An excerpt from Dr. Koop: The Many Lives of the Surgeon General.

“I have learned that, when an idea’s time has come—and it is on your watch—you must seize the moment.”
– CEK, Glasgow speech

It would take C. Everett Koop, M.D., Sc.D., just an hour—one very well-prepared hour—to overturn nine months of obloquy and ridicule. In the process, he re-ordered the public face of the Public Health Service, setting the surgeon general head and shoulders above his boss, the man supposed to have the real power, assistant secretary for health, Edward Newman Brandt Jr., who months before had dismissed the surgeon general’s office as an anachronism ripe for abolition.

In the process, Koop also shattered the easy assumption of Big Tobacco that the favored nominee of smokers’ patron saint Jesse Helms—an old-time conservative, bearded, former pipe-smoker—would prove a milquetoast.

To the savvy and the savaged, the morning editions of The Times and The Post on February 23 made it unambiguously clear. The Times devoted the top left-hand corner of its front page to a picture of the man it had lately deemed “Dr. Unqualified,” declaring smoking “society’s chief cause of preventable death.” (It is paragraph three before we read a reference to “his superior, Dr. Edward Brandt Jr.”) The Post led with the announcement that smoking is now linked to additional cancers. (In this case, Brandt would have to wait until paragraph six before he found his name, after six consecutive references to the surgeon general.)

As planned, Koop had stolen the show. He ended by saying: “Fifty-three million adults in this country still smoke cigarettes, and young people are still taking up the habit. On the evidence of the report we submit to you today, this can only presage human tragedy in the years ahead and enormous economic loss to our country.”

“If you ever saw a press conference where someone really knew their shit, that was the press conference.” Thus, Donald Shopland, longtime U.S. government tobacco control expert and author/editor of the document, on Koop’s first presentation of the annual Surgeon General’s report on smoking, February 22, 1982, just three months after his confirmation.

Brandt got to open the event and to introduce Koop to play what Mike Stobbe, historian of the surgeon general’s office, terms “his assigned bit part.” With his bulky presence and booming voice, Koop immediately dominated the proceedings. After nearly forty years of surgeon general reports, this one was “the most serious.” And, he added, “Our choice of cancer as a subject of this report should not distract attention from the even larger costs of cigarette smoking, which become apparent when deaths from coronary heart disease, chronic lung disease, and other diseases and conditions are taken into account.” Smoking kills 340,000 Americans every year.

The Tobacco Institute, the industry mouthpiece, pushed back with its increasingly risible claim that “the question is still open” whether smoking causes cancer. Koop dismissed them out of hand. “The evidence is strong and scientific, and we stand by it,” according to The Times’ front-page account.

In an hour, Koop had palpably altered the relationship between the U.S. government and one of America’s most important industries. “What had settled into a gentlemanly enmity was kicked into an all-out war,” according to one observer. “I never withheld any of the venom that I had for the cigarette companies.” Koop learned to despise the industry and to convey his contempt whenever he addressed the issue. “The thing that impelled me,” he later said, “was the sleaze with which the tobacco industry foisted their products upon an unsuspecting people with unfair advertising.”

Koop had been working for months on how to turn around the image the press had built of him during the anguished process of confirmation. He had come to the conclusion that the tobacco report provided him with that opportunity. “I think I saw smoking as the most visible thing my predecessors had done, and if I wanted to have some kind of platform from whence to jump to other things, I better do that one well.” It was a popular “apple pie” issue because tobacco consumption was already on the decline, and while the industry was powerful, smokers were not a well-organized interest group. “This was a topic on which he could establish himself as a person to be reckoned with and to do—at least what others considered—the unexpected.”

February 22, 1982, would mark the turning point. “It was the beginning of a long and increasingly warm relationship between me and the press…their point of view was changed.”

To put it another way, just ninety-seven days after being sworn in as the 13th U.S. surgeon general, Koop had his bully pulpit.

Nigel Cameron is a historian and ethicist whose work has spanned the disciplines of bioethics, history, and religion over a distinguished transatlantic academic career. He currently serves as a senior fellow at the University of Ottawa and was previously a research professor of bioethics at the Illinois Institute of Technology in Chicago, where he led pioneering projects on the social and ethical impact of emerging technologies and on diabetes policy. A former Fulbright visiting research chair at the University of Ottawa’s Institute for Science, Society and Policy, he continues to explore the intersection of medicine, ethics, and public policy.

Dr. Cameron was the founding editor of the journal Ethics and Medicine and has served as a hospital consulting ethicist. He has held board roles with UK think tanks 2020health.org and BioCentre, and has testified before committees of the U.S. Congress and the European Union. He has also represented the United States in diplomatic delegations to United Nations health-related agencies and was nominated by the U.S. government to serve as UN Special Rapporteur for the Right to Health.

His books include Dr. Koop: The Many Lives of the Surgeon General, Will Robots Take Your Job? A Plea for Consensus, and The New Medicine: Life and Death After Hippocrates. His current project, Ruth: The Psychiatrist Who Saved Sylvia Plath, Until She Couldn’t, continues his exploration of complex figures in medicine.

For more about his work, visit drkoop.bio, or connect with him on Facebook and LinkedIn.