Volume 198 - Issue 9
Everett Koop — from pariah to paragon
Author: Mike Daube
Med J Aust 2013; 198 (9): 469. || doi: 10.5694/mja13.10512
Published online: 20 May 2013
Published online: 20 May 2013
United States Surgeons-General wield very little actual power, but the late “Chick” Koop nevertheless drove surprising progress in public health.
Leading tobacco-control advocate Mike Daube pays his respects to an elder statesman of American public health
If former United States Surgeon General Everett Koop, who died on 25 February at the age of 96, had died in 1981, obituaries would have described him as a distinguished and innovative paediatric surgeon and teacher, widely known for his evangelical Christianity and his leadership in the antiabortion movement that endeared him to many conservatives in the US.
When Republican president Ronald Reagan — who earlier had featured as an actor in cigarette advertisements — nominated him as Surgeon General in 1981, the opposition from Democrats, media and many in the public health community was instant and ferocious. A New York Times editorial headed “Dr Unqualified” claimed that he lacked public health credentials, was too old and conservative, and his appointment would “be an affront both to the public health profession and the public”.1
By the end of his term in 1989, Koop was a public health hero. Surgeons General have little power: they depend for their impact on the role’s prestige, selection of issues, political savvy and communication skills. Koop looked, and spoke, like an Old Testament prophet. A superb and authoritative communicator, he used the standing of his office — and its vice-admiral’s uniform — to arguably greater effect than any Surgeon General before or since.
He is probably best known for his leadership in campaigning against smoking. He released a series of well publicised Surgeon General’s reports, highlighting the evidence on addiction, and declaring unequivocally that passive smoking is a cause of cancer and that children should be protected from it. He led moves to stronger health warnings and smoke-free environments and called for a smoke-free US by 2000. He not only attacked the “immoral” tobacco industry for “exporting death, disease and disability to the Third World”,2 but did so deep in the heart of US tobacco country. His powerful public statements, combining scientific rigour, evangelical rhetoric and a personality the media loved, constantly reminded the public of smoking’s hazards and encouraged tobacco control activists and action globally.
Although personally opposed to abortion, he believed that a Surgeon General must be informed by the evidence. President Reagan sought a report from him on the effects of abortion on women’s health, clearly expecting it to echo Koop’s previously expressed views. To the dismay of his former devotees, Koop decided after lengthy reviews of the evidence that an antiabortion report was not appropriate, because he had concluded that, in terms of harm, the evidence was insufficient to support “either the preconceived notions of those pro-life or those pro-choice”.3
Kept out of the AIDS debate for some years by the President’s office, he eventually found a rationale for his involvement and, again to the dismay of his earlier backers, became an unstoppable supporter for public health action and education. He bluntly advised all Americans about condom use, and promoted sex education for children “at the lowest grade possible”.4 He ensured the distribution of leaflets on AIDS to over 100 million households. His rationale was clear: “I am the Surgeon General of the heterosexuals and the homosexuals, of the young and the old, of the moral or the immoral, the married and the unmarried. I don’t have the luxury of deciding which side I want to be on”.5
Following from his professional experience as a paediatric surgeon, he championed the cause of babies born with disabilities, leading to the passing by Congress of the “Baby Doe” law that protected their interests.6
Koop saw the role of Surgeon General as one from which he could change the world; but beyond his public personality, he based his work, advice and campaigns on the best available science. Consequently, his views were sought, and respected, on many issues. He feared no one, whether tobacco companies or powerful conservative southern senators, and picked his issues carefully, focusing on areas where it was possible to make a significant impact on public health and the rights of the vulnerable.
Those of us who knew him from his work on tobacco learned that behind the formidable exterior lay a kind personality and a willingness to help and support younger campaigners around the world, as well as in the US.
Helped by Koop’s work and advocacy, action on smoking in Australia moved to new levels in the 1980s, with pioneering Quit campaigns and moves to ban cigarette advertising and strengthen health warnings and protection from passive smoking. Similarly, his humane stance on AIDS provided encouragement to Australians promoting evidence-based responses to challenging public health problems.
Everett Koop showed American health leadership at its best: with fearlessness, a strong public health focus, wonderful communication skills and a belief that “in science, you can’t hide from the data”.7
Competing interests
No relevant disclosures.
References
- Dr Unqualified. New York Times 1981; 9 Apr. http://www.nytimes.com/1981/04/09/opinion/dr-unqualified. html (accessed Apr 2013).
- Executive News Service; United Press International. Koop attacks tobacco industry. 1989. http://legacy. library.ucsf.edu/tid/gjf67c00 (accessed Apr 2013).
- US National Library of Medicine. The C Everett Koop papers: reproduction and family health. http://profiles. nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/88 (accessed Apr 2013).
- Koop CE. Surgeon General’s report on acquired immune deficiency syndrome. Public Health Rep 1987; 102: 1-3. 0_i1115620
- Silverman BK, Waddell A, editors. Report of the Surgeon General’s workshop on children with HIV infection and their families. Washington, DC: US Department of Health and Human Services, 1987. 0_i1115623
- US National Library of Medicine. The C Everett Koop papers: congenital birth defects and the medical rights of children: the “Baby Doe” controversy. http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/86 (accessed Apr 2013).
- Specter M. The Bush administration’s war on the laboratory. New Yorker 2006; 13 Mar. http://www. michaelspecter.com/2006/03/a-reporter-at-large-political-science (accessed Apr 2013).
Provenance: Commissioned; not externally peer reviewed.