TIME: Almanac 1993/TIME Almanac 1993.iso/time/042489/04248900.065

Text File | 1992-09-23 | 12.3 KB | 232 lines

                                                                                PROFILE, Page 82

A Doctor Prescribes Hard Truth


C. EVERETT KOOP, America's Surgeon General, has an opinion on
everything healthful, but he nonetheless enjoys meat and
martinis

By MARGARET CARLSON


    He is, by Washington standards, a little strange. First,
there is the uniform draped with gold braid he insists on
wearing. Before he became famous, it prompted people at
airports to pile him with baggage and ask what time the flight
was leaving. Then there is the big, clunky hearing aid that he
takes out and fusses with right in the middle of a conversation,
as if it were a pipe, and the canvas tote he uses as a
briefcase, and his habit of loudly cracking his knuckles. On top
of that there are the Old Testament beard and the preacher's
voice that make him seem like Moses come down again from Mount
Sinai to deliver commandments 11 through 20. Smoking? It's an
addiction that will kill you. Sex? Only in marriage. AIDS? The
best preventive device is a monogamous relationship; the second
best, a condom. Deformed newborns? Save them. Sex education? In
the earliest grade possible.

    You name it, Surgeon General C. Everett Koop has an opinion,
which he will give you with great certainty at high speed. There
has never been a Surgeon General like him, not even Luther
Terry, who slapped warnings on cigarette packs 24 years ago.
It's a fair guess that Terry was never air-kissed by Elizabeth
Taylor, the butt of jokes in Johnny Carson's monologue, was
never a visitor to the set of Golden Girls, and never lectured
Hollywood producers about showing safe sex in their programs.
Antismoking is a small part of Koop's crusade; AIDS, child
abuse, domestic violence, pornography, old people, drunk driving
and Baby Doe regulations made Koop one of the most visible
officials in Washington. Now at airports people offer to carry
his bags.

    The 13th Surgeon General, whose second term runs through the
end of the year, almost never got a chance to don a uniform.
When Koop, a retired pediatric surgeon, and his wife Betty
moved to Georgetown in early 1981 to await his confirmation,
they became proof of the old saw that if you want a friend in
Washington, buy a dog. The process, expected to take a few
days, turned into nine nightmarish months of name-calling and
personal attacks, as liberals stalled his confirmation. He was
called a right-wing crank, a prolife nut, a religious zealot,
inexperienced, Dr. Unqualified (the New York Times), scary
(California Congressman Henry Waxman) and Dr. Kook. The
intensity of the attacks was fueled by prochoice advocates who
feared his opposition to abortion. In addition to being the
author of several books, Koop was known for an antiabortion
film he produced in which a thousand black and white dolls were
scattered over the salt wastes of the Dead Sea to represent
millions of aborted fetuses. Koop, who became an evangelical
Presbyterian in his 30s, explains his views against abortion
and against withholding food and medical care from congenitally
deformed newborns simply: "If you had led my life, you would
understand." As a pediatric surgeon for 33 years, Koop saved
many babies no bigger than his hand. In the course of treating
100,000 patients, Koop saw many so-called difficult cases become
happy and productive children. One of these was Paul Sweeney,
born in 1965 with twisted intestines, facial deformities and a
cleft palate. Koop operated on him 37 times. For the final
operation by another surgeon in 1983, Koop returned to
Philadelphia in full dress uniform to wheel his former patient
into the operating room. Sweeney recently graduated from West
Chester University in Pennsylvania.

    Accustomed to the godlike treatment accorded surgeons, Koop
was stunned by the viciousness of Washington, which has neither
gods nor heroes. Every day he would go to his temporary office
on the seventh floor at the Department of Health and Human
Services. Every day the phone wouldn't ring. His wife, uprooted
from Philadelphia, waited in their small sublet wondering
whether to unpack. One day Koop returned to find tears rolling
down her face, a critical newspaper article on her lap. He
considered leaving, but Betty persuaded him to stay. The two
had been through a lot -- long years of medical school, Koop's
fractured vertebra and stomach surgery and, worst of all, the
death of a son -- and they stuck it out. Finally, in November
1981, he was confirmed by a Republican-controlled Senate.

    Koop was expected to be a figurehead like most Surgeons
General, with little authority and few staff or duties, but he
quickly shook things up. He insisted that the commissioned corps
of public-health officers wear uniforms. Then the 6-ft. 1-in.,
210-lb. doctor, whose taste for red meat and martinis keeps him
from losing his paunch, pronounced the U.S. a country of fatsoes
who would have to give up cholesterol in favor of fiber. When
Koop found out that the tobacco companies had fought hardest
over the years against the Government's calling nicotine
addictive, he stated high up in his Surgeon General's report
that nicotine is addictive. "They absolutely hated it," he
gloats. He said the companies' claims that science cannot say
with certainty that tobacco causes cancer were "flat-footed
lies" and that sending cigarettes to the Third World was "the
export of death, disease and disability."

    He is not above gimmicks. Pushing his slogan "A Smoke-Free
Society by the Year 2000," he adopted a kindergarten class whose
students pledged not to start smoking ("Like Communists," he
says, "you have to get them when they're young"), and everywhere
he goes he hands out buttons saying THE SURGEON GENERAL
PERSONALLY ASKED ME TO QUIT.

    But Koop might have remained just another bureaucrat if it
had not been for AIDS. As the disease grew to near epidemic
proportions, the Administration had to do something.
Conservatives breathed a sigh of relief when in 1986 the
President handed the job to the Fundamentalist Christian
Surgeon General.

    After getting assurances that he would be the sole author of
the report, Koop took to the task with an open mind, consulting
Government experts like the National Institutes of Health's Dr.
Anthony Fauci and inviting more than 25 groups, from gay
activists to the Southern Baptist Convention, to his office. He
wrote 26 drafts at the stand-up desk in the basement of the
brick house he rents on the campus of the NIH. He numbered the
copies he took to a meeting at the White House and collected all
of them to prevent leaks. The next day, Oct. 22, 1986, he
released the report at a packed press conference; 16 million
copies of the report and 107 million copies of an AIDS pamphlet
are in print.

    Administration conservatives were stunned by the report's
candor. They were particularly outraged that he did not preach
abstinence alone and refer euphemistically to body fluids rather
than semen. "The White House doesn't like the C word. But if you
don't talk about condoms, people are going to die. So I talk."
Liberals were amazed that Koop had produced a reasoned report
with such compassion for homosexuals, whom he had once called
antifamily. Phyllis Schlafly, who said the report sounded as if
it had been edited by a gay-rights group, lashed out against
Koop and led a campaign against him. Her efforts culminated in
the boycott of a dinner in honor of Koop and persuaded two
presidential candidates, Representative Jack Kemp and Senator
Robert Dole, to pull out as sponsors of it.

    Koop says no one should be surprised, that the report is
consistent with his moral view that you can hate sin but love
the sinner. "I am the Surgeon General, not the chaplain, of all
the people, and that includes homosexuals," he says. He outraged
conservatives again in January. Although opposed to abortion
morally, Koop concluded, following an 18-month study undertaken
after President Reagan promised right-to-life leaders a report,
that the evidence just wasn't there to condemn the practice as
psychologically harmful.

    Despite his success in Washington, Koop's real calling is
medicine. By the time he was five, he knew he wanted to be a
doctor like his uncle. At 15, he would take the subway on
weekends from Brooklyn to Columbia-Presbyterian Hospital in
Manhattan, pinch a white lab coat, and take a seat in the
balcony of the operating room, transfixed for hours by
amputations and appendectomies. Back home, while his father was
at the office, he would persuade his mother to help her
precocious only child round up stray cats and dump them into a
sterile trash can with an ether-soaked sponge so that he could
perform exploratory surgery. He brags that he never lost a cat.

    Not your normal teenage pastimes, but Koop managed to avoid
being the science nerd with a slide rule in his back pocket. He
was on the wrestling, football and baseball teams, editor of
the school paper and president of the student council. He went
on to Dartmouth and Cornell University Medical College,
completing his training at the University of Pennsylvania in
1947. He surprised many people when he decided to specialize in
pediatric surgery, a decidedly low-rent field in those days,
when the real brains were going into neurosurgery. "Children
weren't getting a fair shake in surgery, getting giant incisions
like their grandfathers' and being sewn up like a football when
a tiny hole would do," he recalls. "I saw the chance to make a
difference." There were about five such surgeons in the country
at the time (there are close to 500 now), and Koop's training
consisted of going to Boston Children's Hospital and peering
over the shoulders of surgeons there, much as he did at Columbia
when an adolescent.

    Back in Philadelphia, Koop quickly became known as a
tireless and dedicated doctor. When a peptic ulcer threatened to
keep him out of surgery for months, he treated himself at night,
filling an IV bottle with milk and clamping it onto the bedpost.
With the help of his wife, then pregnant with their first child,
he would thread a tube through his nose and down his throat so
the liquid could drip into his stomach while he slept. More than
once, the jury-rigged system failed, and the Koops woke up in
a soaked bed.

    Koop was named surgeon in chief at Children's Hospital of
Philadelphia in 1948. There he perfected techniques for
correcting undescended testicles and undeveloped esophaguses,
skills that he compares to threading together two wet noodles at
the bottom of an ice-cream cone with your eyes closed. His first
brush with fame came when he separated Siamese twins joined at
the abdomen and pelvis. He established the country's first
neonatal unit. Noted for his speed -- he did hernias in six
minutes (he has done more than 10,000) -- he used the time saved
to counsel parents and make house calls on terminally ill
patients he thought were better off at home. Dr. Judah Folkman, a
professor at Harvard Medical School who trained under Koop,
says, "I remain in awe. He was beloved at that hospital,
worrying over patients as if they were his own children." To
criticism that he tinged his medicine with religion, Koop says,
"There are no atheists at the bedside of a dying child."

    Koop learned this firsthand in 1968, when his youngest son
David, a junior at Dartmouth, fell to his death in a
mountain-climbing accident. "I thought I knew what parents went
through, but I had no idea," he says. "I felt bone-crushing
grief." For months he got such a lump in his throat talking to
parents that he had to cut his discussions short.

    Koop and his wife, the daughter of a Connecticut country
doctor for whom a punishing dawn-to-midnight schedule was
normal, have three other grown children and seven
grandchildren. The Koops recently celebrated their 50th wedding
anniversary aboard the QE2.

    Whatever happens when his term is up in 1990, Koop will stay
in Washington, which has made its peace with him. His most
vociferous enemies have admitted they were wrong about him. Most
of the friends he lost in making the ethically correct -- not
politically correct -- decision on AIDS have come back. The city
that worships at the gray altar of ambiguity found there was
room for a man of black and white.