Surgeon General, U.S. Public Health Service and Deputy Assistant Secretary for Health, U.S. Department of Health and Human
Presented to the students and faculty George Washington University School of Medicine
April 23, 1986
(Greetings to hosts, guests, friends, etc.)
In response to the kind invitation tendered by Dr. Zubicki, I thought I'd come by to chat with you today about some of
the things that concern the Surgeon General, whoever that person may be. Right now, I'm in that position and I think it's
good, every now and then, to let people know the concerns I have . . . the issues that I care about . . . and how those concerns
help shape national health policy in this country.
First of all, you should know that there has always been someone specifically concerned with public health who has been privy
to the highest councils of our national government. Let me sketch a little history for you.
In 1798, our second president, John Adams, established the first Marine Hospital in his home district of Boston, Massachusetts,
as part of a new plan to stop the spread of infectious diseases brought to our shores from foreign ports. It was the beginning
of what we now know as the U.S. Public Health Service.
When his vice-president, Thomas Jefferson, became our third president, he appointed a controversial young doctor named Benjamin
Waterhouse to be the new director of the Boston Marine Hospital. Waterhouse was an energetic but controversial character.
Just a few years before he had enthusiastically introduced to the United States a revolutionary new technology called "vaccination,"
which had just been developed in England by Dr. Edward Jenner.
As the new head of the Boston hospital, Waterhouse plunged right in and set one precedent after another:
He established the first out-patient service for merchant seamen who didn't need to be hospitalized, and thus he radically
expanded the range of federal medical care.
He wrote the first regulations governing the way federal medicine would be dispensed . . . who would dispense it . . . and
who would be eligible to receive it. We're still writing those kinds of regulations for Medicare and Medicaid.
Dr. Waterhouse was also a faculty member of Harvard at this time. He set up small clinics within the Boston Marine Hospital,
established a system of student internships, and in effect turned the Boston Marine Hospital into this country's first
"teaching hospital," and G.W. is in that tradition.
Waterhouse was brilliant but abrasive. He was safe during Jefferson's two terms. But in 1809 our fourth president, James
Madison, listened to the arguments of the medical establishment and fired Dr. Waterhouse from government service.
Two hundred years have passed, but the pattern of those early days has been repeated again and again. For example . . .
First, the Marine Hospital Service evolved into the United States Public Health Service, which is a uniformed, quasi-military
service. As Surgeon General of the PHS, I hold the Navy flag rank of Vice Admiral. My deputy, Dr. Faye Abdellah, is a Rear
Admiral, as is each of the 50 Assistant Surgeons General in the PHS. The U.S. Navy, of course, has its own medical service,
but the PHS provides the medical service for the Coast Guard and for the National Oceanographic and Atmospheric Administration,
"NOAA." So the original "Marine" connotation is still very much in evidence.
Second, nearly every American president since John Adams has been personally knowledgeable about -- and personally involved
in -- matters affecting the health of the American people.
Third, medicine and politics became engaged early in our history and have remained engaged ever since. The most successful
physicians in America have never been satisfied just to have a large and rich medical practice. They have also labored --
often for little or no personal gain and sometimes at great personal risk -- to affect the course of public health policy
and, hence, the welfare of their fellow citizens. Some people get upset when they see physicians get active in public affairs
. . . but it happens to be an old and honorable American tradition.
And fourth and finally, ever since the example set by Benjamin Waterhouse, the role of federal medicine has been to lead,
not merely to follow. Most Surgeons General have been up to the task . . . a few have not. Sometimes their colleagues in private
practice have been very supportive. And other times they been very angry.
I was only vaguely aware of this history when President Reagan asked me to be his Surgeon General in 1981.
Thomas Jefferson had boldly picked Benjamin Waterhouse as his chief physician, to the consternation of organized medicine.
And Ronald Reagan reached over the ranks of organized medicine to pick C. Everett Koop, a controversial and overage pediatric
surgeon from Philadelphia, to be his Surgeon General.
I'm the 13th man to hold this job.
Now I can go on and tell you what I do and I know you won't be so surprised. You'll understand that it's all very
much in character with the historic nature of the office.
The first and most important thing I do is to talk to the American people about their health. Most of the time I try to do
this through the physicians and nurses and psychiatrists and others who practice hands-on medicine. But I often talk directly
to them as well, via radio and television messages and newspaper reports.
It's my job to tell the facts as I see them. For example, smoking is bad. "If you smoke, you should quit, and if you
don't smoke, don't start." But I've asked more. I've asked the health professions and the American people
in general to make the United States "smoke-free by the year 2000."
You may recall that Dr. Luther Terry published the first Surgeon General's Report on Smoking and Health in 1964. There
have been 18 such reports in all. The last 4 reports have been under my signature.
But even in this activity, we've been following in the footsteps of our old friend, Benjamin Waterhouse. In 1805 Waterhouse
published report "Shewing the Evil Tendency of the Use of Tobacco."
I have also warned the American people about the very suspicious and serious relationship between aspirin and Reye syndrome
I've raised the alarm about the growing use of cocaine, particularly among young people.
I've been an advocate for the disabled, especially disabled children. Most of what you have heard or read about "Baby
Doe" has either involved me or has somehow been influenced by what I believe and what I have said.
I've spoken out about the need for health professionals -- especially young physicians as most of you are -- to learn
more about the needs of our elderly. I have urged them to modernize their practices and eliminate their "age-ist"
prejudices, in order to provide old people with the quality health care they need and deserve.
And I've urged the public health community to come up with a philosophy of aging that might serve as the underpinning
for this quality health care.
I have stepped in to provide leadership in the area of ventilator-dependency, getting government people in Medicare and Medicaid
to be more flexible on this and other similar problems.
I brought together all the conflicting interests in the field of organ transplantation and got them to negotiate a collective
arrangement that would assure the American people that this new technology would evolve according to the public's needs,
and not merely the needs of the specific parties of interest, such as the surgeons, the organ "harvesters," or the
big medical centers.
And most recently I called together over 150 experts in medicine, public health, nursing, law, and social services to focus
on interpersonal violence as a major public health problem in American society. They came up with 156 recommendations and
we are in the process of beginning to carry that out . . . again, with the help of physicians, nurses, social service workers,
The Surgeon General also has a variety of responsibilities in international health, to which I attach a very high priority.
You may know that more than 40 countries, over one-third of the UN member states, still have infant mortality rates of more
than 100 per 1,000 live births, about what ours was a century ago. In 32 countries, the average life expectancy is less than
50 years of age. I believe we have a moral obligation to do everything we can to help those countries improve upon those statistics.
The United States is a key member of the U.N. World Health Organization -- WHO -- and its affiliate in this hemisphere, the
Pan-American Health Organization, or "PAHO." I am a regular member of the US delegation to the annual WHO meetings
Among our major efforts these days has been to get the nations of the world behind the dissemination of oral re-hydration
therapy and also to support an expanded program to immunize the world's children against the killer infectious diseases
You are probably aware that the United States has fewer than 5 cases of polio a year. We're working with "PAHO"
to see if we can achieve this for the entire Western Hemisphere by the year 1990. We just might do it.
We also provide health-related services under 13 treaties and more than 30 bilateral agreements with countries such as mainland
China, Israel, Egypt, the Soviet Union, Zaire, and India.
My predecessor, Dr. Waterhouse, was the first American physician to push for vaccination is the way to eradicate the scourge
of smallpox almost 200 years ago. Oddly enough, the US Public Health Service -- the legacy, you might say, of Benjamin Waterhouse
-- with the lead agency that vaccinated tens of millions of children around the world in the 1960s and 1970s.
That effort ultimately led to the historic announcement by WHO in 1979 that smallpox had been eliminated as an infectious
disease of Mankind. The human race had never accomplished such a thing before.
That's a run-down of some of the priority activities that command a good deal of my work-day. They are, you might have
noticed, activities that take place outside and beyond the federal service. But I have a rather full agenda of activities
inside the federal service, also.
First and foremost, I am the titular head of a Commissioned Corps of nearly 6,000 public health service officers.
I also serve on a variety of governing boards, such as that of the Uniformed Services University of the Health Sciences, co-located
on the grounds of the Bethesda Naval Hospital, and of the National Library of Medicine, a division of the National Institutes
A function in a similar capacity with . . .
The Armed Forces Institute of Pathology
The National Board of Medical Examiners
The Program of Emergency Military Assistance to Safety and Traffic, or simply "MAST"
And, to keep up my contacts with organized medicine, I am a member of the House of Delegates of the AMA.
I'm also a member of the Defense Health Council, along with the Surgeons General of the other uniformed services. Among
my concerns within that counsel is the ability of our nation to respond to a national non-military health emergency, such
as a major California earthquake or hurricane and major flooding along the Gulf Coast.
My initial nomination and confirmation process took 8 long months back in 1981. But, after having me on the job for 4 years,
the President was satisfied enough to nominate me for a second term. This time, the Senate committee said my name forward
without a hearing and the full Senate voted "aye" in less than 60 seconds. So I breezed right through.
Any ordinary person would feel relieved that happened. And I must confess that I'm proud to been able to think and say
what was on my mind for the past 4 years and still earn the good opinion of the President and the Congress . . . and sometimes
even the grudging respect of my colleagues in medicine.
But I worry every now and then that becoming a captive of the system . . . that I might be turning into a non-controversial
mouthpiece for the establishment. That would be terrible and very much out of character for U.S. Surgeon General.
When I suspect that I'm leaning too far in that direction, I escape to New Hampshire and dependence before steel engraving
of the good Dr. Benjamin Waterhouse.
It always works. I was come back ready again take up battle with the conventional wisdom and stamp my little warning labels
on another million packs of cigarettes.
I hope by this time you understand why I believe I got the best job in American medicine. But in case you don't, I'll
be glad to take your questions.