(University of Massachusetts Press, April 2025) By Nigel M. de S. Cameron
On any accounting, Charles Everett Koop was one of the most interesting and influential Americans of the late twentieth century. A celebrated surgeon but political novice, he was picked in 1981 to be Surgeon General in the insurgent Reagan administration. It was a shrewd sop to growing anti-abortion sentiment, particularly among evangelical Christians, since the seeming grandeur of the office was belied by its extremely limited functions.
As America progressed through the 1980s, Koop’s image underwent a remarkable metamorphosis – from pro-life stooge, excoriated by the press, to the sheer celebrity of a folk hero. By dint of an extraordinary work ethic, a flamboyant media presence, and a series of astute political plays, he had re-defined both his job and himself.
Koop was a household name well before all one hundred seven million U.S. households were mailed his briefing on AIDS. There were Koop editorial cartoons by the hundred. There were Koop super-hero dolls. The Simpsons scripted him, for all the latest “medical poop.”[i] Elizabeth Taylor blew him air kisses on-air.[ii] He was the butt of jokes in Johnny Carson monologues.[iii] He played himself in Exorcist 3.[iv] And Frank Zappa wrote a song about him.[v] By the late 1980s, chief of staff Admiral Edward D. Martin mused, “He was on everything. He was everywhere. Here was a guy with five people on his staff, who was getting more PR than the Secretary… more than the President!”[vi] The image of Koop in uniform (photo #1) was burned into the memories of a whole generation of Americans.
Right from the start, as Food and Drug Administration Commissioner David Kessler put it, Koop “elevated” the post of Surgeon General, despite concerted efforts in the Department of Health and Human Services hierarchy to keep him in his place.[vii] He came into office with what one scholar has termed a “self-dramatizing theatricality.”[viii] It was allied with a force of personality, and deep-seated self-confidence, which brought gravitas to his every move. We shall see how he rapidly turned around his relations with the press by going after the tobacco companies – becoming an instant hero to their critics. And how he became adept at exploiting the anachronisms built into his much-diminished role.
When, a few months after his confirmation, budget cuts elsewhere in HHS added to his portfolio the leadership of the Office of International Health, he grandly established an “Advisory Committee on International Health to the Surgeon General,” with the agency heads, all of higher government rank than himself, as members, and two weeks’ notice to its first meeting.[ix] In their confessedly “scathing and irreverent” Koop assessment, Public Health Profiteering, Washington professors James T. Bennett and Thomas J. DiLorenzo write, if with mild exaggeration, that “Koop treated this brummagem[1] job as a cross between Pope, Secretary of State, and Exalted Ruler of the Universe.”[x] The rise and rise of the Surgeon General’s office under Koop’s flamboyant leadership during the 1980s has few parallels in the history of government.
Once out of office, Koop was determined to remain, as he put it, the nation’s health conscience. There were campaigns and business ventures, a prominent role in the doomed Clinton healthcare reform effort, and a fresh institutional base back at his beloved Dartmouth College from which he sought to project a new vision for the future of medicine. Ever confident and theatrical, Koop had grown into and with the office of Surgeon General. Some would say that, as he became a celebrity, it went to his head. It certainly redoubled his self-assurance and helped set him up for some unfortunate choices in his later years that damaged his reputation and caused him distress.
Koop’s diverse set of commitments rendered him subject to caricature at every turn. Was he the unsophisticated pro-life kook the press suggested? Did he get a serious case of what in Washington is known as “Potomac fever” – an unhealthy taste of power – that undercut his conservative values and led him to go liberal? On retirement, did he exploit his reputation in the crass pursuit of riches? These and other sketches are easy to draw. Like every caricature, they pick out an element of the truth and then twist it out of proportion, so it is true no longer. Koop was an extraordinarily complex individual, as we shall see as we seek to unravel his history, his character, his motivations, and to make sense of his life.
A Life of Faith
While the Christian religion is still widely practiced within mainstream western culture, especially in the United States, its long decline – especially among elites – has made it increasingly challenging for non-religious writers to grasp what it actually means for believers. There is no simpler example than the tendency of so many journalists to write just one thing about Koop’s faith: that it was “fundamentalist,” which it was not. In his essay Surgeon Koop, Gregg Easterbrook suggests that church-going among Washington’s press corps is likely as common as square-dancing. Serious writers and readers need to take the religion of their subject seriously. Koop was a conservative presbyterian, who spent much of his adult life as a member of the mainstream – that is, theologically diverse – presbyterian denomination. Actual “fundamentalists” lock themselves into like-minded faith communities, while they repudiate culture, the life of the mind, and participation in public affairs. They have also not been known to drink double martinis.
The frequent “fundamentalist” dismissal of his religion has helped fuel fundamental misunderstanding of how he understood the significance of his faith for his work as Surgeon General. It’s a complete mistake to think that Koop somehow set it aside. Midway through his second term, he gave a remarkably personal speech on a visit to Scotland, which started out by facing head-on the fact that he had strong convictions. “Well, what happens when a person with strong, controversial, and publicly advertised ideas enters government? Must you deposit your religious beliefs in a blind trust? Should you donate your moral values to charity? Before you move to Washington, should you hide your ethics in an attic trunk? I say, No…. None of the above.”[xi]
A fine assessment of the Surgeon General appeared in an unlikely place – the magazine Mademoiselle. “Dr. Koop keeps surprising us – and, apparently, himself.” The writer challenges John B. Judis, of The New Republic, for writing of Koop’s “separation of professional responsibility from personal views of morality.” Even Koop himself could sometimes parrot this way of speaking, separating “ideology, religion and other things from my sworn duty as a health officer in this country,” so she challenges Koop too! “I think both Judis and Koop are selling the Surgeon General short,” says Mademoiselle. “It seems to me that Koop, by exercising an agonized compassion for the poor, the wounded and the disenfranchised, has successfully and spectacularly integrated his religious and professional life.”[xii]
The Sanctity of Life
For many readers, Koop’s opposition to abortion shapes their assessment of him. Yet as his conduct in office revealed, to the astonishment of friends and foes alike, he proved no cookie-cutter pro-life activist. “I came into the pro-life movement through my work with handicapped children,” he later wrote.[xiii] He feared that acceptance of abortion would lead to the acceptance of infanticide. And after that? The euthanasia of the elderly. “I believe that life issues are like falling dominoes.”[xiv] That was the theme of the documentary movie series that made him a pro-life hero.[xv]
On his appointment as Surgeon General he surprised everyone by deciding to step aside from the abortion debate. There was much else to do in public health, he maintained, that would save lives. “I would espouse the cause of the disenfranchised. Mothers and babies, handicapped children, people who needed transplantation of organs and couldn’t find them, women and children who were being battered and abused….”[xvi] Koop’s vision was unabashedly “pro-life,” both before and after birth. In office, his focus was after. Despite his dramatic campaigns of the 1970s, abortion was not, for him, as it is for some, the kind of overwhelming priority that seems to suck the oxygen out of every other moral question.
Like the rest of us, of course, Koop had feet of clay. As a devout evangelical Christian, who believed that “all have sinned and fallen short of the glory of God,” he knew that well.[xvii] Like others who have lived great, public, lives, and achieved far more than the rest of us, he had the opportunity to reveal his failings on a grander scale, sometimes, embarrassingly, in the eye of the press. At the close of the narrative we return to his personality and character, and reflect on the life that he lived.
His eclectic set of convictions led him to move freely between communities generally seen, not least by themselves, as exclusive of each other. In an age hallmarked by growing social and political conformity and division, Koop plowed his own furrow. That’s what makes him so interesting as a subject, and as an example: his principled, contrarian inclinations; his bucking of trends and expectations; his deep lack of interest in fulfilling the expectations of others; and how that set of characteristics led to remarkable achievement across professions and communities and decades. At the wedding of young friends just two years before his passing he was introduced as someone who had saved millions of lives. Never unduly modest, he muttered with a wry smile: You’re probably right.[xviii]
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Footnote: [1] Brummagem: “showy, but inferior and worthless” – Random House Dictionary.
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Endnotes:
[i] Boston Globe obituary, February 26, 2013.
[ii] Philip Yancey, Sole Survivor (New York: Penguin Random House, 2003), 187.
[iii] Margaret Carlson, “A Doctor Prescribes Hard Truth,” Time, April 24, 1989.
[iv] IMDB blithely defines him as an actor. https://www.imdb.com/name/nm0465601/?ref_=tt_cl_t_9
[v] Zappa lyrics for “Promiscuous” at https://mojim.com/usy102840x7x8.htm
[vi] Mullan/Martin, 37.
[vii] “In a memo to the Senate last month, officials of the Department of Health and Human Services sharply limited the duties of the office, making Koop subordinate in nearly all matters to the assistant health secretary.” The Bulletin (Philadelphia), November 17, 1981.
[viii] Richard Kluger, Ashes to Ashes (New York: Knopf, 1996), 537.
[ix] Memorandum to Agency Heads et al., April 8, 1982. MSC 489 Box 143 F12 Cor.
[x] James T. Bennett and Thomas J. DiLorenzo, Public Health Profiteering (New York: Routledge, 2001), 8.
[xi] Available at https://profiles.nlm.nih.gov/spotlight/qq/catalog/nlm:nlmuid-101584930X779-doc
[xii] Mademoiselle, May, 1989, 126.
[xiii] “God’s Plan for a Surgeon,” The Presbyterian, January, 1987. ACC Box 10.
[xiv] “God’s Plan for a Surgeon,” The Presbyterian.
[xv] Whatever Happened to the Human Race? was issued as a five-part documentary series by Gospel Films in 1979. It is available here: https://www.youtube.com/watch?v=py02pQTyeTE
[xvi] Yancey/Koop.
[xvii] Romans 3:23.
[xviii] Sean David interview.
Randall Balmer of Dartmouth College has praised this book as “The definitive biography for decades to come”.
This excerpt from the book is provided here by permission of the author and copyright holder of the book – i.e., Dr Nigel M. de S. Cameron
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