C. Everett Koop (born 1916), one of America's most outspoken surgeons general, served two terms in the 1980s. Koop's appointment angered liberals. However, the conservative Christian doctor later alienated social conservatives by refusing to compromise his common-sense approach to health issues for the sake of politics.
C. Everett Koop
Brooklyn, NY-born Koop graduated from Dartmouth College in 1937 and earned his M.D. degree from Cornell Medical College in 1941. Following an internship, he pursued postgraduate training at the University of Pennsylvania School of Medicine, Boston Children's Hospital, and the Graduate School of Medicine at the University of Pennsylvania, from which he earned a doctor of science degree in medicine in 1947.
Koop became a professor of pediatric surgery at the University of Pennsylvania's School of Medicine in 1959 and professor of pediatrics in 1971. Koop also was surgeon-in-chief of Children's Hospital of Philadelphia from 1948 until he left academia in 1981. At the hospital, Koop gained renown for success in repairing birth defects, including the separation of conjoined twins. He also was editor-in-chief of the Journal of Pediatric Surgery from 1964 to 1976.
Koop was appointed Deputy Assistant Secretary for Health of the U.S. Public Health Service under the Reagan administration in March 1981 and was sworn in as surgeon general November 17, 1981. He held the post for two terms, serving under presidents Ronald Reagan and George Bush, until resigning October 1, 1989. In that time, Koop's willingness to speak out-and speak out boldly-on public health issues earned him much media attention and the enmity of a number of former allies.
Refused to Compromise on Health Matters
Koop saw fit to wear the traditional braided uniform of the surgeon general, a decision some derided, calling him an admiral without any ships. While traveling, the uniform once caused him to be mistaken for an airline crew member. A more significant departure from the style of previous surgeons general was Koop's decision to ignore advice he had been given upon arriving in Washington. That advice was, "Keep your head down and your mouth shut, " he wrote in Koop: The Memoirs of America's Family Doctor. While the uniform confused some, the man wearing it left no doubt where he stood on numerous public health issues.
Koop took on the American tobacco industry, a bountiful source of campaign contributions for a number of congressional Republicans, when he called for a smoke-free society by 2000. Koop also pushed then-president Ronald Reagan to publicly address the AIDS crisis. In addition he weathered a storm of criticism over positions on abortion and contraception many conservatives said were in conflict with Koop's own beliefs. During the course of his tenure he was shunned by conservative former associates and embraced by liberal former detractors.
Koop became a Reagan nominee largely based on his anti-abortion activism. The devout evangelical Koop had delivered his pro-life message through a number of books, films and lectures nationwide. One film shows Koop surveying a sea of naked dolls, intended to symbolize aborted fetuses, and saying, "I am standing on the site of Sodom, the place of evil and death." Liberals challenged Koop's appointment, delaying Congressional confirmation for eight months. Once Koop took office, though, liberals and conservatives each would do a turnabout.
Shortly after becoming the nation's top doctor, Koop began speaking out against tobacco and pressed for legislation to strengthen warning labels on cigarette packs. He later called for smoke-free work environments. As a result, the ten-year period encompassing Koop's tenure is said to have seen the greatest decline in smoking by Americans ever.
Safe Sex Proponent
In an October 1986 report to the president, Koop argued sex education and condoms were the most effective way to combat the AIDS epidemic. In 1987, Koop was the lone administration dissenter from a plan calling for widespread AIDS testing. His rationale was that the prevailing stigma against people with AIDS made mandatory testing unfair and impractical. He argued that compulsory testing would force those potentially infected with AIDS or HIV, the virus that causes AIDS, further away from medical treatment and education that could prevent spread of the disease.
Conservatives found Koop's views on AIDS so unpalatable they attempted to sabotage a Washington testimonial dinner held in his honor in May 1987. Of the dinner's original sponsors, 11 boycotted the event, including then Republican presidential hopefuls Senator Robert Dole and Congressman Jack Kemp. As pickets demanding his ouster marched outside, Koop thanked those in attendance. "There has never been a time in my life when I wanted or appreciated such a show of friendship." According to a 1987 Time magazine report, Koop was discouraged by the loss of conservative supporters. "They don't listen to what I've said, but they criticize me about what somebody told them they think I've said."
One weapon in Koop's anti-AIDS arsenal was information. The surgeon general was responsible for developing an eight-page booklet on the disease and its communicability at a cost of $17 million. Understanding AIDS was mailed to 107 million households in 1988 following a year and a half of debate over what the pamphlet would and would not say. Social conservatives were angered by the pamphlet's content as it included information on condom use. The AIDS prevention effort had two sides: Prevent the spread of the disease, of course, but also prevent the spread of panic over the disease. "Trying to estimate your chances of catching the virus based on the latest magazine article or newspaper story is like playing Russian roulette, " Koop said at the time of the pamphlet's release.
Unexpected Abortion Report
Koop was routinely caught in the crossfire when medicine and politics clashed, as when President Reagan called upon the surgeon general to report on the psychological effects of abortions on women who have them. One might have guessed the outcome of a conservative president asking a conservative, staunchly anti-abortion doctor for such a document. All bets were off, however, when in early 1989 Koop wrote to the president saying data he had gathered were inconclusive; he could not determine whether women who had abortions suffered psychologically. Koop's response to President Reagan did not go unnoticed by either side of the abortion debate.
Writing in the liberal journal New Republic, John B. Judis commented at the time, "The antagonism generated by the report will only reinforce the reversal over the past eight years in Koop's constellation of friends and enemies. The New Right, which once championed him as a bearded Ahab who would slay the white whale of liberalism (and which helped him get his job), now denounces him as an instrument of immorality. Meanwhile, the liberals, feminists, and public health lobbyists who once called him 'Dr. Kook' sing his praises."
A commentator in the conservative National Review suggested that the thinking behind Koop's abortion letter was in conflict with principles underlying his stance on other public health issues. "Koop's tentative tone on [abortion] contrasts sharply with his own strong statements of yore that abortion does harm women, " according to a 1989 article in the magazine. "Nor is he averse to making stern moral, as opposed to merely medical, statements against smoking. On abortion, as on AIDS, he has learned to assume properly enlightened attitudes."
In an interview following delivery of his letter to President Reagan, Koop articulated his frustration with social conservatives and reiterated his philosophy on health policy. "What has given me so much trouble in this job from the right is that I separate ideology, religion and other things from my sworn duty as a health officer in this country."
When Koop resigned as surgeon general, he did not put the abortion debate behind him. Instead, as he did in a 1991 Good Housekeeping magazine article, he lamented the politicization of an issue that came to life as concern for the unborn and the health of women. "I wonder if they have forgotten what originally prompted the debate: the innocent unborn child, the agonized pregnant woman. Many opposed to abortion have been notoriously unhelpful to unwed pregnant women; they must be more forthcoming with their time and money to help pregnant women in hardship. And those who call themselves 'pro-choice' ought to make more of adoption as a clear choice."
Remained in Debate
Although no longer surgeon general, Koop retained a voice in the debate of public health issues during the administration of Democrat Bill Clinton. He did not keep quiet during the Clinton administration's aborted attempt to reform the health care and health insurance industries and lent his support to some Clinton initiatives.
Koop was not immune to controversy even during his early eighties. When President Clinton granted Koop a waiver in 1994 for burial at Arlington National Cemetery, congressional Republicans thought they smelled a conspiracy and suggested Koop was granted the waiver in exchange for his support of health care reform. Precedent did exist for granting a waiver to a surgeon general who had not served in the armed forces. President Reagan had approved an Arlington burial for Dr. Luther Terry, the surgeon general who first publicized the link between smoking and cancer. Koop later declined the waiver. "I do this without rancor and with an understanding of and respect for the special place that burial at Arlington has in the hearts of the American people, " a Koop statement at the time said.
In 1997, Koop co-chaired a task force on tobacco that recommended a hefty increase in the tax on cigarettes to discourage teenagers from smoking. Koop also was an opponent to granting tobacco companies immunity from further liability in conjunction with a government settlement with the industry over the cost of smoking-related illnesses. The prospect of revenue from a tobacco settlement being used to fight cancer and improve public health must have been gratifying to Koop. Indeed, a Koop remark reported by Reuters in 1998 suggested that the former surgeon general saw similarities between tobacco's reversal of fortune and his own during the 1980s. "The public is now fully aware that the tobacco industry has lied to them. This has enraged a number of Americans and has disgusted a number of people in Congress who were for years the best friends of tobacco."
Koop has written more than 200 articles and books on medicine and surgery, biomedical ethics and health policy. He is married to the former Elizabeth Flanagan and has three living children and seven grandchildren.
Further Reading on C. Everett Koop
Bianchi, Anne, C. Everett Koop: The Health of the Nation, Millbrook Press, 1992.
Easterbrook, Greg, Surgeon Koop, W.W. Norton & Company, 1991.
Koop, C. Everett, M.D., Koop: The Memoirs of America's Family Doctor, Random House, 1991.
Koop, C. Everett, The Right to Live: The Right to Die, Life Cycle Books, 1981.
Koop, C. Everett, Whatever Happened to the Human Race, Crossway Books, 1983.
Koop, C. Everett, and Johnson, Timothy, Let's Talk: An Honest Conversation on Critical Issues: Abortion, AIDS, Euthanasia, Health Care, Zondervan, 1992.
Koop, C. Everett; Virgo, John M., editor, Exploring New Vistas in Health Care, International Health Economics, 1985.
Koop, Everett C.; Elizabeth Koop; and Koop, C. Everett, Sometimes Mountains Move, Zondervan, 1995.
Christian Century, January 26, 1994.
Good Housekeeping, September, 1991.
JAMA: The Journal of the American Medical Association, November 24, 1989.
Los Angeles Times, December 23, 1997.
National Review, February 10, 1989.
New Republic, February 1, 1988; January 23, 1989; October 23, 1989.
Playboy, May, 1989.
Time, June 8, 1987.
U.S. News & World Report, May 16, 1988; May 30, 1988.
Heinz Awards, 1995 Recipients, http://www.awards.heinz.org/koop.html (March 6, 1998).