Tedium - Dr. Koop’s Digital Korner 🩺

Hey all, Ernie here with a refresh of a piece about a well-known figure who served in the Executive Branch of the U.S. government. Not the most recent one, of course. But given the vibe of transition in recent weeks and all of the discussion of misinformation that preceded it, it feels like a good time to bring back the story of Dr. Koop. Read on.

Today in Tedium: Generally, bureaucrats don’t tend to transcend their titles. Often, they leave public service as quick as they entered, or stay behind the scenes over a long career. Dr. C. Everett Koop, a public health official who was the very definition of old school, somehow became the exception. Serving for nearly eight years as the U.S. Surgeon General, Koop was perhaps the only person that served in that role that could be reasonably called a household name—well, at least until 2020 put Dr. Jerome Adams in the crosshairs of a very much imperfect public-health response to COVID-19. Adams, like a lot of presidential appointees from the last administration, was asked to step down this week, which he did. Adams had a tough job in a tough administration, and there were likely folks in D.C. who did far worse than he did over the past 12 months, but ultimately, he likely won’t carry the prestige of C. Everett Koop in the history books. Now, Koop became a trustworthy icon of public health during a period when public health was in crisis in a completely different way. He was important. But the reason I want to talk about him today comes down to his unlikely career riding the waves of the dot-com bubble. Yes, Dr. Koop was once an internet entrepreneur, and today’s Tedium is all about what might be the strangest tech IPO of all time, DrKoop.com. Here’s why it failed. — Ernie @ Tedium

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C. Everett Koop, as shown during his days as Surgeon General. (National Institutes of Health)

Why C. Everett Koop was the perfect choice for a namesake website in 1998

These days, if you’re a public figure, it’s considered table stakes to have a website of some kind.

But for figures higher up the food chain, like Martha Stewart or Bob Vila, they can get away with having a whole website, banked on their name, that’s largely built around content produced by people who are simply making stuff that leverages the topic that the public figure is known for.

With DrKoop.com, C. Everett Koop was perhaps one of the first public figures to try for a digital content play like this. It was a perfect role for Koop, who had improbably withstood the tough headwinds that surrounded his Surgeon General nomination to become the most widely respected voice in public health of his era.

Koop earned the role despite early signs suggesting he would be a divisive figure. In 1981, The New York Times published an editorial titled “Dr. Unqualified,” which implied that the Reagan administration was trying to bring him on board in an effort to support an anti-abortion crusade. The editorial noted that Koop was already of advanced age when he took the role—he was 65 at the time of his nomination, older than most who had taken the role in the past—and wasn’t afraid of making his socially conservative views known.

“Dr. Koop is, of course, entitled to his opinions, but opinions should not be construed as qualifications,” the Times editorial board wrote.

But Koop surprised everyone by not only being good at his job, but by taking stances on public health that at times seemed to conflict with his own personal beliefs.

At the height of the AIDS crisis, he publicly promoted the use of condoms and the need for sex education. In a public service announcement about AIDS he recorded in 1988, he avoided using language designed to prey upon stereotypes. “Let’s stop the rumors and misinformation about AIDS,” he stated.

He helped further the anti-smoking cause, aiming at bold goals at a time when the tide was starting to turn against Big Tobacco. And when Reagan called on Koop to produce a report highlighting the health effects of abortion on women, he didn’t let his personal beliefs get in the way of data that failed to support the conclusion that many abortion critics anticipated.

By May of 1989, as Koop was planning his exit from public office, the same Times editorial page admitted it was happily eating crow regarding its early assessment of Koop:

The skeptics and cynics, this page included, were wrong to fear that Surgeon General C. Everett Koop would use his office only as a pulpit for his anti-abortion views. Throughout his seven years of service—he has now announced his retirement as of July—he has put medical integrity above personal value judgments and has been, indeed, the nation’s First Doctor.

He was put into power under the belief he would turn medicine into a front for the culture wars, but he did the opposite. Koop’s legacy was so strong that it likely led the Surgeon Generals that followed him to face a hard time in the years after. Case in point: Clinton appointee Dr. Jocelyn Elders, the first African American in the Surgeon General role, wasn’t afraid to be frank about the issues like sex education and drug legalization. She was on the job for just over a year before she was pushed out as her views caused backlash.

For a time, at least, Koop managed to take what threatened to be a deeply political role and gave it a voice that transcended its politics. Few can say that.

It made Koop the perfect choice for his own digital empire at a time when many were willing to throw money at the internet.

DrKoop.com: The early Internet startup with a founder that was in his 80s

The decision by Koop to put his knowledge into a branded website was a brilliant play in 1998, keeping him fresh in the minds of millions nearly a decade after he left the job that made him famous.

Even with all that time away, he hadn’t lost his luster—something highlighted by the fact that DrKoop.com managed to draw 2 million visitors in its first month, according to a New York Times article.

“I’ve gone commercial,” he told the newspaper of the effort, which cost a princely $450,000 to build.

At the time of the site’s launch, Koop was 82 years old, most assuredly making him one of the oldest tech startup founders of all time. He, of course, had help—in part because the company’s original name was not DrKoop.com. The company first came to life in 1997 as Personal Health Records, Inc., and according to Texas Monthly, the firm’s founder, Donald W. Hackett, spent months trying to win over Koop, who finally relented, opening up a new stage of his life in the public eye.

Koop’s name, beyond bringing in lots of quick visitors, allowed the site to draw major sponsorships in short order, as well as big-name partnerships.

In an SEC filing ahead of its initial public offering, the company noted it had just entered an agreement with Disney to become the exclusive provider of health content to many of the sites in its Go.com portfolio, along with a major contributor to ABCnews.com. (The deal wasn’t cheap; the company had planned to pay a princely sum of $57.9 million for the access to those platforms, meaning that it needed the IPO to be a success.)

The company’s early success—having served 6 million visitors in less than a year, DrKoop.com saw a 39 percent “pop” in its first day of trading on the NASDAQ, leading other tech-minded health companies to follow in its footsteps—also, of course, opened it up to criticism.

Look at all those ads.

The issue was twofold. Koop had spent much of his two decades in the public eye standing for a particular image of unbiased public health, but the website carried many of the awkward conflicts of interest that many health content websites suffer from today, but during a period before the rules were set. The term native advertising wasn’t in the lexicon just yet, and DrKoop.com wasn’t properly disclosing what was paid and what wasn’t—a major ethical no-no. (Koop himself was reportedly getting commissions from products sold on the site.)

On top of that, the information on the website was heavily scrutinized, much in the way that other well-known online health-content plays, such as WebMD (which both predated and outlived DrKoop.com) and Livestrong.com have often been. It was, simply put, a content farm before content was put in terms of farming. (This makes sense, considering that Demand Media co-founder Richard Rosenblatt once served as DrKoop.com’s CEO; Demand Media, the owner of Livestrong.com, changed its name to Leaf Group in 2016, in part because of the name’s reputation.)

Understandably, considering it had access to a resource with a track record of high public trust, DrKoop.com used Dr. Koop to defend itself and reframe the conversation. On his website, Koop emphasized that the criticisms the site received were warranted; he maintained the platform would be part of the solution.

“I welcome the debate on the value of the Internet as a viable tool for educating the public, as well as the discussion over the creation of standards for editorial representation,” Koop wrote on the site in 2000. “In short, I support any productive activity designed to better the environment where people gain access to accurate healthcare information.”

(Koop’s call, as messy as the situation was, did some good, eventually leading to new ethics standards for medical content websites.)

Koop, as shown in a magazine ad from the era of DrKoop.com. (via NIH)

There was also another, more subtle criticism of the platform from some corners: DrKoop.com, the website, didn’t feel like Dr. Koop, the person. It felt like an excuse to put thousands of pages of medical content online, and observers were quick to point it out.

“Besides lending his ubiquitous name and face, there is little of the famous Dr. Koop voice at the site—that of the Reagan era’s self-important, scolding Mennonite elder, though Koop is a Presbyterian,” The Weekly Standard correspondent Matt Labash wrote in 1999, a few weeks after the stock price peaked. “Sure, he happens by once in a while (three or four times, so far), most recently for a chatroom appearance with supermodel-supermom-fitness-expert Kathy Ireland. But that’s not that important for an Internet business.”

Labash implied that, even despite that weakness, Koop was setting himself up for a mascot-style play with the website, with an eye on living forever through his message. (There were, of course, comparisons to other celebrities with distinctive looks, such as Colonel Sanders.)

Of course, it didn’t quite happen that way. For one thing, when it comes down to it, DrKoop.com was ultimately a big content site, the kind of content site that we now know can be useful in small doses but isn’t by any means a unique beast. And while Koop’s name was an effective branding strategy at first, it ultimately didn’t prove strong enough to corner the market on health content. WebMD, strengthened by a merger, was ultimately able to usurp the brand value that DrKoop.com had tried to bank on from the start.

By the middle of 2000, the company was cutting its staff left and right, and was running on fumes—spending far more money than it was bringing in. Its stock price evoked the popped bubble pretty effectively, falling from nearly $20 just before the year 2000 to 65.6 cents in August of that year.

Even if his value on paper floated in the tens of millions in the middle of 1999, Koop the entrepreneur simply wouldn’t be as successful as Koop the Surgeon General.