76

and a students had a lot to learn by just watching what
they did and the way they thought. It's not so popular
any more. And I think that if medicine continues on the
path that it seems to be taking about being a business,
we are heading ourselves into a future that I don't
think we're going to like as well as we liked the past.

Do you remember when Mr. Clinton campaigned,
he was talking about 34 million people who were
uninsured or under-insured. When he was talking about
his health care reform, as president, that had gone up
to 43 million. And it's someplace above that now. I
think there's a day ahead of us when the critical mass
of people who are uninsured will be so heavy that they
can't stand it, nor can we who are insured stand by and
see them deprived. And I think when that day comes,
there will be a real sea change in the way we practice
medicine in this country, and that's when I see us
moving into a single-payer system that we will do ata
time when every other country that's used it has weighed
it in the balances and found it wanting. It's kind of
the wrong time to go. But I think it is almost

inevitable, and it will happen because people say,
V7

"Well, we've tried everything else."

We really haven't tried anything else. Both
the Democrats and the Republicans, ever since
Mr. Clinton's health care plan failed, are afraid to
talk about a big plan. If you look back on the history
Since 1993, there are no big plans that are discussed
about medicine and health, and yet the problems are
bigger than they ever were before. Talk about this
little thing down here, we'll fix that and nobody will
notice it and they won't get mad at us, and then we'll
fix this little thing over here. Well, by the time you
fix the third thing, the first one's broken down again,
and you know, you're going around in a circle.

And I think that there is a way out of our
troubles that nobody has ever tried and nobody talks
about, and that is to have the care of patients managed
in a public/private partnership. I think public/private
partnerships have a great advantage of a private sector
keeping down fraud, waste and abuse, and the public
sector being able, by regulation and legislation, to set
the parameters within which they think medicine ought to

function. But, there's one thing missing. And I think
78

that we could take a page from the book of the
economists and we need, in medicine, what the economists
have in the way of the Federal Reserve Board. And --

INTERVIEWER: Let me just flip the tape over.

(End Tape 2, Side A)

INTERVIEWER: Tape 2, Side 2. The Federal
Reserve Board.

DR. KOOP: I think it's possible to have a
medical board that sits between the government and the
public/private partnership, that takes care of the
health of America. And I am sure that there are enough
men left in medicine who don't have overpowering
financial connections to some clinic or some legal
enterprise, I think there are enough people who are not
seeking personal aggrandizement, I think there are
enough people who are not trying to squeeze the last
dime out of medicine, who would welcome the opportunity
to act in an advisory capacity, just like the Federal
Reserve Board does. It has an understanding of
economics and that's why it can make its decisions.
This board would have an understanding of medicine,

where it's been, where it could go, and can guide its
79

direction that way, and can respond to the things that
happen in medicine that bother people.

I mean, if you talk to the average patient
today, he doesn’t have much to say about what a
wonderful experience he had. It's all the problems he
had. And when I talk to a stranger about my medical
problems, they say, "Wow! If that's happening to you,
what do you think is happening to me?" And it's a
really serious question to ask.

And I think we need that kind of thinking and
not -- it seems to me that we're stymied in sort of a
quagmire of lack of innovative creativity as far as what
medicine could be. If we look at the things that made
medicine great, and we had a board and a private/public
partnership that tried to guarantee that those things
were sacred and sacrosanct, and would never vary for
future generations of patients, I think we could restore
medicine to what it once was.

One of the things that is of greatest concern
to me is that when I was a young man, no matter whether
it was in a Reader's Digest or Vanity Fair or Fortune

magazine, any poll put the medical profession at the
80

very top of everyone's list for respect and awe. Now
we're number 17. And we should have nipped that in the
bud when we got to be number two and three. But it's
pretty hard to come back from 17.

But the pride that an individual has that he
is responsible for the way his profession is accepted, I
think is gone. And when I talk about doing something in
medicine now, with a medical reserve board and
public/private partnership, then I think I could go back
and I would think about the medical student who hasn't
yet become a medical student. But he is up to his neck,
trying to find a way to get in medical school. He wants
this more than anything else in the world, and so he
spends four years in college worrying about that and
preparing himself intellectually to be that. But nobody
in our profession says, "Welcome to the guild. Let me
tell you some of the things you're going to love about
medicine."

We could build into college students who are
heading for medical school a loyalty to the profession,
a disgust with people who abuse the profession, and we

could turn it around to be what it was in the days of
81

our parents, when they really had tremendous respect for
doctors, and doctors in turn respected them. We don't
have that now.

INTERVIEWER: The amount of malaise and
complaint that you hear within the profession today is
quite profound. I mean, for a long time I wrote it off
as disgruntled people getting more press than others,
but the more I travel and talk, the more folks I hear
are unhappy. And I'm sure you hear the same thing.

Is this failed expectations? Is this greed
not being satisfied? Or is this that the ground really
has shifted, and people who went in with reasonable and
noble expectations have been poorly dealt with by the
profession. What do you think is going on?

DR. KOOP: Well, I think the first thing
that's wrong is that a young person that goes into
medicine doesn't feel that the day he steps over the
line and joins the guild, and he has responsibilities to
that profession and to himself and to his patients, and
there's a code of ethics and there's a code of behavior.

Doesn't realize that any more, and that we have to get

back to. I've already covered what I think the
82

governance should be in the way of a medical board and a
public/private partnership.

And then I think we have to work on the
individual and his profession, and you can't get into
medicine very far without doing something about
malpractice. And I mean, the things that have happened
in the practice of medicine, I mean, they should have
been nipped in the bud in the beginning. I mean, how
can a physician do his bet for a patient if, on the
first occasion when he sees that patient, his patient
brings a lawyer with him, to be sure that everything is
done in such a way that they can sue at the right time
if it doesn’t go right.

And there is a way -- I practiced medicine --
actually practiced medicine after all my training was
finished, from 1945 until 1981. And I had all kinds of
problems. I was in a brand-new specialty, and I did
things that nobody ever did before. And I never got
sued. Now, why didn't I get sued? Because I made the
patients' parents allies with me against the problem
their child had, and we fought it out together. But

that takes an effort, and it takes an understanding of
83

what makes people unhappy about their doctors. But it's
a teachable thing. I mean, you can't teach some
virtues, but you can teach the practicality of getting
on the right side of your patient so he doesn't sue you
when things go wrong.

INTERVIEWER: Is the changing demographics --
more women, and the changing environment, where
professions in America perhaps are not what they once
were, that leisure time has become a more important
phenomenon, is that impacting the profession?

DR. KOOP: Yeah, I think it is. When I was
young, we were looking for training jobs, we wanted to
know what their autopsy record is. Now what people want
to know is how many nights you have off. And how much
money you get paid, and so forth and so on. And so
there has been a shift in that. Some of those things
are inevitable over the passage of time and the growth
in the complexity of the profession.

But I think we have to be more frank about our
problems, and we have to address them as problems and
find solutions to them. If some large international

corporation, like Sony, were having relationship
84

problems between the people who worked for Sony and the
people who bought Sony products, they would either have
to fix it or they'd be out of business. And we've got
to take that attitude, and that's why I say you have to
start in college, you even could start in high school.

You know, if you study the guild system in
Britain, didn't matter whether you were a chimney sweep
or a butcher or you were a doorman, you were proud to be
that, and you wore a uniform that showed that you were,
and you knew what was expected of you and you knew what
was a line you didn't step over. We don't raise people
to feel that way any more.

INTERVIEWER: Your theme about business and
medicine, theme since it impacts many of your diagnoses,
is there a way back from this? I mean, once upon a time
there was a belief that medicine was a profession
relatively untainted by business concerns. You didn't
advertise, for instance. You allegedly saw the poor and
charged them what they could pay, or didn’t charge. You
taught for free or little recompense. And those
traditions have largely fallen by the wayside. And

business has roared into medicine.
85

Is there a way back out of that?

DR. KOOP: There's not an easy way, and
there's not a quick way, I don't believe, out of that.
But it's going to take a generation to change it, but I
think that well-meaning in planning that generation and
keeping tabs on the way it works can bring it about.
But you know, the attention span of people is very
short. And to tell the people who are critical of
medicine, "We can change it, but it won't be until this
college student has gotten to the age of 40, when he's
practicing medicine, and he's only 16 now," well, that's
a long time to wait.

But I think if you don't change it, you're
going to lose it all.

INTERVIEWER: I mean, I do see the ground
shifting in ways that it's hard to imagine it shifting
back, not only in medicine but around medicine. I mean,
the first person whose story I tell in "Big Doctoring,"
which you probably heard, I think I read a quote from
him, Eugene McGregor, who practices up here in a little
town -- or Lebanon, "All is life," was sort of the

classic old-model GP, and he referred to younger doctors
86

who came and had practice and moved, as “gypsy doctors."

"We were gypsy doctors in my day." Of course, he
practiced in one place for 40 years. But it's kind of a
gypsy society, at least compared to the rather more
staid society. And I find it hard to envision, I mean,
the values that you describe make a lot of sense to me,
appeal to me, but I don't see how teachable that is, I
guess is the question I'm asking. I mean, you can teach
a higher level of awareness, but the society is a
different society.

DR. KOOP: Well, you can't teach a society not
to be mobile. But you can teach a doctor, who is taking
care of a member of that mobile society, how to approach
the patient on a new arrangement. Guy used to live in
Des Moines, Iowa, his business changed and how he lives
in Brooklyn, New York, and the culture is different and
the climate's different and the pay is different and
everything is different, but here's a doctor who still
feels the same way toward him. I think that's doable.

INTERVIEWER: And I must say, I see in young
people in medicine, and clinically I work with medical

students and pediatric residents, there is an awful lot
87

of idealism in those folks, to be cultivated, cultured,
nurtured. I mean, that's, to me, the most sustaining
thing, the people who go into it are good people.

DR. KOOP: You're absolutely right. The thing
that impresses me most about medical students today is
that you never hear them talk, as you used to hear them
talk, about the accumulation of wealth. They are not
ashamed to say, "I'm going back to Bridgeport to
practice because that's where I was born and that's
where they need me."

And the thing that proves to me that they mean
what they say is that the average student that comes to
this medical school has had two years minimum between
the time he left college and the time he went to medical
school. And in that period of time, he has almost
always spent that time doing some beneficial service to
society. And it's because he wanted to, not because he
wanted it on his resume so it would get him into medical
school.

INTERVIEWER: Tell me more about your view now
of specialism and generalism. We talked about

specialism in surgery. And I know the Koop Institute
88

has been a pusher of primary care ideas over time. How
have you seen that play out, and where do you see it
going in medicine, in the division of labor.

DR. KOOP: Well, when I came to Dartmouth,

29 percent of medical practitioners were in primary
care. And that got up almost to 45 or something --

INTERVIEWER: When you came to Dartmouth this
time around?

DR. KOOP: Yeah. When I was 72.

INTERVIEWER: That would have been '94? '5?

DR. KOOP: I'm 87 now, you can figure it out.

INTERVIEWER: Well, when you left --

DR. KOOP: It was two years after I left the
government, which was in '89,

INTERVIEWER: So 29 percent then. And as high
as 49?

DR. KOOP: Got as high as about 45 percent in
some parts of the country, and now it's drifting back
again because the same things that led people away from
primary care are at work in the whole business of
medicine. The pay isn't as good, hours are worse, the

leisure time doesn't exist, and there is still, on the
89

part of specialists, an unreasonable failure to
understand the real contribution of the primary care
doctor, who has to know a little bit about such a huge
amount of stuff. And there's nothing that makes me
madder than to see a professor of medicine humiliate a
medical student on grand rounds, because he says, "What
do you expect to do with your life?"

He says, "I'm going to join my father in the
family practice."

It's as though he committed a sin and went
into prostitution.

INTERVIEWER: That does happen.

DR. KOOP: Yeah. And, you know, I am
surprised at the way it's happened. I'm surprised that
-- I'm not surprised at the change in gender. I think
women are kinder, gentler people, and I think they're
good for medicine. And I think there's no reason why
they can't do specialties that people used to think were
only for men. Surgery, for one. A lot of very good
female surgeons around.

But I do see the pull in every way --

economics, leisure time, prestige, importance, self-
90

esteem -- that goes with specialization, as compared to
primary care. And the primary care doctor has to have
his feet on the ground. He has to know himself well
enough to know that he's making a contribution that a
specialist can never make to medicine. And he has to
know that that's what brings him satisfaction and not
envy.

INTERVIEWER: One scenario for the future is
that medicine will become increasingly the domain of
specialism. And that nurses and others will inhabit the
realm of primary care as, to some extent, they've done
already. Is that a plausible outcome or a plausible
possibility? And if so, would that be good or bad?

DR. KOOP: Well, with the caveat that all
people aren't the same, I think that it makes good sense
to share the burden of primary care with people who can
handle certain things, but I think it is a mistake to
say that because a nurse has taken two years of training
to be a nurse-practitioner, that that makes her
equivalent to a primary care doctor. And I think that
is a tendency that you hear criticized by primary care

physicians, and it's a tendency that nurse-practitioners
91

aid and abet by believing it.

INTERVIEWER: My concern is that if medicine
does not take a firm stand for primary care, beyond the
rhetoric -- that is, structuring payment so there's some
pay equity, structuring values so that primary care is
valued and supported in terms of research, in terms of
training, we will have a profession that, because of the
inevitable lure of technology and money, will become
largely balkanized into specialties, with no base.

DR. KOOP: Right.

INTERVIEWER: And I think the nurses and
others will -- because primary care is necessary.
Society says it needs it. Others will migrate in and
populate it, but medicine will essentially have become
a domain of specialists, which to me would be a great
loss. But I think is a possible outcome. I mean,
that's the doomsday outcome, from my perspective. Hope
not.

DR. KOOP: No, I've spent a lot of my time in
the U.K., watching that system work, and there isn't
the same split that there is -- they have more primary

care doctors. And they have fewer specialists. They
92

should go together, but they don't always. And I think
that the differences in income are not as exaggerated as
they are in this country.

And one of the things, while we're on that
subject, might be settled by having the federal medical
board that I was talking about a bit ago, but what's
disturbing to me is that the knowledge that a primary
care physician has is not appreciated and is not
compensated, but if he has a gadget that he can use ona
patient, he does a technical procedure, and he suddenly
can become a quote, "specialist," by buying the gadget.

And I think that there are some other things
in medicine that we have talked about that are affecting
the future. One of them is something that nobody talks
about much -- I do, all the time -- and that is the
great advances in medicine and surgery have made a lot
of acute diseases chronic. We can't afford that. We
can't afford it as a society, and we can't afford it
financially.

One of the other things that bothers me is if
you were to ask the question to a totally honest

audience, unable to give you a false answer, why has it
93

taken us so long to do some of the things that we do?
For example, as the treatment of the cancer program
becomes such big business that there are forces at work
that don't want to see cancer moved toward cure because
that would change the balance of economic power. Very
difficult questions to ask, and even more difficult
questions to answer.

INTERVIEWER: I mean, I've heard those charges
often from what I'll call the "Rodale Community." I
mean, the kind of health food fringe.

DR. KOOP: Oh, yes.

INTERVIEWER: That -- cancer, but
about other -- about disease in general. Do you think
there's credibility at all that there are physicians or
clinicians or clinical specialties that don't want to
see progress because it would be bad for business?

DR. KOOP: I think the more that our
profession becomes a business, the more you'll see that
sort of thing.

There was a certain purity that
professionalism delivered to medicine, and when it is

contaminated by greed. . . . The average guy that went
94

into medicine, even now, he does it for entirely
different reasons than the average guy that goes into
business. Has to make money, to be sure. But that's
not the end-all and be-all. And that is one of the
things that I most enthusiastic about in the future, is
that the medical student of today seems to have lost
that greedy outlook for the future that his predecessors
had 25 years ago.

INTERVIEWER: Speaking of idealism, global
health. Where do you see the role for the United States
in global health? Where have we been? Where are we
going? Is it something we have done well with or not?

DR. KOOP: Well, global anything is kind of
frightening.

When you treat a problem globally -- let me
start it a different way.

The only thing that I am absolutely certain
that we have globalized is the spread of disease. We
have really done that very well.

INTERVIEWER: "We," United States, or --

DR. KOOP: We, all of us, because of

transportation, communication, and reliance on quick
95

treatments, quick fixes, rather than prevention. So
that that's a fact of life, I think, today. And if we
have globalized disease, we certainly have the
obligation to globalize health.

And it seems to me that there was always a
huge barrier to the globalization of health, and that
was it would take so long and so much money to build the
infrastructure in, say, a developing country, that you
might lose sight of your goals before you ever achieved
them. But two things have happened that have changed
that.

One is the invention of the cell phone, and
the other is the Internet.

And with the Internet and the cell phone, you
don't have to build that infrastructure any more
Because instead of having to go through all the stuff
that's down here that used to be called infrastructure,
now you can go from here to here, and here to there.
And therefore I have real hope for globalization, if it
doesn’t destroy the little man in the process. What I
mean by that is, if you globalize everything, then

you're going to have Wal-Marts and K-Marts instead of
96

individual shopkeepers. And I don't know how you're
going to manage the economic side of the change to
globalization if you deprive people of their livelihood.

So I think that that's something that has to be an
economic arm that has to be discussed whenever any of
these things are talked about that are global.

I think that one of the things that I always
wanted to do when I was Surgeon General, was to have an
international health corps, the way we had a national
health corps, because I didn't mean to have people
leaving these shores and going and doing hands-on care
in underdeveloped countries, but I saw a corps of
capable trained people transmitting the know-how to
other people, so that they could do it on their own.
And I think that's the real challenge of globalization
of health care, is that you don't just import the
treatment but you import the understanding so that they
can develop their own system.

And I think that's all the more important when
you try to recognize the cultural differences that we
have -- we have them in this country and we don't

them. It's a totally different cultural
97

challenge to talk against smoking in Utah and
California, than it is in Kentucky or Virginia. Totally
different. We have the same people, we speak the same
language, but it's totally different. It's increased in
complexity when you're talking about a sub-Saharan
African country and something that's attached to India.
And that is going to be the hardest thing, I think, to
learn because you can't treat different cultures with
the same, as I said, the accoutrements of medicine. It
takes more than just the pill.

INTERVIEWER: Any likelihood of an
international health corps, or -- one more question.
Outside of the missionary community, it's argued, and
perhaps outside of the CDC with some of its targeted
efforts, we haven't done a lot to promote, certainly at
a government level, large numbers of teachers,
clinicians, going abroad. Any prospects that we'll be
doing that?

DR. KOOP: I think there are theoretical
reasons why it should work now better than any time that
I've been alive, because you have more disgruntled

physicians leaving medicine because of the things we've
98

been talking about, than ever before.

INTERVIEWER: Who might be recruitable?

DR. KOOP: They're recruitable. And you know,
the thing that I have seen, you take somebody who's
never been off on an altruistic mission to help somebody
in another country, the first time he does it it's like
a new world to him. He just can't believe how great it
is. And they go back.

(Interruption)

If you think about how the Peace Corps came
about, that didn't take a lot. It took one man talking
about it, it took another man writing about it --
Kennedy, Sargeant Shriver, and it took a lot of people
who, once they went, they became the advertisers. And I
think there's so much to be learned, so much to bring
satisfaction with some kind of a thing like an
international health service corps, that it would be
worth some major foundation really attempting to try it.

INTERVIEWER: Yeah. Switching gears. I want
to get at least something on the record about the
National Health Museum. I know it's something you've

been involved with for a number of years, been one of
99

the leaders and thinkers about it. What would the role
of a National Health Museum be in American life?

DR. KOOP: Well, what a National Health Museum
should not be is just a curio shop. There is a real
place in education to have some illustrations from the
past about how things were successfully or
unsuccessfully managed, but the challenge of a so-called
museum today is that it becomes a health education
center primarily to inspire the new generation about
what is possible to be accomplished.

My reason in the beginning for being
interested in a museum in Washington that had to do with
health, was that I used to stand in my office up on the
top floor of the Humphrey Building and see all these
kids standing by one of the reflecting pools, getting
their pictures taken, when they came on their senior
trip to Washington, and I kept thinking about the
wonderful opportunities that they had, and then it
occurred to me that they could be stimulated to be
almost anything in the world by what they saw in
Washington, except something in medicine and health.

Because there's no place to see it.
100

And I think that still should be the major
educational effort to get young people to commit early
to a life of health and medicine and science that leads
to the betterment of the human condition, but there are
so many things that you can tack on to that to make it
interesting, that I think it's a great idea.

INTERVIEWER: Good. The Bushes. We talked a
little bit about George Herbert Walker and a kind of
transition, but you've seen the Bushes as presidents and
worked to some extent with them and their people. Any
thoughts about either or both, and their health
policies?

DR. KOOP: I don't think -- as far as I know,
there's only one person in health that has the ear of
the president. I don't think one person is enough.

INTERVIEWER: This being the current
president? George W.

DR. KOOP: Yeah. And that person is Tony
Boucher(?). And great respect for Tony Boucher in many
ways, but I think one person can't do it.

The thing that I see different about this

administration from the other three that I was
101

associated with is that it is hard to get an answer toa
health question in the White House. And I don't think
that this administration really thinks it needs any
guidance in the health field. And I think that that's
wrong, because nobody can guide in health except
somebody who is trained in health.

And off the record, this is a pretty hard
group to infiltrate. Just twixt thee and me, I sat with
Barbara Bush for eight hours one day, and I filled her
in on a lot of things that I wanted her son to know.

And I said, "I've met him socially and I've met him when
he was governor, but I would like to talk to him about
his presidency because, one, I know where there are a
lot of minefields that he shouldn't step on, but also I
know that there are opportunities for him to make an
absolutely lasting contribution to the health of this
nation. And I'd like to be able to talk to him about
it."

She wrote it all down and she said, "Chick, I
will see that he gets this the first time I see him."

And I know Barbara well enough to know that

she did, but I never have been to see him.
102

And I think the war on terrorism has taken a
lot of attention, but I think if there weren't a war on
terrorism, it would still be about the same because I
don’t think they have the capacity to understand what we
need to do.

INTERVIEWER: Being a senior statesman is a
role you played well. Personally and business-wise, I
know it's been a tough role. Dr. Koop dot com, in
particular. If you were coming out of the surgeon
generalship into your senior statesman role on the
personal side, would you -- business side, would you
have done it differently?

DR. KOOP: With the hindsight I have --

INTERVIEWER: Time Life Books, too, I guess.

DR. KOOP: Something that is not known by the
public and I don’t mind if they do know it, I think the
Time Life venture is one of the best things I ever did,
and I think that what remains and hasn't become
antiquated by the passage of time is still state-of-the-
art.

The reason that that company went bankrupt had

nothing to do with that company. It had to do with the
103

fact that my plans were a threat to the tobacco
industry, and they went to Time Life, Time-Warner, and
said if I were permitted to go the direction I was
going, that they would cease to advertise in People,
Time, Life, Sports Illustrated. We were in business at
4:00 o'clock, and bankrupt at 4:20.

So that was an engineered thing by the greed
of tobacco companies. I think I got caught up in
something that a lot smarter businessmen than I got
caught up in, and that is the dot.com craze --

INTERVIEWER: Yes, on that, the Time Life
Books, which was supporting the videotapes and the --
what was the whole enterprise called?

DR. KOOP: Well, we called it Time Life, Inc.,
and we had the privilege to do that as a franchise.

INTERVIEWER: Right, but the health
information video program, did it have a --

DR. KOOP: Yeah, well, that was called --

INTERVIEWER: Did it have your name on it?

DR. KOOP: No, it didn't have my name on it.
No. Media Information --

INTERVIEWER: There was a program of
104

informational materials, videotapes in particular --

DR. KOOP: There were 34 videotapes. That was
Time --

INTERVIEWER: State-of-the-art commentaries on
different diseases for the layman.

DR. KOOP: Right.

INTERVIEWER: And the legs were cut out from
under it financially because the company went bankrupt?

DR. KOOP: They refused -- Time and Life took
their franchise away from us because they were
threatened with no advertising by tobacco industry.

INTERVIEWER: Is that something you're willing
to -- if I include that in the new --

DR. KOOP: I've said it publicly before.

INTERVIEWER: Okay, good. And drkoop.com.?

DR. KOOP: drkoop.com, we -- you know, the
first year we got every prize that you could get in the
world of the Internet for what we did with that thing.
We really kept the data up-to-date, so forth and so on.
But competition was just too tough. There were too
many people in the business, and I don’t want to say

this, but I'll tell you, one of our competitors was
105

Med -

INTERVIEWER: MedScape? Web, M.D.?

DR. KOOP: Web, M.D. And you know how they're
financed? Any time they need any money, they just call
Bill Gates and he gives it to them. Can't fight that.
And Web, M.D., has not been for the benefit of the
public since that time. It's for the benefit of the
doctors saving money by having electronic ways of
handling their business.

(Recording interruption)

INTERVIEWER: We were talking of drkoop.com.
Anything else -- I mean, I know it was an awful episode
for you, to sort of take the thing public and have as
much attention to it, and then have it fail.

DR. KOOP: Yeah.

INTERVIEWER: Is that --

DR. KOOP: It was a very disappointing thing,
and fortunately I had lots of other interests, and so it
-- I seldom think about it now. I'm not sure that if I
did it again and that I could weather the storm any
better. Because it was just -- just thousands of health

Sites failed.
106

INTERVIEWER: Yeah. I mean, certainly, with
your interest in communication and the explosion of the
Internet, the two seemed destined to work together, and
that they came together and then it didn't work is just
-- I mean, a disappointment to you, a disappointment to
me.

HIV and the world. A problem. You were there
when it started. Where do you see it today?

DR. KOOP: Oh, HIV and the world is a
disaster. There are countries with 38 to 40 percent HIV
positivity, in sub-Saharan Africa. The people that I
talk to who know what's going on in China say that the
future there is grim, because there has been such a
population shift from central China to coastal China,
which is where the business opportunities are today,
that by being introduced in coastal China also
introduces a naive population to the sexually oriented
population, and there is very little understanding about
the transmission of the disease by these country folks
who come in to town. And so public health people in
China are looking forward to a disaster they don't know

how to handle.
107

I think that the obligation of the United
States in all global health problems is to share our
knowledge and to share our know-how and, where possible,
to put in seed money, and I think that the fact that
Mr. Bush has included that in his plans is very good. I
think it's a good sign that some of the pharmaceutical
houses have changed their pricing structure for places
like Africa. But when a country like South Africa still
refuses to believe that HIV is the cause of AIDS, we
have a very serious problem.

And we do know, by the way Uganda has changed
its educational program and has changed its culture, to
some degree, that AIDS is not an insurmountable problem
even in a culture like that. So I think that it needs
organization, there ought to be some kind of African-
Asian consortium that worries about this.

Compared to the United States, the rest of the
world is in terrible shape. The United States, because
it's an affluent country and because we know about
giving AZT to pregnant women and because we know about
fancy therapeutic cocktails, it's possible now to be

diagnosed with AIDS and to live out your life expectancy
108

and die of something else. But that's at the cost of
$20,000.00 a year per person.

INTERVIEWER: A final question. As you look
back on your career, thoughts about it?

DR. KOOP: I've had a very, very interesting
life, and I really feel that I was born at a good time,
because I lived through what I think is the golden age
of surgery, tremendous technical advances, but in the
midst of it was very much a part of the development of
pediatric surgery, which was a special privilege.

My time as Surgeon General was one of the
happiest and I think most productive times of my life.
And the fact that I'm 87 and still active and still
lecturing and still teaching here, is -- it's enough to
raise your eyebrows.

(Laughter)

INTERVIEWER: That's a good place to end.

DR. KOOP: Good.

(End of proceedings as recorded.)