Although he was 96 years old and had a hell of a good run, I was still saddened to learn of the death of former Surgeon General C. Everett Koop in February. I was lucky enough to have known Dr. Koop when he was a teacher and I a student at Dartmouth College. Years later, when our paths crossed at a rest stop on the New Jersey Turnpike, he not only remembered me, but engaged me in a lively and wonderful conversation. (Hey, stranger things have happened at New Jersey rest stops.)
Dr. Koop, a pediatric surgeon, was appointed U.S. Surgeon General by Ronald Reagan in 1981. Koop will be remembered for crucial public-health initiatives such as his anti-smoking crusade; what I remember, most vividly and with gratitude, was his heroic and historic effort to draw attention to the then-emerging AIDS epidemic. Through forthright communication of the scientific evidence (and of the government’s and the public’s lack of knowledge of that evidence) on HIV and AIDS, Dr. Koop shone a light on a disease shrouded in misinformation, fear, and prejudice. This will be his most enduring legacy, and is what made him a rock star for me.
As the New York Times obituary reminds us, AIDS had just been discovered in the U.S. when Koop was awaiting confirmation in 1981. It would soon sweep the country: more than 100 cases were reported in the weeks that followed.
He realized later, he said, that the Reagan administration had been slow to address the disease because the election had brought to power people who were antithetical to homosexuals, then thought to be its only victims.
As the epidemic worsened, reaching drug addicts infected with contaminated needles and hemophiliacs who had received a contaminated blood-clotting factor, Reagan, in 1986, asked Dr. Koop to prepare a special report. Dr. Koop proceeded cautiously, knowing the report would be unpopular with many in the administration, with conservatives in Congress and with church groups opposed to homosexuality. He wrote 17 drafts [“C. Everett Koop, Forceful U.S. Surgeon General, Dies at 96,” published 25 February 2013].
In his final report, Koop didn’t mince words. He promoted the use of condoms for safe sex, and called for sex education to begin in school as early as third grade, and he did it in spite of his personal opposition to homosexuality and premarital sex. He insisted, in the words of the Associated Press, that “Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted” [AP.org, published 26 February 2013].
What he did next is just one example of what separated Dr. Koop from the crowd. He wrote a pamphlet explaining what was known about HIV and AIDS, then — despite some opposition from the Reagan administration — mailed it to all 107 million households in the U.S. It still stands as the largest public health mailing ever.
We could surely use another Dr. Koop right now. Here’s why.
I find more often than not that people consider the HIV|AIDS epidemic to be under control in the U.S. It is not. There are now more than half a million persons aged 13 and older living with the HIV infection in the U.S.; about half of those are not in care.
Consider the following statistics that I found on the website of the Centers for Disease Control (CDC). (Just for today, let’s not worry about the quality of the graphic.)
All of this information is sobering, but the most shocking statistic is the steep rise in prevalence of AIDS in the U.S., or the number of people living with AIDS in a given year. Clearly, it is good to know that more people are surviving longer with the disease, but this is still a pretty sobering figure. “Living” with AIDS does not by any means translate to living an easy life.
We in the United States surely face a number of public health crises and concerns. On this one, I most particularly have missed and will continue to miss Dr. Koop and his ability to craft and deliver, by all means available, a powerful message. I deeply admire, and would like to see carried on, his unapologetic determination to use the status of the Surgeon General’s office to raise public awareness and promote activism, not just at the dawning or most acute stage of a crisis, but over the long term, steadfastly, until real progress toward improved public health is made.