Who is this?

The question above is probably superfluous. Many readers will immediately know that’s a photo of C. Everett Koop. Next week will mark the 10th anniversary of his death, but somehow he seems to still be with us. During his lifetime he was what is often called a larger-than-life figure.

Two things stand out about Dr. Koop that made him such a memorable figure in the history of medicine and public health, at least in this country.

Perhaps a few words of introduction would be appropriate first, though. If you’re unaquainted with the name C. Everett Koop, he was the Surgeon General of the United States from 1982 through 1989. Therein lies his first claim to fame: not in simply holding that office, but in the way he held that office.

Before Koop, Surgeons General were nameless, faceless bureaucrats. People never knew who the current Surgeon General was. Koop changed that with an administration that was so visible that he became a household name that came up on episodes of Seinfeld, King of the Hill, and The Simpsons

It wasn’t that he was looking for publicity personally. But he sounded the message of public health loud and proud and did so despite political pressure from factions left and right.

For example, the Reagan administration under which he served exerted immense pressure on Koop to condemn abortion. With his Amish preacher looks, he might have been expected to gladly cooperate, but he never did. Although he was opposed to abortion on personal and religious grounds, he viewed the subject as a moral issue rather than a subject for public health legislation.

Similarly, he was Surgeon General when the AIDS crisis first erupted, and although roundly criticized by everyone from conservative religious groups to gay activists, he focused on education and prevention rather than moral judgments.

He famously stated, “I am the Surgeon General of the heterosexuals and the homosexuals, of the young and the old, of the moral or the immoral, the married and the unmarried. I don’t have the luxury of deciding which side I want to be on.”

There is something else about C. Everett Koop that makes it quite likely he would appear in this article series even if he had never been in the Surgeon General limelight: his medical career was nothing short of amazing.

From 1946 to 1981 he was chief surgeon at Children’s Hospital of Philadelphia, where he established the first neonatal surgical intensive care unit in the nation. He invented a number of surgical techniques unique to tiny patients that are still in use today. He tackled difficult cases that at the time no one had ever attempted, and did so with an enviable record of successful outcomes. He performed tens of thousands of operations on pediatric patients, including ten groundbreaking procedures on conjoined twins at a time when such operations were always undertaken with the goal of saving one twin at the expense of the other. Successful separations leaving both twins not just alive but healthy was almost unheard of, but they became Dr. Koop’s trademark.

He died February 25, 2013 at age 96. +

The Technobabble-Free Zone

by Dr. Chuck Cadle CAVEAT EMPTOR

(Buyer Beware)

Hello readers, I took a break from writing this column to teach a doctoral course at the University of Memphis. I was required to design and instruct an online course to teach students how to use the creative process to write the literature review for their dissertations. The university’s course software was new to me, and I must say that the project was a formidable challenge. It was one that I enjoyed, but also required me to set aside other activities, such as writing for the Medical Examiner Now that this course is behind me, I look forward to renewing the Technobabble Free column.

OK, let’s restart this monthly column with how I approach new projects. I always like to ask “why,” especially when it comes to technology. My questioning process is twofold.

First, I want to understand the benefit of taking on a new project. A friend recently gave me a book he had just finished. As I picked up the book (fiction), I asked, “Why do I need to read this since my time is constrained already?” That same day, I received an email with a web link to some technocrat touting some new features of Smart City technology. Again I asked, “Why do I need to study Smart City technology?” I have trained my mind to avoid time-wasting activities so that when a new project opportunity arises where I can learn or add value, I have the time to pursue it.

Technology has evolved to a point where it is less a tool and more of a “boss” of our time and money. I remember when television had only free content, cell phones allowed us to untether our need to be attached to a wall, computers enabled us to write letters, and our home security system was a barking dog. The invasive and subtle technological value changes have mostly gone unnoticed by the consumer. Yet, my questioning technique has alerted my awareness to remember Kodak and Gillette, who firmly set the business model for today’s technology companies. This business strategy, referred to as the “Razor and Blades” model, or in the case of Kodak, the “Camera and the Film” model, is a strategy most MBA students learn in their coursework. Simply put, the business strategy is to sell the hardware cheaply or give it away, but then buying add-on services and products is required. These add-on services become a profit opportunity for companies.

How many of you today pay annual renewals on software or security mon itoring fees?

How many have service contracts covering computers, networks, game consoles, TVs, etc.?

A sizeable portion of our monthly income is now required for technology services and support. Even though your cell phone, computer, or TV is working, corporate marketing and sales strategies are making us feel the need to buy a new device to access new features, which have their associated costs. Let’s take streaming as an example. Many consumers purchase TV and Internet content access from Comcast, WOW, ATT, and other providers. Then we opt to have Prime Video, Netflix, and other streaming services, and then we have to pay for the movie or TV series from these streaming providers. Here are some facts that may surprise you:

• The streaming industry is expected to be worth $330 billion by 2030.

• A staggering 85% of U.S. households have at least one video streaming subscription, and 60% have at least one paid music streaming subscription.

• COVID and general growth have also pushed video streaming services to invest more money into new content, including Please see CAVEAT page 11