Remembering C. Everett Koop, America’s doctor

Former Surgeon General C. Everett Koop, often called “America’s Doctor,” is perhaps best recalled for his response to the AIDS epidemic.

In 1985, my last year of medical school, the United States was confronted with 16,000 cases of a new disease that was considered uniformly fatal. Moreover, we had no effective treatments, since the “cocktails” of anti-retroviral drugs were still a decade away from being clinically available.

In 1986, Dr. Koop released the Surgeon General’s report on Acquired Immune Deficiency Syndrome, a document that shifted emphasis from victims of the disease to prevention strategies. By frankly addressing modes of transmission, condom use and sexual education, Dr. Koop alienated some conservatives. His gruff response was to point out that, as Surgeon General, he was entrusted with saving lives, rather than with pleasing any particular constituency.

Dr. Koop focused on various key issues during his tenure as Surgeon General, often related to disease prevention. For example, he likened cigarette smoking to heroin or cocaine addiction and advocated smoking cessation in strong terms. His 1986 report on the dangers of second-hand cigarette smoke was a clarion call, paving the way to the smoke-free public venues, which we now expect in our country.

Indeed, by using the bully pulpit of his office to call for a smoke-free society, he oversaw a decline in national smoking rates from 38 to 27 percent in the 1980s, saving countless lives. Dr. Koop also addressed quality-of-life issues, such as hearing loss prevention and treatment.

Although Dr. Koop’s medical advice was often blunt and tough, it never struck me as a scold. For example, his obituaries remind us that he admitted to being a former pipe-smoker, and would admit to this personal health-related foible when discussing smoking as an addiction. I recently was asked if I believed “blame” was a good approach to educating patients about lack of exercise. I do not favor the blame game as a clinical tool. Education, as Dr. Koop demonstrated, is far more effective in changing human behavior. Unfortunately, hectoring is common in today’s public health campaigns. I was particularly struck by this in the case of New York City’s recent efforts to outlaw purchases of large sodas. The public response was a combination of anger and dismay. I cannot imagine Dr. Koop, speaking always with calm gravitas, evoking a similar response.

Prior to entering public life in his seventh decade, Dr. Koop attended the Perelman School of Medicine at the University of Pennsylvania, and served for three decades as Surgeon-in-Chief at the Children’s Hospital of Philadelphia. Koop pioneered surgical advances, such as repairing congenital esophageal atresia by interposing intestinal grafts. Dr. Koop repaired an estimated 17,000 childhood hernias, and led teams that separated several dozen conjoined twins. Dr. Koop authored more than 200 articles, numerous books, and served as founding editor of the Journal of Pediatric Surgery.

While spear-heading the academic development of neonatal intensive care units, he trained a generation of academic physicians who now head medical school departments worldwide.

After senate confirmation in 1981, Dr. Koop put on the Surgeon General’s uniform in 1982, cutting a striking figure with his signature Lincoln-style beard and vice admiral’s uniform. Upon retiring as America’s chief doctor in 1989, Dr. Koop continued his mission of public education and service.

He earned an Emmy for a television series on the subject of health care reform in 1991, was honored with the Albert Schweitzer Prize for Humanitarianism in 1991 and the Medal of Freedom in 1995. Dr. Koop is the only Surgeon General whose name is instantly recognized by millions. His legacy lives on in the C. Everett Koop Institute, which fosters public health education.

Scott Anderson, M.D., Ph.D. (stamdphd@comcast.net) is clinical professor of medicine, division of rheumatology, UC Davis. This column is informational, and does not constitute medical advice.