The good doctor

The former surgeon general of the U.S.A., C. Everett Koop, has died at the age of 96. If you were American in the 1980s, you might remember this surgeon general. He wore a mustache-less beard and his distinctive uniform, which made him look like a naval officer. Cigarette advertisements (which still appeared in print in those days) always carried the SURGEON GENERAL’S WARNING, bringing Dr. Koop into every magazine and grocery store checkout, whether you wanted to read about him or not.

Dr. Koop obviously had a long life himself (a widower, he remarried at 93). His passing reminds me of what the U.S.A. was like under Ronald Reagan, who appointed him. Dr. Koop disappointed President Reagan and many others in Washington by advocating based on what he honestly saw as threats to public health, rather than ideology. One threat, then as now, was the scandal of many Americans having no health care at all. The surgeon general had no success getting his bosses to care about that.

But there were two other areas of huge danger to people's health in which Dr. Koop didn't toe the line, either. One was the syndrome that came to be known as AIDS, which first appeared in the U.S. at the beginning of the eighties. The other was, as already alluded to, cigarette smoking.

Try to remember what AIDS meant in the decade before antiretroviral drugs. It was a 100% killer which, as we know, brought unimaginable loss to the gay community. Don't Ask, Don't Tell and the Defense of Marriage Act were not even thought of yet--our main national issue was dying men, and women in solidarity with them. AIDS began as GRID or "gay cancer," and was thought only to affect homosexuals. Even later, when others contracted AIDS from blood transfusions, the country saw them as "innocent victims." Which implied that somebody else was guilty.

If we're ever tempted to think that gay Americans haven't made much progress, we should try to recall C. Everett Koop's day. Homophobia in the U.S.A. now is persistent; thirty years ago, it was indescribable. Phobia was an accurate term, because it was as much terror (of those AIDS-spreading gays) as hatred whose pervasiveness is difficult to grasp today, even for those of us who were there.

Before AIDS, homosexuality was more or less unspeakable. When AIDS arrived, and appeared to affect only gay and bisexual men, very few people outside the community cared. It wasn't just a crazy fringe view that these people deserved death as punishment for their lifestyle. That was mainstream America's view, and it was the view at the highest levels of government.

The virus that causes AIDS is often said to have been "co-discovered" by French and American researchers in 1983, although in fact, the French discovered it in 1982 and the U.S. scientific community held off on recognizing this until one of their own had also isolated it--which he could not have done without the French scientists' help. For Dr. Koop, AIDS was not a plague in a biblical drama; it was an epidemic that deserved a scientific response.

What I am perhaps belaboring here is how radical that approach was in the eighties. Even when AIDS began to affect straight people, it was still associated with injecting drug users and homosexuals above all--the guilty victims. Neither group got much compassion in the era of the Reagans and "Just Say No."

This is interesting, because the very people who thought AIDS a just consequence of one's lifestyle did not feel that way about smoking-related diseases. Dr. Koop warred with North Carolinians like Senator Jesse Helms, a Republican, and the Democratic governor who called for him to be impeached. Senator Helms was a ceaseless foe of homosexuality and any representation thereof, for example in art. He also represented a state that is at the center of the tobacco industry, and took every opportunity to protect it.

Here was an industry whose products, Dr. Koop said, killed 300,000 Americans every year, most of whom became addicted in their early teens. If some in Washington had their way, the surgeon general could not defend these kids from cigarette promotion on the one hand, nor protect them from AIDS by mentioning condoms, on the other.

We know now the scale on which Big Tobacco has been a merchant of death, the extent of their denials that their products are both addictive and deadly. We also know that when reason and science are brought to bear on a virus, the epidemic of AIDS is stemmed. But when Dr. Koop said these things thirty years ago, they were not commonly accepted. They were not in the interest of a tobacco-addicted, homosexual-hating country, as large parts of it were.

In 1981, at the beginning of his term, one third of Americans smoked. When he left eight years later, it was down to just over one quarter. President Reagan's first public mention of the word AIDS did not come until 1987, when it was in the context of opposing safe sex education for schoolchildren.

The U.S.A. today is increasingly a country in which homosexuality is accepted as a natural variation in human society, while smoking cigarettes is regarded as a terrible lifestyle choice. Who saw that coming?

Meanwhile, the late C. Everett Koop was not a perfect surgeon general, but he still stands as a good example. May we also go to work every day to serve people, rather than care so much about what authorities think, or the prevailing prejudices of our time.