AIDS and American Values by C. Everett Koop, MD, ScD
Surgeon General of the U. S. Public Health Service
U.S. Department of Health and Human Services
Presented to the Cosmos Club
October 19, 1987
It had been thirteen days since I last spoke publicly on the subject of AIDS.
The Cosmos Club in Washington is nearly 100 years old and one in which membership is obtained not because of family background
or (when it was a club for male members only) membership in an old boys coterie. Membership in the Cosmos Club was on the
basis of achievement and prospective contributions to a convivial club that had started off as a literary organization. The
club has special alcoves or walls where it honors members for winning a Nobel Prize, the Pulitzer Prize, the Cosmos Club Award,
and having been awarded the Presidential Medal of Freedom by the President of the United States. I felt very fortunate to
have my photograph on a wall of Cosmos Award recipients as well as the Presidential Medal of Freedom. I had been a member
of the Club since 1982, and am to this day.
On the outset, I indicated to this audience that I would spend my time with them on the non-medical concerns that had been
brought to my attention concerning AIDS as I traveled about the country and overseas.
I talked about the spreading disease, that now takes about a year for the number of victims to double; at the end of 1985,
there were 19,000 reported cases, and at the time of giving this lecture the total in the United States was 42,000, half of
whom had already died of the disease and the expectation was that the rest would.
There followed information on how the disease is spread, biophysical peculiarities of the AIDS virus, the kinds of groups
that were at highest risk, and introduced the fact that our greatest concern was the increasing incidence among heterosexual
men and women who were not I.V. drug abusers - currently 4 per cent of all patients.
Emphasis was placed on the aspects of AIDS that color everything done and said about the disease: it is still a mystery, it
is fatal, and one gets AIDS by doing things that the majority of people don't do and don't approve of. It is not spread
by casual non-sexual contact.
This means that in some ways the scientific issues pale in comparison to the highly sensitive issues of law, ethics, economics,
morality, and social cohesion.
I also covered the sad state of affairs in that there were members of the medical and dental professions who wouldn't
treat patients with AIDS, that those hospitals with national reputations for providing care for AIDS patients were being by-passed
by medical and nursing students looking for residencies, internship, or a practicum to complete their professional training.
In addition, many non-AIDS patients - especially those with insurance coverage were asking to be admitting to hospitals that
did not have many or any AIDS patients.
Economic questions came next with a question of who should pay. The question raised was this: As the caseload climbs and the
costs rise will the American people continue to support such care that currently costs an excess of $20,000 per patient a
Another question: How much risk can the community tolerate in order to preserve the rights of individuals and the confidentiality
of their records?
This led into discussion of the necessity for confidentiality of medical records and recommendations for who should be tested
and the suggestion that HIV positivity not be advertised except on a "need to know" basis.
Racial disparities were also discussed including the disproportionate number of Black and Hispanic patients that were HIV
positive in comparison to the partition of those two ethnic groups in the general population.
I closed with a thought that since AIDS knew no geographic boundaries, we had to stand together with our neighbors in a global
sense, thus we faced not only death of the flesh, but death of the spirit by living in fear and anger.