ML20003H748

Testimony on Environ Coalition on Nuclear Power Contention 2-33(EP-11),neonatal Hypothyroidism After TMI Accident. Certificate of Svc Encl.Related Correspondence

ML20003H748
Person / Time
Site:	Three Mile Island
Issue date:	04/21/1981
From:	Tokuhata G PENNSYLVANIA, COMMONWEALTH OF
To:
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NUDOCS 8105070391
Download: ML20003H748 (26)

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RELLTED CORRESPONDENCE PA 4/21/81 UNITED STATES OF AMERICA NUCLEAR REGULATORY COMMISSION Before the Atomic Safety and Licensing Board I

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In the Matter of ) Docket No. 50-289 METROPOLITAN EDISON COMPANY, ET AL. ) (Restart)

(Three Mile Island Nuclear Station, Unit 1 }

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Testimony on ECNP Contention 2-33(EP-11) Ctr~E.(([@

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Director, Division of Epidemiological Resea j, 79 Pennsylvania Department of Health 4- V 0 6 193 4qi '

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Graduate School of Public Health rs University of Pittsburgh Submitted April 16, 1981 [

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2 APR 2 81981 I NEONATAL HYPOTHYROIDISM AFTER TMI ACCIDENT f' Omec cf a:,sq C:: d u s s e 4 .

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i Beginning at July 1978 all children born alive in Pennsylvania are l required to be screened for hypothyroidism, the condition characterized by lack of or insufficient level of thyroid hormone in the infant's blood. The screen-ing procedure involves testing for " low" thyroxine (T4) and "high" pituitary thyroid stimulating honnone(TSH). Confirmation of diagnosis is done through thyroid scan, which can help determine various types of the abnormality, includ-ing (a) agenesis (absence of the thyroid gland), (b) dysgenesis (incomplete l maturation and/or displacement of the thyroid gland from the normal position),

(c) dyshonnonogenesis (lack of enzyme necessary to synthesize thyroxine and/or difficulty in releasing thyroxine: the condition usually inherited from the parents as an . autosomal recessive trait), and (d) others (e.g. , abnonnalities caused by environmental agents). In a nonnal population, the incidence of neo-natal hypothyroidism is in a range of one in 4,000 to one in 5,000 live births.

Following'the March 28, 1979 nuclear accident at the Three Mile Island, allegations have been made that there was a significant increase in the incidence of neonatal hypothyroidism downwind and downstream from the damaged TMI-2 nuclear l

reactor because of sufficient release of radioactive iodine-131.

1 As far as we can ascertain from the metabolic screening and diagnostic data compiled by the Pennsylvania Department of Health, there is no evidence to indi-cate that the incidence of neonatal hypothyroidism has been affected by the TMI nuclear accident.

In March 1980 an eleven-member Hypothyroidism Epidemiological Investigative l Comittee was organized, which included expertise in the fields of epidemiology, i

pediatric endocrinology, obstetrics, medical genetics, biostatistics, and radia-tion physics. The Committee reviewed 34 confinned cases of the disorder discovered

by the State Health Department for 1979. Of these confirmed cases,15 were reported prior to the TMI accident and 19 were reported in the nine-month period ,

following the accident. The Committee also reviewed data for 1978.

After careful analysis of the available data the Committee concluded that there is no relationship between reported cases of neonatal hypothyroidism and the Three Mile Island nuclect accident.

The Statewide incidence of neonatal hypothyroidism for 1979 (12-month period) was one per 4,600 live births, which is well within a normal range of expectation. The rate for 1978 (only the latter 6-month period) was somewhat lower; this was expected because of the fact that the hypothyroidism screening program was started in July 1978 and that during this start-up period the screen-ing procedures and standards were not yet fully established. For this reason, the limited and incomplete 1978 Pennsylvania data cannot and should not be used for such comparative purposes. The Statewide incidence for 1980 was one per 4,427 live births, indicating that the level of neonatal hypothyroidism in Pennsylvania remained within a normal range.

An apparent concentration of seven cases of neonatal hypothyroidism in l Lancaster County during 1979 was subjected to a special in-depth analysis. The following features should be noted:

1. One of the seven cases was repc.-ted in January 1979, two months prior to the TMI accident.

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2. One was a case of severe multiole CNS anomalies. This infant was born three months after the accident; therefore, most, if 1

not all of these defects would have come about prior to the TMI accident.

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3. Two represented cases of dysgenesis or ectooi:, i.e. , the thyroid glands were displaced from the normal position. One of these was from a pair of twins in an Amish family; the twins were discordant with respect to the thyroid condition; thus, non-supportive of-eti- -

ology secondary to radiation exposure. This is most likely a case of developmental anomaly.

4. One case of dyshormonagenesis, i.e. , this Amish infant being unable to synthesize thyroxine due to lack of necessary enzyme. The condition is usually inherited from asymptomatic E carrier parents as an autosomal recessive trait.

5. Two cases did not receive thyroid scan, therefore, the exact diagnostic status is unknown.

Having completed detailed diagnostic analysis and epidemiologic assess' ment of the cases reported in Lancaster County during 1979, we concluded that the apparent concentration of neonatal hypothyroidism in this particular location is not related to the TMI nuclear accident. The Lancaster County is atypical in that a considerable proportion of the county population includes Amish fami-lies where consanguinity is not uncommon and the incidence of certain genetic diseases and conditions is higher than other populations.

Apart from the incidence analysis presented above, there is also an impor-tant consideration with respect to radiation in relation to neonatal hypotSyroid-ism.

First, after March 28, within 1979, no single case of neonatal hypo-thyroidism was reported in Dauphin, Cumberland, Perry, Northumberland, Juniata, Snyder, Mifflin, and Union Counties, the areas downwind (N, NW, NNW) from the Three Mile Island during the first 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br /> of the accident, when probably the

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largest amount of radioactive releases took place. This is inconsistent with the alleged claim that the TMI accident caused neonatal hypothyroidism in the vicinity of the plant.

Second, the maximum combined (inhalation and ingestion) human thyroid dose of radioactive iodine in the vicinity of the TMI following the March 28, .1.979 accident (through April 1979) is estimated to be 7.5 mrad (Editorial, Annals of Internal Medicine, Vol. 91, No. 3, September 1979). At least 1,000 times greater thyroid doses (i.e., 7.5 rads) would be required to have significant acute damages to the thyroid gland; however, even at this dose level, many of the damaged cells may be repaired. Based on the experiences of the Marshallese exposed to fresh radioactive fallout, it is considered likely that as much as 50 to 100 rads fetal thyroid doses would be necessary to cause irreversible tissue damage, such as congenital-neonatal hypothyroidism and/or thyroid cancer.

Acknowledging the fact that the fetal thyroid is much more sensitive to radio-iodine than is the m.aternal thyroid (a conservative upper bound estimate is that the thyroid dose to a fetus may be as high as ten times the maternal thyroid dosel the maximum likely fetal thyroid dose (approximately 75 mrad) in the vicinity of l the damaged nuclear plant is still far too small to have caused congenital-l neonatal hypothyroidism.

In any epidemiological investigation of possible " clustering" of a disease or morbid condition, it is important to recognize both the technical difficulty and methodological limitations associated with such investigat'an. It is the overall consistent pattern of observations that provides useful basis for con-

! clusion, rather than a single 1,olated change or difference which 'n most cases, j occurs without substantive epidemiologic significance. This is particularly true when relatively small populations are being studied. One may or may not find a i

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" statistically significant" change, difference, or clustering in morbid rates

! in an area (population) depending upon how such population is delineated geo-graphically and/or temporally. It is equally important that investigators carefully examine the observed relationships and determine if such relationships i I

are consistent with the known biological theory or orientation which is based on i I

i the previous studies and experiences. In the case of neonatal hypothyroidism  !

around the Three Mile Island nuclear plant, the allegations cited earlier are i

not supported either in terms of the overall pattern of observation nor in refer-l ence to the existing scientific knowledge.

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. INFANT MORTALITY WITHIN TEN MILES OF TMI Subsequent to the March 28, 1979 nuclear accident at the Three Mile Island, the Pennsylvania Department of Health initiated a comprehensive evaluation of the e cting vital statistics data in order to determine if the TMI accident has had any measurable influence upon infant mortality in the vicinity of TMI.

In early March of 1981 when final Statewide mortality data for 1979 were made available, we concluded that, based on the analysis of the available data, j

there is no relationship between the TMI accident and changes in the infant mortality in the surrounding consnunities within 10-mile radius.

The above-mentioned conclusions were reached on the basis of the follow-ing criteria, observations and data (Tables 1 and 2):

1. The 10-mile radius of TMI includes communities with a total of nearly 4,000 newborn infants annually which is large enough for the purpose of intended analysis. Both levels of radiation exposure and psychological distress within 10-mile radius were much higher than j those beyond 10-mile radius.

2. The available Ata were analyzed by quarters, as well as annually for each of the three consecutive years, 1977, 1978, and 1979, for the

entire 10-mile area including Harrisburg, the 10-mile area excluding

t Harrisburg, and Harrisburg independently. For cross-sectional compari-son, comparable data for the _ State of Pennsylvania were analyzed for i

I' the same historical periods.

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3. The infant mortality rate was not significantly dirferent between the 10-mile area with or without Harr . ' the State of Pennsylvania i

for any of the three years under considerath n. When Harrisburg was l;

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considered separately, the rate was much higher because of the fact that approximately one .aalf of the infants born in the City were non-white.

4. Tia infant mortality rate within the 10-mile radius including Harris-burg was already considerably high (19.3 per 1,000) during the first quarter of 1979 prior to the TMI accident. Reason for this observa-tion is unknown. The rate remained at the same level during the second--- -- --

quarter of 1979 immediately following the accident, but declined eub-l stantially during the third (12.7) and fourth (13.4) quarters. This temporal pattern of change in the mortality rate is contrary to the allegation; thatis, if the TMI accident had a significant influence, the infant mortality rate would have increased steadily throughout the following quarters. Fetal sensitivity to radiation and stress is much greater in the earlier period of gestation and this would have been reflected on the rising mortality rate toward the latter quarters of 1979.

5. Within the 10-mile radius, the 1979 infant mortality rate (16.1) was not significantly different from the 1977 rate (12.5). The 1978 infant mortality rate (10.8) was somewhat atypical and unusually low particularly for areas outside of Harrisburg (8.4). Reasons for this l observation are not known. Because of this, the 1978 rate should not l

l be used as a normal base for comparison.

l In short, having considered both cross-sectional and-temporal analyses of i

the available vital statistics data compiled by the State Health Department, we found no evidence that the TMI nuclear accident has had any significar.;

impact upon infant mortality. Minor statistical variations, as observed

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J in the 10-mile radius, are considered to be a random phenomenon with no epi-demiologic significance. Theoretically, too, the low levels of radiation exposure as reported offsite cannot be direct 1/ related to such massive destruction or impainnent of cells that cause infant deaths.

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d TABLE 1: RESIDENT LIVE BIRTHS BY QUARTER: PENNSYLVANIA AND TEN MILE TMI AREA CO:NUNITIES, 1977-1979 l

TMI Ten Mile Area I Year / Quarter Harrisburg Excluding Pennsylvania Total City Hbo. City l 1977 (153,415) (3,750) (1,001 ) (2,749)

Jan.-March 36,911 886 242 644 l April-June 38,414 937 248 689 July-Sept. 40,181 977 274 703 Oct. -Dec. 37,909 950 237 71 3 i

1978 (151,438) (3,803) (1,057) (2,746)

Jan.-March z 37,084 926 261 665 1

April-June 36,339 922 262 660 l July-Sept. 39,932 1,029 302 727 Oct.-Dec. 38,083 926 232 694 1979 (157,533) (3,905) (1,185) (2,720)

J&;.-March 38,326 932 296 636 Apiil-June 38,351 983 303 680 l

July-Sept. 41,933 1,023 302 721 Oct.-Dec. 38,923 967 284 683 l

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TABLE 2: RESIDENT INFANT DEATHS, NUMBER AND RATE, BY QUARTER: PENNSYLVANIA AND TEN HILE TMI AREA COMMUNITIES, 1977-1979 a

Number of Deaths Death Rate Per 1,000 Live Births Ten Mile THI Area Ten Mile'TMI Area Harrisburg Excluding Harrisburg Excluding Year / Quarter Hbg. City Pa. Total City Hbg. City Pa. Total City Infant Deaths i 1977 (2,137) (47) (15) (32) (13.9) (12.5) (15.0) (11.6)

Jan.-Ma rch 544 13 6 7 14.7 14.7 24.8 10.9 April-June 554 11 2 9 14.4 11.7 8.1 13.1 July-Sept. 520 9 3 6 12.9 9.2 10.9 8.5 Oct. -Dec. 519 14 4 10 13.7 14.7 16.9 14.0 1978 (2,031) (41) (18) (23) (13.4) (10.8) (17.0) (8.4) g Jan.-March 530 13 8 5 14.3 14.0 30.7 7.5 '

April-June 509 9 3 6 14.0 9.6 11.5 9.1 July-Sept. 473 5 1 4 11.8 4.9 3.3 5.5 Oct.-Dec. 519 14 6 8 13.6 15.1 25.9 11.5 1979 (2,118)* (63) (31) (32) (13.4) (16.1) (26.2) (11.8)

Jan.-March 511 18 10 B 13.3 19.3 33.8 12.6 April-June 537 19 9 10 14.0 19.3 29.7 14.7 July-Sept. 507 13 3 10 12.1 12.7 9.9 13.9 Oc t .-Dec. 562 13 9 4 14.4 13.4 31.7 5.9 4

• Includes one death, month of occurrence, unknown.

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January, 1981 1 CURRICULUM VI"d' E l

Names George K. Tokuhata Citizenship: U.S.A.

Date of Birth: August 25, 1924 Academic Derrees:

B.A. 1950 - Keio University, Tokyo Economics & Statistics)

M.A. 1953 - Miami University, Ohio Demography & Human Ecology)

Ph.D. 1956 - State University of Iowa Behavioral Sciences)

Dr.P.H. 1962 - Johns Hopkins University Epidemiology & Public Health)

(Doctor of Public Health Program. 1959-60-61, at Johns Hopkins included M.P.H.

training and advanced epidemiology training and field experience in researer plus special~ academic training in basic medical sciences and limited clinical exposure which was sponsored jointly by the School of Medicine and. School of Hygiene and Public Health.)

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j -Positions:

1951-53 Research Asst., Scripps Foundation for Population Research, Miami

University, Ohio 1954-56 Instructor, State University of Iowa 1956-59 Research Scientist, Department of Mental Health, State of Michigan 1959-60 USPHS Trainee, Johns Hopkins Medical Center i

1960-61 NIH Post-doctoral Fellow, Johns Hopkins Medical Center l

I 1961-62 Special Asst. to Division Chief, Division of Chronic Diseases, USPHS

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1962.-63 Principal Epidemiologist, Division of Chronic Diseases, USPHS 1963-67 Associate Professor of Preventive Medicine. University of Tennessee College of Medicine. Memphis: Chief of Epidemiology, St. Jude Children's Research Hospital 1967-73 Director. Division of Research and Biostatistics, Pennsylvania Department of Health l

1973-75 Director. Bureau of Program Evaluation, Pennsylvania Department of Health l

1975- Director, Bureau of Health Research, Pennsylvania Department of Health Present Cur ent Acade-tic Arecintments( Ad4unct):

l Professor of Epidemiology and Biostatistics, Graduate School of Public Health, i i University of Pittsburgh 1

, Associate Professor of Community Medicine, Te=ple University College of Medicine l l l Member of Graduate Faculty Committee. Pennsylvania State University l

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Cennittees and Task Forces: Current or Past:

Member, U.S. Matemal and Child Health Research Review Conazittee.

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! Member, Special Study dection, National Institutes of Health.

Chairman, Pltaning Coned.ttee, Intemational Symposium on Genetics and the

! Epidemiology of Chronic Diseases, U.S. Department of Health, Education, and Welfare.

l Member, Subcommittee on Health Manpower, Governor's Task Force on Health Education, Commonwealth of Pennsylvania.

Chairman, Subconsuittee on Mortality, National Commission on Diabetes Mellitus.

j Member, Subcommittee on Economics, National Commission on Diabetes Mellitus.

l Member, Governor's Task Force on Diabetes and Blindness, Commonwealth of l

Pennsylvania.

1 Chief of Epidemiologic Imtstigation of Health Topact, Governor's Fact-Finding Committee on Nuclear Power Plants, Coarnorstealth of Pennsylvania.

! Consultant, Bureau of Product Sifety, Food and Drug Administration.

Member (Ad Hoc), Committee on Accident Prevention, American Acadeg of Pediatrics.

i Member, Program Connittee, Epidead. ology Section, American Public Health Associa-tion.

Member, Health Manpower Consmittee, Epidemiology Section, American Public Health Association. _, , _ ___

Member, Program Development Board, American Public Health Association.

Consultant on MCH and IPO: American Academy of Pediatrics.

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Professional Societies:

( Fellow - American Public Health Association: Epidentiology Section Fellow - American Sociological Association: Medical Sociology Member - Society for Epiriandnlogic Research Member - New York Acade g of Sciences Listed In:

American Men of Science (Physical and Biological Sciences, and Social and Behavioral Sciences)

WHO'S WHO IN THE EAST (U.S. and Canada)

Dictionary of International Biographies (London)

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Publientiens and Reoorts:

1. Tokuhata, G.K. cnd Scehman, V. A. : Mortality in State Mental Hospitals of Michigan, 1950-54. Public Health Reports 23:750-761, 1958.

2. Tokuhata, G.K.: Productivity of the Psychiatric Hospital. Neurology 2:53-64, 1959 3 Tokuhata, G.K.: Social Changes in Japan: The Fadly and Mental Illness,

! J. of Indian Medical Profession VII:3347-3366, 1960.

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L. Tokuhata, G.K.: A Behavioral Analysis of the Practical Nurse Psychiatric

_ .--__ Affiliation Program, Nursing Research 9:141-148, 1960.

5. Tokuhata..G.K. and Stehman. V.A.: Sociological Implicatione,-and--Epidemi ---

ology of Mental Disorders in Recent Japan, Amer. J. of Public Health 51:697-705, 1961.

6. Tokuhata, G.K. and Lilienfeld, A.M. : Fa=414 =1 Aggregation or iung Cancer in Humans, J. of Nat. Cancer Inst. 32:289-412, 1963

< 7 Tokuhata, G.K. and Lilienfeld, A.M. : Fa=414 =1 Aggregation of Lung Cancer l Among Hospital Patients, Public Health Reports 21:277-283, 1963

8. Tokuhata, G.K.: Smoking Habits in Lung-Cancer Proband Families and Compar-able Control Fadlies, J. of Nat. Cancer Inst. 3:1153-1171, 1963 9 Tokuhata, G.K.: Familial ' Factors in Human Lung-Cancer and Smoking, Amer.

J. of Public Health S :24-32, 1964.

1C. Tokuhata, G.K.

Pattern of Drug Administration and Differential Movement for Se).ected First Admissions to a State Mental Hospital, J. of Indian Medical Profession M :4934-4944, 1964.

11. Iqhuhaig, G.K.: The Epidemiologist in a Multidisciplinary Research Hospital, Amer. J. of Public Health j,5,:668-672, 1965 I - - --12.- IqkuhE.A, G.K. : Fa m414 =1 Factors in Lung Cancer and Smoking---Genetierand the Epidemiology of Chronic Diseases, Public Health Service, U.S. Department of Health. Education and Welfare, Part IV, Malignant Diseases, pp. 339-353, 1965 13 Abelin, T. and Tokuhatt , G.K.: Maternal Age at Birth and Susceptibility to Lung Can:.ar, The Lancet II:1121-1123,1965

14. Hernandez K. and Tokuhata, G.K.: Epidemiologic Study of Childhood Leukemia in Memphis and Shelby County, 1939-1962, Public Health Reports 3.1:598-606, 1966.

15 Tokuhata, G.K.: Neoplasms Anong Offspring of Mothers with Breast Cancer and of Mothers with Genital Cancer, Menghis and Mid-South Medical Journal M:99-103, 1966.

16. Tokuhata, G.K.: Epidemiology of Cancer of the Cervix. IV. Tobacco and Cancer of the Genitalia Among Married Women, Amer. J. of Public Health 32:830-839, 1967

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17. Tokuhata, G.K. , Neely, C. , and W4114 ==, D. : Chronic Myelocytic Leukend.a in Identical Twins and a Sibling, BLCOD 3,1:21(:r-225, 1968.

18. Igjggg,ta, G.K.: Smoking in Relation to Infertility and Fetal Loss, Arch. Env.

Health 12:353-359,1968.

" Tokuhata. G.K.: Morbidity and Mortality Among Offspring of Breast Cancer -

Mothers, Amer. J. Epidemiology Q9,:139-153, 1969

20. Tokuhata, G.K. , Dessarer, P. , Pendergrass, E.P. , Hartman, T. , Di.gon, E. and 1 Miller, W. : Pneumoconic':is Among Anthracite Coal Miners in Pennsylvania, Amer.

J. Public Health j0_:441-451,1970.

21. Tokuhata, G.K. and Digen, E.: Cancer of the Female Organs: Epidemiologic Review and Mortality Experience in Pennsylvania (Monograph). Division of Research and Biostatistics, Pennsylvania Department of Health, January 1970.

, 22. Tokuhata, G.K. , Ramaswarq7 t K. , and Digen, E. : Cirrhosis of the Liver Mortality

in Pennsylvania (Monograph). Division of Research and Biostatistics, Pennsyl-vania Department of Health, June 1970.

23 Tokuhata. G.K.: Epidemiole With Emphasis on Multiple-Factor Approach (Monograph)gy . of Chronic Division Diseases:

of Research and Biostatistics, Pennsyl-vania Department of Health, September 1970.

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24. Tokuhata, G.K., Digon, E., and Ramaswamy, K.: Alcohol Sales and Socioeconomic Facters Relau d to Cirrhosis of the Liver Mortality in Bennsylvania, HSMHA Health Reports 34:253-264, 1971.

25 Tokuhata, G.K. and Anderson, R.E.: Accidental Ingestions-An Epider:dologic Study, PENNSYLVANIA'S !!EALTH J2:16-22, 1971.

26. Tokuhata, G.K. and Anderson, R.E. : Hospital Emergency Cases of Poisonings and/

other Injuries Caused by Ingestion, HSliuA Health Reports 36:1042-1050, 1971.

27 Tokuhata. G.K. and Miller. W. : Coronarf Risk Factors in Children: A Review of the Problem and Current Status (Monograph). Division of Research and Biosta-tistics. Pennsylvania Department of H3alth, May 1971.

28. Tokuhata, G.K. , Colflesh. V.G. , and Digon, E. : Diabetes Mellitus in Tyrone.

Pennsylvania (Monograph). Division of Research and Biostatistics Pennsyl-vania Department of Health, Marah 1972.

29 Tokuhata, G.K., Colflesh. V.G., Digen. E., and Marn. L.: Childhood Injuries Caused b* Consumer Producta(Monograph). Division of Research and Biostatis-tice, Pennsylvania Department of Health, May 1972.

30. Tokuhata. G.K.: Diabetes Is People: A Special Report Prepared for the Governor's Comnd.ttee Concerned with Diabetes, Commomrealth of Pennsylvania (Monograph).

Division of Research and Biostatistics, Pennsylvana.a Department of Health, November 1972.

31. Tokuhata, G.K. and Lilienfeld, A.V : s-dlial Aggregation of Lung Cancer Among Hospital Patients. In Pulmonary 6hology and Aging:II, RARIP, MSS Informa-tion Corporation,197A.

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32. Tokuhata, G.K.: Cirrhosis of the Liver: An Epidemiological Review. Public Health Reviews 2:31-58, 1973 33 Tokuhsta, G.K.. Colflesh, V.G., Ramaswa g. K.. Mann, L., and Digen, E.: Hospital and Related Characteristics Associated with Perinatal Mortality: An Empirical Analysis for Pennsylvania Births, American J. Public Health 2:227-237. 1973 l

l 34 Tokuhata, G.K., Digon, E., and Mann, L.: Prenatal Care ~and Obstetric Abnormali-

! ties, J. of Chronic Diseases 25:163-185, 1973 j 35 Tokuhata. G.K.: Statistics in Public Health (Monograph). Division of Research and Biostatistics, Pennsylvania Department of Health, March 1973

36. Tokuhata, G.K. et al. Childhood Injuries by Consumer Products, Preventive Medicine 3:245-267, 1974. .

37 Tokuhata, G.K. Digon, E. , Colflesh, V.G. , Mann,. L. , Ramaswamy, K. , and Smith, . M. :

Prenatal Care, Hospital Services, and Perinatal Mortality (Monograph). Bureau of Program Evaluation, Pennsylvania Department of Health, March 1974.

38. Tokuhata, G.K.: Health Information, Program Evaluation, and Management Decision (Paper). Bureau of Program Evaluation, Pennsylvania Department of Health, l August 1974 39 Tokuhata, G.K.: Cancer of the Lung: Host and Environmental Interaction. JD Cancer Genetics, (Ed. ) Lynch, H.T. ,1975, C. C. Thomas.

, 40. Tokuhata, G.K. , Miller, W. , Digon, E. , and Hartman, T. : Diabetes Mellitus:

l An Underestimated Public Herlth Problem, J. Chron. Dis. 23:23-35, 1975

41. Tokuhata, G.K. , Colflesh, V.G. , Smith, M. , Ramasway, K. , Hartman T. , Mann, L. ,

and Digen, E.: Accidental Injuries Associated with Consumer Products: A Random Sample Household Survey (Monograph). Pennsylvania Department of Health, January 1975 6.2. Werner, J. and Tokuhata, G.K.: Diabetes Mellitus: Its Annual Cost in Pennsyl-vania and the U. 8,. 1975(Paper). Pennsylvania Department of Health, March 1975 43 Tokuhata, G.K. , Mann, L. end Ramasway, K. : Recent Mortality Trends and Life Expectancy: Pennsylvania and U. S., 1970-1973(Paper). Pennsylvania Department of Health, June 1975 44 Tckuhata, G.K., Newman, P., Digen, E., Mann. L., Hartman, T., Ramaswa g , K.:

Health Manpower Distribution in Pennsylvania, Amer. J. Publ Health M :837-848. 1975 l 45 Ramaswa g , K. and Tokuhata, G.K.: Determinants of Expenditures for Physicians'

! Services in Pennsylvania, 1972: An Econometric Analysis. Proceedings of the American Statistical Association, Business and Econo =ic Statistics Section,1975

46. Tokuhata, G.K. , Colflesh, V.G. , Smith, M. , Ramaswag, K. , and Digen. E. : Con-sumer Behavior and Preduct Injuries, J. of Safety Research 8:116-125, l September 1976.

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47 Tokuhata, G.K., Digon, E., Ramaswamy, K.: Fluoridation and Mortality: An Epidemiological Study of Pennsylvania Communities, Bureau of Health Research, Pennsylvania Department of Health, September 1976.

48. Tokuhata, G.K. , Ham, K.S. , Muller, H.A. and Dethlefs, W.C. : Evaluation of Emergency Medical Services in Southcentral Pennsylvania: Experiences of Cardiac and Trauma Patients, Bureau of Health Rese&rch, Pennsylvania Department of Health, June 1977

, 49 Tokuhata, G.K. and Smith, M.W.: Evaluation of Nursing Homes in Philadelphia l and Allegheny Counties: Services for Minorities, Bureau of Health Research, Pennsylvania Department of Health, June 1977

50. Tokuhata, G.K., Hartman, T., Digon, E. and Colflesh, V.: Fatal Injuries Attributed to Consumer Products in Pennsylvania,1971, Public Health Reports

.92:374-382, July-August 1977

51. Tokuhata, G.K. , Colflesh, V.G. , Smith, M.W. and Digon, E. : Prenatal Care and Pregnancy Outcome, Bureau of Health Research, Pennsylvania Department of Health, July 1977

52. Ham, K.S., Tokuhata, G.K., Muller, H.A. and Dethlefs, W.C.: Emergency Medi-cal Services for Trauma Patients: A Component Analysis of Experiences in Southcentral Pennsylvania, Bureau of Health Research, Pennsylvania Department of Health, September 1977 53 Ham, K.S. , Tokuhata, G.K. , Muller, H. A. and Dethlefs, W.C. : Emergency Medi-cal Services for Cardiac Patients: A Compenent Analycia of Experiences in Southcentral Pennsylvania, Bureau of Health Research, Pennsylvania Copartment of Health, January 1978.

54. Tokuhata, G.K., Digon, E., Ramaswamy, K.: Fluoridation and Mortality - An Epidemiological Study of Pennsylvania Communities, Public Health Reports, Vol. 93, No. 1, Jan.-Feb. 1978.

55. Ham, K.S., Yoder, M.D., Tokuhata, G.K., Smith, M.W., Dethlefs, W.C., and Muller, H.A.: Prehospital Emergency Care for Trauma Patients and Mortality In Hospital: Evaluation of Ambulance Services in Southcentral Pennsylvania, Division of Health Services Research and Bureau of Health Research, Pennsyl-vania Department of Health, July 1978.

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56. 'Tokuhata, G.K. , Ham, K.S. , Yoder, M. , Smith, M.W. , Dethlef s, W.C. , and Muller, H.A.: Impact of Emergency Medical Services Upon Cardiac Patients, Lureau of Health Research and Division of Emergency Health Services, Pennsyl-vania Department of Health, September 1978. Also in the Proceedings of the VI7I-th World Congress of Cardiology, Tokyo, Japan, September 1978.

57. Tokuhata, G.K., and Smith, M.W.: Epidemiology of Hypertension: Implications for Prevention, Bureau of Health Research, Pennsylvania Department of Health, September 1978. Also in The Proceedings of The International Symposium on Prophylactic Approaches to Hypertensive Diseases, Matsue, Japan, September 1978.

58. Tokuhata, G.K., Colflesh, V.C., Digon, E., and Smith, M.W.: Prenatal Care and Pregnancy Outcome, Bureau of Health Research, Pennsylvania Department of Health, October 1978.

59. Tokuhata, G.K., and Smith, M.W.: History of Health Studies Around Nuclear Facilities: A Methodological Consideration, Bureau of Health Research, Pennsylvania Department of Health, September, 1979.

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60. Tokuhata, G.K. and Digon, E.: Health Effects of Shippingport Nuclear Reactcr, presented at Symposium " Epidemiological . Studies of Nuclear Accidents,"

Annual Meeting of the Society for Epidemiologic Research, June 1980.

61. Tokuhata, G.K.: Three Mile Island Health Effects Research Program, Proceed-ings of the Pennsylvania Academy of Sciences 54:19-21, 1980.

62. Houts, P., Miller, R., Tokuhata, G., and Ham, K.: Health-Related Behavioral Impacts of the Three Mile Island Nuclear Accident, Part I and Part II,1980.

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Abstracts:

1. Hernandez, K. and Tokuhata, G.K.: Childhood Cancer in Selby County, Tennessee:

An Epide=iological Study, Proc.Am. Assn. Cancer Res. 6:27, 1965.

2. Tokuhata. G.K.: Breast Feeding and Childhood Cancer. Ninth International Cancer Congress, Tokyo, Japan 1966.

3. Hernandez, K. and Tok6hata. G.K.: Childhcod Leukemia and Cancer in Memphis and Shelby County, Tennessee: An Epidemiologic Study, Southern Medical J.

JZ:1477-E78, 1966.

4. Tokuhata, G.K.: Neoplasms Among Offspring of Mothers with Breast Cancer and of Mothers with Genital Cancer, Excerpta Medica, Sect.16, Vol.15(5)

p. 337, May 1967.

5. Tokuhata, G.K., Schildt, G. and Digon, E.

Changes in Nortality Patterns Acong the Aged Since Medicare Program. Proceedings of APHA, 1969.

6. Tokuhats, G.K.: Morbidity and Mortality Among Offspring of Breast Cancer Mothers, Archive, Institute for Documentation and Infomation in Social Medicine and Public Health, West Gemany,1970.

7. Tokuhata, G. ., Dessauer, P., Pendergrass, E., Dicon, E., Hartman, T., and Miller, W.: Pneumoconiosis Among Anthracite Coal Miners in Pennsylvania, Archive, Institute for Documentation and Information in Social Medicine and Public Health, West Ger=any,1970.

• Infomation and News Articles:

1. Genetic Factors in Lung Disesse(Medical World News, No. 9, 1962).

2. Family ?lus Scoking Multiplies Lung Cancer (Public Health Reports 28,1963).

3. Genetic Influence on Lung Cancer (Modern Medicine, May 27, 1963).

4. Tobacco Use Implicated in Cancer of Genitalia (Public Health Reoorts 82,1967).

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5. New Epidemiologic Study Suggests Possible Family Cancer Patterns (JtdA, Medi-cal News, Nov. 22,1965).

6. Smoking's New Threat to Lifc(Medical World Hews, Vol. 8, 1967).

7. Pneumoconiosis and Smoking (Internal Medicine and Diagnosis News, 1969).

8. Pneumoconiosis Prevalence Among Pennsylvania Coal Miners (Public Health Reports Bj,, 1970).

9. Childhood Injuries Caused by consumer Products (Pediatric News, 1973).

10. Prenatal Care and Pregnancy Outcomes (Pediatric News,1973).

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11. Diabetes Mellitus (Internal Medicine anri Diagnosis News, 197k).

12. CIDS in Pennsylvania Linked to Socioecocomics(Family Practice Mews, 7el. A, No. 23, Dec. 1, 1974).

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Papers Pres ented:

, 1. A Msthodological Approach to Theories of Middle-Range ( American Sociological Association Meeting,1957).

2. Configura'. ion and Dynanics of Fertility Expectation ( American Sociological Associatten Meeting, 1958).

3. A Statistical Model for the Measurerent of Psychiatric Patient Movement (American Sociological Association Meeting, 1955). .

l. Epidemiology of Chronic Disease: hith E=phasis on I'ultiple-Factor Approach (Kentuck-/ State Public Health Meeting,1963). _ . . -

5. Familial Aggregation of Lung Cancer in Hu=ans( American Public Health Association Meeting, Mia::.1 Beach, Florida,1963). __

6. Ereast Feeding and Childhood Cancer (flinth International Cancer Congress, Tokyo, 1966).

7. Tobacco and Cancer of the Genitalia ?cong Married '..'emen( A=crican Public Health Association Meeting, San Francisco, California,1966).

8. S=oking in Relation to Infertility and Fetal toss (American Public Health Association Meeting, Mia=3 2each, Florida,1967).

9. Morbidity and & rtality A=cng Offspring of Breast Cancer Mothers (Society for Epide=iologic Research, Washington, D.C., May 1968).

10. Pneu=cconiosis Among Anthracite Coal Miners in Pennsylvania (4=erican Public Health Association Meeting, Philadelphia, Pa.,1969).

11. Epidemiology of Childhood Cancer: Sy=posium on Poscible Viral Etiology (Society for Epide=iologic Research, University of Minnecota, June 1970).

12. Coronary :tisk Factors in Children: A Review: Sy=pesit= on Epide iclogic Uses of Multiphasic Screening Progra=s(Society for Epide=iologic Research, National Center for Disease Control, Atlanta, GeorES, Ma7 1971).

13. Hospital and Related Characteristics Associated tiith Perinatal Mortality

( A=erican Public Health Association, McH Section, Minneapolis, Minnesota, 1971).

11. . Prenatal Care and Obstetric Abnomalities(Society for Epidemiologic Research, Houston, Texas,1972).

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15. Health Manpower Distribution in Pennsylvania (American Public Health Association, Statistics Section, Atlantic City, New Jersey, 1972).

16. Pregnancy Outco=es Associated with Pr 'atal Care (american Public Health Association, Maternal and Child Heal i Sectien, Atlantic City, N.J.,1972).

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, 17. Childhood Injuries Caused by Consumer Products ( American Public Health Association, Epidemiology Section, Atlantic City, N.J.,1972).

18. Diabetes Mellitus: An Underestimated Public Health Problem (American Public Health Association, Statistics Section, San Prsncisco, California, 1973).

19. Childhood Injuries Caused by Constaaer Products ( American Academy of Pedia-trics, Committee on Accident Prevention, Chicago, Illinois, 1973).

, 20. Prenatal Care, Hospital Services and Perinatal Mortality (Second National Conference on Research in Maternal and Child Health, University of

( California, Berkeley, California,May,1974).

21. Epidemiologic Evaluation of Health Hazards on Population Near Nuclear Power Plant ( American Public Health Association, New Orleans, Louisiana, 1974).

22. Sudden Infant Death Syndreme: Experiences in Pennsylvania (American Public Health Association, New Orleans, Iouisiana,1974).

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23. Const ner Behavior and Product Injuries (American Public Health Association, Chicago, Illinois,1975).

24. Patal Cases of Product Injuries: Pennsylvania (American Public Health Association, Chicago, Illinois, 1975).

25. Diabetes Mellitus: Its Annual Cost in Pennsylvania and U. S., 1975(American Public Health Association, Chicago, Illinois, 1975).

26. Determinants of Expenditures for Physicians' Services in Pennsylvania:

Differences Across Counties, 1972: An Economic Analysis (American Statistica.1 Association, Atlanta, Georgia,1975).

27 Fluoridation and Mortality: An Epidemiological Study of Pennsylvania Communi-ties (American Public Health Association, Miami Beach, Florida,1976).

. 28. Epidemiologic Evaluation of Health Hezards on Population Near Nuclear Power l Plant (Workshop on Health Surveillance Around Point Sources of Pollution U. S. Environmental Protection Agency. University of Chicago. Chicago.

Illinois, October,1976).

l 29 Maternal Characteristics and Pregnancy Outcome (Society for Epidemiologic Research, Seattle, Washington, June,1977).

30. Impact of Prehospital Care Components of Emergency Medical Services Upon Trauma Patients' Mortality (National Emergency Medical Services Evaluation Symposium, Seattle, Washington, July 12-15, 1978).

31. Impact of Emergency Medical Services Upon Cardiac Patients (VIII-th World Congress of Cardiology, Tokyo, Japan, September 17, 1978).

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32. Epidemiology of Hypertension: Implications for Prevention (International Symposium on Prophylactic Approach to Hypertensive Diseases, Matsue, Japan, September 27, 1978).

33. Prenatal Care and Pregnancy Outcome (The Annual Meeting of the American Public Health Association, Los Angeles, California, October 17, 1978).

34 Prenatal Care and Pregnancy Outcome (Third Annual National Data Use Confer-ence, Phoenix, Arizona, November 15, 1978).

35. History of Health Studies Around Nuclear Facilites: A Methodological Considera-tion (Second Workshop on Health Surveillance Around Point Sources of Pollution, Albuquerque, New Mexico, January 22-24, 1979, Los Alamos Scientific Laboratory, University of California) .

36. Factors Affecting Pregnancy Outcome: Some New Evidence (Maternal and Child Health Session, American Public Health Association, New York, November 5-8, 1979).

37. Lead Absorption in Secondary Smelter Workers and their Families (Environmental Health Session, American Public Health Association, New York, November S-8, 1979).

38. Pregnancy Outcome Around Three Mile Island (Workshop on Linking Pubife Health Social Worker and Public Social Services for Comprehensive Care for Mothers and Children, University of Pittsburgh, Pennsylvania, March 2R-April 2,1981)..

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UNr2D SIMS & ADRICA

!EKZZAg yarrirrimy (INESSIQt BEPGIE W A2DEC SAFEIT AtB I.IQ25DC 30MtD In tbs Matter of )

)

tenor 0LI:st unScu CanNT, )  ;

) Docket th. 50-289 '

CDires MLla Islami Itaclear ) Olmstart)

Station, Quit !b.1) )

SE M X ,L _IST George F. w t , Esquire Dr. Linda W. Little

. Shea, Pittman, Pbets & Wd-= i Aceic Safety and Ma==47 Board Panel S 1800 M Street, N.W. 5000 HennLtage Drive u.=h4 D.C. 20006 Raleigtt, Nord Ct.colina 27612 Ms. Marjoria M. Aamode W~ and Service Section R.D. #5 office of the S .- 7 Coatesvilla, Pumsylvania 19320 U.S. Ibclear Regulatory CanLasicut

" H-- , D.C. 20555 Anti-ttaclear Gectg ",- ta= Ellyn R. Watss 7 York (AtGir) h 1 dan, Hanzon, Roisant & Weise r 245 W. Ph41=d=1ah4a Street 1725 I Street, N.W., Suita 506 York, Pamsylvaria 17404 W==hingcon, D.C. 20006 <

Ms. Frieda Serryhill, d=i==n Karin P. Sheldon, Esquire (PANO Coalit.icn for 2taclear Pouer Sheldon, Harmort, Roissan & Weiss Planc Poorp = - - e 1725 I Street, N.W., Sutta 506 2610 Gredan Drive "W=enn. D.C. 20006 t.ni,,,an-em, n=1 ==re 19808 JanLs A. Tourtallotte, FJquire Mr. Robert Q. Pollard '

nMica of the Executive IAgal Director 609 +=ra=1_4-* Strenc U.S. !Laclanc D=="1=*a y causdssion Baltiance, Maryland 21218 mahington, D.C. 20555 Walter W. (hh m , Esquire Jota A. IAVin, Esquire Gnstam e Advocata Assistanc Caissel 0%w of Jiastica Permsylveia Public Utility Commission S c h y Square, 14th Floor P.O. Box 3265 Harrisburg, Pemsylvania 17127 Harrisburg, Pe m sylvania 17120 Dr. 01atu.ey Kapford Robert L. Krupp, Esquire j'O $pJ {F8 Judith H. Jotmsrud Assistant Solicitor, Comty of Dauphin Envizemer=1 Coaliticut an !naclear P.O. Box P, 407 North Front Street Power Harrisburg, Permsylvania 17108 a%'. I}l 433 Orlando Aveue

• A' State College, Pensylvania 16801 Jotn E. !*freich, O af ==rt

- '__ " Dauphin Catacy Board of Camaissioners 2t . Steven C. Stelly Daaphin Courthouse Ubion of Ccncerned c '=r4=ts Franc and Streets l 1725 I Street, N.W., Suita 601 Harrisburg, Paesylvania 17101 l Washington, D.C. 20006 Jordan D. n=minghe, Esquire Ms. Iouise Bradford Arrnrnar for IIsubarry Township

"MI Alarc T.M.I. Stascirig Camattese l 315 Peffer Street 2320 North Second Street Harrisburg, Pamsylvania 17102 Harrisburg, Parisylvania 17110 Ivan W. Smith, F. squire, thimart Marvin I. Immis Atomic Safety and f f emairig 3oard Panel 6504 Bradford Terrace

. U.S.14aclear Ragulatory Causdssion Ph41=d=1ah4a, Pumsylvmia 19149 Wahirigton, D.C. 20555 Jana Ime l Dr. Waltar H. Jordan R.D. 3, Box 3521 Acoude Safety and Licensing Board Panel Etters, Pamsylvania 17319

• a- 381 West Outer Drive Oak Ridge, Temassee 37830 ':homas J. Gec:dne, Esquire Deputy Attorney Geeral. Division of Imr l Foem 316, 1100 Raymond Soulevard l Neuark, New Jersey 07102 P00R BRMI.

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,3 Co;3'Et Tied T by the State Health Department for 1979. Of these confirmed cases, 8 were reported prior to the TMI accident and 26, were reported in the nine-month period following the accident. The Committee also reviewed data for 1978.

After careful analysis of the available data the Committee concluded that there is no relationship between reported cases of neonatal hypothyroidism and the Three Mile Island nuclear accident.

The Statewide incidence of neonatal hypothyroidism for 1979 (12-month period) was one per 4,600 live births, which is well within a normal range of dxpectation. The rate for 1978 (only the latter 6-month period) was somewhat lower; this was expected because of the fact that the hypothyroidism screening program was started in July 1978 'and that during this start-up period the screen-ing procedures and standards were not yet fully established. For this reason, the limited and incomplete 1978 Pennsylvania data cannot and should not be used for such comparative purposes. The Statewide incidence for 1980 was one per 4,427 live births, indicating that the level of neonatal hypothyroidirn in Pennsylvania remained within a normal range.

An apparrot concentration of seven cases of neonatal hypothyroidism in Lancaster County during 1979 was subjected to a special in-depth analysis. The following features should be noted: -

1. One of the seven cases was reported in January 1979, two months prior to the TMI accident.

2. One was a case of severe multiple CNS anomalies. This infant was born three months after the accident; therefore, most, if 1

I not all of these defects would have come about prior to the TMI accident.

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l CEKrIFICAIE OF SERVICE I hereby certify that a true and correct copy of the Connorsaalth of Pennsylvania's Testimony of Dr. George K. Tokuhat was served upon

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! the attached Service List this 22nd day of April, l981, by U.S. Mail, postage prepaid. Preliminary copies were hand-delivered to the Board, Counsel for Licensee, and NRC staff, and a representative of ANGRY on April 17, 1981. A preliminary copy was Torwarded to EWP on April 17, 1981, by U.S. Mail, Special Delivery.

• *!!Ot0.6 JActa.(. .

M1Casswum Attorney for the Connonwealth Attachment i

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1:NIH D STAIES T AMERICA

!IIIIAR IEI;CLL~tRY CDtCSSIGI BERRE DE A".DEC SAFT1Y RD IJG25UC BOA:tD In the Matter of )

)

!DDPOLITAN EDISGI CDd' ANT, ) .

) Docket !b. 50-289 Chree Mile Island !belaar ) (Restart)

Station, thit No.1) )

2RVICE LIST Coorge F. Trowbridge, Esquire Dr. Linda W. Little Shaw, Pitt: nan, Pccts & Trowbridge Arr=f e Safety and Licensing Board Panel 1800 M Street, N.W. 5000 Her::itage Drive Washington, D.C. 20006 Raleigh, North Carolina 27612 Ms. Marjorie M. Aamodt Docketirg and Service Section R.D. #5 Office oc the Secretary coatesville, Pemsylvania 19320 U.S. Delmar Pegulatory r*= ion Ms. Holly S. Keck, Iag. Chair:nnn Anti-!bclear Group Papresenting Enyn R. Weiss York (ANGT) Sheldon, Harcon. Roismen & Weiss 245 W. Philadelphia Street 1725 I Street, N.W., Suite 506 York, Pemsylvania 17404 Washirgton, D.C. 20006 I Ms. Frieda Berryhill, Chair: nan Karin P. Sheldon, Esquire (PME)

Cm14**= for Ibclear Power Sheldon, Harmon. Roisman & Weiss Plant Pos % a 1725 I Street, N.W., Suite 506 2610 Crandon Drive Washington, D.C. 20006 WiL:ington, Delaware 19808 James A. Tourtellotte, Esquire Mr. Robert Q. Pollard Office of the hmrive imp 1 Director 609 !intpelier Street U.S. Nelaar Regulatory re-f usion Baltircre, Maryland 21218 , W ahinge= . D.C. 20555 Walter W. Cohen, Esquire Join A. Iavin, Esquire Consumme Advocate Assistant Comsel Department of Justice Pemsylvania Public Utility Canission Strawberry Square, 14th Floor P.O. Box 3265 Harrisburg, Pamsylvacia 17127 Farrisburg, Pemsylvania 17120 Dr. Chamcey Kapford Bobert L. Knupp, Esquire Judith H. Johnsrud Assistant Solicitor, County of Dauphin t Dwiremental Cm14"4m on lbclear P.O. Box P, 407 North Front Street

( Power Harrisburg, Pemsylvania 17108

! 433 Orlando Avenue State College, Pemsylvania 16801 John E. Mhmich, Quirman Dauphin Comty Board of reer-f *sioners Mr. Steven C. Sholly Dauphin County Courthouse thion of Concerned Sciatists Front and Market Streets j 1725 I Street, N.W. , Suite 601 Harrisburg, Pernsylvania 17101 Washingrm D.C. 20006 Jordan D. thin =hm, Faquire Ms. louise Bradford Attorney for Newberry Township OfI Alert T.M.I. Steerirg Camittee 315 Peffer Street 2320 North Second Street Harrisburg, Perinsylvania 17102 Harrisburg, Pemsylvania 17110 Ivan W. Smidt, Esquire Quimun Marvin I. Iewis Armie Safety and Licensing Board Pansi 6504 Bradford Terrace U.S. Ibclear Regulatory Ccx: scission Pb41 =d=1 mh42, Pemsylvania 19149 Washington, D.C. 20555 Jans lee Dr. Walter H. Jordan R.D. 3 Box 3521 Armic Safety ana Licensing Board Panel Etters, Pamsylvania 17319 881 West Guter Drive i Oak Ridge, Temessee 37830 2runas J. Cer=ine Escuire c

Deputy Attorney General, Division of Let l

Focan 316,1100 Raytxxvi Boulevard l

Newark, "aw Jersey 07102 l

i I

l P00R ORilNE t