Koop, Charles Everett

KOOP, CHARLES EVERETT

Dr. Charles Everett Koop, surgeon general under President ronald reagan, boldly led the United States on controversial health issues such as smoking, abortion, infanticide, and acquired immune deficiency syndrome (AIDS). Koop was a driven, dedicated public servant, committed to doing what he felt was best for the health of the American people. He aggressively confronted pressing health issues while dodging Washington, D.C.'s, political machinery. During his eight-year tenure, Koop increased the influence and authority of his post with the public health service. With a passion for medicine and a sincere interest in promoting the public's health, Koop was affectionately regarded as "America's family doctor."

Koop was born October 14, 1916, in Brooklyn, the only surviving child of John Everett Koop and Helen Apel Koop. As a young pupil, he excelled academically and socially, participating in football, baseball, basketball, and wrestling. One month before his 17th birthday, Koop entered Dartmouth College. The Dartmouth coaches quickly recognized Koop's talent at football and awarded him the coveted position of quarterback. However, after a severe concussion damaged his vision and threatened the surgical career that he had envisioned as a young man, Koop quit the team. He immersed himself in pre-med studies, majoring in zoology. Having lost his football scholarship, Koop took a series of odd jobs to finance his way through college.

"I think it ironic that at a time when socialist regimes are collapsing all around the world and American disenchantment with politics and government seems at an all-time high, so many Americans clamor for the government to take over the health-care mess."
—C. Everett Koop

Koop entered medical school at Cornell University in the fall of 1937. In 1938, he married Elizabeth ("Betty") Flanagan, with whom he eventually raised four children. When the United States entered world war ii, and many physicians were called to duty, Koop performed many surgeries that, under normal circumstances, would have been assigned to more senior physicians.

For his next phase of training, Koop and his family moved to Philadelphia. There, he took an internship at Pennsylvania Hospital, followed by a residency at University of Pennsylvania Hospital. After residency, in 1946, Koop became surgeon-in-chief of Children's Hospital of Philadelphia. He was 29 years old.

During his 32 years at Children's Hospital, Koop helped establish pediatric surgery as a medical specialty. At the time he took the job, many surgeons were reluctant to operate on infants and small children because of the risks associated with sedating them. Koop devised anesthetic techniques for his young patients and worked tirelessly to perfect surgical procedures and post-operative care for children. Along with being a skilled surgeon, he was a compassionate doctor. He was sensitive to the parents of sick and dying children, and helped to create support groups to meet their needs.

Koop's work with pre-term and malformed babies at Children's Hospital influenced his strong positions against abortion, infanticide, and euthanasia. While at Children's Hospital, Koop wrote The Right to Live, the Right to Die (1980), a best-seller that outlined the relationship among those three practices. He quickly became a spokesman on these issues and committed a great deal of his time to trying to rouse the American conscience. Later, after he was nominated to be surgeon general, Koop was surprised to learn that his Republican supporters valued him more for his stance against abortion than for his impressive medical career.

In 1980, with retirement just one year away, Koop was asked whether he would consider the surgeon general's post in Reagan's new administration. The surgeon general is an officer in the United States Public Health Service Commissioned Corps, a uniformed, mobile health unit. Under the leadership of the secretary of health and human services, the surgeon general administers health policies and supervises personnel in the field. During his time in office, Koop broadened the surgeon general's role from low-profile administrator to high-profile leader.

Koop's surgeon general's reports and frequent testimony influenced the passage of numerous health-related mandates. He became a household name as he gently, yet firmly, informed the American public about the most preventable threats to their health. Regardless of the political consequences, Koop believed that he was obligated to provide accurate information to the public.

Koop launched an antismoking campaign with the 1982 Surgeon General's Report on Smoking and Health. In that document, he clearly stated the relationship between cancer deaths and smoking. In the years that followed, Koop produced reports that linked smoking to cardiovascular disease and to chronic obstructive lung disease.

In an antitobacco campaign, Koop targeted smokeless tobacco products, such as chewing tobacco and snuff, citing their connections to various cancers. His actions spurred the passage of the Comprehensive Smokeless Tobacco Health Education Act of 1986, 15 U.S.C.A. §§ 4401 et seq., a mandate to educate the public

about this health threat. At Koop's urging, Congress legislated warning labels for smokeless tobacco products.

Koop examined the effects of smoking on nonsmokers in his 1986 report Health Consequences of Passive Smoking. Legislators across the nation responded to his report by creating laws to restrict smoking and to reduce the risk of passive smoking to nonsmokers. By 1987, smoking was banned in all federal buildings, and regulated in restaurants, hospitals, and other public places in over 40 states. In 1988, Koop commissioned studies on smoke in airplanes. Congress reacted to the results of these studies by banning smoking on all flights lasting less than six hours.

Koop publicized the addictive nature of tobacco in his 1988 surgeon general's report. This report forced tobacco officials to agree to more specific surgeon general's labels on cigarettes. However, Koop lost the fight for labels that would have identified nicotine as an addictive substance.

Although Koop was known for his antiabortion stance, he did little on this issue during his time as surgeon general. He viewed abortion as a moral issue, not a political one, and he strongly disagreed with those who wanted to ban contraceptives and abortion. In response to Koop's position on contraception and sex education, many conservatives who at first had supported him turned against him.

Koop faced a dilemma when President Reagan asked him to study the psychological effects of abortion on women. In Koop's opinion, it was a poor strategy to quibble about the effects of abortion on the mother when the effects on the fetus were conclusive. In addition, because both sides of the abortion controversy produced biased studies, the available research was useless. In the end, Koop could not gather evidence to assert conclusively or to refute damaging psychological effects of abortion on the mother. He never completed the report.

In 1982, the Baby Doe case alarmed the nation. Baby Doe was born with Down's syndrome, which results in mental retardation and other physical problems, as well esophageal atresia, an obstruction in the food passageway. The Down's syndrome was not correctable but was compatible with life; the esophageal atresia was incompatible with life but was correctable. On the advice of their obstetrician, the parents chose to forgo treatment, and the baby died.

Koop believed that the child was denied treatment because he was retarded, not because the surgery was risky. Koop himself had performed this kind of surgery successfully many times. Judging this to be a case of child abuse and infanticide, Koop commented publicly that it is imperative to choose life, even when the quality of that life is not perfect.

In 1983, the nation grappled with similar difficult circumstances surrounding the Baby Jane Doe case. Baby Jane Doe was born with spina bifida (a defect in the lower back), an abnormally small head, and hydroencephaly (a condition that causes fluid to collect in the brain). At issue was the baby's right to medical treatment to increase her quality of life, despite her physical handicaps. Koop believed that without medical treatment, Baby Jane Doe's spine would become infected, that the infection would spread to her brain, and that she would become severely retarded. He therefore advocated medical treatment for that condition.

Koop's efforts to educate Congress and the public about the medical injustices affecting handicapped children led to the Baby Doe Amendment (42 U.S.C.A. §§ 5101, 5102, 5103). On October 9, 1984, the amendment extended the laws defining child abuse to include the withholding of fluids, food, and medically indicated treatment from disabled children.

While in office, Koop became embroiled in the politics of educating the public about a growing health threat, AIDS. The Reagan administration prohibited Koop from speaking on the topic for nearly five years. This constraint distressed Koop, who believed that it was the surgeon general's duty to inform the public about all health issues. Despite the Reagan administration's silence on the issue, on October 22, 1986, Koop released The Surgeon General's Report on Acquired Immune Deficiency Syndrome. In it, he clearly stated the facts about the transmission of the disease and identified preventive measures and high-risk behaviors.

Koop was adamant that all U.S. citizens obtain the information that they needed in order to stop the spread of AIDS. In May 1988, he sent the mailer Understanding AIDS: A Message from the Surgeon General to every household in the United States.

When AIDS first attracted attention, it was labeled a homosexual disease because it was transmitted predominantly through sexual contact among gay males. Koop lost the support of staunch conservatives because he refused to use his position to publicly condemn homosexual behavior. Koop's focus was to educate and to save lives. Although he advocated abstinence as the best method for preventing the transmission of AIDS, he also urged the use of condoms by those who continued to engage in risky sexual behavior. Koop spoke against proposals such as mandatory testing and the detention of HIV-positive homosexuals. He challenged those who opposed the use of tax dollars to fund AIDS research. His reasoned approach to the AIDS epidemic helped to calm the hysteria of the public.

Shortly after george h.w. bush became president, Koop expressed interest in the position of secretary of Health and Human Services. Bush chose Dr. Louis W. Sullivan for that job.

Koop resigned from his position as surgeon general at the end of his second term. He wanted new challenges and looked forward to educating the public without the interference of Washington politics. Ironically, Koop's popularity had undergone a complete reversal during his term in office office: Koop had entered his post on the shoulders of conservative Christians, and he was leaving it as a hero of the liberal press and public.

Even in retirement, Koop continues to fulfill his role as public-health educator. He established the Koop Foundation, and the C. Everett Koop Institute at Dartmouth. The Koop Foundation is a private, nonprofit organization dedicated to fitness, education, and research initiatives to promote the health of U.S. citizens. The Koop Institute actively works for reform in medical education and the delivery of medical care. To that end, the institute provides a health-information network to help doctors address challenging medical cases. Still writing, speaking, and consulting on health issues, the diligent Koop continues to champion the cause of better and more accessible health care.

Koop has received numerous awards for his many lifetime achievements. In 1995, President bill clinton awarded Koop the Presidential Medal of Freedom, the nation's highest civilian award.

further readings

Koop, C. Everett. 2002. Critical Issues in Global Health Care. San Francisco: Jossey-Bass.

——. 1991. Koop: The Memoirs of America's Family Doctor. New York: Random House.

The Koop Institute site. Available online at <www.dartmouth.edu/dms/koop> (accessed November 21, 2003).

cross-references

Acquired Immune Deficiency Syndrome; Health Care Law; Surgeon General; Tobacco.