Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination met staunch opposition.

WSJ: Koop, who transformed surgeon general post, dies

Although Koop eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy, his nomination in 1981 met a wall of opposition from women's groups and liberal politicians.

WSJ: C. Everett Koop, ex-surgeon general, dies in NH

It appears to be the dominance of pragmatism over principle, and old-style back-room bargaining over more accountable, albeit potentially slower-moving, politics.

ECONOMIST: Japan��s leadership challenge