SerVaas: Emphysema alone costs
how many billions of dollars a year?
Koop: I don't know how much that
costs alone, but I know that of all the
illnesses leading to death, emphysema
is the most long-drawn-out, miserable
one. I have often said to smokers,
"Don't judge misery by what hap-
pens to a person with a sudden heart
attack from smoking, but go and
watch someone who spends his last
years trying to breathe with emphy-
sema. Then maybe you will quit."
Ser Vaas: Are you satisfied with the
medical profession's ability to help
people, or do you think that organ-
ized medicine is really working suffi-
ciently?
Koop: I have to answer that in two
different ways+irst of all, I think

April `85

doctors themselves have been slow to
pick up the cudgel against smoking.
It's unpopular to tell somebody he
should stop something that he desires
to do very much. I think, therefore,
individual physicians have to try
harder, and I think that's one of the
great advantages of nicotine chewing
gum-they now have something to
offer besides just platitudes. If you
are talking about organized medicine,
I have been discouraged that organ-
ized medicine has not taken as firm a
role and as much of a leadership role
as it should. You expect the Society of
Preventive Medicine to do this, but I
    would like to have seen the
    AMA come out much more
   strongly about it. In recent
   years I have been on the
   house of delegates for the
    AMA. The students and the
   residents, the young people
   who are coming up are the
   most concerned about this,
    and I have to admit that last
   year the resolutions from the
   house were the strongest they
    have been in the last decade.
   I was very disappointed that
    the AMA's enclosure in
   Newsweek magazine on the
   health of this nation totally
   ignored cigarette smoking,
    when it is still the No. 1
   health hazard we have. They
    can do more.
   SerVaas: I wonder, Dr.
   Koop, if you could tell us
   your own personal views-
   many of our readers write
   and say they don't think
    Christians should smoke.

Other readers say they don't think
that cigarette smoking has anything
to do with their religion. In your own
views, do you think that a person who
is going to church and who professes
to be a Christian should be concerned
about smoking?
Koop: I have always had just one
point of view about smoking in the
Christian context, and it hasn't to do
with smoking alone. We are told not
to let anything have the mastery over
us. WelI, if you are smqking some-
thing that contains anaddictive drug,
you have something that has mas-
tered you. I think that is the point we
should stress.
Ser Vaas: And what about smoking in
churches?
Koop: There is just no class to that at
all. X