Who was Dr. C. Everett Koop and why is his life so significant? How did he become so passionate about abortion? How did he navigate bioethical controversies during his tenure as Surgeon General under President Ronald Reagan? We’ll discuss these questions and more with our guest and Dr. Koop’s biographer, Dr. Nigel Cameron. 

Biographer Nigel Cameron is President Emeritus of the Center for Policy on Emerging Technologies (C-PET) in Washington, DC, which he founded in 2007 and led for ten years, former Technology Editor at UnHerd.com and Fulbright Visiting Research Chair in Science and Society at the University of Ottawa, Canada. A native of the UK, he is also a citizen of the United States and Belgium. He has written widely on the policy impacts of emerging technologies, including: Innovation President (Amazon Kindle), The New Medicine, & Nanoscale: Issues for the Nano Century, and Will Robots Take Your Job? A Plea for Consensus (Polity Press / John Wiley). 



Episode Transcript

Scott Rae: [upbeat music] Who was Dr. C. Everett Koop, and why is his life so significant? How did he become so passionate about abortion, and how did he navigate bioethical controversies during his tenure as surgeon general under President Ronald Reagan? We'll discuss these questions and a whole lot more with our guest and Dr. Koop's biographer and medical historian, Dr. Nigel Cameron. I'm your host, Scott Rae, and this is Think Biblically from Talbot School of Theology, Biola University. Nigel, welcome. It's, it's good to reconnect with you, and great to have you, talking about Dr. Koop, a man that we both admire greatly.

Nigel Cameron: Great to be here. Thank you.

Scott Rae: Thank you. Now, for our listeners who might not be familiar with him, tell just briefly, who was he, and why is he significant?

Nigel Cameron: Well, Chick Koop, Chick was his nickname. Everybody called him Chick. He began life, as it were, as the world's most famous pediatric surgeon, separating, you know, conjoined twins, very celebrated, and basically building pediatric surgery as a profession in the US.

Scott Rae: So it wa- it wasn't really a thing before.

Nigel Cameron: I mean, he was one of perhaps the first four... Three or four full-time pediatric surgeons-

Scott Rae: Yeah

Nigel Cameron: ... In the country. It was adult surgeons would do this stuff on kids, and the kids would often just die, and Koop was the guy who began to pull the whole thing together and made it work.

Scott Rae: All right. Now, just say, what was he like as a person?

Nigel Cameron: Well, people often found him rather gruff. I mean, he could, you know, he could be quite sharp-tongued. He could complain a bit about people, students, and so on. But if you got to know him, you know, this mellowed, and he was never gruff with me, and we were really quite friendly. I spoke to one of his former aides, you know, who's now a professor down at University of Chicago, and he said, "Yes," he said, "he... Once or twice, he really cut me off and chewed me up, you know, but I'm sure I deserved it." So Koop had this per- this p-p... Of course, he was a surgeon. He'd been used to telling everybody what to do for 30 years. But to get to know him, he could really be very funny, and the thing is, he was a baby doctor. He was a kiddie doctor. I mean, he could, he could spend hours with little children. He could keep them amused. So he had this incredible soft side to him, even if he could then flip into top surgeon mode- ... And be much more fierce. So, and he called on both of these traits when he was in government.

Scott Rae: Now, it's, it's, it's one thing to admire somebody as a person and admire their life. It's another thing to commit to writing their biography, which you described as a four-year project. What was it that so captured you about Dr. Koop and his life and his legacy that motivated you to write his biography?

Nigel Cameron: I think, I think a couple of different things. From a personal level, I mean, I knew him. We were kind of friendly. I mean, I wasn't that close to him, but I knew him over 30 years, and, you know, he met my family and this sort of thing. And so I was interested. I mean, he... After he passed back in 2013, just about 2020, '21, I... It just came into my head, like people do, you know, who've passed, and I thought, "Well, there must be a biography. Who's working on this?" So I did some Googling and made a couple of phone calls and, thought, "Well, okay, no one's done this, and it needs to be done." And then I said-- secondly, I thought, well, I mean, here was a man who was a absolutely convinced evangelical Christian, Reformed Christian, who ends up being a major public figure, and that is a pretty unusual thing. And in fact, his friend, Harold O.J. Brown, who was one of the leading lights of evangelical theology then, Joe Brown said he was the most significant evangelical in public life since William Jennings Bryan-

Scott Rae: Really?

Nigel Cameron: ... Back in the 19th century.

Scott Rae: That's quite, that's quite a call.

Nigel Cameron: And he didn't count Jimmy Carter. So he was a really important kind of crossover character, and I thought, "Well, someone needs to write about him, who can get a sort of university press sort of branding for the book, not a Christian book, but who will take his faith seriously." And I thought, "Maybe, Nigel, you're kind of semi-retired now, and you should pick it up."

Scott Rae: Now, before he became surgeon general in the Reagan administration, which is, I think, really when he became much more of a public figure, he w- he was impacted significantly by the late Francis Schaeffer. Tell us a little bit about the impact that Schaeffer had on him and maybe vice versa.

Nigel Cameron: Sure. Well, he had met the Schaeffer family, I mean, way back through the hospital, because, one of the Schaeffer kids was having some surgery, and he kind of got involved rather accidentally with this, and then met Edith, who was with the child, and then got into- kind of connected with the Schaeffer family. But I mean, he was, he was converted, back in 1947, at Tenth Presbyterian Church in Philadelphia, under the great, Donald Grey Barnhouse-

Scott Rae: Yeah, yeah

Nigel Cameron: ... Who was our first-ever coast-to-coast radio preacher back in 1928. Very unusual fundamentalist leader of the day, partly 'cause he spoke fluent French, and he would often just speak French at home with his family. Barnhouse doesn't have a biography. Interesting guy, but he and Koop became very close in late '40s through the '50s. And then he bumps into Schaeffer in this rather accidental way, and immediately, being Koop, gets really involved in his ministry, and funding it, and being the doctor of last resort to the kids, and so on and so forth. And then some years later, comes to come across him rather closely, almost by accident, well, by providence, and then they begin talking about the movie series, which really made their partnership famous.

Scott Rae: Yeah, Whatever Happened to...

Nigel Cameron: Whatever Happened to the Human Race?

Scott Rae: Nice. Nice. Yeah. Now, w- how did he become so passionate about abortion? Because as you point out in the book, it was, it was not his religious beliefs primarily that made him such a passionate advocate for the unborn. But if that's not the case, then what was it?

Nigel Cameron: It's a very interesting question. I mean, most evangelicals today would be astonished and horrified and probably rather disbelieving if you pointed out that when Roe versus Wade was handed down, hardly any evangelicals were bothered about it.

Scott Rae: ... Now, that was, that was one of the things that was-

Nigel Cameron: I mean-

Scott Rae: -breaking news to me.

Nigel Cameron: Just, you know, just read the record. Because it was seen as a Catholic issue, and, things like the Christian Medical Association and so on, I mean, these, they were way... It was like, it was like contraception. It was a Catholic thing back then, Catholic versus Evangelical, big divide, and so they weren't much bother. Now, there were exceptions, but they were exceptions, and so it just wasn't an issue. But Koop, pretty interestingly, by providence, as he would certainly have said, in 1973, immediately after Roe was handed down in January, February, whenever it was, he's writing to his attorney and saying, "I would like the judgment from the court," 'cause you couldn't just Google it in those days, "uh, because I've just been invited to give commencement address at Wheaton College, 'cause my daughter is graduating." And so he then delved into the whole thing in de- now, why did he take this view? It's really interesting to see how he came to his pro-life conclusions because in his... He wrote this book in 1976, you know, The Right to the Right to Life, and it uses all sorts of arguments. And his Wheaton address, which was really the basis for that book in '73, which was never published, in full by anybody. It's in the archives of Wheaton College, um-

Scott Rae: And you, and you mentioned in the book, too, that the address was never made public.

Nigel Cameron: It was, it was never... No, I mean, they- Wheaton was really embarrassed by this pro-life speech. This wasn't what they were looking for at all, because back then, I mean, the evangelicals weren't into this thing, and Wheaton has always been very touchy about controversy and so on. So, Koop makes this absolutely belligerent speech about abortion. Now, I think, to a degree, this came, and he would say this after the event, from his practice because here he was, saving little, tiny babies, and, you know, just, 100 yards up the road in the university hospital, they were, they were doing late abortions. And, and this-

Scott Rae: At the same gestational age.

Nigel Cameron: The same gestational age, of perfectly healthy babies, and he was saving the babies who were not perfectly healthy, and this rankled. And I think this... I think this was a major factor. I think he was also theologically engaged with the question, and he knew a lot of Catholics. He was quite, for the time, he was really quite ecumenical in the way in which he built relationships, and, but this all came together. But it's fascinating, I mean, back in, back in '73, over those few months between Roe and Wheaton's commencement, I mean, he was writing this really very powerful speech, and it changed his life and actually changed the life of evangelical America, and as it just happened, the life of political America, which is another question.

Scott Rae: Yeah, I'd ne- I'd never, you know, I'd ne- I had always thought that the, you know, evangelicals would have been always engaged in the, in defending the unborn. And that was, that was quite a bit of breaking news to realize, eh, maybe not so much in the '70s. And some of the people you quote making statements about when personhood begins at birth among, you know, Baptist preachers and evangelical leaders, was actually quite alarming. And so he- was he swimming upstream-

Nigel Cameron: He was

Scott Rae: ... In the evangelical community?

Nigel Cameron: Oh, he was, and he liked doing that. I mean, Chick was a bruiser. I mean, he loved to fight, and so I think that was just, you know, just encouraged him. But there wasn't much discussion among evangelicals. But there were some, and the Christian Medical Society of its day, was very much in this middle position. And there was this big book they published called... Is it called The Christian and the, and the Unborn or something like that-

Scott Rae: Something like that

Nigel Cameron: ... Which was a collaboration of various groups, and a fascinating book. And the consensus in the book is that abortion may be okay at least sometimes. And some of them was precisely up to birth were fine. And, and they would often say, "Well, yes, it's probably a bad thing, but on the other hand, if you can stop something, else bad happening in the family, like there are too many children or something, then it's okay." And that was the way they were thinking. And Koop, well, Koop was always something of an extremist. I mean, he, you know, there's a wonderful article about him in much later life, which says that he has a lot of, lot of opinion, and whenever you're in a room with him, it's very hard not to be influenced by this expression of opinion. And so when Koop thought anything, he thought it, he thought it strongly. And I think that partly explains what happened because, I mean, he- obviously, he was still the world's most famous pediatric surgeon in the '70s, which we know, which was, like, his last decade of professional practice. And I think you could probably say he was probably getting bored.

Scott Rae: Yeah.

Nigel Cameron: You know, I mean, he'd established the profession.

Scott Rae: Yeah.

Nigel Cameron: He built this huge team, the Children's Hospital of Philadelphia. He built out all these subspecialties. His model for how you do a children's hospital had basically won out, and he was a man of absolutely relentless energy. And to be fair, some of his friends would say he needed to be needed. He needed to have a cause. He needed to have people who needed him, and it was all built into his personality. And, and here, Who is it now? I think it may be Michael Specter. So some other writer who's written about Koop, said that, said that sort of he was looking for something fresh to do, and the pro-life movement, you know, had vacancies. A phra- a phrase like that, because here was something quite fresh, and he moves in his somewhat, you know, blundering, bulldozer way into the debate, and offends all kinds of people, but he makes an impact.

Scott Rae: Well, it sounds like the evangelical community needed a bit of a bull in a china shop at that point.

Nigel Cameron: [sighs] And he was, he was, he was the guy.

Scott Rae: And I... Well, I could se- I could see it doesn't take much imagination to see how rankled he got when he was saving kids that they were aborting in the h- in the same medical complex, basically.

Nigel Cameron: Mm-hmm.

Scott Rae: And recognizing that he could do something to make a difference on that. Now, when he was nominated to be surgeon general-... What kind of obstacles did he face before his nomination got cleared?

Nigel Cameron: Well, Koop was first approached about the, about becoming surgeon general, back in, back in, before Reagan was even elected, by Senator Schweiker, who was his home state senator, and he was sounding him out. And, Koop, at that point, thought he'd be in the Cabinet.

Scott Rae: Oh.

Nigel Cameron: I mean, surgeon general has actually never been in the Cabinet, even though it used to be a much more powerful role than it was in Koop's day. But, he had thought, "This is gonna be terrific." And, and he also thought, I suppose in the way you do when you've spent 30 years as the top person in your field, that everybody would just be delighted, and cheer, and say, "Well done." and so when he went to Washington, and d- you know, ran into a buzz saws, you know, of a, of a high-order buzz saws. I mean, the New York Times had an editorial specifically about him, headed "Dr. Unqualified."

Scott Rae: Oh, my God!

Nigel Cameron: And, a slightly smarter- ... Smarter journalist called him Dr. Kook.

Scott Rae: Oh.

Nigel Cameron: And that stuck.

Scott Rae: Yeah.

Nigel Cameron: That stuck. And it's curious, he was... In some ways, he was very thin-skinned. For a sort of bruiser who liked to have an argument, he was curiously sensitive. I mean, most people who spend their lives being controversialists, they don't care. They expect people to cr- but he really took these things to heart, and he got very upset about them. And, and then it emerged that he was gonna spend about nine months, and it was a, it was a technical issue, 'cause he was too old. Because, you see, to become surgeon general, you've got to be an officer of the Commissioned Corps of the Public Health Service, which is a weird, old-fashioned thing, but they still have 6,000 people wear uniforms. And they have to retire when they're 64 and X days. And he was just a few days too old, so they had to have legislation to change the rules about the Commissioned Corps, and that had to go through the House. Now, the House was controlled by the Democrats, so you have this classic Washington fight going on, separation of powers issues involved, the Senate being crossed because the House is making a decision that affects their nomination decision, and Koop in the middle of all this, and he was pretty horrified. But, they made him an, they made him deputy assistant secretary of health, so he had a salary, he had an office, and in fact, had quite a lot of things to do during this nine-month period. But big criticisms made of him, and he did not like this at all. He thought he was, he was a big guy. I mean, the formal criticism was he had no background in public health. He's a surgeon, and it so happens this guy had set up hospitals around the world with support from the State Department.

Scott Rae: Right.

Nigel Cameron: He did all kinds of public healthy things on the side, and, But the American Public Health Association, which is a huge organization, absolutely took him apart in these hearings, and it was, it was pretty grim.

Scott Rae: And never mind the fact that the office was the office of the surgeon general.

Nigel Cameron: Well, that's one of the other... Yes, I mean, there was, well, some of the polls would say, "Why don't we have a surgeon as surgeon general?" You know. But, of course, the office also, there wasn't much to it. I-

Scott Rae: Yeah, it sounds like he really elevated the prominence-

Nigel Cameron: Well, he-

Scott Rae: ... Of the role

Nigel Cameron: The thing is, he thought this was Cabinet. It was never Cabinet. But until the mid-'60s, the surgeon general ran the, you know, Centers for Disease Control, the NIH. He ran the, um-

Scott Rae: CDC

Nigel Cameron: ... CDC. He ran all of these things.

Scott Rae: Yeah.

Nigel Cameron: And had this billion-dollar budget and big staffs. And in the mid-'60s, for political reasons, LBJ decided to move all this stuff onto a political appointee, who was an assistant secretary, who could easily be pushed about. And this very sort of glamorous, old-fashioned title, this guy just floats around, and he can make speeches, and maybe has half a dozen staff. Koop, of course, didn't know this, and so what Koop did in office essentially was to put the office back together again because of his force of personality.

Scott Rae: Yes. Now, his... You mention in the book that his approach to abortion changed slightly once he became surgeon general and was more in the public eye. Tell us a little bit about how you see that shift taking place.

Nigel Cameron: It's complicated. I think one could write another book just about this question, 'cause it's a really interesting question, and it's very complicated. And I believe, We, we tend to think people are ultimately very rational, and when you start writing history about people, you realize maybe they didn't, they didn't know what they're doing. You know? And I don't know whether he had really sorted out his thinking in the sort of way that we would like him to have. And there's a widespread view that he basically went liberal, got Potomac fever, thought, "This is great. I've got a lot of power. Let's forget about these things," which isn't at all true. He obviously thought he was gonna be more liable to be confirmed if he promised people he wasn't gonna talk about abortion, but I think it wasn't primarily that. I think he had this naive notion, and I think he retained it the rest of his life, that being made surgeon general was not really a political appointment. It was kind of promotion in the medical community. And it was as if the country was saying to him, "You're such a, such a great guy, we now want you to be our top public health doctor." And it's as if he sort of Googled public health and run down... Wrote a checklist and thought, "Well, I can do all of these things," and began making a list of things to do. And he would say, "I still think abortion's terrible. If I talk about abortion, it will undercut my credibility on other issues. Other issues are also important."

Scott Rae: Now, you point out, and one thing that I didn't, I didn't know anything about, was that he took on s- the tobacco companies shortly after he became surgeon general. And that, I mean, that... He g- I mean, he's criticized on the left for his, for life views, but he was criticized on the right for taking on smoking. I mean, he went toe-to-toe with the companies, and I think it's, it's, From what you point out in the book, it's, I think it's fair to say that he became... He's the one who sort of put the anti-smoking movement on the map.

Nigel Cameron: Yeah. Yeah, basically, he created the anti-abortion movement, and then he created the anti-smoking movement. [chuckles] yeah, so he, The one legal thing the surgeon general had to do-... Significant public thing was sign an annual report on tobacco. And this go way back, way back. Didn't write it, and it wasn't even his staff who wrote it.

Scott Rae: No?

Nigel Cameron: But he was given it to sign. So his predecessors would just sign this thing and make a little speech. But Koop thought about this. He thought, "How can I get back in the good graces of the press and get my reputation back?" And he was pretty smart. I mean, he was often quite naive politically, but sometimes he really got it right, and this was brilliant. And so, I spoke to a guy called Don Shopland, who is mercifully still around, in fact, edited a book recently on some of these issues. And he was the young guy who was sent in with this report to give to Koop and say, "Please sign." And Koop said, "I'm gonna have a look at it," and he went back, and on every page, there were little stickies and scribbles and questions of this hundreds of page report. And, so, and then he goes to a press conference. Don Shopland wonderfully says, and I think I have this in the book, "That if ever there was a press conference where someone really knew his shit, that was the press conference." [chuckles]

Scott Rae: [chuckles]

Nigel Cameron: Okay? And so his boss, the assistant secretary, who had all the power that surgery used to have, begins a press conference and says, "Well, here we have a surgeon general, and he'll make his own little speech." And one of, one historian of surgeon generals says he'd play his big part. Koop, of course, didn't know how to play a big part, so he just took control of the meeting with his booming voice and some fairy-telling prose about this, the damage this is doing to American health, to the American economy, and on and on. So as one writer put it, he changed the relationship between the American government and one of America's most powerful industries in an hour.

Scott Rae: Amazing.

Nigel Cameron: And it's all about the press. So you go to the Post and The Times the next day, and I get one... I forget which is which, but both of them has this on the front page. And in one of them, the assistant secretary, his boss, had to go to paragraph four to find his name. And, and, yeah, that was the Post. And in the Times, had to go to paragraph six, 'cause this was Koop.

Scott Rae: Yeah.

Nigel Cameron: And Koop said, "After that, the press was always on my side."

Scott Rae: And, yeah, I mean, I think if that by itself would be a legacy that's, that's really worth celebrating. Now, he took on another very controversial cause, not, again, not too long after he became surgeon general, with the out- when the outbreak of AIDS took place. What... And, and he got roundly criticized by the right for that. I think maybe more for things he didn't do than more for things he did do, but tell us a little bit about that. What was that journey like for him?

Nigel Cameron: It was a very difficult thing, and in fact, you know, Harold J. Brown, who was close to him and quite critical of him in some ways, Joe wrote somewhere that he thought Koop found this very hard because he suffered with those he was with. And he was used to suffering with handicapped babies-

Scott Rae: Yeah

Nigel Cameron: ... And I was suffering with gay guys who were dying of AIDS, and I think this is part of what happened. But he had an immense compassion, and some would say Joe, so it warps judgment. I don't think that's what happened, but anyway, until 1986, well, till the end of '85, he was told he couldn't talk about AIDS. His bosses were doing all this, and the White House played it down, although I have evidence in here, this has not been published before, that actually, it was, it was HHS that stopped the White House from talking about AIDS earlier. There's an interesting discussion, sort of inside baseball discussion, about what was going on there, and Reagan's been blamed, I think inappropriately, for not taking it too seriously. But anyway, this is handed to Koop, and whatever the abortion thing, I mean, the sort of the hard, the hard, the hard guys in the White House, the heavy conservatives, like Gary Bauer and so on and so forth, they, were fairly confident that Koop will come up. You know, he's a Presbyterian elder. He'll come up saying, "Abstinence, abstinence. It's bad stuff. You know, it's drugs, and, of course, primarily it's gay sex." And this would- he'd frame the thing in a nice way, from their point of view. And Koop sits down with all sorts of groups of people, including with the leadership of the gay community, and including with, a guy called Jeff Levy, who's now a professor at one of the universities in DC, who spoke very freely to me, and also the guy who was running the, He was the public policy guy for the Gay and Lesbian Task Force. There was a guy who ran the minority, gay network. I've spoken to both these guys, who mercifully survived the epidemic, and they said this guy sat down, and he was very charming and very smart, and they just thought he was having them on, and they suddenly realized it was for real. And he would say things like, "You know, I don't approve of sodomy. I don't like what you do, but I'm a doctor. God is the judge. I'm gonna save your life," and that summarizes his whole approach. He writes his for- report very secretly on a standing desk in his basement. And it comes out, and, well, Ted Kennedy, who initially fought him but then became very, kind of a, kind of almost personal friendship there, he said the, his AIDS report hit America like a lightning bolt. And it didn't just change the way AIDS was viewed in the US. Again, one writer has said, basically, he is, in a sense, became leader of the Republican Party on the AIDS agenda, and the people in the White House who were trying to force it as a sort of moral anti-gay issue, they just lost. They lost so round after round after round. Gary Bauer wouldn't talk to me for the book. I mean, I've met Gary Bauer in the past. He refused to speak to me, for the book because they lost, and he, okay.

Scott Rae: Yeah.

Nigel Cameron: And, I mean, you haven't got to agree with everything Koop said, but Koop himself somewhat regretted some of the things, if he hadn't been more careful in discussing, well, you know, sex education from pretty much the get-go in school and so on, and some of that he qualified later. But he said, "You know, everyone isn't going to abstain-... [chuckles] and he says, "You know, we've got to save the life of the people who don't abstain." He believed in sin, you know, and believed that it be- it's a lack of self-control, however you want to frame the gay sex issue. And so he said, "We've got to save people's lives who don't go along with our good advice." And, I think it was Mike Gerson, you know, who was George W. Bush's chief speechwriter, and sadly died quite recently. Mike said that PEPFAR, you know, the president's big AIDS relief program, which has now been damaged under the current administration, which has saved, I think I saw, around 25 million African lives, something like that, would never have happened unless Koop essentially had opened up the Republicans to a public health approach to AIDS rather than this prejudicial approach. So in a sense, he, you know, his influence is still out there.

Scott Rae: Yeah, that sound, that's... I mean, that's the issue. I think that's, that's not widely known, I think, by people who, unless you're more familiar with his life, the impact and the legacy that that left on the treatment of AIDS, you know, so going forward. Now, he also, he also got heavily involved in one of the most controversial bioethical cases, and it w- it was right in his lane as a pediatric surgeon with the Baby Doe controversy. So and what was that about, and how did he get involved in that?

Nigel Cameron: Well, he... It, it is, I think it's, it's amusing, at least, you know, one has, one has to be amused by some of these stories because he had said goodbye to pediatric surgery and babies and so on. He was not going to talk about abortion, and he had, as a pediatric surgeon, fought very strongly against those who wanted to abandon handicapped babies and put them in the corner of the ward, and so on and so forth. How-

Scott Rae: Which, which was become- which was just beginning to become, I think, more common.

Nigel Cameron: I mean, quite hot out. And all of a sudden, a case comes up from Indiana, of a little baby, who ends up being called Baby Doe because they didn't want to use the name, who's born and who, has a couple of different handicaps, one of which blocks his capacity to eat, and therefore, he can sort of not be fed. I mean, if you don't feed him, he will, he will die. If you don't treat the blockage, he will die, and after, I mean, six days, he dies. And there's a big fight in the hospital. There's a judge involved. The doctors all are screaming at each other. Parents side with a doctor, that the baby should just be treated by not being treated. Baby dies, and this causes a huge furor. I mean, there were lawyers flying to the US Supreme Court the night the baby dies. I mean, they had an appointment with Justice Souter, I think it was. I mean, this... It was that kind of issue from the start, and you had maybe a dozen families in Indiana offering to adopt the baby in a sight unseen, but the parents were determined the baby should die. And so this exploded, and it caused ruptions, but Koop was not allowed to manage it, partly because he really didn't get on with the then Secretary of Health and Human Services, who was a lady, who ex-congressman, who a congresslady, and she didn't like [chuckles] him-

Scott Rae: Her-

Nigel Cameron: But it was, it was, it was mutual. [chuckles]

Scott Rae: You, you had a, you had a long discussion of that in the book.

Nigel Cameron: After-

Scott Rae: Very interesting

Nigel Cameron: ... After about a year of fighting about this and various proposals they make, 'cause Reagan, I'm sure under the impress of the pro-life movement, you know, behind the scenes- ... And his Attorney General, William French Smith, came up with all sorts of regulations and instructions, and so on and so forth. Finally, Koop, apparently on a flight back from Egypt or somewhere, goes, walks along the aircraft to where the secretary is sitting, and kneels down behind her and says, "Please, let me do this." He says, "I'm being blamed anyway for the policy here." And in the end, he gets to handle it, and he does a compromise, which he says he gets 90% of what he wants, and they're gonna set up advisory groups and this and that and the other. A lot of the pro-lifers did not like this at all. They really did not. They thought he was-

Scott Rae: Because of the 10%.

Nigel Cameron: Because of the 10%.

Scott Rae: Yeah.

Nigel Cameron: Because 10%. Koop said, "I'd much rather get the 10%, thank you very much," and he was, again, it's a pragmatist on those sort... He's a clinician. I mean, this is what you do. He's taking an operation, what the risk is. And just so this thing went, it's interesting, controversy, because it went through all three branches of government over several years. But in the end, they came up with a compromise, and, But Koop, I mean, poor man, I mean, here he was in his new job, and he suddenly has his old job coming back to haunt him.

Scott Rae: Yeah. No good deed goes unpunished here.

Nigel Cameron: No.

Scott Rae: No good goes unpunished. Now, back to abortion here for just a second. Later in his tenure as surgeon general, he took heat from the right on abortion as well, and that had to do with the, I think, the 1985, '86 report on abortion and its effect on women.

Nigel Cameron: Yeah, a little later.

Scott Rae: That, so-

Nigel Cameron: Yeah

Scott Rae: ... Tell us about that, 'cause he-

Nigel Cameron: Yeah

Scott Rae: ... That was, that was also very controversial. It's something he waded into.

Nigel Cameron: Well, he had said that he would not talk about abortion when he was surgeon general, and he said that to everybody who would listen, and he managed not to talk about it. And then, and I think this was a little later, this would've been '87, I think '87, obviously under pressure from the pro-life movement, some section of the pro-life movement. They reckoned that if you, did a proper study and looked at, the consequences of abortion for women, psychological and physical, and so on, you could show, that it was a threat to health. There were stories about breast cancer, and there were various sort of, sort of negative consequences coming out of abortion. It's actually a problematic area because abortion, I think, is pretty plainly much safer than having a baby. So, you know, it's, it's not a simple issue, but this- but there was a big push to get the White House to get him to do a report on this, and people assumed that he would come out, you know, on the right side. And Koop was really very angry to be asked to do this, having said he didn't want to, and he was, he was not a modest man. "The president wants you to do this." "Yes, well..." Anyway, so he tries to get out of it. He has two different briefings with the White House officials saying, "Well, you know, I don't want to do this. It's too complicated."... He goes to see one of the cardinals and says, "Well, I'm just gonna have to tell you, 'cause I'm gonna be writing a whole bunch of stuff about contraception, just to let you know that." And, you know, he begins to do some of the sort of field work, and he is partly planning to produce a report on basically how you reduce abortions, even if you can't establish causalities, and disease, and so on. And he has someone do a review of all the studies there were, and he concludes that basically the studies are all prejudicial, that either you've got these pro-life guys who wanna show that it is damaging, or you've got pro-choice progressives who wanna show it's not. And he said, "You have to start again. You have to fund some stuff, progre- some longitudinal studies over five and 10 years if you want an answer." But he kept changing his mind. It was very un-Koop-like, I think I used that term, and his staff were quite bewildered by this and really quite upset by it, 'cause they expected him to come up with something clear. And finally, he just dawdles, and dawdles, and dawdles, and leaves it until after the election. And I think Reagan only has maybe nine or 10 days left in office, this is into January, and he goes to the White House and delivers a letter, it's maybe four pages long, explaining why he can't write the report. And, because he said the evidence is not clear one way or the other. Now, you know, this is political naiveté. You know, why didn't he ask his press secretary to look this over? Because if you say that, the press are gonna say, "Koop says there's no evidence that abortion is harmful."

Scott Rae: Right.

Nigel Cameron: And he drove home that evening to his house, and finds his wife in tears because the TV news is that Koop says abortion isn't harmful. And he spends days on the phone, and then, of course, it's all too late. And meanwhile, the president isn't remotely interested. He's, you know, retiring, and the incoming President Bush, who Koop reckoned he got on with quite well ... But this is politics, it was a polite relationship, has no interest in anything. And this just makes Koop quite sort of toxic for the incoming administration, and because his appointment, you know, is a four-year appointment, he still had, you know, up until October or something, of the incoming president's first year to run. And the press have tried to sort of ease him out, but it all gets pretty messy after that. And I think, I think, I think Koop was beginning to find it hard to be the ex-celebrity, and everything was getting kind of tangled in his life.

Scott Rae: Now, one- let me, let me give maybe a f- a quick follow-up on that. I wonder, put yourself in his place if he were here today. I wonder, would he say something different about the impact of abortion on women today, given some of the data that we have today, or do you think he would still hold to that view that he did in the letter?

Nigel Cameron: Well, I think he'd be very interested in the data, and in fact, in the book, I do refer to some really interesting data. Because, about 20 years after all this happened, a group of feminist researchers got together, and they produced, a thing called the Turnaway Study, which which was made into a book. This wasn't just a research paper, and it's a fascinating study. And they say in the introduction, "Koop said we'd have to do a new study to find out what the sequelae really were, and we've done that study." And what they did was, they went to abortion clinics all over, all over the country, and they went in the waiting rooms, and they found women who went ahead with an abortion at a late-ish sort of stage, and women who were turned away, either because of the state law or because of the competency of the clinic. "No, we don't do them over 20 weeks," or something, yeah, but women do ... Were getting turned away. And they compared these two groups, those who had the abortion 'cause they wanted it, and those who didn't, even though they really wanted it at this late stage, and they were astonished by the result. So was I, [chuckles] 'cause the result isn't... The, the writers say this, that 12 months after the birth of the baby, the women who've had the baby, who've sort of been forced to have the baby, their sort of psychological condition is exactly the same as women who got the abortion 'cause they wanted it, and they were astonished by this. Of course, it's all about the power of babies. Koop would certainly have said that. I mean, he speaks a lot of the power of handicapped children to basically create an emotional world for their parents. So none of this is understand from the outside, but it's a really int- this Turnaway Study is really interesting. The pro-life movement didn't like it for other reasons. I think they should have made much more use of these results.

Scott Rae: Yeah, no, I think you could ... You, you can make the case that, w- you know, the, some of the harms for women are... Now, that's an important component, but maybe incidental to the central issue in the pro-life movement.

Nigel Cameron: Well, actually, I, Koop would say this. He said, "For K-" He said, "This is about killing babies. You see, it's not about-

Scott Rae: Right

Nigel Cameron: ... B- messing up, making women a bit upset or giving them sort of minor surgical complications. I mean, it's about killing babies. That's the issue." And why is it, why... Now, of course, the pro-life movement is trying to do political things here, and, it's very interesting. You know, Jack Wilkie, you know, who ran National Right to Life, and whom I knew somewhat, and I have a lot of respect for Jack Wilkie. He was a very, reflective, sort of astute individual, not knee-jerk, and he knew Koop, and he was disappointed by Koop's report. But he said, "He's basically right, that the evidence does not..." And he said, "There were other things he could have done in the report." but he accepted that in terms of the data, Koop was, Koop was not, you know, was not messing about.

Scott Rae: Nigel, this has been, this has been so fascinating. I so appreciate your... The deep dive you did into the life of this very complicated person. Let me, let me ask one final question. What, what would you say would be maybe the top one or two takeaways from Dr. Koop's life that you would want the reader to make sure that they get?

Nigel Cameron: Well, writing this biography has got me interested in biographies, and I'm now writing another biography, and I think, "Why do we write biographies? Why do we read biographies?" And I think there's nothing quite like this for understanding the course of the arc of our human lives, for putting the pieces together, for working out what is a good life, and for getting some sort of, you know, flashing red signals about what you don't wanna do. Now, Koop did not that well with his kids.... He got married again when he was 93. His wife had died, 93, and his two sons would not go to the wedding.

Scott Rae: Really?

Nigel Cameron: I mean, this was a difficult situation. Now, it wasn't all bad, but I mean, you know, when the kids were small, he was never- I mean, literally never around, never home, never home. I mean, you- there are takeaways like that. How can you lead the good life and even be successful and be busy? But things really matter, and you see, when he was an only child, and his dad would spend many of his lunchtimes in the public library in New York, looking up answers to his son's questions.

Scott Rae: [chuckles]

Nigel Cameron: I don't think he ever really understood the profound difference in the family experience his own children had, and this made him sad, and it's one reason why the pastor who was closest to him in his final years said for his final years, he was profoundly depressed. So I think we learned this. Throughout my work on the book, partly 'cause I knew him, I'd imagine myself presenting him with the chapters and asking him for his view and saying, "Is this fair?" I think Chick would say yes, and I was very pleased that his widow, Cora, whom I've got to know really quite well, she was-- she was very content with, content with the book-

Scott Rae: Well, that-

Nigel Cameron: ... Which meant a lot to me.

Scott Rae: Now, that's a huge win.

Nigel Cameron: Yeah, 'cause I wasn't pasting over his foibles and his arrogance and his-

Scott Rae: Oh

Nigel Cameron: ... All that, but I think he led a good life, and, I think we can be grateful to God for that.

Scott Rae: Well, and I think his-- the legacy that he left, where he basically created a good bit of the evangelical pro-life movement. He created the anti-smoking campaign. He, he had a huge impact on the treatment of AIDS and public health. Those, those are pretty significant legacies for not that long a time period, when he, when he was surgeon general and that time proceeded.

Nigel Cameron: I'll give you one little, one little tell for his story. So when he was 94, and he was remarried, he was invited to the wedding of a young colleague of his, and, the, I think it was the man's father was welcoming him and celebrating and getting him a nice whiskey, which is what he was up for that night. And he said, "You know, this is Dr. Koop, and he saved millions of lives." And Koop, who was never a man to be unduly modest, said, "I think you're probably right." [laughing]

Scott Rae: [laughing] That, that's, that's quite, it's quite a legacy that he's left. Well, I wanna, I wanna really encourage our listeners to pick up the book by Dr. Nigel Cameron, entitled Dr. Koop: The Many Lives of the Surgeon General. It's a great read. You-- for your first time through, I think you've ma- you've mastered the art of being a biographer 'cause it is super interesting to read. And, you know, having sort of come of age in my own interest in bioethics during the time period when he was surgeon general, you know, I lived through a lot of those, a lot of those controversies, and it just, it is such an interesting read, so I highly commend that to our listeners. Nigel, thanks so much for being with us, taking the time to do this. What an interesting conversation.

Nigel Cameron: It's been great. We can be grateful to have such a wonderful man to talk about.

Scott Rae: Hear, hear.

Nigel Cameron: And, we can hope we can, you know, live up to his example. Thank you.

Scott Rae: This has been an episode of the podcast Think Biblically: Conversations on Faith and Culture, brought to you by Talbot School of Theology, Biola University, offering programs in Southern California and online. Visit biola.edu/talbot in order to learn more. To submit comments, ask questions, or make suggestions on issues you'd like us to cover or guests you'd like us to consider, please email us at thinkbiblically@biola.edu. If you enjoyed today's conversation with our friend, Dr. Nigel Cameron, please give us a rating on your podcast app and share it with a friend, and join us on Friday for our weekly cultural update. In the meantime, thanks for listening, and remember, think biblically about everything. [upbeat music]