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Despite enormous pressure, Koop would not back down. One thousand Americans a day were dying of tobacco-related illnesses, and as the nation's top doctor he felt obligated to speak out. (He now points to the decline in cigarette smoking-almost 20 million Americans quit during his term-as his greatest accomplishment.) On cigarette smoking, sex education, free needle distribution for addicts, and many other issues, Koop traveled his own path.

To a jaded public hungry for integrity in their leaders, Koop became a genuine folk hero. And what had looked like a cul-de-sac job gradually developed into a central arena for moral suasion. "I have a sense of right and wrong," he says. "A lot of other people in this town don't have that."

In essence, Koop managed to meet the American expectations of a family doctor. You know your doctor may deliver grim news, and may lecture you about your bad habits, but still you want a doctor who will tell it straight and not mince words, whose only concern is your health. That image, Koop fulfilled on a grand scale.

A bad report card

Another, even more startling reversal took place during Koop's eight years in Washington. As former critics learned to respect his independence and integrity, and the public at large came to revere him as an avuncular folk hero, Koop's original constituency looked on in shock and dismay at what they saw as a betrayal of their cause. Here is Koop's report card as graded by the conservatives:

"Koop has been one of the major disappointments of the Reagan Administration." —National Review "Koop should have kept his lip buttoned."—Phyllis Schlafly "I think the guy's a disgrace. … He sold out the very principles that made him surgeon general." —Michael Schwartz, Free Congress Foundation "If he couldn't act on what he believed to be correct, he should have resigned. He has revealed himself to be a man who prized the public spotlight rather than his conscience." —Howard Phillips, Chairman of Conservative Caucus

Some evangelical Christians, who once lionized Koop, share the sense of dismay. "Long-time supporters of Doctor Koop are bitter and depressed," says commentator Cal Thomas, who grouses, "An atheist would have performed just as effectively for the Left."

Theologian Harold O. J. Brown typifies the concern of evangelicals, It was he who, more than a decade before, had convinced Koop that abortion was always wrong, even in the "hard" cases. In 1975, he and Koop had helped found the Protestant prolife lobby. He openly admires Koop: "Not since William Jennings Bryan has another evangelical Christian of Doctor Koop's degree of clarity, forthrightness, and determination to bring spiritual values into play in public life been appointed to similarly high office."

And yet Brown, too, now wonders aloud whether Koop set back the prolife cause.

Conservatives' complaints center on the major crises: Baby Doe, AIDS, and the effects-of-abortion letter. The Baby Doe controversy came early on (1982-83) and involved two separate instances in which a doctor and family agreed to withhold nourishment from a birth-defective child. No issue was closer to Koop's heart. To him, the deed was infanticide, plain and simple. After Baby Doe died, and the government's stiff regulations to prevent future occurrences were repeatedly overturned in court, Koop met with both sides (the medical establishment vigorously opposed the regulations) and came up with a compromise based on "patient-care review committees" within local hospitals.

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The Embattled Career of Dr. Koop