Koop Turned Surgeon General's Office Into Mighty Education Platform

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C. Everett Koop was the most outspoken and some would argue the most influential of all U.S. surgeon generals. [POST-BROADCAST CORRECTION: The correct plural form of the word is surgeons general.] He wore the uniform throughout most of the 1980s, and he turned an office with little power into a mighty platform - to educate Americans about AIDS prevention and the dangers of smoking.

C. Everett Koop died today at his home in Hanover, New Hampshire. He was 96. NPR's Joseph Shapiro looks back on his career.

JOSEPH SHAPIRO, BYLINE: When C. Everett Koop was nominated in 1981 by President Ronald Reagan to be surgeon general, the reaction was fierce. Koop was called Dr. Unqualified and Dr. Kook. He was a pediatric surgeon from Philadelphia, known for his early work to separate conjoined twins. He'd not been very involved in public health issues, but Koop did have a national reputation as a critic of abortion. So his early supporters were disappointed when he did not use his office to campaign against abortion. And it angered others when he spoke frankly about AIDS. In an interview with NPR toward the end of his time in office, Koop expressed bitterness over those who turned against him.

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DR. C. EVERETT KOOP: Well, I've been a lifelong Republican. I'm very conservative. At the moment, the conservatives hate me, have deserted me, have vilified me and would like to crucify me. They don't like what I've said about AIDS. And I think they are totally wrong. I think they are irresponsible. They talk about knee-jerk liberals - I've never seen such knee-jerks in my life as I have from the conservative right.

SHAPIRO: Journalists sometimes compared Koop to an Old Testament prophet, with his beard and booming voice; his severe and sometimes scolding manner. He used that manner to educate. Koop said he had little choice. As surgeon general, he was given just a handful of staffers and very little funding.

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KOOP: I don't have any line authority. I don't have any power. I don't have any budget. What I accomplish, I accomplish on a basis of moral suasion.

SHAPIRO: Koop said he understood that early on, when he put out his first report on smoking and got his first positive attention from the media. Koop continued to speak out sharply against the tobacco industry.

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KOOP: I view the people who peddle cigarettes as merchants of death because I know that they are killing 390,000 of my fellow citizens prematurely, every year. I can't stand by and let that happen.

SHAPIRO: But the thing that most changed Koop's image was when he spoke out about AIDS. President Reagan had avoided the issue, and Koop had gone along with that. Well into the AIDS epidemic, Reagan asked Koop to write a report. Koop kept it short. And in October of 1986, he released the AIDS report at a press conference, where his remarks got him in trouble.

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KOOP: AIDS education must start at the lowest grade possible, as part of any health or hygiene program; and there is no doubt that we need sex education in schools, and that it include information on sexual practices that may put our children at risk for AIDS.

SHAPIRO: White House officials, and Koop's one-time allies on the right, were furious. They did not like his emphasis on AIDS prevention. He talked about condoms instead of the virtues of sexual abstinence. Most controversial was his call for early sex education. Koop later told NPR that his critics were wrong.

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KOOP: And I said that you have to educate young people about AIDS because they are the most vulnerable, but you can't do that until you've educated them about sex. And that seems a very reasonable point of view, to me. And for anybody to take my simple, 92 words about sex education and convert that into headlines that - says that the surgeon general wants to teach sodomy in the third grade, is a breach not only of honesty but of etiquette and fair play.

SHAPIRO: Koop was stubborn, and he was often naive about how politics worked. He said he saw his job as putting public health first.

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KOOP: I am well aware of the fact that most people get AIDS by doing things that other people do not do, and don't approve of doing. But that doesn't mean that we can abandon the IV drug abuser or the homosexual who is now, as far I'm concerned, neither of those people. He is a sick man, or a woman. I've got to take care of him. And as I once said, I'm the surgeon general of all the people - the rich and the poor, and the white and the black; and what you may call amoral, and what you may call immoral. But I have to meet them at the sore point of anxiety about their health, not my health.

SHAPIRO: Koop was upset when the first President George Bush came into office and did not name Koop his secretary of Health and Human Services. Koop left government. He was asked to help start a health website, and even to let it use his trusted name. But there was controversy over whether DrKoop.com sometimes blurred the line between objective advice and advertising. And there were financial troubles. Koop sued to stop the company from being sold to an email marketer of pills, vitamins and supplements, including ones that Koop thought were unsafe. He lost that lawsuit, and the website carried Koop's magic name, along with a disclaimer that Koop was no longer associated with it.

Joseph Shapiro, NPR News, Washington.

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