Expected to Continue Anti-Smoking, AIDS Campaigns : Koop to Quit Surgeon General Post

Surgeon Gen. C. Everett Koop, the most colorful and activist surgeon general in the nation’s history, informed the White House on Thursday that he will leave his post July 13 and retire from government service Oct. 1.

Koop, en route to a meeting of the World Health Organization in Geneva, refused to speak with reporters, but sources close to him said that he is expected “to continue to do essentially what (he has) been doing, but without government portfolio,” including speaking out on AIDS issues and continuing his war against tobacco. He also plans to write his autobiography.

Koop was not asked by the Bush Administration to remain beyond his scheduled term and would not do so even if asked, according to knowledgeable sources.

Koop’s decision was not unexpected, although it came earlier than anticipated. He had informed President Bush in a Feb. 15 letter that he did not intend to serve out his full term, which ends in November, and in recent weeks told friends and colleagues that he expected to leave sometime this summer.

Dr. James O. Mason, assistant secretary for health, is expected to name an acting surgeon general until a permanent successor is found. There was no immediate word about who would replace Koop, but a White House source said that Bush Administration officials “are looking for an anti-abortion person to fill that position. It’s a litmus test. The President couldn’t take the heat if he appointed anybody pro-choice. But Dr. Koop was anti-abortion, and he took the job and turned out to be very, very fair.”

Health and Human Services Secretary Louis W. Sullivan Thursday praised Koop in a letter, saying that he has been “a voice of honesty, integrity, compassion and plain good sense.”

Sullivan wrote: “There can be no doubt that during your term, America’s attitude toward tobacco use in particular has undergone fundamental change. And, of course, in confronting the challenge of AIDS, you have set an example of professionalism and caring for all Americans.”

Traditionally, the surgeon general has been a figurehead, with few responsibilities other than to issue an annual report on smoking, which began in 1964 with the first major indictment against cigarettes.

But Koop, 72, who has held the post since November, 1981, revolutionized the office with his vigorous crusade against smoking and his willingness to talk frankly about AIDS, often clashing with the Ronald Reagan Administration in the process. As the country’s top doctor, he transformed the public debate on AIDS and angered fellow conservatives by advocating early AIDS sex education and the use of condoms to prevent the spread of the virus. He also urged compassion for the afflicted, the majority of whom in this country are homosexual men.

Unlike his predecessors, he was a familiar presence to both the Washington Establishment and the public-at-large in his Public Health Service uniform. At 6-foot-1 and 206 pounds, he was an imposing and instantly recognizable figure with his booming voice, intimidating demeanor and the same kind of neatly trimmed, square-cut beard favored by his Dutch ancestors.

Innovative Surgeon

Before his appointment to the surgeon general’s post, Koop had practiced for three decades in Philadelphia as a pediatric surgeon, establishing an international reputation for his innovative surgical techniques.

Koop’s confirmation at the beginning of Reagan’s first term was held up nearly a year by Congress. Thus, unlike other Reagan appointees who left with the incoming Bush Administration, Koop was entitled to finish out his full eight-year term.

His original detractors in Congress, led by Rep. Henry A. Waxman (D-Los Angeles), at first considered Koop a right-wing religious zealot whom they feared would allow his conservative views, specifically his hard-line stance against abortion, to influence his decisions.

But Koop surprised all of his critics, including Waxman, by demonstrating a firm commitment to public health and by not allowing his own politics or personal views to influence his scientific judgment.

A Presbyterian with strong moral convictions, he continued to speak out against abortion, and became the chief defender of the Reagan Administration’s controversial “Baby Doe” regulations, which brought the federal government directly into cases involving the treatment of deformed newborns. But he later refused Reagan’s order to write a report on the physical and psychological impact of abortion, saying that there was not enough scientific data to do so.

Calling Koop’s resignation “a real loss for the nation,” Waxman Thursday said that Koop never “let politics or people’s prejudices keep him from giving advice that was based solely on what was good for the public health. People trust Dr. Koop.”

Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Labor and Human Resources Committee, Thursday called Koop “perhaps the best surgeon general ever,” saying that “he won many converts on Capitol Hill” with his “good sense on public health controversies and his no-nonsense, no-ideology approach.”

Koop became an unlikely hero in the AIDS war after he issued his long-awaited report to the public on AIDS in October, 1986. Despite his professed opposition to homosexuality, he called on the public to humanely treat those suffering from AIDS. Further, in the report--which was unusually explicit for a government-sponsored publication--he recommended that AIDS public education be greatly expanded, particularly to young children, and said that he opposed mandatory testing for AIDS infection and the quarantining of AIDS patients. The report also urged the use of condoms to reduce the risk of spreading the virus.

The report was universally lauded within the public health community, although then-Secretary of Education William J. Bennett and prominent conservatives attacked Koop for promoting sex education and the use of condoms.

Jeff Levi, executive director of the National Gay and Lesbian Task Force, said that Koop’s AIDS report “dramatically altered the level of public discussion on AIDS from moral judgment to public health.”

Koop began his term by launching a tireless campaign against smoking, proposing a smoke-free society by the year 2000. In doing so, he antagonized both the tobacco lobby and the Reagan White House.

Gary Miller, assistant to the president of the Tobacco Institute, acknowledged Koop as “a formidable force in the anti-smoking movement” who “certainly provided the ammunition needed by anti-smoking forces,” adding: “We wish him well.”