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Records of the Office of the Chief of Staff (Reagan Administration)
Howard Baker's Subject Files
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Ronald Reagan Presidential Library
Digital Library Collections
This is a PDF of a folder from our textual
collections.
Collection: Baker, Howard H.
Folder Title: AIDS
Box: 1
To see more digitized collections visit:
https://reaganlibrary.gov/archives/digital-library
To see all Ronald Reagan Presidential Library
inventories visit:
https://reaganlibrary.gov/document-collection
Contact a reference archivist at:
[email protected]
Citation Guidelines: https://reaganlibrary.gov/citing
M/
560983
4/26/88
FG006-01
we
UT001-01
FG384
BE004
HE001
The following folders were received in
DRM from the office of Howard Baker,
Chief of Staff:
1
Fairness Doctrine
2
George Hensen
3
Memondums to HHB from JCT
4
Grace Commission
5
Damson Memos
6
Donatelli Memorandums
7
8
Economic AIDS Bill of Rights
ENCLOSURES FILED OVERSIZE ATTACHMENTS 15911
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
July 23, 1987
STATEMENT BY THE ASSISTANT TO THE PRESIDENT
FOR PRESS RELATIONS
The President is announcing today his intention to appoint the
Presidential Commission on the Human Immunodeficiency Virus
Epidemic -- the AIDS Commission.
The Commission's 13 members are drawn from a wide range of
backgrounds and points of view. They bring together expertise in
scientific investigation, medical care and its costs, public
health, private research, and both State and national government,
as well as in fields that deal with the many issues of ethics,
law, and behavior involved in the AIDS epidemic.
The Commission will consist of the following individuals:
William Eugene Mayberry, Chairman
Colleen Conway-Welch
John J. Creedon
Theresa L. Crenshaw
Richard M. DeVos
Burton James Lee III
Frank Lilly
Woodrow A. Myers, Jr.
John Cardinal O'Connor
Penny Pullen
Cory SerVaas
William B. Walsh
Admiral James D. Watkins (Ret.)
The primary focus of the Commission will be to recommend measures
that Federal, State, and local officials can take to stop the
spread of AIDS, to assist in research aimed at finding a cure for
AIDS, and to better care for those who have the disease.
In the course of its work, the Commission will:
Review current efforts at AIDS education;
--
Examine what is being done at all levels of government
and outside of government to combat the spread of AIDS;
--
Examine the impact of the needs of AIDS patients in
years to come on health care in the United States;
--
Review the history of dealing with communicable disease
epidemics in the United States;
--
Evaluate current research relating to the prevention
and treatment of AIDS;
--
Identify areas for future research;
more
-2-
--
Examine policies for development and release of drugs
and vaccines to combat AIDS;
-- Assess the extent to which AIDS has spread both among
specific risk groups and the population as a whole;
-- Study the legal and ethical issues relating to AIDS;
--
Review the role of the United States in the
international battle against AIDS.
The Commission will proceed under the leadership of Dr. Eugene
Mayberry, the Chief Executive Officer of the Mayo Clinic. The
President has asked Dr. Mayberry to move quickly, and the
Commission will deliver its first report to the President within
90 days. It will produce a final report within a year.
The President believes that the spread of AIDS is a cause of deep
concern, but not panic. If Americans work together with common
sense and common purpose, the President believes we will, in the
end, defeat this common threat.
# # #
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
July 23, 1987
The President today announced his intention to appoint the
following individuals to be Members of the Presidential
Commission on the Human Immunodeficiency Virus Epidemic:
COLLEEN CONWAY-WELCH, of Tennessee. Since 1984, Dr. Conway-Welch
has been a Professor and the Dean of Nursing at Vanderbilt
University and Associate Director of the Vanderbilt University
Hospital Department of Nursing. She received her B.S.N. degree
from the Georgetown University School of Nursing in 1965; her
M.S.N degree from the Catholic University of America in 1969: her
C.N.M. degree from the Catholic Maternity Institute in 1969; and
her Ph.D. degree from New York University in 1973. Dr.
Conway-Welch was born April 26, 1944 in Iowa. She is married and
resides in Nashville, Tennessee.
JOHN J. CREEDON, of Connecticut. Mr. Creedon has been with the
Metropolitan Life Insurance Company in New York City since 1942.
He has been serving as President of the company since 1980, and
Chief Executive Officer since 1983. Mr. Creedon is also Chairman
of the Business Roundtable's Task Force on Health and Welfare
Benefit Plans. He is serving as General Chairman of the Greater
New York Blood Program Campaign for 1986 and 1987. Mr. Creedon
earned his B.S. degree in 1952 from New York University, and
earned his LL.B. degree in 1955 and his LL.M. degree in 1962
from New York University School of Law. He served in the United
States Navy during World War II. Mr. Creedon was born August 1,
1924 in New York City. He is married, has six children and
resides in New Canaan, Connecticut.
THERESA L. CRENSHAW, of California. Since 1975, Dr. Crenshaw has
been the Director of The Crenshaw Clinic, which specializes in
the evaluation and treatment of sexual dysfunction, sexual
medicine and human relationships. She was immediate past
President of the American Association of Sex Educators,
Counselors and Therapists. Dr. Crenshaw received her B.A. degree
from Stanford University in 1964 and her M.D. degree from the
University of California at Irvine in 1969. She served in the
United States Navy from 1967 through 1973. Dr. Crenshaw was born
September 25, 1942 and resides in San Diego, California.
RICHARD M. De vos, of Michigan. Mr. De Vos co-founded Amway
Corporation in 1959, and has since been serving as President of
the corporation. He attended the Calvin College in Michigan.
Mr. De Vos served in the United States Air Force from 1944
through 1946. He was born March 4, 1926. Mr. De Vos is married,
has four children and resides in Grand Rapids, Michigan.
BURTON JAMES LEE III, of Connecticut. Since 1969, Dr. Lee has
been a practicing physician at the Memorial Sloan-Kettering
Cancer Center in New York, specializing in the diagnosis and
treatment of lymphomas. He was President of the General Medical
Staff at the Memorial Sloan-Kettering Hospital from 1972 through
1974 and from 1983 through 1985. Dr. Lee earned his B.A. from
Yale University in 1952 and his M.D. from the Columbia University
College of Physicians and Surgeons in 1956. He was born March
28, 1930 in New York City. Dr. Lee is married, has three
children and resides in Greenwich, Connecticut.
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-2-
FRANK LILLY, of New York. Since 1976, Dr. Lilly has been
Chairman of the Genetics Department of the Albert Einstein
Medical Center in New York City. He has also served as a
Professor of Genetics for the Albert Einstein College of Medicine
since 1974. Dr. Lilly earned his B.S. degree from the West
Virginia University in 1951. He earned his first Ph.D. degree
from the University of Paris in 1958, majoring in organic
chemistry, and his second Ph.D. degree from the Cornell Graduate
School of Medical Sciences in 1965, majoring in biology. Dr.
Lilly served in the United States Army from January 1952 -
December 1953. He was born August 28, 1930, in Charleston, West
Virginia and resides in New York.
WOODROW A. MYERS, JR., of Indiana. Dr. Myers is the Health
Commissioner for the State of Indiana and also serves as the
Secretary of the Indiana State Board of Health. He has served in
both of these positions since 1985. Previously, he was the
Physician Health Advisor for the United States Senate Committee
on Labor and Human Resources in Washington D.C., August -
December 1984. Dr. Myers earned his B.S. degree from Stanford
University in 1973, for which he received honors in Biological
Studies. He earned his M.D. degree from Harvard Medical School
in 1977 and his M.B.A. degree from Stanford University Graduate
School of Business in 1982. Dr. Myers was born February 14, 1954
in Indiana. He is married, has two children and resides in
Indianapolis, Indiana.
JOHN CARDINAL O'CONNOR, of New York. John Cardinal O'Connor was
ordained a priest in 1945. He was named Archbishop of New York
in 1984, and Cardinal in 1985. John Cardinal O'Connor served as
Bishop of Scranton, Pennsylvania in 1983. While in the United
States Navy, 1952-1979, he was appointed Navy Chief of Chaplains
in 1974, and Titular Bishop of Cursola and Auxiliary to the
Military Vicar in 1979. John Cardinal O'Connor was born January
15, 1920 in Philadelphia, Pennsylvania. He currently resides in
New York City.
PENNY PULLEN, of Illinois. Miss Pullen was first elected to the
Illinois State House of Representatives in 1976, and has been
serving in the State House since that time. In January 1987 she
was appointed House Minority Leader. Miss Pullen is the sponsor
of AIDS related legislation in the state of Illinois. She earned
her B.A. degree from the University of Illinois at Chicago in
1969. Miss Pullen was born March 2, 1947 in Buffalo, New York.
She currently resides in Park Ridge, Illinois.
CORY SERVAAS, of Indiana. Since 1973, Dr. SerVaas has been
Editor and Publisher of The Saturday Evening Post. She has also
served as President and Research Director of the Benjamin
Franklin Library and Medical Society and Medical Director of the
Foundation for Preventative Medicine, 1976 - present. Dr.
SerVaas earned her A.B. degree from the University of Iowa School
of Journalism in 1946 and did post-graduate work at Columbia
University. She earned her M.D. degree from the Indiana
University School of Medicine in 1969. Dr. SerVaas was born June
21, 1924 in Pella, Iowa. She is married, has five children and
resides in Indianapolis, Indiana.
WILLIAM B. WALSH, of Maryland. Dr. Walsh founded Project
HOPE (Health Opportunity for People Everywhere) in 1958, and has
been serving as President and Medical Director since that time.
He is also a clinical professor of internal medicine at
Georgetown University. Dr. Walsh earned his B.S. degree in 1940
from St. John's University in New York, and his M.D. degree from
the Georgetown University School of Medicine in 1943.
Dr. Walsh served in the United States Navy, 1941-1954. He
received the Presidential Medal of Freedom in June, 1987, and
received the National Institute of Social Sciences Gold Medal in
1977. Dr. Walsh was born April 26, 1920, in Brooklyn, New York.
He is married, has three children and resides in Bethesda,
Maryland.
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ADMIRAL JAMES D. WATKINS, U.S. Navy, Retired, of California.
Admiral Watkins served as the Chief of Naval Operations, U.S.
Navy from 1982-1986. Prior to this, he was Commander in Chief of
the U.S. Pacific Fleet, 1981-1982. Admiral Watkins is a 1949
graduate of the U.S. Naval Academy and received his Masters
Degree from the Naval Postgraduate School in 1958. During his
military service, Admiral Watkins received several Distinguished
Service Medals, including three Legions of Merit and the Bronze
Star. Admiral Watkins was born March 7, 1927 in Alhambra,
California. He is married, has six children and resides in the
District of Columbia.
# # #
THE WHITE HOUSE
Office of the Press Secretary
For Immediate Release
July 23, 1987
Pediatric AIDS
FACT SHEET
As of July 20, 533 cases of AIDS among children age 13 or younger
had been reported to the Centers for Disease Control. The
experience of physicians who deal with HIV infected children
indicates that only one-third to one-half of children infected
with HIV and who show symptoms of their infection meet the CDC
case definition of AIDS. An unknown multiple are infected but
show no symptoms.
The majority of these children contracted AIDS perinatally,
either before birth or in the birthing process (416 or 78%).
Intravenous drug use is the overwhelming cause of HIV infection
transmitted to children by their mothers. In 73% of cases of
perinatal transmission, the mothers are either drug users or
sexual partners of men who use IV drugs.
Sixty-three of these 533 children contracted AIDS through transfusions
conducted before the availability of a test for HIV assured the
safety of the blood supply. Twenty-eight cases resulted from
infected blood products used by hemophiliacs; and in 26 cases the
risk factor has not yet been determined.
The number of women in child bearing years who are infected with
HIV assures that the pediatric AIDS population will grow and the
population infected perinatally will grow. A mother need not
have AIDS in order to transmit the HIV infection to the child --
just having the virus is sufficient and an estimated 50% of the
offspring of HIV infected mothers are also infected with the
virus. The prognosis for children with perinatally acquired AIDS
is grim; of those children who are diagnosed with the severe
manifestations of AIDS, half die within nine months of diagnosis.
Those under one year of age have a more rapid course of disease,
with half dying within six months after diagnosis.
AZT for Pediatric AIDS Patients at the National Institutes of
Health
The Pediatric Oncology Branch of the National Cancer Institute
at NIH is conducting a clinical trial for pediatric AIDS patients
using Retrovir, the trade name for azidothymidine or AZT, under
the supervision of Philip Pizzo, M.D.
Dr. Pizzo began his work with pediatric AIDS patients and AZT in
December 1986 and currently has twelve patients in the clinical
trial. At the outset Dr. Pizzo set a minimum age of five for
prospective patients because of the need to draw a significant
number of blood samples to evaluate the progress of the treatment.
This skewed the possible patient population towards transfusion
acquired and hemophiliac cases. However, Dr. Pizzo's progress
has allowed progressively younger patients to enroll in the
clinical trial. Currently the youngest patient is 16 months old
and became infected perinatally.
-more-
-2-
Retrovir was approved by the Food and Drug Administration on
March 19, 1987, but the use of Retrovir in pediatric AIDS was not
among the FDA's approved uses. Dr. Pizzo's work is a Phase I
clinical trial, designed to determine the toxicity level of
Retrovir for children. Thus far he has found Retrovir useful in
arresting immune system damage among some of his patients.
Dr. Pizzo's patients receive Retrovir through a permanent
cathether which allows continuous administration of the drug.
Treatment is on an outpatient basis with bi-weekly visits to the
Clinical Center.
# # #
WHITE HOUSE
Office of the Press Secretary
For Immediate Release
July 23, 1987
FACT SHEET
Developing Drug Therapies for AIDS
It was in the laboratory of Samuel Broder, M.D., the Associate
Director for Clinical Oncology at the National Cancer Institute
(NCI) of the National Institutes of Health (NIH) that the first
work was done on the use of azidothymidine (AZT) to fight the
Human Immunodeficiency Virus (HIV). Since then, several drugs
now used to treat AIDS have been developed.
The only one of these licensed for clinical use is AZT, a drug
marketed under the name Retrovir. Retrovir reduces the occurrence of
life-threatening opportunistic infections, and has been
particularly effective in treating the dementia frequently seen
in AIDS patients. Retrovir is now prescribed for the majority of
AIDS patients.
Current Public Health Service investigations include:
Dr. Broder's work with DDC (dideoxycytidine), which
is being used along with Retrovir in clinical trials;
laboratory studies involving DDA/DDI (dideoxyadenosine/
dideoxyinosine), also under Dr. Broder's direction;
the work of Dr. Bruce Chabner, Director of NCI's
Division of Cancer Treatment, which has found that
trimetrexate, an anticancer agent, is effective in
treating AIDS patients with pneomocystis pneumonia
which has not responded to standard treatment.
Dr. Candace Pert of the National Institute of Mental
Health (NIMH), an Institute of the Alcohol, Drug Abuse,
and Mental Health Administration, in collaboration with
NCI scientists, has studied the involvement of the
central nervous system in AIDS. Out of this work has
come the possibility of a neuropeptide that may have
antiviral activity, a question that may soon be addressed
in a clinical trial.
The Food and Drug Administration, responding to the President's
Task Force on Regulatory Relief, recently promulgated final
regulations which will speed the pace with which new drugs like
trimetrexatecan reach sick people.
Drugs which show promise in early NCI studies are moved into
expanded studies. The expanded studies are conducted primarily
by special AIDS Treatment Evaluation Units, supported by NIH's
National Institute of Allergy and Infectious Diseases. So far,
the units have treated nearly 1000 patients in about 18 studies.
All of the human AIDS studies are listed in NCI's computerized
database, PDQ. Any physician in the country can check PDQ to
determine the nature and location of studies for all types of
cancer and for AIDS, and how to admit patients to those studies.
# # #
THE WHITE HOUSE
WASHINGTON
fir Aids
June 19, 1987
BOB TUTTLE:
Filling in the blanks of this morning,
Gary has provided the attached names.
My only real quarrel is with educator.
Weir is not a teacher with current
hands-on, nor is Howard; they're both
professional administrators. I have
pretty strong feelings about this, but
SO does Gary.
I have a small problem with Beverly
Newman which is geographic disperse-
ment; she and Judson are both from
Colorado.
As you are focussing on chairman,
first we should be able to defer this
until you get further into it. All I
would like is an opportunity to
present my views.
3
Rhett Dawson
CC: John Tuck
Gary Bauer
THE WHITE HOUSE
WASHINGTON
June 15, 1987
Dear Don:
Thank you for your message recommending
former Senator Harrison Schmitt to serve as
a member of the National Commission on AIDS.
I'm happy to bring your recommendation to
the attention of Bob Tuttle. I assure you
that Senator Schmitt will receive every
consideration.
I continue to value your wise counsel and
look forward to seeing you again soon.
Sincerely,
Howard H. Baker, Jr.
Chief of Staff to the President
The Honorable Donald Rumsfeld
Suite 3910
135 South La Salle Street
Chicago, Illinois 60603
491874
DONALD RUMSFELD
135 SOUTH LA SALLE STREET
SUITE 3910
CHICAGO, ILLINOIS 60603
(312) 853-8270
May 22, 1987
Hon. Howard H. Baker, Jr.
Chief of Staff
The White House
Washington, DC 20500
Dear Howard:
If you are looking for someone to serve on a
committee on the subject of AIDS, you might give
some thought to former Senator Schmidt from New
Mexico. I know he is deeply interested in the
subject.
I hope things are going well Thanks again for the
lunch.
Regards,
Donald Rumsfeld
DR/tf
GOLD AND LIEBENGOOD, INC.
SUITE 950
1455 PENNSYLVANIA AVENUE, N.W.
WASHINGTON, D.C. 20004
(202) 639-8899
May 27, 1987
The Honorable John Tuck
Executive Assistant to the
Chief of Staff
The White House
Washington, D.C. 20500
Dear John:
I recently learned that Dr. David Sundwall is interested in serving
on the President's Commission on AIDS. As you may recall, David was
the top health advisor to Senator Orrin Hatch and eventually became
Staff Director of the Committee on Labor and Human Resources during
the later part of Senator Hatch's chairmanship.
Dr. Sundwall is an M.D. and left the Committee to become Administrator
of the Health Resources and Services Administration at the Department
of Health and Human Services. He also acts as Assistant Surgeon General.
In addition to these posts, David currently serves on the Intra-Govern-
mental Task Force on the Treatment of AIDS Patients.
I think David is highly qualified and would be a real asset to the
new commission. Thank you for your careful consideration.
With best personal regards.
Sincerely,
Haward
Howard S. Liebengood
HSL/mkm
Rheti
GOLD AND Li.
INC
SUITE
Droson
1455 PENNSYLVANIA AVENUE, N.W.
WASHINGTON, D.C. 20004
(202) 639-8899
FXI.
May 27, 1987
The Honorable John Tuck
Executive Assistant to the
Chief of Staff
The White House
Washington, D.C. 20500
Dear John:
I recently learned that Dr. David Sundwall is interested in serving
on the President's Commission on AIDS. As you may recall, David was
the top health advisor to Senator Orrin Hatch and eventually became
Staff Director of the Committee on Labor and Human Resources during
the later part of Senator Hatch's chairmanship.
Dr. Sundwall is an M.D. and left the Committee to become Administrator
of the Health Resources and Services Administration at the Department
of Health and Human Services. He also acts as Assistant Surgeon General.
In addition to these posts, David currently serves on the Intra-Govern-
mental Task Force on the Treatment of AIDS Patients.
I think David is highly qualified and would be a real asset to the
new commission. Thank you for your careful consideration.
With best personal regards.
Sincerely,
Howard
Howard S. Liebengood
HSL/mkm
SEAL
OFFICE OF THE VICE PRESIDENT
WASHINGTON
June 25, 1987
MEMORANDUM FOR JOHN TUCK
FROM:
THOMAS J. COLLAMORE
&
SUBJECT:
Dr. Burton Lee and the AIDS Commission
As we discussed, I believe the Vice President raised with
the President recently the possibility of Dr. Lee being
appointed to the AIDS Commission.
Attached is a copy of a recent letter Dr. Lee wrote the
Vice President. Dr. Lee's address is as follows:
Burton J. Lee, M.D.
Memorial Sloan-Kettering Cancer Center
1275 York Avenue
New York, New York 10021
(212) 794-7092 (Business)
(203) 869-6297 (Home)
If I can provide any further information, please don't hesitate
to ask. Many thanks for your assistance.
Attachment
000 2Tra FAX 35001
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'87 6- 3 17:12
PAGE 03
SIGAR
SETTERING
TVIBOWAW
CANCER CENTER
ESTABLISHED
1954
June 2, 1987
The Honorable George Bush
Vice President of the United States
The White House
Washington, D.C. 20500
Dear Mr. Vice President,
I have been a physician at Memorial Hospital in New York City for
twenty-five years, specializing in the diagnosis and treatment of lymphomas,
the most common cancers affecting people with AIDS. Currently, I have a
very large number of patients with AIDS in my practice, and the percentage
of my lymphoma patients who have the AIDS virus is rapidly increasing.
I was watching television last night and heard you speaking out in
favor of routine testing for the AIDS virus. You were booed by the audience,
and I simply could not believe my ears. It should be obvious, especially to
the medical personnel you were addressing, that the first step toward the
control of any infectious, epidemic-like process is to identify all the
carriers. The contact behavior that leads to the spread of the disease
can then be altered, and the epidemic contained.
With AIDS, this basic rule of epidemiology and public health has been
violated, and confused with civil rights issues. This is not a civil rights
question. This issue, no matter what your detractors may say, is clearly
one of the most serious public health crises this country has ever faced.
This infection is contagious, and it is fatal! Historically, we have taken
the most stringent precautions with diseases of this type, including hepatitis,
syphilis, and tuberculosis, for which mandatory testing has been commonplace.
If a person exposed to smallpox or the bubonic plague were trying to enter
this country, our citizens would scream bloody murder if he were allowed to
immigrate without being adequately tested.
You are taking a most responsible stand in encouraging routine screening
for the HIV virus that causes AIDS. So as not to be discriminatory, this test
should be routine and across-the-board. This is the only way that we can
identify the pool of patients who harbor the virus. In the absence of any
curative treatment, this is also the only way that we can currently contain
the disease. It should also be noted that routine screening can detect the
presence of the virus long before the disease manifests itself. This provides
the individual with the opportunity for early treatment, which may postpone
the aggressive phase of the disease, and prolong survival.
000 2Tra FAX 3500T
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PAGE 04
-2-
AIDS testing. accompanied by appropriate counselling, would appear
to be indicated in the following circumstances:
- certainly, prior to immigration, as you have noted;
- certainly, prior to a marriage;
- certainly, prior to any attempt to have a child;
- certainly, at every hospital admission. Medical
personnel and other patients have a right to
this information to afford themselves and others
protection from contamination. Dentists, dental
assistants, and dental patients also have a right
to know whether there is a chance of HIV contact;
- in all prisons;
- in drug treatment centers;
- in the military (with which no one can argue, for
multiple reasons);
- and, in my mind, on college campuses, where many of
our children are exposed to multiple sex partners
for the first time.
The issue of false positive test results is a red herring. The
initial screening test known as ELISA, is extremely sensitive, and was
so designed to remove any possibility- of contamination from our blood
banks. This test can yield false positives, but when coupled with a
second test, the Western blot test, the incidence of truly false positives
is extremely rare. They do exist, however, and this problem must be
faced, and faced rapidly, with further development of new laboratory
tests. It should be remembered that false positives were a big problem
when we first dealt with syphilis, but this did not stop the routine
screening for the disease.
There are those among us who oppose routine testing, and favor in-
stead voluntary testing and education. While there is compelling evidence
that education and behavior modification have been successful in some urban
gay communities, there is no evidence whatsoever that behavioral changes
are taking place among I.V. drug users, a notoriously difficult population
to reach and educate. The certain knowledge afforded by routine screening
that one is an HIV carrier will surely be our most powerful educational
weapon, and should change that individual's sexual behavior much faster
than billboards, pamphlets, or TV commercials.
I would call for massive help in any educational effort from the
Cay Men's Health Crisis, from groups of single women, from universities,
from drug addiction centers, from the military, from churches, from parents'
groups, from all those people out there who want protection for themselves
and their children from this disease.
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PAGE 05
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It has been estimated that in certain parts of Africa, one-third to
one-half of the population carries the HIV virus. Unless we contain the
spread of this disease now, in a very short time we won't even remember
that this was ever considered "a disease of drug addicts and homosexuals."
If you are going to get booed for taking such a simple and straight-
forward position on containing this most devastating of all epidemics,
then I guess this is the reward of any responsible politician who must
consider the welfare of the public at large.
It is time to face the music. We are talking about a rapidly spreading,
fatal disease. It is time to stop worrying about peripheral factors, and
concentrate on the disease. We all must have compassion for the disease
sufferers. I do. That is why I want mandatory widespread testing, so that,
among other things, there will be no more babies born with this ghastly virus.
I am happy that none of those children were in that audience to hear those boos.
Widespread, routine, and probably mandatory screening for AIDS is going
to become a fact of life in this country very soon anyway. By calling for
such routine testing and the identification of all possible carriers of the
AIDS virus, you are supporting the most basic rule of public health, and are
completely correct in your position.
Sincerely yours,
Burton J. Lee, M.D.
BJL/ma
THE WHITE HOUSE
WASHINGTON
file
Aids
TO: Self
Date: 6-1
FROM:
JOHN C. TUCK
Executive Assistant
to the Chief of Staff
Act correspondence
from Stevens to
Baker about
Bill Hogeltine
to be on AIDS
Commission
Needs
to AiDS
be Corrissor or
and Steven
\
THE WHITE HOUSE
washington
June 26, 1987
AiDS file
Gary Bauer
TO:
Rhett Dawson
John Tuck
FROM:
ROBERT H. TUTTLE at
Deputy Assistant to the President
Office of Presidential Personnel
COMMENT:
Attached is a list of names of
individuals and their recommenders
which I think you should review
before our meeting on Monday.
meeting meet my
at 4.45pm
Runts offer
THE WHITE HOUSE
WASHINGTON
PRIORITY CANDIDATES FOR AIDS BOARD
* Joan Tisch
self
Wife of Preston Tisch,
Postmaster General of US
Dottie Wham
Senator Armstrong
Colorado State Representative
Prime sponsor of CO AIDS Legislation
* Senator Pete Wilson
Self (his #1 priority candidate)
Donald K. Ross
Richard Schweiker
Chairman/CEO, New York Life
Insurance Company
* Donald Rumsfeld
Bill Graham (#1 priority)
Recommended for Chairman
Roland Schmitt
Bill Graham
SVP, General Electric
Corporation
Member, National Science
Board
* Richard Schweiker
Senator Wilson (#4 priority)
Former Secretary of HHS
(Reagan Administration)
Peter Scott
Nancy Reynolds
Jean Settlemyre
Senator Dole
President, Foundation for
Immunological Disorders
Group VP, American
Medical International
Houston, TX
* Michael Shane
Bill Timmons
Head of Leading Edge Computers
* Gary Smith
Ted Stivers
Professor of Law, Emory
Congressman Swindal
University
Conducted a study for the
Center for Disease Control
* Thomas Sowell
Bill Graham (#3 priority)
Senior Fellow, Hoover Institute
* David Rogers
Senator Wilson
President, Robert Wood
Senator Dole
Johnson Foundation
Richard Ogilvie
Former Dean, Johns Hopkins
School of Medicine
Republican
* John J. O'Shaughnessy
self
SVP, Greater New York
Hospital Association
Former Asst Sec'y, HHS
(Reagan Administration)
James T. Lynn
Richard Schweiker
Chairman/CEO, Aetna Life
Insurance Company
* Connie Marshner
Senator Armstrong
Editor, Family Protection
Paul Weyrich
Report
Springhill, VA
EVP, Free Congress Research
and Education Foundation
EVP, Coalitions for America
Robert McMillan
Virginia Knauer
Partner, Rivkin, Radler,
Congressman Lent
Dunne & Bayh
Pat Buchanan
Represents institutions
Congressman McGrath
treating AIDS patients
Matt Scocoza
Republican
Milton Frank
Congressman Fish
Congressman Sundquist
Congressman Lent
James L. Larocca
Howard Phillips
Ira Millstein
Rob Odle
Senior Partner, Weil,
Gotshal & Manges
Democrat
worked with Gary Bauer
re: AIDS
Worked with Pasteur Institute
* Cardinal John J. O'Connor
Carlton Turner
Archdiocese of New York
working on treatment of
AIDS Patients
Connie Horner
Self
Kirk Johnson
Morris Liebman
General Counsel/American
Medical Association
* Kenneth Kizer
Jim Stockdale
Director, California
Governor Deukmejian
Department of Health Services
Mathilde Krim
Nancy Clark Reynolds
AIDS Activist
Senator Kennedy
Handled Liz Taylor event here
AMFAR
* Dr. Herb London
Mitch Daniels (alert if chosen)
Fellow, The Hudson Inst
Gallatin School at NYU
* Joshua Lederberg
Bill Graham
President, Rockefeller
Senator Dole
University
* Steve Herbits
Congressman Cheney
EVP, Segrams
* William Haseltine
Senator Stevens
Associate Professor of Cancer
Senator Kennedy
Biology, Harvard University
Massachusetts
Alvin Friedman-Kien
Senator Dole
Professor, NYU
Physician
Frances Frech
Senator Danforth
Rich DeVos
Senator Armstrong
L. Brent Bozell III
Paul Weyrich
* Charles Edwards
Senator Wilson (#2 priority)
President, Scripps Institute
Senator Dole
Former FDA Commissioner
(Nixon Administration)
Republican
* Carolyn Davis
Senator Wilson (#3 priority)
Former Administrator of
HCFA (Reagan Administration)
Republican
* Disque Deane
Senator Dole
Chairman, Corporate Property
Investors
New York
* John J. Creedon
Senator Dole
President & CEO,
Richard Schweiker
Metropolitan Life
Congressman Michel
John B. Carter
Richard Schweiker
President/CEO
Equitable Life Assurance
Jim Jun
Society of the U.S.
Peter F. Carpenter
Frank Carlucci
EVP, ALZA Corp (pharmaceutical
Congressman Cheney
company)
Palo Alto, CA
* Albert A. Cardone
Nancy Reynolds
Chairman/CEO - Empire Blue
Bernard R. Tresnowski
Cross & Blue Shield Assn
Dr. Paul Cameron
Senator Thurmond
Eleanor S. Staler
* Joe Califano
through Senator Baker
* Gene Antonio
Senator Armstrong
Author of The Aids Cover Up?
Congressman Burton
San Francisco, CA
Phyllis Schlafly
Congressman Armey
* Patricia Allen
Bill Graham (#2 priority)
VP and Comptroller, Richard
Frank Fahrenkopf
V. Allen Company
Senator Laxalt
Wife of Richard Allen
Paul Weyrich
** Burton Lee
Vice President Bush
1986 Federal Staff Directory -Biographies
KEMPF / KENNICKELL 935
KEMPF, RADM Cecil J., Director of Naval Res-
San Diego; San Diego Aerospace Museum; Hono-
erve, Office of Chief of Naval Operations, Dept. of
rary Dep. Sheriffs Assn. of San Diego County;
the Navy, Room 4E466, The Pentagon, Washing-
Assn. of Former Intelligence Officers.
ton, DC 20350. Born Nov. 20, 1927 in Maud, OK to to
John Joseph and Sylvia Lorene (Moody) Kempf.
KENNEDY, Richard T., Ambassador-at-Large,
Married Dec. 20, 1950 to Theodosia Ann Suman.
Special Adviser to the Secretary on Non-prolifera-
Children: Charles John, David Fuller and Suzanne
tion Policy & Nuclear Energy Affairs and U.S. Repre-
Ellen. U.S. Naval Academy, 1950, B.S. in aero.
sentative to International Atomic Energy Agency,
engineering; Naval Postgraduate School 1956;
Dept. of State, Washington, DC 20520. Born Dec.
Massachusetts Inst. of Technology, 1957, M.S.
24, 1919 in Rochester, NY. Married in 1947 to
Commissioned Ensign in 1950, U.S. Navy; ad-
Jean Drew Martin. Univ. of Rochester, 1941, B.A.
vanced to RADM in 1976; designated Navalaviator
in economics; Harvard Univ. Graduate School of
in 1951. Active duty assignments include: 1972-
Business Admin., 1953, M.B.A. Entered active
74, Commanding Officer, USS Dubuque; 1974-75,
duty as 2LT in 1942, U.S. Army; retired as COL. in
Commanding Officer, USS Tripoli; 1975-76, De-
1971; Distinguished Service Medal, Legion of
puty Manager, Anti-submarine Warfare Sys-
Merit, Bronze Star, Army Commendation Medal.
tems Project, Naval Material Command; 1976-78,
1959-61, planning and financial management ad-
Commander, Anti-submarine Warfare Wing, U.S.
viser to Iran; 1962, with Army General Staff in
Pacific Fleet; 1978-79, Director, Aviation Pro-
Washington; 1965-69, with Office of Asst. Secy.
grams Division, Office of Chief of Naval Operations;
of Defense for Intl. Security Affairs; 1969-71, sen-
1979-81, Vice Commander, Naval Air Systems
ior staff member and 1971-72, Dir., Staff Planning
Command; 1981-84, Asst. Deputy Chief of Naval
& Coordination, National Security Council; 1973-
Operations for Air Warfare; 1984-, current as-
75, Deputy Assistant to the President for Natl.
signment. Member: Naval Acad. Alumni Assn.;
Security Council Planning; 1976-80, Commis-
Assn. of Naval Aviation; Episcopal Church.*
sioner, Nuclear Regulatory Commission; 1981-82,
Under Secy. for Mgmt., Dept. of State; 1982-,
KENISON, Robert S., Associate General Counsel
current position. Author of numerous articles about
for Assisted Housing and Community Develop-
civil use of nuclear energy, the worldwide energy
ment, Dept. of Housing & Urban Development,
problem and regulatory matters. Recipient: Secre-
Room 2144, 451 Seventh St., SW, Washington,
tary of the Army Commendation.
DC 20410. Home, 1507 N. Edison St., Allington,
VA 22205. Born July 11, 1938 in Evanston, IL to
KENNEDY Roger G., Director, National Museum
Samuel Morris and Gertrude Bridget (Sullivan) Keni-
of American History, Smithsonian Institution, 14th
son. Married June 12, 1966 to Anne Wiener. Child,
St. & Constitution Ave., NW, Washington, DC
Laura Meredith. St. Anselm's Coll., 1956-60, B.A.
20560. Born Aug. 3, 1926 in St. Paul, MN to
(summa cum laude); Harvard Law School, 1960-
Walter J. and Elisabeth (Dean) Kennedy. Married
63, LL.B.; Princeton Univ., 1971-72, Mid-Career
Aug. 23, 1958 to Frances Hefren. Child, Ruth. St.
Fellow; Red Key Society, St. Thomas More Debat-
Paul Acad., 1944, graduate; Yale Univ., 1949,
ing Society, SNEA, Law School Committee of Phi-
B.A.; Univ. of Minnesota, 1952, LL.B. U.S. Naval
lips Brooks House. 1963-65, volunteer, Peace
Reserve service, 1944-46. 1953, attorney, Dept.
Corps; 1966-68, public housing attorney, 1968-
of Justice; 1954-57, correspondent, NBC; 1958,
71, urban renewal attorney, 1971-74, special
Director, Dallas Council on World Affairs; 1959,
asst., 1974-77, Asst. General Counsel and
Special Asst. to the Secretary, Dept. of Labor;
1977-, current position, Dept. of Housing & Urban
1959-69, Asst. Vice President, Vice President,
Development. Admitted to NH Bar Assn., 1963.
Chairman of the Executive Committee then Direc-
Author: "Off-Track Betting: A Legal Inquiry Into
tor, Northwestern Natl. Bank, St. Paul, MN; 1969-
Quasi-Socialized Gambling," NH Bar Journal,
70, Vice President for Finance, Exec. Dir., Univ. of
1963. Recipient: President's Distinguished Rank
Minnesota Foundation; 1970-79, Vice President
Award, 1984. Member: Inter-American Bar Assn.
for Financial Affairs, Vice President, Arts, Ford
Hobbies: reading, golf, jazz, gardening.
Foundation, New York City; 1979-, current posi-
tion. Author: Minnesota Houses, 1957; Men on the
KENNEALLY, Dennis M., Deputy Assistant Se-
Moving Frontier, 1969; American Churches, 1983;
cretary for Reserve Affairs, Dept. of the Air Force,
Preface to WPA Guide to Washington, 1983; Ar-
Room 5C938, The Pentagon, Washington, DC
chitecture, Men, Women and Money, 1985. Ad-
20330. Home, Arlington, VA. Born June 12, 1946
mitted to Minnesota Bar, 1952; DC Bar, 1953.
in Boston, MA. San Diego State Univ., B.A. (with
distinction in economics) and M.A. in public admin.
KENNICKELL, Ralph E., Jr., Public Printer, Gov-
Enlisted in U.S. Armed Foces in 1963; served as
ernment Printing Office, Room 808, Bldg. 3, North
aircraft commander and fire team leader, helicopter
Capitol & H Streets, NW, Washington, DC 20401.
gunships in Vietnam; released from active duty in
Born Oct. 21, 1945 in Savannah, GA. Married. Two
1970 and transferred to Army Reserve and later to
children. The Citadel Military Coll., 1963-67, B.S. in
CA Army Natl. Guard; Distinguished Flying Cross,
business admin. U.S. Army service in West Ger-
Bronze Star with 'V' Device, Air Medal with 28 oak
many and Vietnam, 1967-70; Vietnam Cross of
leaf clusters, Army Commendation Medal with 'V'
Gallantry, Combat Infantry Badge, Bronze Star.
Device, Army Commendation Medal for Meritori-
1971-81, Vice President & Manager, Kennickell
ous Service, Humanitarian Service Medal. Former
Printing Co.; 1981-82, special consultant to the
budget and legis. analyst then Admin. Mgr. for
Asst. Secy. for Admin., Dept. of the Treasury;
Registrar of Voters, County of San Diego; Chief of
1982, Special Asst. to Assoc. Admin. for Mgmt.
Staff to CA State Rep.; 1982-83, Assoc. Deputy
Assistance, 1982-84, Special Asst. to the Deputy
Admin. for Admin., Veterans Admin.; 1983- cur-
Admin. and 1984, Special Asst. to the Admin.,
rent position. Member: Combat Pilots Assn.; Res-
Small Business Admin.; 1984-, current position.
erve Officers Assn.; Air Force Assn.; Natl. Guard
Member: 32nd degree Mason. Hobbies: bird hunt-
Assns. of the U.S. and Calif.; Maritime Museum of
ing, fishing, golf.
I
THE WHITE HOUSE
WASHINGTON
Date: 7/2/87
TO:
John
FROM:
KATHY RATTE JAFFKE
Office of Legislative Affairs
Senator / Lect handed
this letter to Pam +
ashed her to make
sure Senator Baker received
is
CHIC HECHT
From Japac
NEVADA
to Phit
UNITED STATES SENATE
WASHINGTON, D. C.20510
BOD
July 1, 1987
The Honorable Howard Baker
The White House
Washington, D.C. 20500
Dear Howard:
It is my understanding that Mr. Rich DeVos has
made the "short list" to become a member of the
Presidential Commission on the Human
Immunodeficiency Virus Epidemic.
I would like to take this opportunity to express
my complete support for Mr. DeVos, and I hope
you will review his qualifications thoroughly.
Sincerely,
Chic the Hecht
THE WHITE HOUSE
WASHINGTON
July 2, 1987
MEMORANDUM FOR ROBERT TUTTLE
FROM:
JOHN C. TUCK
SUBJECT:
RICH DEVOS
Thought you would like to know that Senator Symms called me this
afternoon to highly endorse Rich DeVos for membership on the AIDS
Commission.
THE WHITE HOUSE
WASHINGTON
July 20, 1987
MEMORANDUM FOR SENATOR BAKER
TOMMY GRISCOM
FROM:
JOHN C. TUCK
SUBJECT:
CARDINAL O'CONNOR
Monsignor McCarthy of Cardinal O'Connor's staff called Bob Tuttle
to tell him that the President should be aware of the gay
community's dislike of the Cardinal. They stand during his
masses in sign of protest.
Tuck asked Tuttle if this is a request on O'Connor's part to get
out of the Commission. Tuttle advises that he does not think so,
but rather it is simply the Cardinal putting us on notice that he
is controversial on the gay issue.
AiDS
THE WHITE HOUSE
WASHINGTON
file
June 19, 1987
MEMORANDUM FOR RHETT DAWSON
FROM:
GARY L. BAUER gift
SUBJECT:
Additional Commission Names
Attached is information on:
Maurice E. Weir, Sr.
Dr. John Addison Howard
Beverly Newman
Dr. Vernon Mark
Dr. William Hazeltine
Weir and Howard are good "education slot" people. I prefer
Weir. Newman is a relative of an AIDS victim -- her husband who
died from tainted blood. Dr. Vernon Mark & Dr. William Hazeltine
are both good experts.
Aids Expert
CC: John Tuck
Handtine- - ?
RESUME
MAURICE E. WEIR, SR.
6203 KENTLAND STREET
SPRINGFIELD, VA 22150
(703) 569-3164 (h)
(202) 861-0230 (w)
EXPERIENCE
Sept. 1984 to
Present
VICE PRESIDENT, FOR PROTOTYPE DEVELOPMENT AND
SPECIAL PROJECTS
CITIES IN SCHOOLS, INC., WASHINGTON, D.C.
Created concept and Prototype Design for
National Model Coordinated and Intergrated
Human Service Delivery System designed to bring
existing health, social service, employment,
delinquency prevention and other support
services to Public School sites to address the
issues of Teen Sexuality/Pregnancy, Drug Abuse,
Delinquency, Employment, etc. to at-risk youth
and their families.
Supervise and direct all field operations of
CIS Regional Offices in the process of
Replication of the system which is currently
in various stages of implementation and
operation in 65 cities and 94 schools across
the country.
Research and disseminate information relating
to special issues and populations (AIDS, Teen
Pregnancy, Hispanic Youth, Native Americans,
Blacks, families, etc.) for distribution.
Provide consultation and recommendations to
federal, state, local government and private
agency officials regarding services to at-risk
youth and their families
Oct. 1980 to
Present
DIRECTOR
CITIES IN SCHOOLS, ADOLESCENT HEALTH CENTER
WASHINGTON, D.C.
Founder and Chief Administrator of Health
Clinic for Sexually Active and Pregnant and
Parenting Teens.
M. Weir
Resume
Page 2
Drafted initial plan, negotiated over 40
linkage agreements with local hospitals and
health care, and social service agencies.
Coordinated and consult with public/private
health care agencies for AIDS Education
Program for clinic clients.
Review, select, and approve all sex education
curricula and materials.
Direct staff development and training, quality
control, special investigations, inquiry
services and support services.
Sept. 1977 to
Aug. 1980
NATIONAL DIRECTOR OF TECHNICAL ASSISTANCE
CITIES IN SCHOOLS, INC., WASHINGTON, D.C.
Provided Technical Assistance to CIS Project
sites in the areas of Management, Development,
Program Design, Agency Coordination, Network-
ing, Contracts, Evaluation and Case Management.
Liaison to Federal and Local Government
Officials.
June 1969 to
Aug. 1977
EXECUTIVE DIRECTOR
BREAK FREE INCORPORATED
Founder and Chief Administrator of this
non-profit organization whose purpose was
to seek and development educational
opportunities for at-risk youth.
Created the Lower East Side Prep School in
1970 which won National Honors in 1972&73 and
was then adopted into the New York City Public
School System. This school was designated to
serve at-risk youth from New York's Black,
Hispanic, Chinese and Italian communities.
M. Weir
Resume
Page 3
July 1967 to
June 1969
ASSISTANT PROJECT DIRECTOR
YOUNG LIFE CAMPAIGN, COLORADO SPRING, COLO.
Organized and coordinated outreach and consuel-
ing to teenagers on New Yorks Lower Eastside.
Conducted field trips, summer camps and family
retreats.
Wrote proposals and made presentations to
Foundations and Corporate representatives.
1966 to 1967
YOUTH COUNSELOR
NEW YORK URBAN LEAGUE, NEW YORK, NY
Recruiter and counselor for teenage dropout
project.
Counseling for youth returning to school or
entering vocational programs.
Community organizing
EDUCATION
Queens College, Flushing, New York
3 years Liberal Arts Major - 1965-68
Newark Prep School, Newark New Jersey
Diploma 1965
MEMBERSHIPS AND AFFILIATIONS
American Public Health Association
National Association for the Prevention of Teen Pregnancy
Council for the Advancement of Citizenship
Community of Hope Health Clinic - Board Chairman
Community of Caring Teen Pregnancy Program - Board Chairman
Family Resource Coalition
Capitol Hill Hospital Teen Pregnancy Center - Advisory
Board
District of Columbia Mayors Advisory Committee on Teen
Pregnancy Prevention
AIDS Advisory Committee, District of Columbia Commission
on Public Health
School Based Clinic Advisory Committee, District of
Columbia, Commission on Public Health
Ethics and Public Policy Center - Associate
M. Weir
Resume
Page 4
AIDS ENVOLVEMENT
1 - Board Chairman - Community of Hope Health Clinic
(AIDS Screening and Testing Site Serving Mainly Drug
Abusers and the Homeless)
2 - AIDS Advisory Committee - District of Columbia - Commission
of Public Health
3 - Director, Cities in Schools/Adolescent Health Center
(AIDS Education)
4 - National, Cities in Schools - AIDS Information and
Education Coordinator
THE WHITE HOUSE
WASHINGTON
June 15, 1987
MEMORANDUM FOR GARY L. BAUER
FROM:
WILLIAM R. GRAHAM
Ree
SUBJECT:
Nomination for National Commission on AIDS
I submit the following name for membership on the National
Commission on AIDS. Donald Rumsfeld shares my enthusiasm for
this candidate.
Dr. John Addison Howard
President
The Rockford Institute
2431 Rock Terrace
Rockford, IL 61103
General Area: Education, university administration.
Dr. Howard served on the U.S. Commission on Marijuana and
Drug Abuse (1971-73) and the President's Task Force on
Priorities in Higher Education (1969-70). He is the
recipient of many distinguished awards including the
Silver Start with oak leaf cluster, Purple Heart with oak
leaf cluster, Horatio Alger Award, and the Religious
Heritage Educator of the Year Award. His publications
include Dilemmas Facing the Nation. Dr. Howard brings a
wealth of experience in working with young people and an
outstanding record of accomplishment in education to any
task.
Beverly Newman from Denver, Colorado, has a tremendous
grasp of the medical, psychological, and social problems
associated with AIDS. Her husband contracted AIDS around 1980
from blood transfusions after a coronary; it was several years
after Mr. Newman contracted AIDS that he was finally diagnosed as
having AIDS. In fact, Mr. Newman's case was the first AIDS case
diagnosed by the Mayo Clinic. Dr. James Jett of the Mayo Clinic
encourages us to consider Beverly Newman because he believes she
has a very accurate scientific and personal understanding of the
disease. In conversations with our office Mrs. Newman has
repeatedly come out for broader testing and for an emphasis on
values.
Vernon H. Mark, M.D.
Professor of Surgery
Harvard Medical School
Director of Neurosurgery Emeritus and
Honorary Physician, Boston City Hospital
Staff Member, Massachusetts General Hospital
1560 Beacon Street
Brookline, MA 02146
(617) 734-9690; (617) 738-4999
Dr. Mark is Associate Professor of Surgery at the Harvard
Medical School and Director of Neurosurgery Emeritus and
Honorary Physician at the Boston City Hospital. He has been
associated with the Massachusetts General Hospital since
1949 as a full-time staff member on the resident and senior
staff until 1964, and then when he became the Director of
the service at the Boston City Hospital, on the part-time
staff. He was the leader of a team at the Massachusetts
General Hospital who discovered a center in the human brain
exclusively related to pain. He headed a research team that
correlated sexual and abnormal aggressive behavior to damage
in the limbic or emotional brain (recounted in his book
written with Frank Ervin, Violence and the Brain). He
co-authored a book with his wife (The Pied Pipers of Sex)
detailing the effects of the sexual revolution on public
health and education. He and Dr. Tom Sabin started the
first independent C.A.T. scanning laboratory of the brain in
1974. He and Dr. Sabin started one of the first integrative
diagnostic services for patients with dementia and
behaviorial abnormalties related to abnormal brain function
in 1972, and began a private outpatient extension in 1979.
AIDS is one of the most rapidly spreading brain diseases
that causes such abnormalties. As a result of his studies,
in 1985 Dr. Mark cosponsored a leadership conference of the
spread of AIDS into the heterosexual population, including
possible methods of control. He debated the Director of the
Communicable Diseases of the Commonwealth of Massachusetts,
Dr. Nicholas Fiumara, who claimed that AIDS was not spread
heterosexually.
Vernon H. Mark, M.D.
Professor of Surgery
Harvard Medical School
Director of Neurosurgery Emeritus and
Honorary Physician, Boston City Hospital
Staff Member, Massachusetts General Hospital
1560 Beacon Street
Brookline, MA 02146
(617) 734-9690; (617) 738-4999
Dr. Mark is Associate Professor of Surgery at the Harvard
Medical School and Director of Neurosurgery Emeritus and
Honorary Physician at the Boston City Hospital. He has been
associated with the Massachusetts General Hospital since
1949 as a full-time staff member on the resident and senior
staff until 1964, and then when he became the Director of
the service at the Boston City Hospital, on the part-time
staff. He was the leader of a team at the Massachusetts
General Hospital who discovered a center in the human brain
exclusively related to pain. He headed a research team that
correlated sexual and abnormal aggressive behavior to damage
in the limbic or emotional brain (recounted in his book
written with Frank Ervin, Violence and the Brain). He
co-authored a book with his wife (The Pied Pipers of Sex)
detailing the effects of the sexual revolution on public
health and education. He and Dr. Tom Sabin started the
first independent C.A.T. scanning laboratory of the brain in
1974. He and Dr. Sabin started one of the first integrative
diagnostic services for patients with dementia and
behaviorial abnormalties related to abnormal brain function
in 1972, and began a private outpatient extension in 1979.
AIDS is one of the most rapidly spreading brain diseases
that causes such abnormalties. As a result of his studies,
in 1985 Dr. Mark cosponsored a leadership conference of the
spread of AIDS into the heterosexual population, including
possible methods of control. He debated the Director of the
Communicable Diseases of the Commonwealth of Massachusetts,
Dr. Nicholas Fiumara, who claimed that AIDS was not spread
heterosexually.
THE WHITE HOUSE
WASHINGTON
June 19, 1987
Aidstric
-tile
MEMORANDUM FOR RHETT DAWSON g=B
FROM:
GARY L. BAUER
SUBJECT:
Additional Commission Names
Attached is information on:
Maurice E. Weir, Sr.
Dr. John Addison Howard
Beverly Newman
Dr. Vernon Mark
Dr. William Haseltine
Weir and Howard are good "education slot" people. I prefer
Weir. Newman is a relative of an AIDS victim -- her husband who
died from tainted blood. Dr. Vernon Mark & Dr. William Haseltine
are both good experts.
CC: John Tuck
Rhett
GOLD AND Liebengood, INC.
SUITE 950
Droson
1455 PENNSYLVANIA AVENUE, N.W.
WASHINGTON, D.C. 20004
(202) 639-8899
FXI.
May 27, 1987
geT roted
Hear
The Honorable John Tuck
Executive Assistant to the
N
Chief of Staff
The White House
Washington, D.C. 20500
Dear John:
I recently learned that Dr. David Sundwall is interested in serving
on the President's Commission on AIDS. As you may recall, David was
the top health advisor to Senator Orrin Hatch and eventually became
Staff Director of the Committee on Labor and Human Resources during
the later part of Senator Hatch's chairmanship.
Dr. Sundwall is an M.D. and left the Committee to become Administrator
of the Health Resources and Services Administration at the Department
of Health and Human Services. He also acts as Assistant Surgeon General.
In addition to these posts, David currently serves on the Intra-Govern-
mental Task Force on the Treatment of AIDS Patients.
I think David is highly qualified and would be a real asset to the
new commission. Thank you for your careful consideration.
With best personal regards.
Sincerely,
Haward
Howard S. Liebengood
HSL/mkm
Lorner
Hoffman Lahoche
Deuc Firm
THE WHITE HOUSE
WASHINGTON
May 26, 1987
MEMORANDUM FOR SENATOR BAKER
FROM:
RHETT DAWSON
SUBJECT:
AIDS Commission
You asked for my comments on recommendations for the AIDS
Advisory Commission. It should be noted that the DPC expressed
a preference for a "small" group, but did not specify eight
members.
Attached is a side-by-side of the eleven candidates you discussed
with the President (left margin) alongside the eight prepared by
Gary Bauer. The membership of the eleven is superior for the
following reasons:
greater national renown, public prestige and acceptance,
diversity of interests
chairman is an esteemed physician and leader of a dis-
tinguished institution (Dr. Mayberry)
state public health officers are represented (although
Dr. Judson, Denver Public Health Director, could be
substituted for Dr. Kizer, California Health Services
Director)
secondary education is represented by Donna Oliver, the
black high school biology teacher and recipient of the
Presidential award of 1987 -- National Teacher of the
Year.
federal employees are not represented on the list of
eleven. It was determined that the Commission should
be from outside the federal government; if federal
employees need to be involved they can be on the staff
or consultants to the Commission -- but not actually
sit on an advisory board.
distinguished attorneys are represented (Califano and
Jordan)
uniformed military is represented (Admiral Watkins)
insurance industry (and business) is represented (John
Carter, Equitable)
2
A personal experience is worth noting. I am currently seeking
term life insurance. However, since I work and live in the
District, I cannot obtain coverage from any of the major life
insurance companies as they have boycotted all sales in D.C. in
protest of a District statute prohibiting questions regarding
AIDs on life insurance applications.
3
FOR CHAIRMAN:
Dr. William Eugene Mayberry
Dr. William B. Walsh
Chairman, Mayo Clinic
Director, Project HOPE
Board of Governors
MEMBERS:
William F. Buckley, Jr.
Dr. Robert Ray Redfield, Jr.
Columnist, editor and author
Department of Virus Diseases,
Walter Reed Army Institute of
Research
Joseph A. Califano
Michael Novak
Attorney, former HEW Secretary
American Enterprise Institute
John B. Carter
Eunice Kennedy Shriver
President and CEO, Equitable
Executive Vice President,
Chairman, All-Industry Task
Joseph P. Kennedy, Jr. Foundation
on AIDS
Chairman, Special Olympics
Dr. Richard B. Davis
Dr. Sam Broder
Physician
NIH, Discoverer of applicability
of AZT to treat AIDS
Barbara C. Jordon
Dr. Franklin N. Judson
Professor, Attorney and
Director, Denver Public Health
former Congresswoman
President, American Venereal
Disease Association
Dr. Kenneth Kizer
David Swoap
Director, Department of Health
Former Under Secretary, HHS
State of California
Dr. Woodrow A. Meyers, Jr.
Dr. William Eugene Mayberry
Commissioner of Public Health
Chairman, Mayo Clinic
State of Indiana
Board of Governors
Donna H. Oliver, High School
Biology Teacher, 1987 National
Teacher of the Year
Richard F. Schubert
President, American Red Cross
James D. Watkins
Former Chief of Naval Operations
4
FOR CHAIRMAN:
Dr. William Eugene Mayberry
Chairman, Mayo Clinic Board of Governors
MEMBERS:
William F. Buckley, Jr.
Columnist, editor and author
Joseph A. Califano
Attorney, former HEW Secretary
John B. Carter
President and CEO, Equitable
Chairman, All-Industry Task Force on AIDS
Dr. Richard B. Davis
Physician
Barbara C. Jordon
Professor
Attorney, former Congresswoman
Dr. Kenneth Kizer
Director
Department of Health Services
State of California
Dr. Woodrow A. Meyers, Jr.
Commissioner of Public Health
State of Indiana
Donna H. Oliver
High School Biology Teacher
1987 National Teacher of the Year
Richard F. Schubert
President, American Red Cross
James D. Watkins
Former Chief of Naval Operations
5
FOR CHAIRMAN:
Dr. William B. Walsh
Director, Project HOPE
MEMBERS:
Dr. Robert Ray Redfield, Jr.
Department of Virus Diseases,
Walter Reed Army Institute of Research
Michael Novak
American Enterprise Institute
Eunice Kennedy Shriver
Executive Vice President, J.P. Kennedy, Jr. Foundation;
Chairman, Special Olympics
Sam Broder
NIH, Discoverer of AZT applicability to treat AIDS
Dr. Franklin N. Judson
Director, Denver Public Health
President, American Venereal Disease Association
David Swoap
Former Under Secretary, HHS
Dr. William Eugene Mayberry
Chairman, Mayo Clinic Board of Governors
Vai 316 No 21
SOUNDING BOARD
1339
me ........ or dow NAID assumed on immunology
& NEW - IM 18.18
n
this
study group in 1979, the group's attention was focused
U.L.: Government Filling 111110 PUB
"
2215.)
on the development and application of modern tech-
3. Nathenson so. Gellebter J. Pfaffenbach GM, Zeff Murine major histo-
nological advances rather than on diseases.² Areas in
compaubility class.i mulanis. molecular analysis and structure function
which developments in basic immunology were con-
implications. Annu Rev Immunal 1986: 4:47 302.
4. Steinmetz M. How L. Genes of the major hisrocompatibility complex of the
sidered likely to lead to important advances in re-
mouse. In: Panay GS, David C3. ads. Immunogeneties, Vol. 1. London:
search included molecular-gonetic approaches tn im-
Butterworths, 1984:260-93.
munologic systems3,1; cloning of immunocompetent
5. Weyend C. Curonzy 1. Fathmen CG Human T cell clones as diagnostic
tools and potential therapeutic regents. Immunal Invest 1986: 15:591-624.
cells 3.6; hybridoma technology to produce monocional
6. Fitch FW. T-cell stunes and T-cell receptors. Microbil Rev 1986. su:
antibodics7,8; and studies of the antigens of the major
50-69.
7. Kühler G. Derivation and diversification of monacional antibodies. Science
histocompatibility complex and their biologic func-
1986: 233:1281-6.
tions,9.10 the regulatory mechanisms of the immune
1. Aguila HL. Pollock RR, Sgira o, Scbarff MD. The production of more
response, 11.12 and effector mechanisms and media-
uscful municional antibodies. 2. The use of somatic-cell genetic and recome
biuant-DNA technology to tailor-make monocional antibodies. Immunol
tors. 13.14 It was anticipated that broad application of
Today 1986; 7:380-3.
these approaches to the study of disease would lead
9. Havell RA, Allen H. Burkly LC. Sherman DH. Waneck OL Widera C.
Mulecular biology of the H-2 histocompatibility complex. Science 1986
the next revolution in medicine.
233:437-43.
As a result of modern technology and basic research
10. Strominger JL. Biology of the human histucompatibility Icukocyte notigen
in immunology, the complex mysteries of the immune
(HLA) system and a hypothesis regarding the generation of sucommune
discases , Clin lovest 1986; 77:1411-5.
system are unfolding at a pace rarely, if ever, seen in
11. Bloom BR. Perspective on molecular immunology and modulation of iss-
biomedical science. N principal task of the NIAID at
mune responses. Cell Immunol 1986. 99:61-72.
12. Kehri JH. Muraguchi A, Mutter JL_ Falkoff RJM. Fauci AS. Human B call
present is to ensure that breakthroughs in knowledge
activation. proliferation. and differentiation. Immunial Rev 1984: 78:75-96.
are being creatively and effectively translated into
13. Parker CW Mediators: release and function. In: Paul WE. ed. Fundamental
clinical applications. In the past few years, much
Immunology New York: Raven Press. 1984:697-747.
14. Oppenheien 11. Kova's EJ, Massushima X, Durum SK. There is more than
attention and resources have focused on efforts to pre-
one intericukin 1. Insurance Today 19th: 7:45-56.
vent and treat the acquired immunodeficiency syn-
13. Gortliab MS. Schrulf Schanker HM. et at. Pneumocystis carinii pocumo-
drome (AIDS), which, since its initial clinical descrip-
nia and /mucosal candidiasis in previously healthy homosexual mcn: evi-
dence for a Dew acquired cellular immunodeficiency N Engt J Med 1981;
tion in 1981, 15.17 has evolved into the most devastating
305:1425-31.
disease of the adult immune system ever described.
16. Masur H. Michelis MA, Greene JB. of al. Aa outbreak of community-
On the other hand, we recognize that the revulution in
acquired Pneumocysis curimi pneumonis: initial manifestation of cellular
immune dystunction. N Engl 1 Med 1981: 305:1431-8.
immunology continues to provide knowledge about
17. Sictal FP, Lopez C. Hummer as. a al. Severe acquired immmode/iciency
the immunopa hogenesis, treatment, and prevention
B male homosexuals manifested by chrune personal ulcerative herpes sim-
piez lesions. N Engl J Med TYUE: 305:1439-44.
of a wide variety of discases and that the remarkable
18. Nossal GIV. The basic components of the immune system. N Engl , Med
progress that has occurred in research on AIDS has
1487. 310:1320-5.
yielded and will continue to yield knowledge that
can be directly extrapolated to other disorders of the
immune system.
It is clear that the revolution in immunology will
continue well into the next century, providing even
SOUNDING BOARD
more exciting findings than have heretofore been
imagined. Every clinician will have to acquire a basic
WHAT IS SAFE SEX?
understanding of the immune system to comprehend
Suggested Standards Linked to Testing for
and apply these findings in the everyday clinical prac-
Human Immunodeficiency Virus
ricc of medicine. To encourage this process, the Journal
is initiating a scries of comprehensive articles, organ-
SEXUALLY transmitted diseases have never been
ized with the collaboration of the NIAID, that at
eliminated as a public health problem. However, the
tempts to provide a logical understanding of selected
lethality of the acquired immunodeficiency syndrome
aspects of the immune system, along with an explana-
(AIDS), a sexually transmitted disease, poses unique
tion of their clinical relevance.
challenges. Voluntary testing of all sexually active
The first article in this series, by Professor Gustav
adults for antibodies against the causative agent, hu-
J.V. Nossal, appears in this issue. is It is a broad intro-
man immunodeficiency virus (HIV, formerly HTLV-
duction to basic concepts of the immune system, and
III/I.AV), in conjunction with counseling and un-
it will be of value to clinicians and scientists alike.
equivocal "standards" for safe sex, is a first step in
Subsequent articles will deal with various specific as
meeting those challenges.
pects of the subject.
No published data exist regarding the influence of
National léstitute of Allergy
testing on the medical, psychological, social, and eco-
ROBERT A. COLDSTEIN, M.D.
and Infectious Diseases
nomic consequences of HIV infection. These are real
Bethesds. MD 20892
ANTHONY S. FAUCI, M.D.
and important concerns. However, I arguc that the
REFERENCES
benefits of widcspread voluntary testing, to seroposi-
tive as well as seronegative persons, may well out-
1. Immunology: its role in disease and health. summary ecport of the task fince
on immunology and disease. Washington, D C.: Government Printing Of-
weigh the potential harms. The argument is based on
Acc, 1977. (DHEW publication no. (NIH) 77-940.)
two assumptions. First, all people want to protect their
1340
THE NEW ENGLAND JOURNAL OF MEDICINE
May 21, 1987
own health, and most are also concerned about their
ple, stresses the need 10 avoid (but not necessarily
sexual partner (or partners) and offspring. Second,
eliminate) anal scx. But even among the highly cdu-
most people desire intercourse in addition to less inti-
cated and motivated collurt of homosexual men whom
mate types of sexual contact. 1 believe that by linking
my colleagues and I have studied in New York City
safe-sex standards to HIV-antibody status (Table 1),
and Washington, D.C., 18 percent continued to
most adults can enjoy the full range of sexual expres-
have anal SCX in 1986 (unpublished data). Much re-
sion without jeopardizing their own health or that of
cent emphasis has been placed on condoms, and there
their loved ones.
is little doubt that meticulous use of condoms can
reduce the transmission of HIV. However, 77 percent
SAFE SEX WITHOUT TESTING OR STANDARDS
of the nich in our studies who practiced anal SCX in
Credit goes to community-based organizations of
1986 did not use condoms (unpublished data). Fur-
homosexual men for the early recognition that AIDS
thermore, it has recently been shown that condoms
was a sexually transmitted disease and for the initi-
fuiled to prevent HIV transmission in 3 of 18 couples,
ation of "safe-sex" educational projects. Although
suggesting that the rate of condom failure with HIV
successful by some measures, these projects have suf-
may be x3 high as 17 percent® (and Fisch! MA: pcr-
fered from several flaws. In particular, because HIV
sonal communication). It is clear that the usc of con-
was not discovered and its biology was not clucidated
doms will not eliminate the risk of transmission and
until 1984-1985,² some earlier guidelines and pam-
must bc viewed as a secondary strategy.
phiets included the erroneous idca that seemingly
healthy sexual parmers were probably safe. Current
SAFE-SEX STANDARDS LINKED TO HIV STATUS
"safer-sex" guidelines for homosexual men are compli-
The HIV epidemic affects highly diverse communi-
cated and lack clarity, stressing eroticism and mutual
ties. Thus, standards for safe sex must not be based on
masturbation for those who are not monogamous and,
any single community or religious ethic but on firm
in any case, stressing avoidance of anal sex, the use of
scientific data or at least on rational speculation from
condoms, and selection of partners according to sex-
such data. As a starting point, standards for safe sex
ual and medical history. Such advice has led to a doc-
should be tailored to the person's IV-infection status
umented decline in anal gonorrhea and has almost
rather than to assumed risk factors, such as scxual
certainly reduced the transmission of IIIV. Unfortu-
orientation (Table 1). HIV status is the single most
nately, genorrhea and HIV are so dilferent that little
important picce of information for use in planning the
comfort can be drawn. Unlike gonorrhea, HIV infec-
scope of onc's sexual activities.
tion cannot be cured, is certain to bc carried fur a long
If both partners are demonstrated to be negative for
time (possibly for life), and is highly likely to cause
HIV antibodies. they can confidently engage in any
death. The risk of transmitting HIV must therefore bc
intimate activities (Table 1), provided that neither
eliminated, since there is no acceptable level for this
partner has outside sexual partners or other risk fac-
risk. "Lower" risk is an inadequate goal and perhaps
lors for HIV, particularly parenteral drug abusc. IIIV
even a vacuous notion.
scroconversion typically occurs within 6 to 12 weeks
"Lower" risk, however, is the most that traditional
after infection. Therefore, if regular testing for HIV
safe-sex counseling, exhortations, and written hand-
shows that both members of a monogamous couple
outs have achieved. Every communication, for exam-
remain negative for at least six months after the
elimination of outside risks or part-
Table 1. Application of HIV-Antibody Status to Proposed Standards for Safe Sex.
ners, full sexual activity can prob-
ably be resumed without precau-
PROPOSED Sare Bex
tions under the proposed safe-sex
HTV STATUS of
(RMK-NUMENATION)
SUBMITY-PASTMER PAIR
STANDARD'
RISK-REDUCTION MEASUREST
standard. Until that time, however,
such couples must bc considered
Negative-megative
Any activities with should
"Absolute" condoms. no anal intercourse.
"IIIV unknown" (see below). If
monogamy and no paren.
and HIV relesting at Insurent intervals
teral drug use
(m least every 6 no)
outside risks or partners cannot
Pusitive-prektive
No HIV-ncgative or IIIV.
Consums and avoidance of partners
bc climinated, then at least "risk-
unknown partners; effec-
with accurdary infections
reduction" measures should be tak-
tive birth control
en (Table 1).
Discordant (positive-
Mutual masrurbation
"Abrotute" condoms and no
When both partners are infected
negative or negative
anal intercourse
positive)
with HIV (positive-positive in Ta-
Unknown* (positive-
Mutual masturbation
Absolute monugamy. "ahsnlute"
blc 1), there is no compelling evi-
unknown. negative-
condoms, and no anal
dence to discourage sexual inter-
unknown. or unknown-
intercure
course of any type. The primary
enknown)
emphasis of education for positive
- is needed to demonstrate safery. More Mringent standards. week as celtury - velf-mesturbation, are
subjects must br. on eliminating
surmed in be reasonably Life. Limit they invoive no exposure of M universal periner w IIIV
There measures pronehly reduce but du not efiminate HIV - for secondary infections IM
sexual contact with HIV-seronega-
pairs). They are suppented only under conditions in whis H proposed safety standards are -- meetained 18.8., non monagemy
tive and HIV-unknown persons
or - nt personnel dog) "Abrolve" condoms indicases VM from viall w finish for oral or vagmed MI. ideally with 2
spermicide that has and HIV activiry.
and using effective birth control
PO punitive-pusitive. negative negaive, or discription with IIIV name of - perfects is known
to prevent HIV infection of babies.
Vol. 316 No. 21
SOUNDING BOARD
1341
In our studies, we have found no clear evidence that
types, those with a high incidence of AIDS and those
behavior modification lowers the risk of AIDS among
with a low prevalence of HIV- -
those who are already infected.' Because of the pos-
Physicians will be drawn into this debate and must
sibility of weak cofactors, however, it is prudent
bc prepared to distinguish risk from no risk and to
to recommend risk reduction through the use of con-
state clearly what sexual activities are safe for the in-
doms and avoidance of partners with sccondary in-
dividual patient. Many physicians have not been
fections.
trained in taking sexual histories or are uncomfortable
A safe-sex standard for couples who are discordant
in doing so. This is obvious to the patient, who is often
(one seropositive and one seronegative) must be very
too embarrassed to raise sexual questions, even with a
stringent, with sexual activity limited to mutual mas-
synecologist. However, the patient may be very wor-
turbation. Fortunately, discordant couples are rela-
ried about AIDS and in any case is likely to appreciate
lively uncommon. Discordant married couples who
the physician who raises questions about sexual prac-
will not adhere in such a stringent standard must be
tices. The physician can begin by asking about marital
advised to use risk-reduction measures including man-
status (as an unthreatening opening), any sexual ac-
datory condom use for all phases of every oral and
tivity, monogamy, contraceptive practice (particular-
vaginal contact (i.c., fellatio or coitus) and exclusion
ly the use of condoms), and current HIV status of the
of anal intercourse (Table 1).
patient and his or her sexual partner (or partners).
In the majority of the population, currently of un-
Because comparisons with the community are only
known HIV serologic status, each partner must be
measures of relative risk rather than absolute risk of
considered potentially cither at risk or contagious. On
exposure, the type of sexual activities need not be
the basis of current data, only celibacy and masturba-
quantified, with the important exception of anal inter-
tion can be considered truly safe. With universal vol-
course, which facilitates HIV transmission dramati-
untary testing, however, almost all "HIV-unknown"
cally. Similarly, the number of partners need only be
couples could be recategorized into one of the three
quantified as none, one, or more than one. More than
known groupings, with a far more lenient safe-sex
one is unsafe, but the number is less important than
standard for the majority (Table 1). Unless HIV-un-
the serulogic status of the additional partners. Sex
known subjects are tested and develop mutually faith-
with a prostitute may be riskier than sex with a neigh-
ful monogamous relationships with tested partners of
bor, but if neither has been tested for HIV then nei-
similar HIV status, intercourse, even with condoms,
ther can be considered Truly safe.
will carry some risk of HIV transmission.
SUMMARY
IMPLEMENTING AND TESTING SAFE-SEX STANDARDS
Because of the lethality of the IIIV epidemic, ra-
The safe-sex standards proposed in Table I are
tional and scientifically defined standards of sex that
based on rational speculation from existing data.
preclude the spread of sexually transmitted diseases
Thus, their efficacy must be evaluated prospectively.
are required. In the context of an HIV-antibody test
Even if linkage of HIV test results to individuals
that has been documented to be extremely sensitive
proves too controversial, efficacy can be evaluated
and specific, 10 standards for truly safe sex can be de-
by linking test results to anonymous questionnaires.
fined. IIIV testing can be used as a powerful tool for
Scroconversions among those adhering to the stand-
defining a scries of standards for sexual partners
ard would indicate that the standard was imadequate.
that eliminates, with reasonable certainty, the further
For example, intimate kissing has not been demon-
spread of HIV. Such standards provide a defined
strated in transmit HIV, although the virus is found in
benchmark for future research aimed at evaluating the
low levels in saliva." If seroconversions occur in dis-
effectiveness of public health measures in arresting
cordant couples adhering to the standard, a more
the spread of the virus. The fact that at least 10 million
stringent standard that proscribes inrimate kissing in
American blood donors and some 2 million Americans
discordant couples may be required. Alternatively, it
applying for or in the armed forces have been tested
is also possible that more lenient standards may be-
demonstrates that the adverse consequences of testing
come truly safe as anti-HIV drugs are developed for
can be limited. Now is the lime to minimize the fear
systemic use, vaginal use, or use as condom lubricants.
and climinate the risk of transmitting HIV to loved
Any data purporting to show such ellicacy would have
ones by urging widespread voluntary testing of SCX.
to he scrutinized carefully.
ually active adults and by developing standards for
The purpose of establishing, recommending, and
safe sex.
evaluating safe-sex standards, like that of immuniza-
National Cancer Institute
tion programs, is to enlarge the proportion of the pop-
Bethesda, MI) 20892
JAMES J. GORDERT, M.D.
ulation 21 no risk of disease. Reducing risky SCX, mither
REFERENCES
than eliminating it, is like incompletely immunizing a
population - there is Little benefit 10 the individual or
1. Institute of Medicine. Confronting AIDS: directions for public health. health
care, and research. Washington. D.C.: National Academy Press. 1986:.
the community. Undoubtedly, a campaign urging uni-
150-1.
versal voluntary testing and sexual standards would
2. Mclbye M. The natural history of human T lymphotropic virus-III infection:
the cause of AIDS Br Med 1 1986. 292.5-12.
provoke debate, but this debate would bring "risk
3. Judson FN. Fear of AIDS and generrhocs rates in bomosexual men. Lancel
climination" into the vocabulary of communities of all
1983; 2:159-60.
1342
THE NEW ENGLAND JOURNAL OF MEDICINE
May 21, 1987
4. Goodert U. Barngadharen MO. BIREN RJ. of at. Determinants of PEROVIRUS
consuming large doses of ranjugated equine estrogens without ap-
(HTLV-III) antibody and immunodeficiency conditions is homosexual men.
Lancet 1984: 2:711-6.
parent usseous improvement; this observation reinforces our sugges-
5. Cordent H. Diggar RJ. Wine DM. et al. Decreased helper T lymphocytes in
tion that this form altherapy may not be effective for such women'
men. 1. Sexual contact in high-incidence areas for the acquired
2-Hydroxyestrane, the estradiol metubolite whose production is
syndrome. Am 1 Epidemint 1985: 121.629-34.
grently increased in smokers, does not have estrogenic activity, but
6 Idem. Decreased helper T lymplexymes is homorexual men. 11. Sexual
is has substantial affinity for estrogen-binding sites.' our liftle that of
practices. Am , Epidemici 1985: 121:637-44.
or extriol and enough to anticipate antagonism to their -
7. Gooden 11, Biggar RJ. Melbye M. at al. Effect of T4 count and cofactors on
trogenic effects. On the other hand, in affinity is only 1/50 that of
the incidence of AIDS in homosexual men infected with human Immuno-
estradioi, against which it dues me demonstrate extragen antago.
deficiency virus. JAMA 1987: 257:331-4.
nism. The affinities for human estrogen-binding sites of the
8. Fischi MA. Dickinson CIM. Security GB, Klimes N. Fleteher MA. Parks W.
Evaluation of heterosexual partners, children. and household comacts of
require estrugent in Confirment clinical use are apparently unknown,
adults with AIDS. JAMA 1987: 257:640-4.
hur they may he weak enough to allow for antagonism to their
9. Groupman JP., Salahudrin 57. Surngadharan MO. Ct al. HTLV-III in saliva
estrogenic activity by 2-hydroxyestrone.
of people with AIDS-related complex and healthy homoscival men a risk
The studies of Jensen et al." demonstrate that the administration
for AIDS. Science 1984; 226:447-9.
of estradiol in high conventional doses (4 mg per day) to postment
10. Goodert II. Testing for human immunodeficancy virus. Ana Intern Med
pausal smokers produces plasma levels of both estradiol and estrone
1986: 105-609-10.
that are similar to those of nonsmokers consuming much smaller,
but therapeutically effective, doses or estradiol (1 mg per day). If
smokers do not respond to these plasms levels, additional smoking
Induced mechanisms preventing osreus response must be assumed.
The Journal will be adding a Deputy
Siender stature, as well as cigarette smoking, appears to contrib-
Editor, at lcast half-time, to its in-house
use both in the Induction of carly menopause" and to the develop
staff. Applicants must have an M.D. de-
ment of osteoporosis disease states that are most pronounced
among slender smokers. Lower weighes.10 is also associated with
gree and experience in clinical inves-
increased production of 2-hydroxyestrone. The additive anti-estro-
tigation. Clinical practice in a teaching
genic influences of these two factors are consistent with contribu-
hospital and editorial experience are de-
tions by multiple mechanisms, but the simplicity of explaining their
contributions by is single mechanism is attractive.
sirable. Those interested should write to
HARRY W. DANIELL. M.D.
the Editor (for "personal attention"), at
Redding, CA 96001
2626 Edith Ave.
10 Shattuck St., Boston, MA 02115, en-
closing a curriculum vitae.
1. Michnovier u. Hershcopf RJ. Naganuma H. Bradlow HL. Fishman 1.
Increased 2-hydroxylation of cstradiol as & possible mechanism for the anti-
extrogenic effect of cigarette smoking. N Engl J Med 1986: 313:1305-4.
2. Daniell HW. Ostopurosis of the sicuder smoker: vertebral cumpressive
fractures and loss of metacarpal conex in relation to postmenopeusal ciga-
rette smoking and lack of obesity. Arch Intern Med 1470: 136:298-304.
3. Martucci CP. l'ishmas J. Impact of continuously administered catechol
estmgens on uterine growth and hetainizing hormone secretion. P.ndncrinal-
agy 1979; 105:1288-92.
CORRESPONDENCE
4. Kono 3. Brandon DD. Merriam GR. Luriaux DL. Lipsent MB Metabolic
clearance rate and uterotropic activity of 2-hydroxyestrone in rats. Endocri-
Letters to the Editor are considered for publication (subject
nology 1981: 108:40-3.
to editing and abridgment), provided that they are submitted
, Merriam GR. Kono S. Keiser HR. Loriaux DL. Lipsest MB. Effects of
in duplicate, signed by all authors, typewritten in double spac-
carechol estropen Infusions upon gonadormpia and protectin concentrations
ing, and do not exceed 40 typewritten lines of manuscript
in men. , Clin Endor rinoi Merab 1981. 53:784-9.
text (excluding references). Submission of a letter constitutes
6. Jensen J. Christiansen C. Redbro P Cigarette smoking. serum estrogens.
permission for the Massachusetts Medical Society, its licen-
and bone loss during hormone-replacement therapy early after menopause.
N Engl ) Med 1985: 313:973-5.
sees. and its assignees to use it in the/ournal's various editions
7. Daniell HW Smoking. obesity, and the menopause Lancer 1978. 2:373.
(print, data base. and optical disk) in anthologies, revisions,
8. Willett W. Stampler MJ. Bain C. et al. Cigarette smoking. relative weight.
and any other form or medium. Letters should not duplicate
and menopeuse. Am J Epidaminal 1983: 117:651 M.
similar material being submitted or published elsewhere, and
. Schneider J. Bradkre III.. Strain C. Levin J. Anderson K. Fishman 1.
they should not contain abbreviations. Financial associations
of chesity - extradiol mistabolism decreased formation of NOW
or other possible conflicts of interest should always be dis-
oterrtropic metabulies. J Clie Embucrional Metah 1983; 56:973-R.
closed.
10. Fishman J. Buyar RM. Hellinan L Influence of body weight on estradiol
Letters referring to . recent/eurnal article must be received
metabilism in young women. J Clin Endocrinol Metab 1975: 41:989-91.
within six weeks of the article's publication. We are unable to
provide pre-publication proofs, and unpublished material will
The above letter was referred to the authors of the article in
not be returned to authors unless a stamped, self-addressed
envelope is enclosed.
question, who ulTer the following reply:
To the Editor: The anti-estrogenic effect of tobacco consumption
ANTI-ESTROGENIC EFFECT OF CIGARETTE SMOKING
undoubtedly results from multiple mechanisms. In addition to in-
creased estradiol 2-hydroxylainess and decreased busynthesis,' dis-
To the Editor: Drs. Michnoviez et al. (Nov. 20 issue)' have clearly
cussed previously, Dr. Daniell suggrets that direct estrugen antago-
demonstrated important differences between smokers and more
nism may also have A role in this ellert. 2-Hydroxyestrone itself is
smokers in their metabolism of estradiol. Mechanisms leading to
capable of opposing estradiol in tissue-culture experiments,2 but
the anti-extrogenic effect of smoking may, however, be пијге com.
its very high metabolic clearance rate in vivo' prectudes its function
piez than the authors suggest. Several facture raise the possibility of
as a circulating estrogen antagonist in smokers. Nevertheless, since
a substantial contribution to this anti-estrugenic influence by estem-
2-hydroxylation of estrogens apparently occurs in numerous or.
gen antagonists. which may be either absurbed during tobacco use
guns,' increased formation of 2-hydroxyestrogens in hormone.
or produced endogenously as a result of substances absorbed during
responsive cells may provide the mechanism for local estrogen-
such use.
receptor blockade, even when circulating estradiol is adequate.
If smoking augments the estrugen-deficiency diseases simply by
lowering the concentrations of estragens, this effect should hr easily
JUN MICHNOVICZ. M.D., run.
overridden by the administration of supplemental hormones. We
JACK FISHMAN, PH.D.
continue to see postmenopausal smokers with osteoporosis who are
New York, NY 10021
Rockefeller University