C Everett Koop

BMJ 2013; 346 doi: (Published 15 March 2013) Cite this as: BMJ 2013;346:f1491
  1. Bob Roehr, freelance journalist, Washington
  1. BobRoehr{at}

US surgeon general extraordinaire

It is difficult to comprehend the hysteria that surrounded HIV/AIDS in the United States in the first decade of the epidemic. When homosexuality was still deemed taboo. When there was no effective treatment for AIDS, and healthy young men would turn into shuffling cadavers in a matter of weeks, and then disappear.

A firebomb drove the Ray family from their home in Arcadia, Florida, because the parents sought to enrol their boys—aged 8, 9, and 10—in school. The children had contracted HIV through blood products used to treat their haemophilia.

C (Charles) Everett Koop stood as a beacon of reason amid the maelstrom of ignorance and fear surrounding AIDS. As US surgeon general in the Reagan and Bush administrations, from 1982 to 1989, he was one of the few government leaders who spoke of science and compassion when most others were silent or worse.

He issued a report “written personally by me to provide the necessary understanding of AIDS” in 1986 ( Cognisant of the political minefield he was walking through, Koop consulted with leading authorities and wrote 17 drafts. The final version spoke frankly and honestly of sex, transmission of the virus, ways to protect oneself (including the use of condoms), and how casual contact could not spread the disease.

And 18 months later, as the presidential election campaign was gearing up, he mailed Understanding AIDS, an eight page summary of that report (, to every one of the 107 million households in the US. It was part of a coordinated education campaign that unleashed a torrent of telephone calls to the government’s educational hotline, which lasted for two years.

Koop did not show the document to the White House until after it had been printed. And the copies he sent were a special printing on extra heavy paper stock. He believed the presidential assistants would be less likely to edit and demand a reprint if they thought it was more expensive, Mary Beth Albright would later reveal. She worked for Koop at the time and is now a reporter.

The Forum for Collaborative HIV Research honoured Koop by creating the C Everett Koop HIV/AIDS Public Health Leadership Award in 2010. It bestowed the first on its namesake, who spoke at length about his experience with HIV at the ceremony (

Before he assumed the mantle of surgeon general at the age of 66, Koop was surgeon in chief for decades at the Children’s Hospital of Philadelphia, where he pioneered neonatal surgical intensive care and conducted many groundbreaking surgical procedures. The French government honored him for those accomplishments with the Legion of Honor in 1980.

He also was an ardent foe of abortion, which was why leaders of the increasingly politically powerful religious right urged the Reagan administration to name Koop surgeon general. The US Senate’s confirmation process was contentious, and the final vote of approval was 60:24 for the previously low profile position.

The right wing would come to criticise Koop for not using the office to promote his personal views on abortion. They were even more dismayed when he chose to promote a scientific approach to AIDS.

Koop took his responsibilities as surgeon general to heart, and, even though he had a tiny budget and staff, he raised the visibility of the office to national prominence. He regularly wore the uniform of the public health service, a practice that had fallen into disuse. His leadership of the service restored the morale of its dedicated physician members.

He also took on the tobacco industry, upping the ante to an existing public health effort that had been long but tepid. He called nicotine as addictive as heroin or cocaine, and in 1984 he issued a challenge to “create a smoke-free society in the United States by the year 2000.” Thanks in part to Koop’s forceful advocacy, smoking rates fell by nearly a third, from 38% to 27%, while he was surgeon general.

The private man was equally admirable. Albright said Koop would carry a $50 bill in his right pants pocket, folded into the shape of a triangle so that he could quickly palm it and slip it to someone in need, with a goodbye handshake. He didn’t want to embarrass the person by taking out a wallet.

“‘Chick’ Koop … always seemed to do what was the most correct, honorable, and appropriate thing for the health of the nation and the world,” said Anthony S Fauci, director of the NIH National Institute of Allergy and Infectious Diseases.

Charles Everett Koop was born in Brooklyn, New York. He decided as a child that he wanted to be a surgeon and proceeded in his education through Dartmouth College—where he acquired the lifelong nickname “Chick” (a play on chicken coop and his last name)—Cornell Medical College, and the University of Pennsylvania.

He practised surgery nearly his entire career at the Children’s Hospital of Pennsylvania, rising to surgeon in chief, and he taught at the University of Pennsylvania School of Medicine for decades beginning in 1959.

Koop received innumerable awards, including the public welfare medal from the National Academy of Science (1990), the Albert Schweitzer prize for humanitarianism (1991), and the nation’s highest civilian award, the presidential medal of freedom (1995).

He died at his home in Hanover, New Hampshire. The cause of death was not reported, although he had been frail with failing hearing and eyesight in his last years. Elizabeth Flanagan, his wife of 70 years, died in 2007, and their youngest son, David, died in a climbing accident at the age of 20. He leaves Cora Hogue, whom he married in 2010; three children; and eight grandchildren.


Cite this as: BMJ 2013;346:f1491


  • Charles Everett Koop, former US surgeon general (b 1916; q Dartmouth College, Hanover, New Hampshire, 1937; MD, DSc), d 25 February 2013.

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