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A Project of The Annenberg Public Policy Center

Koop’s False Claims

The 93-year-old former surgeon general claims seniors would be 'too old' in the United Kingdom to get a pacemaker or joint replacement. He's wrong.


Former U.S. Surgeon General C. Everett Koop claims that the United Kingdom’s health care system would consider seniors "too old" to qualify for the artificial joints, heart pacemakers and coronary stent that he’s received in the U.S.

U.K. guidelines make clear that patients of "any age" may receive pacemakers, for example. And in fact, official statistics show 47 patients aged 100 or older got new or replacement pacemakers in a single recent year.

Koop, who held office during the Reagan administration, makes his false claim in a TV spot by the conservative 60 Plus Association. We asked 60 Plus to substantiate the claim but received nothing that backs up what Koop said about joints, stents or pacemakers being denied based on age. A spokeswoman for the U.K.’s Department of Health states that Koop’s assertions are "not true."


The ad is part of a national cable media buy of $400,000, according to the 60 Plus Association.

[TET ]

60 Plus Association Ad: "Dr. Koop"

Announcer: Dr. C. Everett Koop was a pioneering pediatric surgeon, and a renowned surgeon general.

Dr. Koop: I’m 93 and thank God for every year. I’m here with two artificial joints, two pacemakers to keep my heart in rhythm, as well as a stent to keep my coronaries open. Seniors in this country can get the same care I received, but in some places, like the United Kingdom, we would be considered too old and the cost to the state too high. It is vital that America’s seniors understand what Congress is doing. But Democrats are working on a health care bill — and keeping the discussions and specifics secret. We seniors are concerned about proposals that would reduce Medicare spending. The administration promised transparent deliberation, which has not been forthcoming. America deserves better than this.

Announcer: Call Congress and tell them to start over and get health care right.


In the ad, Koop tells viewers that he is 93 and lists some details of his personal medical history: "I’m here with two artificial joints, two pacemakers to keep my heart in rhythm, as well as a stent to keep my coronaries open." He then says that "seniors in this country can get the same care I received, but in some places, like the United Kingdom, we would be considered too old and the cost to the state too high."

Hip Replacements Only for the Young?

Do our neighbors across the Atlantic really deny artificial joints and heart procedures for seniors? No. In fact, statistics show that the United Kingdom’s system provides pacemakers to those who are even older than Koop.

The U.K.’s National Institute for Health and Clinical Excellence has posted treatment guidelines online that state "pacemakers may be implanted in patients of any age." A more detailed report for 2007 from the National Health Service (the most recent year for which records are available) said that the average age of recipients of new implants was 75.5 years. Nearly 76 percent of the 36,297 pacemaker recipients that year were aged 70 and older, the report said, and 47 patients were 100 years old or more.

As for joint replacements, a spokesman for the U.K. National Joint Registry told us that there was no age limit for surgery and that he "was not aware of anyone being declined" for joint replacement surgery on account of age. The joint registry didn’t have statistics based on age, but it counted 100,786 hip and knee operations at National Health Service hospitals in 2009.

We sought out an anti-ageism nonprofit group in the U.K., Age Concern and Help the Aged. We figured that if there is any substance to Koop’s complaint of joint replacements being denied to those who are "too old," then this organization would be the first to support it. The group didn’t. Instead, Age Concern’s press office pointed us to government statistics stating that "the over 65-year age group accounts for two in every three" hip replacements performed in the U.K.

Koop’s reference to his heart stent is reminiscent of an anonymous chain e-mail we debunked last summer. The e-mail falsely claimed that anyone older than 59 could not receive heart bypass surgery or stents in England because the procedures were "too costly." A U.K Department of Health spokesman flatly told us that "it is not true that anyone aged over 59 years cannot receive heart repairs, stents or bypass surgery on the basis of their age." The spokesman added: "The NHS Constitution states that the NHS provides a ‘comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief.’ "

We couldn’t track down specific numbers on the age of patients who have received stents, but when we looked into this claim months ago, Age Concern’s press office told us the group had never heard of a prohibition on heart surgery for patients aged 60 and up.

This time, we sent a copy of the Koop ad to U.K. Department of Health Press Officer Julia Harris to ask about his claims. "The Department of Health can confirm that this is not true," she said. "Access to treatment should be offered on the basis of clinical need."

No Support for Claims

When we asked the 60 Plus Association for backup for the ad’s claims, a spokesman did not send us anything about the three medical treatments Koop mentioned or age limits on such procedures. Rather, the group pointed to three clippings that have nothing to do with its claim:

  • A newspaper story about a U.K. government report on abuses at nursing homes.
  • A newspaper story about some doctors in England expressing concern about a hospice approach that allows doctors and caregivers to focus on comfort instead of life preservation at the end of life.
  • A 2006 newspaper story about a then-new bone cancer drug, Velcade, that was not approved for use in England (though it was available in Wales, Scotland and Northern Ireland) because of a concern over cost and effectiveness. However, the drug was approved a year later.

The group also supplied a Wall Street Journal editorial from last summer claiming that Britain’s medical guidelines hold that "except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months." When we asked officials at the U.K.’s National Institute for Health and Clinical Excellence (NICE) about the Journal’s editorial, they referred us to a statement issued a few weeks later by Chief Executive Andrew Dillon, calling such reports "untrue or misinformed" and adding: “We don’t put a limit on the amount the NHS can spend on an individual patient." NICE does have a formula used to assess whether or not a new drug or medical device is worth the cost. But it’s not a simple spending cap. And once a treatment is found to be cost-effective, it is available to all patients regardless of age.

— by Justin Bank, with Lori Robertson


"Summary of Annual Statistics – 2009." National Joint Registry, United Kingdom. 
"Report for European Heart Rhythm Association." National Clinical Audit Support Programme, United Kingdom. 2007. 
"Guidance Chapter 2: Bradycardia – dual chamber pacemakers." National Institute for Health and Clinical Excellence. United Kingdom. accessed 1 Feb 2010. 
"Guidance on the Selection of Prostheses for Primary Total Hip Replacement (TA2)." National Institute for Health and Clinical Excellence. United Kingdom. accessed 1 Feb 2010. 
"Of NICE and Men." Wall Street Journal. 7 July 2009. 
Age Concern and Help the Aged press office. E-mail interview with 27 Jan 2010. 
U.K. Department of Health Press Officer Julia Harris. Phone interview with 1 Feb 2010. 
U.K. National Joint Registry press office. Phone interview with 27 Jan 2010. 
National Institute for Health and Clinical Excellence Press Officer Alice Law. Phone and E-mail interview with 1 Feb 2010.