WASHINGTON — Departing Surgeon Gen. C. Everett Koop, reflecting on his eight years as the nation's top doctor, promised Thursday that after leaving government he will not abandon any of the causes he has actively and publicly promoted.
"I would like someone to say five years from now that when Koop left the office of surgeon general he continued to be the health conscience of the country," he said, speaking in his final meeting with reporters as surgeon general. "I will continue to deliver health messages to this country as long as people will listen."
Koop, who will leave his post July 13 to write his memoirs, said that his greatest satisfactions have come from the public response to his anti-smoking campaign, in which he called for a smoke-free society by the year 2000, and to his 1986 AIDS report, which, he said, "is just as accurate today as it was then."
His 'Top Success'
The percentage of Americans who smoke dropped to 26% from 34% during his tenure, he said, and his anti-smoking messages have inspired many changes in state and local laws regarding smoking in public places. He said that "in the matter of numbers," it was his "top success."
But it was his report to the public on AIDS--in which he called for AIDS education in elementary school and urged the use of condoms to reduce transmission of the virus--that forced a national public debate on issues that many Americans had been unwilling to confront, he said.
"Because I faced the issue squarely and used the language that I did--and I don't know what you can call a penis, a vagina and a condom other than what they are--that finally pushed people reluctantly and slowly into a position of reality," he said.
He said that "certain very conservative" members of the Ronald Reagan White House staff, whom he did not identify, "would have done almost anything to shut me up." In fact, he said, only one week after the release of the AIDS report, they urged him to "update" it by eliminating the references to condoms. He refused.
"They left my office in a huff," he said. "They're gone--and I'm here."
Given Free Hand
However, he added: "Never since I have been in this job has anyone at a high level criticized me, or suggested that I not say something, or say something that I didn't believe in."
Koop raised the ire of many conservatives with his AIDS document, and also by his refusal to write a report describing the physical and psychological ramifications of abortion, a study he said could not be supported by scientific data.
Ironically, it was this same constituency that had avidly backed him during the 10 months it took for his confirmation to be approved. Congressional liberals, led by Rep. Henry A. Waxman (D-Los Angeles), had stalled the nomination because they considered Koop a right-wing religious zealot with little experience in public health. Since then, Waxman and others have become ardent admirers of Koop.
"What happened to me is a lesson about labels," Koop said. "I have always been conservative, but never the arch-conservative that the right-wing politicos thought I was. When I arrived, I never promised to espouse any causes. All I have done in this job is to face issues and deal with them as honestly as I could under the umbrella of public health."
Sees Education as Key
An avowed opponent of abortion, Koop said that he believes the only way to eliminate abortion is not to reverse the 1973 Supreme Court Roe vs. Wade decision, but to "educate people in a way we've never done" in matters of sexuality and contraception.
"It is a social issue which divides the people of this country like nothing else since the days of slavery," he said. "Both sides have become more entrenched, and I don't see any flexibility."
Thus, he said, preventive medicine in the form of increased education is the only solution. "If you want to get rid of abortions, you'd better get rid of the reasons for them," he said.
Koop, a former pediatric surgeon, said he had hoped to be named secretary of health and human services in the Bush Administration. "I would have liked to be secretary, and I think I would have done a very credible job," he said.
Koop said he would not have remained as surgeon general, even if the Bush Administration had asked him to do so.
"I'm 73," he said. " . . . I don't know how much time I have left ahead . . . I would like to take a crack at the private sector and try, if I can, to make some kind of impact on health from that perspective."