The V.D. epidemic; Eradication by 1972

The following program was produced by a group W of the Westinghouse Broadcasting Company and is distributed to educational stations by the national educational radio network. Here is William Schwarz of the United States Public Health Service. One case of smallpox went through New York City a couple years ago. On his way to Canada and fact it was a it was only a tentative diagnosis of smallpox but the following day 6000 people were vaccinated for smallpox in Grand Central Station. Yet we've never seen quite that much excitement over the largest reservoir of infectious syphilis in the United States which is in the same area and here is Dr. Leslie neurons of the venereal disease research laboratory. We could go through many diseases and discuss them. As to why it is that some diseases which occur in minute numbers of people attract they have there are more people working on the disease and research that patients who get the disease. Yet here are syphilis and gonorrhea weighing in very heavily on a scale with a

million and a half cases of gonorrhea hundred a thousand or more cases of syphilis and a very tiny number of investigators. Their boss Dr. William Brown chief of the United States Public Health Service has been areal disease branch adds This is one of our surgeons general I said I feeling that. Nice people don't get selfless. Nice people don't talk about it and nice people don't do anything about it. It is tolerated and until we can make it and intolerable to say I'm afraid this ad will remain with us. What this adds up to is that although one of our young people is being afflicted with infectious VD every minute of every day and an estimated one thousand people a month are dying from syphilis. We are not doing what must be done to eliminate this epidemic and save lives. It is for this reason and not to be sensational that group w Westinghouse Broadcasting Company

is bringing you the series of reports on VD venereal disease in cooperation with the Columbia University School of Public Health and administrative medicine and with the American Social Health Association. Your reporter Walter McGraw been areal disease all myths to the contrary can be contracted by all but the unborn. Only by skin to skin contact it can come from kissing. Usually it's acquired during sexual intercourse either heterosexual or homosexual. There are two main venereal diseases Gana Rio's the more prevalent syphilis the more crippling and deadly if not treated. Dr. Brown points out some other differences. We do not have the to control gonorrhea. Yet we do have the control and to eliminate Cephalus we have a good diagnostic test probably as good a diagnostic test as it is for any disease.

And then we have a good system of case finding by interviewing and following up cases and bringing them in to examination. And treatment if indicated. Now this is true that we can apply the same type of case finding in gonorrhea yet the incubation period in gonorrhea is so short that it does not give adequate time to bring in the people and before they have developed the signs and symptoms and spread the disease. Many of the persons but the incubation period in surplus is such that there is adequate time to bring them in and have them examined and treated before there is a great amount of spray out of a daisy. However in the 1950s gonorrhea like syphilis was thought to be virtually eliminated as the result of penicillin. But then again like syphilis the number of infectious cases began to grow of this resurgence.

Dr. Norman said it taught the lesson that a disease which is on the downward trend cannot be at that point and ignored and written off that vigilance must be maintained that research funds must be kept up because it only takes a feeling of complacency a feeling that antibiotics have solved it all. To lay the groundwork for a future resurgence of the disease which we then saw in syphilis. Which also happened in staphylococcus infections when I was assume that penicillin would solve everything. We've now got penicillin resistant staph we're now getting penicillin resistant gonorrhea and overall people just relaxed about venereal disease and research funds were cut along with all other funds at the very time when the newer tools were emerging. So our job now is to make up for lost time. We've got to hurry and apply the newer tools of the last five or 10 years to have a vaccine for gonorrhea. It may not be really a lifetime vaccine if it were effective for only two years. It would be a very great help in tracking down the spread of gonorrhea.

Many patients with gonorrhea are seen to come into the clinics over and over again. Apparently the natural infection with gonorrhea does not trigger a long lasting immunity and therefore a vaccine might keep these repeaters from coming back all the time and therefore would give time for public health doctors to track down the spread of the thing that is to keep it from ping ponging back and forth as it now does we treat one person by then this person gets it again from someone else who caught it in the meantime. The vaccine would buy us a year or two of time. We are told that only a vaccine can lead to the eradication of gonorrhea and the research funds for VD are much too small to produce such a vaccine in the near future. But there is some good news in this area. We are coming into an attack on gonorrhea with some new tools that we have hopes that within a year or so we shall have a workable mass producible model of a blood test for gonorrhea.

This could make contact tracing of sex partners of those infected with gunna Riya a more valuable tool as it is with syphilis and syphilis we're told can be eradicated by 1972. Again Dr. Brown Congress said to us in the Public Health Service that they expected the public health service to come up with a program of action directed towards the elimination of syphilis because it was a disease which they felt could be eliminated. Certainly the public health problem in this nation. So in the latter part of 1962. The surgeon general appointed a task force this task force made a report to the surgeon general. Outlining a program which they felt if carried out and supported by funds from the Congress should only emanate Cephalus from the United States by the end of a 10 year period at the rate we're going we'll be eradicated when in 1972 five years from now is still time to

achieve this. I'm a little hesitant to use the term eradication because I honestly don't think that we will eradicate syphilis and gonorrhea anymore than we will eradicate some of the other diseases that are difficult to control. I would say that I think that certain things can be done which will make it possible by 972 to bring. Both syphilis and gonorrhea under control to such an extent that it will not be the great problem it is today. But does the consultant of the series of reports on the deed. I'm Dr. Herman Hello Bo and I am a professor of public health practice of the Columbia School of Public Health and administrative Medicine in New York City. With the advent of the pill called new morality you think that it bodes that we will see more problems. I think unless we do more than we're doing at the present time that it is highly probable that we will see more of the problem. But I don't think this is inevitable. I think we simply have to

step up our campaign proportionate to the factors that you mentioned. And if we're willing to invest a sufficient additional amount of money to what we're investing now. I see no reason why we can't go ahead and reduce the prevalence of both syphilis and gonorrhea without any question whatsoever we know what to do. We know how to do it it's a question. Getting the kind of plan accepted and getting the support that's necessary in getting our health agencies both official and voluntary to accept this as one of its primary community responsibilities because that's what it is. One factor that has an inhibitor to fight against BD is the attitude that it's a sort of punishment that fear of the D is needed to control people's activities. But it is pointed out this has never worked as the rising BD statistics show and says Dr Brown a level of sex activity won't cause an aerial AC only of the present.

They are going to cause gonorrhea or surplus because of an aerial essays. There must be an infected individual to transmit that disease to the non infected individual and that is the reason that we try to divorce an area of disease and sex RMR oath. By introducing this education into SKU introduce it into health classes a biology or history or anywhere. But let it be taught as a communicable disease and let the young person be taught the signs and symptoms and high screens Maybe if they have exposed that they should seek medical attention just as much as they would seek medical attention for any other communicable disease. Again Doctor I think the basic difficulty. In education in the schools is something bigger than education. A few years ago a very fine study group called the school health education study

begin to question school children find out what do these young people know about health and how do they feel about health and particularly about their own health and how they took care of themselves. Well the results of these studies have been really rather startling. We really do not have a good health education program in very many of our schools about the country either in elementary or in the secondary grades. And so the problem is not one primarily of the education or of sex education. But it's one of having a poor health educational system throughout our country. Now if we have a good school health education system if we have good teachers enough time in the curriculum if we have the right kind of material and teaching methods there's no reason at all why we can't bring venereal disease education and sex education into a good program of school health education. It may be that some of the teaching will be done in classes on biology others will be done in certain special

classes for health and any conceivable way we can do this will be fine. I would not like to see particular attention given to a class on venereal disease or a class on sex education I would like to see this a part of an improved health education program and doing it this way. Venereal disease will take its appropriate part as a part of the educational curriculum for health in the schools. What about it Bill. When we talk about education for adults I'm a little bit. Depressed and I can't put it any other way because that's actually what it is because it's very hard to change the habits of adults. Perhaps the one thing that can be done here is to give knowledge of what venereal disease is and what effect it has on the body and how it spread. And hope that among some of the adults to whom this information is given there will be a certain feeling of motivation to at least avoid having the ill effects of an air of disease. There will be

some effort when exposed to do something about it. And in many people I'm quite confident that there will be a desire to avoid spreading the disease to others. But I think here are our results are going to be limited in scope and we really here have to come into the area of what we call prevention of progression and we'll have to try and pick up these individuals after they've had disease get them under care as quickly as possible and then do follow up work we can do as well. I'm sure in such a program we can among children. Dr. Brown would like to see more expensive use of another tool for the Prevention of progression. One he feels is important since we yet have no blood test for gonorrhea and sends our blood test for syphilis does not work in the very early stages of infection. A very important part is preventive treatment. If we can get the medical profession to treat every individual who has been exposed to an infectious case of self-less immediately as a preventive measure

even though they are Syrah logically and physically clinically negative at the time of examination this will stop the spread of the disease. And on the subject of the medical profession Dr. Hill opposes this. We have to keep on trying to improve the cooperation with doctors to get them report cases this is really the beginning bottleneck and the whole program. Because unless we have reporting of. I would say at least 80 percent of the new cases that come into physicians offices are going to have great difficulty doing a contact examination. And it's perfectly possible that we can improve the amount of reporting by physicians by working through medical societies by the usual mass media that we use in the medical profession. But to me the critical issue here. Is it. We certainly are going to have more comprehensive health services by 1972. This may seem a short time but if we look over what has happened in the last few

years in medical care particularly the federal legislation in the field of care for the older people and also in the care of people on public assistance we can see that inevitably there will be more comprehensive care for individuals and so I think in the development of comprehensive medical care for a large number of our citizens we will have these individuals reaching public agencies voluntary health agencies whenever they start to work with a need to know more about them and about their health and this certainly would include a blood test. And even in the area of school children. I would say for example that there should be no reason by 1972 that we don't have blood tests on every child and I would say that we should be concerned here any time from 12 years of age on this may be a little disturbing to some of the parents and some of the school people at this time. But it's inevitable that we're going to have to improve the health of our school children to give them a

good start in life. And if we're going to improve it we've got to be comprehensive in the care we give them so to me a key in improving our reporting and getting our cooperation from the doctors in the development of a comprehensive health system for the whole United States. But as of no blood testing for syphilis was sporadic at best. Few doctors and even fewer hospitals give such tests as a regular part of their routine. Dr. Brown a stepped up sere logic testing program a blood testing program I feel could be accomplished to a great extent by requiring a routine serial testing for syphilis. On every individual who is admitted to the hospital. And in addition. A syrah logic test for syphilis on all our patients. This would probably bring us 90 million serialized you test a year. This is getting close to half of our population. Granted that there

would be some repeat test it would get to a tremendous number of individuals. Now one might ask me. Does the right age group and the segment of the population get into hospitals or into our patient clinics. I would have to say probably a large segment of the sexually active population might not get into them. But every case that is picked up through the hospital and application. Testing will lead to many of these individuals. Because when proper interviewing is they name persons who have been sexually exposed and it brings us back to that. Group that may not actually have been in there themselves but through this case finding method we find them eventually finding is another area that needs to be stepped up. Dr. Hill about the case tracing is something that cannot be left to chance.

Or in all honesty to the busy physician taking care of his patients when we stop to think that a busy physician may be seeing 20 or 30 or 40 patients in a single day in his office one asked the question of when is he got time to have the long interviews to go to the places where the contacts are likely to be found. How can he work nights and how can he work weekends. I think we have to be very frank about admitting that. Also that this really shouldn't take the time of a physician who is highly trained for diagnosis and treatment. We don't need a doctor we don't need a nurse we don't need a social worker to do contact examination. I think we can say that as far as contact tracing is concerned. This is something that the official health agencies can do for the physician to help him improve his practice of medicine to relieve him of responsibilities he doesn't have time to carry out anyway. And frankly this is the sort of thing that these people not

only do better but that the physician would like to have someone else do. This is quite necessary because not always would it be possible for the patient to wish to talk the visitation and not always will be possible for the physician to take the time necessary to seek out information he needs. And so I think that the blanketing of an entire area by a sufficient number of vidi investigators to carry on all of the contact examination on all the reported cases from every source in the community not just from the physician. This is the way in which we'll have relatively complete contact examination more about what is needed to eradicate in just a moment. Both the surgeon general and the BD branch have been criticized for not asking Congress for more money. This has been blame for the lack of funds that have been allocated for media control including badly needed research answers Dr. Brown is a program

director who has a responsibility for outlining and promoting a program of control and elimination eradication. We always feel that additional funds can be used profitably. You know I think it is not only the responsibility of the federal government to do this job but it is a responsibility of government at all levels of state and local. And I think that their responsibility should be realized and that they too should provide additional funds to attain this objective. If we stop to think what it costs the taxpayer today to take care of those individuals who are confined to a mental hospital because of insanity due to selfless. A few additional millions for control and eradication would be well spent. Boy it is costing the taxpayer fifty million dollars every year to care for the syphilitic insane and in addition to this

there is another cost to the taxpayer of about six million dollars to take care of the individuals who are blinded because of selfless over all the estimated cost of our case finding failures to the taxpayer is close to 100 million dollars a year ten times what the federal government spends on fighting this growing epidemic. Are we spending what needs to be spent. Dr. Hill No I think we need much more money than this to do the job. I don't think there's any question but what we need to get into a great increase in the number of blood tests are going to be done this costs money. The amount of money that's being spent is largely for routine operations that are going on in the large cities we're going to have to increase by many numbers the so-called detectives who are seeking out the cases who are going to have to get into more costly record keeping. And we're going to have to get into one thing that does cost money and that's

health education. We're going to use the mass media and if we're going to use the latest methods for teaching. Information about the neural disease in the schools and do it on the scale or it will be of a high quality similar to the teaching of mathematics or the teaching of languages or the teaching of history for example. This is going to be expensive and so I am sure that it will be many many times more than 10 million dollars it will be needed. Why don't you think we're getting that money. People I have a feeling and some of our authorities as well that venereal disease isn't too important any more we've got penicillin so it's just a question of using more penicillin. Well there's a little bit more to it than that so we need the combination of the official health agencies and the voluntary health agencies particularly the American Social Health Association to. Planned a campaign just as it was planned several decades ago. If these two groups working

with the state and local health departments can get enough interest in PDA roused again I think this is the stimulus that would be necessary. Of course. Any help we can get from the various sources of mass media your own radio stations the television stations the newspapers anything we can do to. Get people to talk about syphilis and gonorrhea as a public health problem. Anything we can do from our various sources to get the demand made upon our legislators to give this the attention that it deserves because of its importance. As a social problem as a mental problem as a physical problem. These are the kinds of things that I think have to be done. This series on VD disease has been presented by a group w Westinghouse Broadcasting Company to get people to get you to talk about BD not as something sensational not as something

dirty but in the terms of an epidemic which is causing suffering and costing lives. An epidemic we can but are not eradicating these reports were produced in cooperation with Columbia University School of Public Health and administrative medicine and with the American Social Health Association Dr. Herman Miller both was a consultant for the series. Bill kale an executive producer. Your reporter Walter McGraw. This is the national educational radio network.