Koop: a surgeon general who says what he believes

AS he stands behind yet another podium, C.Everett Koop looks both commanding and genial. His Navy-style uniform and familiar square beard seem imposing; yet the US surgeon general handles questions with a blend of substance and humor as he discusses his most recent report, on tobacco. Since he has compared the addiction properties of tobacco to those of heroin, has he thought about narcotics or does he have an opinion about them? Poker face: ``Well, you know, I think about practically everything, and have an opinion about more things than I think about.'' Laughter.

Podiums are familiar places to the peripatetic Dr. Koop, who is in demand across America, often for his frank comments on the disease AIDS. (AIDS recommendations and testing, Pages 2 and 5.)

Last week, for instance, he received the distinguished alumni award at Cornell University, his alma mater. That was Tuesday. Thursday he delivered the commencement address at Albany Medical College. Friday it was on to Houston for a doubleheader: Baylor University's commencement and an address to the city's religious community about AIDS. Saturday he gave the commencement address at Colby College in Waterville, Maine.

Who says 71-year-olds retire? Not Koop: He still rises before dawn and works late into the night.

The man who identifies himself on the phone to friends as ``Chick'' - as in Chick-en Koop - doesn't take himself too seriously. In his office among framed honorary degrees is his 70th-birthday card: a huge poster featuring a caricature of him with a yellow, chicken-style beak.

But he takes his work very seriously. ``What I see,'' says longtime antismoking advocate John Banzhaf III, ``is a person who is not afraid to confront the issues; one who is willing to take tough stands, if they are medically justified - even if they are politically unpopular.''

What drives this surgeon general, says M.Roy Schwarz, is ``his quest for excellence ... a sense of responsibility [as surgeon general] to look after the health of all of the American people.'' Dr. Schwarz, executive assistant vice-president of the American Medical Association, has become a close personal friend. He says Koop, a devout Presbyterian, genuinely ``believes the ethic of Christianity, to be of service'' to others.

In an administration that strongly prefers state to federal statutes in many areas, Koop urges a federal role in keeping tobacco away from minors. He notes the lax enforcement of laws in 43 states that are supposed to prevent children from purchasing tobacco products.

``There could be federal law,'' Koop says, ``that prohibited the availability of cigarettes to any person whose age was not certifiable'' - for instance, vending machines and handouts of cigarettes.

In recent months tobacco and AIDS have been the subjects he has been discussing most. He says flatly that tobacco is addictive. He urges talking frankly about sex and AIDS with children as early as elementary school. As AIDS preventives he urges, among other things, monogamous relationships and proper use of condoms. His candid talk on both subjects has solidified the support liberals now give him, a complete reversal from when he came to Washington seven years ago.

Then liberals considered him an anathema, mostly for his outspoken anti-abortion views, and stalled his confirmation for months. At the same time conservatives thought they had an ally in Koop.

In the early 1980s, he strengthened their belief when he sought to involve the government in the Baby Jane Doe case on the side of requiring medical personnel to treat handicapped newborns, even if parents and physicians had decided otherwise. Court decisions ultimately thwarted him.

In his early days as surgeon general, many serving in the upper ranks of the Department of Health and Human Services (HHS) considered him hard to deal with. He kept speaking his mind, without clearing his comments first.

How perspectives have changed. Koop is now the darling of the liberals, who applaud his stands on smoking and AIDS. He is widely respected at HHS. Those who know him say he hasn't changed: Rather, the issues have, and, with them, public perceptions.

``I think that the change [in the public's view of Koop] really occurred,'' Schwarz says, when he wrote his frank report on AIDS a year and a half ago. ``He took positions that he knew to be right ... from a public-health standpoint. And he did not waiver, despite the pressure he was under'' from conservatives. Support from the moderates and liberals grew as he stood firm.

``He's sincere in his quest for better health care in the country, whatever it takes,'' says George Siguler, chief of staff to then-HHS Secretary Margaret Heckler, Koop's former boss. To Koop, Mr. Siguler says, abortion, AIDS, tobacco, are all part of the same broad issues: saving lives and providing quality care.

``His views on abortion haven't changed,'' Siguler insists, but Koop is now trying to educate Americans on other issues - smoking and AIDS, in particular.

Behind the public figure is a Koop with a softer side. ``He's just like a big, cuddly grandfather,'' Schwarz says. ``He is warm, open, and positive to everybody - drug abusers, little old ladies, congressmen. He's the same to all.''

``I find him to be one of the most warm, personable, and approachable people I've met in government,'' says Matthew Myers, staff director of the Coalition on Smoking OR Health.

Even people who professionally disagree with Koop agree that he is personable and caring.

``He is a delightful man,'' says Walker Merryman of the American Tobacco Institute. And: ``He's a brilliant pediatric surgeon.'' He was a pioneer in establishing and building up the specialty of pediatric surgery.

But Mr. Merryman takes Koop to task for equating tobacco addiction with heroin addiction, as he did in his annual smoking report in mid-May.

``I think he is a man with a mission,'' Merryman says, ``and sometimes allows his emotional attachment ... to run away with what ought to be a less emotional response.''

That kind of comment upsets Koop. ``He gets impatient with people,'' Schwarz concedes, ``who are obstructing things that need to be done. ... He has absolutely no patience'' with the tobacco industry's insistence that there is no proven link between smoking and disease.

``He gets hot,'' HHS associate James Brown says, ``but usually it's when he's being accused of something that's totally ridiculous.''

For example: Because he recommends AIDS education in elementary grades, he was once accused of wanting to provide condoms to third-graders.

``He's extraordinary,'' Myers says, ``at parrying a hostile question and doing it without raising hostility'' himself.

Koop is known for his warm family ties. Every evening he plays out the events of the day to his wife. One wall of his office is covered with family photos, including one of the son killed 20 years ago in a mountain-climbing accident.

When Koop was preparing his report on AIDS, he met with many groups, including representatives of homosexual organizations - to the consternation of many conservatives. Jeffrey Levi, executive director of the Gay and Lesbian Task Force, says of his meeting with Koop: ``Much to my pleasant surprise, he was forthcoming, open....''

Says Mr. Levi about Koop: ``He's been very honest with the American people. ... He's been the nation's doctor, not the nation's preacher.''

Activist Banzhaf calls Koop ``probably the most effective surgeon general we've had in regard to the problem of smoking.''

``It's very, very difficult,'' Siguler says, ``to attract people to government with the professional stature, intellectual depth, and sophistication to deal with these issues, and to articulate them to the public. And Koop did all these things.''