Chapter 25, Part 1

By Frank Tursi, Susan E. White and Steve McQuilkin
JOURNAL REPORTERS
© 1999 Winston-Salem Journal

The reporters who attended the press conference that day in February 1982 for the release of the annual surgeon general's report on smoking and health didn't expect Dr. C. Everett Koop to have much to say on the subject. The issue had largely faded into the background of Washington politics.

Since Congress banned cigarette ads from the public airwaves in 1970, the only government agency to bestir itself against a potential public-health threat was the tiny National Cancer Institute, which had embarked on a $32 million, 10-year quest for a ''safer'' cigarette. The effort accomplished little before ending in 1979. ''The '70s is a wasteland in terms of changes in public attitudes, changes in public policy, emphasis, allocation of resources or reining in behavior of the tobacco industry,'' said Matthew L. Myers, an anti-smoking activist who worked briefly for the Federal Trade Commission in the early 1980s.

The R.J. Reynolds Tobacco Co. was once the largest cigarette company in the United States with a powerhouse of best-selling brands: Winston, Salem and Camel. But times changed, and as the case against smoking became more pronounced in the 1960s, RJR failed to adapt to the marketplace. Its rivals would eventually rush past it, and RJR's efforts to catch up would have a profound impact on the company and the cigarette industry.

After President Reagan's landslide victory in 1980, no one expected the federal government to take a sudden interest in weaning America from its cigarette habit.

With Reagan's election, the gospel of laissez faire became the national creed. The free-market system, Reagan had assured business leaders during the campaign, would be just that under his administration. There wouldn't be any government bureaucrats gumming up the works.

True to his word, Reagan began dismantling government watchdog agencies soon after taking up residence in the White House in 1981. Within a few years, the staff of the FTC, the protector of consumers that had historically taken the lead in recommending restrictions on cigarette ads, was cut by a third. James C. Miller III, the agency's new chairman, said he didn't have time to read his staff's report on cigarette advertising. The 1981 report, required by Congress, called for tougher, rotating warnings on cigarette packs and ads. ''If people want to smoke,'' Miller said, ''that's their business.'' (Kluger footnote; Miller quote.)

During his first year in office, Reagan also took a knife to the U.S. Public Health Service, which was responsible for turning out the surgeon general's reports. More than 1,600 doctors and public-health workers, nearly a quarter of the staff, were let go and almost all of the service's hospitals were closed.

Given this climate, the reporters at the press conference didn't arrive armed with probing questions about smoking.

They were more interested in taking the measure of Koop, the first fulltime surgeon general in 10 years. He was making his first public appearance after a grueling nine-month confirmation. Based on his medical credentials and reputation, Koop should have had an easy time in the Senate.

Named surgeon-in-chief at Children's Hospital in Philadelphia in 1948, at the age of 32, Koop would be the first surgeon general who was actually a surgeon. He had pioneered surgical techniques and diagnostic procedures that significantly lowered the mortality rates for newborns undergoing surgeries. Koop, though, was pilloried by liberal senators for his stance against abortion, which made him the darling of the religious and political right. Sen. Jesse Helms of North Carolina was Koop's main defender in the Senate.

Donald Shopland may have been the first to realize that his new boss wasn't going to ease into the harness with the other Reagan appointees. Since serving as a clerk for the committee that wrote the first surgeon general's report in 1964, the self-taught Shopland had become a walking encyclopedia on the subject of smoking and health. He had gotten so caught up in his work for the committee that he stayed on at the National Library of Medicine as the keeper of the library's archives on the subject. Though he lacked a college education, he became the main technical expert at the Clearinghouse on Smoking and Health, an agency in the Public Health Service that by the time of Koop's arrival had been renamed the Office of Smoking and Health and had the sole mission of turning out the surgeon general's reports. Shopland and Dr. David Burns, a brilliant Harvard-trained pulmonologist, were the reports' authors.

The 1982 report -- the first on Koop's watch -- dealt only with smoking and cancer. It noted that 30 percent of all cancer deaths in the United States -- 110,000 a year -- were attributable to smoking. The final manuscript reached Koop's desk a few months after his confirmation.

Shopland was astonished a few days later when he picked up the manuscript and found it dog-eared and peppered with questions that Koop wanted answered before the press conference. ''He had read that thing cover to cover,'' Shopland recalled. ''If you ever saw a press conference where someone really knew their s---, that was the press conference.''

Koop, the first surgeon general to wear a uniform in public, cut an imposing figure as he stood before the gathered reporters in military dress blues with a splash of gold braid. Broad-shouldered and stocky, Koop, 64, had a square face that looked as if it had been chiseled from weathered rock. His short-cropped gray beard gave him the dour countenance of a taciturn grandfather whom no one dare provoke. A cigar smoker for 10 years, Koop would later note that he harbored no ill will against the tobacco companies until he became surgeon general and learned of ''the incontrovertible truths about the health hazards of smoking.'' It was, he told the reporters, ''the most important public-health issue of our time.'' He brushed off their questions on abortion and his confirmation hearings and hammered away at cigarettes, which, he said, were ''the chief, single avoidable cause of death in our society.'' (Koop footnote; Koop's thoughts about his change of heart concerning smoking.)

Much to the astonishment of politicians on either end of the political spectrum, Koop would become the Reagan administration's lone voice on the perils of smoking. As surgeon general, he was merely the figurehead leader of the Public Health Service. His only power was that of persuasion, but he used his bully pulpit to capture America's attention. During his seven years on the job, Koop would collectively brand the country's tobacco companies as ''a sleazy outfit'' that deserved the public's scorn. He openly mocked the industry's position that nothing had been proven about the health hazards of smoking. Each time he turned on a light, Koop was fond of saying at his many public appearances, he knew he set in motion a whole bunch of electrons. ''But I can't prove it,'' he said.

Along with the 1982 surgeon general's report, two others that bore Koop's signature took the medical case against smoking beyond serious scientific quarrel. The 1983 report was devoted entirely to heart disease. It asserted that heavy smokers were two or three times more likely to die of cardiac complications than nonsmokers. The surgeon general's report the following year concluded that smoking was the ''major cause'' of obstructive lung disease and that almost all smokers had some degree of emphysema.

That was enough for Koop. He declared war on the tobacco industry in May 1984 when he gave the keynote speech at the American Lung Association's annual meeting. ''We're not abandoning them,'' Koop said of the 53 million American smokers, ''whether they appreciate it or not.'' No amount of personal crusading, he said, would convince them to stop smoking. That, he declared, had to be ''the triumph primarily of private citizens and the private sector.''

The speech infuriated Ed Horrigan, the chairman and chief executive of R.J. Reynolds Tobacco Co.

In a letter to President Reagan two months later, Horrigan expressed his dismay at Koop's ''shrill preachments . . . and his call for a second Prohibition.'' To Horrigan, it all amounted to ''the most radical anti-tobacco posturing since the days of Joseph Califano (President Carter's secretary of Health, Education and Welfare).'' (Kluger footnote; Horrigan's letter.)

Guy L. Smith IV, then Philip Morris' vice president for corporate affairs, grudgingly acknowledged Koop's ability to masterfully manipulate the media. ''He was single-handedly responsible for reinvigorating the anti-smoking movement,'' Smith said. (Kluger footnote; Smith quote.)

• Coming Wednesday: Tobacco's No. 1 Enemy