ORIGINAL

ADDRESS
BY

Cm EVERETT KOOP, MID,, Sc,D,
    SURGEON GENERAL

        OF THE

     US, PUBLIC HEALTH SERVICE
U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE HEALTH REPORTING CONFERENCE OF THE
      AMERICAN MEDICAL ASSOCIATION
        BOSTON, MASSACHUSETTS
          APRIL 14, 1989


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

  THANK YOU FOR THIS OPPORTUNITY TO TALK WITH A LITTLE BIT

ABOUT SOME OF THE ISSUES THAT WILL BE -- OR SHOULD BE -- ON YOUR

SUBJECT AGENDA IN THE YEARS AHEAD,

  AT LEAST, b THINK THEY SHOULD BE HIGH ON YOUR LIST OF TOPICS

TO COVER, AND I HOPE, AFTER MY FEW REMARKS ARE OVER, YOU WILL

FEEL THE SAME WAY,

BUT FIRST AN OBSERVATION ABOUT THE VALUE OF THE MEDIA

ITSELF,


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  AS MANY OF YOU MAY ALREADY KNOW, THE SURGEON GENERAL IS A

PECULIAR KIND OF GOVERNMENT OFFICIAL, HE -- OR SHE -- HAS

VIRTUALLY NO STAFF m n m NO BUDGET THAT BUYS ANYTHING BEYOND A

YEAR'S WORTH OF PAPER CLIPS ,a, NO PROGRAM FOR WHICH I ALONE AM

SPECIFICALLY AND LEGALLY ACCOUNTABLE mm, IN FACT, IT'S A POSITION

WITH THE NARROWEST AND SHALLOWEST OF FOUNDATIONS,

  HOWEVER, IT HAPPENS TO BE A POSITION THAT IS GUARANTEED

IMMEDIATE ACCESS TO THE AMERICAN PEOPLE, AND I USE THE WORD

"GUARANTEED" ADVISEDLY,


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  TRADITIONALLY, ALL THE NETWORKS AND ALL THE WIRE SERVICES

CLEAR THE DECKS THE MINUTE THE SURGEON GENERAL SAYS HE HAS

SOMETHING IMPORTANT TO TELL THE AMERICAN PEOPLE,

  I HAVEN'T USED THESE EMERGENCY POWERS, BUT I HAVE GIVEN OUT

CERTAIN "HEALTH ALERTS," SO TO SPEAK, INFORMATION ON ALCOHOL AND

PREGNANCY et, ON HYPOTHERMIA IN THE WINTER mmm ON DEHYDRATION IN

THE SUMMER ,,a AND SO ON,

   THE FACT OF THE MATTER IS THAT THE SURGEON GENERAL IS

PRIMARIIY AND YOU COULD SAY EXCIUSIVEIY A BEARER OF MESSAGES TO

THE PEOPLE OF THIS COUNTRY AND, INDEED, TO THE PEOPLE OF THE

WORLD,


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  AND THAT'S ESSENTIALLY WHAT I'VE BEEN DOING FOR THE PAST 8

YEARS mm, TELLING THE STORY OF MEDICINE AND HEALTH TO THE

AMERICAN PEOPLE, VIA AN ACCOMMODATING ASSEMBLY OF MEDIA,

   I KNOW THAT MANY PHYSICIAN BROADCASTERS HAVE BEEN MY ALLIES

IN THIS WORK AND I WANT TO THANK YOU FOR YOUR HELP,  I OFTEN

THINK THAT THE BROADCAST MEDIA WOULD BE A LOGICAL PLACE FOR ME TO

GO, AFTER I DEPART THE SURGEON GENERAL-SHIP, SINCE I'VE BEEN ON

RADIO AND TELEVISION SO FREQUENTLY FOR SO LONG,


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   IN ANY CASE, I WOULD MAKE THE POINT THAT THE KIND OF WORK

YOU DO IS EXTREMELY IMPORTANT -- AND I'M NOT SAYING THAT MERELY

TO BE POLITE AND INGRATIATE MYSELF WITH YOU, I REALLY MEAN IT,

BECAUSE I KNOW FROM EXPERIENCE -- THE EXPERIENCE OF MY EXALTED

POSITION IN GOVERNMENT -- THAT IT WOULDN'T BE VERY EXALTED AT

ALL, IF THE MEDIA DECIDED ONE DAY TO IGNORE ME,

   I'VE BEEN DELIVERING A BUSHEL OF DIFFERENT MESSAGES IN THE

COURSE OF MY TWO TERMS AS YOUR SURGEON GENERAL, AND MANY OF THESE

MESSAGES WILL NEED TO BE REPEATED AND REINFORCED BY MY

SUCCESSOR, WHOEVER THAT IS, FOR EXAMPLE m,,


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  WE CANNOT LET UP ON THE TOBACCO INDUSTRY AND WE CAN'T GIVE

UP ON SMOKERS,  I THINK WE'VE GOT THE CIGARETTE COMPANIES ON THE

RUN IN THIS COUNTRY AND WE HAVE TO MAINTAIN THE PRESSURE SO THAT

THE DOWNWARD SPIRAL OF CIGARETTE CONSUMPTION CONTINUES AND EVEN

ACCELERATES

  FOR THAT TO HAPPEN, WE NEED TO HELP SMOKERS QUIT AND WE NEED

TO HELP NON-SMOKERS STAY THAT WAY, I KNOW THAT MANY PHYSICIANS

IN THE MEDIA HAVE BEEN EXTRAORDINARILY HELPFUL IN GETTING THIS

MESSAGE ACROSS TO THE PUBLIC,

                                                               I
  AND MY MESSAGE TO YOU IS THIS: FOR HFAVFN S SAKE, DO N'T

STOP NOW!


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  ANOTHER MESSAGE THAT MY SUCCESSOR MUST CONTINUE IS, OF

COURSE, THE MESSAGE OF AIDS: THAT IS, DO NOT ENGAGE IN ANY HIGH-

RISK SEXUAL BEHAVIOR em, DO NOT USE SOMEONE ELSE'S PARAPHERNALIA

WHEN SHOOTING DRUGS 11, IN FACT, DON'T SHOOT DRUGS AT ALL , a, AND

IF YOU SUSPECT YOU MIGHT HAVE BECOME INFECTED, GET SOME

PROFESSIONAL COUNSELING ALONG WITH YOUR BLOOD TEST.

  THE OTHER AIDS MESSAGE IS TO OUR COLLEAGUES IN MEDICINE AND

PUBLIC HEALTH: YOU HAVE TAKEN AN OATH OF SERVICE Ia, AN OATH TO

HELP PERSONS WHO ARE SICK OR DISABLED mms AND, DESPITE YOUR

PERSONAL FEELINGS ONE WAY OR THE OTHER ABOUT THIS DISEASE, YOU

MUST HONOR THAT OATH AND CARE FOR THESE PEOPLE WITH AIDS,


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  I BELIEVE THIS IS LESS OF A PROBLEM THAN IT MAY HAVE BEEN

TWO OR THREE YEARS AGO, WE HAVE BETTER, CLEAR-CUT GUIDELINES ON

PERSONAL SAFETY, CONFIDENTIALITY, AND SO ON,

  BUT OURS IS A DYNAMIC PROFESSION, HENCE, IT NEEDS TO HEAR

CERTAIN BASIC INFORMATION ON A CYCLICAL OR ITERATIVE BASIS, AND

I WOULD HOPE THAT EACH OF YOU WOULD BECOME PART OF THAT EFFORT TO

KEEP THE AIDS MESSAGE UP-TO-DATE AND VITAL TO OUR PROFESSION, AS

IT IS TO u THE PEOPLE OF THIS COUNTRY,


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  BUT BEFORE I GO ANY FURTHER REMINISCING ABOUT WHAT WE'VE

DONE SO FAR, LET ME RE-FOCUS MY REMARKS AND TRY TO LOOK AHEAD ,,a

TO LOOK AT THE KINDS OF MESSAGES I THINK WE'LL BE DELIVERING TO

OUR COLLEAGUES AND TO THE AMERICAN PEOPLE OVER THE NEXT 10, 20,

AND 30 YEARS,

FOR ECONOMY'S SAKE, I'LL LIMIT MY CRYSTAL-BALL GAZING TO

JUST THREE AREAS, BUT THEY'RE BIG ONES,

  THE FIRST AREA CONCERNS TECHNOLOGY, FROM MY EXPERIENCE IN

THE WHOLE ISSUE OF ORGAN TRANSPLANTATION, FOR EXAMPLE, I BELIEVE

THAT A PROFOUND CHANGE IS OCCURRING IN THE RELATIONSHIP BETWEEN

TECHNOLOGY AND THE HEALTH OF THE AMERICAN PFOPLEm


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  FOR OUR PURPOSES THIS MORNING, LET'S DEFINE TECHNOLOGY AS

'THE APPLICATION OF NEW KNOWLEDGE TO REAL EVENTS," IF WE CAN

ACCEPT THAT SIMPLE DEFINITION, THEN IT'S OBVIOUS THE WAY

TECHNOLOGY HAS THUS FAR INFLUENCED HEALTH CARE IN OUR SOCIETY.

  WE'VE GONE THROUGH A 'GOLDEN AGE OF SURGERY" ,,a AND A

'GOLDEN AGE OF DRUG THERAPY" , a a WE'RE IN THE MIDST OF A "GOLDEN

AGE OF ORGAN TRANSPLANTATION' ,,t AND SO ON,

  I DON'T THINK IT'S ALL HYPERBOLE, EITHER, I THINK IT'S

TRUE THAT WE'VE MADE SOME EXTRAORDINARY PROGRESS IN HEALTH CARE,

THANKS TO NEW TECHNOLOGIES OF EVERY KIND,


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  BUT ALL THAT WELL-ADVERTISED PROGRESS MAY ALSO HAVE BEEN A

MIXED BLESSING, THE ARRIVAL OF EACH NEW TECHNOLOGY SEEMED TO

RAISE TO A CONSIDERABLE DEGREE THE PUBLIC'S EXPECTATIONS OF THE

MIRACLES MEDIC I NE COULD ACCOMPLISH,

  AND SO, I'M SORRY TO SAY, THE AMERICAN PEOPLE OFTEN EQUATE

MEDICAL TECHNOLOGY WITH THE MIRACULOUS AND THE NEAR-MIRACULOUS,

  AND LET'S ADMIT THAT SOME OF OUR COLLEAGUES IN MEDICINE HAVE

UNWISELY PROMOTED THIS REVERENCE FOR TECHNOLOGY ,,a AND MAYBE A

REVERENCE FOR THEMSELVES IN THE BARGAIN,


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  BUT WILL TECHNOLOGY ALWAYS BE CONSIDERED A BENEFICENT

MIRACLE? I DON'T THINK SO,

WHY THE CHANGE?

  FIRST OF ALL, I BELIEVE THE PUBLIC NOW SEES TECHNOLOGY AS A

MIXED BLESSING, IN REGARDS TO PROLONGING LIFE, FOR EXAMPLE,

  BOTH THE LAY PUBLIC AND THE MEDICAL PROFESSION ARE EVEN NOW

DEBATING THE WISDOM OF USING SO-CALLED "EXTRAORDINARY" MEASURES

TO SAVE OR PROLONG THE LIVES OF PERSONS PROFOUNDLY TRAUMATIZED OR

TERMINALLY ILL,


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  FOR MANY PEOPLE WHO MUST DECIDE THE FATE OF LOVED ONES,

HIGH-TECH MEDICINE SOMETIMES ACTS LIKE A FRIEND a,, AND

SOMETIMES IT ACTS LIKE AN ENEMY.

  HENCE, SOME PEOPLE ARE TURNING TO LEGAL INSTRUMENTS LIKE THE

SO-CALLED "LIVING WILL" AND THE "DURABLE POWER OF ATTORNEY" TO

PROTECT THEMSELVES FROM RUNAWAY MEDICAL TECHNOLOGY, IN THE EVENT

THEY ONE DAY HAVE A TERMINAL ILLNESS OR CONDITION,

HENCE, IN MANY REAL-LIFE SITUATIONS, TECHNOLOGY IS A MIXED

BLESSING , a, AT BEST , , a AND CAN BE A CURSE, AT THE WORST,


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  THAT'S ONE REASON I THINK WE NEED TO RE-ASSESS THE ROLE OF

TECHNOLOGY IN MEDICINE a  A SECOND REASON GOES BACK TO THE FACT

THAT MEDICINE AND PUBLIC HEALTH HAVE BEEN PREACHING -- CORRECTLY,

I MIGHT ADD -- THAT PEOPLE THFMSELVES CAN AND MUST TAKE CHARGE OF

THEIR OWN HEALTH STATUS,

  AND I'M SURE THAT EVERY PHYSICIAN-COMMUNICATOR HERE THIS

MORNING HAS BROADCAST ONE OR ANOTHER MESSAGE ADVISING LISTENERS

AND VIEWERS TO STAY AWAY FROM FATTY MEATS AND FOODS HIGH IN SUGAR

AND SODIUM, AND TO "SAY NO" TO SUCH HARMFUL DRUGS AS ALCOHOL AND

NICOTINE,

AT LEAST, I HOPE YOU HAVE,


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  NOW, WHEN YOU TELL PEOPLE THAT THE BEST WAY TO BEAT HEART

DISEASE IS THROUGH ROUTINE EXERCISE AND A HEALTHFUL DIET, THAT'S

JUST ANOTHER WAY OF TELLING PEOPLE, "DON'T RELY COMPLETELY ON

HIGH-TECH MEDICINE TO SAVE YOUR LIFE"'

THAT'S REALLY WHAT WE'RE SAYING ,,a AND I BELIEVE WE'LL

CONTINUE TO SAY IT WELL INTO THE NEXT CENTURY,

  AND THIS ADVICE WILL COVER MORE THAN JUST HEART DISEASE,

THE VALUED AND APPRECIATED PHYSICIANS ARE THE ONES WHO WILL

ADVISE PEOPLE ON THINGS THAT THFY THFMSELVFS CAN DO TO PREVENT

STROKE, CANCER, FETAL ALCOHOL SYNDROME, HIGHWAY TRAUMA,

OCCUPATIONAL DISABILITY, HOME ACCIDENTS, AND SO ON,


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  OF COURSE, THE QUESTION MAY WELL BE ASKED IF PHYSICIANS ARE

ACTUALLY TAKING THE LEADERSHIP IN THIS EMPHASIS ON PERSONAL

RESPONSIBILITY, AND I'D HAVE TO SAY, "PROBABLY NOT," INSTEAD

THE LEADERSHIP IS BEING ASSUMED BY A VERY VIGOROUS AND VERY

EXPANSIONIST "SELF-HELP" MOVEMENT ,,, A MOVEMENT, BY THE WAY,

THAT -- BY DEFINITION -- DOES NOT REALLY HAVE ANY LEADERSHIP, BUT

IS GROWING BY LEAPS AND BOUNDS NEVERTHELESS.

THE SELF-HELP MOVEMENT INCLUDES ALCOHOLICS ANONYMOUS AND THE

MANY, MANY GROUPS DEDICATED TO HELPING SMOKERS QUIT THEIR HABIT,


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   IT ALSO INCLUDES SUCH GROUPS AS PARENTS WITHOUT PARTNERS AND

THE GRAY PANTHERS ,a, LA LECHE LEAGUE AND OVEREATERS ANONYMOUS

, , , BROTHER TO BROTHER AND MY SISTER'S PLACE , , , THE AMERICAN

SCHIZOPHRENIA ASSOCIATION mm, THE EPILEPSY FOUNDATION ,,,AND SO

ON,

  I WAS TOLD THAT AN ESTIMATED 15 ARE NOW

INVOLVED IN SOME FORM OF SELF-HELP HEALTH CARE, BUT IN MY

OPINION 15 MILLION IS A GROSS UNDERCOUNT.  I'M INCLINED TO TRIPLE

THAT ESTIMATE MYSELF,


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  AND BY THE WAY, THIS IS NOT "MARGINAL MEDICINE" BY ANY

MEANS, THESE SELF-HELP GROUPS DEAL WITH CONTEMPORARY SOCIETY'S

MOST SERIOUS AND MOST PERVASIVE DISEASES AND DISORDERS:

   SUBSTANCE ABUSE mm, THE EPIDEMICS OF SEXUALLY TRANSMITTED

  DISEASES, SUCH AS SYPHILIS, HERPES, GONORRHEA, AND AIDS ,,a

  AND THOSE THREE MAJOR KILLERS IN OUR SOCIETY: HEART

  DISEASE, CANCER, AND STROKE,

AND I SHOULD ADD THAT THESE "DO-IT-YOURSELF" HEALTH

PROGRAMS ARE NOT FALSE PALLIATIVES THEY REALLY WORK,


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   MY ONLY CONCERN -- AND IT'S A MAJOR CONCERN -- IS THAT THESE

PROGRAMS MAY NOT BE UNIFORMLY HELPFUL FOR EVERYONE,
                      SOME PEOPLE

STILL NEED THE HELP OF TRADITIONAL, MEDICALLY TRAINED EXPERTS,

BUT THEY HAVE TO MAKE THAT CHOICE,
  WHICH WAY SHOULD THEY TURN?

   I THINK INDIVIDUALS SUCH AS YOURSELVES -- ARGUING NOT ON

BEHALF OF TRADITIONAL MEDICINE BUT ON BEHALF OF MEDICINE AND

HEALTH CARE THAT WORKS -- YOU COULD REALLY HELP THE AMERICAN

PEOPLE MAKE WISER CHOICES


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  OF COURSE, FOR YOU TO BE ABLE TO DO THAT, BOTH MEDICINE m

SELF-HELP WILL NEED TO SHED THEIR MUTUAL ATTITUDES OF DISPARAGE-

MENT AND DISTRUST AND TRY, INSTEAD, TO FORGE A NEW PARTNERSHIP OF

HEALTH, HELP, AND CARING.

AND THAT WOULD BE A VERY EXCITING DEVELOPMENT FOR MEDICINE

IN THE 21ST CENTURY,

  BUT FRANKLY, WHETHER TRADITIONAL MEDICINE AND PUBLIC HEALTH

DO OR DO NOT GET INVOLVED, I BELIEVE THE SELF-HELP MOVEMENT WILL

CONTINUE TO GROW IN THE YEARS AHEAD AND WILL BECOME NOT MERELY AN

"ALTERNATIVE" SYSTEM OF HEALTH CARE BUT, IN FACT, OUR OTHER

NATIONAL SYSTEM OF HEALTH MAINTENANCE, HEALTH PROMOTION, AND

DISEASE AND DISABILITY PREVENTION,


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  SO THAT IS A LONG AND SOMEWHAT COMPLICATED LIST OF REASONS

WHY I BELIEVE WE WILL CONTINUE TO REDUCE OUR FAITH u AND OUR

RELIANCE UPON HIGH TECHNOLOGY AND WILL WANT TO PLACE A GREATER

RELIANCE UPON EACH INDIVIDUAL'S OWN "LOW-TECH" HEALTH DECISIONS,

WHAT'S THE SECOND BIG CHANGE ON THE HORIZON?

THIS ALSO IS A CHANGE IN RELATIONSHIPS, I BELIEVE THAT

WE'RE SEEING A CHANGE IN THE RELATIONSHIP BETWEEN THE PUBI IC AND

THE HEALTH CARE SYSTFM 1TSIJ.E I


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  THIS IS AN ESPECIALLY IMPORTANT CHANGE, ITS IMPLICATIONS

ARE VERY FAR-REACHING AND WILL AFFECT NOT ONLY MEDICINE BUT MANY

OTHER PROFESSIONS AND VOCATIONS AS WELL,

  ONE REASON FOR THE CHANGE IN RELATIONSHIPS IS THE JNCREASFD

fl0BILITY OF THE AMERICAN PEOPLE.

  AMERICANS MOVE AROUND SO MUCH THAT IT'S BECOMING HIGHLY

UNLIKELY THAT THE AVERAGE PATIENT WILL BE KNOWN AND SERVED BY THE

SAME PHYSICIAN AND SAME HOSPITAL STAFF THROUGHOUT HIS OR HER

LIFETIME, BUT THAT SITUATION IS NO LONGER THE NORM, IT'S GONE

, I 8 IT'S HISTORY,


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   THE DOCTOR-PATIENT RELATIONSHIP -- NOW AND IN THE FUTURE --

IS A FjELATIONSHIP BETWEFN STRANGFRS,  AND I THINK IT'S REALISTIC

TO ENLARGE UPON THAT AND SAY THAT THE RELATIONSHIP BETWEEN THE

INDIVIDUAL AND THE HEALTH SYSTEM IN IS A RELATIONSHIP

BETWEEN STRANGERS

POPULATION MOBILITY IS CERTAINLY ONE FACTOR, ANOTHER FACTOR

IS THE RISE IN PRE-PAID PRACTICES,

   THESE PLANS SEEM TO BE MORE COST-EFFICIENT. BUT THEY ALSO

ATOMIZE AND SUB-DIVIDE PATIENT CARE, MOVING PATIENTS AMONG AN

ARRAY OF TECHNICIANS AND PROFESSIONALS,


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  THE IRONY OF ALL THIS IS THE FACT THAT OUR PATIENTS APPEAR

AND DISAPPEAR FROM ONE'S PRACTICE AT THE VERY TIME THAT THE

WATCHWORD OF PATIENT CARE IS "CONTINUITY,"

   MOBILITY a,. SHIFTING DEMOGRAPHICS at, PRE-PAID GROUP

PRACTICES mm, THESE ARE THE KEY INFLUENCES CHANGING THE

RELATIONSHIP BETWEEN THE HEALTH CARE SYSTEM AND THE PUBLIC IT

SERVES,

  AND THAT LEADS ME TO THE THIRD AND FINAL AREA I WANT TO

TOUCH ON THIS MORNING,  IT'S THE QUESTION OF COMMUNITY VALUES

AND PUBLIC SUPPORT, RELATIVE TO MEDICINE AND PUBLIC HEALTH,


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  IN THE COURSE OF MY INVOLVEMENT WITH THE AIDS EPIDEMIC, I'VE

SEEN THIS ISSUE BEGIN TO TAKE SHAPE, ALSO, IT'S A COROLLARY TO

THE OTHER ISSUES I'VE DISCUSSED SO FAR a,, THE TECHNOLOGY ISSUE

AND THE ISSUE OF PATIENT-SYSTEM RELATIONSHIPS,

  THIS ISSUE REVOLVES AROUND WHAT THE AMERICAN PEOPLE BELIEVE

ABOUT THEIR HEALTH SYSTEM, OR SYSTEMS, I THINK THEY BELIEVE THAT

IT IS A GOOD AND POSITIVE THING FOR EVERYONE IN OUR SOCIETY TO

ACHIEVE GOOD HEALTH AND THE GOOD LIFE THAT COMES WITH GOOD

HEALTH,

AND THEY'RE WILLING TO PAY FOR THAT, THROUGH CHARITABLE

DONATIONS AND THROUGH TAXES,


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  THEY'RE VERY PATIENT ABOUT THIS AND WILL INVEST IN ALL KINDS

OF TREATMENT AND COUNSELING PROGRAMS BECAUSE THE AMERICAN PEOPLE

BELIEVE IN THE REDEMPTIVE POWERS OF GOOD HEALTH AND SIMPLY HATE

TO GIVE UP ON ANYONE WHO CAN BE "BROUGHT BACK" TO GOOD HEALTH, SO

TO SPEAK,

  BUT THE AMERICAN PEOPLE DO NOT HAVE AN INFINITE CAPACITY

FOR PATIENCE, BELIEVE ME.

  FOR EXAMPLE, MOST AMERICANS DO NOT SMOKE, AND THIS NON-

SMOKING MAJORITY GENERALLY DISAPPROVES OF SMOKING AND WOULD LIKE

TO SEE ALL SMOKERS STOP,


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  HENCE, THE NON-SMOKING PUBLIC IS DEMANDING -- AND GETTING --

NEWER AND STRONGER LAWS AT ALL LEVELS OF GOVERNMENT TO CURB

CIGARETTE SMOKING IN THE WORKPLACE, IN ALL MODES OF TRANSPORTA-

TION, AND IN ALL PUBLIC SPACES, REGARDLESS OF WHO OWNS THEM,

  BUT PUBLIC DISPLEASURE DOES NOT STOP WITH SMOKERS, IT IS

BEING EXERCISED AGAINST OTHERS AS WELL ama PEOPLE WHO WILFULLY

BEHAVE IN A HIGH-RISK MANNER: DRUNK DRIVERS, CHILD MOLESTERS,

WIFE BEATERS, DRUG ADDICTS, PROMISCUOUS AND PREGNANT TEEN-AGERS,

AND ANYBODY ELSE WHO DEVIATES -- OR WHO IS PERCEIVED AS

DEVIATING -- FROM THE COMMUNITY'S STANDARD OF NORMATIVE BEHAVIOR,


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  AS I INDICATED EARLIER, THE AMERICAN PEOPLE ARE GENEROUS AND

FORGIVING, THEY DJ BELIEVE IN -- AND WILL CONTINUE TO SUPPORT --

PUBLIC HEALTH PROGRAMS THAT PROMISE REDEMPTION,

BUT AMERICANS ARE NOT PUSH-OVER!% AND IT'S POSSIBLE THAT

THE AMERICAN PEOPLE -- ALREADY TAKING A CONTENTIOUS APPROACH

TOWARD SOME BACKSLIDERS -- MAY DEMONSTRATE THEIR IMPATIENCE AND

DISPLEASURE ON A GRANDER SCALE, ADDING A STRONG FOOTNOTE OF HIGH

DUDGEON TO THE EXISTING BODY OF AMERICAN PUBLIC HEALTH LAW,


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  AND I BELIEVE WE'RE SEEING SOME OF THAT CONTENTION DEVELOP

IN REGARD TO PERSONS WITH AIDS, NINE OF EVERY 10 PERSONS WITH

THE DISEASE BECAME INFECTED BY DOING WHAT THE MAJORITY OF THE

COMMUNITY REGARDS AS AN UNSAVORY ACT: THAT IS, THEY ENGAGED IN

SODOMY OR INTRAVENOUS DRUG ABUSE,

  TRAGICALLY, ONCE YOU BECOME INFECTED THIS WAY, YOU CAN'T

BECOME MINFECTED, HENCE, THERE'S NO REDEMPTION IN THE USUAL

SENSE 11, THERE'S NO REWARD FOR YOU IF YOU CHANGE YOUR BEHAVIOR,


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  NEVERTHELESS, WE MUST CONVINCE PERSONS WITH AIDS TO CHANGE

THEIR BEHAVIOR ANYWAY, IN ORDER TO STOP THE SPREAD OF THE VIRUS,

AND THAT IS A REWARD OF SORTS FOR SOCIETY, AT THE VERY LEAST,

  AND WE NEED TO MAINTAIN STRONG PUBLIC SUPPORT FOR PROGRAMS

THAT PROVIDE INFORMATION TO PEOPLE AT RISK OF GETTING AIDS ,.. OR

PROGRAMS THAT PROVIDE MEDICAL SERVICES FOR THOSE WHO NEVER DID

GET THE MESSAGE -- AND ARE DYING,

  AND THIS WOULD CERTAINLY BE AN AREA WHERE A GROUP OF

PHYSICIAN COMMUNICATORS SUCH AS YOURSELVES CAN HELP STRENGTHEN

THE PUBLIC'S RESOLVE TO MAINTAIN OUR TRADITIONAL COMMITMENT TO

HELP EVERYONE IN NEED,


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  FOR MANY YEARS TO COME, WE WILL OFFER CANCER DETECTION AND

TREATMENT TO MEN AND WOMEN WHO HAVE SMOKED CIGARETTES -- AND KNEW

BETTER THAN TO DO THAT, WE WILL ATTACK THEIR CANCERS, TRY TO

PROLONG THEIR LIVES, AND -- WHEN THE TIME COMES -- WE WILL DO

WHAT WE CAN TO EASE THEIR DYING,

  WE MUST DO THESE THINGS, IF WE WANT TO CONTINUE TO CALL

OURSELVES A CIVILIZED AND COMPASSIONATE SOCIETY, YET, I WOULD

SUGGEST THAT THE MORE THE MAJORITY BELIEVES IN -- AND PRACTICES

-- THE PRINCIPLES OF PREVENTION AND SELF-HELP, THE LESS WILL BE

ITS PATIENCE WITH THE MINORITY WHO DOES NOT PRACTICE THESE

VIRTUES


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  AND THAT, I BELIEVE, IS AN ISSUE FOR ALL AMERICANS IN THE

COMING YEARS, BUT FOR PHYSICIANS IN THE MEDIA, IT IS AN ISSUE OF

SPECIAL RELEVANCE,

  AS I INDICATED AT THE BEG1 NNING OF MY REMARKS,  I SUSPECT

THAT SOME OF THESE CHANGES WILL BE EASIER TO EXPERIENCE THAN

OTHERS, SOME WILL AFFECT US PERSONALLY 1,. OTHERS WILL AFFECT

THE HEALTH SYSTEM IN GENERAL,


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  BUT, ON BALANCE, I BELIEVE THAT FROM THESE CHANGES WILL

EVOLVE A STRONGER, MORE CONTEMPORARY, MORE COMPASSIONATE, AND

MORE RESPONSIVE SYSTEM OF HEALTH CARE TO SERVE THE NEXT AND

SUCCEEDING GENERATIONS OF AMERICANS ,I, THAT IS TO SAY, YOUR

CHILDREN AND GRANDCHILDREN,

AND THAT'S THE BEST PREDICTION OF ALL,

THANK YOU,

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