C. Everett Koop, Surgeon General Who Took on Tobacco, Dies at 96

C. Everett Koop, the U.S. surgeon general who set aside his religious beliefs to promote childhood sex education for AIDS prevention and issued the first government warning about second-hand tobacco smoke, has died. He was 96.

He died yesterday at his home in Hanover, New Hampshire, according to the website of Dartmouth College, where he was founder of the C. Everett Koop Institute at Dartmouth’s Geisel School of Medicine. No cause of death was given.

With his Lincoln-style beard, military uniform and frequent television appearances, Koop raised the profile of the previously obscure position of surgeon general to celebrity status. He used his role as chief U.S. health educator to campaign for the rights of infants with birth defects to receive medical treatment and for disabled people to have access to public facilities.

An evangelical Christian who served under President Ronald Reagan, Koop angered conservatives by promoting condom use. He insisted that to stop AIDS he had to dispense health advice to all Americans, even if they engaged in practices, such as gay sex or drug use, that conflicted with his own moral views. He urged sex education “at the lowest grade possible” and mailed an eight-page AIDS brochure to 107 million households in 1988.

“I am the surgeon general of the heterosexuals and the homosexuals, of the young and the old, of the moral or the immoral, the married and the unmarried,” Koop told the Washington Post. “I don’t have the luxury of deciding which side I want to be on. So I can tell you how to keep yourself alive no matter what you are. That’s my job.”

Targeting Tobacco

Koop used his post as a bully pulpit to pummel the tobacco industry, which he accused of deceptive advertising. He devoted more time to the issue than any other in his eight years in office, according to the National Library of Medicine.

His landmark surgeon general’s report in 1986 contained the first official government warning on the link between second-hand smoke and lung cancer. He called for a smoke-free society by 2000 and new measures to restrict smoking in the workplace and public settings. Two decades later, many such laws would be in place throughout the U.S.

An opponent of abortion, Koop enraged fellow members of the right-to-life movement by insisting that the issue was a moral one, not a public-health matter. He resisted pressure from Reagan to issue a report stating that abortion was psychologically harmful to women. The scientific studies on the subject were inconclusive, Koop wrote in January 1989.

Opposed Nominee

Twenty-one years later, Koop joined abortion opponents in opposing President Barack Obama’s nomination of Elena Kagan to the U.S. Supreme Court. He urged the Senate to reject Kagan for her work, under President Bill Clinton, against Republican legislation to outlaw the late-term procedure that critics call partial-birth abortion. Kagan was confirmed to the court.

Before taking the post in 1982, Koop helped establish the field of pediatric surgery. He spent 35 years as the chief surgeon at the Children’s Hospital of Philadelphia, where he founded the nation’s first neonatal intensive-care unit. He developed a technique to correct esophageal atresia, a congenital birth defect in which the esophagus doesn’t connect normally with the stomach, saving almost 500 children with the operation.

Koop stayed on as surgeon general for eight months under President George H.W. Bush, resigning in October 1989, a month before the end of his second term. In 1995, President Clinton awarded him the Presidential Medal of Freedom, the highest civilian honor.

DrKoop.com Venture

Some of Koop’s private-sector ventures after leaving office were tarnished by accusations of conflict of interest.

In 1997, he and other investors founded DrKoop.com, one of the first health-information sites on the Internet. By 1999, at the height of the tech-stock boom, the Austin, Texas-based company’s market capitalization had soared to $1.3 billion, and Koop’s stake was valued at $56 million.

Some environmental and health activists said the website unethically blurred the lines between news and advertising. They also said Koop acted as a front for chemical and pharmaceutical companies.

DrKoop.com filed for bankruptcy protection in 2001 and was sold for $186,000 a year later to a firm that kept the domain name. By then, Koop had ended his affiliation.

In 1999 testimony before Congress, Koop played down health-group concerns about allergies to latex surgical gloves. He failed to disclose that he had once received $650,000 in consulting fees from a company that manufactured such gloves.

Dartmouth Return

“So blatant a conflict of interest involving one of the country’s most respected physicians is shocking,” the Chicago Tribune wrote in an editorial. “More shocking still is his apparent inability to understand what the problem is.”

In his later years, Koop taught at Dartmouth’s medical school in Hanover and served as a senior scholar at its C. Everett Koop Institute. He also endorsed Life Alert emergency-response devices for the elderly in television commercials.

Charles Everett Koop was born in Brooklyn, New York, on Oct. 14, 1916, the only child of a banker and a business manager. As early as age 6, he expressed a desire to become a surgeon. His mother administered anesthesia during in-home operations in the neighborhood, a practice sometimes performed by laymen.

“During my childhood, physicians were held in awe,” Koop told People magazine in 1999. “They were gods among men to me. When the family doctor drove up to your house for a house call, you knew the healing had begun.”

Rats, Cats

He attended the Flatbush School, a private high school, and pursued his interest in medicine after class. He would sneak into the viewing gallery of the Columbia University College of Physicians and Surgeons in Manhattan. At home, with his mother administering anesthesia, Koop performed operations on rabbits, rats and stray cats, according to his National Library of Medicine biography. At 16, he volunteered for summer jobs at hospitals.

Koop entered Dartmouth College on a football scholarship in 1933, majoring in zoology. By then known by his nickname, Chick (as in chicken coop), he gave up football after injuring his eye and getting a warning from an ophthalmologist that the sport might endanger his medical career.

At Dartmouth, he met his future wife, Betty Flanagan. They were married in 1938 and had four children.

Pediatric Surgery

Koop returned to New York in 1937 to attend Cornell University Medical College, receiving his degree four years later. He did his internship and residency at the Pennsylvania Hospital in Philadelphia and was asked to join Children’s Hospital as its first surgeon-in-chief.

Pediatric surgery was new at the time, and most medical schools offered little training in the field. Koop prepared for his new post by doing a one-year internship with two of the founders of pediatric surgery in the U.S., William E. Ladd and Robert E. Gross, at Boston Children’s Hospital. He also earned a doctor of science degree from the University of Pennsylvania in 1947.

Koop helped establish the field of pediatric surgery on the principle that children’s bodies are anatomically and physiologically different from adults, requiring special surgical procedures. He made the common hernia operation less painful and disfiguring by using a shorter incision and changing the stitching. In 1977, he became the first surgeon to separate Siamese twins joined at the heart, saving the life of one.

‘Higher Truth’

Though he was raised by a church-going family, Koop wasn’t especially devout until he joined the Tenth Presbyterian Church of Philadelphia in 1948. He had a spiritual awakening.

“As a person whose training and experience put full faith in science, I came to see an even higher truth,” Koop wrote in his 1991 autobiography. “From then on, I saw a coexistence between science and God.”

Koop began speaking out publicly against abortion after the Supreme Court’s landmark Roe v. Wade decision in 1973. He argued that legalized abortion devalued human life and would loosen moral strictures against euthanasia and infanticide. He wrote a book and produced multimedia projects on the subject.

It was Koop’s prominence in the anti-abortion movement that drew the notice of President Reagan, who appointed him deputy assistant secretary for health in February 1981, with the understanding that he would be nominated for surgeon general.

He was confirmed by the Senate in November 1981 after a protracted battle over his views on abortion, and took office in January 1982 as the nation’s 13th surgeon general.

Baby Doe

In his first year on the job, Koop became embroiled in a highly publicized medical-ethics battle known as the Baby Doe case. The parents of an Indiana girl born with Down’s syndrome and esophageal atresia elected not to have surgery performed to open the esophagus, which would have saved the baby’s life. (Baby Doe died before the case was resolved.)

Koop spoke out against the parents’ decision and helped craft a 1984 federal law that extended the definition of child abuse to the denial of doctor-recommended treatment for infants with birth defects.

“I don’t think parents should have the discretion to kill their children,” Koop told the New York Times years later. “I’m a great believer in the slippery slope. You get into the terrible quagmire of having only perfect children, and nobody can guarantee that.”

Koop’s decision to wear a uniform revived a tradition that had been dormant for years. The surgeon general oversees the 6,000-member Commissioned Corps of the U.S. Public Health Service, which began as the Marine Hospital Service in 1870. The corps is organized as a non-armed, uniformed military service, with the surgeon general holding the rank of vice admiral.

Koop ordered corps members to wear their uniforms once a week as a symbol of the original mission. His own gold-braided outfit added gravity to his pronouncements and helped him on his way to becoming America’s most famous surgeon general.

Koop and his wife had three sons -- Allen, Norman, David -- and a daughter, Betsy. David died in a climbing accident in 1968.

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