When C. Everett Koop, M.D., walks into a restaurant, people stop smoking.
Americans listen when the former U.S. surgeon general has something to say, whether it's goading them to kick the tobacco habit, use condoms or generally behave in a healthier manner. He was and is, unequivocally, America's top doc.
"Even though I am not still the surgeon general, people still act as if I were," says Koop, now senior scholar of the Koop Institute at Dartmouth College. Colleagues say the 80-year-old pediatric surgeon still receives thousands of letters from the public and calls from politicians seeking his advice.
"Even today, when you travel with Dr. Koop, everywhere you go there are either (thankful) patients or parents who are grateful (to him) for operating on their children," says Marc Micozzi, M.D., a former student of Koop's at the University of Pennsylvania, now executive director of the College of Physicians of Philadelphia.
Natty in navy blue, Koop cut an impressive figure as commanding officer of the commissioned corps of the Public Health Service during his eight-year reign in Washington. And, although he left office in 1989, he is widely recognized as the nation's foremost fighter for public health.
"When I retired I said I wanted to be the healthcare conscience of America, and I guess that's what I've tried to be," he says.
The road to sainthood. Koop fought scores of political battles to achieve his saintly status with the public. His 1991 memoir, Koop, recounts those Washington war stories as it provides a candid glimpse into the life of a man whom friends call "Chick."
Charles Everett, the only son of John Everett Koop and Helen Apel, grew up on scooters and roller skates in South Brooklyn. Saturday mornings, the precocious Koop would sneak into the gallery overlooking Columbia-Presbyterian Hospital's operating theaters to observe surgery. Summers he worked without pay at Mather Memorial Hospital and St. Charles Hospital for Crippled Children in Port Jervis, N.Y., near the family's beach cottage on Long Island Sound.
"I can't remember when I didn't want to be a doctor," Koop writes.
In 1933, Koop entered Dartmouth College as a pre-med student and "roving center" on the football team. One hard tackle later, Koop was knocked cold and began a lifetime struggle with double vision. Wisely, a professor at the Dartmouth Eye Clinic advised him to drop out of football to save his "surgeon's hands."
On Sept. 19, 1938, Koop married college sweetheart Betty Flanagan, a Vassar girl whom he met through Dartmouth buddy Dan Barker. The Koops eventually had four children.
Snubbed by Columbia University, Koop studied medicine at New York's Cornell University Medical College. After completing his medical degree in June 1941, he reported to Pennsylvania Hospital in Philadelphia as an intern and later to the Hospital of the University of Pennsylvania as a resident. Five weeks from the beginning of his surgical residency, Koop was performing "surgery usually reserved for a resident in his third year," he recalls in his book.
Never shying from challenge, Koop helped pioneer the nascent field of pediatric surgery over an impressive 35-year career. As chief of surgery at Children's Hospital of Philadelphia and a professor of pediatrics and pediatric surgery, he established the nation's first newborn surgical intensive-care unit. He saved countless babies whose lives would have been snuffed short if not for his hunger to develop new surgical techniques and seek advances in pediatric anesthesia.
As a professor, Koop engaged students with entertaining and informative lectures. "We all looked up to him as a role model at that time," says Micozzi, who studied under Koop as a student at the University of Pennsylvania from 1974 to 1979.
Political quagmire. Koop was approaching retirement age when his name began circulating among Republicans as a potential surgeon general candidate. At the time, Koop, an evangelical Christian, had little warning of the firestorm that would erupt among critics of his anti-abortion beliefs. He would watch his nomination stall in an unexpected political quagmire requiring a special act of Congress. By law, the surgeon general could be no more than 64 years and 29 days old, making the 64-year-old Koop about 100 days too old.
On Nov. 16, 1981, eight months after arriving in Washington, Koop finally was confirmed by the Senate. It wasn't long before his cut-to-the-chase style began ruffling political feathers.
He writes, "As surgeon general, I took as my mission nothing less than improving the health of the entire nation. I started with smoking." Not one for mincing words, Koop's annual reports on smoking and health were packed with cold, clinical facts, unnerving tobacco-state lawmakers.
"One congressman from a tobacco-producing state, whose name I've somewhat contemptuously repressed, called me at home several nights after the release of the 1983 Surgeon General's Report on Smoking and Health," Koop recalls in his memoirs. "Our conversation ended when he said, `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?'*"
AIDS challenge. Turf issues prevented Koop from tackling AIDS earlier in the epidemic. But once President Reagan cleared the way, Koop meticulously pursued the truth about the deadly virus. Seventeen drafts later, The Surgeon General's Report on Acquired Immune Deficiency Syndrome eventually made its way into millions of American households, although it offended many who objected to its explicit language.
While working on the AIDS paper, "he made an agreement with himself that if at any point he had to compromise his own integrity, he would walk away from the position (of Surgeon General)," says Michael D. McDonald, now principal investigator of the health information initiative at the Koop Foundation in Rockville, Md. But Koop managed to influence the right people and get the report disseminated. Out of that, he gained enormous credibility with the public, McDonald notes.
Koop's first printed interview on AIDS appeared in November 1985 in Christianity Today. In it, Koop says, "I stated for the first time my oft-repeated conclusion that, in preventing AIDS, the moralist and the scientist could walk hand in hand."
America's leading health adviser provided frank guidance on numerous issues, from diet and nutrition to disease prevention, before retiring from his bully pulpit in 1989. But Koop keeps the vigil through other outlets too numerous to list in their entirety. The Koop Institute, which he founded in 1992 with Dartmouth College, seeks to develop physicians' skills, knowledge and patient interactions through the use of computers and other information technologies. The Koop Foundation, meanwhile, pursues the tools needed to build a health information infrastructure that one day will serve "as the nervous system" of American healthcare.
Speaking his mind. Forthright as ever, Koop continues to speak his mind on the topics of the day. Asked to comment on the physician-assisted suicide movement, Koop says he sees it as a radical and dangerous departure from the physician's traditional role as healer. He is especially concerned about the implications for the nation's 49 million disabled people.
On the growth of managed care, Koop worries that managed-care providers in general, especially for-profit companies, "avoid doing things that aren't absolutely necessary." He predicts two potential pathways for the future. If medical professionals become strong patient advocates, Koop envisions a system incorporating the best of the old-style healthcare delivery system and the financial savings of the new. Alternatively, with a growing uninsured population, we may see a government system step in.
With his outspokenness, Koop breathed life into the surgeon general's office, producing reports that people took as gospel truth. That post remains vacant today, a predicament that Koop finds utterly discouraging and disappointing. Because if he were surgeon general today, you can bet he would be railing against what he still calls the No. 1 cause of preventable death: smoking, of course.