Lecture Vol. 10 Tab A (Pst. SG yrs) cover
                 Speech
                   BY
             C. Everett Koop, MD, ScD

AMA National Leadership Conference
      Phoenix, AZ
    February 25,199O

I was to address this group on two occasions - this one, just after George Bush had been
elected President and the next time, just after he had failed to be re-elected. The
problems of leadership facing the AMA were much greater on the second occasion than
on this one.

I started with the dissatisfaction of patients with doctors, and doctors with patients - the
old problem of the doctor/patient relationship. I made some predictions, which I was
certain would have come to pass by now, as I write this in 2003. It wasan either/or
situation, but I guess we become bogged down, because neither one has happened and
still could be imminent. I tried to face, head on, some of the problems that I see in
medicine. We certainly have high expectations for medicine and health. Some of the
problems stem from the fact that we put faith in new technologies, new pharmaceuticals,
new surgical procedures, and we continue to have faith in what I call the "magic of
medicine". But, we aren't always able to deliver.

Although I tried to illustrate what I said, I stuck pretty much to the main issue, such as
guarding against letting our ethics be determined by our economics; rather than the other
way around, facing the competition between advocates for children and the aged
competing for a small piece of an ever-shrinking pie.

I also went into a recurring theme of mine that is a system of health care, which is
distinguished by a virtual absence of self-regulation on the part of the providers of health
care and also distinguished by the absence of natural marketplace control, such as
competition in regard to price, and quality of service.

After what might have been a gloomy beginning, I spent the rest of my time extolling the
benefits of medical practice and what unbridled opportunities people in medicine had to
lead satisfactory lives and feel that their contributions were truly bringing people what

they needed and making a difference in the system at the same time.

This was a good time to say these things because as I look back on the situation, the last
time we were in a good position to really do something about the problems of medicine
was in the early years of George Bush's one-term presidency. The people to hear this
message were the leadership of the largest organization of medical doctors any place in
the world, and it seemed reasonable for a credible Surgeon General just re-entering the
private sector after eight significant years on the job could have been a good
combination.