American Science’s “Odd Couple” – Dr.’s Koop and Fauci. (Part 2)

The following 5-part series is excerpted from an as yet unpublished history of 20th Century medicine in the United States by Mike Magee MD.

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)

Next: PART III : Sidelined – HIV Off-Limits.

Entire Series with References