The altercation began when Koop opened the discussion for questions, and an older audience member, who spoke when no students volunteered, recited text from Koop's report on fluoride water and accused Koop of disregarding issues regarding treated water. The audience member became infuriated when Koop refused to respond to his questions and approached Koop to forcefully press a copy of the report into his fists.
"You're just in the wrong arena, sir. This conversation is for the students," Koop said.
The audience member returned to his seat.
"For ten years, he hasn't answered my question," he said.
The discussion continued without incident, as student questions delved into childhood obesity, HIV/AIDS and polio, focusing specifically on government policy regarding the issues.
When discussing childhood obesity, Koop was hesitant to place the blame for America's obese children on foods that are advertised to them, but cited school lunches as a major concern.
"If you look at what we know and what we give them, you'd all think that we're schizophrenic," Koop said.
Referring to a study that predicted obesity would soon exceed smoking as the top preventable cause of death, Koop said he views the two threats very differently.
"The thing that makes them different is the addictive quality of nicotine," Koop said. "[Eating is] not a true addiction and therefore treatable."
Surgery to correct obesity is helpful only in extreme cases, Koop said, criticizing patients who see it as a quick, easy solution.
"Someone will go into the hospital for a hernia and ask the doctor if he can do a tummy tuck too," Koop said. "It could be a death sentence when he says that he will do it." Koop cited high rates of infection following these types of surgeries.
Addressing audience concerns about a lack of government action to eradicate polio, Koop said the disease was currently one of many medical concerns.
"It's a good adage to remember to put your money where your biggest problems are, but we have so many big problems," he said, adding that he views the HIV/AIDS epidemic as a larger problem.
Koop criticized current relief efforts as an inefficient allocation of resources, including U.S. President George Bush's recent $15 billion grant for AIDS and tuberculosis prevention in Africa. The efforts are wasteful because the administration does not consult medical professionals, Koop said.
"Bill Gates has given money to medical causes that bother him, but does he really know what the best move to make is?" Koop said. He indirectly advised both Gates and Bush to seek advice from a council of physicians before committing financial resources to relief efforts.
In his position as Surgeon General from 1982 through 1989, Koop drew heavily on his experience as a physician and medical professor, he said. He had not previously considered working on the policy side of medicine, he said, but was offered the job during former U.S. President Ronald Reagan's administration.
"Most people use the Washington experience to rocket them into another position. When I got to Washington, the first thing I found out was that I was two years too old for the job, which was pretty funny because Reagan was even older than me," Koop said.
Koop, who was 65 years old when he took the job, is now 91.
He returned to teaching medicine after serving in Washington and received a position at DMS in 1992.
