The Surprising Dr. C. Everett Koop.

The following 5-part series is excerpted (in part) from “CODE BLUE: Inside the Medical-Industrial Complex.” (Grove/2020)

PART I: The Conversion of C. Everett Koop

On the day after Ronald Reagan’s election, Christian conservative Jerry Falwell was euphoric. As he said, “I knew that we would have some impact on the national elections, but I had no idea that it would be this great.”(1)

One other big personality who saw, in Reagan’s win, a win of his own was C. Everett Koop. Carl Anderson, a Catholic aide to North Carolina Senator Jesse Helms, had informally approached him that fall to explore in earnest his willingness to accept the nomination as Surgeon General of the United States.

For Chick, the timing was perfect. At 64 1/2, he saw his days in the operating theatre at Children’s Hospital in Philadelphia as numbered. He was filled with a sense of mission that energized him, and his wife, Betty, was encouraging him to pursue the new role. In his customary fashion, Chick did his homework, gauging his supporters and his opponents. (2) Among the former, in addition to Jesse Helms and Strom Thurmond, there was the conservative Catholic Henry Hyde of Illinois. Regrettably on the negative side of the ledger sat the American Medical Association, which saw him as unpredictable and were already on record as supporting University of Texas vice chancellor of Health Affairs, Edward Brandt Jr.

The opposition of the AMA should have been an early warning signal. But Chick, hard-nosed, direct, and science driven, was also something of a dreamer, a Don Quixote optimist, prone to a romantic vision of the world and his role in it. His governor in Pennsylvania, Richard Schweiker, the lead candidate to head up Reagan’s Department of Health and Human Services, split the difference. Edward Brandt would be made the Assistant Secretary of the department, and Koop would be nominated for Surgeon General.(3)

If Chick thought that this compromise had resolved the issue, he was soon surprised as an avalanche of opposition to his nomination rapidly congealed.(4) Anticipating speedy approval, he had taken leave of his position in Philadelphia, resigned from the Boards of several Christian Conservative organizations, and taken up residency in Washington. He knew that the AMA had approached the White House through the back door and was encouraging them to drop him, but he felt that issue had already been decided. He knew as well that his past publications and activism as writing and traveling tour partner to uber conservative minister Francis Schaefer ensured the opposition of Planned Parenthood, the National Organization of Women, and the National Gay Alliance. But when the American Public Health Association (APHA) came out in full-throated opposition – that was a surprise. In the past 100 years, they had never before formally opposed a nominee for this post.(2)

For the dignified surgeon and conservative Presbyterian, who was used to professional adulation, and believed that he had led a conscience driven, moral and upstanding life, in the service of his fellow Americans, the APHA move was a slap in the face. But that was nothing compared to what he read on the editorial page of the New York Times when he opened his paper on April 9, 1981. There, in black and white, was the lead editorial with a blaring title – “Dr. Unqualified”.(5) In the editorial, they acknowledged in the first line that he had a “fine reputation as a pediatric surgeon” but found him “not deserving” of the role of Surgeon General. The charge that he had no “significant experience in the field of public health” wasn’t a big surprise, especially since the APHA had torched him. But the attack that followed, cued up by the supposition that his “attractiveness to the Administration must lie elsewhere” had to bring a grimace to his stately face.

Answering their own query, the editors said, “That ‘elsewhere’ may be his anti-abortion crusade. Two years earlier, he and Francis Schaefer had toured 20 cities with a film whose message was that abortion led inexorably to euthanasia for the elderly. And he has described amniocentesis, a procedure used to detect congenital disorders like Down’s syndrome and Tay-Sachs disease in fetuses, as ‘a search-and destroy mission.’”

Pending approval, Schweiker put Koop on the payroll as his assistant. The months dragged on, and Koop, encouraged to stay under the radar screen, focused on establishing as many relationships as possible. The people he met were surprised, as they had always been throughout his life. The severe physical package did not reflect the accessible and generous individual within. Chick would later reflect, “Out of those tough months, I made a number of very important friends in HHS who believed in me, believed I was being given a raw deal, who did think I was credible, who did think I had an idea and the ability to do something with it.”(6)

In October, 1981, while testifying before Congress, he surprised his audience when he stated clearly, “It is not my intent to use any government post as a pulpit for theology”.(6) Apparently, his Christian conservative backers thought this was simply a matter of political slight of hand. But for the Democratic leaders, like Henry Waxman and Ted Kennedy, this was a turning point. In November, the Senate confirmed him with a vote of 68 to 24, and on January 21, 1982, more than a year after the battle had engaged, C. Everett Koop was sworn in as the 13th Surgeon General of the United States.(7)

Part II: A Communications Genius Rides Tobacco To Success.

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. (1)

The vehicle that the CDC chose was a weekly report called the Morbidity and Mortality Weekly Report or MMWR.(2) 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.(3)

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, whether from the podium, before Congress or in front of the television cameras. He also understood very well, from his adventures with Francis Schaefer, that his image, voice and stature were memorable.

Others, of course, were less aware that the man was a communications genius. Most saw him as a bold, almost stereotypical surgeon, who had wandered into Washington on a white horse, having traveled from the Kingdom of Christendom, an outlier, an oddity. That began to change when, 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. In fact, Brandt was the lead speaker that day. But Koop, a strategist who was never unprepared, had spent time on the issue, aware that his predecessor, Julius Richmond, had risen high in the public’s eyes, in part by attacking tobacco companies.(4)

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 lies and deceit, and for the fact that they had dared to suggest there was limited evidence that tobacco caused cancer. 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.

The next day both the New York Times and Washington Post gave him favorable reviews. The New York Times led with Koop in the first paragraph, not Brandt, quoting him as saying “Cigarette smoking is clearly identified as the chief preventable cause of death in our society.”(5) As Koop said, after that, “I began to be quoted as an authority. And the press from that time on were all on my side… I made snowballs and they threw ‘em.”(6)

The other thing that Koop noticed early was that the Administration didn’t shut him down. Not the least of those offended was his original patron, Senator Jesse Helms of tobacco haven North Carolina, who had been so thrilled with his original nomination that he had called President Reagan to thank him personally.

Add to Jesse’s wrath, R.J. Reynold’s CEO, Edward Horrigan, complained directly to Reagan about Koop’s “increasingly shrill preachments.” (6) And Ed had lots to complain about. 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.(7)

Still Reagan didn’t shut him down. So Chick kept ramping it up to see how far he could push the industry. He railed against their advertising approaches, their marketing to children, their bogus research operation, their unwillingness to come clean on nicotine addiction. He said their product was more addictive than heroin. He called their leadership “morally corrupt”. He informed the public about the dangers of second hand smoke, smoking while pregnant, and smoking in public places, including hospitals. He was relentlessly provocative, and used tobacco to test his theories about hands-on, public health campaigning.

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.”(6)

Part III: Sidelined – HIV Off-Limits

By 1984, as Reagan’s second term approached, Brandt was gone and Koop’s strength continued to grow. He had successfully raised esprit de corps among the 5,600-person Public Health Corps, who were now required to wear uniforms to enhance their visibility and hopefully contribute to the long term funding viability of the department. (1) But in the most pressing public health challenge of the day, HIV/AIDS, the department was AWOL. Brandt and Margaret Heckler, probably at the insistence of Reagan’s domestic policy adviser and “family values” enforcer, Gary Bauer, had assigned themselves the duty of addressing all questions on the topic. It was explicitly off-limits to Koop.(2)

Not surprisingly, the situation deteriorated rapidly. Heckler at one point suggested that AIDS was Reagan’s “number one priority” even though he had never uttered the words HIV/AIDS in public.(3) She also told the public to expect a curative vaccine in two years. That was 1984.(4) As for Brandt, when he tried to align with the increasingly vocal and activist gay community that was pressing for increased funding for research and treatments for the disease, and agreed to attend their fundraising event, conservatives made such a fuss about it that Heckler forced him to back down.(5) Soon after Brandt resigned. Everyone was feeling the heat, including the CDC, who removed funding for AIDS education after being accused of promoting sodomy by conservatives.(6)

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 directed Koop to coordinate a report on AIDS for the American public.(7)

In October, 1986, Reagan first uttered the word, AIDS. By then, over 16,000 Americans were already dead.(8) Inside his Administration, Reagan gave voice earlier to people like Bill Bennett who discouraged providing AIDS information in schools and 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.”(9) And Bauer wasn’t the only one. Jerry Falwell declared the disease “the wrath of God upon homosexuals”. Pat Buchanan cruelly labeled the disease “nature’s revenge on gay men”.(9)And William F. Buckley suggested, in a New York Times article on March 18, 1986, that HIV-positive gay men should have the information forcibly tattooed on their buttocks.(10)

Reagan’s conversion was indirect. Elizabeth Taylor wrote he and Nancy a letter on April 10, 1987, that began, “On Sunday evening, May 31st, at 6:00 P.M., at Potomac on the River, the American Foundation for AIDS Research will host a dinner to help raise the research funds that are so desperately needed to help stop the ‘AIDS epidemic’ that threatens us all. Also, during the dinner, U.S. Surgeon General C. Everett Koop, will be honored for his leadership in educating the public on the AIDS issue. I am writing from my heart to ask if you both would attend the dinner and if you, Mr. President, would give the keynote speech.”(11) The actress felt the time had come, not only because of their friend Rock Hudson’s publicized death, but also because the latest federal budget included an 11% cut in AIDS spending compared to the prior year.(12)

On that evening, May 31, 1987, he delivered his first major address on the topic. It was six years late. 21, 000 Americans were now dead, and 36,000 more lived with a diagnosis of the disease. His prior actions could not be blamed on ignorance or lack of exposure. Koop had done his best to keep the President informed. Nor is it possible to simply say that his bias against gays was historic or “principled”. In fact, his defeat of Jimmy Carter in 1980 was achieved with active gay support in California in return for his opposition to the Jerry Falwell and Anita Bryant led antigay measures that went down in defeat in California in 1978 with his help.(13)

As the president moved into his second term, he had the full support of the Moral Majority. The doors of the White House were wide open to Christian Conservative elite. Policies were being pushed, as promised, to reinstitute traditional Judeo-Christian values.(14) 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.(15)

Part IV: “We Are Fighting Disease – Not People.”

From 1983 to 1985, Koop was excluded from the Executive Task Force on AIDS established by his own HHS vice-secretary, Edward Brandt. Brandt was now gone, Heckler had been burned twice and was more than willing to push the increasingly popular Koop out front. The public was becoming more and more fearful, as the numbers of dead and infected rapidly rose. Politicians, and some physicians, were calling for mandatory testing, once a test had been developed to detect the virus in blood in 1985.(1) This followed heavily publicized cases of death from HIV tainted blood in hemophiliacs, and fears that the entire US blood supply might be contaminated.

If Chick and Fauci needed a climactic turning point, a moment that linked them together, it perhaps came 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.(2) 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 in the absence of his leadership and the provision of proper health education. For 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, he 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.(3)

When President Reagan, feeling the pressure, finally did direct Chick to create a report, he was more than prepared to respond. The Administration’s focus was on testing, detection and isolation. Koop would deal with those issues, but he already knew that his major emphasis had to be on prevention. He interviewed AIDS activists, representatives from the medical and hospital associations, Christian fundamentalists, and politicians from both sides of the aisle. (4)

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.(5) 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 AID’s”. 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.” (6)

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.”(7)

Fauci was much more careful after that, taking good council from Koop on public information techniques. At the same time, Chick 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.(8)

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 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.”(9)

The entire effort was quick, comprehensive and confidential. In October of 1986, he carefully walked the Administration through a draft tailored for approval, collecting all print copies as participants left the room, to make it more difficult for his detractors to organize a blocking effort, now or in the future. On October 22, 1986, the report was officially released, and challenged parents and schools to discuss AIDS, promote public education, and employ condoms for prevention. 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, 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.(8)

In the forward he wrote, “At the beginning of the AIDS epidemic, many Americans had little sympathy for people with AIDS. The feeling was that somehow people from certain groups ‘deserved’ their illness. Let us put those feelings behind us. We are fighting a disease, not people…The country must face this epidemic as a unified society. We must prevent the spread of AIDS while at the same time preserving our humanity and intimacy.” (9)

His inside 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 messaging had been tested and found to be effective. The mobilization effort and quiet execution would have impressed the CIA. The huge 1988 print run 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 Jess Helms rang off the hooks. Falwell and Robertson, and their like, were apoplectic. Attempts to halt it were futile. The mass mailing had been completed in bulk. There was no going back.

The medical community applauded loudly, as did the Press and the majority of the public. When his original Baptist patrons, and their captive Senators went after him, he took no prisoners. “I’m the nation’s doctor, not the nation’s chaplain”, he said.(8)

Part V: Forgive, But Never Forget.

Chick Koop’s opponents were still in a daze as the dust settled from the direct mail assault. But it had been well received by the American public, who appreciated the frank style and that they finally were “in the know”. Now they understood what this scary disease was, and whether or not they were at risk. The public began to coalesce and unify.

On the science side, the major pharmaceutical companies saw an opportunity to trigger flexibility and efficiency inside the FDA by joining hands with an unlikely partner. For the past seven years the AIDS epidemic had raged throughout America.

One year earlier, an AIDS activist group had coalesced in Greenwich Village, New York. They called themselves ACT UP (AIDS Coalition to Unleash Power).(1) They were largely HIV-positive individuals who were fed up with being given the cold shoulder by government health officials in New York City and Washington. They decided that if they were going to die, they would go down fighting.

They believed that step one in helping themselves was to better understand the science, especially the drug development process. If solutions weren’t coming off the pipeline, they decided it was time to find out why. Once they knew what to do, their step two was an “in your face” assault on the individuals and the institutions they felt were responsible, and that included the President, the Vice-President, the NIH, and the FDA for starters.(2)

On October, 11, 1988, at the end of a Columbus Day weekend of protests that had included a march on the Health and Human Services Offices in Washington, DC, they showed up in mass on the FDA campus. Approximately 1500 fully energized protesters drew broad national media coverage.

Their list of demands were clear and focused:

1. Quicker drug approvals. They wanted access to any new discovery as soon as basic safety and toxicity studies had cleared Phase I studies.

2. No use of placebos or double blind studies. Doing so with this deadly disease, they viewed, was unethical.

3. Studies must include a diverse population of patients including young and old, male and female, and all races and sexual orientations.

4. The experimental drugs must be covered by Medicaid and private insurers.

5. The FDA must support community outreach, and involve those with AIDS directly in the process.

The demonstration was titled, “Seize Control of the FDA”, and the elaborate outfits and placards delivered a simple message, “You are either with us or against us.” Tony Fauci of the NIH, who in June of 1988 had been publicly tarred as an “incompetent idiot” by ACT UP leader Larry Kramer in the San Francisco Chronicle, arranged meetings with leaders of the group, and discussions around their objectives.(3)

In June of 1989, in a meeting with activists, he wandered into FDA territory and endorsed a parallel tract for HIV drug approval. The New York Times headlined it.(2) The FDA was not thrilled with Fauci going “off the reservation”, but now they were aboard as well. Within 1 year of the protest, ACT UP’s proposal for a fast track, or parallel process, that would make new AIDS treatment available after clearing Phase I studies, was approved.(3)

Now, in addition to AZT, a second AIDS drug, dideoxyinosine, was made available.(4) President Reagan had approved the creation of the “National Committee To Review Current Procedures For Approval Of New Drugs For Cancer And AIDS”.(5) The task force included the top AIDS scientists, FDA and NIH staff, and the lead HIV activists. Fauci had survived, and would live to fight another day.

For Koop, life was never the same. After the pamphlet’s release, he received mountains of hate mail, but it only seemed to embolden him. He went to Falwell’s Liberty University and appeared on Pat Robertson’s “700 Club”. He told Pat, “No conservative Christian leader, no conservative Christian publication, to my knowledge, has been critical of the Surgeon General’s report or of me, but many constituents of those denominations and movements have been… I’ve gotten a tremendous amount of hate mail. It’s vituperative. It again assumes, you know, that I’ve departed the faith, whatever that means.”(6)

As the end of Reagan’s second term approached, Koop was once again asked by the President to generate a report. This time the President tossed him what he thought was a conservative soft ball. His enraged Moral Majority supporters, including Gary Bauer, had been looking for a way to signal to their constituents that Reagan was still in their camp. They had convinced themselves that there was good scientific evidence that abortion had a lasting negative physical and psychological effect on mothers. Reagan asked Koop to study it and report back.

With his usual diligence and thoroughness, he completed his work, and attempted to arrange a meeting with the President to share his findings. The meeting was blocked by Bauer as the President closed in on his final days of office. With few options, Koop released the news on January 9, 1989, that there would be no report, no conclusion. His investigation had determined that there was not sufficient evidence to warrant a conclusion, one way or the other. (7)

The double-cross was now almost complete. The new President, George H.W. Bush, now found the iconic Surgeon General too hot to handle and without hesitation moved him out. One year later, Koop published “The Agony of Deceit: What Some TV Preachers Are Really Teaching”.(8) In it Koop leveled an attack on televangelists who see sickness as a sign of sin, and who claim that resistance to healing reflects a lack of faith. While Falwell and Robertson, Koop reasoned, might sometime in the future “forgive,” he knew in his heart that they and their accomplices would never, ever forget.

When Chick Koop died at age 96, on February 25, 2013, Tony Fauci remembered him saying of the couple years earlier, ‘Tony, you do the science, I’ll do the education for the public.’”(9)

________________________________________________________

REFERENCES:

Part I:

1.Balmer R. The Real Origins of the Religious Right. 5/27/2014.Politico.com. https://www.politico.com/magazine/story/2014/05/religious-right-real-origins-107133/

2. Specter M. Postscript: C.Everett Koop, 1916-2013. New Yorker Magazine. 2/26/2013.
https://www.newyorker.com/news/news-desk/postscript-c-everett-koop-1916-2013

3. Stobbe M. Surgeon General’s Warning: How Politics Crippled The Nation’s Doctor. University of California Press, Oakland, CA. p.174,175.

4. “Dr. Unqualified”, April 9, 1981. New York Times. http://www.nytimes.com/1981/04/09/opinion/dr-unqualified.html

5. Stobbe M. Surgeon General’s Warning: How Politics Crippled The Nation’s Doctor. University of California Press, Oakland, CA. pp.175,176.

6. C. Everett Koop (1982-1989). Biographical Overview. https://profiles.nlm.nih.gov/spotlight/qq/feature/biographical

Part II:

1. Shilts R. And The Band Played On: Politics, People, and the AIDS Epidemic. St. Martin’s Press, New York. 1987. pp.68,69.

2. MMWR; June 6, 1981, p.2. Epidemiologic Notes and Reports: Pneumocystis Pneumonia — Los Angeles.
http://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm

3. AIDS.gov. A Timeline for AIDS. 1982. https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/

4. Weber B. Julius B. Richmond, Who Led Head Start and Battled Tobacco, Dies at 91. New York Times. 7/30/2008. http://www.nytimes.com/2008/07/30/us/30richmond.html

5. Reinhold R. Surgeon General Report Broadens List of Cancers Linked To Smoking. New York Times. 2/23/1982. http://www.nytimes.com/1982/02/23/science/surgeon-general-report-broadens-list-of-cancers-linked-to-smoking.html

6. Stobbe M. Surgeon General’s Warning: How Politics Crippled The Nation’s Doctor. University of California Press, Oakland, CA. p.177.

7. Markel H. One Man’s Rise From “Dr. Unqualified” to surgeon-in-chief. PBS Newshour. 11/15/2013. http://www.pbs.org/newshour/rundown/one-mans-rise-from-dr-unqualified-to-a-household-name/

Part III:

1. Stobbe M. Surgeon General’s Warning: How Politics Crippled The Nation’s Doctor. University of California Press, Oakland, CA. pp.181,182.

2. Stobbe M. Surgeon General’s Warning: How Politics Crippled The Nation’s Doctor. University of California Press, Oakland, CA. p.183.

3. The Age of AIDS. Interview Margaret Heckler. PBS. 1/11/2006. http://www.pbs.org/wgbh/pages/frontline/aids/interviews/heckler.html

4. Editorial. Nature Immunology. Don’t Stop Me Now. Nature Immunology 9, 821 (2008).http://www.nature.com/ni/journal/v9/n8/full/ni0808-821.html

5. Shilts R. And The Band Played On: Politics, People, and the AIDS Epidemic. St. Martin’s Press, New York. 1987. p. 456.

6. Shilts R. And The Band Played On: Politics, People, and the AIDS Epidemic. St. Martin’s Press, New York. 1987. p. 586.

7. Stobbe M. Surgeon General’s Warning: How Politics Crippled The Nation’s Doctor. University of California Press, Oakland, CA. p. 184.

8. A Brief Timeline of AIDS. http://www.factlv.org/timeline.htm

9. Ocamb K. Ronald Reagan’s Real Legacy: Death, Heartache, and Silence Over AIDS. 2/7/11. The Bilerico Project.
http://www.bilerico.com/2011/02/ronald_reagans_real_legacy_death_heartache_and_sil.php

10. Buckley WF. Crucial Steps in Combating the AIDS Epidemic; Identify All the Xarriers. New York Times. 3/18/1986. https://www.nytimes.com/books/00/07/16/specials/buckley-aids.html

11. Elizabeth Taylor’s Letter to President Reagan. Frontline. 4/10/1987.
http://www.pbs.org/wgbh/pages/frontline/aids/docs/taylor.html

12. Plante H. Reagan’s Legacy. San Francisco AIDS Foundation.
http://www.sfaf.org/hiv-info/hot-topics/from-the-experts/2011-02-reagans-legacy.html

13. Montopoli B. Remembering Reagan. Columbia Journalism Review. 6/7/2004. http://www.cjr.org/blog_report/remembering_reagan.php

14Sizemore B. The Christian With Four Aces. Virginian Pilot. Spring, 2008.
http://www.vqronline.org/essay/christian-four-aces

15. Profiles in Science. National Library of Medicine. The C. Everett Koop Papers. AIDS, the Surgeon General, and the Politics of Public Health
http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/86

Part 4:

1. Profiles in Science. National Library of Medicine. The C. Everett Koop Papers. AIDS, the Surgeon General, and the Politics of Public Health

http://profiles.nlm.nih.gov/ps/retrieve/Narrative/QQ/p-nid/86

2. Ryan White: 1971-1990. Ryan White: his story. http://www.ryanwhite.com/Ryans_Story.html

3. Specter, Michael (September 3, 1985). “AIDS Victim’s Right to Attend Public School Tested in Corn Belt”. The Washington Post. https://www.washingtonpost.com/archive/politics/1985/09/03/aids-victims-right-to-attend-public-school-tested-in-corn-belt/8ffb6ac0-93cc-4c6f-88da-f3bb23664294/

4. AIDS.gov. A Timeline for AIDS. 1982. https://www.aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/

5. Bernard D. Three decades before coronavirus Anthony Fauci took heat from HIV protestors. May 20, 2020. Washington Post. https://www.washingtonpost.com/history/2020/05/20/fauci-aids-nih-coronavirus/

6. Henderson D. Great Moments in Epidemiology. April 5, 2020. https://www.econlib.org/great-moments-in-epidemiology/

7. Shilts R. And The Band Played On: Politics, People, and the AIDS Epidemic. St. Martin’s Press, New York. 1987. p.322.

8. Unger DNS. I saw people who were in pain. Holy Cross Magazine. Summer, 2002. http://www.holycross.edu/departments/publicaffairs/hcm/summer02/features/fauci.html

9. Andriote JM. Doctor, Not Chaplain: How a deeply religious surgeon general taught the nation about HIV. The Atlantic. 3/4/2013.
http://www.theatlantic.com/health/archive/2013/03/doctor-not-chaplain-how-a-deeply-religious-surgeon-general-taught-a-nation-about-hiv/273665/surgeon-general-taught-a-nation-about-hiv/273665/

Part 5:

1. ACT UP Capsule History 1989. http://www.actupny.org/documents/cron-89.html

2. How To Survive The Plague. PBS. 12/6/13
https://www.pbs.org/video/independent-lens-aids-activists-bring-dead-white-house/

3. Crimp D. Before Occupy: How AIDS Activists Seized Control of the FDA in 1988. The Atlantic. 12/6/2011.

http://www.theatlantic.com/health/archive/2011/12/before-occupy-how-aids-activists-seized-control-of-the-fda-in-1988/249302/

4. Pinsky L, Douglas P, Metroka C. The Essential HIV Treatment Fact Book. Simon & Schuster, New York. 1992. p.67.

5. Pear R. Faster Approval of AIDS Drugs Urged. New York Times. 8/16/1990. http://www.nytimes.com/1990/08/16/us/faster-approval-of-aids-drugs-is-urged.html

6. AIDS Report Draws Hate Mail From Fundamentalists. (AP) Los Angeles Times. 2/7/1987. http://articles.latimes.com/1987-02-07/local/me-1796_1_koop

7. Shear MD. Koop Stands By Views on Status of Abortion Data. Los Angeles Times. 3/17/1989. http://articles.latimes.com/1989-03-17/news/mn-1654_1_abortion-issue

8.Horton M, Srout RC, Koop CE, Nederhood J. The Agony of Deceit: What Some TV Preachers are Really Teaching. Moody Press, Chicago, IL 1990. https://www.amazon.ca/Agony-Deceit-Preachers-Really-Teaching/dp/0802487769

9.Painter K. Former Surgeon General C. Everett Koop dead at age 96. https://www.usatoday.com/story/news/nation/2013/02/25/surgeon-general-koop/1947347/

10. https://www.politico.com/magazine/story/2013/12/c-everett-koop-obituary-101454/