C. Everett Koop - Government Service

Government Service

Today Koop is well known for four facets of his work:

• Abortion: Though Koop was philosophically opposed to abortion on personal and religious grounds, he declined to state that abortion procedures performed by qualified medical professionals posed a substantial health risk to the women whose pregnancies were being terminated, despite political pressure to endorse such a position.
• Tobacco: In 1984 he wrote that nicotine has an addictiveness similar to that of heroin or cocaine. Koop's report was somewhat unexpected, especially by those who expected him to maintain the status quo in regard to his office's position on tobacco products. Koop also instituted the practice of requiring rotated health warning labels on cigarette packs and required advertising to include the labels, although some warnings had been required since 1965. Koop issued a challenge to Americans in 1984 to "create a smoke-free society in the United States by the year 2000." As Surgeon General, he released eight reports on the health consequences of tobacco use including the first report on the health consequences of involuntary tobacco smoke exposure.
• AIDS: Koop was Surgeon General when public health authorities first began to take notice of AIDS. Koop wrote the official U.S. policy on the disease and took unprecedented action in mailing AIDS information to every U.S. household. Gay activists and their supporters were unhappy with the way in which he targeted gay sex and the risk of infection through anal sexual intercourse as primary vectors of the disease, but Koop was unapologetic claiming such activities entail risks several orders of magnitude greater than other means of transmission. Religious activists, upset over the pamphlet's frank discussion of sexual practices and advocacy of condom use, called for Koop's resignation. Koop also infuriated some former supporters by advocating sex education in schools, possibly as early as the third grade, including later instruction regarding the proper use of condoms to combat the spread of AIDS. While a straightforward telling to the public about the disease was controversial, Koop was also criticized by some health activists who claimed that his office had not gone far enough in attempting to develop a cure or vaccine, reducing the role of his office to educating the public on health concerns.
• Baby Doe and the Rights of Handicapped Children: In April 1982, a child born in Bloomington, Indiana was diagnosed with Down syndrome as well as esophageal atresia with tracheoesophageal fistula. Six days later, after court involvement and parental discussion involving disagreement among physicians about whether or not to treat the baby or let him die, the baby died, having been denied surgical treatment to correct his esophageal atresia and tracheoesophageal fistula. Baby Doe, as he would be known, became a symbol for children with birth defects, handicapped infants, and the debate over infanticide. Koop was not initially involved with the Baby Doe case but had a special interest in it. As a pediatric surgeon in Philadelphia, he and his colleagues had operated on 475 such babies during his 35 years there, with ever-increasing survival rates. During his last eight years in active practice, Koop never lost a full-term baby upon whom he had operated to correct esophageal atresia. It was due to this background that he became actively involved championing policies to protect the rights of newborns with defects, which led to Congress passing the Baby Doe Amendment.

Taken together, these four issues combined with Koop's personality and his willingness to make use of mass media brought to the office of Surgeon General a higher public profile than it previously had merited; he is, for instance, the first Surgeon General to have been the subject of a popular song – "Promiscuous", by Frank Zappa. Koop was well known for his mustache-less beard and colorful bow ties. He wore the Surgeon General's ceremonial military uniform (a naval admiral's dress uniform, complete with medals) during much of his day-to-day work, reviving an old practice.