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. (Published 01/09/2000)
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.' "
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.