C. Everett Koop

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C. Everett Koop
C. Everett Koop, 1980s.jpg
13th Surgeon General of the United States
In office
January 21, 1982 October 1, 1989
President Ronald Reagan
George H. W. Bush
Preceded by Edward Brandt (Acting)
Succeeded by James Mason (Acting)
Personal details
Born
Charles Everett Koop

(1916-10-14)October 14, 1916
New York City, New York, U.S.
DiedFebruary 25, 2013(2013-02-25) (aged 96)
Hanover, New Hampshire, U.S.
Political party Republican
Spouse(s)Elizabeth Flanagan (1938–2007)
Cora Hogue (2010–2013)
Children4
Education Dartmouth College (BA)
Cornell University (MD)
University of Pennsylvania (DSc)

Charles Everett Koop (October 14, 1916 – February 25, 2013) [1] [2] was an American pediatric surgeon and public health administrator. He was a vice admiral in the Public Health Service Commissioned Corps, [1] and served as the 13th Surgeon General of the United States under President Ronald Reagan from 1982 to 1989. According to the Associated Press, "Koop was the only surgeon general to become a household name." [3]

Pediatric surgery medical specialty

Pediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults.

Vice admiral is a three-star commissioned naval officer rank in the United States Navy, the United States Coast Guard, the United States Public Health Service Commissioned Corps, and the National Oceanic and Atmospheric Administration Commissioned Officer Corps, with the pay grade of O-9. Vice admiral ranks above rear admiral and below admiral. Vice admiral is equivalent to the rank of lieutenant general in the other uniformed services.

United States Public Health Service Commissioned Corps federal uniformed service of the U.S. Public Health Service

The United States Public Health Service Commissioned Corps (PHSCC), also referred to as the Commissioned Corps of the United States Public Health Service, is the federal uniformed service of the U.S. Public Health Service (PHS), and is one of the seven uniformed services of the United States.

Contents

Koop was known for his work to prevent tobacco use, AIDS, and abortion, and for his support of the rights of disabled children.

Smoking seorang yg hensem,bijak dan diminati perempuan bangla

Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly the substance is the dried leaves of the tobacco plant which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Smoking is primarily practiced as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gasses and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas into a form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to spiritual enlightenment.

HIV/AIDS Spectrum of conditions caused by HIV infection

Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Following initial infection, a person may not notice any symptoms or may experience a brief period of influenza-like illness. Typically, this is followed by a prolonged period with no symptoms. As the infection progresses, it interferes more with the immune system, increasing the risk of developing common infections such as tuberculosis, as well as other opportunistic infections, and tumors that rarely affect people who have uncompromised immune systems. These late symptoms of infection are referred to as acquired immunodeficiency syndrome (AIDS). This stage is often also associated with unintended weight loss.

Abortion is the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus. An abortion that occurs spontaneously is also known as a miscarriage. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently an "induced miscarriage". The word abortion is often used to mean only induced abortions. A similar procedure after the fetus could potentially survive outside the womb is known as a "late termination of pregnancy" or less accurately as a "late term abortion".

Early life and education

Koop was born in Brooklyn, New York, the only child of John Everett Koop (1883–1972), a banker and descendant of 17th-century Dutch settlers, and Helen (née Apel) Koop (1894–1970). [4] In 1937, he earned his Bachelor of Arts in zoology degree from Dartmouth College, [5] where he was given the nickname "Chick" (occasionally used for his first name, Charles, but here an allusion to a chicken coop). [6] His interest in medicine followed a year in the hospital following a childhood skiing accident and brain hemorrhage. [7] He earned his MD degree from Cornell Medical College in 1941 and Doctor of Science degree in medicine from the University of Pennsylvania in 1947. [8]

Brooklyn Borough in New York City and county in New York state, United States

Brooklyn is the most populous borough of New York City, with an estimated 2,648,771 residents in 2017. Named after the Dutch village of Breukelen, it borders the borough of Queens at the western end of Long Island. Brooklyn has several bridge and tunnel connections to the borough of Manhattan across the East River, and the Verrazzano-Narrows Bridge connects Staten Island. Since 1896, Brooklyn has been coterminous with Kings County, the most populous county in the U.S. state of New York and the second-most densely populated county in the United States, after New York County.

Dartmouth College private liberal arts university in Hanover, New Hampshire, United States

Dartmouth College is a private Ivy League research university in Hanover, New Hampshire, United States. Established in 1769 by Eleazar Wheelock, it is the ninth-oldest institution of higher education in the United States and one of the nine colonial colleges chartered before the American Revolution. Although founded as a school to educate Native Americans in Christian theology and the English way of life, Dartmouth primarily trained Congregationalist ministers throughout its early history. The university gradually secularized, and by the turn of the 20th century it had risen from relative obscurity into national prominence as one of the top centers of higher education.

Chicken coop place where chickens roost

A chicken coop or hen house is a small house where, typically, female chickens or other fowl are kept safe and secure. There are nest boxes found inside the hen houses for egg-laying, and perches on which the birds can sleep.

Career

Medical career

From 1946 to 1981, Koop was the surgeon-in-chief at the Children's Hospital of Philadelphia (CHOP). [9] Koop was able to establish the nation's first neonatal surgical intensive care unit there in 1956. [10] He helped establish the biliary atresia program at CHOP when Japanese surgeon Morio Kasai came to work with him in the 1970s. He also established the pediatric surgery fellowship training program at CHOP. During his tenure there he graduated thirty-five residents and fourteen foreign fellows, many of whom went on to become professors of pediatric surgery, directors of divisions of pediatric surgery, and surgeons-in-chief of children's hospitals.

Childrens Hospital of Philadelphia Hospital in Pennsylvania, United States

The Children's Hospital of Philadelphia (CHOP) is a children's hospital in Philadelphia, Pennsylvania, with its primary campus located in the University City neighborhood of West Philadelphia next to the campus of the University of Pennsylvania. It is one of the largest and oldest children's hospitals in the world, and United States' first hospital dedicated to the healthcare of children. CHOP has been ranked as the best children's hospital in the United States by U.S. News & World Report and Parents Magazine in recent years. As of 2012, it was ranked number one in the nation by U.S. News for six out of ten specialties. The hospital is located next to the University of Pennsylvania and its physicians serve as the pediatrics department of the Perelman School of Medicine at the University of Pennsylvania.

Biliary atresia congenital disorder of digestive system investigation of choice of the disease is MRCP

Biliary atresia, also known as extrahepatic ductopenia and progressive obliterative cholangiopathy, is a childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent. It can be congenital or acquired. As a birth defect in newborn infants, it has an incidence of one in 10,000–15,000 live births in the United States, and a prevalence of one in 16,700 in the British Isles. Biliary atresia is most common in East Asia, with a frequency of one in 5,000.

Morio Kasai was a Japanese surgeon who had a strong interest in pediatric surgery. While Kasai went into practice at a time when pediatric surgery was not an established subspecialty, much of his clinical and research work was related to the surgical care of children. He is best known for devising a surgical procedure, the hepatoportoenterostomy, to address a life-threatening birth defect known as biliary atresia. The modern form of the operation is still known as the Kasai procedure.

Koop became a professor of pediatric surgery in 1959 and professor of pediatrics in 1971 at the University of Pennsylvania School of Medicine. [8]

Pediatrics field of medicine dealing with the care of children

Pediatrics is the branch of medicine that involves the medical care of infants, children, and adolescents. The American Academy of Pediatrics recommends people be under pediatric care up to the age of 21. A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children"; they derive from two Greek words: παῖς and ἰατρός. Pediatricians work both in hospitals, particularly those working in its subspecialties such as neonatology, and as primary care physicians.

Perelman School of Medicine at the University of Pennsylvania medical school in Philadelphia, Pennsylvania, United States

The Perelman School of Medicine, commonly known as Penn Med, is the medical school of the University of Pennsylvania. It is located in the University City section of Philadelphia. Founded in 1765, the Perelman School of Medicine is the oldest medical school in the United States and is one of the seven Ivy League medical schools. Penn Med consistently ranks among the highest recipients of NIH research awards, and it is currently tied for 3rd place on U.S. News & World Report's "Best Medical Schools: Research" list.

While a surgeon in Philadelphia, Koop performed groundbreaking surgical procedures on conjoined twins, invented techniques which today are commonly used for infant surgery, and saved the lives of countless children who otherwise might have been allowed to die. He invented anesthetic and surgical techniques for small bodies and metabolisms and participated in the separation of several sets of conjoined twins whose condition other physicians at the time considered hopeless. He first gained international recognition in 1957 by the separation of two female pygopagus infants (conjoined at the pelvis) [11] and then, again, in 1974 by the separation of two ischiopagus twins (conjoined at the spine) sharing a liver, colon, and parts of the intestines with their entire trunks merged.

Conjoined twins identical twins joined in utero

Conjoined twins are identical twins joined in utero. An extremely rare phenomenon, the occurrence is estimated to range from 1 in 49,000 births to 1 in 189,000 births, with a somewhat higher incidence in Southwest Asia and Africa. Approximately half are stillborn, and an additional one-third die within 24 hours. Most live births are female, with a ratio of 3:1.

Vertebral column bony structure found in vertebrates

The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord found in all chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs. The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord.

Koop was active in publishing articles in the medical literature. Koop later wrote that

Each day of those early years in pediatric surgery I felt I was on the cutting edge. Some of the surgical problems that landed on the operating table at Children's had not even been named. Many of the operations I performed had never been done before. It was an exuberant feeling, but also a little scary. At times I was troubled by fears that I wasn't doing things the right way, that I would have regrets, or that someone else had performed a certain procedure successfully but had never bothered to write it up for the medical journals, or if they had I couldn't find it. [12]

Koop helped rectify this by publishing his own findings and results. Additionally, he became the first editor of the Journal of Pediatric Surgery when it was founded in 1966. [8]

In contrast to his years as surgeon general, when it was his policies and speeches that had bearing on other people, his years as an operating pediatric surgeon involved a more individualized, direct, hands-on effect on others. During the course of his long career, for example, he performed some seventeen thousand inguinal hernia repairs and over seven thousand orchidopexies (surgery for correcting undescended testicle). He developed new procedures, such as the colon interposition graft for correcting esophageal atresia (congenital lack of continuity of the esophagus) or ventriculoperitoneal shunts for treatment of hydrocephalus (accumulation of excessive cerebral spinal fluid in and around the brain causing neurological problems). [10] He also tackled many difficult cases ranging from childhood cancer to surgeries done on conjoined twins, of which he and his colleagues operated upon ten pairs during his 35-year tenure. In all he operated on many children and babies with congenital defects 'incompatible with life but amenable to surgical correction'.

In 1976, Koop wrote The Right to Live, The Right to Die, setting down his concerns about abortion, infanticide, and euthanasia. [10] Koop also took some time off from his surgical practice to make a series of films with Christian apologists Frank Schaeffer and his father Francis Schaeffer in 1978, entitled Whatever Happened to the Human Race? based on the book of the same title that was previously written by the elder Schaeffer. [10] Frank Schaeffer and his associate, Jim Buchfuehrer provided a private, five hour screening to U.S. Rep. Jack Kemp and wife Joanne on their home that, according to Frank Schaeffer's account of the late evening and early morning event in his book Crazy for God, led to both the Schaeffers and Koop obtaining "...access to everyone in the Republican Party". [13]

President Ronald Reagan, shortly after his first inauguration, appointed Koop Deputy Assistant Secretary for Health in February 1981. [1] It was understood that Reagan would later nominate Koop to be surgeon general. [1]

Surgeon General of the United States

Koop with his wife, Betty, Senator Orrin Hatch of Utah, and Secretary of Health and Human Services Richard Schweiker. C. Everett Koop on the day of his confirmation as Surgeon General (QQBBQB) noframe.jpg
Koop with his wife, Betty, Senator Orrin Hatch of Utah, and Secretary of Health and Human Services Richard Schweiker.

As expected, Koop was nominated to be Surgeon General of the United States by Reagan later in 1981. [14] Many liberal politicians and women's groups opposed the nomination because of Koop's very conservative views and strong anti-abortion beliefs. [14] His nomination was confirmed by the U.S. Senate on November 16, 1981, by a vote of 60–24. [15] He was sworn into office on January 21 the following year. [15]

Koop Report

Koop, an opponent of abortion, resisted pressure from the Reagan administration in 1987 to prepare a report stating that abortion was psychologically harmful to women. [16] He said it was not a public health issue but a moral one. [1] Koop assigned an assistant, George Walter, the task of researching the matter. Walter obtained a list of articles from the Centers for Disease Control and Prevention (CDC), authored mostly by CDC abortion-surveillance staff, and consulted with Alan Guttmacher Institute personnel. Walter wrote a draft report on his findings and gave it to Koop.

In a January 10, 1989 letter to Reagan, Koop said that there was insufficient evidence to substantiate issuing the finding desired by the administration. [1] [16] [17] He also commented about how some of the president's advisers thought that "it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe v. Wade". [17]

Koop did not present the draft report to Reagan and claimed he never approved it. [17] In March 1989, the "Koop Report" became public after it was subpoenaed and became part of a Congressional subcommittee hearing. [17] Although there were allegations that the report had not been released previously because it was biased, the document contained all arguments on both sides of the issue. [17]

Later career

Following his career as Surgeon General, Koop was on The Firestorm Solutions Expert Council. [18] Koop hosted a documentary series in 1991, simply titled C. Everett Koop, M.D. It aired for six episodes on NBC. [19]

Koop and other investors established drkoop.com in 1997, during the dot-com bubble. [2] This medical information website was one of the first major online sources of health information. Critical review of the site content revealed that many of the private care listings, medicinal recommendations, and medical trial referrals were paid advertisements. The company went bankrupt in 2001 [2] . Koop continued to endorse Life Alert bracelets for the elderly.

In 1999 testimony before Congress, Koop minimized concerns from health groups about the severity of allergies to latex gloves. [1] It was later discovered that a company that manufactured latex gloves had previously paid Koop $650,000 for consulting work. [1]

Koop held three professorships at Dartmouth Medical School, where he was also the senior scholar at the C. Everett Koop Institute. [8]

Legacy

Koop is perhaps most remembered for four facets of his professional work.

Abortion

Though Koop was opposed to abortion on personal and religious grounds, [4] [14] [20] [21] he declined to state that abortion procedures performed by qualified medical professionals posed a substantial health risk to the women whose pregnancies were being terminated, despite political pressure to endorse such a position. [17] [21]

Tobacco

In his 1988 Report of the Surgeon General, it was reported that nicotine has an addictiveness similar to that of heroin or cocaine. Koop's report was somewhat unexpected, especially by those who expected him to maintain the status quo in regard to his office's position on tobacco products. During his tenure, in 1984, Congress passed legislation providing for new, rotated health warning labels on cigarette packs and required advertising to include the labels. Those labels remain unchanged today. New labels containing graphic depictions of smoking-caused illness and death have been announced by the FDA, but are on hold pending the outcome of tobacco industry legal challenges. Koop issued a challenge to Americans in 1984 to "create a smoke-free society in the United States by the year 2000." [22] As Surgeon General, he released eight reports on the health consequences of tobacco use, [23] including the first report on the health consequences of involuntary tobacco smoke exposure. During Koop's tenure as Surgeon General, smoking rates in the United States declined significantly from 38% to 27%. [24]

AIDS

Koop was Surgeon General when public health authorities first began to take notice of AIDS. [25] For his first four years in office, Koop, the nation's top health officer, was prevented from addressing this health crisis, for reasons he insisted were never fully clear to him but that were no doubt political. [26] Koop wrote the official U.S. policy on the disease, and in 1988 he took unprecedented action in mailing AIDS information to every U.S. household. [27] Gay activists and their supporters were unhappy with the way in which he targeted gay sex and the risk of infection through anal sexual intercourse as primary vectors of the disease, but Koop was unapologetic, claiming such activities entail risks several orders of magnitude greater than other means of transmission. Religious activists, upset over the pamphlet's frank discussion of sexual practices and advocacy of condom use, called for Koop's resignation. [28] Koop also infuriated some former supporters by advocating sex education in schools, possibly as early as the third grade, including later instruction regarding the proper use of condoms to combat the spread of AIDS. While a straightforward telling to the public about the disease was controversial, Koop was also criticized by some health activists who claimed that his office had not gone far enough in attempting to develop a cure or vaccine, reducing the role of his office to educating the public on health concerns.

Baby Doe and the rights of handicapped children

In April 1982, a child born in Bloomington, Indiana, was diagnosed with Down syndrome as well as esophageal atresia with tracheoesophageal fistula. Six days later, after court involvement and parental discussion involving disagreement among physicians about whether or not to treat the baby or let him die, the baby died, having been denied surgical treatment to correct his esophageal atresia and tracheoesophageal fistula. Baby Doe, as he would be known, became a symbol for children with birth defects, handicapped infants, and the debate over infanticide. Koop was not initially involved with the Baby Doe case but had a special interest in it. As a pediatric surgeon in Philadelphia, he and his colleagues had operated on 475 such babies during his 35 years there, with ever-increasing survival rates. During his last eight years in active practice, Koop never lost a full-term baby upon whom he had operated to correct esophageal atresia. It was due to this background that he became actively involved championing policies to protect the rights of newborns with defects, which led to Congress passing the Baby Doe Amendment.

Style

These four issues combined with Koop's personality and his willingness to make use of mass media brought to the office of Surgeon General a higher public profile than it previously had merited; he is, for instance, the first Surgeon General to have been the subject of a popular song – "Promiscuous" by Frank Zappa. He was interviewed by Ali G for comedic effect.

Koop was well known for his mustache-less beard and colorful bow ties. During much of his day-to-day work, Koop wore the Surgeon General's US Public Health Service Commissioned Corps uniform, a uniform similar to that of a U.S. Navy Vice Admiral's. During his tenure he re-instated the daily wearing of the PHS uniform by the officers of the PHS.

Personal life

In early 1968, Koop's son David was killed in a rock climbing accident on Cannon Mountain during his junior year at Dartmouth College. Koop later wrote that because of his son's death he thought, "I might be better able to help parents of dying children, but for quite a while I felt less able, too emotionally involved. And from that time on, I could rarely discuss the death of a child without tears welling up into my eyes." [29] Years later, he and his wife wrote a book called Sometimes Mountains Move to help others who had lost a child. Koop's son Rev. Norman Koop attended Eastern Baptist College (now Eastern University) and graduated in 1969. The following year the elder Koop was elected to the board of trustees, becoming the first non-Baptist member of the board. [30]

In February 2007, Elizabeth Koop, his wife of nearly 70 years, died. On April 17, 2010, he married Cora Hogue, a former staff member of Tenth Presbyterian Church in Philadelphia.

Death and legacy

At a 2010 news conference, Koop spoke from a wheelchair and said that he was "very, very deaf" and legally blind. [2] Koop died on February 25, 2013, at the age of 96 at his home in Hanover, New Hampshire. [2] According to a Koop aide, he had been ill for several months and had suffered kidney failure the previous week. [5] No official determination of cause of death has yet been announced.[ may be outdated ] [31]

Remarking on Koop's death, American Medical Association president Jeremy Lazarus commented, "Because of what he did, and the way he did it, he had a dramatic impact on public health." [32] The Associated Press called his impact "great", [31] while The Philadelphia Inquirer called him "a courageous and brilliant pediatric surgeon who pioneered techniques ... and became an outspoken surgeon general". [33] Writing for The New Yorker , Michael Specter said, "I don’t think I have ever met anyone for whom I had more respect... In this era, during which progress, facts, and science are under unrelenting siege, it is thrilling to remember that even ideologues can love the truth." [34]

Awards and honors

Publications

Related Research Articles

Esophageal atresia congenital disorder of digestive system

Esophageal atresia is a congenital medical condition that affects the alimentary tract. It causes the esophagus to end in a blind-ended pouch rather than connecting normally to the stomach. It comprises a variety of congenital anatomic defects that are caused by an abnormal embryological development of the esophagus. It is characterized anatomically by a congenital obstruction of the esophagus with interruption of the continuity of the esophageal wall.

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References

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Further reading