In short, Koop used the time to dream about what difference a surgeon general could make. And his very notoriety ensured that after his installation everything he said or wrote attracted a swarm of media attention. His detractors, who meant to do him harm, paradoxically helped deliver to him the platform he would need to accomplish his goals.
But Koop soon found that he had the rank of three-star admiral but no ship to command. He set to work to change that. The office of surgeon general, vaguely defined to begin with, had been sorely neglected (President Nixon never even got around to appointing one).
Koop had little decision-making power, no budget authority, and a minuscule staff to carry out his will. Reagan's budget cuts had just closed hospitals and slashed 2,600 Public Health Service jobs, and PHS's Commissioned Corps morale was at an all-time low.
In an attempt to bolster that morale, Koop urged the corps to wear the uniform that had long since fallen out of vogue. He set a personal example, dressing in a starched uniform bedecked with bars, epaulets, ribbons, and gold braid. The practice took a while to catch on. More than once airplane passengers mistook Koop for a steward and asked for help with their luggage. And the Washington press, most notably political cartoonists, now had a visual focus for their derision. Who was this strange M.D. with a Captain Ahab beard and a cruise-ship uniform, this man who in a city of designer briefcases carried a canvas tote bag?
Yet the very distinctiveness of Koop's style kept the media's attention. At 6'1", 210 pounds, he made an imposing uniformed figure, and as he began delivering pronouncements on the nation's health in his strong Brooklyn voice, fascination soon replaced derision. As one reporter put it, "On television, the steely beard and gold shoulder boards of the PHS uniform project a stern Dutch uncle inveighing against the evils of indulgence."
But in person, those same reporters came away impressed with the cordiality and openness of the new surgeon general. Before long, he was the hottest interview in town. Magazines put his stern visage on their covers, Johnny Carson wrote him into monologues, Elizabeth Taylor blew him on-air kisses, and "The Golden Girls" proposed a cameo appearance.
"Where there's Koop, there's controversy," became a Washington slogan. He lashed out against drunk drivers, convened task forces on child abuse and spouse abuse, criticized American eating habits. And then there were the Big Three controversies of his term: the Baby Doe case, the AIDS report, and the effects-of-abortion letter. Koop became even bigger news.
Koop's employers didn't know what to think, especially when he broke ranks to challenge their policies. For example, Ronald Reagan had promised southern senators such as Jesse Helms that he would not use his administration as a bully pulpit against smoking.
But here was Reagan's surgeon general calling the tobacco lobbyists "sleazy" and "flat-footed liars," and accusing them of exporting death to the Third World. The administration was embarrassed; North Carolina's Jesse Helms, once Koop's strongest supporter, was appalled.