February 25, 2013

C. Everett Koop, ex-surgeon general, dies at 96

Koop raised the profile of the surgeon general by railing against smoking and endorsing condoms and sex education.

The Associated Press

With his long silver beard and uniform with braided trim, former Surgeon General C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.

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In this May 12, 1997, file photo, former Surgeon General Dr. C. Everett Koop discusses the proposed increase of the New Hampshire cigarette tax at the governor's office in the Statehouse in Concord, N.H. Koop, who raised the profile of the surgeon general by riveting America's attention on the then-emerging disease known as AIDS and by railing against smoking, died Monday, Feb. 25, 2013, at age 96. (AP Photo/Andrew Sullivan, File)

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In this Sept. 19, 1974 file photo, Dr. C. Everett Koop, surgeon-in-chief at Children's Hospital in Philadelphia, talks about surgery that separated 13-month-old conjoined twins, Clara and Alta Rodriguez, at the hospital. Koop, who went on to serve as U.S. surgeon general, raised the profile of the office by riveting America's attention on the then-emerging disease known as AIDS and by railing against smoking. Koop died Monday, Feb. 25, 2013, in Hanover, N.H. He was 96. (AP Photo/William G. Ingram, File)

Highlights of C. Everett Koop's career:

—Koop helped pioneer the field of pediatric surgery in the late 1940s, a time when medicine didn't recognize that children weren't just miniature adults but required special procedures. He established the nation's first intensive care unit for newborns undergoing surgery, and in 1977 he gained international attention for separating conjoined twins.

—Koop became surgeon general in 1981, the same year that the first cases of what would become known as AIDS were discovered.

—In 1984, Koop launched a campaign to make America smoke-free by the year 2000. He stressed the dangers of second-hand smoke. A former pipe smoker, he said cigarettes were as addictive as heroin and cocaine.

"Cigarettes are the most important individual health risk in this country, responsible for more premature deaths and disability than any other known agent," Koop said.

—The conservative Reagan administration was reluctant to address AIDS, and Koop was kept silent on the issue during his first few years in office. But Koop lived on the NIH campus at the time and would stop in Fauci's office on the way home, to ask about the latest science on what he recognized as a rapidly growing threat, Fauci recalled Monday.

"We did that for weeks and weeks until he was conversant enough in it where he said, 'We have got to do something about it. We are too silent. The government is too silent,'" Fauci said.

In 1986, asked by President Ronald Reagan to prepare a report on AIDS, Koop issued the first explicit federal advice on how Americans could protect themselves. He urged the use of condoms for safe sex and advocated sex education as early as third grade, a discussion surprisingly frank for the time.

—In 1988, after some maneuvering around his reluctant bosses, Koop went a step further and sent an educational AIDS pamphlet with that same plain-spoken information to more than 100 million U.S. households.

"He really changed the national conversation," said Chris Collins of amFAR, the Foundation for AIDS Research.

A biography posted online by the National Library of Medicine says that Koop's "report, speeches and television appearances did much to change the public debate on AIDS in the United States and, along with it, attitudes toward public discussion of sexuality."

—Koop resigned as surgeon general in 1989, but continued to lecture widely on a range of public health issues for the next two decades.

In a 2010 speech, he called AIDS the "forgotten epidemic," and urged Americans to end complacency that he called "as dangerous as the irrational fear in the early days of the AIDS controversy."

-- The Associated Press


His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.

Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.

Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.

An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.

Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."

A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.

"A lot of people don't realize what an important role he played in the beginning of the AIDS epidemic. At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," said Chris Collins, a vice president of amFAR, the Foundation for AIDS Research.

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.

In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.

(Continued on page 2)

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