Charles Everett Koop (October 14, 1916 – February 25, 2013) was an American pediatric surgeon and public health administrator who 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" due to his frequent public presence around the HIV/AIDS crisis of the 1980s.

Koop was known for his work on tobacco use, AIDS, and abortion, and for his support of the rights of children with disabilities.

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). He attended and graduated from Flatbush School. In 1937, he earned his Bachelor of Arts in zoology degree from Dartmouth College, where he was given the nickname "Chick" (occasionally used for his first name, Charles, but here an allusion to a chicken coop). His interest in medicine followed after a year spent in the hospital after a childhood skiing accident and brain hemorrhage. 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.

Medical career From 1946 to 1981, Koop was the surgeon-in-chief at the Children's Hospital of Philadelphia (CHOP). Koop was able to establish the nation's first neonatal surgical intensive care unit there in 1956. 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 35 residents and 14 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.

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

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) 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.

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

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). 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 strong opposition to abortion and euthanasia. Koop also took some time off from his surgical practice to make a series of films with conservative Christian 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. 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".Schaeffer, Frank. Crazy for God: How I Grew Up as One of the Elect, Helped Found The Religious Right, and Lived to Take All (or Almost All) of It Back. Carrol & Graf Publishers, 2007, pp. 284–285.

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

Surgeon General of the United States

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

Abortion Although Koop was against abortion on personal and religious grounds, 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.

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. He said it was not a public health issue but a moral one. 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 mainly 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 there was insufficient evidence to substantiate issuing the finding desired by the administration. 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".

Koop did not present the draft report to Reagan and claimed he never approved it. In March 1989, the "Koop Report" became public after it was subpoenaed and became part of a Congressional subcommittee hearing. 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. Koop himself said at the hearing, "My position [on abortion] is well known to everybody in this country. I'm opposed to it. But I also took an oath to uphold the law of the land. That's why I walk a tightrope and why I prepared the report as I did."

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.

"He railed against their advertising approaches, their marketing to children, their bogus research operation, their unwillingness to come clean on nicotine addiction. He said their product was more addictive than heroin. He called their leadership "morally corrupt". He informed the public about the dangers of second hand smoke, smoking while pregnant, and smoking in public places, including hospitals. He was relentlessly provocative, and used tobacco to test his theories about hands-on, public health campaigning."

During his tenure, in 1984, Congress passed legislation providing new, rotated health warning labels on cigarette packs and required advertising to include the labels. Those labels remain unchanged today. The FDA announced new labels containing graphic depictions of smoking-caused illness and death, but they were put on hold pending the outcome of the tobacco industry's legal challenges. Koop challenged Americans in 1984 to "create a smoke-free society in the United States by the year 2000."Koop CE. Call for a smoke-free society. Pediatric Pulmonology 1985;1:4–5 As Surgeon General, he released eight reports on the health consequences of tobacco use,* 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%.

AIDS

Koop was Surgeon General when public health authorities first began to take notice of AIDS. 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 apparent to him but that were no doubt political. 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.Understanding AIDS – A Message from the Surgeon General. Profiles.nlm.nih.gov. Retrieved on 2013-02-27. Health advocates and organizations expressed dissatisfaction with the focus on same-sex activity and anal sexual intercourse as primary vectors for disease transmission. Surgeon General Koop maintained that these activities posed significantly higher risks than other transmission methods. In addition, some religious groups raised concerns about the pamphlet’s candid discussion of sexual practices and its promotion of condom use, leading to calls for Koop's resignation. 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 to develop a cure or vaccine, reducing his office's role in educating the public on health concerns.

Disability