Recent Criticisms of Dr. Koop
from the New York Times and Chicago Tribune


New York Times
October 29, 1999


Koop Criticized for Role in Warning on Hospital Gloves

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Related Articles
Hailed as a Surgeon General, Koop Criticized on Web Ethics (Sep. 5, 1999)
Drkoop.com Official Said to Break Rules (Sep. 4, 1999)
Insider Makes Illegal Gains on DrKoop.com (Aug. 21, 1999)
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By HOLCOMB B. NOBLE

I n the spring of 1997, Dr. C. Everett Koop, the former Surgeon General,
made a telephone call to Dr. Linda Rosenstock, director of the National
Institute for Occupational Safety and Health. The agency was about to warn
health workers that latex gloves widely used in hospitals could cause
serious, even life-threatening allergic reactions. Dr. Koop told her that the
language of the warning was "way overstated" and could cause health workers to
abandon gloves that could protect them against infection, Dr. Rosenstock said.

The issue arose again this year when Dr. Koop testified in the House
on March 25 before the oversight and investigations subcommittee of the
Committee on Education and the Work Force. Dr. Koop told the panel that the hazards
being linked to the gloves by scientists and other health authorities were
exaggerated.

"Borderline hysteria," he called them.

But now, a spokeswoman for Dr. Koop, Mary Beth Zupa, acknowledges that
Dr. Koop had received substantial sums of money under a four-year, $1
million contract he signed in 1994 with a leading manufacturer of the latex
gloves, a relationship he did not disclose to Dr. Rosenstock or the
subcommittee.

Dr. Koop was not required to have registered as a paid lobbyist for
the company since he was not under contract with the glove manufacturer
when he made the call to Dr. Rosenstock at NIOSH or testified before the
subcommittee, which is headed by Representative Charlie Norwood,
Republican of Georgia.

When told of Dr. Koop's contract with the glove manufacturer, John
Stone, the press secretary for Norwood, said, "This is the kind of thing he is
adamant about at hearings on all issues. He always wants to know if there have
been financial arrangements with parties interested in matters under
discussion."

Dr. Koop repeatedly declined to discuss the matter, but Ms. Zupa said
he had done nothing improper. His contract with the glove maker, WRP
Corporation, did not last the full four years and had nothing to do with its latex
division, she said, adding that it never occurred to Dr. Koop to make
such disclosures.

NIOSH issued its warning anyway. But ethicists and public interest
groups say that although he was not required to do so by law, Dr. Koop had an
obligation to disclose his financial ties to NIOSH, to the Congress and to the
public.

"What this long admired and respected man has done in taking money
from a glove manufacturer and then speaking out on its behalf is wrong," said
Susan Wilburn, senior specialist in occupational safety and health for the
American Nurses Association.

"But worse, he has given very powerful help to an industry whose
product is harming health workers and patients."

She added, "People harmed through use of the gloves, and their loved
ones, wouldn't call the concern 'hysterical.' "

Ms. Wilburn said an estimated 200,000 nurses had developed allergies,
and NIOSH studies show that 10 percent of health-care workers regularly
exposed to the gloves and 17 percent with heavy exposure have developed
allergies. Nearly 10 million Americans are employed as health workers but little
data exists on their rates of exposure to the gloves.

More than 300 lawsuits have been filed by health workers and patients
who say they have been harmed. Also, some of the nation's leading hospitals,
including the Mayo Clinic and Johns Hopkins, have begun replacing
powdered latex gloves with alternatives. Hospital officials say these gloves
work as well as the powdered latex gloves and are well accepted by hospital
workers.

Dr. Koop has long been one of the nation's most trusted health
experts, a reputation he gained as Surgeon General in the 1980's in battling the
tobacco industry and focusing a reluctant nation on the seriousness of AIDS,
among other efforts.

But critics have found fault with steps that Dr. Koop and his business
associates took to profit from his name and reputation, including
establishing financial ties to companies whose products and services
were described on a Web site he established, dr.koop.com, which is designed
to present objective health information. (Modifications were subsequently
made on the site in response to the criticism.)

The critics say the glove contract is more troubling because it
involves public policy and public health.

According to filings with the Securities and Exchange Commission, the
glove company contract called for Dr. Koop to deliver four speeches a year
on health and nutrition. He gave the company the right to use his "name,
picture, speeches and biographical information" and agreed to serve as
a company adviser. He also agreed not to endorse products of
competitors, and to submit his speeches for editing as long as the company did "not
change the substance" of the text. The contract also entitled Dr. Koop to a
five-year option to buy 500,000 shares of company stock at a 1994 price, and a
percentage of the net sales of nutrition products, a new line the
company was entering.

Ms. Zupa, said that Dr. Koop did not receive the full $1 million
called for in the contract, but she would not say how much he did receive.

However, a footnote to a WRP Corporate filing with the S.E.C.
refers to an unnamed "individual" who served as a "spokesman for the
company" and received $656,250 in consulting fees, through February 1997.

A representative of the company confirmed that the individual was Dr. Koop.

Sanford Lewis, a lawyer for a group called Healthcare Without Harm,
formed, Lewis said, to monitor health and safety in the medical field, said
that Dr. Koop's activity on the glove issue, and particularly his testimony in
Congress, had been influential.

"Would even Dr. Koop have sounded so convincing," Lewis asked, "if he
had disclosed his financial deal with the glove company?"

Lewis said Dr. Koop's testimony in March was still being cited in
state legislatures as reasons to delay action on the gloves, even though "it
was based on a study that was never done." Dr. Koop had told Congress that
he based his conclusions -- that concern about the gloves was unwarranted
-- on a study by the Centers for Disease Control. But the agency said later
that it had not made such a study.

The report Dr. Koop referred to was paid for, it turned out, by
another glove maker, Allegiance Healthcare Corporation, the author of the study said
in a court deposition.

Dr. Koop said in an interview last month that he had been misled about
the report's origin.

Ms. Zupa said Dr. Koop became involved with WRP because of an interest
"in increasing the efficacy of vitamins for health care for some time."
She said he never received any royalties on net nutrition sales because there
were none, something confirmed in the company's 1997 10K filings with the
S.E.C. As a result, the company declared it was concentrating on latex
gloves.

According to S.E.C. documents, the company's board had already decided
that the company should get out of the nutrition business. "That means,"
Lewis said, "that for a year and a half after the company lost any interest
in promoting its nutrition products, Dr. Koop was still its consultant --
and it would be hard for him not to know what business they were in."

Dr. Rosenstock of NIOSH said that Dr. Koop telephoned her as her agency
was preparing its bulletin on the potential dangers of exposure to rubber
latex gloves containing protein and powdered corn starch. The powder is
meant to make it easier to get the gloves on and off, but allergists say that
when it mixes with the protein in the gloves it can cause severe allergic
reactions leading on rare occasions to anaphylactic shock and, in five known
cases, death, Dr. Rosenstock said. If the powder from the gloves is dispersed
in the air, it can even affect people who have not worn the gloves.

Dr. Rosenstock, whose agency is a research division of the C.D.C.,
said Dr. Koop told her he had seen a draft of the NIOSH bulletin. She said his
view was that it would "cause more harm than good" because it might
frighten hospital workers out of using gloves that protect them in handling
infectious materials, Dr. Rosenstock said.

"I assured him that we had sent the bulletin out for peer review and I
was confident that it was well based scientifically," she said, and in the
end, the agency issued the bulletin, including language in the final
version that Dr. Koop objected to.

The bulletin suggested that health workers use nonlatex gloves for
activities not involving infectious materials and that if they chose latex gloves
for handling infectious materials, they use "the powder-free kind with
reduced protein content."

Since then, the Food and Drug Administration, the Occupational Safety
and Health Administration and a number of scientists, including members of
the American Academy of Allergies, Asthma and Immunology, all have taken
the same basic position.

Sheldon Krimsky, a professor in urban and environmental policy at
Tufts University who has written extensively in science journals on
disclosure issues, said of Dr. Koop's role in the glove issue, "anyone who
attempts in a public forum to influence public policy has an absolute obligation to
disclose any financial interests he has or has had within a time frame
that could be perceived to represent a bias -- and it certainly did in the
Koop cases."

Dr. Sidney M. Wolfe, a physician and director of Public Citizen's
Health Research Group, which sought unsuccessfully in 1988 to have the
powdered-gloves banned from all hospitals, said, "The whole issue with
these gloves is a no brainer: Powdered gloves are causing serious problems.
They're causing hospitals to lose workers who become disabled and there are
perfectly good alternatives to that type of glove -- and Dr. Koop has absolutely
no scientific basis for the position he has taken."

In response to criticism, an OSHA spokeswoman said that the current
warnings seemed to be sufficient but that the agency was considering whether to
take active enforcement action.


THE TARNISHED IMAGE OF DR. KOOP

Chicago Tribune
October 30, 1999


Dr. C. Everett Koop was the first U.S. surgeon general Americans knew by name. Sadly, it's a name that has lost a good bit of its luster lately.

Earlier this year, he was criticized for confusion on his health Web site over what was paid advertising and what was not and
for taking commissions on health items sold over the site. He took steps to remedy those problems, but now it seems he is guilty of another, more serious, breach of ethics.

Koop has been a vocal opponent of the banning by hospitals of certain types of latex gloves worn by health-care workers because of fears that they may cause allergies, perhaps even life-threatening ones.

In 1997, shortly before the National Institute for Occupational Safety and Health issued a warning about the gloves, Koop
called the agency's director to try to sidetrack it. And last March he testified before a congressional committee on the subject, saying the gloves' hazards had been exaggerated.

Now it turns out that Koop had been a paid consultant for a major manufacturer of the latex gloves. In 1994 he signed a $1 million contract with the company to deliver speeches, which he submitted to them for editing, and to allow use of his name and likeness.

So blatant a conflict of interest involving one of the country's most respected physicians is shocking. More shocking still is his apparent inability to understand what the problem is.

The problem is that his medical opinion is valuable in the shaping of public policy because he is assumed to be an unbiased professional. But by failing to disclose his financial ties to a latex-glove maker, he renders his opinion suspect at best and useless for purposes of determining a proper course of action.

Dr. Koop may be quite right when he says the latex-glove controversy is overblown. But that is not the issue, because there is no knowing whether his opinion has been bought.

He should have disclosed his financial ties to the company and let others decide whether he was speaking as a doctor or a shill. By keeping mum, he has encouraged public opinion to assume the latter.