A tribute to C. Everett Koop

Commitment to service, loyalty to science, and passion for public health were the hallmarks of Dr. C. Everett Koop’s career. His death in February, 2013 at the age of 96 is a reminder that one determined person with the courage to look past ideology and on to the greater good can make an enormous difference.

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Dr. C. Everett Koop.

That determination and courage wasn’t what many people expected when Dr. Koop—“Chick” to his friends—was nominated for the position of US Surgeon General by President Ronald Reagan in 1981. The opposition to his appointment from progressives in Congress, women’s rights groups, and a host of health-related organizations was ferocious, largely because of his well-known moral opposition to abortion and his lack of any apparent public health experience.

However, after a bitter confirmation process, Koop began to win his critics over, not only because he had an authority that commanded attention, but also because he spoke truth to power. He said things in public that angered the politicians who had promoted his appointment, he never equivocated, and he didn’t back down. Koop became the nation’s doctor.

The four of us worked with Dr. Koop in different capacities, but to each of us, he was a colleague, mentor, and friend, a man we deeply admired.

Early in his tenure, Koop began to take on the tobacco industry, releasing data-filled report after report demonstrating the health hazards of smoking. He pushed for much stronger warnings on cigarette packs and smokeless tobacco, set goals for “a smoke-free society,” testified in favor of a ban on cigarette advertising, and joined the chorus of voices emphasizing that nicotine is an addictive substance.

It didn’t matter to Koop that free cigarettes were still being distributed at Republican fundraising dinners or that packs bearing the presidential seal were available at the White House. Koop wasn’t concerned about what the industry or its political allies thought. When the time came to consider negotiations with the tobacco companies—stricter regulation in exchange for a release from liability—a lot of us struggled mightily with the wisdom of a settlement. Koop never did: He was not interested in bargaining to make peace with “evildoers.”

Koop brought that same kind of steely eyed clarity to AIDS. The science was what mattered, and when the science told him that latex condoms could prevent the spread of infection, that’s the news he was determined to share. The White House warned Koop not to use certain words to educate the public about HIV—words like “penis” and “vagina”—but he did so anyway. He said over and over that he was the Surgeon General of homosexuals as well as heterosexuals. When Koop was politically pressured to condemn the people who were at highest risk, he said that he was the nation’s doctor, not the nation’s chaplain.

That attitude did not sit well with some in the Reagan Administration who pushed Koop to remove all references to condoms before releasing The Surgeon General’s Report on AIDS. Koop refused to make the changes, and in the end 20 million copies of the report went out across the land.

Koop applied his uncompromising scientific principles to abortion as well. Koop was an evangelical Christian, and he believed that life began at conception. In his opposition to terminating a pregnancy, he was also influenced by his experiences as a surgeon operating on babies born with defects. Koop feared that society would progress too readily from permitting abortion to permitting infanticide and euthanasia.

The White House knew Koop’s views when he was appointed, and probably assumed he would not object to writing a report indicating that abortion was medically harmful to women. However, once again, the ideologues had not fully considered with whom they were reckoning. Koop read the science and recognized that it did not support categorical claims that women were harmed physically or emotionally by abortion. The issue, he said, was moral not medical, and he would not sacrifice his allegiance to the latter to support his personal views on the former.

It took determination to stand firm on those kinds of issues, especially at a time when many policymakers felt free to ignore or distort evidence in service of a cause. Representative Henry Waxman, who had been a vociferous critic of Koop’s appointment but who became a supporter of Koop’s work on tobacco and HIV, later apologized to him privately and publicly. “I was wrong about you,” he said.

As he elevated the once-obscure post of Surgeon General, Koop was able to achieve far more than even the most powerful Cabinet secretary. His relentless courage of conviction overpowered the doubters who once dismissed him as a political neophyte. Koop liked to say that opinion polls showed he was the most trusted person in America, and he learned how to use that to his advantage.

Koop cared passionately about the nation’s health. The American people saw in him a leader who did not waver and they liked that. Years after he left government service, Koop remained a beloved figure. His stature and vaguely Old Testament-like appearance meant that people still recognized him at airports, restaurants, even public restrooms, and they would say, “You were my favorite Surgeon General.” With his usual wry humor, Koop invariably replied, “Can you name another?”

Koop’s journey to prominence began in modest Brooklyn, New York, surroundings, where he was born in 1916. Koop wrote in his autobiography that he could not remember a time when he did not want to become a doctor. Always large for his age, he began masquerading as a medical student at age 14, sneaking into Columbia Presbyterian Medical Center to observe surgery as it was performed. By the time he graduated from Dartmouth College, Koop had already worked with one doctor willing to let him perform autopsies and another who guided him through a leg amputation.

Koop earned his medical degree at Cornell Medical College and completed his residency at the University of Pennsylvania Hospital. Almost immediately afterward he was offered a job as surgeon-in-chief at Children’s Hospital in Philadelphia and remained there until the White House came calling 35 years later.

While at Children’s Hospital, Koop earned a reputation as a groundbreaking pediatric surgeon and a powerhouse in the medical community. He was also a great teacher, as eminent cancer pioneer Judah Folkman and the many others who trained with him could testify. Koop invented new surgical techniques to correct birth defects in infants, transforming the field as he dedicated himself to saving children who had once been considered beyond help.

Koop married his college sweetheart, Betty Flanagan, in 1938 and the couple remained together until her death almost 70 years later, in 2007. They raised four children, celebrated the births of eight grandchildren, and endured the excruciating loss of a son, David, in a mountain climbing accident when he was 19. Koop remarried in 2010 and is survived by his wife, Cora Hogue.

C. Everett Koop was blunt and unsentimental, a tireless public servant who lived fearlessly for what he believed was right. All of us owe him a debt of gratitude for his very tangible accomplishments in advancing the public health. Perhaps more importantly, we owe him a renewed commitment to build policy on a foundation of scientific evidence.