RE

BY

C, EVERETT KOOP, MaDa, SCaDt
   SURGEON GENERAL
      OF THE

U, S, PUBLIC HEALTH SERVICE

PRESENTED TO THE REPUBLICANS ASSOCIATED FOR MUTUAL SUPPORT
           WASHINGTON, D, C,
           NOVEMBER 19, 1987


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

  I WANT TO THANK YOU ALL VERY MUCH FOR INVITING ME TO SPEAK TO

YOU THIS MORNIN

          SPONSE TO THE EP
                         -zamP w~*~~s-ze~~~I .l;--i, * r~.*.-w--*-        s I .*I

                                                                           J

SAY THAT I RECOGNIZE AND APPRECIATE+ LEADERSHIP
             ;-H'EALTH ON THIS VERY

TRIBUTIONS OF,

RTIGER ARE SHINING

ES OF :fHAT PUBLIC HfALTH LEADERSHIP CAN ACCOMPLISH,

                                                            8
                   .,'
YOU WILL BEJ&u~~ING AIDS EDUCATI~N,~N,-GENERAL AND FOR
    ND SO ON, AND THAT'S FINE WITH ME, BUT I WOULD LIKE
                                                                  . /~
                                                                 ' j.., "iv
  A LITTLE MORE PHILOSOPHICAL, SINCE MOST OF YOU'ARQHIGHLY
                                                 Fx. ^,

IED EXPERTS ON THE ISSUES TO BE DISCUSSSED THIS MORNING, I".

  'D LIKE'TO LOOK AT THIS PANDEMIC OF AIDS FROM A LITTLE

DIFFERENT POINT OF VIEW,  I WANT TO TALK ABOUT WHAT IT'S DOING TO
SOME OF OUR PEOPLE, ,,WHAT IT CAN DO TO u OF OUR PEOPLE, ,,AND WHAT
EMUST DO TO HELP PEOPLE CONJJUER AIDS, THE MOST VICIOUS OF

INFECTIOUS DISE!?.~': IN THE HISTORY OF THE HUMAN RACE,


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LET ME CONFESS THAT, IN THE BATTLE AGAINST THIS DISEASE,

MEDICINE AND SCIENCE ARE MAKING VERY SMALL HEADWAY, RELATIVE TO WHAT
HAS YET TO BE ACCOMPLISHED,

  IN FACT, I'LL GO EVEN FURTHER AND SAY THAT THE FINAL VICTORY
OVER THIS DISEASE WILL NOT FOLLOW THE PATTERNS OF OTHER SUCH

VICTOR'IES -- THE ONE OVER SMALLPOX, FOR EXAMPLE, OR POLIO,

NO, THIS TIME, THE VICTORY WILL PROBABLY m BE THE EXCLUSIVE

VICTORY OF SCIENTIFIC RESEARCH AND CLINICAL PRACTICE,

THE FINAL VICTORY OVER THE DISEASE OF AIDS WILL MUCH MORE

LIKELY SPRING FROM THE IMPELLING FORCE OF COMPASSIONATELY COMMITTED,
ETHICALLY MOTIVATED, AND COURAGEOUS MEN AND WOMEN WITH LITTLE OR NO

MEDICAL BACKGROUND AT ALL,

LET ME TAKE A LITTLE TIME TO EXPLAIN THAT OBSERVATION,

EVERYTHING THE PUBLIC THINKS AND DOES ABOUT AIDS SEEMS TO BE

RELATED TO THE THREE BASIC ASPECTS OF THE DISEASE:


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FIRST OF ALL, IN SPITE OF ALL WE'VE LEARNED ABOUT THIS VIRUS IN

THE PAST 6 YEARS, AIDS ISSTILL PRETTY MUCH OF A JIYSTERY,

ESPECIALLY TO THE PUBLIC, WE KNOW HOW IT'S TRANSMITTED, FOR
EXAMPLE, AND WE ALSO KNOW HOW IT ATTACKS AND DESTROYS THE HUMAN

IMMUNE SYSTEM,  BUT WE DON'T KNOW WHY IT DOES THAT AND WE STILL
CAN'T PREDICT WHEN THE AIDS VIRUS WILL -- OR WILL NOT -- PROCEED
ON*ITS DESTRUCTIVE PATH, SO, FIRST ON OUR LIST IS MYSTERY,

BUT MEDICAL SCIENCE DOES NOT THRIVE ON MYSTERYwIT THRIVES ON

DISCOVERY, AND DISCOVERY STILL SEEMS TO BE SOME DISTANCE AWAY FROM

us,

  AIDS IS A MYSTERY,,,BUT IT'S NOT ONLY A MYSTERY,
                  IT'S AN
ENORMOUS HUMAN CATASTROPHE, ,,A DISEASE THAT HAS AFFLICTED MORE THAN

44,000 AMERICANS,,,OF WHOM NEARLY 2G,OOO HAVE ALREADY DIED,

  MANY PEOPLE DENY THAT THEY ARE NOW -- OR COULD EVER BE --

INFECTED WITH THE AIDS VIRUS, EVEN THOUGH THEY MAY ENGAGE IN HIGH-
RISK BEHAVIOR,,,ANAL INTERCOURSE, FOR EXAMPLE, OR NEEDLE-SHARING

AMONG IJ, DRUG ABUSERS,


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BUT MORE IMPORTANT, MANY PEOPLE WHO DO NOT ENGAGE IN ANY HIGH-

RISK BEHAVIOR AT ALL AND ARE -wILi PROBABLY NEVER CATCH AIDS, ARE
READY TO GIVE UP ON PEOPLE WHO QQ HAVE AIDS,

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

  AND THAT'S THE THREAT FROM THIS ASPECT OF AIDS, ,,THE THREAT

RAISED BY ITS MYSTERY,

   &EPT THE CONTINUING CATASTROPHE OF LOSS OF HUMAN
             .-__,
LIFE,,,

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

BUT IN THIS TERRIBLE AND FEARSOME PERIOD, I MAINTAIN -- AS A'

PHYSICIAN, AS A SCIENTIST, BUT ALSO AS A HUMAN BEING -- THAT MAN

CANNOT BE DENIED I


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AIDS -- BY ITSELF -- WOULD MAKE USDO THAT,

PEOPLE WHO LIVE IN TOTAL FEAR OF AIDS WOULD HAVE US DO THAT,

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

BilT WE CANNOT,

AND THAT'S WHY WE MUST RECOGNIZE THIS ASPECT OF MYSTERY FOR

WHAT IT ISwAND OVERCOME IT,

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

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

THOSE PEOPLE HAVE ALREADY DIED,

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

PERCENT OF THEM HAVE ALREADY DIED,


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OF THOSE WHO HAD THE DISEASE IN 1982, SOME 87 PERCENT HAVE

ALREADY DIED,

OF THOSE IN 198% 89 PERCENT OF THEM- HAVE ALREADY DIED OF AIDS,

AND30 ON,

AFDS IS THE CLOSEST THING IN OUR ENVIRONMENT TODAY TO BEING A

"VIRTUALLY 100 PERCENT FATAL DISEASE,"

i

  E HAVE NOTHING AT ALL,,,NoTHING,,,THAT wiLL SAFELY AND
EFFECTIVELY STOP THE DISEASE OF AIDS IN ITS TRACKS,

  WE HAVE NO DRUGS,;,NO VACCINESmNO MAGIC BULLETSwNOTHING

THAT CAN ACCOMPLISH THAT LIFE-SAVING JOB,

WHAT j)Q WE HAVE? ONLY EDUCATION,


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IT IS IMPERATIVE-THAT WE TELL THE *PUBLIC, WHOSE SYMPATHY AND

COOPERATiON ARE SORELY NEEDED, THAT -- AT THE MOMENT -- DEATH IS THE

PARTNER OF PEOPLE WITH AIDS,

IT'S A GREAT MISTAKE TO UNDERESTIMATE THE SIGNIFICANCE OF THIS

SECOND ASPECT OF AIDS -- ITS VIRTUALLY 100 PERCENT MORTALITY RATE --

BECAUSE THIS FACT IS ALREADY RAISING THE POSSIBIILITY OF ABANDONMENT

IN THE MINDS OF OTHERWISE RESPONSIBLE PEOPLE,

I'VE BEEN HEARING STORIES OF SOME PHYSICIANS AND NURSES -- VERY

FEW, THANK GOODNESS,. BUT EVEN m IS ONE TOO MANY -- PHYS!CIANS AND

NURSES WHO DON'T WANT TO TREAT AIDS PATIENTS BECAUSE OF THE DANGER

OF BECOMING INFECTED WITH THE VIRUS THEMSELVES,

  Barr,,,1 KNOWwAND THEY KNOW THAT SUCH A DANGER IS

MINUSCULE,,,AT THE VERY J'IOST,


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YET WE ALL WATCHED THE TELEVISION NEWS COVERAGE OF THE TRAGEDY

OF THE RAY FAMILY IN ARCADIA, FLORIDAmREJECTED AND EXPELLED NOT

ONLY BY PLAIN TOWNSPEOPLE BUT ALSO BY EDUCATORS AND COMMUNITY

LEADERS,

   1. THINK THEY MAY BE TRYING TO TELL US SOMETHING ELSE,, SOME-
THING `SO CONTRARY TO WESTERN ETHICAL TRADITIONS THAT THEY SIMPLY

CANNOT BRING THEMSELVES TO SAY IT STRAIGHT OUT, BUT I THINK THEY
MIGHT BE'TRYING TO SAY WHAT SOME HAVE ALREADY SAID TO ME,,,

"WE DON'T CARE, BECAUSE THESE PEOPLE WITH AIDS ARE AS GOOD AS

DEAD ANYWAY,"

THAT'S A HORRIBLE STATEMENT, AND THE FIRST MOMENT IT IS SAID IT MUST

STIMULATEUS TO EXTEND EVEN FURTHER OUR CALL FOR COMPASSION FOR

PEOPLE WITH AIDS,

THERE IS A MESSAGE THAT EACH OF US MUST DELIVER TO THE WORLD

EVERY DAY, THE INEVITABLY OF DEATH FROM THE DISEASE OF AIDS SHOULD

NOT -- BY ITSELF -- CAUSE THE VICTIMS OF AIDS TO BE ABANDONED AND,
                                                                           ;.

IN THE WORDS OF THE PHILOSOPHER MARTIN BUBER, GIVEN THE "FORETASTE.

OF DEATH,"


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WE HAVE NO REASON TO LET THAT HAPPEN,

SO THERE IS THE MYSTERY OF AIDS,

AND THERE IS THE CERTAINTY OF DEATH FROM AIDS,

  AND FINALLY, THERE IS THE THIRD ASPECT OF THE DISEASE OF AIDS

THAT ISPOSED TO ME IN JUST ABOUT EVERY QUESTION-AND-ANSWER PERIOD

WHEREVER I SPEAK, AND IT'S THAT PEOPLE GET AIDS BECAUSE THEY DO
11
H S S

  BUT THIS THIRD ASPECT OF THE ISSUE OF AIDS IS EVEN MORE

COMPLICATED THAN IT SEEMS,

IN ADDITION TO THE 28,000 HOMOSEXUALS AND BISEXUAL MALES WHO

HAVE HAD AIDS, WE MUST ADD THE 10,000 DRUG ADDICTS WHO HAVE SHARED

DIRTY NEEDLES AND OTHER PARAPHERNALIA AND, BY SUCH ACTIONS' SPREAD

THE DISEASE OF AIDS EVEN FURTHER,

  THE VAST .PlAJORITY OF AMERICANS DON'T 'SHOOT" DRUGS, BELIEVE

ME, NOR DO THEY .APPROVE OF PEOPLE WHO DO,


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IN ADDITION, OF THOSE DRUG ADDICTS WITH AIDS, THERE ARE 4

BLACKS AND LATINOS FOR EACH WHITE PERSON, SO THERE IS YET ANOTHER
ELEMENT OF SOCIAL RANCOR AND DIVISION THAT FILLS OUT THIS THIRD

ASPECT OF AIDS,

OF

BE

TH

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

NOW THAT THEY HAVE THE DISEASE, IT IS A VIRTUAL CERTAINTY THAT

:Y WILL DIE,

AND THE REST OF US WILL BE WITNESS TO THEIR DEATHS, YET WE WILL

HAVE NOTHING AT HAND TO PREVENT THOSE DEATHS,

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

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

WILL THE AMERICAN PEOPLE BE ABLE TO UNDERSTAND THAT? I&HOPE

SOwBUT I'M NOT REALLY SURE THEY'RE READY YET,


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LIKE IT OR NOT, WE ARE IN THE MIDST OF AN EPIDEMIC THAT IS

TESTING NOT ONLY OUR CAPABILITIES IN BIOMEDICAL RESEARCH AND
CLINICAL PRACTICE,, JUT IT'S ALSO TESTING OUR CAPABILITIES AS HUMAN

BEINGS WHO HAVE BEEN RAISED IN -- AND'WHO ARE PRESUMABLY STILL
COMM I TTEti TO -- THE AFFIRMATIVE ETHICAL, MORAL, AND RELIGIOUS

TRADITI-ONS OF OUR COUNTRY,   OfintQ WI-I-U l/iEd
@ne lqflLC.( k  7c, ,3g /ruldq(j&tc /rt/ /qud 7~w+

  THOSE TRADITIONS HAVE BEEN LIVFD BY MILLIONS OF PEOPLE WHOSE
NAMES WE WILL NEVER KNOW, BUT WHO JUST HAVE LIVED THAT WAY FOR US TO

HAVE ARRIVED AT THIS POINT AT ALL-;

--y  THIS IS NOT AN EASY-TIME FOR US, EVEN FOR THOSE OF US WHO HAVE
HAD THE TRAINItiG AND THE EDUCATION AND THE PROFESSIONAL COMMITMENT

AND SO ON,

  HOW MUCH HARDER, THEN, IS IT FOR OUR NEIGHBORS TO BE COURAGEOUS

maaT BE WI SE, ,,AND TO BE INVOLVED?


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SOMETIMES THOSE OF US IN PUBLIC HEALTH WILL RECOGNIZE A DISEASE

FOR WHICH MEDICINE ITSELF CAN OFFER ONLY A PARTIAL CURE, WHILE THE
SOCIAL AND SPIRITUAL STRENGTH OF SOCIETY MUST COME UP WITH THE REST,

I BELIEVE THAT AIDS IS SUCH A DISEASE AND, THEREFORE -- YOU AND

I AND AS MANY OTHERS AS WILL JOIN WITH US -- WE HAVE MUCH WORK TO
DO,,,TOGETHER, .

#I!###