Immortal Surgeon General: C. Everett Koop, 40 years on.

From the blog of the American Journal of Bioethics

By Nigel M. de S. Cameron, PhD, MBA

The remarkable impact on America of bearded, Presbyterian social conservative C. Everett Koop – “Chick” to his friends – continues to reverberate. Hailed as “immortal” by the editor of USA Today (AP called him a “rock star”), Koop became extraordinarily well-known as the 13^th Surgeon General of the United States. At his 90^th birthday party Senator Orrin Hatch lauded him as “one of the most popular people in the history of government.” Per The Health Care Blog, he was “perhaps…the most revered Cabinet member” in history. (He was not, however, in the Cabinet.) As I work on a biography of this colossal figure, I find the debts America owes him just keep piling up.

Forty years ago this spring President Reagan plucked the world’s most famous pediatric surgeon from retirement. In 35 years as Chief of Surgery at Children’s Hospital of Philadelphia, Koop established the nation’s first Neonatal Intensive Care Unit; edited pediatric surgery’s first professional journal; held two simultaneous chairs at Penn (in Pediatrics and Pediatric Surgery); laboriously piloted specialty recognition through a reluctant medical establishment; and demonstrated dazzling technical mastery in thousands of procedures on tiny infants, using techniques he often developed himself. His celebrated separations of conjoined twins earned him global fame.

That wasn’t why the Reagan White House wanted him. A few short months after Roe was handed down in 1973, Koop issued a thunderous pro-life call at evangelical citadel Wheaton College. Later in the 70s he would spend 18 months making and presenting pro-life documentaries on abortion and euthanasia with philosopher-theologian Francis Schaeffer. He fast became the best-known pro-life doctor on the planet. For a President beholden to the Republican Party’s growing social conservative constituency, Koop made the perfect Surgeon General candidate. A grueling confirmation process in the Senate followed.

Conservatives who backed him expected, and liberals who opposed him feared, a barnstorming pro-lifer with the Office of the Surgeon General as his bully pulpit. But neither side had the measure of this complex and principled man. He told everyone who would listen that he didn’t plan to promote his own religious ideology. In fact, Koop’s faith instilled a very clear sense of vocation. He’d been called to a new and all-consuming position in public health. Abortion access simply wasn’t on his public health agenda. 

Once confirmed, Koop weighed in on a slew of issues with profound ethical implications. He tussled with the administration on breastfeeding. He defined domestic violence as a matter of public health. He called for a crusade against drunk driving.

But there were four set-piece battles in which he put his stamp on great ethical issues of the day: tobacco, Baby Doe, AIDS, and abortion.

First, smoking. Building on his predecessor Luther Terry’s work from the 1960s, Koop upped the ante. Nicotine was an addictive drug. Smoking could kill. Big Tobacco lied and deceived. By the time he stepped down, the U.S. smoking population had dropped from 33% to 26%. As one leader in the tobacco control field put it, he “totally changed the landscape.”

Second, Baby Doe. Not long after his confirmation there were press accounts of an Indiana baby with Down Syndrome, whose parents decided to forgo life-saving surgical treatment on the advice of their obstetrician. Koop was enraged, stating he had performed hundreds of the required interventions, and that whatever the views of parents and physicians, the children had the right to proper treatment. After much controversy Congress passed a law that defines the inappropriate withdrawal of treatment from disabled newborns as child abuse, immediately setting a new standard of care in pediatrics.

In this age of radical political polarization, it’s good to be reminded of a man whom Reagan hired to please the social conservatives, yet whose 90^th birthday party was hosted by Hillary Clinton.

Third, AIDS. Koop’s 1986 report on AIDS was an extraordinary document. Surgeon General reports are generally written by expert committees and lengthy. Koop wrote it himself. In a scanty 36 pages, and the follow-up pamphlet mailed to every household in the country (a first), he declined to moralize about AIDS. He rejected suggestions that sufferers be quarantined, tattooed, or sent to Alaska. Koop had called gay sex “sodomy,” yet he built a strong and mutually respectful relationship with leaders of the gay community as he worked on his plan to defeat the virus. While they had initially feared him, Koop became an unlikely hero in the AIDS crisis. As Jeffrey Levi, government relations chief for the National Gay and Lesbian Task Force, would put it after Koop’s death, the relationship was “as transformative as all the obits are saying.”

Fourth, abortion. Koop kept his word and stayed out of the abortion debate. But toward the end of Reagan’s time in office the President requested a report on the health effects of abortion on women. Koop tried to avoid the task, and finally reported that there simply was not enough scientific evidence one way or another. Studies could be done, but they would be costly and take years. 

A journalist once asked Koop what the medal ribbons on his admiral’s uniform stood for. “The top row is for what the liberals did to me,” he quipped; “the bottom row is for what the conservatives did to me.”  In this age of radical political polarization, it’s good to be reminded of a man whom Reagan hired to please the social conservatives, yet whose 90^th birthday party was hosted by Hillary Clinton.

“Chick” Koop died on February 25, 2013. The next day, The New Yorker’s Michael Specter wrote that he “turned out to be a scientist who believed in data at least as deeply as he believed in God.” “I doubt he and I agreed on any political issue, yet, I don’t think I have ever met anyone for whom I had more respect.”