COMMENCEMENT AUIRESS
     BY

C, EVERETT KOOP, MID,, SC,D,
   SURGEON GENERAL
      OF THE

    U, S, PUCLIC HEALTH SERVICE
U, S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED AT COLBY COLLEGE
  WATERVILLE, MAINE
    MAY 29, 1988


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

  THANK YOU VERY MUCH FOR YOUR HONOR AND YOUR KINDNESS, AND
THANK YOU FOR ENCOURAGING ME TO GET AWAY FROM WASHINGTON TO SPEND
A DAY OR SO IN THIS BEAUTIFUL PART OF THE WORLD,

  I AM YOUR SURGEON GENERAL AND I SUPPOSE I SHOULD TALK ABOUT
HEALTH MATTERS, AND I WILL, BUT PERHAPS NOT THE ONES YOU'D
EXPECT ME TO TALK ABOUT,


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  THIS IS THE SEASON OF COMMENCEMENT SPEECHES AND THIS YEAR I
ACCEPTED TEN INVITATIONS, SIX OF THEM ARE MEDICAL SCHOOLS AND
I'VE CHOSEN TO SPEAK ON SIX ASPECTS OF ETHICAL IMPERATIVES FOR
YOUNG PHYSICIANS, EACH GRADUATE OF THOSE MEDICAL SCHOOLS WILL
RECEIVE A BOUND COPY OF ALL SIX SPEECHES PLUS FOOTNOTES,

  THE OTHER FOUR SCHOOLS ARE UNDERGRADUATES, EACH WITH
DIFFERENT MISSIONS, SO I HAVE THE OPPORTUNITY TO SPEAK NOT ONLY
TO SOME FUTURE PROVIDERS OF HEALTH CARE, BUT ALSO TO SOME
RECIPIENTS,

  IF YOU DIDN'T EXPECT SOME KIND OF HEALTH MESSAGE TODAY, I
HAVE TO REMIND YOU THAT IT IS ONE OF THE RISKS YOU TAKE WHEN YOU
INVITE THE SURGEON GENERAL TO SPEAK,


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  BUT THIS WILL BE A HEALTH MESSAGE WITH A DIFFERENT T;JIST,  I
DON'T WANT TO CROWD JANE FONDA, DR, TIMOTHY JOHNSON, OR EVEN
DR, RUTH,

  FIRST OF ALL -- EVERYTHING YOU WILL DISCUSS ABOUT MEDICINE,
HEALTH CARE OR PUBLIC HEALTH POLICY FOR THE REST OF THIS CENTURY
WILL BE MERELY SYMPTOMATIC OF THE OVER-RIDING TENSION BETWEEN OUR
ASPIRATIONS AND OUR RESOURCES, OR TO SAY IT ANOTHER WAY -- THE
TENSION BETWEEN WHAT WE WANT IN THE WAY OF HEALTH CARE AND WHAT
WE CAN AFFORD,


  THAT b/ILL BE TRUE WHETHER YOU ARE DISCUSSING THE MEDICARE
TRUST FUND, -- OF CURRENT INTEREST TO YOUR GRANDPARENTS, OF
IMMEDIATE INTEREST TO YOUR PARENTS AND -- DON'T LAUGH -- OF
EVENTUAL INTEREST TO YOU, -- OR THE GRAYING OF AMERICA, OR HOW WE
WILL MANAGE, PAY FOR AND SURVIVE THE EPIDEMIC OF AIDS,

  WE AMERICANS HAVE HAD A WONDERFUL, EXCITING, EXPENSIVE
HISTORY OF REPARATIVE AND REHABILITATIVE MEDICINE AND SURGERY,

  FOR EXAMPLE, I KNOW YOUR INTEREST HAS BEEN AROUSED AND YOUR
CURIOUSITY TITILLATED BY HEART TRANSPLANTS, REPLACEMENT OF
ARTHRITIC HIP JOINTS WITH TEFLON, AND LIPOSUCTION,


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  BUT WE CAN'T AFFORD ALL OF THEM FOR EVERYBODY AND I'M AFRAID
YOU WILL HAVE TO LOOK FORWARD TO SOME KIND OF RATIONING,

  IN FACT, THAT ERA IS ALREADY UPON US, THE STATE OF OREGON
MADE THE DECISION A FEW WEEKS AGO THAT THEY WOULD FOREGO 30 ORGAN
TRANSPLANTS IN FAVOR OF 1,500 WELL BABIES BORN AFTER EXEMPLARY
PRENATAL CARE,

  THE FIRST VICTIM AFTER THE DECISION WAS A LITTLE BOY WHO
NEEDED BUT DID NOT GET A BONE MARROW TRANSPLANT, HE DIED, HE
COULD HAVE BEEN YOUR BROTHER,

  THIS IS BUT AN EXAMPLE OF THE TYPE OF TRAGIC CHOICES THAT
ARE BEING MADE FOR YOU TODAY, HOW DO YOU PLAN TO PARTICIPATE IN
THIS DECISION-MAKING PROCESS IN THE FUTURE?


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  LET ME GIVE YOU WHAT I THINK ARE SOME INCREDIBLE NUMBERS ON
WHICH SOME OTHER DECISIONS WILL INEVITABLY BE MADE,

  OF ALL THE PEOPLE WHO EVER REACHED AGE 65 IN THE UNITED
STATES, ONE-HALF OF THEM ARE ALIVE TODAY, THE MOST RAPIDLY
GROWING SEGMENT OF OUR POPULATION IS 80 TO 90, WE HAVE 12
THOUSAND PEOPLE AGED 100 OR MORE IN THE UNITED STATES TODAY; IN
2005 THAT NUMBER WILL BE 100,000,

  TODAY THERE ARE FIVE TAX PAYING WAGE EARNERS FOR EVERY
PERSON OVER 65; IN 2005 THAT NUMBER WILL BE BUT 3,

  ALL OF THIS BY WAY OF SAYING, THE GRAYING OF AMERICA IS
GOING TO REQUIRE SOME DECISIONS IN THE DISTRIBUTION OF HEALTH
CARE AND THE RATIONING OF SERVICES, CAUSED BY THE ECONOMICS OF
THE ADDITIONAL NUMBERS OF SENIOR CITIZENS,

  AND I'M NOT JUST TALKING ABOUT OLD CROCKS,  I'M ALSO TALKING
ABOUT ME! I'M IN MY 72ND YEAR, I MAY NOT BE MUCH FOR SPEED, BUT
WHEN IT COMES TO STAMINA AND MAYBE EVEN PRODUCTIVITY -- I'LL
COMPETE,


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  YOU WILL BE MAKING DECISIONS ABOUT THOSE FUTURE DAYS IN TWO
WAYS: AT THE BALLOT BOX AND IN THE WAY YOU CARE FOR YOURSELF,

  SO JUST IN YOUR OiJN SELF-INTEREST, IF THERE IS GOING TO BE
ANY KIND OF SHORTAGE, IT WOULD BEHOOVE YOU TO ARRIVE AT THOSE
GOLDEN YEARS IN THE BEST HEALTH POSSIBLE, THE TIME TO START IS
NOW,

  THE PREVENTION OF DISEASE AND THE PROMOTION OF HEALTH IS NOT
GLAMOROUS, BUT IT IS EFFECTIVE AND IT IS EXTRAORDINARILY CHEAP,
I'M TALKING ABOUT LIFE STYLES, MY RECOMMENDATIONS ARE FEW AND
THE BEAUTY OF IT IS THAT IT'S ALL DO-IT-YOURSELF,

  LET ME START WITH THE DON'T% DON'T TAKE DRUGS, DRUGS NOT
ONLY DISRUPT LIVES AND CAREERS, BUT THEY CAN AND DO KILL YOU,


  IF YOU DO
  DON'T SMOKE,  IF YOU HAVEN'T STARTED, DON'T,
SMOKE, STOP,
   SMOKING IS NO LONGER SEXY -- AND IT DOES CAUSE
PREMATURE WRINKLES, YES, I KNOW ALL ABOUT ADDICTION TO
NICOTINE, TO YOU SMOKERS I SAY, 43 MILLION PEOPLE ALIVE TODAY
HAVE QUIT, YOU CAN TOO,

  ALCOHOL IS ABUSED BY ABOUT 12 PERCENT OF THE ADULT
POPULATION, IF YOU ARE ONE OF THOSE, THE ADVICE IS THE SAME AS
FOR SMOKING, STOP,
       IF YOU ARE NOT AN ABUSER OF ALCOHOL NOW,
FINE AND GOOD, BUT YOU COULD STILL BECOME ALCOHOL DEPENDENT, SO
USE IT IN MODERATION,


  STATISTICS INDICATE THAT IT IS AT YOUR AGE THAT MANY YOUNG
MEN AND WOMEN TAKE UP THE HABIT OF BOTH SMOKING AND DRINKING,
I'M VERY GRATIFIED ABOUT THE DOWNWARD TRENDS OF THE INCIDENCE OF
SMOKING IN THE UNITED STATES, BUT I AM QUITE DISCOURAGED ABOUT
THE BARELY IMPERCEPTIBLE CHANGE AMONG WOMEN AT YOUR AGE LEVEL,

  I ASSUME YOU ARE ALL JOGGING, OR RUNNING, OR BICYCLING, OR
SWIMMING, -- AND EATING YOGURT AND SALADS FOR LUNCH,  IF SO, YOU
WILL ARRIVE AT THE GOLDEN YEARS WAY AHEAD OF THOSE WHO ARE NOT
PAYING ATTENTION TO NUTRITION AND EXERCISE,

  NOW THAT WASN'T TOO BAD, WAS IT? 2 DON'TS AND 3
ADMONITIONS, ONLY THREE THINGS LEFT: HAVE YOUR BLOOD PRESSURE
CHECKED BY YOUR PHYSICIAN WHO SHOULD ALSO CHECK YOUR CHOLESTEROL
LEVEL, AND FINALLY AVOID STRESS, BELIEVE IT OR NOT THAT'S
ANOTHER LIFE STYLE THAT YOU m TAKE CHARGE OF, ENJOY LIFE, BE
HAPPY, MENTAL STRESS CAN DISABLE AND IT CAN BE A KILLER,


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  FOR YOUNG MEN AND WOMEN SUCH AS YOURSELVES, THE POST-
GRADUATE WORLD IS FULL OF PROMISE AND EXCITEMENT, YOU SHOULD
STRIVE TO OBTAIN YOUR OWN FULL MEASURE OF BOTH,

  BUT, AS YOU DO SO, PLEASE BE AWARE OF YOUR OWN FRAGILITY AS
HUMAN BEINGS,

  REMEMBER, PLEASE, THAT THE HUMAN MIND AND BODY ARE VERY
RESILIENT no, WITH ALMOST MIRACULOUS POWERS OF SELF-RENEWAL ,,a
BUT YOU CAN QUICKLY RUN OUT OF MIRACLES, AS YOU TRY TO MAKE YOUR
WAY IN A COMPLEX AND DYNAMIC SOCIAL AND ECONOMIC ENVIRONMENT,


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  NOW THAT I KNOW YOUR HEALTH, HAPPINESS AND LONGEVITY ARE
ASSURED, LET ME TURN TO SOMETHING PERSONAL AND TELL YOU SOME
THINGS THAT IN THE LONG RUN MAY PROVE JUST AS VALUABLE AS THAT
HEALTH MESSAGE I HOPE YOU LISTENED TO,

  1988 IS OUR GOLDEN WEDDING ANNIVERSARY YEAR, AND, THOUGH
BETTY AND I MAY NOT LOOK IT, WE WERE REVOLUTIONARIES IN OUR DAY
AS PERHAPS SOME OF YOU ARE IN YOUR DAY, WE WERE 40 MILES APART
FOR A YEAR BEFORE WE MET BUT DIDN'T KNOW IT,

  WE MET WHILE I WAS STILL AT DARTMOUTH AND SHE WAS AT VASSAR
AND WE'RE MARRIED THE YEAR AFTER I GRADUATED AT THE START OF MY
SECOND YEAR IN CORNELL UNIVERSITY MEDICAL COLLEGE, MEDICAL
SCHOOL WAS -- AND IS -- DIFFICULT, BUT IT WOULD HAVE BEEN EVEN
MORE DIFFICULT FOR ME - UNMARRIED,

  IN THE 1930'S, THAT WAS, VERY DECIDEDLY, A MINORITY OPINION
BECAUSE MOST MEDICAL SCHOOL DEANS AND FACULTY AND ESSENTIALLY ALL
INTERN AND RESIDENCY COMMITTEES SINCERELY BELIEVED THAT MEDICAL
TRAINING AND MARRIAGE DID NOT MIX,


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  MY RECORD IN MEDICAL SCHOOL WAS FINE AND FOR ALL OF MY
INTERVIEWS FOR INTERNSHIP AND RESIDENCY, I WAS WARMLY RECEIVED,
YET I WAS TURNED DOWN FOR MY TWO TOP CHOICE INTERNSHIPS BECAUSE I
WAS MARRIED, AND THE TRAINING DIRECTOR OF THE FIRST SURGICAL
RESIDENCY I APPLIED FOR WROTE BACK: "DEAR KOOP, YOU DIDN'T SAY
WHETHER YOU WERE MARRIED OR NOT, IF YOU ARE, DON'T ANSWER THIS
LETTER?

SO, BETTY AND I WENT TO MEDICAL SCHOOL TOGETHER, -- I WAS A

MEDICAL STUDENT AND SHE AS AN EMPLOYEE OF THE SOCIAL SERVICE
DEPARTMENT OF THE NEW YORK HOSPITAL, I STILL THINK SHE LEARNED
MORE ABOUT MEDICINE AT LUNCH WITH ME AND MY FELLOW STUDENTS THAN
SOME OF THE MEN WHO GRADUATED WITH ME, AND OF COURSE, IT MEANS
SHE KNOWS MORE MEDICINE THAN SOME DOCTORS DO TODAY,


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  I AM SOMETIMES INTRODUCED AS BETTY KOOP'S FIRST HUSBAND, AND
I AM ETERNALLY GRATEFUL THAT SHE'S KEPT IT THAT WAY,

  I KNOW THAT BETTY HOLDS THE TOP SPOT IN THE HEARTS OF OUR
CHILDREN AS WELL, WE HAD FOUR a,, AGAIN, MORE CHILDREN THAN
TODAY'S AVERAGE COUPLE HAS,

  WHAT I WANT YOU YOUNG MEN AND WOMEN TO REMEMBER IS THAT THE
FACTOR OF "MUTUALITY" HAS BEEN VERY IMPORTANT IN OUR MARRIAGE,
THERE HAS BEEN MUTUAL SHARING OF LIFE AND CAREER EXPERIENCES AND
MUTUAL RESPECT FOR WHAT EACH OTHER m aa, AND fi,


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  I'VE ALWAYS SEEN BETTY'S ROLE AS AN EQUAL PARTNER IN MY
CAREER, SHARING IN ALL MY VICTORIES AND -- ALAS! -- ALL MY
DEFEATS AS WELL,

  AND I'VE BEEN ABLE TO SHARE HERS, ALSO -- THE VICTORIES AND
DEFEATS OF FAMILY AND CHILDREN AND FRIENDS ,,a THE KINDS OF

THINGS THAT, INCREMENTALLY, ADD UP TO ONE'S REAL LIFE,

AFTER OUR SON, DAVID, WAS KILLED IN A MOUNTAIN-CLIMBING

ACCIDENT, BETTY AND I SHARED OUR GRIEF AND OUR MEMORIES,

  AFTER A TIME, WE CO-AUTHORED A BOOK ABOUT OUR SON AND THE
MEANING OF HIS UNTIMELY DEATH,  WE CALLED IT SOMFTIMES MOUNTA
MOVE, WE HOPED OUR BOOK WOULD, IN TURN, HELP OTHER PARENTS WHO
EXPERIENCE SUCH A TRAGEDY, AND BY ALL REPORTS IT HAS,


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  DOWN THROUGH THE CENTURIES, WOMEN LIKE ELIZABETH KOOP HAVE
SERVED THE HUMAN RACE VERY WELL I,, KEPT IT GOING AND KEPT IT
DECENT, BUT THE HUMAN RACE HAS GENERALLY NOT RETURNED THE FAVOR,

  BUT I BELIEVE THINGS HAVE IMPROVED, ESPECIALLY OVER THE PAST
TWO DECADES, MEN -- AND WOMEN THEMSELVES -- ARE GIVING WOMEN
THEIR RIGHTFUL PLACE AS EQUAL PARTNERS IN THE WRITING OF HUMAN
HISTORY,

  IF I WERE TERRIBLY EGOTISTIC, I'D SAY THAT THE HUMAN RACE IS
JUST GETTING AROUND TO DOING WHAT BETTY AND I HAVE DONE FOR THE
PAST 50 YEARS,

BUT I WON'T,

  I WILL ADD ONE MORE THOUGHT, MARRIAGES LAST BECAUSE OF
COMMITMENT TO -- MARRIAGE, ROMANTIC LOVE IS WHAT GETS IT ALL
STARTED AND I DISTINCTLY REMEMBER HOii GREAT IT WAS, BUT IT IS
SLOWLY -- AND AT BEST IMPERCEPTIBLY REPLACED, IN A SENSE, BY A
DEEPER, ABIDING AFFECTION, LOVE AND RESPECT,


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  BUT SOME DON'T NEATHER THAT TRANSITION AS IDEALLY AS I JUST
DESCRIBED IT, I TRULY BELIEVE THE PRICELESS INGREDIENT IS
COMMITMENT TO MARRIAGE -- NOT TO ROMANCE, NOT TO EACH OTHER --
THAT GETS YOU OVER THE BUMPS,

  YOU HAVE BEEN TOLD MANY TIMES THAT YOU WILL GRADUATE INTO A
WORLD WHICH OFFERS MANY NEW OPPORTUNITIES AND ROLES, BUT NEW
ROLES DON'T AUTOMATICALLY BRING EQUALITY, ALTHOUGH OUR MARRIAGE
CONFORMED TO THE TRADITIONAL GENDER ROLES OF TWO GENERATIONS AGO,
IT WAS BASED UPON AN EQUALITY FOSTERED BY MUTUAL RESPECT,

  TOO MANY PEOPLE -- WOMEN AND MEN -- CONCENTRATE THEIR
EFFORTS UPON ACHIEVING A CHOSEN ROLE IN SOCIETY RATHER THAN ON
HOW THEY PERFORM -- AS PEOPLE -- IN THOSE ROLES,

  I'M SURE YOU REALIZE HOW IMPORTANT THAT IS NOW THAT YOU HAVE
SPENT FOUR YEARS IN THIS EDUCATIONAL ENVIRONMENT, TRUE EDUCATION
WILL NOT TAKE HOLD UNLESS THERE IS RESPECT AMONG THE
ADMINISTRATION, FACULTY, AND STUDENTS, IN LIKE MANNER A MARRIAGE
WON'T SUCCEED UNLESS THERE IS MUTUAL RESPECT,


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  IN YOUR NEW ROLE AS GRADUATES OF THIS COLLEGE I'M SURE YOU
WILL FIND ONCE AGAIN THAT IT IS NOT THE POSITION YOU HOLD BUT
RATHER WHAT IS GENERATED BY THE EXPOSURE OF YOUR HUMAN QUALITIES,

  I AGREE WITH THE PSALMIST WHO SAID WE ARE FEARFULLY AND
WONDERFULLY MADE, AS A SURGEON WHO HAS POKED INTO THE NOOKS AND
CRANNIES OF THE HUMAN BODY, I CAN CERTAINLY ATTEST TO THAT, THE
THINGS I SAID ABOUT THE PROMOTION OF GOOD HEALTH AND THE
PREVENTION OF DISEASE ARE NOTHING MORE THAN ANOTHER KIND OF
RESPECT -- RESPECT FOR ONE'S BODY,

  AND RESPECT RATHER THAN ROLE PLAYING SHOULD MARK A
RELATIONSHIP AS WOMEN AND MEN AS COLLEAGUES, HUSBANDS AND WIVES,
WELL PEOPLE, AND ILL PEOPLE, ALL CREATED -IN THE IMAGE OF GOD, GO
ABOUT THEIR APPOINTED TASKS,

THIS TOO, MAKES FOR A HEALTHY AMERICA,


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  AND WITH THOSE REMARKS I'LL SAY GOODBYE WITH THIS BRIEF BUT
SINCERE WISH FOR EACH ONE OF YOU:

THAT YOU HAVE GOOD HEALTH a,, A LONG LIFE,, a

AND A TRUE LOVE TO MAKE THEM BOTH WORTHWHILE,

THANK YOU,