Obituary: C. Everett Koop / Government's face in the AIDS fight as surgeon general

Oct. 14, 1916 - Feb. 25, 2013

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C. Everett Koop, the former surgeon general of the United States who started the government's public discussion of AIDS during the Reagan administration, died Monday at his home in Hanover, N.H. He was 96.

A spokeswoman for the C. Everett Koop Institute at Dartmouth confirmed his death but did not disclose the cause.

Dr. Koop was the most recognized surgeon general of the 20th century. He almost always appeared in the epauleted and ribboned blue or white uniform denoting his leadership of the commissioned corps of the U.S. Public Health Service. With his mustacheless beard, deep voice and grim expression, he looked like a Civil War admiral.

The appearance, however, masked a fierce self-confidence, an unyielding commitment to professional excellence, and a willingness to challenge the expectations of his patrons.

A 64-year-old retired pediatric surgeon at the time Ronald Reagan nominated him in 1981, Dr. Koop had no formal public-health training. His chief credential was that he was a socially conservative, devout Christian physician who had written a popular treatise against abortion. His confirmation took eight months. Few people expected him to talk about homosexuality, condoms and intravenous drug use when almost nobody else in the Reagan administration would even utter the word "AIDS."

Dr. Koop, however, believed information was the most useful weapon against the AIDS virus at a time when there was little treatment for the infection and widespread fear that it might soon threaten the general population. In May 1988, he mailed a seven-page brochure, "Understanding AIDS," to all 107 million households in the country.

Among AIDS activists, Dr. Koop became an unlikely hero, although some came to think that his sexually explicit talk tended to further stigmatize gay men.

"Most of us thought that a huge part of how the crisis grew exponentially was that those in power chose to ignore it for as long as they could," recalled Peter Staley, a founding member of the AIDS Coalition to Unleash Power. "He was the only person in that administration who spoke the truth when it came to AIDS."

Dr. Koop was also a tireless campaigner against tobacco. As surgeon general, he released a report in 1982 that attributed 30 percent of all cancer deaths to smoking. He wrote that nicotine was as addictive as heroin, warned against the hazards of secondhand smoke and updated the warning labels on cigarette packs.

Michael Fiore, founder of the University of Wisconsin Center for Tobacco Research and Intervention, once said Dr. Koop's reports on smoking "totally changed the landscape" of tobacco control.

He was among the last survivors of a small generation of American doctors forced by World War II into highly responsible roles at very young ages. After the war, many became academic physicians and researchers who helped fuel the explosion of medical therapeutics in the second half of the 20th century. In Dr. Koop's case, the new frontier was pediatric surgery, a specialty that barely existed when he entered it. He became one of the half-dozen leading practitioners in the world.

Charles Everett Koop, an only child, was born in New York City on Oct. 14, 1916. His father, who did not finish high school, was an officer at a bank. His mother occasionally assisted in at-home surgical operations in the neighborhood by administering anesthesia -- a task the surgeon often farmed out to a responsible bystander. His paternal grandparents lived with his family, and his maternal grandparents and many cousins lived nearby.

Dr. Koop attended Dartmouth College on a football scholarship but had to give up the sport after suffering an eye injury. He majored in zoology and graduated in 1937. That fall he entered Cornell University's Medical College, in New York City.

He graduated in 1941 and did an internship in Philadelphia before starting surgical training at the University of Pennsylvania. By the time his residency began, six months after the Pearl Harbor attack, much of the surgical staff had entered military service.

That left a large amount of work to the surgical residents, and Dr. Koop proved to be an unusually skilled and energetic one.

After the war ended, the surgeon in chief at the hospital suggested that Dr. Koop take a job as the head of surgery at Children's Hospital of Philadelphia. When he assumed the position in January 1946, he was not yet 30.

At the time, general surgeons, or specialty surgeons such as urologists, operated on infants and children without specific training in how their anatomy and physiology differed from adults'. The only pediatric surgery program in the country was in Boston. Operations on newborns were rare and mortality was high.

In 1956, he created what was reputedly the first neonatal surgical intensive care unit in the country.

After retiring as surgeon general in 1989, Dr. Koop lectured, wrote an autobiography, and in the 1990s with other investors established a website,, that provided medical information. The enterprise proved an embarrassment, however, when it turned out some of the information was paid advertising. It no longer exists.

President Bill Clinton awarded Dr. Koop the Presidential Medal of Freedom in 1995. In recent years, he was a scholar at an institute that bears his name at Dartmouth Medical School.

A son from his first marriage, David Koop, was killed in a mountaineering accident in New Hampshire in 1968 when he was a 20-year-old student at Dartmouth. Dr. Koop and his first wife, the former Elizabeth Flanagan, who died in 2007, later wrote a book, "Sometimes Mountains Move," about their experience of grieving in the hope it might help other parents who had lost children.

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