Koop: The Memoirs of America’s Family Doctor
by C. Everett Koop
Random House, 342 pages, $22.50
What baleful things may befall a rugged, plain-spoken, life-affirming man when he ventures into that great bourne called The Beltway”that is the (probably unintended) theme of the autobiography of Charles Everett Koop, M.D., former Surgeon-General of the U.S. The malignant drugs pressed upon the great-hearted doctor were the familiar irresistible ones: the trappings of authority, the seductive illusion of puissance, the orbital proximity to the political Sun. The landscape of The Beltway is littered with the bleached bones of other voyagers: Brigadier-General Wallace A. Graham (White House physician to President Harry Truman), Sherman Adams, more recently Governor John Sununu”all decent men drawn like Odysseus’ sailors by the hypnotic spell of the bitch-goddess Power, to be turned into swine for their trouble. Charles Everett Koop was an only child born into a comfortable middle-class household in 1916 Brooklyn. Early on he determined that he had a medical vocation, acquired a first-rate undergraduate (Dartmouth College) and graduate (Cornell University Medical College) education. One personal aside: my father was his instructor in obstetrics and gynecology at Cornell, and remembered Koop as an earnest if humorless young man who was thoroughly impatient with the slow pace of the labor and delivery process. He was even then more attracted to the crisp discipline and crackling drama of the operating room. He did not serve in the armed forces during World War II, but spent the war years in residency training in surgery at the Hospital of the University of Pennsylvania. Subsequently, he branched off into the then-nascent subspecialty of pediatric surgery, devising novel surgical techniques for use on sick and handicapped infants. His career as a pediatric surgeon was a distinguished one, replete with professional honors. He was and is a believing Christian (he terms himself an evangelical Christian), and for a number of years while in residence in Philadelphia he taught students at the Wayside Gospel Mission, helped feed homeless men at the 12th Street Gospel Hall, and directed a free medical clinic on Sundays for those unfortunates. He married his college sweetheart and raised a fine family of three sons and a daughter. He has known his share of domestic tragedy: in 1968 his son Norman was killed in a mountain climbing accident, and of that experience he remarks that from that time on he could rarely discuss the death of one of his pediatric patients without tears welling up in his eyes. An exemplary life, and an unusually productive one. Why, then, would this good and decent man desire (and as it turns out, lust for) a demeaning post as a third-level apparatchik in the Kafkaesque labyrinths of the federal Department of Health and Human Services? Why would this trusting naif at the age of sixty-four willingly subject himself to the cruel byzantine intrigues of grandmaster-level players in Big Government? Why would he submit to a confirmation process, which he himself describes as painful, humiliating, and infuriating, that dragged on for nine months, required the passage of special legislation to exempt him from the age limits prescribed for the post of Surgeon-General, and forced him to all but disown his pro-life commitment? Why would a man of his redoubtable professional stature grovel before the likes of Henry Waxman, Lowell Weicker, and Edward Kennedy? (Kennedy remarked of him during the debate on his confirmation that Koop endorsed a cruel, outdated, and patronizing stereotype of women.) Koop and the respected theologian Francis Schaeffer had some years earlier authored a program of seminars, films, and books called “Whatever Happened to the Human Race?” that dealt forcefully with the issues of abortion, infanticide, and euthanasia (they deplored all three) and that found considerable favor in conservative political circles. During his confirmation process, a Washington TV station showed eighty-seven minutes of that pro-life film, and Koop describes this as a “dark cloud” since it marshaled Planned Parenthood, NOW, the National Abortion Rights Action League (NARAL), and assorted other bands of moral brigands against him. His pro-life stance had now become”at least according to his ambitious lights”a dangerous millstone. But what did he expect? Did he truly believe he’d been nominated for the post of Surgeon-General because he was a first-rate pediatric surgeon (actually, he lacked even the basic requisites for the job, i.e., formal training and a graduate degree in Public Health)? If truth be told, he was remarkably unqualified for the post: he had no training in epidemiology or biostatistics, and his major qualification was his pro-life commitment, which was congruent with the Reagan Administration Zeitgeist. But Koop, a little wonderingly, remarks of those who had placed his name before the U.S. Senate: “ . . . in hindsight it is clear they saw the Surgeon-General’s job primarily as a means of promoting their social agenda”especially prolife and family issues.” Later he muses to himself that “no one ever said explicitly that the price of my job was to be the zealous pursuit of the pro-life agenda.” When even nominees to the Supreme Court of the United States are vetted for their social and political views by the administration in power, why should a minor functionary in a massive bureaucracy be exempted from this same scrutiny? He freely acknowledges that his staunchest allies in the confirmation process were the leaders of the conservative pro-life factions in the Administration and in the Congress: Carl Anderson, Henry Hyde, Jesse Helms, Strom Thurmond. And for their pains he gave them the back of his hand in the struggle over the AIDS issue. He identifies as his implacable foes in the confirmation process Waxman, Weicker, and Kennedy, ultra-liberal abortion advocates of whom he would later observe: “The people I needed to win over in those first nine months would in the years ahead become my allies in joint ventures for the health of the American people.” Of Edward Kennedy, he indicates that he entered happily into an “affable cooperation” with that charred and smoking ruin. How sharper than a serpent’s tooth . . . Once confirmed, he was entitled (as he puts it) to wear a uniform with all the regalia befitting his rank as Vice-Admiral, and to all appearances he never took it off. Follow me closely there: he was a Surgeon-General wearing an admiral’s uniform”a bureaucratic version of cross-dressing, I imagine. I recall meeting him at a convention of Americans United for Life in Chicago in the mid-eighties: he was resplendent in his Graustarkian outfit weighted down with epaulets, stripes, ribbons, medals, and yards of gold braid”under full sail, as it were. Of his tenure in office, he describes four major campaigns: antismoking, the AIDS problem, the rights of handicapped children, and abortion. One must concede that smoking is a hazardous addiction and a significant public health problem: it is estimated that the smoking habit costs the public treasury $13 billion annually in smoking-related health care expenses (though to be fair the government exacts $15 billion a year in taxes on tobacco products”not a bad trade-off). Koop attacked the smoking problem with gusto”one might even describe him as an antismoking “zealot.” Of course this variety of zealotry was safe and politically correct. He is not as kind to pro-life leader Nellie Gray, whom he describes as an abrasive, brash, irritating, and embarrassing “zealot” because she had the courage to chastize Ronald Reagan for allowing federal funds to be used to finance abortions in the District of Columbia. With his incessant railing at smokers and the tobacco industry, with his skull-cracking lectures against the evils of tobacco, he came to bear an unfortunate resemblance to Carry Nation, the anti-whiskey saloon-smasher of the turn of the century. Mother Nation and Father Koop were both Old Testament types. The commonly employed description of Carry Nation as a fearsome engine of piety was not entirely inappropriate to the good doctor, although he did not enlist the powers of music in his campaign (Nation was noted for smashing saloons while braying the hymn “Who Hath Sorrow, Who Hath Woe”). If his confrontation with the tobacco interests was politically correct, his position on AIDS was a paradigm of political rectitude (I am the very model of a modern Surgeon-General). He commences his discussion of the AIDS campaign with this ringing manifesto: “ . . . if ever there was a disease made for a Surgeon-General, it was AIDS.” (At the time of this curious epiphany”1981”there had been all of 108 cases of AIDS with 43 deaths.) But because the victims of the disease at that time were almost exclusively homosexualists (I use the word advisedly to accent the political rather than the sexual proclivities of that community) and because the homosexualists dominated the glitzy worlds of fashion and entertainment (gown and clown), the liberal media became their lap dogs: any public figure who would court the media had first to make his bones with the homosexualist cadres. The litmus test for the entertainment and fashion industries in the 1980s became: how many AIDS benefits have you done this year? In the early eighties, Koop was still smarting over media disapproval. He was convinced that he was perceived as a far-right anti-abortion evangelical Christian with”heaven forbid”normative standards against which to measure human behavior. Now was his opportunity to shed that encumbering baggage and enlist in the AIDS crusade. He accuses the Reagan Administration of making a conscious decision to ignore the AIDS problem and in effect muzzle him. That the Centers for Disease Control organized its first AIDS task force as early as 1981 (the year in which the disease was first identified) seems not to disturb his conviction that there was an organized conspiracy of silence within the Administration on the AIDS issue. He conveniently passes over the fact that AIDS funding proliferated so rapidly that by the end of the second Reagan term $3.7 billion a year was being spent on AIDS, $1.2 billion of which was funding basic research. Currently, the U.S. government spends $15,450 per AIDS patient; contrast that with $28
5 per cancer patient, $33 per heart disease patient, and $25
per diabetic. Sickle-cell disease afflicts 150,000 African-Americans in this country. It is a catastrophic disorder, disabling partly or completely a significant segment of this minority group. It is not uncommonly fatal and it is incurable. Government funding for research into sickle-cell disease is pitifully inadequate (the Sickle-Cell Society receives no government funds at all). Clearly then, the strategy of “victimidation” in the AIDS matter has been extraordinarily successful for the homosexualist victims of AIDS. Koop himself was an early and willing casualty of the homosexualist strategy of victimidation. He characterizes the Reagan Administration’s circumspection on the AIDS problem with this bleary aperfu: “Within the politics of AIDS lay one enduring central conflict: AIDS pitted the politics of the gay revolution of the 70s against the politics of the Reagan revolution of the 80s.” Perfect. Here is the Surgeon General of the U.S. by inference laying the blame for the AIDS epidemic at the feet of the U.S. government, the Roman Catholic Church, the conservative press (“the stridently conservative Washington Times”), Phyllis Schlafly (whom he describes as “beneath contempt” because she opposed him on his proposed condom solution), and a sinister cabal of White House conservatives led by Carl Anderson. He holds responsible anything and anyone but the original carriers themselves, those whose lifestyle defined the mode of transmission of the plague. As Charles Krauthammer has put it, AIDS is the archetypal behavioral epidemic: it is not spread through the water supply or the air, it is not transmitted in contaminated food or infected fomites. It is an epidemic spread by feckless libertine behavior, and the means of its control rest not so much upon the discovery of a cure (desirable as that may be) but upon the curbing of the behavior in question. Instead of acknowledging these basic epidemiological truisms, Koop continued to push condoms and sex education as the solution to the AIDS problem. By this time (1986), he was basking in media approval and reserving basilisk stares for those conservatives who dissented. But whereas his virtually unopposed anti-tobacco crusade had marched to the joyful strains of “How Great Thou Art,” his foray into the treacherous marshes of the AIDS controversy was to be played out to the lugubrious rhythms of Duane Eddy’s “Forty Mile of Bad Road.” The conservative opposition found the passion of his condom advocacy not only thoroughly objectionable but medically unsound; his apocalyptic predictions regarding the spread of AIDS (by 1999, he claimed, one out of every four people around the globe would have the virus) became increasingly tedious and incrementally unbelievable. Koop describes his campaign for the rights of handicapped children with considerably less relish, and understandably so. Baby Doe, the Down’s syndrome child in Bloomington, Indiana, also had a surgically remediable defect of the esophagus: a relatively simple operation would have repaired the defect and allowed the child to survive. Nevertheless, the parents of the child opted not to have the surgery performed, and the child died after six days of starvation and neglect in April 1982. Although this squalid tale played itself out on Koop’s watch, there was not a single word of protest, not a murmur of disapproval, not even an indication of interest in this dismal episode from the office of the Surgeon-General while it was happening. Where was America’s Family Doctor (as he styles himself on the cover of his book) when this shabby tragedy was going down? Early on in his book, he declaims, “I saw the Surgeon-General’s office . . . as a position of medical leadership.” The dismaying truth is that far from taking the lead, Koop quickly discerned that the media were generally siding with the parents in their decision to let the child die and it seems that he shrewdly decided to hunker down in his foxhole. Later he would say that “those kinds of questions [to starve the afflicted child] can be answered best by the people who are right there on the scene, if they think clearly and act responsibly.” Very well, but to take the position (as he does later in an analysis of the issues in the case) that he was not only Baby Doe’s Surgeon-General, he was also the Surgeon-General for the parents of Baby Doe as well as the Surgeon-General for all the physicians in Bloomington, Indiana, is a clumsy and ludicrous attempt at self-exculpation. He makes it sound as if he had been anointed, not appointed. His coda to that disheartening episode is: “Baby Doe needed help, but so did his parents.” That observation brings to mind the old saw about the two social workers who happen upon a man lying beaten, battered, and bloody in the street. One social worker turns to the other and says, “The person who did this really needs our help.” But it is over the issues of abortion that the good doctor stumbles most egregiously. “Abortion poisoned my confirmation process,” he declares, airily oblivious to why he was there in the first place. Further on he leaps into the Cuomo Straddle with astonishing agility for a man of his years: he was personally opposed to abortion but in his public office he had to respect the law of the land, blah blah blah. Ronald Reagan was the highest elected official in the nation and he had no difficulty expressing himself on the abortion issue: why should this unelected middle-level bureaucrat hold himself above the fray with such disdain? Koop insists that the fetus is an extraordinarily important being but that as a public health officer he felt that smoking was the number one health problem. In 1991 there were 350,000 smoking-related deaths; in the same year 1.6 million unborn babies perished in the abortion juggernaut. It doesn’t take a rocket scientist to figure out the arithmetic here. What is most troubling in the abortion section”and for that matter, in the whole book”is the manner in which Koop savages certain elements of the pro-life movement. He reserves his most ferocious verbal assaults for “zealots” like Nellie Gray; he attacks Phyllis Schlafly (“Why anyone paid any attention to this lady is one of the mysteries of the 80s”); he turns on Carl Anderson, who perhaps more than any other single figure in the Reagan Administration was responsible for the success of Koop’s confirmation process, and berates him unmercifully for his opposition to the condom solution for AIDS. He trashes the Ad Hoc Committee For Life, calling its publication Life Letter “an unbelievable rag.” He is not above taking a stealthy swipe at Ronald Reagan from time to time but he reserves his most scathing remarks for those who, as he puts it, “saw nothing strange about being against both abortion and contraception.” He concludes his discussion of the abortion issue with this perplexing proposal: if the pro-life forces had accepted a compromise position allowing for abortion in the case of a defective baby (this from a preeminent pediatric surgeon), rape, incest, or to save the life of the mother, he is certain that abortion advocates would have jumped to agree and the million or so annual toll of aborted babies would have been avoided. What can the doctor be thinking? As a founding member of NARAL, I can assure him that abortion advocates then and now would settle for nothing less than everything. With all due respect, the Admiral is all at sea on that one. Dr. Koop closes his book on this simple note: “I rested [after leaving office] in the firm faith that my future like my past was shaped by the sovereignty of God.” A fine sentiment, and a humble one. It brings to mind a remark Indira Gandhi is reported to have made to one of her political underlings: Don’t be so humble”you’re not that great.
Bernard N. Nathanson, M.D., is a former abortionist who is now a pro-life activist. He is author of Aborting America and The Abortion Papers.