Even the Mighty Might Fall: The Continued Story of C. Everett Koop

Everett Koop was a man of morals. A religious man who read the bible. He was also a man of science. He got his job through politics. Yet he knew how to keep these forces separate. Nowhere was this more apparent than in his pushback against political pressures to oppose abortion on health grounds and to educate the populace on AIDS and against tobacco use.
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He was also a man of courage, not afraid of attack by those whose moral stance opposed his scientific evaluations, even as they conflicted with his values. Staying true to science was his lodestar. Where are such heroes today?

Aborting the Anti-Abortion Advocates

A religious Christian evangelical, Koop was tapped to be Surgeon General, in large measure, because of his personal and public opposition to abortion. The venom of the liberals was palpable:

“The Times ran an editorial titled, “Dr. Unqualified,” … he was referred to as “Dr. Kook.” Rep. Henry Waxman… 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."

But his opponents were soon surprised. When the administration sought his scientific imprimatur on banning abortion– Koop refused. Science, he believed, could prove some things and disprove others, but on some matters – it could not deliver enough evidence. Using personal morality to fill those gaps was an anathema to him. And kowtowing to politics was simply out of the question.

An early (and current) claim of those opposed to abortion is that the procedure caused physical and psychological damage to the would-be mother. President Reagan wanted Koop’s scientific report to confirm the Republican political platform outlawing the practice. After reviewing the data, Koop refused. As reported by the New York Times,

“Once again, Dr. C. Everett Koop, Surgeon General of the United States, has confounded the White House and Congress, liberals, and conservatives. This time he told President Reagan in a letter Monday that, after extensive study, he could not conclude one way or another that abortions were harmful to women. His position has again left him a hero to those who once opposed him and a villain to those who once backed him.”

Koop had previously written about his views on post-abortion trauma, vividly describing his observations. But after reviewing 250 studies on the psychological impact of abortion, Koop didn’t find the causal connection abortion opponents so reverently believed in. In concluding that ''scientific studies do not provide conclusive data about the health effects of abortion on women,'' Dr. Koop refused to bow to political pressure and ideology – earning him the wrath and contempt of former supporters and the admiration from those who once opposed him.

Even though it went against his values, the science just didn’t comport with his personal beliefs and the political morality of some of the population – and Koop wouldn’t compromise on the science. Jim Brown, Kopp’s press spokesman, said, “The book reflected Dr. Koop's personal observations, not scientific data….He's seen a lot of women who have been depressed after an abortion, but he wants scientific evidence.''

Distancing himself from conservatives who opposed abortion, perhaps like some of those who oppose vaccines today, earned Koop vicious and ad hominin attacks by those rejecting sound science in favor of beliefs. The Ad Hoc Committee in Defense of Life called Dr. Koop's refusal to issue a report 'an insult to the Reagan Administration's principled stand against the evil of abortion on demand.”

''Dr. Koop has determined that it would be inappropriate for him to convert his beliefs to action. But if one does not act on his beliefs, then one doesn't deeply hold those beliefs. Dr. Koop is quintessentially the other-directed man. He's afraid to apply his own views and values.”

 - Howard Phillips, chairman of the Conservative Caucus,

So, even back in 1989, politics tainted political judgments -- and the CDC had allegations leveled against it. This time it was about squelching Koop’s report on the safety of abortion. Koop’s report, made public by the House Government Operations Committee (after subpoenaing various “confidential” documents), urged the Department of Health and Human Services to assure the public that health research is not affected by political judgments, concluding that “valid scientific studies had shown that modern abortion was medically safe and did not increase the risk of infertility, miscarriage or premature birth….”

And so it was, until Dobbs.


Next came Koop’s assault on the addictiveness of nicotine, which his report noted was similar to that of heroin or cocaine. Again, his position was unexpected by his former conservative confreres and the administration who had expected him to “toe the line” and maintain the status quo. (Senator Jessie Helms of  North Carolina, home of Big Tobacco, was one of Koop’s initial champions)

Instead, during Koop’s tenure, Congress passed legislation regarding new types of warning labels on cigarette packs, a procedure which remains unchanged until today. (Proposed new labels depicting graphics of smoking-related illness have been announced by the FDA  - but are on hold due to challenges by the tobacco industry). Eight times Dr. Koop released reports on the health consequences of tobacco smoke, including that from involuntary exposure. While tobacco industry enthusiasts weren’t pleased with his efforts, smoking rates in the US declined from 38% to 27% during his tenure.

Aiding AIDS sufferers

“Koop did more than any other public official to shift … the public debate over AIDS from the moral politics of homosexuality, sexual promiscuity, and intravenous drug use, practices through which AIDS was [primarily] spread, to concern with the medical care, economic position, and civil rights of AIDS sufferers.”

– National Library of Medicine

If there ever was a public health “conspiracy,” it was the silence surrounding AIDS during the Reagan administration. The President believed this was a self-inflicted disease brought upon its sufferers (who he believed were IV drug users and homosexuals [1]) and not a public health threat. Surgeon General Koop set out to rectify this.

On October 22, 1986, C. Everett Koop released the Surgeon General's Report on Acquired Immune Deficiency Syndrome. Long prevented by the administration from speaking out on the issue, in 1988, he mailed a seven-page version of the original 36-page report, providing a simply worded and clear AIDS information brochure to all 107,000,000 American households.,

For four years, he tirelessly devoted himself to the issue.  The politicization of abortion and tobacco were nothing compared to that surrounding AIDS. Koop should have been revered for his efforts to protect public health. Instead, he was attacked by conservatives and liberals alike. Liberals were upset that he emphasized the sexual nature of the transmission vector and for advocating abstinence as the safest means of prevention. Conservatives, aligned with the President’s belief in the immoral “cause” of the disease, were shocked at the explicit language and his recommendations to use condoms and provide sex education for children. And yet, there were champions, including members of the National Institute of Medicine.

Even the Mighty May Fall

After leaving office, Dr. Koop involved himself in public health education; his drkoop.com was one of the first major sources of online health information. Perhaps feeling betrayed by the attacks of his former conservative allies, perhaps on the belief that ‘if you can’t ‘beat em join em,’ perhaps motivated by the sheer practical exigencies and necessities of life in a capitalistic society, the site contained recommendations to paid-subscribers, and for a time Koop was entitled to commissions on these products. The site eventually went bankrupt.

Dr. Koop also was criticized for minimizing concerns about the severity of allergies to latex gloves.  It was later learned that a company manufacturing latex gloves had contracted and paid Koop $650,000 for consulting work. However, the division for which Koop was consulting was apparently unrelated to their latex division.

Is this a lapse in judgment or an error in optics? Does this misstep tarnish Dr. Koop’s legacy?  I will leave it to you, dear readers, to decide.

There is a story in the Talmud about the high priest Johanan who became corrupted at the age of 80, leading to the aphorism “ Do not be sure of yourself till the day you die.” I can only surmise that the lesson is one must always be self-vigilant - and attacks on those who really care about public welfare - may eventually take their toll.

And yet, he was a hero, at least to many. As one political observer noted at the end of Koop’s life:

"I don't think I have ever met anyone for whom I had more respect... 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."

-  Michael Specter, The New Yorker

[1] Ryan White was one of the first children and among the first patients with hemophilia to contract AIDS and die. Isaac Asimov, neither homosexual nor drug user, similarly died of AIDS due to a contaminated blood transfusion.