The Institute for Health Quality and Ethics

The Wallenberg Files 


Raoul Wallenberg was a Swedish diplomat in Nazi-occupied Hungary who led an extensive and successful mission to save the lives of nearly 100,000 Hungarian Jews. Though his efforts to save Jews from the Holocaust is one of the most treasured aspects of that time, his fate and ultimate death is unknown.


March 7, 2013


C. Everett Koop, MD died on February 25, 2013, at the age of 96 at his home in New Hampshire. Our friendship, improbable as that still seems to observers, was not based on our mutual affinity for annoying both friends and foes alike—true as that might be. No, our friendship developed on the heels of my one-man challenge to his leadership as Surgeon General on the leading issue of the day: tobacco. As a confirmed smoker, I am still on the losing end of the tobacco debate that seems to have shifted to marijuana. A positive alternative? No doubt. The real sin will soon be inhaling no matter the substance inhaled.

For those who are too young to remember Dr. Koop's legacy, he was a pro-life Reagan appointee, who ended up winning over many (and alienating former supporters) with his even-handed approach and straightforward discussion of the most pressing health issues of the day.  Despite his personal opposition to abortion, he refused the administration's request to author a position claiming substantial health risk to women when he determined it would run contrary to the evidence.   He was responsible for mailing information on AIDS to every household in the country, angering groups from gay activists to religious groups with his frank discussion of the issue.  Under his leadership, the Office the Attorney General took an unexpectedly strong stance against smoking and publicized the harmful effects of tobacco and second hand smoke. Of great importance to my work, Dr. Koop took on the practice of infanticide for disabled infants, becoming a champion to protect the rights of newborns with disabilities in supporting the Baby Doe Amendment.

Our friendship was based on an understanding of the role that ethics play in any public policy discussion of health care, too often an unwelcome intrusion into contemporary medical debates. When we had the opportunity we would spend hours discussing and solving the important issues of health care. We feared that the introduction and final dominance of utilitarian ethics would lead inexorably to formal rationing and the devaluation of certain lives. Newborns with disabilities and those over 70 with diseases would be first to be targeted.  I wish we were wrong.

But what captured me originally was the work Dr. Koop did before his prominence as Surgeon General. He became surgeon-in-chief at the Children’s Hospital of Philadelphia. He amassed numerous titles, in 1956 established the country’s first neonatal surgical intensive care unit, and became a professor of pediatric surgery and then professor of pediatrics in 1971 at the University of Pennsylvania. Wikipedia mentions just a few of his accomplishments, many of which had no name. They had never been done before.

“He separated conjoined twins; invented techniques which today are commonly used for infant surgery; and saved the lives of countless children who otherwise would have been allowed to die. He invented anesthetic and surgical techniques…”

The list goes on. He saved the lives of thousands of children but is better known for his political and social beliefs. I had to step cautiously and, when possible, to avoid some subjects. Dr. Koop (or “Chick" as he was fondly nicknamed) was a flawed human being. Would that we should all be so flawed. When I began the program under Medicaid to move control of long term care dollars directly to those who needed assistance, I helped to create the first advisory committee and sought a chairperson. We called this movement "self-determination."  In the early 1990’s I was at the University of New Hampshire, and I called Dr. Koop when the Robert Wood Johnson Foundation committed 7 million dollars to our new approach to reforming long term care. After a single sentence explaining self-determination to Dr. Koop, he immediately agreed to serve as chair.

I always think of him as a 19th century conservative sea captain. I was always afraid he would ask me about whaling.

There are too many things about him which are not known in terms of his courage and consistency. One story may suffice since he is too often painted solely as a conservative--which he was, of course. Over 15 years ago I received a call from one of the more liberal advocacy groups in New York.  They worked with women who had been abused and often ended up in jail when they retaliated. Many had children ignored by the criminal justice system. Their request, conveyed through my sister Mary, was simple. Could I convince C. Everett Koop to be their keynote speaker at their annual fundraising event.  That’s right, Koop and one of the most liberal groups in New York City.  Oh, and please ask if he would do it for free.

Unbeknownst to many, as Surgeon General Dr. Koop elevated the issue of violence against women to a national emergency, giving it the status it needed to garner more attention and funding.

Wikipedia’s last entry on Dr. Koop was dated just a few days ago:

Remarking on Koop's death, American Medical Association president Jeremy Lazarus commented, "Because of what he did, and the way he did it, he had a dramatic impact on public health ;  The Associated Press called his impact "great" while the Philadelphia Inquirer called him "a courageous and brilliant pediatric surgeon who pioneered techniques ... and became an outspoken surgeon general." Writing for The New Yorker, Michael Specter said, "I don’t think I have ever met anyone for whom I had more respect... In this era, during which progress, facts, and science are under unrelenting siege, it is thrilling to remember that even ideologues can love the truth."

So how did we become friends? I was in his office during the early years of the Reagan Administration for a meeting on the re-authorization of the Child Abuse Amendments of 1984. I had been invited as a Kennedy Foundation Fellow in Public Policy, along with several high ranking officials from the Administration. (This was before the White House found out that I was a registered Democrat.) His office was the size of a basketball court.

Before the meeting began I started to fantasize about lighting a cigarette, then wondered just what the consequences would be. Would I dare?  It became an uncontrollable compulsion, and I could no longer contain myself. I slipped my left hand into my jacket pocket and slowly fished out a cigarette. I turned slightly away from the others and struck the match. As I brought it to the tip of the cigarette and slowly inhaled I heard loud gasps and cries from the others. As I proudly turned to the group, Everett Koop slowly moved to the side of his desk and we all saw a glint of silver flash. I thought for sure it was a gun or a knife. Koop walked over to me and gently put his arm over my shoulder. He said “We don’t do that here, Tom.” In his hand he held a silver-lined cardboard ashtray with which he carefully grasped the cigarette and put it out. He made me promise to come back and see him as soon as this new type of nicotine gum came on the market. Not once in all of our subsequent conversations did he ask me if I still smoked or even if I was a Democrat. I was surely one of his few medical failures, but I remain his great admirer.

Tom Nerney is the Policy Director for the Center for Self-Determination and Executive Director of the Institute on Health Policy and Ethics. He lives in Wakefield, RI

Tom Nerney helped to expose the common practice of infanticide as reported in this 3 part CNN series on babies born with spina bifida.




More Wallenberg Files
Tom Nerney is the Policy Director for the Center for Self-Determination and Executive Director of the Institute on Health Policy and Ethics. He lives in Wakefield, RI

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