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'Going Commercial' to Spread a Gospel of Health / Scientist at Work / C. Everett Koop ANOVER, N.H. - February 2, 1999 - Crammed into a small back room at the Koop Institute here are 13 computer screens, their processing units, a fish tank and a group of Dartmouth College students angry about what they see as the tobacco industry's efforts to hook children on smoking. Applying the advanced computer skills of the present-day undergraduate, they are piecing together the slick digitized images of Smoking Joe Moose, an evil character who is trying to take over the world with the most addictive cigarette ever known. The students are producing an animated action film, a James Bond parody for children, called, "Tobacco Never Dies?" In a role as a behind-the-scenes foil to the moose is a character who bears a striking resemblance to the former Surgeon General, Dr. C. Everett Koop, the founder of the institute, who raised the money to support it and operates it in alliance with the Dartmouth Medical School. Dr. Koop works with help from an army of student and faculty protégés and other professionals and volunteers from the worlds of health, science and education. As Surgeon General during the Reagan Administration from 1981 to 1989, Dr. Koop was known as America's Doctor -- and it is clear from interest in his new Web site <http://www.drkoop.com> that a good many people still regard him that way. Now, at 82, he directs his army with the animation, fire and bluntness that seem to make him a formidable opponent for Mr. Moose and the tobacco industry and for a list of other forces he believes threaten the nation's health. The tobacco industry remains his chief foe and is constantly on his mind. "Tobacco was on the ropes last summer -- 57 senators were lining up for tough antismoking legislation," he says, "and it was pushed off the floor by a few politicians and lobbyists who cared more about selling cigarettes than the health of the American people." He is angry, too, that Time Inc., a subsidiary of Time-Warner, citing poor sales, ended a joint venture to produce videos on causes and treatments of disease before he could make one on the hazards of smoking. Dr. Koop contends the cigarette industry is moving out in front again in the tobacco wars. "You now see groups of kids smoking on college campuses all over the country, which you did not see only two years ago," Dr. Koop said. But his list of other public health enemies is long. Among them are the following: -A health care system that leaves almost 50 million Americans with no insurance coverage. -The system's failings in the care it does provide, made worse by the demands of managed care. -What he calls inadequate attention to people infected with the hepatitis C virus. -Increasing obesity, particularly among young Americans. -The quality of teaching in medical schools. -The high number of preventable accidental deaths among children. That Dr. Koop was still a household name became evident in December, when he hung his shingle on the Internet. In less than a month, the Web site has had two million visits, more than the sites of the Mayo Clinic and Johns Hopkins Medical School. Dr. Koop's site offers free medical and health information about diseases, treatment and medication options and records of treatment risks and successes. It also provides a place to create a permanent personal medical history that subscribing hospitals and doctors can plug into. Fifteen hospitals have paid about $100,000 each for places on the site -- far less, Dr. Koop says, than it would cost them to create their own sites. He said he expected 15 more within a month. "I've gone commercial," he said. In fact, he said, he was offered millions for endorsements when his term as Surgeon General ended. One company dangled $1 million if he agreed to appear in a commercial holding a box of cereal. "That," he said, "I would not do." He said his first business foray, in 1995, was the venture with Time to produce the television videos in which he would appear to explain the symptoms of diseases, the treatment options and the relative risks. Some critics said he was shifting from doctor to entrepreneur. But Dr. Koop said such efforts were crucial to improving public health. In any event, Time withdrew from the video project in 1996 after the first batch of 34 films was completed, citing disappointing early sales. Dr. Koop says he believes his work on the videos and with Empower Health Corporation of Austin, Tex., the company he formed to run the Web site, helps encourage people to take charge of their health. This, he said, could ultimately "empower them to rise up in critical mass and demand a health care system that is more responsive and effective for everyone." Dr. Koop sought financial backers for the enterprise, which he said cost about $450,000 to create. He is the corporate chairman, with, he says, a small block of stock. Trudging through the third snowfall of the week in Hanover, with temperatures sinking to 19 degrees below zero, Dr. Koop said he had slowed down after turning 80 two years before. But this is not readily apparent. He is up at 6 A.M. and barely pauses from then on. The rounds this morning start the way one might think all mornings should start for students, teachers and talkative doctors. Dr. Koop sits at a polished wood conference table in a large seminar room, whose 33-pane, 25-foot-high arched window overlooks snow-covered pines. He speaks to 15 psychology students about how to prepare scientific papers for submission to professional journals. The papers are based on research gathered by the Koop Institute's Center for Educational Outcomes. Several papers from previous seminars have found publishers. The center and this seminar grew out of a project that Dr. Koop started, to evaluate his own work, almost immediately after establishing the institute in 1992. Though Dr. Koop was a respected pediatric surgeon and professor of surgery and pediatrics at the University of Pennsylvania before he became Surgeon General at age 66, "we wanted to make sure we were actually accomplishing something" at the project, Dr. Koop said. The center's director, Dr. G. Chris Jernsted, head of the college's psychology department, said one of his first tasks as director was to read Dr. Koop's collected lectures, speeches and pronouncements about what makes a good doctor. "Six themes emerged," Dr. Jernsted said. They were these: -Doctors should use their experiences in treating diseases to help prevent their recurrence. -Doctors and patients must try to learn from each other. -Treat the whole person, not a single complaint. -Work as a member of a medical team, not as a star or lone cowboy. -Learn to listen and to talk so that you can be understood. -Remain a generalist even if you are a specialist, remembering that no medical specialty exists in isolation. The center leaders found about 2,000 first-year students at 15 medical schools, presented them with the Koop theories and monitored their performance and progress in mock interviews with actors playing patients. Officials at the center said the experiments so improved the medical students' behavior with patients that the center expanded the theories to teaching in general and began a series of experimental programs in several public schools. After class, Dr. Koop is taken by van to a parking lot about a half mile away. As the van arrives, he is reminded of how rough a place the campus once was for an undergraduate, and revealed how, as a result, he later became a quadriplegic for 72 hours while he was Surgeon General. He broke his neck while ski jumping in an intramural competition near this parking lot 64 years ago. The scars enlarged over the years and eventually combined with arthritis to compress the spinal cord and shut down part of his nervous system. He said people in the Department of Health and Human Services -- he called them political enemies -- started to rush out a press release saying he had suffered a stroke and would never resume his duties. "A network of doctors quickly got the press release squelched," he said. The paralysis began to ease within three days, and he then underwent surgery to prevent a recurrence. It was 66 years ago on a field where the parking lot is now, he said, where a football injury gave him permanent double vision. As a freshman, he was knocked out in practice, playing for Dartmouth's legendary coach Earl Blaik. The campus doctor said he had suffered a serious eye injury, though it was correctable with glasses. "My wife," he said, "always threatened to tell my surgical patients that I see double." He said another such blow could have been fatal or caused blindness, so he told the coach he would have to quit football. "The great man said, 'Good, we don't want cowards on this team,' " Dr. Koop recalled. Another of his major concerns in public health is managed care. "The solution to the problem of inadequate care in this country," he said, "is going to come when people have been persuaded to take charge of their health, to educate themselves on what may be involved if they become sick, to learn the options available to them, to learn what can be done to stay healthy, to understand what they can of their medical history. "By the year 2002, when the number of people without health insurance increases from the 50 million at present to 60 million, a critical mass of people is going to rise up and demand that some kind of national system be put in place to correct this." Dr. Koop talks often about the subject with the medical school dean, Dr. John C. Baldwin. The dean holds similar views and recently proposed setting up what he would call the Dartmouth Community Medical School. An electronic school on the Internet, it would allow people to tap into medical teachings and research and, in effect, take not-for-credit courses in areas that might directly affect their health or the health of their families. Dr. Baldwin said the proposal was in a preliminary but serious stage of consideration. While these issues and wars are being explored and waged in the foreground, the young Dartmouth animators are sinking Smoking Joe Moose and his henchmen off the China coast, along with their cargo of superaddictive tobacco, through the work of "Nick Free," also known as Triple-O-Seven. "We saved the world from the evils of smoking," Nick Free says at the end of the film. "Don't get too excited, Free," says his beautiful sidekick, Wu Yan. "Our job's only just begun." By PHIL NOBLE Copyright 1999 The New York Times Company <http://www.nytimes.com/library/national/science/020299sci-koop.html> janet paterson - 51 now /41 dx /37 onset - almonte/ontario/canada http://www.newcountry.nu/pd/members/janet/index.htm [log in to unmask]