Copyright 2000 The Washington Post
The Washington
Post
January 9, 2000, Sunday, Final Edition
Correction Appended
NAME: C. EVERETT KOOP
SECTION: STYLE; Pg. F01
LENGTH: 3928 words
HEADLINE:
The Fox in 'Chick' Koop; The Former Surgeon General Has Gone Public, and
Prospered in the Process
BYLINE: John Schwartz,
Washington Post Staff Writer
DATELINE: HANOVER, N.H.
BODY:
C. Everett Koop has always charged
boldly forward--and sometimes, even he admits, he doesn't know when to stop.
He tells a horrifying story on himself from his days as a surgical
resident in the early 1940s. As he recounts in his memoirs, he was checking in
on a patient after routine gallbladder surgery when she suddenly clutched her
throat and died. He gripped the sides of her gurney and wheeled it into the
elevator and up a floor, crashing his way into the operating room. He grabbed
the instrument tray away from the hospital's astonished head of surgery as he
was about to begin an operation, and--without even taking time to scrub--sliced
open the woman's chest.
"I had never before opened a chest, so I didn't
do it properly, but I got in there," Koop recalled. "Somehow I located the
blocked pulmonary artery, slit it open, and extracted a blood clot over nine
inches long, in the shape of a Y . . . Then I slapped the heart, and it began to
beat." As the gathering throng of surgeons crowded around the doorway, "to my
amazement and joy, she began to stir." He sewed up the artery as the other
surgeonsstared in awed at the young doc who was brash even by their standards.
And then he went too far. Koop decided to drizzle a few precious drops
of the then-new drug penicillin over the patient's heart to
prevent infection. "To my amazement--and horror--the heart stopped immediately,"
Koop recalled. "I did not know about the high concentration of potassium in
penicillin--enough to stop any heart." Koop calls the incident "a fatal gilding
of the lily."
Those were simpler times: Instead of phoning a malpractice
lawyer, the woman's family thanked Koop for his dramatic attempt to save her
from a complication of surgery that would otherwise have left her dead anyway.
And that is the world that formed "Chick" Koop. (The corny college
nickname is a play on "chicken coop.") You did what was right, took your
chances. If you made a mistake, well, people forgave you so long as they knew
your heart was in the right place. From the moment at age 5 when he knew he
would become a doctor to the eight-year term that made him unquestionably
America's most famous surgeon general, Koop has been self-assured to a
preternatural degree.
It is a trait that has served him spectacularly
well, first making his distinctive visage almost synonymous with medicine and
public health, gravitas and integrity--and then making him rich.
And, as
it turns out, the rich really are different: They get a lot more criticism.
Ever since the successful initial public offering of stock in his online
health information company, Drkoop.com, made him millions (his 737,000 shares
are currently valued at $ 9.5 million, down from a peak of more than $ 41
million in the high-flying days after the stock was first issued last June), the
newly high-profile Koop has been accused of cashing in on his reputation. Some,
particularly environmental and health activists, see an unethical mixing of news
and advertising on his Web site.
They also accuse him of acting as a
front for chemical and pharmaceutical manufacturers. In 1999 testimony before
Congress, Koop played down health groups' concerns that health care workers and
some patients were being sickened by allergies to latex surgical gloves, saying
calls for bans on the gloves' use bordered on "hysteria." He pressed a
government official to soften a warning about use of the gloves as well. In both
cases, Koop failed to disclose that he had once received $ 650,000 in consulting
fees from a company that manufactures the gloves.
He also testified in
favor of extending patent protection on Schering-Plough's
blockbuster anti-allergy drug Claritin, without telling
lawmakers of another possible conflict. The company had contributed a million
dollars to the Dartmouth-based Koop Foundation, tied to an institute he founded
that promotes medical education for consumers and better methods and practices
for health care providers.
An editorial in the Chicago Tribune called
Koop's behavior "shocking" and a "blatant conflict of interest" that has caused
Koop's name to lose "a good bit of its luster lately." Even the paper in his
home town of Hanover, N.H., ran a column saying that the recent revelations
"raise questions about the former Surgeon General's current levels of
trustworthiness and credibility." Writer Matt Labash wrote in the conservative
Weekly Standard that " 'Koop' could mean what it does in Amsterdam's Red Light
district, where Dutch hookers stand under signs that read 'te koop.' There, it
simply translates 'for sale.' "
Koop--for sale? This, after all, is the
public health paragon who wrote in his 1991 memoir that "like many Americans, I
was disgusted with the way retired politicians--even presidents--cashed in on
their celebrity status. I was not about to sell or rent my integrity and the
public trust." Has he let his standards of propriety slip in his late years?
Koop says the criticisms are based on misinformation or a too-expansive
definition of conflict of interest. He suggests he is merely a casualty of a
nasty and increasingly personal battle with the environmental left. "I am not a
conspiracy guy," he insists, "but I know I have made these people lose face."
On the Edge
Koop--who chose the most
excruciatingly harrowing specialty imaginable, pediatric surgery, and
transformed the field--has spent much of his life surviving tough scrapes. In
college, he put his surgical ambitions on the line--literally--going out for
center on the Dartmouth football team. (He dropped out after a vicious hitleft
him seeing double--for the rest of his life, as it turned out.) Taking a ski
jump recklessly later in college caused a somersaulting fall that left him
partially paralyzed for the better part of a week.
And then he really
got rash: He came before Congress as the surgeon general-designate in 1981.
Liberals there and in the media vilified him as a religious crusader who would
use the office to proselytize against abortion--and, in fact, Koop had helped to
make an antiabortion documentary and made no secret of his evangelical Christian
faith. The New York Times editorialized that he was "Doctor Unqualified";
another newspaper called him "Dr. Kook."
After surviving a long and
difficult confirmation process, Koop took to the job with a ferocity on issues
that turned his old enemies into his strongest supporters--and utterly alienated
the conservatives who were his early boosters. Generally staying away from
abortion issues, Koop took hard stands against smoking and the tobacco industry,
and campaigned for AIDS education that would encourage condom use and educate
young people--even in elementary school--about the dangers of unprotected sex.
He had millions of copies of an explicit AIDS education pamphlet, and mailed one
to every American household. For his troubles, conservative activist Phyllis
Schlafly accused him of trying to teach "safe sodomy" to third-graders, and
columnist Robert Novak suggested in print that Koop would "have to go."
He seemed to rush from one firestorm to another, never uncertain about
his course. When people asked what the decorations on his Public Health Service
Commissioned Corps uniform stood for, he'd point to the top row and joke, "These
are for what the liberals did to me." Then he'd point to the second row: "And
these are for what the conservatives did to me."
The Good Doctor
Koop, now 83 years old, eases into the cavernous dining room of
the Hanover Inn looking more like an Old World patriarch than an Internet
millionaire.
The former surgeon general who sternly told America to
shape up orders his usual: two poached eggs on red flannel hash. Red meat isn't
red enough--at the Hanover they boost the color by grinding in a liberal portion
of beets. "This place hasn't changed since I was a student here!"--more than 60
years before.
The Lincolnesque beard is still there, and despite the
hash and eggs he is trim and energetic, his voice resonant with a hint of Old
Testament thunder. Wherever he goes, all eyes turn his way; the people he passes
point and murmur, a low chorus of "Koop-Koop-it's-Koop" ripples in his wake.
As he gets up to leave, a family rises from breakfast to greet him.
Stephanie Kong enthusiastically grasps Koop's hand, saying, "You're my hero!"
Stephanie's husband, Waine Kong, head of the Association of Black
Cardiologists, seems incredulous to hear of anti-Koop sentiments. "Because he's
getting rich?" the doctor asks. "That is so silly. The man deserves everything
he gets. I'm constantly amazed when people believe they can walk better if their
neighbor has a broken leg."
If he'd wanted to sell out, Koop argues, he
could have done it long ago. In one week after leaving public office, he says,
he turned down $ 8 million in endorsements and other deals.
Drawing
himself up as if on camera, he mockingly announces: "Total Cereal. That's all
you need and more."
"That's a million bucks," he says of that potential
endorsement: $ 125,000 per word. "If I had a price, I'd be a billionaire."
Koop's seeming tone-deafness about the appearance of conflicts of
interest has, however, caused concern among some of his allies.
"Those
of us who know him reasonably well are convinced he's not corrupt--but that
doesn't make it right," said one person who has worked with him for years.
Another of Koop's confederates in the fight against Big Tobacco, former
FDA commissioner David A. Kessler, says, "The shame of it is he doesn't have
people who can say, 'Hey, Chick, that's not a smart thing to do.' "
Taking Sides
Koop has long sought corporate
money to fund his causes while actively lobbying Congress. The difference, in
recent years, is that he has become an increasingly high-profile ally of a major
player in many acrimonious public health debates: The American Council on
Science and Health (ACSH), a nonprofit organization that gets extensive funding
from chemical and manufacturing industries--and is widely seen as an industry
front group.
Koop's advocacy, though, hadn't gotten him into much
trouble until two things happened: He lost a ferocious battle in the tobacco
wars, and he became an Internet millionaire.
Losing the battle got him
angry enough to shout a little louder. And striking it rich made him one very
fat target.
During the 1998 attempt to reach a deal between Congress and
a lawsuit-battered tobacco industry, Koop pushed to impose tough terms on the
industry well beyond the public health concessions the companies had agreed to.
But ultimately, the industry balked, the votes evaporated, and Koop was left
with nothing to show for his passionate efforts.
That loss "did
something to me--that was the crack, the final crack," he said. "To see it all
come to naught, if somebody with my reputation and access couldn't engineer a
better result . . ."
He recalls talking with his wife Betty in their
kitchen in Bethesda, Koop railing against the intransigence of the industry and
the lawmakers he felt betrayed the cause. "I stopped to catch my breath, and we
said in unison, 'Let's get out of here.' " The next day they put their house on
the market and ordered a new home to be built in Hanover, just a few hundred
feet away from the converted-dorm offices of the Koop Institute.
Koop
had left town, but he carried his anger with him. He escalated his alliance with
ACSH. He chaired an organization-sponsored panel that declared vinyl-softening
chemicals known as "phthalates" safe. Environmental and health groups, citing
studies showing cancer and organ damage at high doses in some animals, want the
chemicals immediately removed from medical products and toys. (The European
Union has banned phthalates in toys and American toymakers have largely dropped
them.)
Koop's Web site featured "exclusive" commentaries written by ACSH
President Elizabeth Whelan and others from the group that tweaked
environmentalists and championed corporate positions. Their bottom-line:
Americans should focus on eliminating known killers such as smoking, excessive
drinking, drug abuse, accidents, unprotected sex and sloth
rather than obsess over small amounts of useful chemicals that pose an unproven
risk.
But Koop didn't stop there. In a blistering Wall Street Journal
essay that ran last summer, he called the debate over phthalates "The Latest
Phony Chemical Scare."
"This ceaseless obsession with ousting the
frequently nonexistent bogeymen from our chemical cornucopia does quite a lot to
strengthen the ranks of consumer groups," he wrote, "but very little to actually
improve the health and quality of our lives."
At any other time, he
might have been just another formerly famous talking head. But the skyrocket
stock offering from Drkoop.com happened just two weeks before the publication of
the phthalates report. The phenomenally successful IPO generated headlines
around the nation--and gave Koop's critics a mountain of ammunition for their
attack. Now they are striking back.
Just call consumer health advocate
Sidney M. Wolfe, who heads Public Citizen's Health Research Group, and you'll
get an earful about the practices at what he calls "Drkoop.con," including
vitriolic commentary about "Liz Whelan and her hoodlum friends."
The
publicists paid to spin for environmental causes have long been hoping for Koop
to fall, and have tried to help the process along. They exult over Koop's
treatment in three tough articles by New York Times reporter Holcomb Noble.
Publicists for Environmental Media Services, a Washington-based public
relations shop, make it clear that Koop has been targeted. One suggests the
names of several people "who have been actively researching Koop," including
spokesman David King of the National Environmental Trust, who she says "set up
the Noble piece."
"Dave got him [Noble] on this," NET official Jeff Wise
crows, explaining that King sent the Times reporter a story from an online
environmental publication showing that a Drkoop.com editorial on phthalates
tracked, line by line, a defense of the vinyl softeners written by the counsel
for the plastics industry.
Wise and King speak of Koop with bitterness,
saying he has become little more than a brand name: "It's exactly what he said
in his autobiography that he would not do," King says.
Noble says that
is not correct. He says he first became interested in the story after a reporter
at the Newark Star-Ledger broke the story about the Claritin testimony and "I
must have talked to 500 people over the course of three months."
If Koop
is under attack, he also has defenders. "Koop is taking the rational position on
a lot of these things," says journalist Gregg Easterbrook, who has himself
sparred with environmentalists. "Everything he says is very strongly grounded in
a decent body of research--it's just a body of research that the environmental
left doesn't like. . . . If you wanted to make political hay, he's somebody
you'd try to go after."
Koop, fighting spin with spin, has hired a media
consultant of his own, Eric Dezenhall. Practiced at the art of defending large
corporations that get into trouble, Dezenhall says Koop, an individual who
believes he has done nothing wrong, is an unusual client. "Most of my clients
are like, 'Eric, we dumped the acid in the river--we didn't mean to, but we
did--and here are the five things we're doing about it.' "
The Dezenhall
touch shows through in a bare-knuckle Koop speech in Woodstock, Vt., before a
gathering of about 50 New England newspaper editors. Koop's 45-minute broadside
against "junk science" takes on the Times coverage directly, and reporter Noble
personally. "When real science thwarts the purposes of the scaremongers, they
resort to personal attacks," he says. "The tactics of the health scare groups
are pretty facile. These groups find an inexperienced reporter . . . and give
him a chance to be a rock star."
During much of the past few years,
Noble had written science briefs and obituaries--including Koop's, prewritten,
as is the newspaper's custom. Noble argues he's anything but inexperienced. The
66-year-old Timesman was deputy editor of the paper's science section, editor of
one of its magazine supplements and covered moon shots for the Associated Press
in the 1970s.
In an interview, Koop admits to missteps with Noble in the
days before Dezenhall was there to coach him. The former surgeon general
defended himself against conflict-of-interest charges by saying he is an "icon,"
exhibiting the same mixture of tin ear and ego that seems to lie at the base of
so many of his troubles.
Say the word "icon" to him today and he puts a
hand over his face and shakes his head. "I never should have used that," he
says, but adds that so many people have called him exactly that to his face that
he'd gotten used to it.
"I think one of the great blessings of my life
was I was an appreciated public servant," he says. "I don't think people come up
to Henry Kissinger and wring his hand and thank him for what he did for the
American public."
'It Never Occurred to Me'
Koop
answers each criticism with indignation. About his testimony supporting the
extension of Claritin's patent protection, he
says, "You might think I'm naive, but it never occurred to me that it could be a
conflict of interest," since the company's contribution went to the foundation
and does not benefit him directly.
On latex allergies, he argues that
his contract with the manufacturers was about kicking off a new line of
vitamins, and he never had any dealings with the glove division--or even knew at
the time that it existed. The contract ended two years before the testimony
occurred. "Why would I make a disclosure--I had absolutely nothing to do with
latex gloves in that company!" Koop says. Again: "It never occurred to me."
His belief in the safety of latex goes back decades, Koop explains:
"Please remember that I spent four years of my life as surgeon general trying to
put a thin layer of latex between the American people and the AIDS virus.
Naturally my passion for that had not abated."
Some of his gaffes he
simply chalks up to sloppiness on his part and on the part of his staff. In his
glove testimony, for example, he said that a study largely exonerating latex
gloves came from the Centers for Disease Control and Prevention--when it
actually came from a glove manufacturer. "I have no excuse for it," he says,
except to say that he was "misled."
As for the Web site, he notes many
of the ethical problems--such as glowing copy about a group of hospitals that
wasn't identified as paid advertising--are being addressed and corrected. "It's
very hard to keep track of 92,000 pages and 103 employees, not all of whom are
as steeped in the ethics you have," he says.
Koop insists his Web site
is not about making money, but is his most recent attempt to get Americans to
learn about and take control of their care--a central tenet of his work as a
public health leader. Koop says he tried to promote education and self-help
through nonprofit organizations after leaving office, but found the results
disappointing.
The fact that he's worth millions in stock because of his
involvement, he insists, doesn't mean much to him; he calls it "monopoly money"
tied up in high-flying Internet stock that he couldn't even touch under
Securities and Exchange Commission rules.
Koop's self-defense does not
entirely persuade John Fletcher, professor emeritus of ethics at the University
of Virginia who was asked by The Post to review the facts of the Koop
controversy. While Fletcher jokes that "the population of Washington would
shrink by half if you had suddenly a ban from moving from public service to
public life," he argues that the transition calls for great care--adding that
Koop should have done more to ensure that his dealings with business were above
reproach.
The ethicist is particularly troubled by the appearance of a
conflict over latex gloves. "I really do think that he crossed the line there. .
. . If you are a person of his stature and you are going to enter into a
contract to be a spokesperson for this company, it behooves you to find out all
about it and to have a way to check it from stem to stern."
Koop,
Fletcher said, has been "morally reckless with the trust that had been invested
in him."
An expert on online business says Koop has had to learn some
hard lessons about the online world, but gives him good marks for responding to
criticism, and, among other things, establishing clearer distinctions between
advertising and editorial content. "To his credit, he rode that learning curve
really fast," says Donna Hoffman of Vanderbilt University. "Doing business
online is a massive experiment. . . . I just wish other firms would be as quick
to learn from their mistakes."
Last summer Koop convened a group of
executives from the biggest health care sites to begin discussing a code of
ethics for their nascent industry. "Should we not have an industry group that
leads by example rather than waits for regulation?" asks Donald Hackett, chief
executive of Austin-based Drkoop.com.
Whelan of ACSH argues that the
views expressed by Koop and her group should be judged on their own, not by who
pays the bills. But while she boasts of having a thick skin, she says she is
"appalled and saddened" to see Koop under fire. "What is wrong if you were a
public servant and gained fame, and you get into the private sector and people
want to throw money at you to get you involved in their cause, or have you lend
your name? . . . I'm a capitalist, and I think that's great--as long as you stay
true to the science, and he does that.
"I think it's naive on the part
of people to think that he should just retire into mediocre poverty when he
could be contributing to society and making money at the same time," she says.
"Mediocre poverty" certainly overstates the case, since Koop earns a
more than comfortable living from speaking fees alone. Koop, who earned so
little during his surgical training that he put his growing family in a house
that had been abandoned for 17 years before they moved in, said his bank balance
has never been a big issue. "My wife and I have never had an argument about
money," he explains. "We've had a very simple economics. First we had nothing,
then we had enough. And that worked out just fine."
No amount of
supportive talk from his allies can take the sting out of Koop's loss of
reputation. At his speech to the editors, standing in the dim room with his face
lit from below by the lectern lamp, he recalled that in 1968 he had been asked
to speak at a prayer breakfast in Philadelphia and wrote remarks for the
occasion. "Between the time I wrote them and the time I appeared for my prayer
breakfast, my third son was killed." He told them about stopping in mid-sentence
to say "something happened in my life that I would like to share with you."
Standing before the editors, Koop went on: "Now I find myself in the
same position."
But this time, it wasn't the loss of a son who bled to
death in a climbing accident, but the accusations against him he wanted to
address.
At another point in the day, when the subject of reputation is
raised, he also drifts into a discussion of the loss of his son David at the age
of 20--a needless death, he suggests, that could have been averted, if only
someone had been able to stop the bleeding.
CORRECTION-DATE: January 9, 2000
CORRECTION:
The amount of DrKoop.com stock owned by
C. Everett Koop is misstated in a story in today's Style section, which was
printed in advance. The correct amount is 1.8 million shares, currently worth $
23.1 million.
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