The Office of the Surgeon General isn’t often in the news these days, for the simple reason that it isn’t much of an office any more.
It certainly was once. Until the mid-’60s the Surgeon General’s budget was in the billions. He (always a he, back then) had charge of the entire public health apparatus, including the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Institutes of Health. Then, suddenly, with Lyndon B. Johnson’s approval, every one of these responsibilities was stripped away, handed to an assistant secretary in the department of Health, Education and Welfare (which later became Health and Human Services).
Why? For ease of political control, in an era of burgeoning health and research budgets.
But, like the smile of the Cheshire Cat, the office of the Surgeon General remained, with the dignity of Senate confirmation, ceremonial command of the “commissioned corps” of public health officers and — should the incumbent be so inclined — a splendid uniform befitting a vice-admiral. Beyond that, the Surgeon General was, as one writer put it, a “glorified health educator,” though not actually all that glorified. The main thing he had to do was give Congress an annual report on smoking. Yet he did not write the report. He just signed it. He did not even supervise the staff who wrote it.
All of this was painfully learned by our one memorable modern Surgeon General, Charles Everett Koop. The New York Times denounced him in an editorial headed “Dr. Unqualified;” a nimbler commentator christened him “Dr. Kook.” He had no public health experience and unpopular abortion views. As controversy raged in inverse proportion to the actual importance of the office (Bill Clinton managed one whole administration without appointing anybody), Koop was thinking through what could actually be accomplished from his modest but high-profile perch.
And he decided to be an influencer. Long before “influencing” became a profession, Dr. Koop, retired pediatric surgeon and anti-abortion combatant, demonstrated genius at wielding a combination of medical authority, moral conviction and media savvy, to shape public opinion and national health policy. From his “merely health educator” perch, Koop emerged in the 1980s as one of the most recognizable and trusted figures in American public life. He harnessed his visibility to effect sweeping cultural and behavioral changes, particularly around smoking, HIV/AIDS and a range of preventive health issues, setting a potent precedent for his successors.
Koop understood the power of his persona. The instantly recognizable look — a patriarchal beard, the navy-type uniform, and an often gruff demeanor — lent him a visual authority that matched his vocal clarity. He never sought to cultivate charm, and it was his credibility that granted him instant access to media gatekeepers and undercut partisan resistance.
He leaned on scientific consensus, communicating it in direct, digestible terms — a technique today’s influencers use (whether or not science is backing them up!).
Koop’s most influential, and controversial, moment came with the AIDS epidemic. At a time when many public officials refused even to speak the word, Koop insisted on candor. In 1986, tasked by the Reagan White House with writing the first government report on AIDS, he advocated not merely abstinence (as many had expected) but also comprehensive sex education and condom use. His conscious choices about audience, tone and accessibility all reflect how social media influencers communicate today. Then, in 1988, Congress enabled him to follow up with an unprecedented eight-page AIDS mailer to all 107 million U.S. households.
At the core of Koop’s influence lay his reputation for refusing to be silenced or co-opted. An evangelical Christian, with initial support from the religious right, he disappointed many ideological allies by resisting their push for anti-abortion messaging, though others understood his argument — that anti-abortion speech-making would undercut his credibility in anything else. In today’s influencer ecosystem, authenticity is the core currency. Koop’s brand of unwavering integrity gave him a moral authority that transcended partisanship.
Koop was an influencer before Instagram, before YouTube, almost before the internet itself. He built his influence through scientific credibility, and a gravitas that carefully cultivated public trust. He redefined the potential of his anachronistic office as a bully pulpit for national transformation. His legacy offers a blueprint for public health communication in the 21st century.
I’ve never met Dr. Casey Means, the president’s choice for Surgeon General, and I’m not here to take sides on her nomination. I understand that many feel she has some strange views and limited experience. Yet if she retains the president’s confidence, she will shortly find herself a vice admiral with a navy-style uniform (if she chooses to suit up), and become our influencer-in-chief of public health.
Nigel M. de S. Cameron recently published “Dr. Koop: The Many Lives of the Surgeon General” (University of Massachusetts Press, 2025).