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But those conservatives who had stood by Koop during the Baby Doe and AIDS controversies were rocked yet again in early 1989 when the press reported on a letter from Koop to President Reagan regarding abortion. The previous fall, one of Reagan's prolife advisers had convinced him that the surgeon general should research the health effects of abortion on women. "The findings would be so devastating," he predicted, "that they would reverse Roe v. Wade."

Prochoice activists, knowing Koop's views on abortion, braced for the worst. But in January of 1989, Koop submitted his findings to the President in a letter that concluded, "I regret, Mr. President, in spite of a diligent review on the part of many in the PHS and in the private sector, the scientific studies do not provide conclusive data about the health effects of abortion on women." Instantly, leaders of the prochoice movement trumpeted the message, slightly distorted, "Koop says abortion does not harm women."

"Koop's Stand on Abortion's Effect Surprises Friends and Foes Alike," read a New York Times headline the next day, a headline that could win a Pulitzer Prize for understatement. For some evangelicals, Koop's letter was the last straw, for it appeared that Koop had abandoned the very principles that had gotten him nominated. The controversy left a permanent stain on Koop's career, and may have contributed to his retirement from public service.

Koop himself feels personally betrayed over the issue. He had reviewed 255 reports on the health effects of abortion. Some "proved" abortion was harmful, some "proved" it was harmless. Taken together, they all seemed flawed methodologically. Although Koop had much anecdotal evidence of the harmful psychological effects of abortion, he had no rigorous scientific data to back it up. His letter to the President recommended such a study—it would take five years and cost one hundred million dollars, he later estimated, and would very likely prove what the President wanted proved—but for the present he had to acknowledge insufficient statistical data.

Koop delivered his letter in person to the White House, extracting a promise that no one would disclose its contents until the President had a chance to respond. But when Koop reached his home a short time later, his wife met him in the driveway in a panic. She had just heard Peter Jennings, Tom Brokaw, and Dan Rather quoting from the "confidential" letter. Moreover, they were reporting flatly that "the surgeon general could find no evidence that abortion is psychologically harmful."

Koop stayed on the phone until one in the morning trying to clarify his position, and appeared the next morning on "Good Morning, America" to correct wrong impressions. But the damage had been done. Prochoice activists continued to misquote his findings; prolifers still felt double-crossed.

The next few months in office were unpleasant ones for Koop. A new administration took office, naming someone else as head of Health and Human Services, a cabinet position Koop had wanted. No one asked him to leave, but they didn't offer to reappoint him as surgeon general, either. And through a series of petty tactics, Koop was made to feel unwelcome. He was denied access to the executive dining room. He was not invited to a departmental retreat for senior executives. His top aide was let go. White House staff no longer returned his phone calls.

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