ORIGINAL

ADDRESS

BY

C, EVERETT KOOP, M,D,
   SURGEON GENERAL
U,S, PUBLIC HEALTH SERVICE

         AND

DEPUTY ASSISTANT SECRETARY FOR HEALTH
US, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE FELLOWS OF THE JEWISH HOSPITAL
  WASHINGTON UNIVERSITY MEDICAL CENTER
       ST, LOUIS, MISSOURI
        SEPTEMBER 23, 1984


(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,)

  IT'S A GREAT PLEASURE TO JOIN YOU TODAY, AND IT IS A DISTINCT
PRIVILEGE TO BE THE FIRST HONORARY LECTURER FOR THE FELLOWS OF JEWISH
HOSPITAL,

  IT IS A PRIVILEGEwAND IT'S ALSO A MARVELOUS OPPORTUNITY TO HELP
SET A TONE FOR WHAT I HOPE WILL BE A LONG AND EXCITING HISTORY OF
PEOPLE COMING HERE TO SHARE WITH YOU THEIR KNOWLEDGEmTHEIR INTUITION
,,,THEIR SUCCESSES,,,THEIR FAILURES,,,BUT, MOST OF ALL, TO SHARE THEIR
HOPES FOR THE FUTURE OF HEALTH CARE IN AMERICA,

  WITH THAT AS A KIND OF PREAMBLE, I WOULD LIKE TO THINK OUT LOUD
ABOUT THREE ISSUES IN HEALTH CARE THAT INTEREST ME AND WHICH, I
BELIEVE, ARE ESPECIALLY RELEVANT TO THIS EXTRAORDINARY INSTITUTION,
JEWISH HOSPITAL OF ST, LOUIS, THE ISSUES ARE RESEARCH,,,DEMOGRAPHY,, ,
AND THERE-DEFINITION E HEALTH CARE IN THE FUTURE,

  I BRING UP THE SUBJECT OF RESEARCH HERE BECAUSE, FIRST OF ALL, IT
HAPPENS TO BE A VERY IMPORTANT MATTER FROM THE VIEWPOINT OF NATIONAL
HEALTH POLICY, A SOLID R & D PROGRAM HAS BEEN -- AND REMAINS -- THE
FOUNDATION FOR ALL OUR EFFORTS TO PROVIDE BETTER HEALTH AND MEDICAL
CARE FOR OUR CITIZENS,


2

  AND SECOND, I KNOW THAT JEWISH HOSPITAL HAS A VERY STRONG
COMMITMENT TO RESEARCH, AS PART OF ITS OVERALL OPERATING PHILOSOPHY,
INVESTIGATORS AT THIS INSTITUTION ARE PROBING INTO SOME VERY EXCITING
AND PROMISING AREAS, SUCH AS IMMUNOLOGY AND LYMPHOCYTOLOGY, BONE
METABOLISM AND BONE CELL FUNCTION, CANCER THERAPIES, GENETIC
DISORDERS, AND SO ON,

  THIS HOSPITAL COULD NOT MAKE THE KIND OF SHOWING IT HAS IN R & D
-- WITH RECOGNITION COMING FROM COLLEAGUES BOTH HERE AND OVERSEAS --
UNLESS IT HAD THE UNDERSTANDING AND SUPPORT OF ITS COMMUNITY, AND, IN
PARTICULAR, THE FELLOWS OF JEWISH HOSPITAL,

  THE STAFF OF THIS HOSPITAL DESERVES OUR CONGRATULATIONS FOR WHAT
THEY ARE ACCOMPLISHING, AND I'M SURE YOU WOULD AGREE, BUT YOU DESERVE
RECOGNITION AS WELL FOR BACKING THEM UP,

  OUR AMERICAN TRADITION IN SCIENCE INCLUDES THIS PLURALISTIC MIX
OF PRIVATE NON-PROFIT SUPPORT, PRIVATE FOR-PROFIT SUPPORT, AND PUBLIC
m GOVERNMENTAL SUPPORT, EACH INTEREST MAY COMPETE WITH OTHER TWO,
BUT THE COUNTRY WOULD BE THE LOSER, IF ANY ONE OF THOSE THREE
INTERESTS RETIRED FROM THE FIELD,

  DON'T MISUNDERSTAND ME, THIS IS NOT A WAY OF SAYING THAT THE
GOVERNMENT IS TIRED AND WANTS OUT OF RESEARCH, FAR FROM IT, YEAR
AFTER YEAR, THE LEVEL OF FEDERAL SUPPORT FOR BIOMEDICAL AND/BEHAVIORAL
RESEARCH HAS STEADILY GONE UP, REGARDLESS OF WHO HAS BEEN IN THE WHITE
HOUSE OR WHICH PARTY HAS CONTROLLED THE CONGRESS, AND WE CAN BE SURE
THAT THIS WILL BE JUST AS TRUE IN THE FUTURE AS IT HAS BEEN IN THE
PAST,


3

  SO MY CONCERN ABOUT RESEARCH FOR BETTER HEALTH CARE IS NOT
POLITICAL AT ALL, RATHER, IT IS A CONCERN FOR THE BALANCE OF OUR
OVERALL, NATIONAL EFFORT IN RESEARCH AND DEVELOPMENT, THE NATIONAL
R & D ENTERPRISE, LIKE ANY OTHER MAJOR ACTIVITY IN OUR SOCIETY, MUST
GIVE THE SAME DEGREE OF ATTENTION TO STRENGTHENING WHAT WE HAVE TODAY
AS IT DOES TO INVESTING IN WHAT WE WANT TOMORROW,

  SO FAR, THIS COUNTRY HAS BEEN SECOND TO NONE IN MAKING THOSE
INVESTMENTS FOR THE FUTURE AND THE RECORD WILL PROVE IT:

*

     WE'VE HAD OVER 60 NOBEL PRIZE-WINNERS IN MEDICINE AND RELATED
STUDIES, PEOPLE WHO HAVE GENERATED A GREAT DEAL OF BASIC NEW KNOWLEDGE
FOR US AND, INDEED, FOR ALL MANKIND,, ,

*

     WE'VE SET THE WORLD STANDARD IN SUCH AREAS AS VACCINE
RESEARCH AND MOLECULAR AND CELLULAR RESEARCH AND WE HOLD HUNDREDS OF
PATENTS THAT PROVE -- ON PAPER -- THE QUALITY OF OUR LEADERSHIP,,,

*

     AND WE'VE PUT IN PLACE A TRULY REMARKABLE ARRAY OF RE-
SOURCES IN OUR PUBLIC AND PRIVATE UNIVERSITIES, IN OUR FOUNDATIONS, IN
BUSINESS AND INDUSTRY, AND -- OF SPECIAL IMPORTANCE TO US TODAY -- IN
OUR HOSPITALS AND MEDICAL CENTERS,


4

  THIS YEAR, WE ESTIMATE THAT THE NATION AS A WHOLE WILL INVEST
CLOSE TO $12 BILLION IN HEALTH-RELATED R 8, D, THAT'S A SUBSTANTIAL
INVESTMENT, BUT IT IS WORTH NOTING THAT PRIVATE INDUSTRY WILL BE
RESPONSIBLE FOR 39 PERCENT OF THATwWHILE THE NATIONAL INSTITUTES OF
HEALTH -- GOVERNMENT'S MAJOR HEALTH RESEARCH ORGANIZATION -- WILL BE
RESPONSIBLE FOR 36 PERCENT,

THIS REFLECTS A NATIONAL TREND IN R & D, WHERE THE PRIVATE SECTOR

-- ACROSS THE BOARD -- BUYS A SLIGHTLY LARGER SHARE OF RESEARCH
ACTIVITY THAN THE GOVERNMENT DOES,

  ONE OF THE HALLMARKS OF ALL THAT ACTIVITY AS RECENTLY AS THE
DECADE OF THE 1970s WAS THE MAINTENANCE OF A STRONG EFFORT IN BASIC
RESEARCH, THE KIND THAT TURNS UP BRAND-NEW KNOWLEDGE, THE GOVERNMENT
LED THE WAY IN THE FUNDING OF BASIC RESEARCH, BUT IT WAS NOT ALONE,
THE PRIVATE SECTOR ALSO SUPPORTED A LARGE COMMUNITY OF RESEARCHERS
DIGGING AWAY AT THE VERY FRONTIERS OF KNOWLEDGE,

  BUT IN RECENT YEARS WE HAVE SEEN A GRADUAL SHIFT IN PRIORITIES,
RAISING THE POSSIBILITY THAT OUR NATIONAL RESEARCH EFFORT COULD LOSE
ITS HISTORIC SENSE OF BALANCE,

  FOR EXAMPLE, WHILE FEDERAL SUPPORT CONTINUES TO RISE, THE LEVEL
OF FEDERAL DOLLARS FOR BASIC BIOMEDICAL RESEARCH IS GOING DOWN,
NOTHING DRAMATIC, OF COURSE, BUT DROPPING NEVERTHELESS BY A.FEW
PERCENTAGE POINTS EACH YEAR,


5

  THE PRIVATE SECTOR, ON THE OTHER HAND, IS NOT TAKING UP THE
SLACK, INSTEAD, BOTH GOVERNMENT AND THE PRIVATE SECTOR ARE INVESTING
MORE HEAVILY IN APPLICATIONS AND DEVELOPMENTmTHE "D" IN R & D,
WE'RE ALL COMPETING FOR THE BEST AVAILABLE TALENT TO HELP US APPLY
THAT PRICELESS BASIC RESEARCH KNOWLEDGE WE ACQUIRED BACK IN THE 197Osn

  BUT OUR RESOURCES FOR THIS WORK ARE NOT INFINITE, WE'RE A RICH
COUNTRY, YET THERE ARE LIMITS TO THE PEOPLE, FACILITIES, AND DOLLARS
AVAILABLE FOR BIOMEDICAL AND BEHAVIORAL RESEARCH, THAT MEANS WE'VE
GOT TO DO A BETTER JOB AT EVALUATING OUR RESEARCH PROGRAMS, WHETHER IN
GOVERNMENT, IN INDUSTRY, OR IN MEDICAL CENTERS, SUCH AS JEWISH
HOSPITAL HERE IN ST, LOUIS, WE NEED TO TAKE A LONGER VIEW OF WHAT WE
NEED TO KNOW,

  IF WE DO, THEN I THINK WE'LL COME AROUND TO ACCEPTING AGAIN THAT
NOTION OF A "BALANCED RESEARCH PROGRAM" AND WE'LL BEGIN WORKING TO
RECLAIM IT, BECAUSE OF THE STEADY SHIFT THAT'S GOING ON, AWAY FROM
BASIC RESEARCH AND TOWARDS FINDING NEW APPLICATIONS FOR THE MARKET-
PLACE, NOW IS THE TIME TO WORRY ABOUT OUR ABILITY TO PUT NEW KNOWLEDGE
"IN THE BANK," SO TO SPEAK, IN PREPARATION FOR THE 21ST CENTURY,

  THAT'S A TOUGH ISSUE,  I'M SURE THAT MANY OF YOU HERE TODAY HAVE
TRIED TO DEAL WITH IT IN THE CONTEXT OF YOUR OWN BUSINESSES, HOW DO
YOU PUT ASIDE SOME MONEY TO MAKE SURE THAT YOUR COMPANY WILL NOT LACK
THE FACILITIES AND THE KNOWLEDGE AND THE PEOPLE TO BE STRONGYEARS AND
YEARS INTO THE FUTURE? IT'S HARD TO DO, AND I CAN ASSURE YOU THAT
IT'S EVEN HARDER FOR GOVERNMENT TO DO,


6

  IN A WAY, THAT BRINGS UP THE SECOND ISSUE, WHICH ISmTHE
CHANGING DEMOGRAPHY OF THE UNITED STATES,, ,OR, AS MOST PEOPLE NOW CALL
IT, "THE GRAYING OF AMERICA,"

  I'M SURE YOU'VE READ THE STATISTICS, SO I'LL SKIP MOST OF THEM
AND GET TO THE PUNCH-LINE:

EARLY IN THE NEXT CENTURY, ABOUT 1 IN 5 AMERICANS WILL BE OVER THE
AGE OF 65, A SIZEABLE NUMBER OF THEM WILL BE OVER 75, AND ALL
SIGNS POINT TO THIS GROUP AS HAVING MUCH BETTER HEALTH THAN IS
ENJOYED BY PEOPLE THE SAME AGE TODAY,

AS MUCH AS PEOPLE HAVE WRITTEN ON THIS SUBJECT -- IN TIME AND NEWSWEEK
AND IN EVERY MAJOR SUNDAY NEWSPAPER -- WE HAVE ONLY THE VAGUEST IDEA
OF WHAT'S AHEAD OF US, WE CAN'T DRAW ON ANYONE ELSE'S EXPERIENCE
BECAUSE, TO THE BEST OF OUR KNOWLEDGE, NO SOCIETY THAT WE ARE AWARE
OF IN HUMAN HISTORY HAS EVER HAD TO COPE WITH A POPULATION SO HEAVILY
TILTED TOWARD ITS AGING,

  IN OUR OWN COUNTRY, FOR EXAMPLE, THE CLOSEST WE COME IS THE STATE
OF FLORIDA, WHERE 1 PERSON OUT OF EVERY 6 IS OVER THE AGE OF 65, HERE
IN MISSOURI IT'S CLOSER TO 1 OUT OF 8, SO WE'VE GOT A LOT TO LEARN
ABOUT HEALTH CARE IN A SOCIETY WHOSE AGED POPULATION IS GOING TO BE 1
OUT OF 5 OF THE TOTAL POPULATION,


7

  BUT MUCH OF WHAT WE HAVE TO LEARN SIMPLY RUNS COUNTER TO JUST
ABOUT EVERYTHING TAUGHT IN MEDICAL SCHOOL, THERE, THE STUDENT-
PHYSICIAN LEARNS ABOUT "FOLLOW-THROUGH" AND "FOLLOW-UP" AND "LINKAGES"
AND SO ON, YOU'RE ADVISED TO TELL THE PATIENT TO RETURN AGAIN IN 6
MONTHS AND LOOK FOR THIS,
          THEN, AFTER A YEAR, YOU HAVE THE PATIENT
COME BACK AND YOU LOOK FOR THAT,

  BUT THE AGING EXPERIENCE LEADS TO A TERMINAL END-POINT,,,THE AGED
PATIENT PROGRESSES STEADILY TOWARD HIS OR`HER OWN DEATH, THERE MAY BE
VERY LITTLE TIME FOR "FOLLOW-THROUGH" OR "FOLLOW-UP",,,AND THE PATIENT
MAY DIE MONTHS BEFORE THAT FIRST RETURN APPOINTMENT,

  PHYSICIANS WHO HAVE BEEN TRAINED TO PROVIDE THEIR PATIENTS WITH A
LONG-TERM CONTINUUM OF REPARATIVE AND CURATIVE CARE ARE OFTEN
FRUSTRATED BY THE CONFINEMENT AND THE FINALITY OF MEDICAL CARE FOR THE
AGED, AS A RESULT, MANY PHYSICIANS DON'T ADVISE THEIR 70-YEAR-OLD
PATIENTS TO STOP SMOKING, WHY BOTHER? "LET THEM ENJOY THEIR LITTLE
VICE WHILE THEY CAN,"

  AND THEY PASS UP ANY CHANCE TO SUGGEST A ROUTINE OF PHYSICAL
EXERCISE TAILORED FOR OLDER PEOPLE, WHY SHOULD THEY? "WHEN OLD
PEOPLE GET TOO ACTIVE, THEY HURT THEMSELVES,"

  I DON'T BELIEVE I'M OVER-STATING THE CASE EITHER, A GREAT MANY
OF OUR PRACTICING PHYSICIANS -- LIKE A GREAT MANY AMERICANS.IN GENERAL
-- HAVE GROWN UP WITH CERTAIN STEREOTYPICAL PRECONCEPTIONS ABOUT OLD
PEOPLE,, ,PRECONCEPTIONS THAT ARE NOT ONLY WRONG BUT ARE ALSO BARRIERS
TO THE DELIVERY OF GOOD HEALTH CARE, AND THAT'S EXACTLY THE KIND OF
THING WE HAVE TO ADDRESS IN THE YEARS AHEAD,


8

  THE GREAT DANGER, OF COURSE, IS THAT THESE AGE-PREJUDICES BECOME,
IN MEDICINE AS ELSEWHERE, SELF-FULFILLING PROPHECIES, LET ME GIVE YOU
AN EXAMPLE,

  THE AGING PROCESS IS MOST OFTEN PERCEIVED -- INCORRECTLY, I MIGHT

ADD -- AS A CHAIN OF SUCCESSIVE AND PREDICTABLE EVENTS, A PHYSICIAN
WILL SAY, "YOU KNOW, YOUR FATHER IS GETTING ON IN YEARS, SO, YOU CAN
EXPECT THIS TO HAPPEN,, ,AND THEN THAT WILL HAPPEN, AND YOU SHOULD
PREPARE YOUR FAMILY FOR THIS OTHER THING TO HAPPEN,"

  IT ALL SOUNDS REASONABLE, ORDERLY, AND THEREFORE SOMEHOW COMFORT-
ING, ESPECIALLY TO ANOTHER MIDDLE-AGED PERSON WHO MAY SHARE THE SAME
PREJUDICES AS THE PHYSICIAN, BUT LIFE IS NOT A VERY ORDERLY OR
PREDICTABLE PROCESS, REGARDLESS OF HOW OLD YOU ARE, EVENTS TUMBLE IN
ONE UPON THE OTHER, ,,PEOPLE INTERACT IN NOVEL WAYS AND CAUSE OTHER
THINGS TO HAPPENwAND THE ENVIRONMENT ITSELF CHANGES, TRIGGERING
OTHER AND EQUALLY UNPREDICTABLE RESPONSES,

  THAT IS ALL PART OF NORMAL LIVING, AND WHEN AN AGED PERSON LIVES
NORMALLY -- MOVED BY EVENTS, PEOPLE, AND THE ENVIRONMENT IN A RATHER
RANDOM FASHION -- THE REST OF US BECOME CONFUSED AND EVEN FEARFUL, SO
WE CONCLUDE THAT "SOMETHING IS WRONG WITH DAD,  THIS IS HAPPENING WAY
AHEAD OF SCHEDULE AND THAT SHOWS NO SIGN OF HAPPENING AT ALL,"
           IN
OTHER WORDS, "DEVIATION" FROM AN ANTICIPATED NORM BECOMES A CAUSE FOR
CONCERN,, #EVEN THOUGH THE PERCEIVED "DEVIATION" IS REALLY HEALTHFUL
BEHAVIOR,


9

  OLD PEOPLE ARE VICTIMIZED BY THIS KIND OF RESPONSE,  IF WE

ANTICIPATE THAT DETERIORATION IS GOING TO TAKE PLACE, THEN WE ARE
INCLINED TO FEED AND MEDICATE THE OLDER PERSON AS IF DETERIORATION
WERE IN FACT TAKING PLACE,
  AS A RESULT, THE OLDER PERSON MAY BECOME
MALNOURISHED AND LISTLESSwAND THEN BEGIN TO DETERIORATE, FULFILLING
OUR PROPHECY,

  OVER-MEDICATION IS ANOTHER DANGEROUS MODE OF PHYSICIAN BEHAVIOR
TOWARD THE ELDERLY, ONCE AGAIN, WE HAVE BEEN TAUGHT THAT THE AGING
PERSON USUALLY PRESENTS CERTAIN SYMPTOMS AND, HENCE, WILL REQUIRE
CERTAIN MEDICATIONS, WE TEND TO ANTICIPATE THE ARRIVAL OF THE
SYMPTOMS AND SO WE GO AHEAD AND ADMINISTER THE MEDICATIONS TOO SOON,
AND WHAT IS THE OUTCOME? THE OLDER PATIENT IS ADVERSELY AFFECTED BY
THE MEDICATIONS AND BEGINS TO DEMONSTRATE THAT BEHAVIOR,
                     THAT, OF
COURSE, REINFORCES THE ERRONEOUS EARLIER DIAGNOSIS,,,BUT IT ALSO
FULFILLS THE PROPHECY OF DETERIORATION,

   WHAT I HAVE JUST DESCRIBED IN A KIND OF SHORT-HAND FORM IS A VERY
SERIOUS ISSUE FACING PHYSICIANS AND HOSPITALS, THE FACT IS THAT, IN
THE NOT-TOO-DISTANT FUTURE, A SIZEABLE PORTION OF OUR POPULATION WILL
BE CALLED "THE ELDERLY,"  AND RIGHT NOW, THE MEMBERS OF THE MEDICAL

PROFESSION TEND TO SEE THE ELDERLY WITH PECULIAR AND OUT-DATED VISION,

  THIS ALWAYS REMINDS ME OF AN INCIDENT INVOLVING MS, GLORIA
STEINEM, I RARELY HAVE AN OCCASION TO QUOTE HER, BUT THIS IS,

CERTAINLY ONE, THE INCIDENT OCCURRED 10 YEARS AGO ON HER @TH
BIRTHDAY, WHEN AN ADMIRER CAME UP AND SAID, "GLORIA, YOU DON'T LOOK
40/  TO WHICH MS, STEINEM REPLIED, "YOU'RE WRONG, THIS IS WHAT 40
LOOKS LIKE,"


10

  EARLIER THIS YEAR, GLORIA STEINEM TURNED 50 AND SO DID SHIRLEY
MAcLAINE AND SOPHIA LOREN AND A FEW OTHER FAMOUS PERSONALITIES, THEIR
PICTURES WERE IN ALL THE NEWSPAPERS, IN MAGAZINES, AND ON TELEVISION,
AND MILLIONS OF YOUNGER PEOPLE SAW JUST WHAT 50 LOOKS LIKE, AND I
THINK THEY ALL HAD TO AGREE THAT 50 LOOKED GREAT,

  LADIES AND GENTLEMEN, I MIGHT ADD THAT YOU ARE NOW LISTENING TO
-- AND LOOKING AT -- THE OLDEST PERSON EVER TO HOLD THE OFFICE OF
SURGEON GENERAL,  I AM 67 YEARS OLD,, BAND I'M DELIGHTED TO SAY THAT
THIS IS WHAT 67 LOOKS LIKE,

  OF COURSE, DESPITE SUCH GOOD FEELINGS, WE STILL KNOW THAT THE
MYSTERY OF IT ALL REMAINS, FOR EACH OF US, THE QUESTION IS STILL
THERE: "WHEN WILL THIS ALL BE OVER?"

  WELL, WE JUST DON'T KNOW, EVEN THOUGH THE LIFE EXPECTANCY OF
AMERICANS KEEPS INCHING UP YEAR AFTER YEAR, WE UNDERSTAND THAT WE ARE
NOT IMMORTAL, LIKE EVERY OTHER ORGANIC, LIVING THING ON THIS PLANET,
WE, TOO, HAVE SOME BIOLOGICAL OR GENETIC TIMING MECHANISM THAT WILL
SIGNAL THE END OF OUR OWN'INDIVIDUAL ADVENTURE ON EARTH,

  BUT UNTIL THAT SIGNAL COMES, WE MUST CONTINUE TO LIVE A LIFE THAT
IS AS HEALTHFUL AND AS PERSONALLY SATISYING AS IT CAN POSSIBLY BE,
AND WE MUST DEMAND THAT OUR PHYSICIANS GIVE US THE KIND OF MEDICAL
CARE THAT IS PREDICATED ON THOSE REALITIES OF THE AGING EXPERIENCE,
WE MUST REJECT MEDICAL CARE THAT REINFORCES THE ERRORS AND PREJUDICES
OF THE PAST,


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  I HAPPEN TO THINK THAT THE QUALITY OF HEALTH CARE FOR OUR AGED IS
SO IMPORTANT AN ISSUE FOR AMERICAN MEDICINE THAT I HAVE DEVOTED A
LARGE PERCENTAGE OF MY TIME TO IT OVER THE PAST THREE YEARS, AND I
INTEND TO DEVOTE MORE TIME TO THIS ISSUE DURING THE REMAINING YEAR OF
MY FOUR-YEAR APPOINTMENT AS YOUR SURGEON GENERAL,

  AND INCIDENTALLY, I LOOK UPON THIS HOSPITAL AS BEING UNIQUELY
EQUIPPED TO DEVELOP JUST SUCH A REALISTIC APPROACH TO HEALTH CARE FOR
THE AGED, YOU NOW HAVE, AS MEMBERS OF YOUR HOSPITAL COMMUNITY, A
LARGE GROUP OF HEALTHY, ACTIVE, ELDERLY PEOPLE, THESE ARE THE MORE
THAN 10,000 CARD-CARRYING MEMBERS OF 'OASIS,' THE OLDER ADULT SERVICE

AND INFORMATION SYSTEM,

   TO SUCCESSFULLY PROVIDE FOR A HEALTHY OLD AGE, YOU HAVE TO DESIGN
PROGRAMS THAT NOT ONLY ANSWER MEDICAL QUESTIONS BUT ALSO HELP OLDER
ADULTS REMAIN ACTIVE, INVOLVED, AND CONTRIBUTING MEMBERS OF SOCIETY,
AND 'OASIS" SEEMS TO DO JUST THAT, AS OF THE FIRST OF THIS MONTH, AS
I UNDERSTAND IT, THIS INNOVATIVE PROGRAM BECAME A PART OF JEWISH
HOSPITAL, YOU ARE ALL TO BE CONGRATULATED FOR BRINGING ABOUT THIS
POTENTIALLY VERY IMPORTANT PARTNERSHIP OF EXPERIENCE, AND 'OASIS,'
WHICH CELEBRATES ITS SECOND BIRTHDAY THIS WEEK, IS TO BE

CONGRATULATED, ALSO, AND I WOULD BE REMISS IF I DID NOT CONGRATULATE
AND THANK THE MAY STORES FOR THEIR ROLE IN 'OASIS' OFF THE GROUND,


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  "OASIS" SHOULD REPRESENT, FOR THIS HOSPITAL, A READY-MADE
POPULATION OF ELDERLY WHO ARE BUSY, ACTIVE, AND INQUISITIVE,,,WHO HAVE
THE CAPACITY TO LEARNmAND WHO ALSO HAVE THE CAPACITY TO HEAL AND TO
BE RENEWED, HERE ARE PEOPLE FROM THIS ST, LOUIS AREA WHO OUGHT TO BE
GIVEN THE CHANCE TO TEACH THE STAFF AND THE ADMINISTRATION OF JEWISH
HOSPITAL SOME OF THE NEW REALITIES ABOUT GROWING OLD IN AMERICA,,,
REALITIES THAT WE NEED TO ABSORB AND PROCESS DURING THESE WANING YEARS
OF THE 20TH CENTURY,

  AND I MUST SAY, YOU ARE NOT AT A LOSS FOR OPPORTUNITIES, FOR
EXAMPLE, DRS, WILLIAM PECK AND LOUIS AVIOLI OF THIS HOSPITAL ARE
LEADING YOUR BIOMEDICAL RESEARCH EFFORT IN OSTEOPOROSIS, ONE OF THE
MOST SIGNIFICANT AND CALAMITOUS DISEASES OF THE ELDERLY, IT STRIKES
ABOUT 20 MILLION AMERICANS EACH YEAR, MOST OF THEM WOMEN OVER THE AGE
OF 55, IT ALTERS THEIR WAY OF LIFE -- AND THE CHANGE IS ALMOST ALWAYS
FOR THE WORSE,

  THE COST TO SOCIETY FOR THE DETECTION AND TREATMENT OF OSTEO-
POROSIS -- PLUS THE SOCIAL AND EMPLOYMENT LOSSES -- IS ESTIMATED TO BE
AN INTOLERABLE 83,8 BILLION A YEAR,

  THE INTEREST AT THIS HOSPITAL IN OSTEOPOROSIS IS IMPORTANT, NOT
ONLY FOR THE PEOPLE OF ST, LOUIS BUT FOR THE PEOPLE OF THE NATION,
BUT THERE IS MORE TO THE RESEARCH EFFORT THAN AN INVESTIGATION OF ITS
PATHOLOGY, WE ALSO NEED TO LOOK AT THE WAY PEOPLE FUNCTION.DURING THE
ONSET OF THE DISEASE, ,,HOW THEY COPE WITH IT AND HOW THEY COULD COPE
WITH IT, WITH SOME ADDITIONAL HELP,,,WE NEED TO LEARN ABOUT WAYS TO
PREVENT THE DISEASE FROM OCCURRING, AS WELL AS WAYS TO PREVENT IT FROM
TOTALLY DISABLING ITS VICTIMS, AFTER IT STRIKES,


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  FOR THIS KIND OF TOTAL BIOMEDICAL AND BEHAVIORAL RESEARCH PRO-
GRAM, YOU NEED SUBJECTS WHO ARE HEALTHY, ALERT, AND INTERESTED" 'YOU
NEED OLDER PEOPLE WITHOUT THE DISEASE SYMPTOMS, IN ADDITION TO THOSE
WHO ARE ALREADY OSTEOPOROTIC, I WOULD THINK THE PRESENCE OF THE
"OASIS" PROGRAM WITHIN THIS INSTITUTION MIGHT MAKE THIS KIND OF
RESEARCH EFFORT ALL THE MORE POSSIBLE,

  IN THIS CONNECTION, LET ME SAY THAT, EARLY IN THIS NEXT FISCAL
YEAR, WHICH IS ONLY A WEEK AWAY, I HOPE TO AWARD THIS HOSPITAL AND ITS
"OASIS" CONNECTION A SUBSTANTIAL PUBLIC HEALTH GRANT IN THIS VERY
TOPIC, IN MY OPINION, THAT MONEY SHOULD BUY US SOME MUCH-NEEDED
INFORMATION ABOUT THE CAUSES AND THE PREVENTION OF OSTEOPOROSIS AMONG
THE ELDERLY,

  I'VE SPENT THE PAST FEW MINUTES DISCUSSING THE SECOND ISSUE OF
THE THREE I CAME WITH TODAY, THAT'S THE ISSUE OF DEMOGRAPHY,,,OF THE
EVOLVING CHANGE IN THE BALANCE OF AGE GROUPS WITHIN OUR SOCIETY, AND
IN THE COURSE OF MY REMARKS I'VE ACTUALLY BEEN QUITE CONVENTIONAL'
THAT IS, I'VE TALKED A LOT ABOUT AGING FROM A DISEASE OR PATHOLOGICAL
POINT OF VIEW, AND THAT'S FAIRLY TYPICAL, BECAUSE PHYSICIANS AND
HOSPITAL STAFFS ALWAYS WANT TO KNOW WHAT IS WRONG WITH YOU SO THAT
THEY CAN FIX IT, BUT FOR THE FUTURE, THAT APPROACH IS NOT GOING TO
WORK, AND THAT BRINGS ME TO MY THIRD AND FINAL ISSUE:

THIS IS THE ISSUE OF DEFINITION,,,THE ISSUE OF "WHAT WILL THE

WORD 'HEALTH' MEAN IN THE YEARS AHEAD?"


14

  I BELIEVE IT'S TIME WE BEGAN TO ROUTINELY LOOK AT HEALTH AS A
POSITIVE CONDITION BY ITSELF, AND NOT JUST A CONDITION IN WHICH THERE
IS NO EVIDENCE OF ILLNESS,  IN OTHER WORDS, A HEALTHY OLDER PERSON IS
MUCH MORE THAN JUST A PERSON WITH NO SIGNS OF NEUROPATHOLOGY OR WHO
DOES NOT HAVE A CARDIOVASCULAR CONDITION.

  BUT THIS IS NOT SOMETHING WE SHOULD RESERVE JUST FOR OLDER
PEOPLE, IT IS A POINT OF VIEW THAT PHYSICIANS, NURSES, HOPSITAL
ADMINISTRATORS,,,THE WHOLE HEALTH COMMUNITYmNEEDS TO ADOPT OVER
TIME, AND THE REASONS ARE TWO-FOLD:

FIRST, THE RESEARCH EFFORTS OF THE PAST SEVERAL DECADES HAVE LED TO
MODES OF HEALTH CARE THAT -- DESPITE MY CRITICISMS TODAY -- HAVE
HELPED GIVE AMERICANS THE BEST OVERALL HEALTH STATUS SINCE THOSE
RECORDS HAVE BEEN KEPT,

AND SECOND, AT THE WORKING CENTER OF OUR NATION TODAY IS A GENERATION
THAT IS THE MOST HEALTH-CONSCIOUS, HEALTH-KNOWLEDGEABLE GENERATION IN
HISTORY, THEY ARE IN THEIR 20s AND 30s AND THEY ARE THE "BABY BOOM"
JOGGERS AND HEALTH-FOOD FANATICS, THE SWIMMERS AND THE EXERCYCLERS,,,
THEY ARE THE ONES WHO ARE "DEALING WITH STRESS" AND ARE "IN TOUCH WITH
THEIR FEELINGS,"  SOME OF THIS IS TO AVOID ILLNESS, THAT'S TRUE, BUT
MOST OF IT IS POSITIVE, MOST OF THE HEALTH-RELATED ACTIVITY OF THE
"BABY BOOM" GENERATION IS GEARED TO PERPETUATE AND TO ENJOY ONE'S OWN
GOOD HEALTH,


15

  AND BY THE WAY, "BABY BOOMERS" AND THEIR POSITIVE HEALTH FEELINGS
ARE WINNING THE WAR AGAINST CIGARETTES, JUST THIS PAST SPRING I
CALLED FOR A "SMOKE-FREE SOCIETY BY THE YEAR 2000" AND THE RESPONSE

HAS BEEN TERRIFIC, A GROWING NUMBER OF HOSPITALS AROUND THE COUNTRY
ARE, LIKE JEWISH HOSPITAL, STRENGTHENING THEIR SMOKING CESSATION
PROGRAMS AND BANNING THE SALE OF ALL TOBACCO PRODUCTS ON THEIR

PREMISES, I WOULDN'T BE SURPRISED IF THIS COUNTRY HAS SMOKE-FREE
HOSPITALS WELL BEFORE THE YEAR 2000,

  WHAT DOES ALL THIS HAVE TO DO WITH OUR UNDERSTANDING OF THE WORD
"HEALTH"? I THINK THE IMPLICATIONS ARE ENORMOUS, FOR EXAMPLE,,,

9

     IF OUR COUNTRY DOES ACHIEVE THE HOPED-FOR SMOKE-FREE STATUS
BY THE NEXT CENTURY, THEN MUCH OF THE OFTEN-FATAL HEART DISEASE,
CANCER, AND GASTROINTESTINAL DISEASE ASSOCIATED WITH SMOKING SHOULD
DECLINE,,,

*

     AND AS A RESULT OF A BETTER UNDERSTANDING OF NUTRITIONwTHE
NEW POPULARITY OF BRAN AND OTHER WHOLE GRAINSwAND THE MORE CAUTIOUS
APPROACH BY CONSUMERS TOWARD HIGH CHOLESTERAL FOODS, WE COULD SEE A
MARKED DROP IN MANY DIET-RELATED DISEASES OF THE CARDIOVASCULAR
SYSTEM,, ,

*

     AND AS A RESULT OF STIFFER DRUNK-DRIVING LAWS AND A UNIVERSAL
ACCEPTANCE OF SEAT-BELTS, WE COULD SEE A SHARP DROP IN THOSE.NEURO-
MUSCULAR AND MUSCULOSKELETAL COMPLAINTS THAT PLAGUE THE LIVES OF
SURVIVORS OF AUTO ACCIDENTS,,,


16

      *  AND AS A RESULT OF OUR RECENT AND MASSIVE CHILD IMMUNIZATION
PROGRAMS, THE CHILDREN OF THE "BABY BOOM" GENERATION WILL NOT HAVE HAD
CONGENITAL RUBELLA OR MEASLES AND, THEREFORE, WILL NOT ENTER THEIR
SENIOR YEARS WITH THE DISEASE-RELATED BURDENS OF BLINDNESS AND
DEAFNESS, MENTAL RETARDATION, OR WEAKENED HEARTS, AND THEY WILL BE
THE FIRST GENERATION IN HUMAN HISTORY TO BE TOTALLY FREE OF TETANUS,

  THESE AND OTHER POSSIBLE DEVELOPMENTS ARE ALL REASONS TO REJOICE,
BUT THEY ARE ALSO REASONS FOR US TO LOOK AGAIN AT THAT WORD "HEALTH"
TO SEE IF WE REALLY KNOW WHAT IT CAN MEAN FOR THE FUTURE AND IF WE ARE
TRULY READY TO LIVE WITH THAT NEW MEANING,

  AND IF YOU'RE DEVOTED TO YOUR HOSPITAL, AS I KNOW ALL OF YOU ARE,
THESE ARE ALSO GOOD REASONS TO MAKE YOU RE-EVALUATE THE FUTURE ROLE OF
THIS AND OTHER HOSPITALS BECAUSE THEIR SERVICE TO THEIR COMMUNITIES
MIGHT NO LONGER BE THE CURING -OF- DISEASE BUT MUST RATHER INCLUDE THE
ADDITIONAL SERVICE OF REINFORCING GOOD HEALTH,

  I BEGAN THESE REMARKS BY SAYING THAT I HOPED I MIGHT CONTRIBUTE
TO THE FUTURE TONE OF THESE LECTURES FOR THE FELLOWS OF JEWISH
HOSPITAL, BY THAT I MEANT THAT MAYBE THE CONCERNS OF YOUR GUESTS
WOULD INCLUDE SOMETHING OF THEIR VISION OF THE FUTURE OF HEALTH CARE
IN THIS COUNTRY AND THE ROLE THAT THIS HOSPITAL, WITH ITS STAFF AND
ITS THOUSANDS OF DEVOTED SUPPORTERS, MIGHT PLAY IN SUCH A FUTURE,

  I THINK, FOR EXAMPLE, THAT THE FUTURE VITALITY OF OUR HEALTH CARE
SYSTEM WILL DEPEND PRIMARILY ON OUR ABILITY TO DEVELOP NEW KNOWLEDGE
ABOUT HEALTH THROUGH A VIGOROUS NATIONAL PROGRAM OF BIOMEDICAL AND
BEHAVIORAL RESEARCH,


17

   BUT MEDICINE -- LIKE EVERY OTHER IMPORTANT ACTIVITY IN OUR
SOCIETY -- MUST ADJUST TO THE NEW REALITIES OF DEMOGRAPHY, THE
CHANGING NATURE OF OUR POPULATION, AND THE NEW MODES OF CARE THAT IT
MAY REQUIRE,

  AND SO I BELIEVE WE'VE GOT TO START NOW TO THINK ABOUT THE FUTURE
ROLE OF MEDICINE,,,OF PHYSICIANSmOF HOSPITALS,,,INDEED, OF EVERYONE
IN THE HEALTH CARE SYSTEM, CHANGE IS OCCURRING, WHETHER WE'RE READY
FOR IT OR NOT, THERE ARE INEXORABLE FORCES SHAPING THE FUTURE OF OUR
COUNTRY, WE OUGHT TO HAVE THE GOOD SENSE TO RECOGNIZE THEM AND
SOMEHOW HELP OUR CHILDREN DEAL WITH THEM,

  IN THIS CONNECTION, THERE IS A QUOTATION THAT IS A FAVORITE OF
MINE, AS I'M SURE IT IS OF YOURS, AND I THINK IT APPLIES EXACTLY TO
WHAT I'VE JUST BEEN TALKING ABOUT, IT IS MADE UP OF THE THREE
QUESTIONS OF THE GREAT TEACHER, HILLEL, WHO LIVED ABOUT 2,000 YEARS
AGO, HE ASKED,, ,

  "IF I AM NOT FOR MYSELF, WHO WILL BE FOR ME?  BUT IF I'M ONLY FOR
MYSELF, WHAT AM I? AND IF NOT NOW, WHEN?"

  YES, THERE IS MUCH TO BE DONE IN THE WORLD OF HEALTH CARE,, mTODAY
, ,,FOR OURSELVES, FOR OUR FAMILIES, AND FOR OUR COMMUNITY, BUT THERE
IS ALSO MUCH GOOD WORK TO DO FOR OTHERS, FOR PEOPLE WHO ARE -- AND WHO
ALWAYS WILL BE -- UNKNOWN TO US, wESPECIALLY THOSE PEOPLE WHObARE
COMING ALONG BEHIND US,


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  HOWEVER, AS HILLEL WARNS US, WE' CANNOT PUT OFF THE DECISION TO BE
INVOLVED, WE'VE GOT TO DO WHAT WE HAVE TO DO,,,AND WE'VE GOT TO DO IT
NOW,

  THANK YOU VERY MUCH FOR YOUR INVITATION, AND PLEASE ACCEPT MY
BEST WISHES FOR A HAPPY NEW YEAR,

THANK YOU,                                  \

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