Medicine remembers legacy of C. Everett Koop, MD
■ The 13th U.S. surgeon general was known for pioneering advances in pediatric surgery, crusading for a tobacco-free nation and educating the public on HIV/AIDS.
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When pediatrician Woodie Kessel, MD, MPH, would walk around his native Philadelphia with friend and former U.S. Surgeon General C. Everett Koop, MD, it wasn't uncommon for passers-by to stop and thank Dr. Koop for his dedication to medicine.
“They would say, 'You saved my life,' ” Dr. Kessel recalled. “ 'You saved the life of my child.' ”
Since Dr. Koop's death on Feb. 25 at age 96, health professionals and medical organizations have been commemorating his accomplishments, recounting his compassion, and noting his impact on pediatric surgery and public health.
Former colleagues and friends said Dr. Koop was known most for his trailblazing work on separating conjoined twins, advocating for a smoke-free nation and educating the public on the scientific facts about HIV/AIDS when few people spoke publicly about the disease. They said his sincerity, his willingness to speak honestly and his dramatic style, which included sporting a striking chin beard and wearing his public health corps uniform during public appearances, made him largely well-liked by members of the media.
In one memorable instance, Dr. Koop poured blood on his hands to emphasize that people shouldn't overreact to the threat of HIV transmission, said John R. Seffrin, PhD, CEO of the American Cancer Society.
“He was a bold leader, courageous and willing to say what needed to be said,” Seffrin said. “To me, his contributions [to medicine and public health] are legendary.”
Dr. Koop, whom close friends called “Chick,” spent much of his medical career at the Children's Hospital of Philadelphia, where he was surgeon-in-chief from 1946 to 1981, when he became the nation's 13th surgeon general. His pediatric surgery accomplishments included establishing the nation's first newborn surgical intensive care unit and implementing Children's Hospital's surgical fellowship training program, the hospital said in a statement.
“He transformed the relatively new field of pediatric surgery into a significant specialty in its own right,” said Steven M. Altschuler, MD, the hospital's CEO. “The Children's Hospital of Philadelphia will be forever indebted to Dr. Koop for the imprint he left upon the institution and upon all of pediatric health care.”
Highly influential top doctor
Despite his pediatric surgical achievements, some in the medical community were skeptical about whether Dr. Koop could succeed as surgeon general when President Reagan appointed him to the position, Seffrin said. At issue was Dr. Koop's lack of public health experience.
It took Congress months to confirm his nomination for the seat, which is unusually long for the post, Seffrin said. “It was a pretty tough time. He and his colleagues and friends and family had to wonder if it was worth it. But he hung in there.”
Dr. Koop went on to hold the position from November 1981 to October 1989, during the course of which he became what many observers consider the most influential surgeon general to date.
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The percentage of smokers in the U.S. fell from 34% to 26% during Dr. Koop's 8 years as surgeon general.
He had a “positive, lasting impact … on the health of our nation,” said Jeremy A. Lazarus, MD, president of the American Medical Association.
Among his most notable moves, Dr. Koop became the first administration official to call for a smoke-free nation. In 1988, he issued a landmark report finding that nicotine had addictive qualities that are similar to those of heroin and cocaine, according to Dartmouth College in New Hampshire. Dr. Koop earned his undergraduate degree from the college in 1937 and later founded the C. Everett Koop Institute at Dartmouth's Geisel School of Medicine. In part, the institute aims to support informed individuals to take charge of their health and well-being.
“Dr. Koop did more than take care of his individual patients — he taught all of us about critical health issues that affect our larger society,” said Dartmouth President Carol L. Folt, PhD. “Through that knowledge, he empowered each of us to improve our own well-being and quality of life.”
Among the eight major reports he issued on the health consequences of tobacco use was the nation's first study on the dangers of secondhand smoke. His anti-tobacco efforts helped lead to a decrease in the percentage of Americans who smoked, said Georges C. Benjamin, MD, executive director of the American Public Health Assn. The portion of smokers fell from 34% to 26% during his eight years in office, he said.
“The health and well-being of millions of people around the world are his legacy,” Dr. Benjamin said.
A lasting legacy on AIDS
Dr. Koop also made his mark on the issue of HIV/AIDS, members of the medical community said.
During the 1980s, when AIDS still widely was considered a “gay disease,” Dr. Koop advised the nation that it was a threat to all Americans. To help prevent transmission of the disease, he urged comprehensive sexual education in schools and condom use by people at risk for contracting or spreading HIV. Those positions, which were part of a comprehensive HIV/AIDS strategy, generated controversy among observers who thought they were in conflict with Dr. Koop's personal, socially conservative views.
In his 1986 report on HIV/AIDS, which Reagan requested, Dr. Koop aimed to educate the public about the disease, dispel myths about how it is transmitted and address ways to slow its spread. Those who knew the surgeon general said the report showed his passion for fixing things that weren't right and reducing human suffering.
“It is time to put self-defeating attitudes aside and recognize that we are fighting a disease — not people,” Dr. Koop said in a prepared statement on Oct. 22, 1986, when the report was issued. “We must control the spread of AIDS, and at the same time offer the best we can to care for those who are sick.”
To drive home that message, he sent “Understanding AIDS,” a U.S. Public Health Services brochure based on Centers for Disease Control and Prevention guidelines, to 107 million U.S. households in 1988, said current U.S. Surgeon General Regina M. Benjamin, MD. That was the largest public health mailing at the time.
“Dr. Koop proved to be an outspoken advocate on public health issues,” Dr. Benjamin said. “The nation and the world will miss a most notable public health figure.”