[Statement before the Senate Labor and Human Resources Committee, Washington, DC]
In his statement, delivered after several months of controversy over his nomination, Koop asserted that his 35-year career
as pediatrician-in-chief at one of the nation's leading children's hospitals gave him the medical and administrative
experience to be an effective Surgeon General, contrary to critics' contention that a surgeon devoted to the care of individual
patients was not qualified to address the health needs of the nation as a whole. Koop delivered his statement before a committee
chaired by his most outspoken critic in the Senate, Senator Edward Kennedy of Massachusetts.
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1981-10-01 (October 1, 1981)
Koop, C. Everett
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It is with a sense of gratitude that I come before you today. Gratitude first to the President for nominating me to the position
of Surgeon General of the US Public Health Service and gratitude to members of this Committee for the gracious manner in which
they received me. I would like to acknowledge the close cooperation between the present Secretary of Health and Human Services
and the distinguished ranking minority member of this Committee and their considerable contributions to improving the health
of the people of this nation. My special appreciation goes to you, Mr. Chairman, for your concern throughout the past several
months the importance and the value to the American people of the post of Surgeon General. It's in that same spirit that
I am here this morning as the nominee for the position of Surgeon General.
Mr. Chairman, there have been a dozen men who have held the position of Surgeon General, since that title was authorized in
1875. If this Committee should recommend to the Senate that I be approved, then it will be my good fortune to succeed these
eminent men of medicine. But I understand that this is not a decision the Committee or the Senate will make on behalf of C.
Everett Koop. It is a decision made on behalf of the people of the United States and their unique Public Health Service. It
is my hope that in the next few minutes I may indicate to you the kinds of professional and personal strength I would bring
to this position so that, if confirmed, I may add my contribution to those made by my distinguished predecessors.
The twelve men who have held the position of Surgeon General thus far have been able to function effectively because each
has shared three kinds of experiences vital to success in that position: First, a professional career in medicine through
which he has learned the specific problems of an individual encountering his or her environment.
My professional career began at age 29 as the sixth surgeon in the United States to confine his surgical practice exclusively
to the care of children. In addition to applying my surgical skills to improve the health of the individual child I helped
found societies pertinent to pediatric surgery, and established liaison with other distinguished body such as the American
Academy of Pediatrics and the American College of Surgeons in order to more broadly address the health of all children.
I founded the first and only Journal of Pediatric Surgery in English and was editor-in-chief of that journal for twelve years
in addition to my other duties.
Thirty-five years ago the surgical mortality of children was abysmal, particularly that of infants and especially the newborn.
In the words of the past Surgeon General "The health of a nation can be no better than the health of its children."
In this regard I believe I contributed significantly to the improvement of child health in our country: First, by assessing
the need for improvement in pediatric anesthesia and providing leadership (as well as participation) for the establishment
of the specialty of pediatric anesthesiology: Secondly, by direct contribution to the basic knowledge of surgical techniques
as well as pre-and post-operative care: Then, by establishing with the grant from the Children's Bureau the first neonatal
intensive care unit in the country: And forth, by contributing technical changes to the most widely used incubator for premature
infants so that surgical patients could be cared for in that environment.
At the University of Pennsylvania and the Children's Hospital of Philadelphia, surgeons had to earn their living on a
fee-for-service basis. So I had a long and concentrated experience in the marketplace. [Handwritten Note: Omit does not flow]
When I left my surgical life in the spring of this year, I had been practicing the specialty of pediatric surgery longer than
anyone else in this country.
The second attribute vital to the effectiveness of the Surgeon General is experience in dealing with the broad health needs
of a cross-section of American society, both as a physician with hands-on practice, and as administrator of a medical or public
health organization. In 1946 I assumed the responsibilities of surgeon-in-chief of the first and oldest children's hospital
in the country, the Children's Hospital of Philadelphia. (At the same time I began the long climb up the academic ladder
in the University of Pennsylvania, -- starting as instructor in surgery and reaching the position of Professor of Pediatric
Surgery in 1959. I was appointed professor of pediatrics in 1975.) [Handwritten note: Omit]
I became responsible for half of the beds in the Children's Hospital, was director of one of the most sought-after pediatric
surgical training programs in North America, drew together as a partnership a most comprehensive group of surgical specialist
for children, and was for five terms, the President of the medical staff of the Children's Hospital of Philadelphia. These
endeavors were not only associated with the practice of clinical surgery, but required administration of the eight surgical
divisions in the department of surgery, the training program, the research effort, the liaison between hospital and University
and the administration and leadership of the surgical partnership.
Fundamentally, public health addresses the health care needs of populations rather than individuals. Perhaps because of the
newness of my specialty, perhaps because of the time in which I began, my concern for individual patients has generated an
overriding concern for one of this nation's most valuable resources -- children. As such during my career I have organized
or participated in a number of public health initiatives for children.
In working with the American Academy of Pediatrics I played a role in first obtaining calibration of the machinery and finally
eliminating altogether the dangerous practice of x-raying the feet of children to ascertain the proper fitting of their shoes.
While a member of the Accident Prevention Committee of the same Academy we brought about a court order to remove attractive
coloring and flavoring from corrosive oven cleaners which children assumed to be candy, suffering burns of the esophagus after
ingestion and lifelong problems of stricture formation.
My first experience with epidemiology came during World War II when hepatitis was an all too common condition. Dr. Joseph
Stokes was assigned the task of studying hepatitis during the Allied invasion of Italy. I was the surgical consultant to hepatitis
unit. This early work led to the first description of the passage of hepatitis virus across the placenta to the fetus without
affecting the pregnant female.
In the late 1940s solid cancers in children were not appreciated for the public health problem they presented. I not only
provided some of the innovative measures still used to treat cancers in children but worked with cancer committees and cancer
registries of appropriate bodies to impress upon the profession and parents alike the cancer was killing more children than
was commonly appreciated. Today, while considerable advances have been made in children's cancer centers it is known the
cancer kills more children than any other cause except accidents.
It was while delivering babies in homes in Harlem that I first became aware of the problems of health care for the underserved.
This interest saw further expression in the interface of private and public care for the underserved for the 29 years I worked
at the Children's Hospital of Philadelphia while it was in the midst of the black ghetto of Philadelphia before moving
to University location.
Third, a successful Surgeon General must have some personal experience in the health affairs of other nations and societies
as well since we are all part of the human family, and the health needs of other societies tell us much about her own health
needs. Also, we are frequently asked to contribute to the alleviation of disease elsewhere as well as communicating advances
in health care throughout the world. The Public Health Service has a remarkable record for doing so -- not the least of which
was its leadership in eliminating smallpox as a disease of mankind.
My interest in international public health goes back to 1960 when I went on an extensive assignment around Africa as a member
of the board of the Medical Assistance Programs, Inc. I was assigned the task by the US State Department of convincing the
Ministry of Health of Ghana and the then President Nkruma that an American type medical school had more to offer that country
than the three proposals made by the Soviet Bloc. I succeeded and in addition worked with the College of Physicians of Philadelphia
to staff the school in Ghana for the next five years. This was a legal necessity until we turned the school over to a national
faculty in Ghana.
Your party heard of my long-time interest in health care for children in Poland. Not mentioned was my teaching of pediatric
surgery in the UK, France, Spain, Italy, Germany, Sweden, Denmark, Greece, Iran, Thailand, the Philippines, Taiwan, Japan,
and Hong Kong.
About a decade ago at the request of the Ministry of Health of the Dominican Republic, I assessed their need during an epidemic
of diarrhea in that country and set up nine hydration stations with the happy outcome that the mortality dropped radically.
A long-time interest in the Tarascan Indians in central Mexico, largely without medical care when I first met them, has enabled
me to set up several small clinics for symptomatic treatment to which we added the preventive measures of added protein, nutrition,
and vitamins and on occasion family-planning.
The program that I am most pleased with is that known as the Map Readers Digest International Fellowship. Nine years ago I
obtained a grant from DeWitt Wallace of the Reader's Digest in order to send medical students in their third and fourth
years to lesser developed countries in primitive health settings. I have acted as chairman of the selection committee for
these fellowships and to date we have awarded 790 fellowships to medical students in the United States and Canada. Just about
10% of the students we have sent abroad acknowledge that because of the experience they changed their career plans and switched
to public health. About 100 of the students either graduated from, are enrolled in, or plan to go to a school of Public Health.
In summary, Mr. Chairman and members of this Committee, I believe, my role as a clinician has enabled me to see the problems
of larger segments of our population. I think the clinical and administrative experience I have recounted to you indicates
that I have been able to assess public health problems and address them either by active personal participation and/or team
leadership to bring a satisfactory conclusion to a public health endeavor. I think, therefore, that the extensive experience
I have had as a clinical surgeon enhances the skills that I bring to the post Surgeon General.
One role of the Surgeon General is usually invisible to the general public; the leadership of the US PHS Commissioned Corps.
I think the Commissioned Corps of the Public Health Service is one of the organizations of which this country has the right
to be most proud.
I believe in the existence of a Commissioned Corps, flexible and available a 24-hour notice. I believe in the significance
of its mission, and in the use of the Corps for national health emergencies and other special efforts such as the screening
of refugees; Three Mile Island, Mt. St. Helens, etc. Since I have been in Washington as Deputy Assistant Secretary for Health
I have visited public health facilities and meetings of officers of the Commissioned Corps. I am committed to the effective
leadership of the Commissioned Corps and to keeping you and the country informed of the valuable services it performs on your
Ensuring the health of our people has become very complex of late. This is a time when people need a growing sophistication
in reference to the health advice they want and may not always receive. Therefore it is, I believe, a time when this role
of the Surgeon General must be tended with great care. I want to stress to you my overriding commitment to provide straightforward,
helpful information to the general public regarding the prevention of disease and the promotion of health. This function of
the Surgeon General must be carried out diligently on the basis of good science.
If I may, Mr. Chairman, I would like to present to this committee for the record description of a current effort of this type
namely the "Healthy Mothers" information program. You will note that many of the messages are from the Surgeon General
of the United States.
One of the mechanisms that make government work is access by groups with a variety of perspectives. Individuals in government
make their contributions most easily and perhaps most effectively if they are willing to accept and willing to understand
the wide variety of constituents. In the six months that I have functioned as Deputy Assistant Secretary for Health, as during
my whole professional life I have been open to and able to exchange views with a variety of interests.
In closing, Mr. Chairman, let me mention two initiatives in addition to the leadership of the Commissioned Corps that I would
like to direct my attention to.
I have been asked to oversee a number of bilateral health agreements between the United States and foreign countries. I feel
very comfortable in this role, knowing the health leaders of many of the countries involved in having functioned in a number
of such circumstances in the past several months.
I am fully aware, Mr. Chairman, that has always been the role of Surgeon General to provide appropriate support and counsel
to any group providing quality health and medical services to persons in need. Two such groups in need are the disabled and
the aged. In addition, I believe that the ability of our society to provide essential health care for the disabled and the
aged does not depend upon any one government agency, federal, state or local. It depends upon the understanding and the willingness
of all Americans to take up the challenge, and our families, our communities, our schools, our various voluntary and professional
I have been deeply involved in the international year of the disabled person, have learned a great deal and, I hope, contributed
something to the American effort. I do not intend to have that interest and in December: It must continue.
Mr. Chairman, it is my hope to translate these experiences into information that will help all health professionals -- and
the public generally -- in dealing with health promotion and disease prevention throughout the life continuum. This will not
be an easy task -- but it is the right one for the Surgeon General of the United States Public Health Service. If I am to
be that person, then that task has to be mine and you can be assured of my effort to carry it out effectively.