The General's Warning
Koop vows to win the war against smoking

D r. C. Everett Koop, the colorfully
  .outspoken surgeon general of the
United States, chuckles when he tells a
story about two bartenders he met at a
Maryland country club a few years ago.
"They asked me if I was the one who
put those [warning] signs on the cigarette
boxes," Koop recalls, `and I said, `Sure,
and they're also true.'

House to the lushly appointed offices of
the tobacco industry's barons, who con-
sider Koop a half-cocked kook. Their ar-
gument: No certifiable medical evidence
links smoking to poor health, so get off
our backs. No way, says Koop.

"Well, they listened to me as I gave
them the pitch for about five minutes. I
came back four months later - same coun-
try club, same two bartenders - and I went
right up to them and I said, `Do you re-
member me?'

His incessant hammering lends signifi-
cant prestige and weight to anti-smoking's
burgeoning battalions, once manned only
by so-called wimps and health freaks.
And though many members of the anti-
smoking forces blanche at some of the
doctor's right-wing, fundamentalist views
on issues like abortion, they need him to

quit, but why don't they?' he asks.
"They're addicted to the most addictive
drug in our society. It isn't like telling
people they shouldn't eat fudge . . .
"In the war against cancer,' smoking is
a high priority, primarily because it's
something you can change so easily. You
can't go out and change certain things in
the environment. You can't change gene-
tic things, but smoking is something you
can.

" `Do I remember you?'
one of them says. `I ain't
smoked since you were in
here.' "

"That's one of the things that makes my
crusade a reasonable one. What you are
eventually saying [to smokers] is, `For
     your own good, and that of
     those around you, would you
     change your behavior?' "

Koop has seen cancer's rav-
ages first-hand.

Koop wishes it were only
that easy to convince the rest
of the nation's 55 million
smokers. But give him cre-
dit - he tries. For the last five
years, from smoke-filled bars
to the halls of Congress, the
nation's top doctor has spread
his grim-reaper message:
Smoking kills.

Just look at the evidence,
Koop counsels: Tobacco con-
sumption is responsible for the
deaths of 350,000 Americans
each year-nearly 142,000
from   cancer  alone - and
leaves a multi-billion-dollar
trail of health-related costs in
its wake.

His mother, a non-smoker,
had breast cancer when she
was 49. A radical mastectomy
"which didn't leave much"
helped her live to be 86. And
the nurse who ran Koop's
operating room at Children's
Hospital in Philadelphia died
last July from lung cancer, no
thanks to a two-pack-a-day
cigarette habit which Koop
nagged her about "at least
once a day."

Koop passionately argues

Ahab: With his grey beard,
summer-white uniform of the
Public Health Service and
steely gaze, Koop looks like
a modem-day Captain Ahab
loaded for whale. But he's ac-
tually a low-key fellow who

that it needn't be this way: "I  Koop: "My position is to encourage, exhort and to be catalyst. "   cuts and polishes precious
now realize that without                              stones to keep his surgeon's
doubt, smoking is the number one public  reach their goal of a smoke-free society  eyes and hands in shape.
health problem in this country. But by 2000-a time when, Koop says, "the   His spacious office with a view of
perhaps more important than that, the be-  smoker will not smoke in the presence of  Capitol Hill and the National Gallery of
havior that leads to this terrible situation  a non-smoker without obtaining permis-  Art features a wallful of food for thought:
is something that people enter into con-  sion. The non-smoker's home will be his  A print of a large yellow light bulb proc-
sciously. And, it's behavior that can be  castle and the smoker will not invade it."   laims: "Think: Smoking Dims." Another
changed.                 His is a crusade spurred by a physician's  depicts a crumpled Marlboro cigarette
"Smoking is the leading preventable  regard for a patient's health, a commit-  box. And one plaque proclajms the "1 lth
cause of death in this country and that's  ment to his three children and seven grand-  Commandment: Thou Shalt Not Smoke."
worth fighting for."            children, common sense and a severe dis-   Out on the stump, Koop hands out blue-
Blunt: Koop is not, as they say in  like for what he calls the "sleazy" tactics  and-white lapel buttons, which he paid for
Washington, "political." He's blunt, he's  of the tobacco industry, which, if you lis-  himself, stating: `The Surgeon General
to the point and, sometimes, he's as subtle  tened to Koop, would hand out a pack of  personally asked me to quit smoking." If
as a sledgehammer.           cigarettes with every birth certificate.   miscreants, like those country club barten-
He has raised dust from the White   "Ninety percent of all smokers want to  ders, come, around, they get another pin

16 COPE MAGAZINE o OCTOBER 1986


saying, "And I did."

Koop's office -not among the govem-
ment's more powerful agencies -over-
sees federal hospitals and research
facilities, as well as programs dealing with
health education and preventive medicine.

As surgeon general, he's required to
report to Congress each year on smoking
and health. This year's topic: The sus-
pected nasty effects of "sidestream"
smoke on non-smokers.

Koop isn't afraid to vent his controver-
sial views on other touchy subjects: Por-
nography is a moral cancer. Abortion is
wrong. Television violence promotes ag-
gressive behavior. Video games addict
youngsters. Too many Americans kill
themselves with sugary, fatty diets.

Sparks: But despite the public's interest
in those topics, it's smoking- an issue
the Reagan Administration has ignored -
that has won him the most press.

This summer on Capitol Hill, the sparks
flew over a Congressional bill that would
ban all tobacco advertising in. this coun-
try-an emotionally charged topic that
wraps the concept of free speech around
the threatened loss of billions of advertis-
ing dollars.

The surgeon general endorses the idea;
the White House, still enjoying its long
honeymoon with American big business,
doesn't.

So just before Koop hiked up Capitol
Hill to testify before a House subcommit-
tee, Reagan's chief of staff, Donald
Regan, jerked the doctor's chain and or-
dered him to heel. The resulting publicity

Battle ribbom Fighting peer pressure.

later forced Regan to relent-but not
before he made it clear that Koop was
speaking only as an informed citi-
zen, not as a presidential emissary.

Koop told the House Energy and
Commerce Subcommittee on Health
and the Environment that "cigarette
ads have an insidious effect on the
population as a whole by maintain-
ing and encouraging use and under-
mining health-education efforts."

But the question remains: How
can Koop operate in an administra-
tion which subsidizes tobacco farm-
ers and opposes any restrictions on
an industry he says does more phys-
ical harm than economic good?

"I find it frustrating, but on the
other hand, after you are in govem-
ment for a while, you begin to
realize that there are certain facts of
life that you live with."       Top dot: A modern-day Ahab, loadedfor whale.

In Washington, however, there
are some who will say Reagan got more
than he bargained for when he appointed
Koop in 1981.

thanks, in part, to advertising.

The industry swears it uses ads only to
persuade smokers to switch brands. Koop
sees it as a deadly enticement for the
young: "Suppose you had never heard of
a cigarette. And just suppose that people
in Europe use cigarettes and you knew all
the [bad] things about them and their ill
effects.

A Brooklyn native, Koop graduated
from Dartmouth in 1937 and Cornell's
med school in 1941. He went into chil-
dren's medicine and surgery, where he
concentrated on fixing birth defects. In-
deed, Koop gained international fame in
1974 after he successfully separated
Siamese twins in Philadelphia.

He went on to become a professor of
pediatric surgery at the University of
Pennsylvania's School of Medicine and
chief of surgery at Children's Hospital of
Philadelphia. A strong voice in the anti-
abortion  movement,   he came to
Washington in 1980 as deputy assistant
secretary for health in the Department of
Health and Human Services.

Women's groups and Planned Parent-
hood, among others, opposed his nomina-
tion as surgeon general. Sen. Edward Ken-
nedy, the Massachusetts Democrat, said
Koop was "out of touch" with modem-day
society. Koop won the job anyway.

After he took office, then-Gov. Jim
Hunt of tobacco-rich North Carolina
called for his resignation. Said Koop in
response: "My position is to encourage,
exhort and to be a catalyst."

And, he might have added, to badger
the tobacco industry. It's a business, he
says, that tells "flat-footed lies, like `We
don't really know what causes cancer."'

Koop's opposition is noteworthy: To-
bacco's place in society dates back to the
1700s when, as the colonies' top cash
crop, it bankrolled the Revolution. Since
then, its privileged place has held strong,

"Tomorrow morning, you read in the
newspaper, `U.S. to Import Cigarettes for
the First Time. ' What would happen here?
There would be a revolution."

Mark Twain once cracked that quitting
smoking was easy-he'd done it a
thousand times. But Koop says a smoker
has to want to do it.

"I came home from college for a
weekend in 1933, long before people
talked about smoking and health. My
mother stopped me in the kitchen and said,
`What are we going to do about your
father? He smokes more than two packs
a day, has this terrible cough and I'm sure
he's shortening his life.'

Overheard: "I said, `Mom, forget it. Pop
hasn't got the guts to quit.' What I didn't
know is that he had walked in behind me
and heard the conversation.
"Well, he walked out, threw his cigar-
ettes down the toilet, packed his parapher-
nalia in a handkerchief and never smoked
again in his life . . . You have to have a
self-rewarding goal."    . . *"
The key, however, to a healthy life is
never to start smoking-even though the
American Academy of Pediatrics esti-
mates that 90% of America's smokers
started before they were 20. The average
beginning age: 14.

COPE MAGAZINE o OCTOBER 1986 17


And that's where education plays such
an important part.

Koop says it must begin as early as the
first grade to combat peer pressure and
advertising. "The greatest problem is the
length of time before the insult and effect.
If you died of cancer two weeks after you
smoked, there would be no problem at all.

"But the fact is that if you sit down and
try to talk to a 16-year-old kid about the
fact that he's going to die at 60 from lung
cancer, he won't even talk to you. It
doesn't impress him."
Some of the message seems to be get-
ting through.

Testifying: ` `Z find it frustrating. ' '

A June Gallup poll showed that
cigarette smoking dropped to its lowest
point in 42 years - 3 1% of the adults ques-
tioned, down from a high of 45% in the
mid-1950s.

For men, it stood at 35%; women, 28%.
The biggest drop came in the 18-29 age
group, which fell 11 points to 27%. And
while the number of teenagers who
smoke - 13% - has  remained  constant
over the last four years, young survey re-
spondents said they are smoking less.

Congress, wary of smoking's hazards,
could very well raise the federal excise
tax on cigarettes 8 cents this year. And
the National Academy of Science has
called for a federal smoking ban on all
domestic commercial flights.

A Canadian airline already offers non-
smoking flights; Continental Airlines'
,hands out fare discount coupons to passen-
gers who don't smoke.

The movement's future, then, will con-
tinue to lie in the grassroots, not in federal
government fiat. But Koop vows to keep
up the fight.

"The jury came in a long time ago. They
found that the indictment was correct and
that the tobacco industry was guilty as
charged. I'm a poor loser and I'm in the
fight against cigarettes. And I'll win."

18 COPE MAGAZINE o OCTOBER 1986