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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IHT Rendezvous: IHT Quick Read: Feb. 28

NEWS Miguel Díaz-Canel Bermúdez, 52, the top contender to succeed the Castros in Cuba, will need to display the authority of a future president while acting as if he does not want the job. Damien Cave reports from Mexico City.

In the waning hours of his troubled tenure, tens of thousands of believers gathered in St. Peter’s Square for Pope Benedict XVI’s valedictory address. Daniel J. Wakin reports from Vatican City.

The former mayor of Greece’s second city, Salonika, and two of his top aides were sentenced to life in prison on Wednesday after being found guilty of embezzling almost €18 million, or $23.5 million, in public money — a rare conviction in a case involving the political corruption that has contributed to the country’s dysfunction and economic decline. Niki Kitsantonis reports from Athens.

After Lars Hedegaard, a Danish polemicist, faced an attack for his anti-Islamic views, Muslim groups rallied to defend his right to free speech. Andrew Higgins reports from Copenhagen.

Islamic bonds, or sukuk, have long been popular with investors in the Middle East. Now they are being discovered in Europe and the United States. Sara Hamdan reports from Dubai.

The European Commission on Wednesday blocked the third attempt by Ryanair to acquire Aer Lingus, saying a union of the two Irish airlines would damage competition and raise prices on air routes to Ireland. James Kanter reports from Brussels.

At the Mobile World Congress, the industry’s largest convention in Europe, Samsung appears to be taking a page from Apple. Kevin J. O’Brien reports from Barcelona.

FASHION Fifteen years after much of its fashion manufacturing left for cheaper markets, Spain is trying to rebuild the sector and train new craftsmen. Raphael Minder reports from Madrid.

ARTS Van Cliburn, the American pianist whose first-place award at the 1958 International Tchaikovsky Competition in Moscow made him an overnight sensation and propelled him to a phenomenally successful and lucrative career, though a short-lived one, died on Wednesday at his home in Fort Worth, Texas. He was 78. Anthony Tommasini reports.

Giuseppe De Nittis was an original and innovative force and responsible for evocative images, persuasively demonstrated by an exhibition of 118 of his works in Italy. Roderick Conway Morris reviews from Padua, Italy.

SPORTS Real Madrid beat its archrival, 3-1, in Barcelona, less than a week after the Catalan club lost in the Champions League. Rob Hughes reports from Barcelona.

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Debbie Reynolds: Carrie Fisher Will Be 'Just Fine' After Hospitalization

By Elaine Aradillas

02/28/2013 at 08:40 AM EST

Carrie Fisher (left) and Debbie Reynolds

Ethan Miller/Getty

Carrie Fisher was briefly hospitalized last week for her bipolar disorder after a bizarre performance aboard a cruise ship, but her mother Debbie Reynolds says she'll be fine.

"She's had manic depression bipolar since she was 13. It's an illness, and she's doing much better," Reynolds told PEOPLE exclusively Wednesday night. "I'm very proud of her, and she's doing exceptionally well. She'll be just fine, just great, and continue her writing as she always does."

Fisher, 56, who has spoken openly about her mental illness, performed on the Holland American cruise liner Eurodam in the Caribbean. The actress and author gave a rambling performance, leaving many in the audience wondering what was wrong.

"She clearly had trouble remembering things," says Chris Smith, a guest on the cruise. "She tried to tell some stories about her parents and Hollywood, but was having a hard time."

After a video of the performance went viral, her publicist released the following statement: "There was a medical incident related to Carrie Fisher's bipolar disorder. She went to the hospital briefly to adjust her medication and is feeling much better now."

Reynolds, 80, who spoke Wednesday to a sold-out audience attending the Rancho Mirage Lecture Series at Eisenhower Medical Center in Rancho Mirage, Calif., talked about the effects of mental illness.

"[It's] really dreadful, and you are so alone because you're criticized, and people think you're doing it on purpose, and that you're misbehaving or having a spell because you want attention," she says. "It's not true. It's extremely difficult for everyone to deal with."

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Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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On the Web:

The OIG report: http://1.usa.gov/VaztQm

The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1

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Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

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Prince Harry Dances, Cooks with Kids In South Africa

By Simon Perry

02/27/2013 at 08:30 AM EST

Prince Harry, at Lesotho's St. Bernadette's Centre for the Blind

Chris Jackson/Getty

From the slopes of the Alps to the southern African mountain kingdom of Lesotho, Prince Harry is now giving back.

Just returned from his skiing holiday with girlfriend Cressida Bonas, Harry is spending a couple of days in Africa, to work with the Sentebale charity he set up with Lesotho's Prince Seeiso.

Early Wednesday, the Prince, 28, visited the Kananelo Center for the Deaf just outside the capital Maseru, where he was welcomed with a huge "Hi Harry" sign on the chalkboard.

As he attempted to learn some sign language from the children, he quipped to his friend Seeiso, "I'm never going to get this right."

The two princes, who set up the charity (Sentebale means "Forget Me Not") in honor of their late mothers, were then taken to the school's kitchen, where Harry slipped on a purple apron decorated with teddy bears before they tried their hand at making Sotho sweet bread cooked in boiling oil – also known as "fat cakes."

They also got down on their knees to join the kids in a dance.

Following that visit, the pair headed to St. Bernadette's School for the Blind in the capital, Maseru. There, Harry was welcomed with a song sung in the Sesotho language.

The charity supports tens of thousands of children who are either suffering from HIV/Aids, have been orphaned, or have disabilities.

Later, he is to be guest of honor at a fundraising dinner in Johannesburg.

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Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

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Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

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Stock futures little changed as market awaits Bernanke, data

NEW YORK (Reuters) - Stock index futures were little changed on Wednesday as investors awaited a second round of testimony in Congress by Federal Reserve Chairman Ben Bernanke for signs of whether the Fed will continue its economic stimulus program.

Economic data was also in focus with U.S. durables goods and homes data due out at 8:30 a.m. ET (1330) GMT and 10:00 a.m. ET (1500 GMT), respectively.

Bernanke will make his second appearance before the Financial Services Committee at 10:00 a.m. ET (1500 GMT).

"Of course, Bernanke is in the spotlight again but I don't expect him to vary from his comments from yesterday," said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

A day earlier, Bernanke strongly defended the Fed's monetary stimulus efforts before Congress, easing financial market worries over an early retreat from the Fed's bond buying program, which had been triggered by minutes of the Fed's January meeting released a week ago.

His remarks, along with data showing sales of new homes hit a 4 1/2-year high, helped U.S. stocks rebound Tuesday from their worst decline since November.

Despite the bounce, the S&P 500 was unable to move back above 1,500, a closely watched level that had been technical support until recently, but may now prove a resistance point.

The benchmark S&P 500, up 6 percent for the year, was within reach of record highs a week ago before the minutes from the Fed's January meeting were released. Since then, the index has shed 1 percent as the minutes raised questions about the longevity of the Fed's economy-stimulating measures.

S&P 500 futures rose 2.1 points and were in line with fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures fell 1 points while Nasdaq 100 futures added 4 points.

In earnings news, Target Corp posted a lower quarterly profit as sales of food and value-priced items only partially mitigated weakness in holiday spending. The stock fell 1.7 percent to $62.99 in premarket trading.

Dollar Tree Inc reported a higher quarterly profit as the chain controlled costs and as consumer spending improved. The stock rose 4.5 percent to $42.91 in premarket trading.

In Europe, shares rose, steadying after the previous session's sharp losses, though jitters over the euro zone kept a lid on gains.

Italy's 10-year debt costs rose more than half a percentage point at the first longer-term auction since an inconclusive parliamentary election, although they remained below the psychologically important level of 5 percent.

(Editing by Bernadette Baum)

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British Media to Challenge Secrecy Bid in Litvinenko Case

The British Broadcasting Corporation said it and other news organizations would oppose an effort on Tuesday by the British government to limit information disclosed to the planned inquest into the death of Alexander V. Litvinenko, a former officer in the KGB who died of radiation poisoning in London more than six years ago.

The BBC reported that the government had planned to apply for a so-called Public Interest Immunity certificate, usually issued on the grounds of national security that would prevent the inquest from hearing information on topics which have not been made public.

The authorities’ resistance to full disclosure may force a postponement in the scheduled May 1 start date for the inquest, which would be the first — and likely the only — forum for sworn testimony about the killing, according to a lawyer for Mr. Litvinenko’s widow, Marina Litvinenko.

The lawyer, Ben Emmerson, complained on Tuesday that the preparations for the inquest were becoming “bogged down” by “the government’s attempt to keep a lid on the truth.”

“It is the government’s secret files that are delaying this inquest,” he said, according to the Press Association news agency, which also quoted the coroner, Sir Robert Owen, as saying on Tuesday that “due to the complexity of the investigation which necessarily precedes the hearings” the schedule for the inquest to begin on May 1 “may be a timetable to which it may not be possible to adhere.”

The Guardian newspaper, which is also opposing the government’s effort to restrict evidence, said that it would argue that “the public and media are faced with a situation where a public inquest into a death may have large amounts of highly relevant evidence excluded from consideration by the inquest. Such a prospect is deeply troubling.”

But the Foreign Office said the authorities had made their application in line with their “duty to protect national security and the coroner would rule according to “the overall public interest.”

The case has strained ties between Britain and Russia, reviving memories of the cold war.

Mr. Litvinenko, who styled himself a whistle-blower and foe of the Kremlin, died in November, 2006, weeks after he secured British citizenship. He had fled from Russia to Britain in 2000.

Britain’s Crown Prosecution is seeking the extradition from Russia of Andrei K. Lugovoi, another former KGB officer, to face trial on murder charges. Mr. Lugovoi denies the accusation and Russia says its constitution forbids it from sending its citizens to other countries to face trial.

At a hearing in December in advance of the inquest, which is to start on May 1, Mr. Emmerson, the lawyer representing Marina Litvinenko, said that Mr. Litvinenko was a “registered and paid agent and employee of MI6, with a dedicated handler whose pseudonym was Martin.”

Mr. Litvinenko also worked for the Spanish intelligence service, Mr. Emmerson said, and both the British and Spanish spy agencies made payments into a joint account with his wife. The lawyer added that the inquest should consider whether MI6 failed in its duty to protect him against a “real and immediate risk to life.”

The BBC said Marina Litvinenko would also oppose the British government’s effort to limit information about its knowledge of her husband’s death.

The coroner has said in previous hearings that he will examine what was known about threats to Mr. Litvinenko and would also seek to determine whether the Russian state bore responsibility. In a deathbed statement, Mr. Litvinenko directly blamed President Vladimir V. Putin, who dismissed the accusation.

Russian state prosecutors are expected to be represented at the inquest. Moscow has denied British suggestions that it may have been involved in killing Mr. Litvinenko, who died after ingesting polonium 210 — a rare radioactive isotope — at the Pine Bar of the Millennium Hotel in central London.

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Charlize Theron & Channing Tatum's Oscars Dance - No Practice Makes Perfect!

By Oliver Jones and Tim Nudd

02/26/2013 at 08:35 AM EST

Channing Tatum and Charlize Theron

Getty

Who knew Charlize Theron could dance? Or that Channing Tatum could do so with his clothes on?

Together they wowed the Academy Awards on Sunday, performing a challenging ballroom dance in front of 40 million viewers – each counting on their background in dance to make up for a frightening lack of rehearsal time.

"They were going to cram and rehearse constantly over two days [right before the Oscars]. But then they both simultaneously got the flu," producer Neil Meron tells PEOPLE.

"We were going, 'Oh my God.' Literally at the last minute they got to rehearse and miraculously got up there and they killed."

It helped that both know a little something about dance.

Theron, 37, studied at the Joffrey Ballet School in New York before embarking on her Oscar-winning acting career. "We reached out to Charlize first, and there was no hesitation. She absolutely jumped on board," says Meron.

Tatum, 32, was less sure of himself, despite loads of dance experience in movies like Step Up and Magic Mike, the latter loosely based on his own experiences as a male stripper.

"Chan said to us, 'Look, I have danced in all these movies, but I have never really done honest-to-God choreography. I don't know that I can do that,' " Meron says. "We told him, 'We believe you are a great dancer, and that you will be able to do it.' He said he would give it a try."

In the end, they dazzled with a Fred Astaire and Ginger Rogers style number choreographed by Rob Ashford.

And Chan even kept his tux on.

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Koop, who transformed surgeon general post, dies

With his striking beard and starched uniform, former Surgeon General Dr. C. Everett Koop became one of the most recognizable figures of the Reagan era — and one of the most unexpectedly enduring.

His nomination in 1981 met a wall of opposition from women's groups and liberal politicians, who complained President Ronald Reagan selected Koop, a pediatric surgeon and evangelical Christian from Philadelphia, only because of his conservative views, especially his staunch opposition to abortion.

Soon, though, he was a hero to AIDS activists, who chanted "Koop, Koop" at his appearances but booed other officials. And when he left his post in 1989, he left behind a landscape where AIDS was a top research and educational priority, smoking was considered a public health hazard, and access to abortion remained largely intact.

Koop, who turned his once-obscure post into a bully pulpit for seven years during the Reagan and George H.W. Bush administrations and who surprised both ends of the political spectrum by setting aside his conservative personal views on issues such as homosexuality and abortion to keep his focus sharply medical, died Monday at his home in Hanover, N.H. He was 96.

An assistant at Koop's Dartmouth College institute, Susan Wills, confirmed his death but didn't disclose its cause.

Dr. Richard Carmona, who served as surgeon general a decade ago under President George W. Bush, said Koop was a mentor to him and preached the importance of staying true to the science even if it made politicians uncomfortable.

"He set the bar high for all who followed in his footsteps," Carmona said.

Although the surgeon general has no real authority to set government policy, Koop described himself as "the health conscience of the country" and said modestly just before leaving his post that "my only influence was through moral suasion."

A former pipe smoker, Koop carried out a crusade to end smoking in the United States; his goal had been to do so by 2000. He said cigarettes were as addictive as heroin and cocaine. And he shocked his conservative supporters when he endorsed condoms and sex education to stop the spread of AIDS.

Chris Collins, a vice president of amFAR, the Foundation for AIDS Research, said many people don't realize what an important role Koop played in the beginning of the AIDS epidemic.

"At the time, he really changed the national conversation, and he showed real courage in pursuing the duties of his job," Collins said.

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."

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

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 after he told a Senate panel he would not use the surgeon general's post to promote his religious ideology. He kept his word.

In 1986, he issued a frank report on AIDS, urging the use of condoms for "safe sex" and advocating sex education as early as third grade.

He also maneuvered around uncooperative Reagan administration officials in 1988 to send an educational AIDS pamphlet to more than 100 million U.S. households, the largest public health mailing ever.

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 further 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.

Koop maintained his personal opposition to abortion, however. 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.

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, but Reagan would not interfere.

Koop, worried that medicine had lost old-fashioned caring and personal relationships between doctors and patients, opened his institute at Dartmouth 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 born in the New York City borough of Brooklyn, 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.

Koop 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, one of whom died in a mountain climbing accident when he was 20.

Koop 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.

Koop's wife died in 2007, and he married Cora Hogue in 2010.

He was by far the best-known surgeon general and for decades afterward was still a recognized personality.

"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."

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Ring reported from Montpelier, Vt. Cass reported from Washington. AP Medical Writers Lauran Neergaard in Washington and Mike Stobbe in New York contributed to this report.

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