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Surgeon General Koop: The Legacy of a Health Warrior

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C. Everett "Chic" Koop became U. S. Surgeon General under President Reagan. He was a world renowned pediatric surgeon who had a tumultuous Senate confirmation process due to partisanship. Chic took office in January 1982, a time of "tobacco wars" and a new and evolving terrifying disease that we ultimately came to know as AIDS. Chic forever changed and elevated the standard of practice for all surgeons general who followed him.

A man of enormous physical presence and stature, he became a public figure at the juxtaposition of a nation yearning for a credible, visible and competent health leader with that of a national media consumed by an insatiable appetite for content.

As a young surgeon in training at the University of California San Francisco General Hospital in the early '80s, my colleagues and I were inundated with an epidemic of young men with fevers, rashes, swollen lymph nodes and eventually death. It was a terrifying time for us, and the world for we did not know the cause of or how to treat this devastating disease.

This was also at a time that some national elected officials were telling the public that this was God's way of punishing homosexuals in spite of the fact that scientists in 1983 discovered that this was a communicable infectious disease, HIV/AIDS.

Although challenged by political pressure and threats to have him fired for his adherence to science, Chic persisted in his role as surgeon general to inform the public that this was a preventable infectious disease. At a presentation at San Francisco General Hospital he told us, "I am the surgeon general of the heterosexuals and homosexuals, of the young and the old, of the moral and immoral, the married and unmarried. I don't have the luxury to decide what side I want to be on." In doing so, Chic managed to change the national and global dialogue from one being tainted by nonscientific political and ideological bias, to a scientific approach which ultimately changed the course of this global disease, resulting in slowing the spread of HIV/AIDS and saving lives.

Historically, the position of surgeon general has been an embattled one for well over a century. In 2007, Surgeons General Carmona, Satcher and Koop testified to Congress about the attempts at politicizing science and the Office of the Surgeon General. The testimony of 3 surgeons general was unprecedented and remarkably similar, providing invaluable information to Congress, which Congress failed to act on.

Chic particularly enjoyed the distinction that he and I were the only two surgeons in history to be surgeon general. I came to personally know Chic as a new surgeon general in 2002 when he befriended and mentored me. For he understood that there was no formal training program for surgeons general and that each of us enters the "combat zone" naïve and wanting to stamp out disease, famine, pestilence and to correct social injustice and health inequity. He realized that sometimes the harshest plague we faced was not emerging infections or terrorism but rather the plague of politics.

He understood that "once a surgeon general, always a surgeon general" and that part of his job in perpetuity was to mentor others who followed in his footsteps so they could serve optimally in a tenure that moves at warp speed surrounded by many with competing political interests.

One of the first things Chic told me as I entered the Office of the Surgeon General was to be aware of all the "staffers" who will repeatedly come to you and begin their requests with "the White House wants...." He said that these are mostly people with their own political agendas who need you to give credibility to their particular endeavor. Chic said, when the POTUS or cabinet members want you, they can easily find you. Chic was correct. Every day was a challenge to filter out the nonscientific ideological requests from those who were self-serving rather than providing selfless service to the nation.

Always with dignity and integrity, Chic fought the tobacco wars and other contemporary public health challenges with his greatest asset, the best science. He also treasured the U.S. Public Health Service Commissioned Corp and encouraged them to wear their uniform and be proud of who they are. He admitted to me on one occasion how he grew up in a very strict and conservative family. But he continued to say that his personal upbringing never biased his surgeon general decisions and that he recognized that he was not the surgeon general of the Democratic Party or Republican Party, but rather the doctor of the people.

Chic became an iconic figure in life. His legacy is a gift to us. He showed us how we must rise up against political oppression and ideology. He readily accepted the burden of national leadership and never faltered in his quest to be the doctor of the people. He always spoke truth to science and power and became a surgeon general the public was proud of and a role model for me and other surgeons general to aspire to. He was a health warrior whose presence and actions redefined the job description of the surgeon general.

A grateful world, nation and cadre of surgeons general who followed in his shadow are forever indebted to Surgeon General Koop's wisdom, fortitude, integrity and selfless service.

Now in honor of Surgeon General Koop's legacy, we should ensure that the position of surgeon general is protected from political interference, funded appropriately and nominated from the ranks of career public health professionals who merit consideration as is done in the other uniformed services.

Richard Carmona, M.D., M.P.H., FACS

17th Surgeon General of the United States