WHO: Slight cancer risk after Japan nuke accident

LONDON (AP) — Two years after Japan's nuclear plant disaster, an international team of experts said Thursday that residents of areas hit by the highest doses of radiation face an increased cancer risk so small it probably won't be detectable.

In fact, experts calculated that increase at about 1 extra percentage point added to a Japanese infant's lifetime cancer risk.

"The additional risk is quite small and will probably be hidden by the noise of other (cancer) risks like people's lifestyle choices and statistical fluctuations," said Richard Wakeford of the University of Manchester, one of the authors of the report. "It's more important not to start smoking than having been in Fukushima."

The report was issued by the World Health Organization, which asked scientists to study the health effects of the disaster in Fukushima, a rural farming region.

On March 11, 2011, an earthquake and tsunami knocked out the Fukushima plant's power and cooling systems, causing meltdowns in three reactors and spewing radiation into the surrounding air, soil and water. The most exposed populations were directly under the plumes of radiation in the most affected communities in Fukushima, which is about 150 miles (240 kilometers) north of Tokyo.

In the report, the highest increases in risk are for people exposed as babies to radiation in the most heavily affected areas. Normally in Japan, the lifetime risk of developing cancer of an organ is about 41 percent for men and 29 percent for women. The new report said that for infants in the most heavily exposed areas, the radiation from Fukushima would add about 1 percentage point to those numbers.

Experts had been particularly worried about a spike in thyroid cancer, since radioactive iodine released in nuclear accidents is absorbed by the thyroid, especially in children. After the Chernobyl disaster, about 6,000 children exposed to radiation later developed thyroid cancer because many drank contaminated milk after the accident.

In Japan, dairy radiation levels were closely monitored, but children are not big milk drinkers there.

The WHO report estimated that women exposed as infants to the most radiation after the Fukushima accident would have a 70 percent higher chance of getting thyroid cancer in their lifetimes. But thyroid cancer is extremely rare and one of the most treatable cancers when caught early. A woman's normal lifetime risk of developing it is about 0.75 percent. That number would rise by 0.5 under the calculated increase for women who got the highest radiation doses as infants.

Wakeford said the increase may be so small it will probably not be observable.

For people beyond the most directly affected areas of Fukushima, Wakeford said the projected cancer risk from the radiation dropped dramatically. "The risks to everyone else were just infinitesimal."

David Brenner of Columbia University in New York, an expert on radiation-induced cancers, said that although the risk to individuals is tiny outside the most contaminated areas, some cancers might still result, at least in theory. But they'd be too rare to be detectable in overall cancer rates, he said.

Brenner said the numerical risk estimates in the WHO report were not surprising. He also said they should be considered imprecise because of the difficulty in determining risk from low doses of radiation. He was not connected with the WHO report.

Some experts said it was surprising that any increase in cancer was even predicted.

"On the basis of the radiation doses people have received, there is no reason to think there would be an increase in cancer in the next 50 years," said Wade Allison, an emeritus professor of physics at Oxford University, who also had no role in developing the new report. "The very small increase in cancers means that it's even less than the risk of crossing the road," he said.

WHO acknowledged in its report that it relied on some assumptions that may have resulted in an overestimate of the radiation dose in the general population.

Gerry Thomas, a professor of molecular pathology at Imperial College London, accused the United Nations health agency of hyping the cancer risk.

"It's understandable that WHO wants to err on the side of caution, but telling the Japanese about a barely significant personal risk may not be helpful," she said.

Thomas said the WHO report used inflated estimates of radiation doses and didn't properly take into account Japan's quick evacuation of people from Fukushima.

"This will fuel fears in Japan that could be more dangerous than the physical effects of radiation," she said, noting that people living under stress have higher rates of heart problems, suicide and mental illness.

In Japan, Norio Kanno, the chief of Iitate village, in one of the regions hardest hit by the disaster, harshly criticized the WHO report on Japanese public television channel NHK, describing it as "totally hypothetical."

Many people who remain in Fukushima still fear long-term health risks from the radiation, and some refuse to let their children play outside or eat locally grown food.

Some restrictions have been lifted on a 12-mile (20-kilometer) zone around the nuclear plant. But large sections of land in the area remain off-limits. Many residents aren't expected to be able to return to their homes for years.

Kanno accused the report's authors of exaggerating the cancer risk and stoking fear among residents.

"I'm enraged," he said.

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Mari Yamaguchi in Tokyo and AP Science Writer Malcolm Ritter in New York contributed to this report.

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Online:

WHO report: http://bit.ly/YDCXcb

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Obama Admin to Court: End Calif. Gay Marriage Ban

In a historic argument for gay rights, President Barack Obama on Thursday urged the Supreme Court to overturn California's same-sex marriage ban and turn a skeptical eye on similar prohibitions across the country.

The Obama administration's friend-of-the-court brief marked the first time a U.S. president has urged the high court to expand the right of gays and lesbians to wed. The filing unequivocally calls on the justices to strike down California's Proposition 8 ballot measure, although it stops short of the soaring rhetoric on marriage equality Obama expressed in his inaugural address in January.

California is one of eight states that give gay couples all the benefits of marriage through civil unions or domestic partnership, but don't allow them to wed. The brief argues that in granting same-sex couples those rights, California has already acknowledged that gay relationships bear the same hallmarks as straight ones.

"They establish homes and lives together, support each other financially, share the joys and burdens of raising children, and provide care through illness and comfort at the moment of death," the administration wrote.

Justin Sullivan/Getty Images

The brief marks the president's most expansive view of gay marriage and signals that he is moving away from his previous assertion that states should determine their own marriage laws. Obama, a former constitutional law professor, signed off on the administration's legal argument last week following lengthy discussions with Attorney General Eric Holder and Solicitor General Donald Verrilli.

In a statement following the filing, Holder said "the government seeks to vindicate the defining constitutional ideal of equal treatment under the law."

Obama's position, if adopted by the court, would likely result in gay marriage becoming legal in the seven other states: Delaware, Hawaii, Illinois, Nevada, New Jersey, Oregon and Rhode Island.

In the longer term, the administration urges the justices to subject laws that discriminate on sexual orientation to more rigorous review than usual, as is the case for claims that laws discriminate on the basis of race, sex and other factors.

The Supreme Court has never given gay Americans the special protection it has afforded women and minorities. If it endorses such an approach in the gay marriage cases, same-sex marriage bans around the country could be imperiled.

Friend-of-the-court briefs are not legally binding. But the government's opinion in particular could carry some weight with the justices when they hear oral arguments in the case on March 26.

Despite the potentially wide-ranging implications of the administration's brief, it still falls short of what gay rights advocates and the attorneys who will argue against Proposition 8 had hoped for. Those parties had pressed the president to urge the Supreme Court to not only overturn California's ban, but also declare all gay marriage bans unconstitutional.

Still, marriage equality advocates publicly welcomed the president's legal positioning.

"President Obama and the solicitor general have taken another historic step forward consistent with the great civil rights battles of our nation's history," said Chad Griffin, president of the Human Rights Campaign and co-founder of the American Foundation for Equal Rights, which brought the legal challenge to Proposition 8.

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Japan's factory output up 1.0% in January

TOKYO: Japan's factory output for January rose a smaller-than-expected 1.0 per cent from the previous month, official data showed on Thursday.

The rise was weaker than a 1.5 per cent expansion expected by the market and a revised 2.4 per cent increase in December.

But the ministry maintained a positive view, saying in a monthly report: "Industrial production has bottomed out and shows some signs of picking up."

- AFP/ck

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CBI seeks more documents, looks at tweaking of specifications

NEW DELHI: The CBI on Wednesday said it had sought more documents related to the AgustaWestland helicopter deal from the defence ministry as it prepares to question suspected beneficiaries about alleged kickbacks received in the Rs 3,600 crore deal.

The agency will also seek all documents related to changes made in the specifications of 12 VVIP choppers by the office of former IAF chief S P Tyagi to allegedly benefit Italian firm Finmeccanica, sources said.

The agency has also sought the reply given by Finmeccanica to the questions raised by the ministry, CBI sources said. They added the agency was focusing on the circumstances in which the requirements were tweaked in the defence ministry to allegedly suit Finmeccanica and its subsidiary AgustaWestland.

They said files related to alterations in the helicopter's specifications will help the agency identify defence ministry officials who could be questioned. A CBI team is in touch with defence ministry officials who have been asked to produce these files at the earliest, they said.

The CBI is also likely to seek documents from the corporate affairs ministry on the shareholding pattern of Aeromatrix and IDS Infotech, allegedly involved in the kickbacks trail.

The agency has registered a preliminary enquiry against 11 people including former IAF chief S P Tyagi, his three cousins, European middlemen and four companies. Two Indian firms allegedly used to route bribe money are among these four companies.

Tyagi has refuted all allegations against him. The agency has also got some documents from Finmeccanica on the basis of which it has started a probe in the matter.

CBI sources said during the preliminary enquiry, the agency's powers in summoning and carrying out searches were limited and it was trying to complete the enquiry as early as possible so that a clear view of alleged corruption could emerge based on which future course of action would be taken.

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Huge study: 5 mental disorders share genetic links

WASHINGTON (AP) — The largest genetic study of mental illnesses to date finds five major disorders may not look much alike but they share some gene-based risks. The surprising discovery comes in the quest to unravel what causes psychiatric disorders and how to better diagnose and treat them.

The disorders — autism, attention deficit-hyperactivity disorder or ADHD, bipolar disorder, major depressive disorder and schizophrenia — are considered distinct problems. But findings published online Wednesday suggest they're related in some way.

"These disorders that we thought of as quite different may not have such sharp boundaries," said Dr. Jordan Smoller of Massachusetts General Hospital, one of the lead researchers for the international study appearing in The Lancet.

That has implications for learning how to diagnose mental illnesses with the same precision that physical illnesses are diagnosed, said Dr. Bruce Cuthbert of the National Institute on Mental Health, which funded the research.

Consider: Just because someone has chest pain doesn't mean it's a heart attack; doctors have a variety of tests to find out. But there's no blood test for schizophrenia or other mental illnesses. Instead, doctors rely on symptoms agreed upon by experts. Learning the genetic underpinnings of mental illnesses is part of one day knowing if someone's symptoms really are schizophrenia and not something a bit different.

"If we really want to diagnose and treat people effectively, we have to get to these more fine-grained understandings of what's actually going wrong biologically," Cuthbert explained.

Added Mass General's Smoller: "We are still in the early stages of understanding what are the causes of mental illnesses, so these are clues."

The Psychiatric Genomics Consortium, a collaboration of researchers in 19 countries, analyzed the genomes of more than 61,000 people, some with one of the five disorders and some without. They found four regions of the genetic code where variation was linked to all five disorders.

Of particular interest are disruptions in two specific genes that regulate the flow of calcium in brain cells, key to how neurons signal each other. That suggests that this change in a basic brain function could be one early pathway that leaves someone vulnerable to developing these disorders, depending on what else goes wrong.

For patients and their families, the research offers no immediate benefit. These disorders are thought to be caused by a complex mix of numerous genes and other risk factors that range from exposures in the womb to the experiences of daily life.

"There may be many paths to each of these illnesses," Smoller cautioned.

But the study offers a lead in the hunt for psychiatric treatments, said NIMH's Cuthbert. Drugs that affect calcium channels in other parts of the body are used for such conditions as high blood pressure, and scientists could explore whether they'd be useful for psychiatric disorders as well.

The findings make sense, as there is some overlap in the symptoms of the different disorders, he said. People with schizophrenia can have some of the same social withdrawal that's so characteristic of autism, for example. Nor is it uncommon for people to be affected by more than one psychiatric disorder.

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Online:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60223-8/abstract

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Holder Says Sequester Makes America Less Safe

The looming budget sequestration will make Americans less safe, Eric Holder says—and anyone who says otherwise isn't telling the truth.

"This is something that is going to have an impact on the safety of this country," the U.S. attorney general told ABC's Pierre Thomas on Wednesday in a wide-ranging, exclusive interview.

"And anybody that says otherwise is either lying or saying something that runs contrary to the facts," Holder said.

In his interview with ABC News, Holder reiterated warnings that if automatic spending cuts are triggered on Friday, the Justice Department will be handicapped in some of its most vital missions to prevent terrorist attacks and crime.

"The Justice Department is going to lose nine percent of its budget between now and September 30th. We're going to lose $1.6 billion. There are not going to be as many FBI agents, ATF agents, DEA agents, prosecutors who are going to be able to do their jobs," Holder said. "They're going to be furloughed. They're going to spend time out of their offices, not doing their jobs."

Portions of the interview will air Wednesday, February 27 on "ABC World News"

Patrick Semansky/AP Photo

Eric Holder Says Homegrown Terror Threat Equals International: Exclusive Watch Video

Eric Holder Remembers Newtown, His Worst Day on the Job: Exclusive Watch Video

President Obama's Cabinet members have been warning for weeks that budget sequestration, which will begin Friday unless Obama and Republicans reach a deficit-reduction deal to avoid it, will leave their agencies shorthanded and could bring about disastrous consequences. Homeland Security Secretary Janet Napolitano and Transportation Secretary Ray LaHood have both appeared at the White House press briefing room to warn that furloughs for border-patrol agents, TSA agents and air-traffic controllers will mean weakened border and port security, longer waits in airport security lines, and logjammed air travel.

Holder, for his part, warned in a Feb. 1 letter to the Senate Appropriations Committee that cuts to the FBI, the ATF, the U.S. Marshals Service, and U.S. Attorneys would limit the department's capacity to investigate crimes. Cuts at the Bureau of Prisons, Holder wrote, would mean lockdowns and potential violence, with fewer staff members on hand. In a separate letter, FBI Director Robert Mueller warned that counterterrorism operations would be affected, with the possible elimination of some joint terrorism task forces with state and local police. Limited surveillance and slower response times would mean unwatched targets and the possibility that individuals on terrorism watch lists could gain entry to the U.S.

"FBI's ability to proactively penetrate and disrupt terrorist plans and groups prior to an attack would be impacted," Mueller wrote.

To Holder, the problem is simple.

"If you don't have prosecutors and agents doing what we expect them to do, and we won't if this thing actually takes place, we are going to be a nation that is going to be less safe. And that is simple fact," Holder said.

Some Republicans have claimed the Obama administration is exaggerating the sequester's purported consequences as a ploy to campaign for tax hikes. On "Fox News Sunday" this week, Sen. Tom Coburn, R-Okla., posited that federal agencies enjoy enough flexibility to avoid the worst consequences of the cuts.

On Wednesday, Holder acknowledged that the Justice Department will do what it can to avoid compromised security, while maintaining that furloughs can't be avoided.

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Iran upbeat on nuclear talks, West still wary

ALMATY (Reuters) - Iran was upbeat on Wednesday after talks with world powers about its nuclear work ended with an agreement to meet again, but Western officials said it had yet to take concrete steps to ease their fears about its atomic ambitions.

Rapid progress was unlikely with Iran's presidential election, due in June, raising domestic political tensions, diplomats and analysts had said ahead of the February 26-27 meeting in the Kazakh city of Almaty, the first in eight months.

The United States, China, France, Russia, Britain and Germany offered modest sanctions relief in return for Iran curbing its most sensitive nuclear work but made clear that they expected no immediate breakthrough.

In an attempt to make their proposals more palatable to Iran, the six powers appeared to have softened previous demands somewhat, for example regarding their requirement that the Islamic state ship out its stockpile of higher-grade uranium.

Iran's chief nuclear negotiator Saeed Jalili said the powers had tried to "get closer to our viewpoint", which he said was positive.

In Paris, U.S. Secretary of State John Kerry commented that the talks had been "useful" and that a serious engagement by Iran could lead to a comprehensive deal in a decade-old dispute that has threatened to trigger a new Middle East war.

Iran's foreign minister said in Vienna he was "very confident" an agreement could be reached and Jalili, the chief negotiator, said he believed the Almaty meeting could be a "turning point".

However, one diplomat said Iranian officials at the negotiations appeared to be suggesting that they were opening new avenues, but it was not clear if this was really the case.

Iran expert Dina Esfandiary of the International Institute for Strategic Studies said: "Everyone is saying Iran was more positive and portrayed the talks as a win."

"I reckon the reason for that is that they are saving face internally while buying time with the West until after the elections," she said.

The two sides agreed to hold expert-level talks in Istanbul on March 18 to discuss the powers' proposals, and return to Almaty for political discussions on April 5-6, when Western diplomats made clear they wanted to see a substantive response from Iran.

"Iran knows what it needs to do, the president has made clear his determination to implement his policy that Iran will not have a nuclear weapon," Kerry said.

A senior U.S. official in Almaty said, "What we care about at the end is concrete results."

ISRAELI WARNING

Israel, assumed to be the Middle East's only nuclear-armed power, was watching the talks closely. It has strongly hinted it might attack Iran if diplomacy and sanctions fail to ensure that it cannot build a nuclear weapon. Iran denies any such aim.

Israeli Prime Minister Benjamin Netanyahu said economic sanctions were failing and urged the international community to threaten Iran with military action.

Western officials said the offer presented by the six powers included an easing of a ban on trade in gold and other precious metals, and a relaxation of an import embargo on Iranian petrochemical products. They gave no further details.

In exchange, a senior U.S. official said, Iran would among other things have to suspend uranium enrichment to a fissile concentration of 20 percent at its Fordow underground facility and "constrain the ability to quickly resume operations there".

The official did not describe what was being asked of Iran as a "shutdown" of the plant as Western diplomats had said in previous meetings with Iran last year.

Iran says it has a sovereign right to enrich uranium for peaceful purposes, and wants to fuel nuclear power plants so that it can export more oil.

But 20-percent purity is far higher than that needed for nuclear power, and rings alarm bells abroad because it is only a short technical step away from weapons-grade uranium. Iran says it produces higher-grade uranium to fuel a research reactor.

Iran's growing stockpile of 20-percent-enriched uranium is already more than half-way to a "red line" that Israel has made clear it would consider sufficient for a bomb.

In Vienna on Wednesday, a senior U.N. nuclear agency official told diplomats in a closed-door briefing that Iran was technically ready to sharply increase this higher-grade enrichment, two Western diplomats said.

"Iran can triple 20 percent production in the blink of an eye," one of the diplomats said.

The U.S. official in Almaty said the powers' latest proposal would "significantly restrict the accumulation of near-20-percent enriched uranium in Iran, while enabling the Iranians to produce sufficient fuel" for their Tehran medical reactor.

This appeared to be a softening of a previous demand that Iran ship out its stockpile of higher-grade enriched uranium, which it says it needs to produce medical isotopes.

Iran has often indicated that 20-percent enrichment could be up for negotiation if it received the fuel from abroad instead.

Jalili suggested Iran could discuss the issue, although he appeared to rule out shutting down Fordow. He said the powers had not made that specific demand.

The Iranian rial, which has lost more than half its foreign exchange value in the last year as sanctions bite, rose some 2 percent on Wednesday, currency tracking websites reported.

(Additional reporting by Fredrik Dahl and Yeganeh Torbati in Almaty, Georgina Prodhan in Vienna, Zahra Hosseinian in Zurich, Gabriela Baczynska in Moscow, Dan Williams in Jerusalem and Marcus George in Dubai; Writing by Timothy Heritage and Fredrik Dahl; Editing by Louise Ireland)

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Batman to lose son Robin

NEW YORK: Batman may be able to save the world, but he'll lose his sidekick Robin -- who in his current incarnation as his son -- in the upcoming Batman Incorporated comic book series.

DC Comics said the caped crusader's acrobatic young assistant, Batman alter ego Bruce Wayne's son Damian, will die in Wednesday's issue number eight.

"This master theme of damaged and ruined families was nowhere more in evidence than in the creation of Damian, the first 'Son of Batman' to be acknowledged in the canon," series writer Grant Morrison said in a statement.

"In many ways this has been Damian's story as much as it has been the story of Bruce Wayne and it's a story that had its end planned a long time ago -- for what son could ever hope to replace a father like Batman, who never dies?"

The good news for those who might miss Robin is that this is the comics universe and characters who are killed can easily return. Even a previous incarnation of Robin was killed and resurrected before.

"You can never say never in a comic book," Morrison told the New York Post. "Batman will ultimately always have a partner."

-AFP/gn

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Amarnath Yatra registration from March 18

JAMMU: Jammu and Kashmir governor and chairman of Shri Amarnath Shrine Board, N N Vohra, on Tuesday reviewed the arrangements made for the Amarnath Yatra which is scheduled to take place from June 28- 21.

He was told that 422 branches of different banks spread across the nation will start registration for the Yatra from March 18.

The Board's CEO Navin Chaudhary briefed Vohra about all the measures taken for registration of Yatris on March 18 which will be managed through 422 outlets as compared to 276 provided last year. He further stated that 121 Branches of J&K Bank, 50 Branches of YES Bank, 101 Branches of State Bank of India, 100 Branches of Punjab National Bank and 50 Branches of HDFC Bank will be used for registration. The list of bank branches, application form and compulsory health certificate format and names of doctors have been uploaded on www.shriamarnathjishrine.com.

Vohra asked Chaudhary to issue clear advisories from time to time to Yatris about the requirements. He further asked him to meet Union Ministry of Information and Broadcasting, Doordarshan, and All India Radio officials to ensure an early launch of the awareness campaign.

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C. Everett Koop, 'rock star' surgeon general, dies

NEW YORK (AP) — Dr. C. Everett Koop has long been regarded as the nation's doctor— even though it has been nearly a quarter-century since he was surgeon general.

Koop, who died Monday at his home in Hanover, N.H., at age 96, was by far the best known and most influential person to carry that title. Koop, a 6-foot-1 evangelical Presbyterian with a biblical prophet's beard, donned a public health uniform in the early 1980s and became an enduring, science-based national spokesman on health issues.

He served for eight years during the Reagan administration and was a breed apart from his political bosses. He thundered about the evils of tobacco companies during a multiyear campaign to drive down smoking rates, and he became the government's spokesman on AIDS when it was still considered a "gay disease" by much of the public.

"He really changed the national conversation, and he showed real courage in pursuing the duties of his job," said Chris Collins, a vice president of amfAR, the Foundation for AIDS Research.

Even before that, he had been a leading figure in medicine. He was one of the first U.S. doctors to specialize in pediatric surgery at a time when children with complicated conditions were often simply written off as untreatable. In the 1950s, he drew national headlines for innovative surgeries such as separating conjoined twins.

His medical heroics are well noted, but he may be better remembered for transforming from a pariah in the eyes of the public health community into a remarkable servant who elevated the influence of the surgeon general — if only temporarily.

"He set the bar high for all who followed in his footsteps," said Dr. Richard Carmona, who served as surgeon general a decade later under President George W. Bush.

Koop's religious beliefs grew after the 1968 death of his son David in a mountain-climbing accident, and he became an outspoken opponent of abortion. His activism is what brought him to the attention of the administration of President Ronald Reagan, who decided to nominate him for surgeon general in 1981. Though once a position with real power, surgeon generals had been stripped of most of their responsibilities in the 1960s.

By the time Koop got the job, the position was kind of a glorified health educator.

But Koop ran with it. One of his early steps involved the admiral's uniform that is bestowed to the surgeon general but that Koop's predecessors had worn only on ceremonial occasions. In his first year in the post, Koop stopped wearing his trademark bowties and suit jackets and instead began wearing the uniform, seeing it as a way to raise the visual prestige of the office.

In those military suits, he surprised the officials who had appointed him by setting aside his religious beliefs and feelings about abortion and instead waging a series of science-based public health crusades.

He was arguably most effective on smoking. He issued a series of reports that detailed the dangers of tobacco smoke, and in speeches began calling for a smoke-free society by the year 2000. He didn't get his wish, but smoking rates did drop from 38 percent to 27 percent while he was in office — a huge decline.

Koop led other groundbreaking initiatives, but perhaps none is better remembered than his work on AIDS.

The disease was first identified in 1981, before Koop was officially in office, and it changed U.S. society. It destroyed the body's immune system and led to ghastly death, but initially was identified in gay men, and many people thought of it as something most heterosexuals didn't have to worry about.

U.S. scientists worked hard to identify the virus and work on ways to fight it, but the government's health education and policy efforts moved far more slowly. Reagan for years was silent on the issue. Following mounting criticism, Reagan in 1986 asked Koop to prepare a report on AIDS for the American public.

His report, released later that year, stressed that AIDS was a threat to all Americans and called for wider use of condoms and more comprehensive sex education, as early as the third grade. He went on to speak frankly about AIDS in an HBO special and engineered the mailing of an educational pamphlet on AIDS to more than 100 million U.S. households in 1988.

Koop personally opposed homosexuality and believed sex should be saved for marriage. But he insisted that Americans, especially young people, must not die because they were deprived of explicit information about how HIV was transmitted.

Koop's speeches and empathetic approach made him a hero to a wide swath of America, including public health workers, gay activists and journalists. Some called him a "scientific Bruce Springsteen." AIDS activists chanted "Koop, Koop" at his appearances and booed other officials.

"I was walking down the street with him one time" about five years ago, recalled Dr. George Wohlreich, director of the College of Physicians of Philadelphia, a medical society with which Koop had longstanding ties. "People were yelling out, 'There goes Dr. Koop!' You'd have thought he was a rock star."

Koop angered conservatives by refusing to issue a report requested by the Reagan White House, saying he could not find enough scientific evidence to determine whether abortion has harmful psychological effects on women.

He got static from some staff at the White House for his actions, but Reagan himself never tried to silence Koop. At a congressional hearing in 2007, Koop spoke about political pressure on the surgeon general post. He said Reagan was pressed to fire him every day.

After his death was reported Monday, the tributes poured forth, including a statement from New York Mayor Michael Bloomberg, who has made smoking restrictions a hallmark of his tenure.

"The nation has lost a visionary public health leader today with the passing of former Surgeon General C. Everett Koop, who was born and raised in Brooklyn," Bloomberg said. "Outspoken on the dangers of smoking, his leadership led to stronger warning labels on cigarettes and increased awareness about second-hand smoke, creating an environment that helped millions of Americans to stop smoking — and setting the stage for the dramatic changes in smoking laws that have occurred over the past decade."

Dr. Anthony Fauci of the National Institutes of Health taught Koop what was known about AIDS during quiet after-hours talks in the early 1980s and became a close friend.

"A less strong person would have bent under the pressure," Fauci said. "He was driven by what's the right thing to do."

Carmona, a surgeon general years later, said Koop was a mentor who preached the importance of staying true to the science in speeches and reports — even when it made certain politicians uncomfortable.

"We remember him for the example he set for all of us," Carmona said.

Koop's nomination originally was met with staunch opposition. Women's groups and liberal politicians complained Reagan had selected him only because of his conservative views, especially his staunch opposition to abortion.

Foes noted that Koop traveled the country in 1979 and 1980 giving speeches that predicted a progression "from liberalized abortion to infanticide to passive euthanasia to active euthanasia, indeed to the very beginnings of the political climate that led to Auschwitz, Dachau and Belsen."

But Koop, a devout Presbyterian, was confirmed as surgeon general after he told a Senate panel he would not use the post to promote his religious ideology. He kept his word and eventually won wide respect with his blend of old-fashioned values, pragmatism and empathy.

Koop was modest about his accomplishments, saying before leaving office in 1989, "My only influence was through moral suasion."

The office declined after that. Few of his successors had his speaking ability or stage presence. Fewer still were able to secure the support of key political bosses and overcome the meddling of everyone else. The office gradually lost prestige and visibility, and now has come to a point where most people can't name the current surgeon general. (It's Dr. Regina Benjamin.)

Even after leaving office, Koop continued to promote public health causes, from preventing childhood accidents to better training for doctors.

"I will use the written word, the spoken word and whatever I can in the electronic media to deliver health messages to this country as long as people will listen," he promised.

In 1996, he rapped Republican presidential hopeful Bob Dole for suggesting that tobacco was not invariably addictive, saying Dole's comments "either exposed his abysmal lack of knowledge of nicotine addiction or his blind support of the tobacco industry."

He maintained his personal opposition to abortion. After he left office, he told medical students it violated their Hippocratic oath. In 2009, he wrote to Senate Majority Leader Harry Reid, urging that health care legislation include a provision to ensure doctors and medical students would not be forced to perform abortions. The letter briefly set off a security scare because it was hand delivered.

Koop served as chairman of the National Safe Kids Campaign and as an adviser to President Bill Clinton's health care reform plan.

Worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, Koop opened an institute at Dartmouth College in New Hampshire to teach medical students basic values and ethics. He also was a part-owner of a short-lived venture, drkoop.com, to provide consumer health care information via the Internet.

Koop was the only son of a Manhattan banker and the nephew of a doctor. He said by age 5 he knew he wanted to be a surgeon and at age 13 he practiced his skills on neighborhood cats. He attended Dartmouth, where he received the nickname Chick, short for "chicken Koop." It stuck for life.

He received his medical degree at Cornell Medical College, choosing pediatric surgery because so few surgeons practiced it. In 1938, he married Elizabeth Flanagan, the daughter of a Connecticut doctor. They had four children. Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was appointed surgeon-in-chief at Children's Hospital in Philadelphia and served as a professor at the University of Pennsylvania School of Medicine. He pioneered surgery on newborns and successfully separated three sets of conjoined twins. He won national acclaim by reconstructing the chest of a baby born with the heart outside the body.

Although raised as a Baptist, he was drawn to a Presbyterian church near the hospital, where he developed an abiding faith. He began praying at the bedside of his young patients — ignoring the snickers of some of his colleagues.

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Contributing to this report were Associated Press writers Wilson Ring in Montpelier, Vt.; Jeff McMillan in Philadelphia; and AP Medical Writer Lauran Neergaard in Washington.

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