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

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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


He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop further angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

Koop maintained his personal opposition to abortion, however. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day, but Reagan would not interfere.

Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was born in the New York City borough of Brooklyn, the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats.

He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

Koop received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it.

In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children — Allen, Norman, David and Elizabeth. David, their youngest son, was killed in a mountain climbing accident when he was 20.

Koop was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine.

He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was by far the best-known surgeon general, and for decades afterward was still a recognized personality.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."


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