Warning: the Surgeon General may be good for your health - C. Everett Koop reports on AIDS

Washington Monthly, March, 1987 by Paul Glastris

Koop wrote regulations that incorporated thegroup's guidelines. A court later struck them down. But by the summer of 1984 Congress, inspired andguided in part by Koop's compromise, passed overwhelmingly an amendment to the Child Abuse Act, defining refusal to treat handicapped newborns as child abuse. This allowed Washington to withhold federal money to states that lacked procedures for guaranteeing the medical rights of disabled infants.

The Baby Jane Doe case showed a diplomaticside of Koop that liberals hadn't noticed in 1981. "Behind the scenes he really was manipulating and moving the administration to the decentralized, non-federal approach," says Jenison. "He was the one who could speak from a medical viewpoint. That had a lot of weight."

Smoke out

Liberals would also learn to apreciate Koop'szealous side, at least when he applied it against smoking. Past surgeon generals have warned of the dangers of smoking; Koop has turned that warning into a pesonal crusade. In his reports, he warns of smoking's ruinous effects on the heart; he calls smoking "an addiction"; he attacks smokeless tobacco; he warns of the dangers to nonsmokers of "passive smoking" and cites smoking as the number one hazard in the workplace. In May 1984, he began a public relations campaign, calling for "a smokeless society by the year 2000." In countless press conferences and speeches, Koop has argued that by the end of the century our attitudes should evolve to the point that no smoker will light up in the presence of a nonsmoker without permission. Jesse Helms, who had been Koop's strongest Senate supporter, called for his resignation.

The style he'd employed as the pro-life movement'smost effective propagandist served him here. With his steely gaze, Dutchman's beard, summer white uniform and powerful Brooklyn voice, he is an imposing speaker. People don't often light up in front of the man; when they do, he sternly hands them a button that reads, "The surgeon general personally asked me to quit smoking." He has called tobacco companies "sleazy" and labeled as "flat-footed lies" their claims that science can't say with certainty that tobacco causes cancer. Antismoking groups, like pro-life groups before them, value Koop's knack for drawing the attention of both the public and the press.

To the Reagan administration, however, Koop'santismoking crusade has been a headache. It doesn't seem to share Koop's extreme distaste for tobacco and the tobacco industry. Quite the opposite, in fact. In a 1980 campaign appearance the president promised to "end what has become an increasingly antagonistic relationship between the federal government and the tobacco industry. I can guarantee that my own cabinet members will be far too busy with substantive matters to waste their time proselytizing against the dangers of cigarette smoking."

With Koop running around the country passingout buttons, that's been a hard promise to keep. But some in the administration have tried. Last March, for instance, Koop lost a battle with Defense Secretary Caspar Weinberger. Military personnel have long enjoyed a discount on cigarette purchases. In fact, cheap smokes during World War II were the chief cause of the great rise in the number of smokers in the late forties and fifties. Koop had been working behind the scenes with the Defense Department's assistant secretary for health affairs, Dr. William Mayer, to eliminate the discount. Weinberger overruled Mayer, bowing to pressures from tobacco state legislators, the tobacco industry, and associations of present and former military personnel. The military groups had protested that cuts in cigarette discounts would provide a dangerous precedent for cuts in other benefits. "It just doesn't make sense to me," Koop said publicly of Weinberger's decision. "How could the removal of cigarettes be viewed as a reduction in benefits when the only benefits would be a lifetime of illness and early death?"