Koop stresses need to bolster public health
"We need a new television show called 'CDC,'" said Dr. C. Everett Koop. "And I'm only half joking."
In a time when SARS cases continue to emerge across the globe, the 86-year-old former Surgeon General expressed a hope that the glamorization of preventative medicine would lead to an increase in applications for study in the public health field.
Koop also stressed the importance of national preparedness against chronic illnesses and biological terrorism in a talk to students at the Dartmouth Medical School yesterday.
He held the medical students captive for a mere 61 minutes -- in which he proudly covered 171 topics, mentioned 19 diagnoses, 10 treatments and an additional 17 facts.
Koop compared the need to increase both knowledge of preventive health measures and the role of public health workers to the way that anti-terrorist efforts have been improved after Sept. 11, 2001.
"There really is no infrastructure to cope with a smallpox attack if it comes in the form of a bio-terrorist attack," he said, advising that Congress adequately fund the Center for Disease Control and urge more people to enter the public health sector.
"If one of you can find a way to make the prevention of disease more glamorous -- as glamorous as the transplant of a baboon heart or a Teflon knee -- I will guarantee you the Nobel Prize," Koop said.
Koop, who left the field of pediatric surgery, in which he was a pioneer, to enter the sector of public health as the Surgeon General, said that public health and preventive medicine have saved more lives than medical procedures on individuals.
He spoke at length on the globalization of disease and the necessity of being prepared for any and all illnesses to afflict Americans.
"Disease has always disregarded geographic borders," Koop said, cautioning his attentive listeners that, "There is no disease anywhere on this planet that is someone else's problem exclusively."
Koop brought up both the positive impacts of genetic testing as a preventive measure and the logistical, ethical and economic problems that accompany it.
The role of primary care physicians would be changed, as the task of determining what to test patients for would fall to them. The financing of such tests would require changes in the way health care costs are covered, as a substantial number of Americans are either uninsured or underinsured under the current system. The ethical questions raised by genetic testing that Koop mentioned included the impact of test results on jobs, insurance policies and family life.
"This sounds like the stuff of a novel by George Orwell or Franz Kafka, but it's in our immediate future," he said.
Chronic illnesses that would be tested for have increased among the American population because modern medicine has become so effective at saving people from fatal disease.
Throughout history, Koop said, most deaths occurred from involuntary causes such as infectious diseases, wars, industrial accidents and malnutrition. Today, most deaths in the United States are the result of lifestyle choices such as smoking, unhealthy diet, lack of proper exercise and abuse of alcohol, he said. He cited statistics that over 400,000 people die each year from tobacco use -- the most common cause of death in the country. The second and third highest causes were obesity, killing 300,000 a year, and alcoholism, from which over 200,000 people die per year.
Although preventive measures such as early testing for cancers, healthy eating and exercise habits and not smoking have proven effective in increasing life span and improving the quality of life, Koop said that there is resistance to government intervention and the imposition of laws against unhealthy habits such as smoking.
"Now we must cope with the fact that prevention is seen as un-American," he said.