Dr. C. Everett Koop was never shy about saying what he thought. In the years leading up to his 1981 nomination as U.S. Surgeon General, the Brooklyn-born pediatric surgeon barnstormed the country to talk about the evils of legal abortion. When we treat pregnancy termination as a mainstream medical procedure, he argued, we’re on the path to euthanasia, infanticide and “the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen.”
The rhetoric surrounding reproductive rights hasn’t cooled since then, but Koop, who died at age 96 this week, was fundamentally different from many religious conservatives. Instead of shunning science and common sense to impose his faith on the rest of society, he counted on science and common sense to hold religious fervor in check. Three decades later, few Americans can even name the current surgeon general, but the big man with the silver beard and the Colonel Sanders uniform remains a cultural icon.
The AIDS epidemic was still in its infancy when Koop came to office, and because the first U.S. cases involved gay men and injecting drug users, the Reagan administration greeted it with a mix of silence and sarcasm. The president himself never uttered the word “AIDS” during the first five years of the plague. But Koop emerged a crusader for pragmatism and compassion, speaking out for condom distribution, needle exchange, medical research and explicit public education―even as Sen. Jessie Helms demonized dying people for “deliberately engaging in unnatural acts.” In 1986, the White House finally authorized a Surgeon General’s Report on AIDS. The document Koop produced advised against discriminatory immigration policies and called for comprehensive sex education from third grade on. Fellow conservatives were livid, and Reagan largely ignored the report’s recommendations, but Koop sent a fact-based AIDS pamphlet to 100 million households and still kept his job for three more years. “As HIV/AIDS was growing into a public health crisis, Dr. Koop was a lone voice for aggressive, comprehensive intervention to curb the disease,” the Washington-based Human Rights Campaign said in a statement this week.
And he never piped down. Koop took on the tobacco industry early and often, pushing for stronger warnings on cigarette ads and challenging the nation to go smoke-free by the year 2000. Rather than skirt the truth about the health impact of a legal and profitable industry, he likened cigarettes to heroin and cocaine―equally addictive, equally deadly and far more pervasive. He pledged to “use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen,” and he didn’t pull punches for political convenience. In 1996 (after Koop had left public office), presidential candidate Bob Dole questioned whether smoking was really addictive. Koop publicly lamented that his fellow Republican had “either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry.”
He wasn’t just badmouthing the tobacco business and its enablers. Koop’s larger point―a critical one during the reign of the Republican ignorance caucus―was that public policy shouldn’t be rooted in willful blindness. He never changed his own view of abortion. Yet when Reagan asked him to issue a surgeon general’s report on “post-abortion syndrome,” a constellation of physical and emotional symptoms ostensibly suffered by women who terminate their pregnancies, he declined. Much as he might have liked to put the authority of his office behind his own moral views, he reviewed a draft and saw no factual basis for the claim. So rather than succumb to White House pressure, he begged off with the president. “In the minds of some [White House advisers], it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade,” he wrote in a 1989 letter to Reagan. He could have issued a report stuffed with scary anecdotes and urgent calls for further research. But he had more integrity than that. “There is no doubt . . . that some people have severe psychological effects after abortion,” he later told a congressional hearing, “but anecdotes do not make good scientific material.
Self-delusion is a pox on public health. Dr. Koop knew that. He was rare in his own time and even rarer today.