A: Yes. If they see an abused child, they know who to call to have the child taken from the home to safety. And they know that the law will protect someone who reports child abuse. But if they see an abused wife, they feel that reporting it may open a Pandora's box. Doctors don't know which social-services agencies to call. They fear getting mixed up in legal cases. They tend to accept it if the woman says she received her injuries from "a fall" or some other obviously untrue explanation.
Q: How can that be changed?
A: The American Medical Assn. has recently taken some responsive steps. They asked that medical schools incorporate into their curriculum instruction on domestic violence as a health issue. And many residency programs are beginning to include protocols on how to recognize the symptoms.
Q: \o7 You've spoken often of the health effects of underage drinking. Since teen-agers have always found ways to sneak beers, why do you think it's worse today?\f7
A: Today, the problem is more rampant and more openly tolerated. High-school data show that 92% of teen-agers drank in the past year, and one-third tried alcohol in binges. One-fourth tried binge drinking by eighth grade. By the way, the data also show that kids in college drink more than kids who don't go to college. When you're a parent paying all that money to send your kids to college just to drink more, maybe it's time to do something about it.
Q: \o7 By numbers, cigarette smoking dwarfs all other public-health issues combined--as many as 395,000 deaths per year from cigarettes, more than a thousand per day. This continues, though the public has been elaborately warned that cigarettes ruin the lungs and the heart.\f7
A: I worry about smoking across-the-board, but I am now very much worried about women smoking, because the numbers show that young women are smoking more while young men smoke less. And young women are smoking Winstons and Marlboros (high tar and nicotine brands). Cancer of the lung has surpassed cancer of the breast as a women's problem. Women tell me that part of liberation is behaving like men, including smoking like men. But is it really necessary to get men's diseases in order to be liberated?
Q: \o7 What's left to do from an anti-smoking standpoint?\f7
A: Traditionally, it is said that smoking is a personal decision that only effects the smoker, whose rights should not be impinged. Understanding of passive inhalation is changing that premise. Consider the data on the Japanese wives who died of cancer of the lung when they never smoked themselves. (Their husbands smoked.) If people who smoke are harming someone other than themselves, the freedom-of-choice equation changes.
Q: \o7 Doesn't your office already consider secondhand smoke a health threat?\f7
A: The Environmental Protection Agency has concluded that, and we believe the EPA analysis. The estimate is 3,800 deaths per year from passive inhalation. For instance, in the cases where cancer of the lung occurs in children, one parent or the other is a smoker.
Q: \o7 About AIDS--the perception now is that the spread has leveled off. Has it?\f7
A: Don't, don't believe that AIDS has leveled off. In the original target population of homosexual men, AIDS might be leveling, mainly because they have become serious about methods of prevention. But AIDS in homosexual men will be surpassed by AIDS among heterosexuals in some parts of the population. In New York and New Jersey, AIDS is now the first cause of death for women between the ages of 15 and 44. And remember, there is a new transmission means now--from women with HIV to their children as they are born. That was not an issue 10 years ago when the epidemic started, but is an issue now. The transmission rate from mothers with AIDS to infants is 30%, much higher than the transmission rate among homosexual adults.
Q: \o7 Young people seem to think of AIDS as a disease of the over-30 generation.\f7
A: Complacency and lack of knowledge about AIDS is common among young homosexuals. If the young homosexual disregards the epidemic and has unprotected sex, the next generation will be at risk. Twenty-one percent of adolescent homosexual boys have a minimum of four sexual partners; 63% do not use condoms with their multiple partners. And the data clearly show that young people generally are having sex earlier than ever, at ages when they are least likely to understand about protected sex. What effect will that have on AIDS transmission? The people who are now developing symptoms in their 20s must have contracted the virus when they were aged 13 to 19.
Q: \o7 The Public Health Service is currently recommending to the White House that infection with HIV be dropped as a barrier to entry into the United States. In fact, the PHS recommends that visa applicants to the U.S. no longer be restricted for any deadly disease except tuberculosis. The White House is strongly resisting this idea. What's your rationale?\f7