ADDRESS

BY

C, EVERETT KOOP, M,D,, Sc,D,

    SURGEON GENERAL

         OF THE

     UA PUBLIC HEALTH SERVICE

U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE METRO NEW YORK CHAPTER OF THE

     YOUNG PRESIDENTS' ASSOCIATION
        NEW YORK, NEW YORK
         MARCH 7, 1989


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.>

  I'M DELIGHTED TO BE HERE TO SHARE WITH YOU MY OBSERVATIONS

ABOUT TWO KEY ISSUES IN PUBLIC HEALTH TODAY, OF COURSE, YOU HAVE

ME AT A GREAT DISADVANTAGE, WHEN MS, FAYE WATTLETON EXTENDS THE

INVITATION ON YOUR BEHALF,

  MS WATTLETON AND I SHARE A RARE AND EXCEEDINGLY STRONG

BOND, WE HAVE BOTH BEEN UNMERCIFULLY BADGERED BY ONE OF THE

SHARPEST LEGAL MINDS IN THE COUNTRY, PROFESSOR ARTHUR MILLER OF

HARVARD LAW SCHOOL,


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  THOSE OF YOU WHO MAY HAVE WATCHED FRED FRIENDLY'S SERIES ON

ETHICS, THAT HAS BEEN SHOWN ON PUBLIC BROADCASTING STATIONS THIS

WINTER, WILL KNOW WHAT I MEAN AND, THEREFORE, YOU WILL UNDERSTAND

WHY IT'S A MATTER OF HONOR FOR VETERANS OF THAT PROGRAM TO COME

TO EACH OTHER'S AID,

  I ALSO FIND IT VERY DIFFICULT TO TURN ASIDE AN INVITATION TO

SPEAK ABOUT TWO UNCONNECTED MATTERS -- SMOKING AND AIDS --

MATTERS THAT HAVE SHADOWED ME THROUGHOUT MY 8 YEARS AS YOUR

SURGEON GENERAL,


  A MEMBER OF MY STAFF SAID JUST THE OTHER DAY -- A BIT

WISTFULLY, I THINK -- THAT HE WAS SORRY THAT SOMEHOW, DURING THE

LAST FEW YEARS, OUR SCIENTISTS DID NOT DISCOVER THAT SMOKING

CIGARETTES CAUSES AIDS, HE THOUGHT SUCH A DISCOVERY WOULD HAVE

HELPED ME A GREAT DEAL IN MY DAY-TO-DAY JOB,

  SUCH A DISCOVERY HAS ND BEEN MADE AND I SERIOUSLY DOUBT

THAT IT WILL, NEVERTHELESS, THEY ARE THE TWO PARAMOUNT ISSUES ON

THIS SURGEON GENERAL'S AGENDA -- AND I'M AFRAID THEY WILL BE ON

MY SUCCESSORS' AGENDA AS WELL FOR THE NEXT DECADE OR TWO,


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  LET ME BEGIN BY AT LEAST CLEARING,UP A MATTER OF HISTORY,

CONTRARY TO POPULAR BELIEF, J- DID NOT INVENT THE ISSUE OF

SMOKING,

  IN FACT, JUST RECENTLY, ON JANUARY 11, WE MARKED THE 25TH

ANN.IVERSARY OF THE FIRST SURGEON GENERAL'S REPORT ON SMOKING AND

HEALTH, IT WAS ISSUED IN 1964 BY THE LATE DRn LUTHER TERRY, A

TRUE AMERICAN HERO, HE IS, BY THE WAY, THE ONLY SURGEON GENERAL

TO BE BURIED IN ARLINGTON CEMETERY, AN HONOR GIVEN HIM BY

PRESIDENTIAL ORDER,

WHEN THAT FIRST REPORT WAS RELEASED, 50 PERCENT OF AMERICAN

MEN AND 32 PERCENT OF AMERICAN WOMEN SMOKED CIGARETTES.


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  TODAY, LESS THAN 32 PERCENT OF MEN AND LESS THAN 27 PERCENT

OF WOMEN SMOKE CIGARETTES, IN FACT, FOR EACH OF THE PAST 14

YEARS, PER CAPITA CIGARETTE CONSUMPTION -- WHICH JS THE KEY

NUMBER --- HAS STEADILY DECLINED, YEAR BY YEAR,

WE STILL HAVE ALMOST 50 MILLION AMERICANS WHO SMOKE -- FAR

TOO MANY, IN MY BOOK -- BUT HAD THERE BEEN FIQ ANTI-SMOKING

CAMPAIGN OVER THE PAST 25 YEARS, WE WOULD HAVE HAD OVER 100

MILLION SMOKERS TODAY maa AND ALL THE MEDICAL AND PUBLIC HEALTH

CHAOS THAT WOULD GO WITH THEM,   SO WE'VE MADE SOME REAL

PROGRESS,


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  IN ADDITION, YEAR AFTER YEAR, WE'VE LAID OUT BEFORE THE

AMERICAN PEOPLE -- AND THE PEOPLE OF THE WORLD -- THE MOUNTING

AND CONCLUSIVE EVIDENCE AGAJNST CIGARETTE SMOKING, DURING MY

TENURE ALONE WE'VE ISSUED SEVEN LANDMARK REPORTS,

  IN 1982, WE CLEARLY LINKED SMOKING TO CANCER, AND I DON'T

BELIEVE THE TOBACCO INDUSTRY HAS EVER QUITE RECOVERED FROM THAT

ONE, THE RESEARCH IN THAT REPORT HAS CONTRIBUTED SUBSTANTIALLY

TO THE HUNDREDS OF LIABILITY SUITS BROUGHT AGAINST CIGARETTE

MANUFACTURERS

  IN SUBSEQUENT REPORTS WE DEALT WITH SMOKING AND HEART

DISEASE, STROKE, AND CHRONIC OBSTRUCTIVE LUNG DISEASE, AGAIN,

THE EVIDENCE HAS BEEN OVERWHELMING AND VERY DAMAGING TO TOBACCO,


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I AM ESPECIALLY PLEASED, HOWEVER, TO HAVE RELEASED REPORTS

ON SMOKING AND THE WORKPLACE AND ON INVOLUNTARY SMOKING,

TOGETHER, THESE REPORTS HAVE BECOME THE BASIS FOR AN

EXTRAORDINARY NUMBER OF NEW ANTI-SMOKING LAWS AND POLICIES FOR

RETAIL ESTABLISHMENTS, MANUFACTURING, BUSINESS OFFICES, AND

GOVERNMENT BUILDINGS,

AND THE 1987 REPORT PRESENTED CONVINCING EVIDENCE THAT

CIGARETTES AND OTHER TOBACCO PRODUCTS ARE CLINICALLY ADDICTING,


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  THE NICOTINE IN TOBACCO DOES CAUSE ADDICTION, AND WE'VE

FOUND THAT THE PHARMACOLOGIC AND BEHAVIORAL PROCESSES THAT

DETERMINE TOBACCO ADDICTION ARE THE SAME AS THE PROCESSES THAT

MAKE COCAINE AND HEROIN ADDICTIVE,

PEOPLE DON'T LIKE TO HEAR THAT, I SUSPECT THAT SOME OF THE

SMOKERS HERE OR SOME OF THE PEOPLE WHO ARE CONNECTED WITH

CIGARETTE ADVERTISING OR PUBLIC RELATIONS ESPECIALLY DON'T LIKE

TO HEAR THAT,

BUT IT'S TRUE,


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  I SHOULD ADD THAT THE DEFINITIONS USED IN THAT REPORT ARE

NOT MINE, TOBACCO IS AN ADDICTIVE DRUG, NOT JUST BECAUSE Cm

EVERETT KOOP SAYS SO, BUT BECAUSE THE WORLD HEALTH ORGANIZATION,

THE AMERICAN PSYCHIATRIC ASSOCIATION, AND THE AMERICAN MEDICAL

ASSOCIATION SAY SO,

ACCORDING TO THESE ORGANIZATIONS ,,m

+

TOBACCO IS A "MOOD-ALTERING" SUBSTANCE . , ,

9

+

SMOKERS ARE COMPULSIVE IN THEIR USE OF TOBACCO , ma

TOBACCO REWARDS THE USER -- IT IS, THEREFORE, A

  "REINFORCING" SUBSTANCE . , n


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SMOKERS BUILD UP A TOLERANCE TO NICOTINE AND, FROM TIME TO

  TIME, WILL REQUIRE HIGHER DOSE LEVELS TO GET THEIR

   NICOTINE "HIGH" an,

PHYSICAL DEPENDENCE CAN OCCUR, WHICH MEANS A WITHDRAWAL

  SYNDROME FOR THOSE WHO QUIT , t u

AND -- AS WITH HEROIN, COCAINE, AND OTHER ADDICTIVE DRUGS --

  THE USER WILL VERY LIKELY RELAPSE AND RETURN TO THE USE

   OF THE DRUG,

I STRONGLY BELIEVE THAT YOUNG PEOPLE NEED TO BE WARNED ABOUT

THE ADDICTIVE NATURE OF TOBACCO, BECAUSE -- LET'S NOT KID OUR-

SELVES -- RIGHT NOW, YOUNG PEOPLE ARE THE PREFERRED TARGET OF

TOBACCO ADVERTISING AND PUBLIC RELATIONS,


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THAT'S NOTHING LESS THAN A CYNICAL, DESPERATION STRATEGY BY

AN INDUSTRY WHOSE DAYS ARE NUMBERED IN THIS COUNTRY,

  PEOPLE OFTEN ASK ME HOW THE SMOKING ISSUE COMPARES IN

GRAVITY TO THE ISSUE OF AIDS THAT'S A LITTLE LIKE COMPARING

APPLES AND ORANGES, BUT OVER THE PAST SEVERAL MONTHS I'VE WORKED

OUT AN ANSWER, AND I WILL SHARE IT WITH YOU NOW,

SMOKING AS A HEALTH ISSUE HAS BEEN ON OUR PUBLIC HEALTH

AGENDA FOR 25 YEAR AT LEAST,


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  AIDS, ON THE OTHER HAND, HAS NOT YET PASSED ITS FIRST DECADE

AS AN JDENTIFIABLE DISEASE, AND ITS RESEARCH ARCHIVE, WHILE

QUITE LARGE, IS STILL MODEST BY COMPARISON TO THE 60,000 OR SO

STUDIES THAT HAVE BEEN DONE ON SMOKING,

   AND -- SO FAR, AT LEAST -- THE MORTALITY AMONG SMOKERS STILL

FAR EXCEEDS THAT OF AIDS: WELL OVER 390,000 DEATHS A YEAR ARE

SMOKING-RELATED, RUT ONLY 11,200 AIDS-RELATED DEATHS WERE

REPORTED TO US LAST YEAR,

  HERE'S ANOTHER WAY OF PUTTING IT: THE NUMBER OF PEOPLE WHO

HAVE DIED OF AIDS IN THE PAST 8 YEARS EQUALS THE NUMBER OF

PEOPLE WHO DIE OF SMOKING-RELATED CAUSES EVERY 7 WEEKS,


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SO THERE'S QUITE A DIFFERENCE IN THE ORDER OF MAGNITUDE,

  BUT I SHOULD ADD THAT THE MORTALITY RATE FOR AIDS IS

VIRTUALLY 100 PERCENT, \lJHICH TS HIGHER THAN THE MORTALITY RATE

FOR SMOKERS, AND THE KEY DIFFERENCE, OF COURSE, IS THAT YOU

CAN'T PREDICT WHICH SMOKERS ARE GOING TO DIE; WHEREAS, YOUR

PREDICTIONS FOR PERSONS WITH AIDS ARE VIRTUALLY 100 PERCENT

ACCURATE,

   BUT EVEN THAT NEEDS SOME QUALIFICATIONS
       LET'S LOOK, FOR

EXAMPLE, AT TWO YOUNG MEN, EACH 22 YEARS OF AGE, BOTH MEN AT

THAT AGE HAVE A STATISTICAL LIFE EXPECTANCY OF ABOUT 74 YEARS ,,a

IN OTHER WORDS, THEY CAN ANTICIPATE ANOTHER 52 YEARS OF LIFE

AHEAD OF THEM,


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  NOW LET'S SAY THAT ONE YOUNG MAN BECOMES INFECTED TODAY WITH
THE HUMAN IMMUNODEFICIENCY VIRUS, OR H,I,V, HE WILL VERY LIKELY

DIE OF AIDS AND ITS COMPLICATIONS BEFORE HE TURNS 30,

  WE SAY, THEREFORE, THAT HE WILL DIE PREMATURELY BY ABOUT 44

YEARS,

  THE SECOND YOUNG MAN OF 22 BEGINS TO SMOKE CIGARETTES TODAY
AND CONTINUES TO SMOKE THEM FOR THE REST OF HIS LIFE, HE WILL
VERY LIKELY DIE OF HEART DISEASE OR LUNG CANCER AROUND THE AGE OF

56, ALL OTHER THINGS BEING EQUAL,

HE ALSO WILL DIE PREMATURELY, BUT BY ABOUT 18 YEARS,


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   so  I I I YES, THE AIDS VIRUS, COMPARED TO CIGARETTE SMOKING,

DOES SHORTEN PEOPLE'S LIVES MORE QUICKLY THAN TOBACCO DOES,
BUT
THE QUALITY OF LIFE FOR BOTH VICTIMS IS GREATLY DIMINISHED,

REGARDLESS OF THE NUMBER OF YEARS THEY HAVE,

AND FOR BOTH, PREMATURE DEATH IS PREMATURE DEATH, THE

VICTIM DISAPPEARS EARLY wan AND FOREVER,

  SO, ESSENTIALLY, THE OUTCOME OF A LIFE OF CIGARETTE SMOKING

IS NOT VERY DIFFERENT FROM THE OUTCOME OF AN ADMITTEDLY SHORTER

LIFE SPENT ENGAGING IN THE HIGH-RISK BEHAVIOR THAT LEADS TO AIDS:

YOU'LL BE DEAD a,, AND DEAD TOO SOON,


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  AND BOTH CONDITIONS -- THAT IS, BEING A CIGARETTE SMOKER AND

TESTING POSITIVE FOR AIDS -- ARE THE RESULTS OF WILLFUL PERSONAL

BEHAVIOR: IN OTHER WORDS, YOU DON'T "CATCH" AN ADDICTION TO

TOBACCO AS YOU DON'T "CATCH" AIDS, YOU HAVE TO DO SOMETHING IN

BOTH INSTANCES,

  HENCE, THE VERY BEST WEAPON WE HAVE TO FIGHT BOTH DISEASE

CONDITIONS -- TOBACCO ADDICTION AND H,I,V, INFECTION -- IS

EDUCATION ,a, EDUCATION .,, AND MORE EDUCATION,


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  THERE IS, HOWEVER, ONE KEY DIFFERENCE BETWEEN THE TWO:

CIGARETTE SMOKING IS ACTIVELY PROMOTED BY THE CIGARETTE INDUSTRY

ITSELF, WHICH IS THE SOLE BENEFICIARY OF THIS PUBLIC ADDICTION,

SINCE IT ENGAGES IN INTERSTATE COMMERCE, THE CIGARETTE INDUSTRY

CAN BE REGULATED BY THE PUBLIC AND BY GOVERNMENT,

BUT AIDS IS A DIFFERENT MATTER,

  THERE IS NO AIDS "INDUSTRY," ANALOGOUS TO THE TOBACCO

INDUSTRY, THEREFORE, ANY ACTION BY THE PUBLIC AND THE GOVERNMENT

AGAINST AIDS FALLS INTO THE CATEGORY OF EDUCATION 11, OF

PERSUASION , , , OF INFLUENCING HUMAN BEHAVIOR nm, AND SO ON,


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  WE MUST DO THE KIND OF THING WE'VE DONE IN REGARD TO THE

BATTLES AGAINST HYPERTENSION, DRUG ABUSE, TEENAGE PREGNANCY, OR

DRUNK DRIVING,

  WE CAN PASS LAWS TO PROHIBIT THE SALE OF CIGARETTES TO YOUNG

PEOPLE OR TO MANDATE CERTAIN WARNING LABELS FOR CIGARETTE
PACKAGES OR TO LEVY HIGH TAXES ON EVERY PACKAGE SOLD, AND THOSE

LAWS SEEM TO HAVE AN EFFECT,

  BUT WE HAVE A MUCH MORE DIFFICULT TIME PASSING LAWS -- AND

ENFORCING THEM -- TO PROHIBIT CONSENSUAL SODOMY WITHOUT A CONDOM




I I I OR PROMISCUOUS HETEROSEXUAL INTERCOURSE ,, , OR THE USE OF

CONTAMINATED NEEDLES WHILE "SHOOTING UP" WITH DANGEROUS DRUGS


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  NOR IS IT A SIMPLE MATTER TO KEEP RECORDS ON PEOPLE WITH

AIDS, IF THOSE RECORDS CAN EVER BE SOMEHOW USED AGAINST THOSE

PEOPLE IN SOME WAY,

   SO THERE ARE MANY THINGS ABOUT SMOKING AND AIDS THAT MAKE

THOSE HEALTH THREATS QUITE DIFFERENT FROM EACH OTHER, HOWEVER,

THEY DO HAVE ONE ASPECT IN COMMON: AND THAT IS THEIR INTER-

NATIONAL
CHARACTER,

   TOBACCO AND AIDS NOW SHARE TOP BILLING AT THE WORLD HEALTH

ORGANIZATION IN GENEVA, AND I HAVE TO SAY THAT THE AMERICAN

CIGARETTE INDUSTRY WORKED VERY HARD TO EARN THAT TOP POSITION,


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  FOR EXAMPLE, MR, J,Tm BUNN OF THE,LEAF TOBACCO EXPORTERS

ASSOCIATION TOLD THE INTERAGENCY COMMITTEE ON SMOKING AND HEALTH

-- WHICH I CHAIR -- THAT IN 1987 "at ,THE VALUE OF US, EXPORTS OF

LEAF TOBACCO AND TOBACCO PRODUCTS TOTALLED $383 BILLION t THE

VALUE OF US, TOBACCO IMPORTS TOTALLED ABOUT $705 MILLION/'

   MRn BUNN THEN PROUDLY POINTED OUT THAT AMERICA'S "NET

FAVORABLE BALANCE OF TOBACCO TRADE WAS $2,6 BILLION, THIS IS AN

IMPORTANT CONTRIBUTION TO OUR BALANCE OF PAYMENTS," MRa BUNN

SAID,


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WELL, MAYBE IT IS, BUT OTHERS DON'T QUITE SEE IT THAT WAY,

  IN 1987 IN TOKYO, REPRESENTATIVES OF 15 ASIAN COUNTRIES

ATTENDED A WmHnO, "REGIONAL WORKING GROUP ON TOBACCO OIJ HEALTH,"

HERE ARE SOME OF THE THINGS REPORTED AT THAT MEETING BY THE TOP

HEALTH EXPERTS FROM THOSE 15 ASIAN COUNTRIES:


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  FIRST, THEY SAID THAT CIGARETTE CONSUMPTION EVERYWHERE IN

ASIA WAS RISING FASTER THAN THE OVERALL RISE IN POPULATION, THE

PEOPLE'S REPUBLIC OF CHINA, FOR EXAMPLE, REPORTED THAT 90 PERCENT

OF ITS MEN SMOKE a,, PAPUA NElJ GUINEA REPORTED THAT 85 PERCENT OF

ITS MEN NOW SMOKE ,,a THE PHILIPPINES, 78 PERCENT 0.1 AND SO ON,

  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 WHO b/ILL DIE PREMATURELY

FROM SMOKING,


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   SECOND -- AND HERE'S WHERE WE DESERVE TO SQUIRM 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 HAVE A HIGHER TAR CONTENT AND ARE, THEREFORE, EVEN

MORE DANGEROUS THAN THE LOWER-TAR, FULLY-LABELLED PRODUCTS SOLD

HERE IN THE UNITED STATES,


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  NOW, LET ME MAKE SURE YOU UNDERSTAND WHAT I JUST SAID, I

SAID THAT SOME AMERICAN CIGARETTE MANUFACTURERS -- AS KNOWLEDGE-

ABLE AS I AM, CONCERNING THE HEALTH RISKS OF SMOKING -- KNOWINGLY

PRODUCE A MORE HARMFUL CIGARETTE FOR EXPORT THAN THEY PRODUCE FOR

DOMESTIC CONSUMPTION,

  WHAT DO YOU MAKE OF THAT? HOW DO YOU EXPLAIN SUCH

UNFORGIVABLE CORPORATE CONDUCT? MAYBE YOU, WHO ARE IN LEADERSHIP

POSITIONS IN THE PRIVATE SECTOR, HAVE SOME WAY OF EXPLAINING IT.

I CERTAINLY DON'T,


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  SO, ONE, CIGARETTE CONSUMPTION IN ASIA IS OUT-RUNNING
POPULATION GROWTH, TWO, AMERICAN CIGARETTES BE1 NG CONSUMED THERE

ARE OFTEN MORE DANGEROUS THAN THE SAME BRANDS SMOKED HERE IN THE

STATES n a n WHICH IS DANGEROUS ENOUGH,

  AND THIRD -- AND NOT SURPRISINGLY -- THESE SAME 15 COUNTRIES

AT THE WmHeOu WORKSHOP REPORTED THAT COMMUNICABLE DISEASES WERE

COLLECTIVELY NO LONGER THE NUMBER ONE PUBLIC HEALTH MENACE IN

ASIA, TODAY, THE TOP THREE CAUSES OF DEATH IN ASIA ARE 1.1 CAN

YOU GUESS?


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  THAT'S RIGHT, THE LEADING KILLER DISEASE OF MOST ASIANS

ARE THE SAME LEADING KILLER DISEASES OF MOST AMERICANS: HEART

DISEASE, CANCER, AND STROKE , , , WHICH ALSO HAPPEN TO BE

OVERWHELMINGLY RELATED TO SMOKING BEHAVIOR,

  IN OTHER WORDS, THE TOBACCO EPIDEMIC AND ITS LETHAL CONSE-

QUENCES HAVE HIT ASIA 11, AND -- THANKS TO OUR OWN CIGARETTE

INDUSTRY -- HAVE HIT ASIA HARD,

  FORTUNATELY, THE ASIANS THEMSELVES ARE BEGINNING TO ORGANIZE

THEIR OWN ANTI-SMOKING CAMPAIGNS AND WE'RE HELPING THEM AS MUCH

AS WE CAN, WITHIN THE BOUNDARIES OF INTERNATIONAL PROTOCOL,


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  AND OUR EFFORTS HAVE NOT GONE UNNOTICED, MR, J,T, BUNN, THE

VOICE OF TOBACCO, WARNED ME A YEAR AGO THAT IF I CONTINUE TO

PROMOTE ANTI-SMOKING CAMPAIGNS WORLDiJIDE -- WHICH I HAVE SURELY

DONE -- I WOULD BE "TELLING OUR FOREIGN FRIENDS HOW TO CONDUCT

TRADE AND HOW TO CHANGE THEIR HABITS,  IT PROJECTS FOR THE US,

AN IMAGE OF 'THE UGLY AMERICAN,"' SAID MR, BUNN, IN ONE OF THE

CLEAREST DEMONSTRATIONS OF BARE-FACED CORPORATE CYNICISM I HAVE

HAD THE DUBIOUS PRIVILEGE TO ENCOUNTER,

  WELL, THEN, MR J, Tm BUNN, "UGLY AMERICAN" I /$! . a. AND

"UGLY AMERICAN" I INTEND TO REMAIN, AND YET, I'LL WAGER THAT, IN

15 YEARS' TIME, IT WILL BE You, MRn BUNN -- AND NOT I -- WHO WILL

TRULY BE THE "UGLY AMERICAN" OVERSEAS


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BRIEFLY, THEN, THOSE ARE A FEW WORDS REGARDING THE CIGARETTE

EPIDEMIC OVERSEAS, I FOCUSED ON ASIA, BECAUSE THE SITUATION IN

EUROPE -- WHICH IS NOT GOOD EITHER -- HAS BEEN WIDELY REPORTED,

  ALSO, THE EUROPEANS THEMSELVES ARE MUCH BETTER ORGANIZED FOR

AN ANTI-TOBACCO CAMPAIGN, I JUST RETURNED FROM A MEETING IN

VENICE, WHERE I PRESENTED OUR 25-YEAR EXPERIENCE TO ACHIEVE A

"SMOKE-FREE AMERICA,"

   THE MEETING \JAS SPONSORED BY THE ASSOCIATION FOR RESEARCH ON

CANCER AND THE PARTICIPANTS WERE ALL COMMITTED TO ACHIEVING A

"SMOKE-FREE EUROPE," BASED ON THE AMERICAN MODEL, THE EURTIPEANS,

OF COURSE, WILL BECOME A UNIFIED "ECONOMIC COMMUNITY" IN 1992

AND, EVEN IN MATTERS SUCH AS SMOKING AND HEALTH THEY ARE

BEGINNING TO THINK AND WORK TOGETHER,


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SO THAT'S SOME OF THE LATEST INFORMATION REGARDING CIGAR-

ETTES, NOW, WHAT ABOUT AIDS?

AIDS IS DIFFERENT,

  THE UNITED STATES HAS BEEN A WORLD LEADER IN THE EFFORT TO

ISOLATE AND IDENTIFY THE AIDS VIRUS AND IN THE BATTLE TO STOP THE

EPIDEMIC AND TURN IT AROUND,


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  WE ESTABLISHED WHAT HAS COME TO BE THE MODEL REPORTING

SYSTEM FOR AIDS AND WE'RE HELPING A NUMBER OF COUNTRIES --

ESPECIALLY THOSE IN SUB-SAHARA AFRICA -- TO DO THE SAME THING, SO

THEY WILL KNOW WHERE THE DISEASE IS MOST PREVALENT AND HOW

PREVALENT IT IS,

  WE'VE ALSO FINANCED MOST OF THE AIDS RESEARCH, BOTH HERE

AND ABROAD, AND WE'RE DEEPLY INVOLVED IN W,H,O,'s "GLOBAL

PROGRAMME ON AIDS."

  THE PUBLIC HEALTH SERVICE IS SPENDING ABOUT CLOSE TO $1.3

BILLION ON AIDS THIS YEAR, AND ABOUT TWO-THIRDS OF THAT IS GOING

TO RESEARCH, THE PRESIDENT'S BUDGET REQUEST FOR FISCAL YEAR 1990

RECOMMENDS INCREASES ACROSS-THE-BOARD,


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  DESPITE THESE ENORMOUS INVESTMENTS, THE EPIDEMIC IS

SPREADING THROUGHOUT 135 COUNTRIES OF THE WORLD, AS IT IS

SPREADING HERE IN THE UNITED STATES

  BUT MANY COUNTRIES OF THE WORLD HAVE YET TO DEAL CANDIDLY

WITH THE UNSETTLING NATURE OF THE AIDS EPIDEMIOLOGICAL DATA, AS

WE HAD TO DO A FEW YEARS AGO,

  IN HONG KONG, FOR EXAMPLE, IT'S AGAINST THE LAW TO ENGAGE IN

HOMOSEXUAL SEX,  THEREFORE, SAY THE AUTHORITIES OF HONG KONG,

SEXUAL PROMISCUITY AMONG HOMOSEXUALS DOES NOT OCCUR IN HONG KONG,

BUT OF COURSE IT DOES,


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  ELSEWHERE THE CASELOADS SEEM TO BE RISING MAINLY BECAUSE OF

HaI&-INFECTED BLOOD AND BLOOD PRODUCTS, A RISK THAT WE'VE

VIRTUALLY ELIMINATED HERE IN THE STATES

  ALSO, MANY NATIONS ARE NOW BEGINNING TO REPORT -- HOWEVER

RELUCTANTLY -- A RISE IN TRANSMISSIONS VIA HETEROSEXUAL CONTACTS,

TRACEABLE TO THE VERY HIGH PROPORTION OF H, I %-INFECTED

PROSTITUTES, IN SOME CITIES IN CENTRAL AFRICA, FOR EXAMPLE, UP

TO 90 PERCENT OF ALL FEMALE PROSTITUTES CARRY THE AIDS VIRUS, WE

HAVE THIS PROBLEM, ALSO, BUT IT SEEMS TO BE CONTAINED AMONG

PROSTITUTES WITHIN THE DRUG ABUSE COMMUNITY, WHICH IS DIFFERENT

FROM THE AFRICAN EXPERIENCE,

WHAT'S THE PROGNOSIS FOR THIS EPIDEMIC?


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GENERALLY SPEAKING, IT'S STILL NOT GOOD FOR THE FORESEEABLE

FUTURE,

  WHILE THE RATE OF SPREAD OF THE DISEASE SEEMS TO BE SLOWING

DOWN AMONG THE LARGEST HIGH-RISK GROUP -- THAT IS, AMONG

HOMOSEXUALS AND BISEXUAL MEN, THANKS TO STRONG EDUCATIONAL

PROGRAMS -- THE VIRUS IS SPREADING AT A RATHER FAST PACE AMONG

I,V, DRUG ABUSERS, AND THEY'RE THE PEOPLE WE'VE ALWAYS HAD

TROUBLE REACHING WITH A PUBLIC HEALTH MESSAGE,

  WE ARE JUST IN THE FIRST STAGES OF DEVELOPING A SAFE AND

EFFECTIVE VACCINE, BUT I DON'T SEE US HAVING ONE MUCH BEFORE THE

TURN OF THE CENTURY -- IF THEN,
             THE OTHER DRUGS ClE'VE DEVELOPED

DEAL WITH SYMPTOMS OF THE DISEASE -- THEY DON'T PROTECT ANYONE

FROM THE DISEASE OF AIDS ITSELF,


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  I SPEND A GREAT DEAL OF MY TIME ON THESE TWO PUBLIC HEALTH

EPIDEMICS -- CIGARETTE SMOKING AND AIDS -- BUT THEY ARE NOT THE

ONLY THINGS THAT CONCERN ME ABOUT THE HEALTH OF OUR NATION,

  I'M ALSO CONCERNED ABOUT DRUG ABUSE ,a, MATERNAL AND CHILD

HEALTH n u a THE HEALTH OF THE AGED IN AMERICA n a a HANDICAPPED

CHILDREN a mm DOMESTIC VIOLENCE 1.1 AND SO ON,

  BUT FOR SHEER NUMBERS OF HOURS, BAGS OF MAIL, LOGS OF PHONE

CALLS, AND PERSONAL VISITS TO MY OFFICE, THE TWO LEADING ISSUES

ARE CIGARETTES AND AIDS BY FAR,


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  THERE AREN'T ANY EASY ANSWERS TO HELP US CONTROL AND REVERSE

EITHER EPIDEMIC, THE OLDER EPIDEMIC OF SMOKING OR THE NEWER

EPIDEMIC OF AIDS,

  WHAT WE MUST DO, THEREFORE, IS WHAT WE'VE BEEN DOING SO FAR

, , , .ONLY MORE SO:
    WE MUST CONTINUE TO APPLY HARD WORK, SCARCE

RESOURCES, AND LOTS OF FAITH TO THESE ISSUES, IN THE HOPE THAT --

SOONER RATHER THAN LATER -- THE GOOD SENSE OF ALL PEOPLE

EVERYWHERE WILL ULTIMATELY PREVAIL,

AND I THINK IT WILL,


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  I HOPE THIS HAS BEEN HELPFUL TO YOU IN SEEING THESE TWO

MAJOR HEALTH PROBLEMS FROM MY PERSPECTIVE, AND NOW, IF YOU WISH,

I'D BE HAPPY TO ANSWER A FEW QUESTIONS,

THANK YOU,

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