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Surgeon General Koop asks for more voluntary AIDS testing.


The question is legitimate, but the denial is emphatic. "Absolutely not," roars the man in the military dress whites. "M run for president? I would never be a candidate for elective office." Case closed. Then he softens, almost smiles, and issues one of his famous Surgeon General's warnings: "Anybody who comes anywhere near this office with that suggestion will be shot."

He's kidding, of course-- something C. Everett Koop doesn't do with great regularity. An imposing man-- all 61 , 206 pounds of him--he's a gruff cross between Abraham Lincoln and one of the Smith Borthers. But he likes his job, and after six years of sitting in the hot seat at the Department of Health and Human Services, he's warming up to the controversy of it all. He has every intention of completing the term that won't expire until 1989, a full year into the next administration, and he's planned a full agenda. The reason his second four-year tour of duty doesn't end with the changing of the guard is that his original battle for confirmation was the longest in history. The heated hearings that resulted in eventual confirmation proved to be a colorful preview of things to come. In fact, a favorite quip around Washington goes, "Where there's Koop, there's controversy." Not true, Dr. Koop insists.

"Until I was confirmed, the controversy centered on abortion," he explains, referring to his well-known pro-life stance, documented in the two books and numerous articles he's written on the subject. "I don't think anybody who said I was incompetent really thought I was incompetent. The abortion issue made it look like my opponents had a real case against me. Then, from the time I was confirmed until AIDS [became a major issue], I enjoyed an increasing acceptability by the press because I think they saw me not as a rabble-rouser but as a person who was hewing to the line of his mandate from Congress. I was presenting facts about health and disease prevention honestly and on target. And I've done that with AIDS."

AIDS, however, has increased the media's ongoing fascination with Koop. Surrounded by elected officials with more power and budget to initiate change, he's still considered to be one of the hottest interviews in town. Gaining access to his L-shaped office on the seventh floor of the Hubert H. Humphrey Building is an exercise in patience and determination. Take a number and wait. Although his typical day is 12 hours long, he likes to spend most of it at his desk digging out from a backlog of work he estimates to be three days deep. Interviews are sometimes squeezed into coffee breaks and are often granted when he wants to share a particular message with a particular audience.

Such was the case at the beginning of this year, when Dr. Koop made an all-out effort to convince leery church communities that school-age children need to understand their own sexuality. With his usual candor, he comfortably discussed the value of sexual abstinence, the importance of marital monogamy, and the good sense of condoms, a term some Christians prefer to avoid, to mention only in a whisper, or to disguise as the mysterious "c-word."

"No one in the Christian community who was in a position of leadership ever attacked me," he reports about his campaign to reach the evangelical masses. "Nor did any Christian magazines attack me. They were extraordinarily cordial when I said I thought I'd better spend my time in the beginning of 1987 talking to the church because I didn't think they understood the AIDS problem or its severity. Their response was remarkably good. Many of them used the media that they control--radio, television, and print--to get the message out, not just about AIDS, but about how people can't understand AIDS unless they understand their own sexuality. So, I've been pleased."

The fruits of his efforts hang on his office wall--a gallery of framed magazine covers with the same bearded face sternly peering down from each. The publications are an interesting mix--religious, medical, and general-interest magazines--and they underscore his emphatic statement that he is the Surgeon General of all the people, not just the special-interest groups that would like to claim him. His body of supporters seems to be growing, although at different points in the last six years he's stepped on more toes than an out-of-sync waltz partner. He's angered the tobacco industry with his call for a smoke-free society, alienated the women's movement with his firm antiabortion views, and jolted some with his endorsement of sex education in the schools.

Koop stands by his 36-page Surgeon General's Report on AIDS, issued exactly one year ago and available at no cost to anyone requesting it. Congressmen have sent more than 12 million copies of the controversial and comprehensive document to their constituents. The booklet deals with the symptoms, prevention, and transmission of AIDS. It makes grim predictions (179,000 AIDS deaths by 1991) and urges preparation and education.

"The impact of the report has been tremendous," he says on the eve of its first anniversary. "Six months ago the controversy was 'What are we going to do about this terrible problem of sex education?' Now the problem is 'How soon can we get state legislatures to make sure our kids learn something about their own sexuality?' So we've made progress on sex education, and we've succeeded in teaching people what AIDS is all about and how it's transmitted."

He grieves for victims already afflicted with the virus and frequently visits AIDS patients in hospitals across the country. His more than three decades as a renowned pediatric surgeon prepared him for dealing with terminally ill children, but youngsters born of AIDS-positive mothers and young hemophiliacs who contracted AIDS from tainted blood products are a special concern.

"I went to Harlem Hospital with Dr. Koop to visit the children the AIDS," recalls Jim Brown, the director of the Public Health Service's news division. "The first child we saw was a little boy in an oxygen mask who wore blocks on both arms so he wouldn't hurt himself when he kept hitting the sides of the crib. It was obvious that he was going to die. Dr. Koop was moved but was able to cope as doctors are trained to do. But I found it difficult to go on. Both Dr. Koop and Dr. Windom [the No. 2 official at the Department of Health and Human Services] have called for volunteers to visit AIDS children in hospitals since many of them have been virtually abandoned because of their disease."

Koop's current hospital rounds are ceremonial and are slated to boost spirits, not treat illnesses. At age 71, he says he doesn't miss the active practice of surgery, even when he reads about the recent separation of Siamese twins at Johns Hopkins Hospital. He was famous for the procedure at his home hospital in Philadelphia.

"I still maintain contact with many of my old patients," he says. "They write and tell me their news or ask for advice. If I miss anything, it's what I did best and what I got my kicks out of: finding the sore point of anxiety of a family and solving the problem. That, I liked."

In a sense, he's still involved in problem solving. He's still in the business of saving young people's lives, only now his mission also includes changing young people's lifestyles. He's encouraged by new data that indicate post-college heterosexuals are moving away from high-risk behavior and toward monogamous relationships. Now he wants to concentrate efforts on preadolescents with the goal of raising a generation of youngsters who will practice abstinence until marriage. He knows skeptics scoff at the idea and call him idealistic, but he insists that success is possible.

"They may laugh at me, but they say, 'Sure, try it,'" he boasts.

His greatest challenge is not with young married couples or with preteens. The people least likely to heed his advice on abstinence and monogamy are adolescents who have already become sexually active with one or more partners.

"I think I'm a realist enough to know when you take a 17-year-old boy who has begun to have sexual relationships, he is almost never going to turn around and go back to abstinence. This is the group that is not going to listen to a just-say-no program; so to them we have to say, 'Unless you are absolutely certain about your partner--and how can you be? --you've got to protect yourself against AIDS.' I recommend the use of a condom, knowing full well it's not 100 percent safe," Koop says.

Koop is not afraid to talk about condoms, even to large audiences vocally split on the issue. When he addressed 6,000 people at the conservative National School Boards Association convention in San Francisco last April, a surprising standing ovation resulted. Any animosity was quickly dispelled when he opened with a joke about himself. He explained that unlike most of his predecessors, he likes wearing the official garb of the Surgeon General. The office carries the rank of a three-star admiral, and the uniform that goes with the title is heavy on stars, bars, epaulets, and ribbons. Once on a flight from Hawaii, he recalled for his audience, he was striding down the aisle of the plane when he paused to nod at two elderly tourists struggline to stuff packages of souvenirs under the seats in front of them. Mistaking Koop for an airline steward, the women beckoned him and gave him their sacks of treasures to deposit in the overhead compartments.

The NSBA audience roared its approval and awarded the warm-up round to their guest speaker. Then Koop began delivering his hard punches: a plea for sex education and assurances that abstinence is best but that condoms have an important place in the real world. In the end, the decision was unanimous. Koop was a winner.

Such openness has set a certain tone at the Public Health Service. Throughout PHS quarters in Washington, cartoons about condoms are tacked to bulletin boards, AIDS-related brochures produced by various state public-health departments are stacked on desks, and magazine ads that promote condoms are framed and hung in waiting rooms. One full-color advertisement proclaims condoms as "smart sportswear for the active man; the latest in evening wear; available in all colors; one size fits all; on display at fine drugstores everywhere." Another poster resembles the scrawling artwork of a pre-schooler and urges, "I have AIDS, please hug me."

This candor carried over into the nationwide media blitz, part of AIDS Awareness Month. In promoting a two-hour TV special about AIDS, the sponsoring Metropolitan Life Insurance Company used the slogan, "You Get AIDS from Blood, Semen and Ignorance." Koop and his colleagues at the Department of Health and Human Services participated in dozens of special events in conjunction with the month-long observance to boost public knowledge of AIDS and dispel misconceptions about the disease. His efforts to go public with the sensitive subject were remarkably like those of a predecessor, Surgeon General Thomas Parran, who, 50 years ago, insisted on discussing the "shocking" disease of syphilis on network radio.

After completion of October's AIDS Awareness campaign, Koop plans to take a reading of the situation and identify the pockets of people who need to be reached with additional information. "These people are drug abusers, and many of them are blacks and Hispanics," he says. "I see the management of the drug abuser and the way he is putting AIDS into the heterosexual population as the biggest issue we now face."

He also hopes to accumulate more factual data on the sexual habits of Americans. "I think we have tremendous amounts of misinformation or poor information on the sexual life-styles of both heterosexual and homosexual people," he says. "We need to know the frequency of contacts, the number of contacts, and how many couples engage in anal intercourse, which is the most common way of transmitting AIDS. If we knew, for example, that X percentage of married couples were carrying out anal intercourse, it would make a lot of difference in the way we stress education."

The Surgeon General's stand on AIDS testing remains the same. He favors voluntary testing. He encourages altar-bound couples to submit to testing but quickly points out that in this country most high-risk people are not getting married.

The affirmative side of mandatory testing, he admits, is that it would allow the medical community to better predict the number of victims who will require care in the next few years. Cities and states could prepare adequate treatment facilities if they had advance warning.

He admits to feeling some frustration at having to deal with different sets of health laws passed by 50 different legislatures in 50 different states. He recently compared notes with Britain's minister of health and concluded that overseeing a country's well-being is a lot easier if only one central governing body sets policy.

"I'm not saying they do it better in Europe, but if, for instance, you have a health problem in Finland, everyone speaks the same language, they all go to the same church, they all have the same kind of ideas, and 98 percent of them are sort of clones of the others. If the government health officer says, 'Do this; do that,' everyone answers, 'O.K., we'll do it.' It doesn't work that way here. When you want to do something in the way of an educational program in the United Kingdom, it comes out of the Department of Health. If you want to do it here, it comes out of 50 different places."

Nobody said it would be easy, and as Koop looks forward to his final two years in office, the prognosis is mixed. Another controversy is brewing, and it involves his old nemesis, abortion. President Reagan has asked him to prepare a report for the American people on the health and psychological effects of abortion on women. Whereas when he gathered information for his AIDS report he met with 26 groups of people who had a message for him, he's already identified 150 groups that want to offer input on abortion. Beyond that, it will be business as usual.

"I plan to continue to do what I've been doing," he says. "I'll concentrate on smoking, AIDS, handicapped children, the sexual abuse of children, and the care of the elderly."

Such a jammed schedule merely underscores his refusal to consider a presidential bid. "My appointments for the abortion report take me through June," he says. After that? He says, "I've got four book ideas running around in my head."

Case closed.

Photo: Author Holly Miller and the Post editor have a chance to ask Surgeon General Koop questions such as: "Is it true that you pre-donated your own blood when you had surgery recently?" and, "Are Health and Human Services employees tested for AIDS before working outside the country?"

Photo: When C. Everett Koop separated Siamese twins from the Dominican Republic, he was revered by the island populace as some kind of savior. (Ironcally, a few years later one of the little girls choked on a large kidney bean and died.) Countless life-endangered newborns now survive because of intensive-care units pioneered by Dr. Koop at Philadelphia's Children's Hospital.

Photo: Though Dr. Koop was surgeon-in-chief at Children's Hospital of Philadelphia, he spent a great deal of time overseas in outreach programs of MAP International and the Christian Medical Society, performing surgery and organizing medical-care programs for the impoverished in underdeveloped countries. This missionary spirit pervades his approach to his chosen field of public health.

Photo: Dr. Koop wears his military uniform with pride and preference. On the warm day we interviewed him, he was in his Navy whites. His position as Surgeon General gives him the rank of three-star admiral.

Photo: Dr. Koop's job as Surgeon General has taught him a lot about the real world. He explains that we can't mandate a piece of Nicorette in every pack of cigarettes because some nicotine addicts would chew the nicotine-containing gum while at the same time smoking to get a better nicotine high. Paul SerVaas nevertheless welcomed the opportunity to present this idea to the fearless, cigarette-battling Surgeon General.

Photo: We asked the generalissimo of our Public Health Service to check out the MAMMOBILE when it was in Washington crusading for more women to be mammogramed. Recent studies show that many lives would be saved if all women over the age of 40 would have mammograms every other year or even yearly.
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Title Annotation:C. Everett Koop
Author:Miller, Holly G.
Publication:Saturday Evening Post
Date:Nov 1, 1987
Previous Article:First results from the anonymous AIDS questionnaire.
Next Article:In memory of David Koop.

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