U.S. News

02.26.13

C. Everett Koop: Pioneering Surgeon General Spurred Reagan Response to AIDS

The plain-speaking physician, who has died in New Hampshire, badgered and finally wore down the Regan administration into responding to the growing AIDS crisis in the1980s, and changed the discussion with his blunt, 36-page report on the disease.

C. Everett Koop, a pediatric surgeon who shocked the Left and the Right (especially the Right) alike in the 1980s by viewing HIV infection as a disease and not a moral construct died today at age 96. Although I never met him, I was around when he was around in the early and darkest days of AIDS, and without question, he was a real beaut—a large, ursine presence who in appearance at times veered precariously close to something, perhaps a Who in Whoville, from Dr. Seuss. He was willing to be a large, near-caricature as he moved from camera to camera in those Armed Services whites, the military stripes gleaming on his chest and the bars across his shoulders, as if it were he and not Dutch Reagan who had stepped out of a World War II B-movie. No one in that era enjoyed being himself more than Dr. Koop, even the president.

Before becoming a celeb, Koop was a very successful and respected pediatric surgeon at Children’s Hospital of Pennsylvania (CHOP), with almost 300 academic articles to his name. Always conservative, he cut his political teeth in the 1970s by penning a fiercely argued book, The Right to Live, the Right to Die, which challenged abortion, the Karen Quinlan case (in many ways a 1970s version of Terri Schiavo ), and other third-rail topics, then followed it up with the more inflammatory, Whatever Happened to the Human Race, which he co-authored with Dr. Francis A. Schaeffer.

The works surely caught the eye of the new president, who nominated Koop in 1981 to be surgeon general. Neither man could anticipate the world-altering epidemic that would run in parallel and eventually come to dominate the Ronald Reagan years. The first cases of AIDS were reported in the summer of 1981, just a few months after Reagan’s inauguration. And the infection picked off all the people the Reagan Revolution didn’t want to think about—gays, Haitian immigrants, drug addicts— and it killed them slowly and miserably. Plus, unlike movies that bombed or ex-wives who dithered, it wouldn’t go away.

The early years of AIDS were truly hopeless. No way to diagnose it, treat it, or prevent it, and a president who, according to Randy Shilts in his epic retelling, And the Band Played On, did not mention the disease till well into his second term. But then in 1983 the virus was identified, and a year later a test for infection developed and hope appeared a little—though only a little.

Enter C. Everett Koop, who spent several years trying to get the administration to go public with advice, with direction, with something to let the country know it cared even if it didn’t. But it wasn’t easy, even for the surgeon general. He was excluded from the high-level meetings the Reagan Administration was having on AIDS until at least 1983; the inner circle saw AIDS as a punishment for misbehavior—surely things the president never had seen in Hollywood—and wasn’t interested in a high falutin scientific explanation.

Then finally, under tremendous public pressure, Reagan green-lighted his surgeon general in 1986 to actually say something—or rather, write something (he was forbidden to answer questions posed by the press). After all, for Reagan and his government-phobic pals, the surest way to invite obsolescence and derision was to write a memo or a brochure—another useless government document sure to gather dust in some box somewhere until discovered decades later perhaps, and found to be smirk-worthy.

Koop produced the now famous 36-page document that talked about non-procreative sex (no!) including gay sex (please God, no!). Condoms were mentioned (salts, pass me the smelling salts!) and sex education emphasized! Why, it may have been as lurid as the Ken Starr report! Words like vagina and penis were used—words right out of junior high school biology! Koop even sent, in 1988, a condensed version to every household in America. In it, he made it clear that people should understand that unprotected sex could be dangerous; that the threat of tragic spread and a global epidemic was real; and that blaming the victims was not acceptable behavior for this or any disease.

At first blush, it was incredible. Someone—one of their very own—standing up to the bullies and too-busy-for-us businessmen of the White House, the Regans and the Meeses and the Rumsfelds who had real business to tend to, not this irritating public-health shit. Koop, a man of the far right, was standing tall and unbending. And he won.

Thinking about it now though, it’s obvious why Koop did what Koop did. He was a doctor from a bygone era, a pediatric surgeon. The rock and moral center of some small town. And his bread and butter to operate on three-pound preemies with congenital defects. He was great at it, at dealing with the hopeless, at calming the broken hearts of parents, at trying to see something faintly hopeful ahead. He was actually inspiring to me and to other doctors at the time—someone of principle. Never mind that he tried to cash in a few years later with a failed website and an attempt to brand the Koop name. His judgment was off—large fame should never happen to the older man.

Dr. Koop should less be remembered as the guy who badgered and finally wore down Reagan, or even as the one who led the first baby steps of the government’s response to AIDS, than as a physician who let his heart and not a preconceived ideology guide his decisions. He made doctoring, for a brief shining moment on the hill, once again an admirable profession, connected not to blood tests or billing or even to health care, but to a large and even spiritual calling. He returned medicine to its most elemental form—a profession that tries to help out someone who is sick.