A Surgeon General without an army.

KOOP D'ETAT

A T AGE 65 most people slip into obscurity with a
  retirement check and some golf clubs. But Dr. C.
Everett Koop, a world-renowned pediatric surgeon, is
on the brink of a new career. On October 28, the
Senate Labor and Human Resources Committee ap-
proved Koop's nomination as Surgeon General of
the United States. Despite a request by Senator
Charles McC. Mathias, Republican of Maryland, that
the full Senate postpone its vote to allow time for
further research into the candidate's background, the
nomination is expected to go through. The appoint-
ment is a controversial one. Dozens of newspapers and
national organizations oppose Koop on the basis of his
doctrinaire anti-abortion stance, his backward views
on women's and gays' rights, and particularly his inex-
perience in the field of public health. Koop's colorful
way of expressing his moral convictions has made him


an easy target ror meala attacks that ignore more
pertinent issues. A fundamentalist Christian, Koop
has compared legalized abortion with "the beginnings
of the political climate that lead to Auschwitz, Dachau,
and Belsen." He has denounced most main-line Chris-
tian denominations as "depraved." And he predicted, in
a 1979 commencement speech, that 20 years hence the
Rockefeller Foundation will be funding homosexual
test-tube babies to give the gay movement more politi-
cal clout. Perhaps he was kidding, but President Rea-
gan isn't. The President is determined to have his man,
even if it means making ineffectual the position the
Philadelphia surgeon is intended to fill. In an attempt
to make two wrongs equal one right, Reagan is placing
an unqualified man in a job whose legitimacy is itself
increasingly questionable.

T HE position of Surgeon General, which slowly
  evolved from the "supervising surgeon" for the
Merchant Marines in 1798 to the nation's chief spokes-
man for public health issues in the 1920s, has always
been nebulous. The power of the office peaked in 1964,
when the influential report on the health hazards of
cigarette smoking was issued. In 1966, all decision-
making functions of the post were transferred to
H.E.W.`s office of the Assistant Secretary for Health,
and the Surgeon General became more of an advisory
figure than an administrator. President Nixon abol-
ished the position in 1973 when, unable to find a
candidate, he simply neglected to appoint anybody.
President Carter reinstated the position, but combined
it with the job of Assistant Secretary for Health. In
whatever form, the job has managed to survive as that
of the national counselor for public health matters.
The three previous Surgeons General all had back-
grounds in public health. Dr. William Stewart special-
ized in epidemiology and public administration in the
Public Health Service before his appointment in
1965. His successor, Dr. Jesse Steinfeld, was a
scientist and a deputy director of the National Cancer
Institute before his nomination in 1969. And Dr. Julius
Richmond, who served as both Surgeon General and
Assistant Secretary for Health under Carter, had been
chairman of Harvard Medical School's department of
preventive and social medicine.

Koop, on the other hand, has virtually no experience
in the field of public health, the function of which,
according to the American Public Health Association, is
preventing disease and promoting the health needs of
the population as a whole. The A.P.H.A. says that
most of Koop's admittedly impressive achievements-
including new surgical techniques and the treatment
of childhood cancer-are in the field of "patient care,"
which concentrates on the treatment of illness rather
than its prevention. At his confirmation hearing in
October, Koop pointed to his experience curing var-
ious epidemics and coordinating programs for medical
fellowships abroad as public health qualifications. But

the A.P.H.A. says that these do not constitute the
"specialized training or significant experience in public
health programs" required by law for the position of
Surgeon General.

When Koop was nominated in September, the main
part of the job was supervision of the 6,00O-member
Commissioned Corps, a medical team that staffs the
Public Health Service hospitals and clinics and the
Indian reservation health centers. The corps is on hand
in case of a national medical emergency such as the
eruption of Mount St. Helens. But several weeks ago
the government announced it will no longer fund the
eight hospitals and 27 clinics. The hospitals, which
were originally set up to treat commercial seamen and
to keep communicable diseases out of the country,
over the past 40 years have gradually become health
centers serving low-income communities. According
to Health and Human Services Department spokes-
men, the Surgeon General's main job, aside from
directing the pared-down corps, will be to advise the
Administration on policies regarding the elderly, in-
cluding overseeing the White House Conference on
Aging, which will be held at the end of the month.

F OR THIS kind of job, it makes little difference
whether or not Koop has the requisite experience
in public health. If he did, he would have little opportu-
nity to apply his knowledge. Government health offi-
cials acknowledge that the position is most important
for symbolic reasons. "The Surgeon General is more.
tradition than anything else," says Jim Buchan of the
Public Health Public Affairs office. "We've had a Sur-
geon General since the 1700s." But such a cavalier
attitude angers some in the field of public health. Dr.
William McBeath, executive director of the American
Public Health Association, says he would rather have
no Surgeon General at all than one who does not have
adequate background in public health. "That would be
preferable to pulling a travesty on the public, by pass-
ing off a leopard as a tiger," he said.

The President's motives in appointing Koop appear
to be more those of self-interest than of concern for
the public health. The nomination is a way to appease
the anti-abortion forces who backed Koop and who
opposed the appointment of Supreme Court Justice
Sandra Day O'Connor. Koop's lack of public health
qualifications may also help pave the way for further
erosion of the already diminished Public Health Ser-
vice. As for the nominee himself, the title of Surgeon
General will provide a pleasant way to keep busy after
the mandatory age of retirement. If Koop is to be a
mere figurehead, President Reagan should follow his
own preachings on the size of government and abolish
the position as Nixon did. But if the post is to be a
viable one, it should be filled by somebody with the
necessary qualifications.

ELISA ISAACSON

NOVEMBER 18.1981 11