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An American pediatric surgeon who was the only surgeon general around that time that became a household name.

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A brilliant pediatric surgeon, C. Everett Koop, MD, FACS, was surgeon-in-chief at the Children's Hospital of Philadelphia (CHOP) from 1946 to 1981. During his tenure there, Dr. Koop established the nation's first neonatal surgical intensive care unit in 1956. He helped establish the biliary atresia program at CHOP when pioneering surgeon Morio Kasai came to work with him in the 1970s. He also established the pediatric surgery fellowship training program at CHOP. During his tenure, 35 residents and 14 foreign fellows graduated, many of whom went on to become professors of pediatric surgery, directors of divisions of pediatric surgery, and surgeons-in-chief of children's hospitals. Dr. Koop also successfully separated several sets of conjoined twins and was the inaugural editor of the Journal of Pediatric Surgery.

Dr. Koop was nominated as Surgeon General by President Reagan and confirmed in 1981. His appointment was controversial because of his known conservative stance on many issues and his opposition to abortion.

In a 1988 report, he likened the addictive properties of nicotine to that of heroin and cocaine. This report led to a reform of the tobacco industry, and Dr. Koop challenged Americans to create a smoke-free society by the year 2000. Although this goal has yet to be achieved, smoking rates dropped from 38 to 27 percent during his tenure.

Most notably, the AIDS pandemic was recognized just after Dr. Koop's appointment, and it put him at the front line of perhaps the greatest public health challenge in U.S. history. In 1988 he took the unprecedented step of mailing information about AIDS to every U.S. household. The literature included frank descriptions of high-risk behaviors and stressed abstinence as the best method of prevention, but it also acknowledged the need for condoms if high-risk behaviors were undertaken. He also advocated early sex education in schools. This period was tough for Dr. Koop, but he was committed to and unapologetic about the distribution of this information.

Finally, Dr. Koop was an advocate for the rights of handicapped children. The case of Baby Doe, in which parents of a child refused to allow treatment for a tracheoesophageal fistula, resonated with Dr. Koop, who was very familiar with the excellent results of this procedure. This case led to the Baby Doe Amendment, which protects the rights of handicapped infants and children.

These major issues combined with Dr. Koop's powerful personality and his willingness to make use of mass media brought the Office of Surgeon General to a higher public profile than ever before. He became a well-known and very recognizable public figure. Dr. Koop passed away on February 25, 2013, at the age of 96.

The lessons we can all learn from Dr. Koop are straightforward. As surgeons, we must lead with conviction. This is true in the operating room, in the boardroom, the community, and in the political arena. Only when we lead with full commitment and conviction can we reach our maximum effectiveness.

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On the Shoulders of Giants: C. Everett Koop, MD, FACS

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"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. 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." The Washington Post (May 24, 1987)
Dr. C. Everett Koop was a prominent pediatric surgeon, a commissioned officer in the US Public Health Service, and the 13 th Surgeon General of the United States. Dr. Koop was a pioneer in the field of pediatric surgery, and his contributions include advances in complex surgical procedures, establishment of the nation's first newborn surgical intensive care unit, and the implementation of a surgical fellowship training program at the Children's Hospital of Pennsylvania. Dr. Koop was a relentless advocate for public health and health education, focusing his efforts on diet, nutrition, and disease prevention, treating these threats as public health rather than moral issues.

As Surgeon General, Dr. Koop applied his skills as a clinician and healer to address the critical health challenges of the country. He became a household name, known across the nation as "America's Family Doctor." He was a leader in the fight to create a smoke-free nation, testifying before Congress in favor of rotating labels warning against the specific dangers of smoking, and continuing his advocacy even after the Reagan White House withdrew its support under pressure from the tobacco industry. The AIDS epidemic emerged at this time as a new threat to the public health, and he used his platform as Surgeon General to speak candidly and honestly to the nation, focusing the conversation on science and education.

Dr. Koop stepped down as Surgeon General in 1989, and returned to Dartmouth, his alma mater, where he continued his lifelong mission to educate the public on health issues in his role as Senior Scholar of the Koop Institute.

"Dr. Koop was not only a pioneering pediatric surgeon but also one of the most courageous and passionate health advocates of the past century. He did not back down from deeply rooted health challenges or powerful interests that stood in the way of needed change. Instead, he fought, he educated, and he transformed lives for the better." Wiley W. Souba, MD, Former Dean of the Geisel School of Medicine at Dartmouth.

C. Everett "Chick" Koop was born in Brooklyn, NY, on October 14, 1916. He was an only child, and grew up surrounded by close-knit extended family. He expressed interest in medicine at an early age, and as a teenager he would sneak into the viewing gallery in the operating theaters at Columbia University's College of Physicians and Surgeons. His family nurtured his aspiration to become a surgeon, with his mother administering anesthesia during his home surgeries on rabbits, rats, and stray cats. He attended Dartmouth College on a football scholarship, which he gave up after sustaining an eye injury and receiving a warning from the school ophthalmologist that he was endangering his future as a surgeon.

Dr. Koop graduated from Dartmouth College in 1937, with a degree in zoology, and received his MD degree from Cornell Medical College in 1941. He pursued postgraduate training at the University of Pennsylvania School of Medicine, Boston Children's Hospital, and the Graduate School of Medicine at the University of Pennsylvania, from which he received the degree of Doctor of Science (Medicine) in 1947. He was named Professor of Pediatric Surgery at the School of Medicine at the University of Pennsylvania in 1959 and Professor of Pediatrics in 1971.

From 1948 to 1981, he served as Surgeon-in-Chief at the Children's Hospital in Philadelphia, where he developed new procedures specific to infants and children, and established the first neonatal intensive care nursery in the nation. Koop helped establish the field of pediatric surgery on the basis that children's bodies are not adult bodies in miniature, but are anatomically and physiologically different and so require special surgical procedures. Included among his innovations were a device to prevent anesthesia overdoses in children, and new techniques to correct inguinal hernias and esophageal atresia. He also demonstrated that once terminal conditions, such as hydrocephalus and diaphragmatic hernias, were correctable. He was the first surgeon to separate Siamese twins joined at the heart.

Dr. Koop received numerous honors and awards, including 17 honorary doctorates. He was awarded the Denis Brown Gold Medal by the British Association of Paediatric Surgeons; the William E. Ladd Gold Medal of the American Academy of Pediatrics in recognition of outstanding contributions to the field of pediatric surgery; the Order of Duarte, Sanchez and Mella, for his achievement in separating conjoined Dominican twins. He was awarded the Medal of the Legion of Honor by France in 1980, inducted into the Royal College of Surgeons in England in 1982, and the Royal College of Physicians and Surgeons of Glasgow. He was also the author of more than 200 articles and books on the practice of medicine, and received an Emmy in 1991 for a five-part series on health care reform.

Dr. Koop was sworn in as the nation's 13 th Surgeon General on November 17, 1981, appointed to the post by President Reagan. As Surgeon General, he oversaw the activities of the 6,000 member U.S. Public Health Service Commissioned Corps, in addition to advising the president and the public on health matters such as smoking, diet and nutrition, and the importance of immunization and disease prevention.

Dr. Koop did not enter the office of Surgeon General as an anti-smoking crusader, but once he began to study smoking as a public health issue, he was appalled by the deceptive advertising and aggressive lobbying of the tobacco industry. His first official act after his confirmation was to issue the 1982 Surgeon General's Report on Smoking and Health, the most authoritative statement to date on the connections between smoking and cancer. In May, 1983, Dr. Koop received the Public Health Service Distinguished Service Medal in recognition of his extraordinary leadership of the U.S. Public Health Service.

Dr. Koop's two terms as Surgeon General coincided with the rise of the AIDS epidemic in the U.S. After being relegated to the sidelines by the Reagan Administration during his first term, Koop dedicated his time and energy to the disease in his second term. In 1986, he was finally authorized to issue a Surgeon General's report on AIDS. It was explicit, non-judgmental, controversial and popular. It contributed significantly to providing accurate, comprehensive information on this disease that no one had heard of just a few years earlier. Dr. Koop was also responsible for the largest public health mailing ever done, when he wrote and disseminated "Understanding AIDS," the PHS brochure based on CDC guidelines that was sent to 107 million households in the United States.

Through his reports and his many speeches and interviews on AIDS, Dr. Koop did more than any other public official to shift the terms of the public debate over AIDS from the moral politics of homosexuality, sexual promiscuity, and intravenous drug use, to concern with the medical care, economic position, and civil rights of AIDS sufferers. Dr. Koop also promoted redefining the prevalent scientific model of the disease, from a contagion akin to historic epidemics to a chronic disease that was amenable to long-term management with drugs and behavioral changes.

Dr. Koop proved to be an outspoken advocate on public health issues. He turned a federal office with a minimal budget and staff into an authoritative platform from which to educate the nation on matters of health promotion, disease prevention, and emerging health threats. In September, 1995, President Clinton awarded him with the Presidential Medal of Freedom, the nation's highest civilian award.

In 1992, Dr. Koop returned to Dartmouth as the Elizabeth DeCamp McInnery Professor of Surgery at the Geisel School of Medicine. He became a founding member and Senior Scholar of the C. Everett Koop Institute, a partnership of educators, scholars, researchers, and practicing physicians dedicated to promoting health and well-being through disease prevention.

Dr. Koop was predeceased by his first wife, the former Elizabeth Flanagan, and by their son, David. He is survived by three children, eight grandchildren; and his wife, the former Cora Hogue.

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"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. 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.

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On July 4, 1988, then-U.S. Surgeon General C. Everett Koop signed my commissioning papers, making me an officer in the U.S. Public Health Service Commissioned Corps. This connectivity with a public health legend set me on a pathway of service.

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World AIDS Day has been celebrated on the first day of December every year since its founding at the height of the AIDS epidemic in 1988. It provides an annual opportunity to show support for those living with AIDS and to remember those we have lost; to look back at how it started and see how far we have come; and to realize that the fight against AIDS is not yet over.

In the earliest days of AIDS, when the disease was less understood and the government was dragging its heels in formulating any kind of effective response to the growing epidemic, Surgeon General C. Everett Koop proved an unlikely but effective ally in changing public policy. In 1981, the very conservative Dr. Koop was nominated by President Reagan to be Surgeon General and was sworn into office in January 1982 after a contentious confirmation process. Opponents on the left feared that his appointment was giving political ideology priority over public health, but as Michael Specter put it in his 2013 Postscript for The New Yorker, "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."

As AIDS first began to spread, there was a great deal of uncertainty over just how contagious the disease was and how it was being transmitted. AIDS seemed to resemble earlier catastrophes such as bubonic plague and yellow fever. Some proposed drastic measures, such as mass quarantines and mandatory screening of at-risk populations. Many people treated AIDS patients with disdain. The disease had become associated with populations outside the mainstream: gay men, drug addicts, and the sexually promiscuous. At times, this social attitude even took on a religious tone; victims were accused of being under a curse for their immoral behavior.

Dr. Koop recognized early on that the disease that came to be known as AIDS had the making of an epidemic, but differentiated this disease from easily transmitted contagions such as bubonic plague, yellow fever, Spanish flu, and the more recent COVID-19. Those diseases required extraordinary public health measures such as mandatory testing and quarantine of infected patients. AIDS, in contrast, was a chronic disease that could be managed with drugs and behavioral changes and could be prevented by educating the public in how to protect themselves without discriminating against AIDS sufferers in schools, the workplace, and housing.

The conservative Reagan administration, squeamish about starting a public debate over homosexuality, sex education, and drug abuse, contributed a small amount of funding for medical research, but largely ignored the disease and its victims. For two years Assistant Secretary of Health Edward Brandt-Koop's immediate superior-excluded Koop from the Executive Task Force on AIDS and forbade reporters to ask the Surgeon General questions about AIDS. Koop raised the objection that "you can't talk of snake poisoning without mentioning snakes."

In 1985 the death from AIDS of actor and celebrity Rock Hudson, a personal friend of Ronald and Nancy Reagan, served to focus attention of the public and the White House on the seriousness of the disease. During the same year, a test was developed to identify AIDS antibodies in the blood supply used for transfusions.

In February 1986, President Reagan finally authorized Koop to produce a Surgeon General's Report on Acquired Immune Deficiency Syndrome. There was never any direct, formal request. During a speech given to employees of the Department of Health and Human services on February 5, 1986, Reagan mentioned casually that "I'm asking the Surgeon General to prepare a major report to the American people on AIDS." Fortunately, Surgeon General Koop happened to be at the meeting and took the hint! With the assistance of a few trusted advisors, Koop wrote the report himself, at a stand-up desk in the basement of his home, rather than delegating the writing as government officials so often do. The finished report was presented before the President and the cabinet before going public. To avoid excessive, nitpicky meddling, he had the pamphlet printed on very expensive paper. On October 22, 1986, he released the finished report at a press conference.

The Surgeon General's Report discussed symptoms of AIDS and explained frankly how it was spread-through sexual intercourse, sharing of contaminated needles among drug users, from infected mother to child during pregnancy or birth, and through transfusion of contaminated blood or blood products. Readers were assured that AIDS could not be transmitted through casual contact. The report advised prevention through a program of compulsory sex education in schools, increased use of condoms, and voluntary, confidential testing. AIDS was a chronic, incurable disease, but it could be managed with drugs.

Though the Surgeon General's Report was not received without controversy (objections were raised to the mention of sex education and condoms; Koop was burned in effigy), it was notable for treating AIDS as a health issue rather than a moral issue and for giving the victims of the disease hope that they could extend their lives, participate fully in society, and be treated with respect and compassion.

In 1988, misinformation was still being spread about how AIDS is transmitted. Millions of Americans still believed they could get AIDS from cats, from mosquito bites, from toilet seats, from donating blood, even from sitting next to a child in school. Another misunderstanding being spread was that only people from certain "high risk groups" were infected with AIDS. In order to counter this constant stream of misinformation, the Surgeon General sent out a mailer entitled Understanding AIDS to everyone on the IRS mailing list. It was the largest mailing in American history: 107,000,000 copies. The brochure explained in plain language exactly how one can and can't get AIDS.

At the time of Surgeon General Koop's report, a person diagnosed with AIDS had little chance of surviving the next two or three years, and next to no chance of surviving longer than that. Today there is still no cure, but with modern treatments AIDS patients are living long and fulfilling lives. Still, it is important to remember on World AIDS Day and after that there is a constant need for us all to unite in the fight to to eliminate the disparities and inequities that create barriers to HIV testing, prevention, and access to HIV care.

For more information about what you can do to make a difference, see hiv.gov.
Article by Bobby Griffith.
Bibliography

"AIDS, the Surgeon General, and the Politics of Public Health." The C. Everett Koop Papers. National Library of Medicine: Profiles in Science.

"The AIDS Epidemic." Reports of the Surgeon General. National Library of Medicine: Profiles in Science.

Koop, C. Everett. "The Early Days of AIDS, as I Remember Them." Annals of the Forum for Collaborative HIV Research 13, no. 2 (2011).

Koop, C. Everett Understanding Aids. Rockville MD: U.S. Dept. of Health and Human Services, 1988.

Specter, Michael. "Postscript: C. Everett Koop, 1916-2013." The New Yorker. February 26, 2013.

U.S. Department of Health and Human Services. Surgeon General's Report on Acquired Immune Deficiency Syndrome. Washington, D.C.: U.S. Dept. of Health and Human Services, 1986.

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C. Everett Koop and the First Surgeon General's Report on AIDS

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World AIDS Day has been celebrated on the first day of December every year since its founding at the height of the AIDS epidemic in 1988.

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Widely regarded as the most influential Surgeon General, Dr. Koop passed away in February 2013 at the age of 96

C. Everett “Chick” Koop was born in Brooklyn, NY,

. He was an only child, and grew up surrounded by close-knit extended family. He expressed interest in medicine at an early age, and as a teenager he would sneak into the viewing gallery in the operating theaters at Columbia University’s College of Physicians and Surgeons.

He attended Dartmouth College on a football scholarship, which he gave up after sustaining an eye injury and receiving a warning from the school ophthalmologist that he was endangering his future as a surgeon.

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Dr. Koop was a relentless advocate for public health and health education, focusing his efforts on diet, nutrition, and disease prevention, treating these threats as public health rather than moral issues.

He became a household name, known across the nation as “America’s Family Doctor.” He was a leader in the fight to create a smoke-free nation, testifying before Congress in favor of rotating labels warning against the specific dangers of smoking, and continuing his advocacy even after the Reagan White House withdrew its support under pressure from the tobacco industry.

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The AIDS epidemic emerged at this time as a new threat to public health, and he used his platform as Surgeon General to speak candidly and honestly to the nation, focusing the conversation on science and education. Through his reports and his many speeches and interviews on AIDS, Dr. Koop did more than any other public official to shift the terms of the public debate over AIDS from the moral politics of homosexuality, sexual promiscuity, and intravenous drug use, to concern with the medical care, economic position, and civil rights of AIDS sufferers. Dr. Koop also promoted redefining the prevalent scientific model of the disease, from a contagion to historic epidemics to a chronic disease that was amenable to long-term management with drugs and behavioral changes.

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The first comprehensive National HIV/AIDS Strategy, released by the White House in 2010,4 outlines four main challenges:

Too many people living with HIV are unaware of their status; almost one in six (15.8%) are unaware of their infection.6

Access to HIV prevention is too limited.

There is insufficient access to care.

Diminished public attention has been paid to the HIV/AIDS epidemic.