Editorial: C. Everett Koop; Nation Benefitted From His Practice

There’s much to be said for a good bedside manner when it comes to practicing medicine, but most patients ultimately want their doctors to deliver the information and counsel needed to get them and keep them healthy, even when the advice can’t be sugar-coated. It’s hard to imagine a career that better embodied that fact than that of Dr. C. Everett Koop, the former U.S. surgeon general, who died Monday in Hanover.

The extent to which Koop’s professional integrity and commitment to the practice of medicine wound up having a profound influence on the nation’s health might have surprised both his initial supporters and detractors. After a distinguished career in pediatric surgery — a relatively new specialty that he did much to advance after being hired as head of surgery at Children’s Hospital of Philadelphia in 1946 — he attracted the attention of the Reagan administration largely through his outspoken opposition to abortion. Koop’s strong views attracted not only the admiration of conservative Republicans but also sharp opposition to his appointment by many on the left.

As it turned out, the only significant role Koop’s personal beliefs about abortion played during his eight-year tenure as surgeon general was the disappointment he stirred among conservatives by keeping largely silent about it. According to The New York Times, once Koop determined that the procedure itself posed no health threat to women, he regarded it as a moral question and therefore not a suitable matter for the nation’s top public health official. That hardly pleased the White House.

Koop adopted virtually the opposite approach when it came to tobacco use. Appalled by the magnitude of the health toll attributable to tobacco, Koop pushed a variety of measures to both educate the public and discourage smoking, including higher taxes, stronger consumer warnings and tougher regulations. In doing so, he battled not only the enormously powerful tobacco companies but also their equally powerful political allies, including both Republicans and Democrats from tobacco states.

It was a fight that Koop largely won. Smoking rates had dropped significantly by the time he left office, and regulations banning smoking in public places became widespread in response to his campaign about the dangers of secondhand smoke. “I never could have envisioned restaurants in New York City banning smoking — or a diner in Colebrook, New Hampshire, not having ashtrays on the tables,” he told Dartmouth Alumni Magazine, remarking on the magnitude of the cultural change he helped bring about. It’s hard to overestimate how many lives were saved or ailments averted thanks to his advocacy.

Koop took on a different sort of adversary — prejudice — when the country was confronted with the AIDS epidemic. Not only did Koop have to overcome widespread indifference to a disease that was strongly associated with gays and drug users, he had to dispense public health advice that caused deep discomfort among members of a conservative administration — the role of practicing safe sex in preventing the spread of the HIV virus. According to the Times, Koop refused to delete a reference to the importance of using condoms in a special report his office prepared in 1986, despite tremendous pressure from the Reagan administration. He said he would not join those who “placed conservative ideology far above saving human lives.”

He was not uniformly successful or above criticism in all of his undertakings. He made no more progress at advocating for universal health care in this country than any of the other prominent politicians and health care officials who preceded him. And after the Dartmouth graduate returned to Hanover following his government work and served as senior scholar at the medical school’s Koop Institute, he was justifiably criticized for his involvement in the DrKoop.com website, which blurred the line between medical advice and commercial promotion.

In general, though, the doctor adhered to the standard he established for himself and described to his first wife, Elizabeth, while preparing for what he knew would be a contentious confirmation hearing in the Senate in 1981: “If I ever have to say anything I don’t believe or feel shouldn’t be said, we’ll go home.”