The late C. Everett Koop chose to fight the AIDS epidemic at its 1980s outset, despite resistance from the conservative base that brought him into the office.
His 6'1" stature, gray mustache-less beard, booming voice, the gold-braid and epaulettes of his vice admiral's uniform gave C. Everett Koop the appearance of an Old Testament prophet. Many noted the likeness during his tenure (1981-89) as the most influential surgeon general in American history, and in the years afterward as an outspoken opponent of the tobacco industry.
Dr. Koop died at his home in Hanover, New Hampshire on February 25. He was 96.
Dr. Koop -- "Chick" to his friends -- answered President Reagan's call to become surgeon general, even though he had no public health training and was already in his sixties, legally too old to join the U.S. Public Health Service he would be leading.
To be sure, Koop brought a reputation for boldness, first evidenced when he became surgeon in chief of Children's Hospital in Philadelphia shortly after finishing his residency. When Reagan nominated him, 35 years later, Koop had stellar credentials as a pediatric surgeon. In one of the thousands of complex operations he performed, he separated conjoined twins connected at the heart, knowing that only one child could survive.
As a deeply religious Presbyterian and the author of a book opposing abortion, Koop also brought the evangelical Christian credentials Reagan wanted to reward the religious right wing that had helped elect him.
"It's hard to understand how desperate those of us who were affected by the epidemic were for the validation by a mainstream public health official."
Liberal Democrats in Congress worried Koop would use the surgeon general's bully pulpit on public health issues as a de facto church pulpit to push a conservative religious agenda on the nation. Senate health committee chairman Ted Kennedy held up Koop's nomination in the Senate. Representative Henry Waxman, chairman of the health subcommittee, strenuously opposed him in the House. Public health groups, women's and gay rights groups and medical associations lobbied against his appointment.
The New York Times called him "Dr. Unqualified." The Boston Globe argued that the "fanatical" Koop was a "dogmatic Christian fundamentalist with the kind of tunnel vision that limits bureaucrats of any ideological stripe." But after eight long months, he was finally confirmed.
As the political drama played out on Capitol Hill, a far bigger and deadlier drama was just beginning, as the first cases of AIDS were reported in the summer of 1981. Young, formerly healthy men in Los Angeles, New York, and San Francisco suddenly began to get sick and quickly die from pneumocystis carinii pneumonia and Kaposi's sarcoma, infections that preyed on people with a weakened immune system.
For his first four years in office, religious conservative politics swayed the nation's health chief away from addressing the growing AIDS crisis. Without a cure or vaccine, and with mounting public hysteria, Koop in 1986 was finally authorized to report on the epidemic.
When Koop set out to write his report, no one knew what, exactly, he would say. Evangelicals and gay groups alike, then the key advocates for people with AIDS because so many of them were gay men, were nervous.
"We were desperately afraid when he took on doing the report," recalled Trust for America's Health executive director and George Washington University health policy professor Jeffrey Levi, who was then the government relations director for the National Gay and Lesbian Task Force. "It's hard to understand how desperate those of us who were affected by the epidemic were for the validation by a mainstream public health official."
It was, after all, in 1986 that conservative commentator William F. Buckley, Jr. called for the tattooing of every gay man and injection drug user. Other conservative Republicans talked about quarantining HIV-positive people and "rounding up" all gay men.
But Levi and other advocates for people with AIDS were pleasantly shocked by the man who met with them. Instead of a religious zealot they expected to "go berserk" about homosexuality and promiscuity, Levi said, "We were totally unprepared for the nature of the conversation because it was so positive and so forthcoming."
Levi says the Surgeon General's Report on Acquired Immune Deficiency Syndrome was "as transformative as all the obits are saying."
While he was preparing the landmark report, Koop and his wife lived in the surgeon general's official residence on the campus of the National Institutes of Health, in Bethesda, Maryland. Two hundred feet away was the office of Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease and the government's most visible HIV/AIDS scientist. Fauci became not only Koop's personal physician and friend, but his tutor on the epidemic as well.
He got it in his mind that we as the federal government need to be explicit about this -- oral and anal sex, commercial sex. He was hell-bent on doing it.
"He would come home from hearings downtown as things started to accelerate with HIV," Fauci told me. "As he was walking home he had to pass my office. Around 7:30 at night, he would come knock at my door. He would say this thing about AIDS is very troubling, and I want to make the right impression on public awareness. He got it in his mind that we as the federal government need to be explicit about this -- oral and anal sex, commercial sex. He was hell-bent on doing it. When it came out, it shocked a lot of people because of its explicitness."
Dr. Koop wrote in the report's foreword, "At the beginning of the AIDS epidemic, many Americans had little sympathy for people with AIDS. The feeling was that somehow people from certain groups 'deserved' their illness. Let us put those feelings behind us. We are fighting a disease, not people ...The country must face this epidemic as a unified society. We must prevent the spread of AIDS while at the same time preserving our humanity and intimacy."