Catch That Koop

May-June, 1992

By Jerry Sweers

CLAREMONT, California —The doctor who won't give up is still at it. Koop: The Memoirs of America's Family Doctor (Random House, 1991) is, of course, by and about C. Everett Koop, M.D., former Surgeon General of the United States.

When the Reagan administration named Koop to become Surgeon General, many greeted the appointment with derision. "Dr. Unqualified," The New York Times called him, primarily because of his highly publicized opposition to abortion. His confirmation took almost a year. But Koop surprised critics and supporters alike with his non-ideological approach to health issues, his refreshingly forthright public pronouncements, and his vigorous campaign to mobilize America against the scourge of AIDS.

To the Reagan administration at the start, Koop was a "conservative Republican, one who is pro-life with a credible experience in academia." To the AMA, Planned Parenthood, the National Organization of Women, the National Abortion Rights Action League, and the American Public Health Association, on the other hand, Koop was not only "uniquely unqualified," he looked like the most dangerous man in the country. What the right saw as a tool, the left saw as a challenge. In the end, he confounded them all.

Dr. Koop was a successful Christian surgeon who, after taking office, took seriously his legally defined duty to warn the American people about risks to their health. In eight years he learned a great deal about politics but refused to abandon his principles for the sake of political expediency. When the dust settled, many of his early opponents praised him and many of his early supporters damned him, but nearly everyone agreed that he had become the most effective and outspoken Surgeon General in American history.

What amazed both friends and enemies was Koop's success in managing somehow to mix medical science, biblical faith, and the health needs of a diverse, highly complex society in ways that tried both to honor the Creator and to give each person and group just treatment.

The first great issue was smoking. The 1982 Surgeon General's Report on Smoking and Health clearly defined the medical and social consequences of smoking. In subsequent years, Koop expanded his efforts to reduce the serious public health consequences of nicotine addiction. In his memoirs, Koop quotes one congressman from a tobacco-producing state who called him several nights after the 1983 Surgeon General's Report on Smoking came out: "I don't give a good goddamn how many people die of cancer or anything else that you say is associated with tobacco. All I want is jobs and prosperity for constituents in my district. Why don't you lay off all this nonsense about smoking and health?"

This attitude was backed by billions of dollars and considerable political clout. But Koop persisted in doing his job. He steadfastly maintained that the tobacco interests are only one part of the "American Public." There are many other persons and groups who deserve both information about the physical and economic consequences of their choices and a hearing for their opinions about the issue.

The information he provided was heard and taken seriously. In 1964, half of all adult Americans smoked. By 1989, the smokers were down to 26 percent. Koop's efforts were foundational to the smoke-free workplaces, airplanes, and restaurants we enjoy today—along with the resultant improvements in the general health of the American people.

AIDS came next. In August, 1981, there were 108 cases of AIDS reported, with 43 deaths. Dr. Koop had not yet been confirmed. He knew AIDS was serious, but there was nothing he could do about it. As it turned out, it was a long time before he was allowed to speak publicly about the disease. Although he didn't realize it in the beginning, Koop was muzzled because AIDS was a political issue first, a public health issue only when convenient and non-controversial.

"AIDS pitted the politics of the Gay revolution of the seventies against the politics of the Reagan revolution of the eighties," Koop writes. It took him five and a half years to get around the politics and into the health battle. He made the end run on a hand-off from the President who mentioned, in a speech, that he was asking the Surgeon General to prepare a special report on AIDS. Immediately, Koop went to work on his report.

What he released was a "health report, not an exercise in moral censure." He wrote as "the Surgeon General of homosexuals as well as heterosexuals and of the promiscuous as well as the moral." Koop was "moved by Christian compassion and the profession of medicine ... to do all [he] could... to halt the spread of AIDS by educating the American people accurately and completely."

The report went out and people finally got the facts about AIDS. Many of Dr. Koop's opponents began to see his virtues; many former supporters began to castigate him, and some on the religious right even began to question his salvation.

"All the fuss surprised me," he says. "I just did what I had always done as a doctor. My whole career had been dedicated to prolonging lives, especially the lives of people who were weak and powerless, the disenfranchised who needed an advocate: newborns who needed surgery, handicapped children, unborn children, people with AIDS."

This book is both encouraging and instructive—especially, I think, for those Christians who wonder whether it is possible to "do justice" as an employee of the state. Dr. Koop found it was not easy, but it was possible and very rewarding.

[Mr. Sweers is a communications consultant who served for more than fifteen years as an executive of World Vision International in Monrovia, California.]