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Remembering C. Everett Koop and his Campaign to Stub out Cigarettes

March 4, 2013

C. Everett Koop died last week at the age of 96. Here’s the summary from his Wikipedia page. (

Charles Everett Koop, MD (October 14, 1916 – February 25, 2013) was an American pediatric surgeon and public health administrator. He was a vice admiral in the Public Health Service Commissioned Corps,[1] and served as the 13thSurgeon General of the United States under President Ronald Reagan from 1982 to 1989.[3] According to the Associated Press, “Koop was the only surgeon general to become a household name”.

He worked tirelessly to turn the United States into a smoke-free society but at the time of his death about 20% of Americans are still smoking ( But that’s a lot better than half of the population smoking, which is how it used to be. Smoking continues to be the largest preventable health problem in most societies, including North America. It is estimated that cigarettes continue to kill more than 400,000 Americans a year, which is an amazing figure.
Here is an excerpt from a report that the Centers for Disease Control put out a few years ago. (

“During 2000–2004, smoking resulted in an estimated annual average of 269,655 deaths among males and 173,940 deaths among females in the United States (Table). The three leading specific causes of smoking-attributable death were lung cancer (128,922), ischemic heart disease (126,005), and chronic obstructive pulmonary disease (COPD) (92,915). Among adults aged >35 years, 160,848 (41.0%) smoking- attributable deaths were caused by cancer, 128,497 (32.7%) by cardiovascular diseases, and 103,338 (26.3%) by respiratory diseases (excluding deaths from secondhand smoking and from residential fires). Smoking during pregnancy resulted in an estimated 776 infant deaths annually during 2000–2004. An estimated 49,400 lung cancer and heart disease deaths annu- ally were attributable to exposure to secondhand smoke. The average annual SAM estimates also included 736 deaths from smoking-attributable residential fires.”

The following photo is from a page of photos of kids smoking. (
In view of this public health disaster, it is difficult to understand why cigarettes continue to be sold legally. It is hard to imagine the totality of illegal drugs ever doing as much damage as is done by nicotine. And yet there is a war fought on every drug except nicotine. The stated goal is to prevent young people from smoking, but the tobacco industry knows that it has to get people while they were young. The teenage brain is low on executive functioning and impulse control and kids that age are hardly thinking about health problems that may hit them in their fifties or beyond. I remember a heavy smoking colleague that I knew in the 1980s and his argument was “I don’t want to die as a beautiful corpse”. But then I also remember Gerald Salton, a pioneer in the field of information retrieval, publicly regretting his smoking habit a few months before he died of smoking related causes.
Of course gaming (gambling) is another activity that is hard to justify from a public health perspective. There are many problem gamblers out there, and the idea of getting free money by chance doesn’t seem to go with ethical ideas of people getting what they deserve. Yet both smoking and gambling are tolerated and perhaps even encouraged because of the large sums of money that they bring to government coffers. With governments worldwide struggling to balance the books, taxes on cigarettes, alcohol, and gambling have become the lifeblood of many governments. Which is ironic. Governments use the profits from destroying lives to fund a system that is meant to be providing services to those same systems. It’s easy to see that this is a huge conflict of interest. We need stronger auditing of government that’s four sure. Auditing by electorate is not adequate. Can you imagine forensic accounting of large corporations being carried out by popular vote?
Let’s finish with a quick summary of Koop’s campaign against smoking (I’m grateful to his Wikipedia page for supplying the information). It can be argued that Koop did more than anyone else to lower smoking rates. That’s a little ironic because he was actually appointed as surgeon-general by President Reagan because of this anti-abortion views. Reagan and the other conservatives were expecting Koop to right damning reports about the medical consequences of abortion, but instead, as a good physician he went after what he saw as the bigger medical problem which was smoking. He was still very strongly opposed to abortion, but he saw it as a moral, rather than a medical problem. Koop was surgeon general for most of the 1980s (it was a time of big hair, as his photo above shows). Here’s an excerpt from his wikipedia page that summaries some of his key activity as surgeon general.
“In his 1988 Report of the Surgeon General, it was reported that nicotine has an addictiveness similar to that of heroin or cocaine. Koop’s report was somewhat unexpected, especially by those who expected him to maintain the status quo in regard to his office’s position on tobacco products. During his tenure, in 1984, Congress passed legislation providing for new, rotated health warning labels on cigarette packs and required advertising to include the labels. Those labels remain unchanged today. New labels containing graphic depictions of smoking-caused illness and death have been announced by the FDA, but are on hold pending the outcome of tobacco industry legal challenges. Koop issued a challenge to Americans in 1984 to “create a smoke-free society in the United States by the year 2000.” As Surgeon General, he released eight reports on the health consequences of tobacco use, including the first report on the health consequences of involuntary tobacco smoke exposure. During Koop’s tenure as Surgeon General, smoking rates in the United States declined significantly from 38% to 27%.
Will we see a smoke-free society any time soon? I don’t think so. There are too many people making large sums of money from cigarettes, and especially governments. Gold, diamonds, ivory, coffee, alcohol, gambling, nicotine, oil, they all generate far too much cash. They are strong temptations that distort the actions of people and governments. Often we know what should be done, but we fail to act because in doing so it would be necessary to oppose powerful interests. Paraphrasing from memory it was Oscar Wilde who said “I can resist anything except temptation”. And so it is with governments.
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