Subject: Dr. C. Everett Koop's Qualifications to be Surgeon General
This memorandum responds to your request for our views as to whether Dr. C. Everett Koop meets the qualifications set forth
in recent amendments to the statutory requirements for the position of Surgeon General. As indicated below, we conclude that
his experience and background in public health programs satisfy those requirements.
Section 204 of the Public Health Service Act, as amended by H.R. 3831, requires the Surgeon General to be appointed from individuals
who "have specialized training or significant experience in public health programs." The following are some of the
experiences of Dr. C. Everett Koop that would meet that requirement:
Indian Health Needs
Dr. Koop has organized programs to provide medical care to the Tarascan Indians in central Mexico. He established clinics,
and trained staff to meet the basic health needs of this heretofore medically unserved tribe. He trained the staff to treat
the Indians for a variety of common diseases including worms, diarrhea, and vitamin deficiencies. The training also included
improved protein nutrition for children and the adoption of breast feeding by the women.
Dr. Koop provided significant advice to the Dominican Republic Ministry of Health during a serious epidemic of diarrhea in
that country. As a result of that epidemic, there was an infant mortality rate of approximately 70 percent. Dr. Koop set up
hydration stations, obtained materials from nearby countries, and arranged for doctors and nurses in the area to give intravenous
infusions. The physicians that he mobilized at that time are still providing medical care to the underserved in the Dominican
When Dr. Koop entered the practice of pediatrics 35 years ago, cancer (other than leukemia) was not considered a public health
problem for children. Through education programs and stumping the country, Dr. Koop raised the awareness of cancer as a childhood
problem and improved techniques for treatment of cancer in children. Through the American Academy of Pediatrics, he established
a registry of cancer in children. Now cancer is recognized as the number two killer of children and NIH has established a
series of centers for treatment and research of children's cancer.
At the time Dr. Koop began surgery on the newborn in 1946, the survival rate of the newborn having major birth defects was
in the neighborhood of five to ten percent. By teaching the concept of physiologic care for the newborn, establishing the
first newborn intensive care unit, and leading a team effort in the improvement of anesthesia for infants, these rates have
been reversed and it is now the mortality rate for infants with major defects that is in the five to ten percent range.
Dr. Koop was among the first to recognize the radiation hazards associated with the x-ray machines that were used to fit childrens
shoes. Through the American Academy of Pediatrics, he worked to regulate and eventually to eliminate the use of these machines.
Accidents are the chief killers of children. Again through the American Academy of Pediatrics, Dr. Koop was responsible for
having the coloring and flavoring removed from corrosive substances that were used to clean ovens. This has greatly reduced
the number of burns to children who thought these substances were candy.
Delivery of Care to the Underserved
Early in his career, Dr. Koop delivered babies at home in Harlem. For 30 years he has been deeply involved in providing primary
care and consultative services to children in the black ghetto in Philadelphia.
The Childrens Hospital of Philadelphia, where Dr. Koop was Chief of Surgery, owned and operated the Philadelphia serum exchange
where hyperimmune sera and serum globulin were manufactured. The Hospital also experimented with
plasmaphoresis and manufactured blood typing sera for rare blood types.
During World War II Dr. Koop was surgical consultant to a hepatitis research unit. He worked with Joseph Stokes, who at that
time was hepatitis consultant to the Army for Italy. Dr. Koop was the first to describe transmission of hepatitis virus across
Reduction in Medical Costs -- Health Planning Activities
Dr. Koop pioneered with cooperative arrangements in Pennsylvania and New Jersey for the care of respirator-dependent children
in their own homes, cutting the cost of that service from $600 a day to $50 a day.
Third World Medical School
At the request of the U.S. State Department, Dr. Koop went to Ghana to "sell" to Nkruma an American medical school
for Accra. In spite of Russian and Czechoslovakian competition he did this and guided the staffing of the school until all
Departments were turned over to Ghanians.
Fellowships for U.S. Medical Students in the Third World
With a grant from Dewitt Wallace of the Readers Digest Dr. Koop set up a fellowship program for U.S. medical students to have
ten weeks to six months experience in small hospitals in third world countries. Seven hundred and fifty such students have
been awarded fellowships by a committee which Dr. Koop chairs and some of the earlier grantees are now committing themselves
to Public Health careers in the third world.
The above examples demonstrate that Dr. Koop has had significant experience in developing and carrying out public health programs.
Each of the above experiences demonstrates not only his awareness of public health needs, but also his ability to bring research
and its clinical application into use to devise effective solutions to public health problems.