With record highs in sight, stocks face roadblocks

NEW YORK (Reuters) - If Wall Street needs to climb a wall of worry, it will have plenty of opportunity next week.

Major U.S. stock indexes will make another attempt at reaching all-time records, but the fitful pace that has dominated trading is likely to continue. Next Friday's unemployment report and the hefty spending cuts that look like they about to take effect will be at the forefront.

The importance of whether equities can reach and sustain those highs is more than Wall Street's usual fixation on numbers with psychological significance. Breaking through to uncharted territory is seen as a test of investors' faith in the rally.

"It's very significant," said Bucky Hellwig, senior vice president at BB&T Wealth Management in Birmingham, Alabama.

"The thinking is, there's just not enough there for an extended bull run," he said. "If we do break through (record highs), then maybe the charts and price action are telling us there's something better ahead."

Flare-ups in the euro zone's sovereign debt crisis and next Friday's report on the U.S. labor market could jostle the market, though U.S. job indicators have generally been trending in a positive direction.

Small- and mid-cap stocks hit lifetime highs in February. Now the Dow Jones industrial average <.dji> and the S&P 500 <.spx> are racing each other to the top. The Dow, made up of 30 stocks, is about 75 points - less than 1 percent - away from its record close of 14,164.53, which it hit on October 9, 2007. The broader S&P is still 3 percent away from its closing high of 1,565.15, also reached on October 9, 2007.

The advantage may be in the Dow's court. So far in 2013, it has gained 7.5 percent, beating the S&P 500 by about 1 percent.

THE RALLY AND THE REALITY CHECK

The Dow's relative strength owes much to its unique make-up and calculation, as well as to investors' recent preference for buying value stocks likely to generate steady reliable gains, rather than growth stocks.

But the more defensive stance illustrates how stock buyers are getting concerned about this year's rally. While investors don't want to miss out on gains, they're picking up companies that are less likely to decline as much as high-flying names - if a market correction comes.

The Russell Value Index <.rav> is up 7.6 percent for the year so far, outpacing the Russell Growth Index's <.rag> 5.7 percent rise. Within the realm of the S&P 500, the consumer staples sector led the market in February, gaining 3.1 percent.

There is some concern that growth-oriented names are being eclipsed by defensive bets, said Ryan Detrick, senior technical strategist at Schaeffer's Investment Research in Cincinnati.

"This isn't a be-all and end-all sell signal by any means, but we would feel much more comfortable if some of the more aggressive areas, like technology and small caps, would start to gain some leadership here," Detrick said.

Signs that investors are becoming concerned about the rally's pace is evident in the options market, where the ratio of put activity to call activity has recently shifted in favor of puts, which represent expectations for a stock to fall.

"We are seeing some put hedging in the financials, building up for the past month," said Henry Schwartz, president of options analytics firm Trade Alert in New York.

The put-to-call ratio representing an aggregate of about 562 financial stocks is 1:1, when normally, calls should be outnumbering puts.

Investors have no shortage of reasons to crave the relative safety of blue chips and defensive stocks. Although markets have mostly looked past uncertainty over Washington's plans to cut the deficit, fiscal policy negotiations still pose a risk to equities.

The $85 billion in spending cuts set to begin on Friday is expected to slow economic growth this year if policymakers do not reach a new deal. Markets so far have held firm despite the wrangling in Washington, but tangible economic effects could pinch stock prices going forward.

The International Monetary Fund warned that full implementation of the cuts would probably take at least 0.5 percentage point off U.S. growth this year.

EASY MONEY AND TEPID HIRING

Investors will also take in a round of economic data at a time when concerns are percolating that the market is being pushed up less by fundamentals and more by loose monetary policy around the world.

The main economic event will be Friday's non-farm payrolls report for February. The U.S. economy is expected to have added 160,000 jobs last month, only a tad higher than in January, in a sign the labor market is healing at a slow pace. The U.S. unemployment rate is forecast to hold steady at 7.9 percent.

While lackluster data has been a catalyst in the past for stock market gains as investors bet it would ensure continued stimulus from the Federal Reserve, that sentiment may be wearing thin.

Markets stumbled last week following worries that the Fed might wind down its quantitative easing program sooner than expected.

"It shows the underpinning of the market is being driven at this point by monetary policy," Hellwig said.

With investors questioning what is behind the rally, it will make a run to record highs even more significant, Hellwig added.

"There's smart people that are in the bull camp and the bear camp and the muddle-through camp," Hellwig said. "The fact that you can statistically, using historical evidence, make a case for going higher, lower, or staying the same makes this number very important this time around."

(Wall St Week Ahead runs every Friday. Comments or questions on this column can be emailed to: leah.schnurr(at)thomsonreuters.com)

(Reporting by Leah Schnurr; Additional reporting by Doris Frankel in Chicago; Editing by Jan Paschal)

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World Briefing | Europe: Ireland: Suspect in Terrorism Case Faces Extradition to U.S.

The United States government has petitioned the Irish High Court to extradite an Algerian man living in Ireland on terrorism charges relating to a plot to assassinate a Swedish artist, officials said Thursday. The United States alleges that the man, Ali Charaf Damache, planned to set up terrorist training camps and kill several Europeans, including a Swedish artist, Lars Vilks, whose sketch of the Prophet Muhammad’s head on a dog, published in 2007, had enraged the Islamic world. On Wednesday, Mr. Damache pleaded guilty in the Waterford Circuit Court to making a menacing phone call to an American peace activist, a charge for which he was arrested and detained in 2010. The judge sentenced him to time served and released him, but Mr. Damache was immediately rearrested on the American extradition warrant. Mr. Damache arrived in Ireland in 2000 and married an Irish woman in 2002. The relationship ended in 2008 and he then married an American citizen, Jamie Paulin Ramirez. Ms. Ramirez has pleaded guilty in the United States to charges of conspiring with Colleen LaRose, also known as Jihad Jane, to support and train terrorists.

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The 5 Most Infamous Oscar Dress Mishaps

From Anne Hathaway's controversial Prada swap to Natalie Portman's Dior diss, see how stars have created fashion drama on the red carpet

Credit: Steve Granitz/WireImage

Updated: Wednesday Feb 27, 2013 | 03:25 PM EST
By: Kate Hogan

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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: Eve Best Returns to the Globe, This Time as a Director

LONDON — The recent press conference announcing the 2013 season at Shakespeare’s Globe on one level seemed like variations on an ongoing theme.

A onetime Falstaff at this address, Roger Allam, is returning to open the season as Prospero in “The Tempest,” directed by Jeremy Herrin, while the perennial favorite, “A Midsummer Night’s Dream,” will be seen in May in a new staging, this time from the Globe’s artistic director, Dominic Dromgoole. The 2011 Olivier winner Michelle Terry (“Tribes”) will play Titania.

The international season that so galvanized the space for six weeks last spring will return in a greatly pared-down form, and there will be three new plays, including one, “Blue Stockings” by Jessica Swale, that tells of the first female students at Cambridge University.

But it’s the last in the trio of supernaturally charged Shakespeares that promises to break fresh theatrical ground. In what represents her first-ever stab (you’ll forgive the word in context) at directing, the much-laureled actress Eve Best will stage a new production in June of “Macbeth.” Joseph Millson and Samantha Spiro have signed on as the murderous couple at the play’s black, bleak heart.

What prompted one of the most accomplished stage performers of her generation (an actress with an Olivier Award and two Tony nominations) to make the shift? The answer was arrived at via a lengthy phone call to a remote island in Denmark, where Ms. Best, 41, is currently filming “Someone You Love” for the director Lars von Trier’s Zentropa production group. This film’s specific director is Pernille Fischer Christensen.

To hear Ms. Best describe it, she thought her time at the Globe was finished, at least for a while, following a triumphant 2011 production of “Much Ado About Nothing” in which she played Beatrice opposite Charles Edwards’s no less witty and scintillating Benedick. (That staging opened within days of a contrasting commercial production of the same play, with David Tennant and Catherine Tate, and trumped its starrier competitor hands down.)

“I love the Globe so much,” Ms. Best recalled, “and wanted any excuse to spend some time there, having played Beatrice which was just my most favorite part ever. But I did think I was sort of running out of parts to play for a little while until I get into the world of Cleopatra and those kinds of parts” — that’s to say, Shakespeare’s more senior women.

But all that was before Mr. Dromgoole surprised Ms. Best with an offer to take on the directing of the Shakespeare tragedy in which she had made her Globe debut in 2001, opposite Jasper Britton.

“I put myself forward to direct something thinking that they might say yes in a couple of years and that if they did say yes they might start me off with something light or something simpler or more obscure,” she said.

“I was not prepared for them to turn around and say, ‘Yes, all right, and what about “Macbeth?”’ Ms. Best continued, delight evident in her voice. “It took me back. My first response was: ‘Absolutely no way; you must be kidding!’”

The play is particularly challenging at the Globe. Open to the elements, the theater is a tricky fit for a text suffused with darkness, and it can be hard to focus the gathering intensity of the Macbeths’ toxic rise and fall.

“We are in the broad daylight and the open air,” Ms. Best acknowledged, “and that particular circular shape is certainly going to have a significant effect on the kind of production ours is. We can’t set it in the dark with candles, so we just have to embrace what it is that the Globe will give us: I’m very interested in just seeing the play as clearly as we possibly can and focusing on the human relationships within it.”

Mr. Dromgoole for his part said he thought Ms. Best would be able to meet the play head-on without lots of additional mumbo jumbo. “I wanted someone who I thought could just let [“Macbeth”] play itself rather than forcing it down a tunnel of darkness.”

As it happens, Ms. Best has firsthand knowledge of both central roles. In addition to acting Lady Macbeth at the Globe, she participated in workshops of the play in New York with the Scottish actor Alan Cumming in which she played the title role opposite Mr. Cumming’s Lady. Mr. Cumming is soon to open his own solo take on the play on Broadway.

(For those collecting “Macbeths,” the West End is now hosting the film actor James McAvoy in a modern-dress, gory, commendably visceral version. That one, at the Trafalgar Studios, will have finished roughly two months before Ms. Best’s begins.)

“What’s really lovely about this play — and all Shakespeare plays obviously — is that they are so magnificently and eminently flexible,” said Ms. Best, who was sounding in no way deterred by other productions arriving before hers. “They can encompass 6 or 8 or 10 productions all going on at the same time, all equally fascinating, all equally interesting, with all kinds of different approaches.”

Nor was she sounding spooked by a famously hexed play that has on occasion brought disaster in its wake. Whereas theater lore, for instance, often insists that those involved with this text refer to it as “the Scottish play,” Ms. Best was having none of that.

“I’ve been saying it like mad,” she said. “If we’re going to be working on it for two months, life’s too short to be worried.”

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Billie Joe Armstrong Comes Clean About Rehab

By Kevin O'Donnell

02/27/2013 at 08:00 PM EST

Last September, Billie Joe Armstrong made headlines when, during his band Green Day's performance at the I Heart Radio Music Festival in Las Vegas, the rocker unleashed a profanity-laced tirade that took aim at everyone from the concert's promoter, Clear Channel, to Justin Bieber.

The meltdown forced Armstrong to enter an outpatient rehab program for a month and in the latest issue of Rolling Stone, the frontman, who turned 41 this month, reveals his struggle to get sober.

"I'm a blackout drinker," he reveals. "That's basically what happened [that night]."

Leading up to that infamous performance, Armstrong was struggling with a dependence on pills for anxiety and insomnia, combined with a heavy drinking problem. After the concert, he agreed to enter an outpatient rehab program for a month.

Although he declines to specify what type of medications he was taking, he tells the magazine, "I started combining them to a point where I didn't know what I was taking during the day and what I was taking at night. It was just this routine. My backpack sounded like a giant baby rattle [from all of the bottles inside]."

Armstrong, who has been married to wife Adrienne since 1994 and has two sons, Joseph and Jakob, also reveals how hard it was to go through withdrawal.

"That was gruesome, laying on the bathroom floor and just feeling like ... [pauses] I didn't realize how much of that stuff affected me." He also opens up about the toll it took on his family: "I kept [the withdrawal] away from my sons pretty good ... [And my wife] knew the deal. I'm sure it was rough for her to see me going through this."

Now, the musician insists he's on the mend and no longer drinking. "I want to put on good shows," says Armstrong, who will resume touring with Green Day on March 10 in Pomona, Calif. "I want to be reliable." 

Armstrong also admits maintaining his sobriety will be a challenge. "There is still the obsession for alcohol," he says. "There's also sleepless nights. But I have to work on it every day. Because I know what goes on out there … I've got to watch my step."

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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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News Analysis: Now Gathering in Rome, a Conclave of Fallible Cardinals

Dmitry Lovetsky/Associated Press

St. Peter’s Basilica on Tuesday. Roman Catholic cardinals were gathering at the Vatican amid scandal to choose a new pope.

The sudden resignation of the most senior Roman Catholic cardinal in Britain, who stepped aside on Monday in the face of accusations that he made unwanted sexual advances toward priests years ago, showed that the taint of scandal could force a cardinal from participating in the selection of a new pope.

His exit came as at least a dozen other cardinals tarnished with accusations that they failed to remove priests accused of sexually abusing minors were among those gathering in Rome to prepare for the conclave to select a successor to Pope Benedict XVI. There was no sign that the church’s promise to confront the sexual abuse scandal had led to direct pressure on those cardinals to exempt themselves from the conclave.

Advocates for abuse victims who were in Rome on Tuesday focused particular ire on Cardinal Roger M. Mahony, the former archbishop of Los Angeles, and called for him to be excluded from the conclave. But Cardinal Mahony, who has vigorously defended his record, was already in Rome, posting on Twitter about the weather.

Even stalwart defenders of the church point out that to disqualify Cardinal Mahony would leave many more cardinals similarly vulnerable. Many of the men who will go into the Sistine Chapel to elect a pope they hope will help the church recover from the bruising scandal of sexual abuse have themselves been blemished by it.

“Among bishops and cardinals, certainly the old guys who have been involved for so long, sure they’re going to have blood on their hands,” said Thomas G. Plante, a professor of psychology at Santa Clara University, who has served on the American bishops’ national abuse advisory board and has written three books on sexual abuse. “So when Cardinal Mahony says he’s being scapegoated, in some respects I think he’s right. All the focus is on him, but what about the other guys?”

Among the many challenges facing the church, addressing the wounds caused by sexual abuse is among the top priorities, church analysts say. When Pope Benedict was elected in 2005, many Catholics hoped that his previous experience at the helm of the Vatican office that dealt with abuse cases would result in substantive changes.

Benedict has repeatedly apologized to victims, and listened personally to their testimonies of pain. After the abuse scandal paralyzed the church in Europe in 2010, and began to emerge on other continents, Benedict issued new policies for bishops to follow on handling sexual abuse accusations, and he held a conference at the Vatican on the issue. But despite calls from many Catholics, he never removed prelates who, court cases and documents revealed, put children at risk by failing to report pedophiles or remove them from the priesthood.

It is not that these cardinals behaved so differently from the others, or that they do not have achievements to their names. It is just that they happened to come from pinpoints on the Catholic world map where long-hidden secrets became public because victims organized, government officials investigated, lawyers sued or the news media paid attention.

They include cardinals from Belgium, Chile and Italy. They include the dean of the College of Cardinals, Angelo Sodano, who is accused of taking large monetary gifts from a religious order, the Legion of Christ, and halting an investigation into its founder, the Rev. Marcial Maciel — who was later exposed as a pathological abuser and liar.

They also include cardinals reviled by many in their own countries, like Cardinal Sean Brady, the primate of All Ireland, who survived an uproar after government investigations uncovered endemic cover-ups of the sexual and physical abuse of minors.

“There’s so many of them,” said Justice Anne Burke, a judge in Illinois who served on the American bishops’ first advisory board 10 years ago. “They all have participated in one way or another in having actual information about criminal conduct, and not doing anything about it. What are you going to do? They’re all not going to participate in the conclave?”

Even one cardinal frequently mentioned as a leading candidate for pope has been accused of turning a blind eye toward abuse victims. The Canadian Cardinal Marc Ouellet issued apologies to the many victims of abuse in church boarding schools in Quebec Province, but left behind widespread resentment when he reportedly refused to meet with them.

Pascale Bonnefoy contributed reporting from Santiago, Chile; Ian Austen from Ottawa; and Gaia Pianigiani from Rome.

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Bobby Brown Sentenced to 55 Days in Jail in Drunk Driving Case

02/26/2013 at 09:30 PM EST

Bobby Brown has been sentenced to 55 days in jail and four years probation in his most recent drunk driving arrest.

Brown, 44, was pulled over in Studio City, Calif., on Oct. 24 for driving erratically and was arrested when the officer detected "a strong scent of alcohol." He was charged with DUI and driving on a suspended license.

He was also arrested for driving under the influence in March of 2012.

Brown pled no contest to the charges on Tuesday, reports TMZ. He was also ordered to complete an 18-month alcohol treatment program.

The singer, who married Alicia Etheredge in Hawaii in June of 2012, must report to jail by March 20.

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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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