By MIKE MAGEE
The Ghost of Christmas Past, in the form of Surgeon General C. Everett Koop, has returned this season to torture one RFK Jr who refuses to fully share life saving vaccines with children. In the encounter, the ghostly Koop reviews a time 37 years ago when citizens came together to celebrate separating scientific fact from fiction with life-saving effects.
Beginning in 1988, the United States, along with the rest of the world, had formally acknowledged and celebrated World AIDS Day on December 1st each year – that is until 2025. At President’s Trump’s direction the State Department, and with HHS support, turned their back on an inconvenient truth – the Republican early record on HIV/AIDS. Let’s channel the truth-telling Surgeon General from Christmas past and remember this telling story.
On June 5, 1981, the CDC reported 6 cases of Pneumocystis carinii associated with a strange immune deficiency disorder in California men. Drs. Michael Gottlieb and Joel Weismann, infectious disease experts who delivered care routinely for members of the gay population in Los Angeles, had alerted the CDC. Inside the organization, there was a debate on how best to report this new illness in gay men.
The vehicle that the CDC chose was a weekly report called the Morbidity and Mortality Weekly Report or MMWR. So as not to offend, the decision was made to post the new finding, not on page 1, but on page 2, with no mention of homosexuality in the title. Almost no one noticed.
On April 13, 1982, nine months after the initial alert, Senator Henry Waxman held the first Congressional hearings on the growing epidemic. The CDC testified that tens of thousands were likely already infected. On September 24, 1982, the condition would for the first time carry the label, AIDS – acquired immune deficiency syndrome.
The new Surgeon General, C. Everett Koop’s focus at the time, along with the vast majority of public health leaders across the nation, was not on a new emerging infectious disease, but rather on the nation’s chronic disease burden, especially cardiovascular disease and cancer being fed by the post-war explosion of tobacco use. He had already surmised that the power of his position lie in communications and advocacy.
One month after his swearing in, he appeared on a panel to release a typically boring Surgeon General update report on tobacco. He was not intended to have a big role. When Koop rose to deliver what all thought would be brief, inconsequential remarks, he wasted no time disintegrating the lobbyist organization, the Tobacco Institute. For print journalists in the audience, he was clear, concise and quotable. For broadcast journalists, he was a dream come true – tall, erect with his Mennonite beard, in a dark suit with bow tie, exuding a combination of extreme confidence and legitimacy mixed with “don’t mess with me” swagger.
As Koop would later say, after that, “I began to be quoted as an authority. And the press from that time on was all on my side… I made snowballs and they threw ‘em.” The other thing that Koop noticed early was that the Reagan Administration didn’t shut him down. That was surprising since Koop’s major supporter in a year long confirmation battle (the AMA opposed his appointment) was NC arch-conservative Senator Jesse Helms.
Add to Jesse’s wrath, R.J. Reynold’s CEO, Edward Horrigan, complained directly to Reagan about Koop’s “increasingly shrill preachments. Cigarette consumption in the US was in free fall. By 1987, 40 states would have laws banning smoking in public places; 33 states had bans in public transportation; and 17 already had eliminated workplace smoking.
Still Reagan didn’t shut him down. Now everyone from public schools to medical groups to women’s associations to civic enterprises wanted him. And beginning in late 1982, he arrived in full regalia, in a magnificent Public Health Service, Vice-Admiral’s uniform with ribbons and epaulettes. And his aide, also in uniform, always carried with him a bag of buttons for distribution which read, “The Surgeon General personally asked me to quit smoking.”
But in the most pressing public health challenge of the day, HIV/AIDS, the department was AWOL. Koop was actively sidelined by top Administration officials. Not surprisingly, the situation deteriorated rapidly. Everyone was feeling the heat, including the CDC, who removed funding for AIDS education after being accused of promoting sodomy by conservatives.
As more and more people died – now not only gays, but also heterosexuals, hemophiliacs, drug users, newborns of infected mothers – Reagan’s silence became deafening. To relieve the pressure, in 1986, the President finally freed Koop’s hands and directed him to coordinate a report on AIDS for the American public.
In October, 1986, Reagan first uttered the word, AIDS. By then, over 16,000 Americans were already dead. Inside his Administration, Reagan gave voice earlier to people like Education Secretary Bill Bennett who discouraged providing AIDS information in schools and Domestic Policy Adviser and Christian evangeliser Gary Bauer, who Koop said, was “my nemesis in Washington because he kept me from the President. He kept me from the cabinet and he set up a wall of enmity between me and most of the people that surrounded Reagan because he believed that anybody who had AIDS ought to die with it. That was God’s punishment for them.”
On May 31, 1987, Reagan, at the urging of his wife Nancy and their friend and actress Elizabeth Taylor, delivered his first major address on the topic at the American Foundation for AIDS Research event. It was six years late. 21,000 Americans were now dead, and 36,000 more lived with a diagnosis of the disease.
His prior inaction could not be blamed on ignorance or lack of exposure. Koop had done his best to keep the President informed. But the doors of the White House remained wide open to the Christian Conservative elite. Policies were being pushed, as promised, to reinstitute traditional Judeo-Christian values. All the while, a pandemic was raging, which some believed was “the hand of God at work”. And yet, there was the wild card. Koop, now self proclaimed the “Nation’s Doctor”, had evolved.
A critical turning point for the pediatric surgeon turned Surgeon General had come earlier, on December 17,1984, when a young hemophiliac from Kokomo, Indiana, undergoing a partial lung removal for severe consolidated pneumonia, was diagnosed with HIV/AIDS. His name was Ryan White. He was 14 years old at the time. He became infected while receiving an infusion of a blood derivative, Factor VIII, for his hemophilia. When he was cleared to return to school, 50 teachers and over a third of the parents of students from his school signed a petition asking that his attendance be barred.
Koop clearly understood that continued inaction on his part would be unacceptable. This was what could happen when scientific fact and fictions deliberately distorted. In the absence of his leadership and the provision of proper health education, ignorance and prejudice would rein supreme.
Ryan White (after the state’s health commissioner and the New England Journal of Medicine reinforced that the child’s disease could not be spread by casual contact) was readmitted to school in April, 1985. He would die 5 years later, and legislation, in his name, would open up much needed federal funding to care for those affected by the disease.
By then, President Reagan, feeling the pressure, finally did direct Koop to create a report, he was more than prepared to respond. He interviewed AIDS activists, representatives from the medical and hospital associations, Christian fundamentalists, and politicians from both sides of the aisle. Few knew fully what he was up to. One exception was his colleague and personal physician at the National Institute of Health, Infectious Disease specialist, Tony Fauci, who headed up the AIDS Research effort for the NIH.
Fauci had a troubled history with AIDS activists. This dated back to a serious misstep by him on May 6, 1983. On that date, the Journal of the American Medical Association generated a press release, liberally quoting Fauci, titled “Evidence Suggests Household Contact May Transmit AIDS”. In the piece, the NIH scientist says, “We are witnessing at the present time the evolution of a new disease process of unknown etiology with a mortality of at least 50% and possibly as high as 75% to 100% with the doubling of the number of patients afflicted every six months…If routine close contact can spread the disease, AIDS takes on an entirely new dimension.”
The release, not surprisingly caused a massive wave of public hysteria. The Religious Right came out of the woodwork. The executive vice-president of Moral Majority said, “We feel the deepest sympathy for AIDS victims, but I’m upset that the government is not spending more money to protect the general public from the gay plague.”
Fauci was much more careful after that, taking good council from Koop on public information techniques. At the same time, Koop learned everything he could about the virus, its’ behavior and transmission from Fauci, which he intended to share with the public in the future. Fauci also was the first to actively include the vocal AIDS activists in the government’s scientific advisory boards in their effort to combat the disease. At first the target of their anger and frustration, as more and more died in the face of a clearly disinterested government and hysterical public, Fauci subsequently earned the praise and admiration of leaders of the AIDS activist community.
Koop would consult with Fauci, day by day, as he formulated his drafts in secret. Fauci would later note, “He would come home from hearings downtown as things started to accelerate with HIV. As he was walking home, he had to pass my office. Around 7:30 at night, he would come knock at my door. He would say this thing about AIDS is very troubling, and I want to make the right impression on public awareness. He got it in his mind that we as the federal government need to be how explicit about this — oral and anal sex, commercial sex. He was hell-bent on doing it. When it came out, it shocked a lot of people because of its explicitness.”
The report drew immediate criticism from the Conservative Right, but nothing compared to the furor that arose nineteen months later.
In the period following the initial report’s release, Koop quietly employed the Public Relations firm, Ogilvy and Mather, to make certain he had the messaging, language and imaging right. He then created an 8-page pamphlet for mail distribution under the title “Understanding AIDS,” after raising adequate funding on the side, from various branches of government, to support the mass mailing costs of delivering 107 million copies of the publication to every household in America.
His message was a call to action. His dramatic image was attached to the title: “A Message From The Surgeon General”. Understanding AIDS was not an innocent read. It was frank and factual, covering anal and vaginal intercourse, injectable drug transmission, and condoms for starters. It promoted sex education beginning in elementary school and pierced the current messaging of the most popular Christian televangelists of the day with this comment: “Who you are has nothing to do with whether you are in danger of being infected with the AIDS virus. What matters is what you do.”
The huge 1988 print run had required government printing press activities 24 hours a day for several weeks. Delivering the load for mailing utilized 38 boxcars. And approval for the mailing skirted normal procedure. When the eight page pamphlets began to arrive, the phones in the Senate offices of conservatives like Jesse Helms rang off the hooks. Televangelists Jerry Falwell and Pat Robertson, and their followers were apoplectic. Attempts to halt it were futile. The mass mailing had been completed in bulk. There was no going back.
His ghostly presence these days should disturb the sleep of RFK Jr. As Jacob Marley expressed to his ghost, “I wear the chain I forged in life.” At least for the moment, eternal torment appears this Kennedy’s reward.
Not so for C. Everett Koop. Whether personal religious or political motivation, his actions were motivated by fierce commitment to scientific integrity. When criticized Koop took no prisoners. His reply: “I’m the nation’s doctor, not the nation’s chaplain.”
Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical-Industrial Complex. (Grove/2020).
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