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4 4 o REdY.4RKS OF THE SURGEON GENERAL * * *

- - -

         SLF?GEON GENERAL I/.OOP:  Mel1 thank you very


much,  3ob.  Nhat you hear in the way of a voice this

morning  is not the usua1 Chick Koop;  that is a Swiss


virus.  I thought it was  going to be lethal, and then

I was afraid it might not be,  but I did survive and


here I am.

       I'm very happy  to be here and to see the

workings of this Interagency Committee, because as I

~II: frequently asked,  as I was in an intervietil this

morning before I came here,  what have I set for my

goals,  one o? the things  that I always mention--and

it might seem t,o you to be impertinent--is that I

would like to have a role in developing a philosophy

on aging in this country.  And what I mean by that is

that aging is a part of iiving,  and whether or not

one has to make a decision about his own aging, or

about a member of his family,  or about society, I

think that that kind of a decision  should be based on


infcrwaticn  rather than upon preJudice,  and even in

Govern:qent circles, as hard as we try, I find there

is still a lot of prejudice and concern that doesn't

hive %o be there.  This doesn't mea?  that there will


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ever be a document which says+ "This is the

philosophy s? aging,"  but the C'ffice of the Surge.;n

General,  which has  essentially no power,  does have a


ict si moral  suasion and I find that in certain areas

Mere I ZIG ?;sked  to talk Uhat I have to say is at

least 1i;tened to, and hopefully some of the things

that UC discuss in the way of philosophy might

eventually take hold.

       You might as4 hov comfortable I feel in

making an aging proJect one of my maJor  initiatives

in Government after having  spent a lifetime with

children.  particularly with very young children. And

the ansl;er is I feel very comfortable about it

because there are a lot of things that are very

sirr,ilar about the dependence of elderly people and


the  dependence of children.  And I don't feel that

I've taFen a giant step  in any direction at all. It

JUSC;  seemed to be a very natural evolution of the

things  that I was concerned about in protecting

people who required protection.

       f<y iirst real effort in re?'erence to aging

was 3 total failure.  And that is,  at the time of the


White House Conference I tried to convince the


Presiden? that it  would be a marvelcus gesture if he

provided Dr.  Butler with the six research beds he


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WaRted at the Clinical Center and a 'very fine gesture

to the Conference  about his own concern about these

things. I  almcst thought, with some of the

inscrsafion that Dr.  Gibson and Dr.  Butler provided,


and  the response from the White House,  that that

might have happened, but as you know, it didn't. I

hope  that mq next venture may prove to be

   more effective,  and I'll say a little bit more


about  that later.

       Let me Just tell you, from the point of

viev oi the Surgeon General, functioning in the

capacity that I do now as Deputy Assistant Secretary

of Health as well,  how I think all this fits into the

perspectives  of our general Department's efforts. A5

ycu know,  Secretary Schweiker is very much interested

in health promotion and disease prevention,  and you

will be seeing something  almost weekly now about a

neu initiative in the iield of prevention.  bje are


comsi tted to  this as a major health policy and I

218      think this has  been clear from the confirmation


219     hearings oi Secretary Schweiker right on down to his

220       m5s.C;  recent press releases.  In general, what we're


221     foll*o:Ji?g,  are the guiCe! ines set i'orth in the


222     Surgeon General's  Report on health promotion and


223     disease prevention :dhi:h was entitled "Healthy


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People",  and in the follow-up document which was


called,  "ObJectives fcr the Nation". And you are very

familiar with these things. In these two documents ze

really ha\,e  isolated five separate  categories or

ob Jecti;,es  ILhich are g.oals  for prevention and health

promotion  that we hope 0~~7  society can achieve by the

year 1990.  They include such things as trying to

lower  our infant  mortality rate from it5 present

almost 12 to 9 per 1,009 live births; to assure some

kind of longterm,  successful control of high blood

pressure by at least b0 percent of persons with the

disease,  and that of course impinges very definitely


upon your concerns;  to reduce the proportion of

smoking adults to  less than 25 percent of the

pop*Jlation --the  kind of effort that the smoking

lobby,  or the tobacco lobby is making against it at


this tipe,  that seems problematical. They have

already spent  in advertising this year more than zur

entire budCjet on smoking and health, and that is only

25 percent of this year's budget for lobbying against

the  things that we think are proper;    and other such

things as trying to cut  down on infant fetal alcohol

syndrome and  such thi,ngs as that, :tihich are not part

.

or your aging  concerns.


         f-u f iLle believe that interagency cooperation


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is absolutely essential  for attaining any of these

gcais, and  the kind of a meeting you're having this

morning  is Certainly evidence of the fact that YOIJ

understand these things as well.  We need the

Depar tcent 0C: Nousing and Urban Development to help

achieve sat'ety and sanitation goals for improved

living  environments.  We need the Department of

Agriculture to improve nutrition, especially in our

initiatives with pregnant women and children,  and as

you see it,  with the aging population.  We certainly

need the Health Care Financing Administration to help

to fund demonstrations in new health care

te:hnoIogies and to encourage  the application of the

results and so on.  And 1'11 say a few things about

that in a nonent.

         So,  many of thece goals may not appear at

first hand to be specifically targeted at the

nation's elderly.  But :tie also have a separate program


devoted to  the specific problems of longterm care

which ClJhS across all ige group5 and effects all

social avd economic grotrp; as uell.  So often longterm

care is asslJned by the listener to refer only to the

aging population,  but I  certainly in my former

incarnation realized that a lot of longterm care Iwznt

into very young children indeed,  and they had to have


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it _ ,
  i-r nuch  longer periods of  time than do the aged.

        You are aware of the fact that Assistant

Secretary Drandt appointed me as the Chairman of a

Pcbiic Health Service Task Force on Longterm Care,


and  ue r-,o\*ed  into that with some degree of  enthusiasm

only to +ind  then that we were sort of downgraded a

littie bit by the whole Department of Health and

Human Services getting into the same act. And you

know that <tie shifted gears as rapidly as we could and

tried to comply with Assistant Secretary Rubin's

request for an inven%ory  of what was going on in

various parts of the Public Health Service. And

inasnuch as what Dr.  Butler and Dr. Gibson are on


that task force,  I won't have anything more to say

about that.

        I've alluded to the fact that I would

mention something to you a little bit further about

another opportunity we might have,  and 1'11 JU',~

specificalIy mention it because it involves several

agencies here,  and that  is a longterm concern  that 1

have had about incontinence. One oi the most

fascinating  diseases of childhood is Hirschsprung's


disease,  or aganglioni: ,xegacolon,  and for every  cne

of those that you seer  you see perhaps 35 or 40

chil ,iren uho are thought  to have that disease but


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merely have the symp%oms  of it without the pathology,

ana all oi'  these children tend to have problems in

incontinence.  And therefore 1 have been concerned


about  the phys islogic pathology, or the pathologic

physiology,  of incontinence.  And as I got into the

Public i-iealth Service and recognized uhat nursing

home adnissions consisted of,  and realized how much

longtern care was associated with incontinence,  and

be3al-l  to get the  statistics on this,  I realized that


i$ `de  warlteti to make a really cost-effective stab at

something i n the future,  incontinence would be a

marvelol-ls goal.  If you could do all the things you

wanted to do and you were  100 percent successful, you


could  save as much as $9 billion dollars a year in

lor,gter,:: care by conquering  incontinence by one way


or another.  And there are many ways that can be done,

not JUSt SL'  svrgical means and mechanical


contrivances,  bcrt most  egfectively by the use of

biomedical feedback techniques.

         And on one of the occasions when I was  able

to corner the Secretary, I pointed out to him that if

he really wanted an initiative that wculd sing for

him in days to comer  incontinence would be it, and if

we could have his support,  i would be very happy to

try  to work  with people out here at NIA to spearhead


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this and get some of  the answers that we'd like to


h a :' e .  As you know, Ijr, Engle working at the Institute

in 1
   %a  timo7e has a very high success rate among

anbulatory elderly,  bettieen 55 and 90, with

incontinence.  And my concern is, can he get the sa,ne

kind of an effective result with people who are

admitted to nursing hones,  especially to do it

quickly enovgh before they get into the situation of

having bed sores which make their discharge

absolutely  impossible from a nursing home?

       And it is along  those lines that I

approached the Secretary and got his support to go to

Dr.  Carolyn Davis,  and we have her promise of a

substantial account of financial support as soon as

the pew fiscal year arrives to try to set up a unit

in Zaltinore which would be a typi:al nursing home

unit  where we would not  be dealing with a select

population,  blot the run-of-the-mill, across the


board,  inrJntinent patient that comes to a nursing

ho,Te, and  see what these bioFeedbac? methods might do

in such a circumstance.

       No:, I'm not naive enough to believe that

even ii yau had a marvcious result with that, that

tj.2~ could taa:h the do:tsrs of America to teach their
      not
pat1entsj 'to be incontinent.  It's  just not exciting


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enough for then.  gut I think there is a way that we



Can  IJtilire another phencnenon  in our  modern medical

picture today, and  that is the teaching nursing home

that Cr.  Eutler has been so instrumental in bringing

about.  And tie have met with people from one of the

teaching nursing homes here in Washington, and it

would appear that if we do it just the right way t;?at

we ccl,ld indeed put out a nursing initiative acT.oss

this land,  suggesting that this would be a maJor

contribution and a verg  cost -effective one if nurses


would assume  to themsel.ges the role of teaching

elderly people who are incontinent how to use the

biofeedback  techniques to inprove their situation,

       And as those of you who may not know as

well as I do,  there is a constant friction between

physicians and nurses in hospitals over the value of

training,  and who is gazing  to make decisions,  and I

think here is a place where we could ask the nurses

to step  into a role of teaching and responsibility

where they Isould not have any competition from

doctcrs  a;r,d where,  becatis e of Cheir own particular


skills and  compassion,  we might achieve the ends that

we'd IiAe to achieve far  better than if we put this


in  the  hands  of physicians.  And I say that in spite


Of  the +act that I,  myself,   am one.


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       Finaliy,  I've Just  returned from the Llorld

Health Assemb lq,  where I did not have   as much time to

do the things I wanted to do on the side as I had

hoped,  but I did meet with Dr. Caprio and Dr. MacFadyen,

       who are responsible for the aging

initiatives Of WHO.  They are very enthusiastic about

the upcoming \Jorld Assembly on Aging to be held later

this summer in Vienna.  I think that they believe that

there will not: be 3i ministers of various countries


who  go as chief delegates to that,  which I think is


v2rg  important;,  because it neans that it has a high

profile and a sense of iinportance  in those countries.


And as  ycu know, it has a very high profile and a


very  iinportant role in this Department because our

own Secretary is going  to lead the delegation to

Vienna in late July.  And at the ns=xnent it appears as

though both Dr. Butler and I, among others1 will be

accompanying him. And that night ~IJW well for the

future.

       And I might ,~wst say in closing that it liras

very gratifying to be part of the Public Health

Service in Geneva and to realize in what tremendous



es tee:> %he  Y!ational Institutes of jVealth are held)


ezpe :ially  the l4ational Institute on Aging,  but  most

especia!lq qour leadei- Dr.  Butler.