Dr. Koop was the most recognized surgeon general of the 20th century. He almost always appeared in the epauleted and ribboned blue or white uniform denoting his leadership of the commissioned corps of the U.S. Public Health Service. With his mustacheless beard, deep voice and grim expression, he looked like a Civil War admiral or, as some cartoonists suggested, a refugee from a Gilbert and Sullivan musical.
The theatrical appearance, however, masked a fierce self-confidence, an unyielding commitment to professional excellence and a willingness to challenge the expectations of his patrons.
A 64-year-old retired pediatric surgeon at the time Ronald Reagan nominated him in 1981, Dr. Koop had no formal public-health training. His chief credential was that he was a socially conservative, Christian physician who had written a popular treatise against abortion. His confirmation took eight months. Few people expected him to talk about homosexuality, anal intercourse, condoms and intravenous drug use when almost nobody else in the Reagan administration would even utter the word “AIDS.”
Dr. Koop, however, believed information was the most useful weapon against HIV at a time when there was little treatment for the infection and widespread fear that it might soon threaten the general population. In May 1988, he mailed a seven-page brochure, “Understanding AIDS,” to all 107 million households in the country.
“He was a guy who surprised everybody,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, who was Dr. Koop’s chief tutor in AIDS matters and became a close friend. “People expected one thing, and they not only got another thing, they got someone who was amazingly effective.”
“You couldn’t go anywhere where he wasn’t recognized. Even the tollbooth guy on the [Boston] Callahan Tunnel — everybody recognized that beard,” said former Food and Drug Administration commissioner David Kessler, who worked closely with Dr. Koop on the campaign against tobacco, among other issues. “He really was America’s doctor.”
Kessler recalled Dr. Koop’s refreshing lack of ideology, which sometimes perplexed those inside the Beltway.
“He knew very little about Washington when he arrived, and he developed political instincts that were very attuned to what the country expected,” Kessler said. “It’s really proof that you can’t really label anyone.”
Among AIDS activists Dr. Koop became an unlikely hero, although some came to think that his sexually explicit talk tended to further stigmatize gay men.
“Most of us thought that a huge part of how the crisis grew exponentially was that those in power chose to ignore it for as long as they could,” recalled Peter Staley, a founding member of the AIDS Coalition to Unleash Power. “He was the only person in that administration who spoke the truth when it came to AIDS.”