C. Everett Koop was not a moderate man. He was not a Democrat and he was not particularly democratic, either. He could be gruff, unpleasant, and dismissive. 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. (Though it took me a while to get on board.) Koop’s strident 1979 manifesto, “Whatever Happened to the Human Race?,” helped establish the evangelical base for America’s anti-abortion movement. (Before the book was published, opposition to abortion was seen largely as a Catholic issue. Koop, who died yesterday at the age of ninety-six, helped convince his fellow evangelicals that it was their fight, too.) It is not possible to overstate the joy expressed by America’s most conservative leaders when, in 1981, Ronald Reagan nominated Koop to the position of Surgeon General. North Carolina Sen. Jesse Helms (whose state is the home base of Big Tobacco) was one of his principal supporters, and South Carolina’s Strom Thurmond promised to help Koop in any way he could. Illinois Rep. Henry J. Hyde, who in 1976 sponsored the signature amendment to prevent Medicaid from paying for abortions, was so delighted with the appointment that he thanked Reagan personally.
Democrats were not so grateful. Surgeons General are usually confirmed quickly and forgotten at once. (How many can you name?) But liberals on Capitol Hill denounced Reagan’s choice for what it was: a blatant attempt to place ideology over the demands of public health. Koop was a brilliant doctor—he served for thirty-five years as surgeon-in-chief at the Children’s Hospital of Philadelphia—but he had no public-health experience. Democrats revolted, and for more than a year, they subjected Koop to the kind of horrific nomination battle we have practically come to consider normal. The Times ran an editorial titled, “Dr. Unqualified,” but mostly he was referred to as “Dr. Kook.” Rep. Henry Waxman, then and now Congress’s most sophisticated student of the American health-care system, called him “scary” and “intolerant.” For the first time in its hundred-year history, the American Public Health Association went on record against a nominee. “We’d be better off with no Surgeon General than with Koop,” said their executive director. No public-health official in American history has generated more controversy.
Finally, though, Waxman and his colleagues gave in. After all, it was mostly a titular post. Surgeons Generals have little actual power—and there were other wars to wage. I covered science policy at the time for the Washington Post and I expected Koop to generate a lot of news. But neither I, nor anyone else, could have envisioned that by the time he left office eight years later, he would have managed to transform his job into the most electrifying bully pulpit in medicine. And he did it in the most unexpected way: by telling the truth.
Koop turned out to be a scientist who believed in data at least as deeply as he believed in God. And he proceeded to alienate nearly every supporter he had on the religious and political right. To fight the growing epidemic of AIDS, Koop recommended a program of compulsory sex education in schools, and argued that, by the time they reached third grade, children should be taught how to use condoms. He did not consider homosexuality morally acceptable—and he never changed his view about that. But he understood that viruses have no religion or sexual orientation and that H.I.V. was a virus. He campaigned vigorously against smoking in public spaces, saying that tobacco should be eliminated from American society by 2000. He was the first public official to state categorically that second-hand smoke causes cancer. Tobacco companies—and Jesse Helms, their biggest congressional ally—could hardly believe Koop’s treachery.
Abortion, at least, was a platform on which President Reagan and Koop seemed to think as one. So when Reagan asked Koop to prepare a report on the psychological effects of abortion, conservatives finally felt certain of the result. After all, this was the man who had compared abortion to the killing of Jews at Auschwitz. Koop took to the road and met with hundreds of activists on both sides of the issue and reviewed hundreds of scientific publications. Then, for a while, there was silence. One day a member of his staff called me and said that Koop had decided to issue no report.
“Huh?” I said. “How can that be?” Simple, I was told. Koop was unable to say whether, with any scientific certainty, an abortion was always more damaging than the alternative. He refused to issue the report, because, as he told the President, there weren’t enough data to support either “the preconceived notions of those pro life or those pro choice.” The Administration, once again, was shocked.
But it shouldn’t have been. Because Everett Koop, the grumpy man who dressed like a nineteenth-century preacher and wore a beard that made him look like Lincoln, was the most utterly consistent public servant I have ever seen. He simply required scientific decisions to be governed by science. People rarely asked him about that—because few believed it was possible. If they had, he would have told them what he told me when I talked to him a few years ago, for a story I wrote about the George W. Bush Administration’s many attempts to bend scientific facts to fit its political vantage point. “You have to separate moral questions from the questions of science,” he told me at the time. He had been out of office for nearly two decades, during which time he founded a Web site, DrKoop.com, that was successful for a while but went bust when the Internet bubble burst. For many of the last twenty years he ran a institute named for him at Dartmouth College.
“You know, I never changed my stripes during all that time, and I still haven’t,” Koop said. “What I did in that job was what any well-trained doctor or scientist would do: I looked at the data and then presented the facts to the American people. In science, you can’t hide from the data.”
By the time Koop left office, his enemies had become his friends (and vice versa). When he presented Waxman with a copy of his autobiography, “Koop: The Memoirs of America’s Family Doctor,” he signed it: “to the biggest man in Congress.” Waxman is five foot five. Yesterday, he called Koop a hero.
“I have been away for some time, and I am more of a spectator now,” Koop told me when we spoke. “But stem-cell research is as volatile as any subject can get. People are completely driven by their beliefs or their desires. Not the facts. Scientists have hyped it, and often they act as if there were no ethical considerations at all. That is not true. But you have to weigh the facts, and this Administration doesn’t seem to take that approach. One thing that I have learned is that belief doesn’t change reality.”
In this era, during which progress, facts, and science are under unrelenting siege, it is thrilling to remember that even ideologues can love the truth. R.I.P. Dr. Koop.
Photograph courtesy United States Public Health Service.
