ML20081E064
| ML20081E064 | |
| Person / Time | |
|---|---|
| Site: | Harris  |
| Issue date: | 10/28/1983 |
| From: | Eddleman W EDDLEMAN, W. |
| To: | Atomic Safety and Licensing Board Panel |
| Shared Package | |
| ML20081E011 | List: |
| References | |
| 82-468-01-OL, 82-468-1-OL, ISSUANCES-OL, NUDOCS 8311010450 | |
| Download: ML20081E064 (65) | |
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UNITED STATES OF AMERICA NUCLEAR BEGULATOBY COMMISSION 0,cobg38,y9p Yi;
((CITbc 0
b BEFORE THE ATOMIC SAFETY AND LICENSING BOARD Glenn Dr. O. Bri James H.ght Carpenter James L. Kelley, Chairman In the Matter of
) Dockets 50 400 OL CAROLINA POWER AND LIGHT CO. et al. ) 50 401 OL (Shearon Harris Nuclear Power Plant, )
Units 1 ani 2) ) ASLBP No. 82-h68-01
) OL Wells Eddleman's Response to Apolicants ' Motion for Summary Disposition on Contention 373 This response is filed under an extension of time annroved by attorneys Baxter (for Applicants) ard Barth (for NRC Staff),
and by Judge Bright in Judge Kelley's absence, all by phone communication.
With respect to cancer and genetic defects and health effects caused by rediation, I adopt hereby Joint Intervenors' resnonse to sumnary disposition on Joint II and Joint Intervenors ' responses to discovery by Annlicants and Staff re Joint II, 'as if set out here in full.
With resnect to pain and suffering: 1. Anplicants' expert Fabrikant is not an expert on nain and suffering. 2. Aunlicants o a:
(D o Q admit that pain and suffering is not actually conaarsidered in the o[
Eo cost-benefit analysis for Harris. 3. Applicants imuroperly seek diseases (Dg to compare the nain and suffering of diseases and cancer deaths not o
OO caused by the Harris plant, to those that are. The proner comnarison o$ is between the alleged benefits of Harris operation (electricity) and the effects (including pain and suffering) which weigh against it.
1.
4 Therefore, Applicants ' point on pain and suffering is irrele vant .
The second issue of 37B is diseases other dban cancer. Genetic
. 8 defects are covered under the Joint Intervenors ' resnonse adonted above.
As to the other defects:
(p.31)
- 1. Fabrikant is wrong to say Berte11 has done no original analysis:
Rad AIHJ See See he Nuclear Worker Environmental andReview, Health Ionizing 6/81, ? nn h3-52, cony,
-~
annended.398-399, 5/79; als
- 2. The analysis by Berte11 in the Environmental Health Review
-26) shows that the claim (Fabrikant, n.25) that children who develop leukemia are more susceptible to other diseases before coming down with leukemia,does NOT exnlain the difference between leukemia in children who are irradiated and children who are not. (Berte11, p.48 and Table h) 3 Fabrikant fails to refute the statistica l association (Berte11's Table 5, p.h9) between other " indicator diseases" and radiation, which increases the risk of dying from leukemia (Table 6, ibid, p.49, probabilities less than 0.05 for pp30-31 association by chance). 4 Fabrikant cites Gilbert and Marks as refuters of Mancuso-Stewart-Kneale, but fails to mention (a)
Marks' role in getting Mancuso's contract cancelled when he declined to misleadingly allege that his data refuted that of Samuel Milham on excess deaths among the Hanford workers; (b) K.Z. Morgan's accentance of the basic conclusions of M*S*K as to some cancers (c ) J.W. Gofman's indenendent analysis of the Hanford data which supports MSK.
Fabrikant is simply wrong to say MSK are discredited: In fact, they continue to dispute the issue in scientific articles in neer-retiewed jcurnals (see Fabrikant, pp23-24). 5 Fabrikant does not describe any reanalysis of the Tri-State and other data cited by Berte11 .
(her 1978 Congressional testimony is attached) which shows that the association of radiation with other diseases is not correct.
See Berte11 1978 congressional testimony and The Nuclear Worker and Ionizing Radiation, Am. Ind. Hygiene Journal (AIHJ) 0:5,395-kO1, 1979.
Fabrikant notes (p.30) that Parkinson and Fairk, whom he cites 5
as the only critics of Berte11's work on other diseases, are employed by Oak Ridge National Laboratory. ORNL is a major nuclear weapons operation, with an obvious vested interest in claiming that radiation has no serious health effects. j Considering Gofman's experience at Lawrence Livermore Laboratory, I where he and Arthur Tamplin had funds cut off and were harassed !
l for recorting higher effects of radiation (see Poisoned Power)
(by Gofman and Tanolin), it is not surprising that industrial health physicists at a government nuclear laboratory who . wish to keep their jobs would criticize Bertells work. But what this criticism shows is that there IS controversy.
For the above reasons, Sunnary Discosition on 37B must fail.
37B also involves coal particles (alleged facts G12 and S88/89) which have been refuted by Joint Intervenors. I adopt their refutation here.
Anplicants ignore both my and Joint Intervenors' objections stated in discovery to consolidating Joint II and Eddleman 37B. They distinguish no different facts pertaining to 37B in their list of " facts" they claim am not in dispute. Therefore, I adopt Joint Intervenors' list of facts discuted (" matters in dispute on Joint Contention II") as fGrk b my list of facts in dispute for 37B, ame ta w.
Wells Eddleman 10-28-83 m
)
. t STATEMENT OF FACTS DISPUTED ON EDDLEMAN 37B
- 1. I Adont and incornorate by reference here, Joint Intervenors '
statement of facts in dispute on Joint II, since Anolicants have not distinguished any facts applicable only to 37B in their list of " facts".
- 2. Berte11 has done original analysis ofdata on radiation health effects. (The Nuclear Worker and Ionizing Mad, 398-399; J. Jananese Scientists 18(2) 16-21 and citation of radiation risk study therein).
- 3. M*S*K on Hanford data has not been discredited. Health ohysicists such as K.Z. Morgan and John Gofman do not believe it's discredited.
- h. Berte11's work relating diseases besides cancer to radiation is correct.
- 5. Berte11 has shown (Environmental Health Review 6/81) that radiation exposure produces a higher rate of leukemia among persons who have diseases associated with it (e.g. asthma ) .
- 6. The existence of disnutes about the validity of Berte11's, Bross 's, and others' work is evidence that there ARE issues of fact concerning 37B,
- 7. Scientific facts are not given validity by the number or necessarily the credentials of persons supporting them, but by research and by the scientific method.
- 8. Disputes about statistics do not mean there are zero health effects where there is stitistical uncertainty about the health effects.
- 9. Radiation has been linked to numerous diseases and causes of death, including suicide, as shown to Aphlicants on discovery.
- 10. Aoplicants have not refuted the relation between radiation exnosure and suicide.
- 11. Applicants admit that pain and suffering occur in victims of diseases caused by radiation.
- 12. Apolicants improperly seek to compare such pain and suffering to that caused by other diseases, instead of weighing it P) antH OEI f'
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RADIATION EXPOSURE ~ AND byR - B-in.Ph.D..c.~.S.H HUMAN SPECIES SURVIVAL are no genetic effects. This was even admitted by the A.B.C.C.
Few people would deny that we are living in a crisis time. The in the report of their non-findings (5). Dr. Alict Stewart has decisions which are made today will have a profound effect on pointed out the depletion of the population of Hiroshima and future generations; therefc4e, it is extremely important to describe Nagasaki of persons with poor capacity for survival - the gene-all the dimensionsof risk and address all of the pertinent questions tically damaged - because of disruptive social and health delivery basic to these decisions. systems, and because of death due to infectious disease (6). I The question which is most neglected at present - and which have shown the mathemr.tical plausibility of Dr. Stewart's hypo.
is the ultimate question with respect to deciding the future com- thesis in written response to an Interagency Task Force report on mitment to nuclear weapons and nin: lear power - is that of . lonizing Radiation in March 1979 ('l)in the United States, species survival. Can the human race continue to exist in the face cf increased po!!ution of air, land, wrter and food with this in- There is no way for scientific peers to assess the second-dustry's radioactive chemical pollution? Are we engaged in futile generation Japanese A-bomb survivors' radiation-related (linesses planmng for the energy needs of a planet which will soon be un- without access to the basic data. The effect of mild mutations in able to sustain basic life functions? Are we preparing for a war in this population apparently went unmeasured; nor was there any which everyone loses? attempt to consider change of genetic charactersitics within fami-The question of mild mutations, slow degradat. ion of the i;,3' gene pool and slow species death with increased nuclear techno- It is not then reasonable to base a decision with respect to logy, was raised by Hermann Muller and published in a prophetic endangerment of the unbom on science pre-screened and re-leased by the U.S. military, science based on an inappropriate and article en the foumal of the Amer / con M/ic Health Assocla-t/on in 1964 (1). The prestigious Amencan Academy of Science depleted data base, and science which addresses only gross morta-Committee mentioned this problemin the 1972 and 1979 ediuons lity rates and major genetic diseases in first-generation offspring cf the,ir report on the Biological Effects of lon,izmg Radiation (2) of the exposed Japanese population. The key question of species but then failed to deal with it. survival has not been raised.
It would be, of course, the ultimate ,ni selfish exploitation There are other major problems with the credibility of A~B' to charge health costs of today's life styles to those who are yet CC research, such as its failure to include in aH analyses a cor-unbom. Yet some persons might even embrace this solut,on i ifit rection for the medical X-ray exposure to survivors since the
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i meant a level of ill health for future generat,ons which would bombing, failure to consider syndrome effects of biongulatory evzntually stabihze. However, m the m,mds of most rat onal con- damage, and failure to apply systems analysis techniques to the cerned persons, the n,sk of deliberate species extinction is not a long-term interaction between biological effects on chromosomes negotiable in any risk-benefit equation.
and blood cells and clinical signs of reduced ability to physically in this paper, informat, ion available from sc.ientific sources cope with stress. Scientists from many countric> are now calling
, for an international investigation of ti.e methodology and find.'
without vested interests in the use of radiauon will be examir.ed m the hope of elucidating the probable long-term effects on the ings of the A.B.CC lt is important to judge A.B.CC work with human species of widespread radionuclide contammation. Dis- the usual scientific criteria and peer review, and to limit their tmguishing between problems of nuclear war, catastrophic ac. credibliity to matters for which their scientific research is valid.
cadent m a nuclear industry, waste disposal, terrorist action, peri-odic accident situations and routine so<alled normal pollution intemational Commission on Radiological Preection (l.C.R.P.h '
The I.CR.P., a reorganization of the In'emational X-ray and seems fruitless as these differ only in degree of pollution per time Radiation Protection Commission, was fo med in London, Eng-period, if there is indeed a species death process involved, the s rate cf deterioration will depend on the rate of pollution, but the land,in 1950. It became formally affiliated with the World Health Organization in 1956, as a "non-governmental participating or-rzsult will be the same.
ganization". The I.CR.P., together with the Intemational Ccm-The Atomic Bomb Casualty Commission (A.B.CC.): mission on Radiological Units (l.CR.U.) seems to have acquired -
(Replaced in 1975 by the Radiation Effects Research Foundation) an undeserved reputation as an independent scientific advisory Using Japanese atomic bomb victim studies as a criterion for body on worker and general public exposure to ionizing radiation.
determining the probability of species death from the radioactive Membership in the I.CR.P. is contingent upon nominatiori chemical pollution of nuclear industries is questionable for several by members of the International Congress of Radiology and by reasons. The primary reason would be the fact that all basic data I.CR.P. members and is subject to approval and selection by the on A bomb survivors is classified by the United States government I.CR.P. Intemational Executive Committee. It is a self-perpetua-and kept secret because of national security. These health effects ting organization of scientists with a vested interest in the use of are viewed as a result of a military weapon, and thus secrecy in- radioactive material, not a scientific society based on general pro-hibits scientific peer review. fessional excellence. l.CR.P. recommendations for human ex-There are published research papers which give some of the Posure to ioniaing radiation andl.CR.P. estimates of the probabic A-bomb victim information which has been screened for release . effects of such recommendations have become increasingly " poli-to scientific joumals.The early genetic papers and the scientific tical" over the years instead of speaking directly to radiation pr blems they pose are adequately discussed in two published protection standards, l.CR.P. members have engaged in risk /
papers by Paul de Bellefeuille,from the Department of Pediatrics benefit statements favorable to growing commercial, military and at the University of Ottawa (3,4). The limitations in analytic medical uses of radiation. In the most recent 1.CR.P. publication, ability to detect genetic effects even if present, the selection of No. 26 (8), the recommended maximum permissible bone mar-enly major genetic effects for study, and the many uncertainties row dose for workers is actually raised from the Frem per year
- in A bomb data do not allow the scientist to conclude that there Environmental Hea!thItevicw 43
r--
in an article in Science in 1957, Theodore Dobzhansk! sums
, dose recommended in 1965 to 44em per year. The Skem up the studies of mutagenic acti:n af ionizing radiation done t one marr:w dose corresponds to between 1,000 and 3,000 chest between 1925 and 1957 in tha f;lltwing terms:
X rays (see Appendix), or W pelvic X-rays. Raising this dose "if anything, radiation-induced mutants are more by a factor of 7,is equivalent to abdicatingall responsibility for destructive than the spontaneous ones. As far as genetic worker health! It may be cased an even more shocking failure for effects are concerned, the only safe dose of high energy ,
l.CR.P. than was its silence during t! e controversy over exposures radiation is no radiation."(10) to workers in tiranium mines. l.CR.P. has never taken aThere stand is in a rather complete bibliography on the genetic effects of favor of public or worker health on any major controversial radia. radiation, known in 1957, after Part 11 of the paper by Paul de tion issue.He uranium mining " mistake" has cost, or will cost, Bellefeuille in Acto Radiologica (4).
about 1,100 lung cancer deaths in the United States. The bone Both human and animal studies confirm the existence of marecw exposure recommendation may well cause 100 times that genetic damage with radiation exposure and the ability of scien-Cumber! tists to measure such damage. Present scientific pretense that The I.CR.P. recommended dose limits are based on a "stan- damage is unmeasurable has no foundation in scientific literature.
dard man" concept which is inadequate for handling global There is also reason to suspect malicious neglect in the rnetic and environmental diversity. It is also inadequqte for pre- failure of the military and industrial nuclear industries to keep dicting changes as the species develops in time. Yet there is no on- careful reproductive history records on personnel exposed to g;ing audit of I.CR.P. predictions which could serve to alert a ionizing radiation over the past 35 years. The present number of population to a deteriorating health problem before it reaches workers exposed to iorizing radiation in the U.S. is about 7,000,-
crisis proportions. l.CR.P. has never set up an on-going epidemi- 000. The global number must be staggering. Yet - since no epi-ological survey, even though its 1959 publication, No. 2, clearly demiological study of the reproductive experience of nucIcar stated that this was the only way such effects could be detected. workers has ever been conducted (11) - no factual data supports it is then irrational to depend on the I.CR.P. recommenda- the euphemistic predictionsof the I.CR.P. that genetic damage is tions of exposure levels of radiation as if they were protective of the whole human species for all future time. This group lacks now of lesser concern than it was in 1957. Non-collection of is not an acceptable method of proof in scientific circles.
credibility on several bases: in its manner of organization, in its statements and in its remmmendations. No condemnation of individual members of I.CrLP. is here intended. When they speak Tri-State Leukemia Survey Data:
as a group, however, they are not recognizabfe as a scientific The data collected in the United States between 1959 an society concerned with human survival and/or seseech excellence 1962,in New York State, Maryland and Minnesota,is one of the and deserve to be treated as persons with vested interest venturing best sources of detailed information for scientists not satis en opinion. with military secrecy and military / industrial non-co!!cction of Early Research on Genetic Damage from lonizing Radiation: data relative to this issue of species survival. There are numerous in a paper pubidhed in 1955, Macht and Lawrence reported published journal articles based on the Tri State data. A few will a significant increase in malformed offspring of physicians with be referenced here so that the interested scientist can further and without occupational exposure to X-ray (9). They reported purne the question (12).
significant increases in all birth defects (p=0.012) and heart Radiation exposures considered in the Tri State Survey were disease (p=0.02) in offspring of exposed physicians relative to off- from d,i agnostic medica! X-ray venfied by the laboratory, doctor spring of unexposed physicians. It was estimated that exposed u hospital involved. Levels of exposure were well within I.CR.P.
physicians received about 2.5 r/ year between the usual age of pr p sed exposure guidelines for workers and the generaf public commencing clinical practice,20 years, and average age at con. (see Appendix).
ception of offspring,30 years.
TABLE 1 Randomly Chosen Control Children With and Without Radiation, Tri. State Leukemia Survey With and Withcut Indicator Diseases 1 to 3 Years Prior to Interview
- Children with Ch!!dren with Preconception, No Radiation Exposure in utero or Postnatat Radiation Disease No Disease Disease ' Children with indicator diseases within one Age No Disease year of interview were eliminated from this
' chart. Based on Table 4 in " Genetic (57.08) (5.92) Damage from Diagnostic Radiation" by
$es .. .
Exp I.D.J. Bross and N. Natarajan. J AM A 53 8 237:2399 2401 (1977).
5-9 yean 33 79 (8.60) ,
D' .. .. ($ 2.40) 10-14 years 30 6 obs 72 16
.. (29.44) (6.55) ,
Exp ..
- W .07)
Os .'. . (138.92)
Exp h
46 Environmental Health Review J
' Children with indicator diseases within one year of diagnosis of
_ -Parental exposures prior to the conception of offspring,in utero and post natal exposures were considered for cases and leukemia (or interview for controls) were eliminated from this chart. Based on Table 4 in " Genetic Damage from Diagnostic controls under 15 years of age. in the adult portion of the data, Radiation" by 1.D.J. Bross and N. Natarajan. J AMA 237:2399-diag 60stic X-ray received one or more years prior to leukemia diagnosis for cases or interview for controls was considered.This 2401 (1977).
both excludes X-ray taken for the purpose ofleukemia diagnosis ..
and allows for the body to repair any damage it is able to repair. .
11 can easily be seen that there is no excess of children with indi-Adult exposures were in small fractionated doses extended over a cator diseases one or more years prior to leukemia diagnosis in twenty year period (13). the non-irradiated children. The , irradiated children, on the con- ,
The Tri-State Survey includes 1,700 cases, with a comparable trary, show a strik,ing (and statistically significant) excess.One is number of random controls. There was stradficat~on of controls reminded of Dobzhanski's remark about the destructiveness of to approximate age, sex and geographical distribution of the radiation 4nduced mu.at, ions. The statistical model for quanti-cases. The survey includes 48 million person-years of experience. fying the obvious difference noted in these tables between ,
Table 1, constructed from one of the published research spontageous and radiation-related leukem,ia is g,iven m the Bross/
papers on the Tri-State Survey (14), gives the distribution of Natarajan arye M Mat h of imponance he is me obsena-control children with and without pre conception, in utero or tion that ch,mcal signs of pre-leukem,ic indicator diseases appear post-natal irradiation. The children are further divided into those earlier when there is radiation-related damage of a child. It with and without a diagnosis of certain indicator diseases one or should be obvious that, in a situation such as prevailed in Hiro-more years prior to the leukemia diagnosis for cases or interview shima and Nagasaki after the bombing, such children would be for controls. The indicator diseases were: asthma, urticaria, expected to die of the indicator diseases rather than leukemia.
ecrema, pneumonia, dysentery and rheumatic fever. Such proxi. Thus pre-leukemic children would die of pneumonia, dysentery mate diseases are likely to be the pre-leukemic signs of system or other infectious disease.
breakdown due to the leukemic process itself. Children with Control children were randomly selected from the popula-these diseases within the year prior to leukemia diagnosis, or tion at a rate of 1 in 3,255 chiMren. Hence the deficit ofindica-interview for controls, were therefore eliminated from this tot diseases among children in the irradiated controls 1 to 4 years table ~ of age represented a large number of children. In another pub-lished Tri-State Survey paper, a more detailed analysis of the cases Using the non-irradiated control children as " normal", ex-and controls between 1 and 4 years was given (15). In this analy-pected numbers of irradiated control children with and without the indicator diseases can be estimated. About half the expected sis, only childhood virus diseases contracted one or more years number with diseases were observed in the irradiated 1 to 4 year prior to diagnosis for cases, or interview for controls, were con-sidered pathological indicator diseases. These included measles, olds tnd slightly less than expected were observed in the other two age groups. The deficit in irradiated children with indicator rubella, chicken pox, mumps, poliomyelitis, herpes zoster, en-diseases in the early years is not persistent into the older age cate- cephalitis and infectious mononucleosis. There are more cases and controls in this analysis since children with concurrent diag-gories, indicating that most likely the "no disease" irradiated noses of the indicator diseases and leukemia (or interview) were children moved into the " disease" category at a more rapid rate not eliminated as was done in the Bross/Nataraian paper (14). .
than did the non-Irradiated children.
Table 2 is a comparable report on the children dying of These children were included in the "no disease" one or more leukemia at the time the survey was taken. years prior category.
TABLE 3 Tri State i.eukemia Survey TABLE 2 Randomly Chosen Control Children 1 to 4 Years Tri-State f.eukemia Survey of Age With and Without Radiation Exposure, Otild Cases With and Without Radiation, With and Without Pathological Indicators
- With and Without Indicator Diseases
- Radiologic 1 to 3 Years Before Diagnosis
- Factors Children with ChRdren with Preconception, Pathologic Factors 0 1 2 land 2 Total No Radiation Exposure in utero or Postnata! Radiation 0 42 25 12 6 85 ..
bs Age No Disease Disease No Discar Disease ,
M yean 44 19 9 4 76 3 45 12 Obs 1 27 (12.57) (6.29) (89.05)
(51.64) (5.Q Exp (26.19) gp (27.18) (2.82) 2 20 4 0 1 25 Obs I'"" 11 7 Exp (11.91) (5.71) (2.86) (40.48) 13 3 Obs (2.26) (15.46) (2.54)
(13.74) Obs l and : 22 8 5 2 37 "
- P Exp 0 3.09) (6.29) (3.14) (44.52) m u ,,,,, , , ,
"' Total 128 56 26 13 223 (1.64) (6.54) (1.46) Obs Exp (7.36) Exp (76.19) (36.57) (18.29) (259.05)
^H88'$ 48 7 60 23 *This is based on Table 2 in " Leukemia in Children Exposed to 5
(48.28) (6.72) (73.64) (9.36) Multiple Risk Factors" by R. Gibson, et al. New Eng. Jr. Med.
279.906-909 (1968).
=
Environmental Health Review 47
Table 3 shows the distribution Ef control children on pitho. TAILE4 ,
logic factors: Tri-State Leukemia Survey O no viral indicator or matemal history of miscarriaps Leukemic Odidren 1 to 4 Years of Age and stillbirths; With and Without Radiation Exposure, .
With and Without Pathological Indicators
- 1 childhood virus diagnosed one year or more prior to Interview; Radiolosic 2 maternal history of miscarrlaps and stillbirths prior to this conception; Pathologic Factors 0 1 2 1 and 2 Total 1 and 2 both pathologic factors present; ,,, , ,, 33 , 3 43 and on radiologic factors: Exp (12.5) (6.0) (3.0) (42.50) 0 no maternal preconception irradiation and no in utero obs 1 22 11 8 7 4s radiation; Exp (22,00) (13.09) (6.24) (3.14) (44.52) 1 ' irradiation of mother before conception of the child; obs 2 10 3 3 1 17 2 Irradiation of the child in utero; Exp (10.00) (536) (2.86) U.43) (20.24) 1 and 2 both radiologic factors pre ent; obs 1 and 2 17 13 4 4 41 Expects'd values in a table such as this can be generated Exp MM M M (22.26) assuming any combination of one column and one row as "given". obs Total 70 40 24 17 151 Of course, the marginal sums are usually used, but in this parti. Exp (64.00) (38.09) (18.29) (9.14) (129.52) cular table the marginal numbers are random estimates of sur. *This is based on Table 2 in " Leukemia in Children Exposed to vivors in the Tri-State area ahve at or beyond age one. in order t Multiple Risk Factors" by R. Gibson, et al. New Eng. Jr. Med.
cstimate the distribution and size of the population lost as early embryonic, fetal, neonatal or infant deaths, I made two assump- 2 M M M $ 8) ti2ns: .
in Table 4, the expected numbers were derived from the non-If ordinary diagnostic X-ray exposure has little effect Irradiated children and those without pathologic factors in the on the survival of offspring, then:
control series. It is evident that children dymg of leukem,a i are
- 1. The non-Irradiated children can be used to esti- selected from both the irradiated and those with pathologic mate the proportions of children with pathologic factors at a higher than expected rate.There is a near doubling of
- factors in the irradiated population; and leukemic children above the expected number for combined
- 2. The children with no pathologic factor can be used mother's preconception and in utero irradiation, to estimate the pesportions of children with radio. Again, the interested scientist can read the joumal article (15) logic factors in the pathologic population. for further details and estimates of leukemia risk among children These are conservative assurnptions, since it might well be Way wn is n t the pwpose of this paper to repeat analyses already published. What is important here is the obvious trgued that mothers with a prior history of stillbirths and/or mis-carriages might be expected to have more X rays during preg-un ymntapn q cand Men ammg h with Pathologic and radiologic factors and the over-representat,on i of nancy. The tristate Survey was conducted between 1959 and the categnes in the sample of children dying ofleuk::mia.The 1%2, before there was broad medical consensus on the harm of radiation exposure of pregnant women. This consensus, of course, casename o ae a rate Mcated W th cetrol sample between conception and age one year is about 14 per formed after the excellent work of Dr. Alice Stewart in analyzing hundred. While Dr. Mole descnbes this as a ' mechanism which reduces the likelihood of development of a malformed child" se ed pr p ni in the "no exposure" and **ie "no ,
pathology" categories were assumed to be " normal", and esti- * #* * " , " E*P' ^" Y"' "
quainted with random mutat. ion models of hymg systems can mates for all other combinations of factors and marginal totals were then estimated' attet to se fact eat snany mcessive genetic mutaties are '
intr duced into the P henotypically non damaged population for !
As can be seen in Table 3, the number of children observed each dommant mutation directly expressed by non-viable off-In each entry is less than the number expected for that category under the assumption of no radiation effect. Considering nine of 'P" I g,gg, ggg g the sixteen numbers as mdependent, the probability of all being among irradiated, as evidenced in Table 1, is indicative of this bel:w the expected number by random chance is 0.002. There-heility M me wpwficialh " undamaged".
fore, this deficit of children is significant and this cannot be con-sidered a random variation.
1 Further examination of this table indicates that the assump- Tri. State Adult Data:
tirn of nearly 100% survival for children with no pathologic The question which remains is that of the radio-sensitivity factors was most likely wrong. The number of children lost of the irradiated population surviving to adulthood. In the adult because of these exposures is undoubtedly greater than indi- sample there is no information on the origin of cause of patho- l cated here. For lack of a realistic way to estimate lost pregnancies logic indicators, but is is possible to asseis the interaction between ;
in this category (the 4th row), no estimate was attempted. pathologic factors and X-ray exposure, j 48 Environmental Health Review
from medical X-ray is roughly equivalent to 0.4 to 1.7 ram bone TABLE 5 marr w dme. hsn factors we sen h an Appendix to Tri-State leukemia Survey - Adult Sample this paper.
4 The Relative Risk of Myeloid Leukemia in Persons With 5 or More Years Prior Experience TABLE 7 With the Indicated Diseases Tri-State teukemia Survey - Adult Sample mie remale oiwaw Sex and Age-Adjusted Relative Risk Proba- Relative Proba. of Non-lymphatic Leukemia Ratative Rist hairy Risk bility With Exposure to More Than 15 Rad Diagnostic X-ray 1.78 0.18 4.94* 0.02 Asthma for Persons With and Without Indicator Diseases 1.79 0.18 4J3 0.29 Hay Fever Number of Relative 7.07 " 4 0.001 1.27 0.44 Number Frobability Ecaema Category W Caus Co .erots Risk 2.29 0.36 2.01 0.13 Goiter 7.63* 0.03 9.67 0.17 459 IJ9 ( 0.01 Diabers Mellitus With disease 297 2.09 0.11 .. ..
295 1.12 0.44 Herpes Zaster Without disease 96 2.17 0.25 5.22 0.08 Psoriasis Neuroderm 754 1.47 4.0.01 0.70 8.63 " 0.002 Summary 393 Tuberculosis 0.83 1.86* 0.04 1.13 0.45 Penumonia 4.47 " 4 0.001 2 97* 0.04 Heart When cases and controls, both having the indicator diseases, 0.65 0.83 2.94* 0.02 Rheumatism are compared, there is a significant increase in non-lymphatic leukemia with diagnostic X ray exposure. Any increase in X-ray
- Sisnificant on the 5% evel. resulting from having the indicator diseases is controlled for in
- Sisalficant on the 1% lcvet. this analysis, therefore, it cannot be argued that the indicator diseases were the cause of the " extra" X-ray exposures.
Table 5 contains selected information from a published Tri.
State paper by Viadana and Bross (19). Selection was made here TABLE* 8 cf pathologic indicators of susceptibility to myeloid leukemia.
- Other research on radiation.related leukemia (20,21) which was Tri. State leukemia Survey - Adult Sample iestricted to non-lymphatic types made this selection necessary Risk of Non-lymphatic Leukemia for preliminary study of the interaction of pathology and radia- for Persons With Indicator Diseases tion in adults. Relative to Those Without Indicator Diseases There is strong indication that occurrence of these diseases for Exposure Age +
five or more years prior to the diagnosis of leukemia for cases (cr interview for controls) significantly increases the probability Catesory or Number Number of Relative controls Risk hobaWty of succumbingtoleukemia. xp sure Ase+ w Cases When these diseases (Table 5) were combined, the relative 107 1.0a 0.77 15-34 22 risk cf leukemia, adjusted for age, was significantly increased in 26 79 2.16 " ( 0.01 35-44 102 4J4" < 0.01 males, females and combined categories. . 45-54 29 63 151 1.44 0.05 55-64 86 136 1.43 0.0a 65 74 84 1.12 0.67 TABLE 6 75 84 72 85+ 95 96 3.18 " 4 0.01 Tri-State Leukemia Survey - Adult Sample m i (age Age-Adjusted Relative Risk of Leukemia 340 1.91 " 4 0.01 adjusted) 231 Given a Medical History of Related Diseases Female (age 162 415 1.43 " 40.01
- Number Number of Relative Probability adjusted)
Cargory of Cases Controis Risk 1.96 4 0.01 393 755 1.69 " ( 0.01 Male 231 340 Sumrnary 415 1.34 ( 0.05 F emale 162 1.6s <,0.01 Cambined 393 755 l l + Exposure Age is chronotosical age plus the number of rads trunk medicat l i
As a first apEroximation of the interaction between disease X-ray plus one-fourth the number of rads non-trunk medical X ray. '
l and X-ray exposure, sex and age adjusted risks of non-lymphatic ** Significant on the 15 :evet.
leukemia for exposure to 15 rad or more diagnostic X-ray (skin I dose) relative to less than 15 rad exposure were calculated. The X ray dose had been fractionated and spread over a period one to nineteen years prior to diagnosis or interview. Only ordinary diagnostic X-ray one or more years prior to diagnosis (or inter- i view) was liscluded. Persons with fluroscopy and radiation therapy l wire excluded. It should also be noted that 15 rad skin dose Environmental Health Review 49 r
)
l
Using the previously developed technique of increasing the age of each case and control proportional to their own verified TABLE 10 X-ray exposure history (20,21), it was possible to do a detailed Relative Risk of Non-Lymphatic Leukemia I analysis of the interaction between diseases and radiation-related with more than 15 Rad X-ray Exposure leukemia. Each case and control was " aged" by one year for each after Adjustment for Exposure Age
- trunk exposure of one rad, and by one. quarter year for each non.
trunk exposure of one rad. The new combined measure was called , ,
exposure age. It is obvious that the younpr suceptibles are dying c. ,,,,,y Mr cases controls Risk bility I during exposure ages 35 to 54. These are young adults, capable J Male Exposure ase cf parenting, who tragically die during life's most potentially 268 and diseaws 203 1.21 0.18 fruitful years.Tneir death is hastened by radiation exposure. l Female Exposure age and diseases 142 301 0.79 0.11
)
Relative Risk for Non-lymphatic Leukemia With Exposure age j dis **ses andsex 74 196 0J8 0.51 ,
for Males with le dicator Diseases, for Exposure Age Without Exposure age Exposure Number Wmber Relative Proba- Attributable diseases and sex 271 373 1.06 0.48 Age Cases controls Risk bility Proportion Exposure ase, 15 34 15 50 1 34 0.34 14% Summary sex and 345 569 1.02 0.56 35-44 13 22 11.78 0.00 77% diseases 45 54 13 53 7.27 0.00 75%
55-64 40 81 1.15 0.59 8%
65 74 50 63 1.58 0.12 28%
- This analysis demoristrates that the sample is adjusted for age, radiatiort 75 84 44 35 1.22 0.56 13% affect and sex.
85 ce more 53 36 4.08 0.00 70%
A recent paper published by Bross, et al, (22) reports a heart Summary 231 340 1.91 0.00 37%
disease / leukemia syndrome in the irradiated Tri-State Survey adults reminiscent of the indicator disease / leukemia syndrome in This table appeared as Table 11 (page 43) .in " Health Hazards the childhood cases. These diseases apparently give evidence of involved in the Production, Storage and Use of Nuclear Weapons ,.
the gross general damage done by radiation when causing leuk.
Invited Address. Proceedings, Japan International Congress emia. The supposed discrediting of the Bross research published Agamst A- and H-bomb. Osaka, Japan. August 1978. In the same joumal issue (23) is invalid, but discussion of that paper is beyond the scope of the present text. Joumal handling Table nine, previously published (21), shows that males w.th i of this paper is indicative of the unscientific harassment against indicator diseases have 12 times the risk of non-lymphatic leuk- any scientist who tries to report findings on radiation-related emia during exposure age 35 to 44, and 7 times the nsk during health effects. juxtaposition of paper and critique, where critique exposure age 45 to 54. The excess deaths begin occurring younger undermines credibility of data base and presents invalid alternate in males than in females.This is perhaps reflective of their shorter models for a part (not the whole) of the data, causes confusion.
life span, in males,70 to 80 per cent of the non-lymphatic leak- Scientists in search of knowledge cannot resolve the factual cmia deaths prior to exposure age 54 have mdicator diseases. questions (which should have been settled before publication)
Their deaths are hastened by radiatiore exposure. and can be easily deceived by a partial mathematical model not it is important to note that this analysis controls for rad.ia- adequate to explain all of the data.
tion and also demonstrates that such control better identifies it has been difficult to glean even this much factualinforma-the high-risk group. What is being done amounts to combinmg tion in the present climate of national security secrecy and de-natural aging and radiation exposure as measures of phys,ologic i fensive science. I would define the latter as science-for-hire or breakdown of the individual, and then' estimating leukemia ince- science for the purpose of proving the rectitude of a military, dence resultmg from this physical mability to cope. Table 10 industrial or political position. One could, of course, always wish demonstrates the fact that using exposure age controls for in- for further detail and broader categories of radiation exposure creased leukemia nsk from radiation not only in the whole g;g g; g , ,' cure" the malicious neglect sample, but also in the subsamples created by considerms male inherent in not systematically collecting information on workers tnd female separately, or by considenng persons with and with- and the general public at risk, such information will not be forth-out the indicator diseases separately. coming.
The following broad strokes provide clues for predicting th:
One more point should be noted, just as natural aging con- future of the human species with respect to exposure to radio-tinues to diminish a person's physical ability to cope with the active chemical pollution from nuclear industries: l 4 11ukemic process, a process pcrhaps initiated two or three years 1. Radiation related leukemia is in general preceded by a earlier, so the aging effect of X ray is important even though the longer period of ill health than is non radiation-related !
X-ray follows leukemogenesis. For this reason it seems not to be leukemia. :
inappropriate to consider alI X-ray exposures more than one year . j prior .to leukemia diagnosis an this analysis, regardless' of the , ,,
length of the leukemia mduction penod. ,, ,, .
Wh 1 1 50 Environmental Health Review _
I
'13. M le, R.H. Radiation Eff cts on Pre Natal Development and 22. Bross, I. at al. A Dosage Response Curve for the One R Their Radiological Significance. British joumal of Radiology Range: Adult Risks from Diagnostic Radiation. Am. Jr. I 52:614 (pp. 39101) Feb.1979. of Public Health 69:2 (1979).
> $ 9. Viadana, E. and Bross, I. Use of Medical History to Predict 23. Boice, J. and Land, C. Adult Leukemia Following D? agnostic the Future Occurrences of Leukemia in Adults. Preventive X-rays? Am. Jr. of Public Health 69:2 (1979).
Medicine 3,165-170 (1974). 24. Dertell, R. New Structures for Growth. Science and Techno.
- 20. Bertell, R. X ray Exposure and Premature Aging. Jr. Surgical logy and the future, Proceeding and joint Report of World '
Oncology 9:379 391 (1977). Future Studies Conference and DSE-Preconference, May
- 21. Bertell, R. Health Hazards involved in the Production, Stor. 410,1979. Part 1. Editors: Hans Buchholz and Wolfgang age and Use of Nuclear Weapons. Invited Address. Proceed- Gmelin; Publisher: K.G. Saur, p. 345-352.
ings, Japan Intemational Congress Against A- and H-Bomb.
Osaka, Japan, Aug.1978.
Q&QQ Radiation Exposure and Hufnan Species Survival EHR June 1981 Vol. 25 - No. 2 by Rosalie Bertell, Ph, D., G.N.SH.
atomic bomb survivors perfomed by censorship of scientific findings. He notes Dr. R. Bertell's article in the June 1931 that the staff including executives, were issue of Environmento/ Heale Revkw medical officers of the armed services and the Public Health Service in coopera- civilians who would resist such a move.
contains a number of serious and erro.
tion with colleagues from Japanese medi- He joined ABCCin March 1948.
neous allegations about the Radiation cal school faculties. It is noteworthy that The Bib //ography ofhb//shed Arpers Effects Research Foundation (RERF) and its predecessor, the Atomic Bomb Casu. Secretary Forrestal's letter states: of me Atom /c Bomb Grsua/ty Comm/s-alty Commission (ABCC), which at the Homewr, de study /s beyond the s/on 1947 74 lists 967 articles in the minimum require public rebuttal;indeed scope of m///tary and now/ affa/rs, world biomedicalliterature beginning with InvoMnp as it does human /(y in the " Genetics Conference, Committee on they are deserving of public apology.
peneral, not only In war but In ant /. Atomic Casualties, National Research Dr. Bertell states in reference to ABCC and RERF findings: c/ pated problems of peaceM /ndust. Council; genetic effects of the atomic ry andagr/ culture. bombs in Hiroshima and Nagasaki" in
. . . all bas /c data on A bomb sur. Sc/ence, . volume 106, pages 331333, whors As class / fled by de United ABCC was thus established under the direct supervision of the U.S. National 1947. RERF's most recent appraisal of States powenment and Aept secret the genetic effects of exposure to the because of national security. These Academ'y of Sciences, an independent agency which most regard as comprised bomb was Schull, Otake, and Neel, "Ge- t health effects are v/ewd as a result of the cream of American scientists. From netic effects of tne atomic bombs: a re-cf a m///tary wapon, and thus sec-Its initiation, ABCC was staffed by both appraisal",5chnce, 213:1220-1227,1981.
recy inh /b/ts scient/fic peer rev/ew. ,
American and Japanese scientists. From it indicates our continuing concern with (p. 43) .
their beginnings, ABCC and RERF have collection and interpretation of quanti-and again: tative information -on radiogenic muta-carried out collaborative studies 'with It is not den reasonable to base a Japanese and American university faculty tions in man.
dec/s/on w/th respect to endanger. Far from being findings from "an members.
ment of the unborn on sc/ence pre- Inappropriate and depleted data base",
In a search for the origins of Dr.
screened and released by de U.S. the early prospective studies of the out-Bertell's misinformation concerning ABCC m///tary, science based on an /noppro. comes of >70,082 pregnancies ofirradia-pr/ ate and depleted data base, and and RF,RF, I have found the following.
During the early U.S. occupation, in- tad survivors and controls during the post science Wr/ch addresses only pass formation of the physical, chemical, and war years, the continuing studies of mortal /ty rates and major penet/c d/-
geological effects of the atomic bombs growth and development of > 200,000-
- seases in first generat/on offspring children of survivors and controls, the-were classified,.and there may have been cf the exposed /apanese populat/on. studies of mortality among > 50,000 some censorship of biomedical findings (p. 43) about which I am not aware. I have spo- members of the F 1 generation, and It may be helpful to briefly review ken to a few biomedicalinvestigators and ongoing F 1 cytogenetic ( > 10,000,th F1 the history of the studies of ABCC, and others who were here at the time, how- examined to date) and biochemical ge-then the current prngram of RERF. ever, and they .do not recall censorship net!c studies (>17,000 F1 examinea to ABCC was established on the recom- of any data or manuscripts. One is an date) make the survivors' families the i mendation of the Division of Medical Australian national and thus like the most thoroughly genetically analyzed po-
". japanese staff members, not eligible for putation in the world. Furthermore, far ed P side t try m security clearance. He has always enjoyed from be,ms devoted only to " gross mor.
by Secretary of the Navy James Forrestal free access to the institution's data and tality rates and major genetic diseases" fi dings. He noted that some letters of subjects admittedly of the greatest con-at n I c tookth ac on inquiry from the military in the late cern to the survivors, the F1 cytogenetic in response to a medical survey of the 1940s were classified, but knows of no study deals in part, and the biochemical 46 Environmental Health Review June 1982
~- _ -- - .-
i
- T- -
youngest youp by at least 14% but, thereafter, disease Pelvis 829 610 7.93-296.46 proneness increases in ne irradiated children more (to fetus) rapidly than in the non-Irradiated children. 5.73 53.68 Umbs 117 100 0.17-1.2
- 3. Both children and adults with pathologic factors are Dental 1138 910 0.65 2.44 more vulnerable to radiation-related leukemia.
Data in the above table was compiled from:
- 4. It is both possible and probable ~ that some irradiated " Population Exposures to X ray U.S.1964" children and adults die of the pre-leukemic illnesses " Population Exposure to X ray U.S.1970" DHEW Publ. (FDA) before they develop the leukemia.
73-8047
- 5. Mild mutations causing early appearance of chronic " Organ Doses in Diagnostic Radiology" DHEW Publ. (FDA) diseases such as asthma, arthritis, diabetes, ischemic 76 8030 heart, and atherosclerosis are transmittable to offspring "The Mean Active Bone Marrow Dose to the Adult Population of and are indicators of increased susceptibility to radia- the U.S. from Diagnostic Radiology" DNEW Publ. (FDA) 77 tion effects. 8013.
- 6. Radioactive chemical p"ollution increases the proportion cf susceptible people in a population at the same time
REFERENCES:
ts it increases the radioactive content of the environ- 1. Muller, H. Radiation and Heredity. American joumat of ment with which these more vulnerable persons must Public Health 54:1 (1964) pp. 42-50.
Physically cope. 2. The Effects on Populations of Exposure to Low Levels of This last effect is what I would call a species death process. .lonizing Radiation, Report of the Advisory Committee on At present the incidence rates of chronic diseases, and the ages at the Biological Effects of lonizing Radiation. Nov.1972 edi-which they are diagnosed, go unmonitored in society. Public tion, page 48; Revised edition,1979, page 118-119.
health efftets caused by a highly sophisticated nuclear technology, 3. de Bellefeuille, P. Genetic Hazards of Radiation to Man.
whether for weapons or commercial uses, are crudely measured Part I: Acta Radiologica Vol 56:65-80 (1961).
- 4. de Bellefeuille, P. Genetic Hazards of Radiation to Man.
. by either predictive computer models or by cancer deaths.The Part II: Acta Radiologica Vol. 56:145-159 (1961).
l former lose credibility for two reasons: Because of their associa.
tion with the military and industrial promoters of the use of S. Kato, H. Genetic Effects.1. Early Genetic Surveys and
' ionizing radiation for weapons and electrical generation; and Mortality Study. J. Radiot. Research Supplement 67 74 because they are forecasts not verified by an audit. Cancer death (1975) pp. 69-70.
rates are a very crude measure of the health status of a popula. 6. Stewart, Alice. Possibfe Sources of Error in Risk Estimate tion randomly exposed to a mutagen in the form of radioactive Based on A-bomb Survivors.13' March 1979. Available from chemicals. One could have a cancer epidemic without its impact. the Regional Cancer Registry, University of Birmingham, ing death statistics for ten years.
Birmingham, England. See also Radiation Cancers and The instinct of the public, which is beginning to react strong- A bomb Survivors. The Lancet. Nov. 27,1971 (1203).
- 7. Public comments on the Work Group Reports, June 1979.
j ly against invisible destructive radioactive chemicals being added to air, f:od, water and land, seems truer than the advice of some Interagency Task Force on the Health Effects of lonizing Radiation. U.S. Dept. Health, Education and Welfare Docu-j chemists, physicists and nuclear engineers. Care of public health needs to be retumed to the hands of Public Health officials, and ment 49.
these efficials need access to the best available technology for 8.1.C.R.P. Publication 26. Recommendations of the Inter.
national Commission on Radiological Protection, Adopted monitoring human health. Citizens need free access to all informa.
I tion on pollution and risk in their living space, just as the worker jan.17,1977. Pergamon Press.
has the right to know the hazards connected with his or her work 9. Macht, S. and Lawrence, P. National Survey of Congential place. Persons at risk from high technology have the basic human Malformations Resulting from Exposure tn Roentgen Radia-tion. Amer. Jr. Roentgenol. 73 (1955) pp. 442-466.
l, right to know that risk and to enter into decisions regarding it at a level of collective bargaining. New structures need to be 10. Dobzhanski, Th. Genetic Loads in Natural Populations. '
' weveloped in society to provide orderly handling of the increase Science 126 (1957).
- 11. Bertell, R. The Nuclear Worker and lonizing Radiation. Am.
in technological and industrial expansion (24). The failure to act ind. Hygiene Assoc. joumal 40:5 p. 395401 (1979).
in the ptesent crisis, the failure to produce channels for creative and life protective responses, means opting for irrational en. 12. Graham, S. et al. Methodological Problems and Design of-the Tri. State Leukemia Survey. Ann. N.Y. Academy of dangerment of human survival on the planet earth.
i Science 107:557-569 (1963).
j 13. Gibson, R. et al. Irradiation in the Epidemiology of Leuk.
APPENDIX emia Among Adults.- jr. Nat. Cancer inst. 48:301-311 Estimated Skin and Bone Marrow Dose From (1972).
magnostic X<ay 14. Bross, L and Natarajan, N. Genetic Damage from Diagnostic Body Area Skin Dose in mR Bone Marrow Dose Radiation. Jr. American Medical Assoc.237:22 (1977).
Average per film per film in mrad 15. Gibson R. et al. Leukemia in Children Exposed to Multiple Risk Factors. New England Jr. of Med. 279:906-909 (1968).
1960 1970 (1970)
- 16. Stewart, A. et al Malignant Disease in Childhood and Diag-Head / Neck 279 300 12.8 24.0 nostic Irradiation in Utero. Lancet 2:447 (1956).
Thoracic Spine 1265 980 10.8 65.7 17. Stewart, A. et al A survey of Childhood Malignancies. Br.
Chest 45 44 0.75-6.82 Med. jr.1:1495-1509 (1958).
Abdomen 790 960 8.5-200.6 Environmental Health Review 51
,e . .
pnetics study deals primarily, with sub- TR of the ninth report on our Life Span was supported entirely by grants from tfe genetic changes which produce no Study will have available , 400 page American Cancer Society and National demonstrable poss abnormality. Indeed, appendix of data tables on the mortality Cancer Institute.
the biochemical genetics study is designed experience of a population of 110,000 Of the more than 50 professional l to detect " recessive" mutant molecules . Individuals followed for 28 years. investigators in RERF's Hiroshima and l in heterorygous offspring. The fact that As to the structure of RERF, since Nagasaki laboratories, most are japanese, '
less than five putative mutant proteins its establishment from ABCC in 1975 it seven are American, one Canadian, and has been an independent binational foun- one Israeli. Last year, one was from Main-have been detected in measurements of the first 500,000 gene products is far dation equally financed by the Japanese land China. To suggest that these scien-I from disappointing to me, and I believe, Ministry of Health and Welfare and the tists, including investigators of interna-U.S. National Academy of Sciences, the tional prominence, would submit to cen-to the survivors.
In 1957, ABCC established the poli. latter with funds from the Department of sorship by the U.S. military is demeaning.
cy cf publishing all results in technical re- Energy. The two Japanese resident Di. Either the author is possly unfamiliar ports (TR) in a bilingual format for rectors including its Chairman came to with the facts or does not wish to re-RERF after distinguished careers in pub. cognize them.
distribution to Japanese and American
. age ncies, libraries, and individu als through- lic health and academia. The two Ameri. I urge the Env/ronmento/ #eo/th Re-out the world. Before publication,all TR cans were faculty members at medical r/ew to print this statement in entirety manuscripts are refereed by independent schools. Their only association with the and retract Dr. Bertell's unfounded a!!e.
investigators at American and/or Japanese military was service in the armed forces gations.
Institutions. Although most of the reports of their respective countries during the Sincerely, are then also published in (again) refereed 1940s and early 1950s. Personally, I eHy H. QUton, AD.
journals, the TR system allows presenta- severed my connections with the military Pennanent Director and Oiief of Research tion of more detail than is possible in on honorable discharge as a Seanian .
First Cass, U.S. Coast Guard, in June Radiation U/ects most journals. RERF has continued the 1946. In three decades as a cancer re. Research Foundation TR series; as an illustration of the greater searcher and radiobiologist, my research Hiroshima,/apan inforrnation allowed by this sys' tem, the Dr.Rosalie Bertell,Ph.D.,G.N.S.H.
RESPONSE By April 28,1982 Thank you for the opportunity to res. Ironically, Sidney Marks had been the wrote to the Department of Energy after pond to Dr. Gifton's critique of my govemment employee who tried to my request, he stated: "In view of Dr.
paper on Red /or/on Exposure and Human suppress Dr. Mancuso's work and prevent Bertell's bias,it would seem inappropriate Specles Sury/w/ in this issue. Its publication (1). for RERFto establish any formal relation.
The reader will note that my claim Similarly, when Dr. Irwin Bross and ship with her." l was that the basic ABCC data, i.e. the I published the radiation related findings in 1978, when I was in Japan, Dr.
records of radiation dose and subsequent from the Tri-State Leukemia Survey, the lssei Nishimori, an internationally known ,
health problems of atomic bomb sur- U.S. pvernment obtained computer scholar at the University of Nagasaki, vivors, is classified and not available tapes of the data and hired Michael was refused the RERF data on original for scientists who request access to it Ginevan of the Argonne National Wea. atomic bomb radiation doses for indivi-for legitimate research purposes. Dr. pans 1.aboratory to re analyze the data. duals he had collected health data on for Kelly Oifton addressed a second and These re-analyses of Hanford and Tri- a number of years. I was told by Dr.
different question, namely the sup- State data included the use of cruder Stuart Finch, then director of RERF, pression of findings or limitation of statistical tests, elimination of some in- that Dr. Issel Nishimori "might be biased access to data among the staff of the formation, inclusion of some unverified against radiation." He also made the re-RERF. As he pointed ot t, this may have information, and then pnerally con- mark t'iat the japanese (not on the RERF been a problem in the ea-ly ABCC days. ciuded that the researchers' claims staff) did not need to know the radiation i did not even address this possibility were " unproven". The govemment then doses in order to treat the illnesses of the ,
in my paper. called for more time to continue the re. survivors. This was to my mind a clear it has been the custom in radiation search, and at the same time it cut off policy of exclusive right to control re-health research to use the atomic bomb the funding for such research (2), search on atomic bomb victims by survivor findings as the " classical re- On the other hand, the atomic bomb RERF. Ocarly the data base is classified, l setrch" against which all other research findings have been challenyd by Dr. as I have said, and all the researchers 1 is judged. For example, when Dr. Thomas Joseph Rotblat (3), Dr. Alice Stewart chosen as " unbiased against radiation".
Mancuso found levels of cancer among and myself. We have asked to test our The interested reader may wish to the Hanford nuclear workers to be sig- hypotheses against this data base, expec- obtain a copy of the book produced by nificantly higher than would have been ting govemment cooperation to resolve the japanese: Hirosh/mo and Nogosok/
predicted on the basis of atomic bomb the discrepancies between the atomic The Physka/, Med/co/ and Socto/ Effects survivor experience, the U.S. govemment findings and the findings of researchers of the Atomic Somb/ngs." The book confiscated his computer tapes containing using populations such as nuclear workers was published by lwanami Shoten of the basic data. These tapes,were given and people exposed to medical X-rays. Tokyo in 1981, in English. The original to Sidney Marks and Ethel Gilbert to re- A!I requests for access to the data have Japanese version was released in 1979.
analyze at U.S. government expense. been refused. In a letter Kelly Qifton it is a scholarly treatise of about 700 June 1982 Environmental Health Review 47
pages, containing very factual details tions, however, do not guarantee an about the experiences of the survivors. accurate unbiased data base, reasonable .
The second question., raised by research hypotheses, open access to the ,
Kelly Clifton, has to do with the trust- data for competent outside scientists, and accountability of government re-worthiness of the data base and the research produced by ABCC and RERF. searchers to their peers.
This trustworthiness is not simply a matter, in a world with 50,000 nuclear of internal freedom of access at the warheads and more than 8%00 MW(e) nuclear power capacity; a world contami-RERF centres.
According to the U.S. Department nated with over 1,200 nuclear bomb cf Health and Human Services: tests and millions of tons of nuclear The ABCC data /s subjected to waste, it would indeed be tragic to dis-senrol recognited biases; primally cover the ABCCIRERF had made an those ofselect/w survivorship, under. error about human tolerance of radio-ascertainment of Infant mortality activity! It is obviously the miiitary es-tablishment which has the greatest vested ardsma// sample site (4).
interest in perpetuating the probable Dr. Alice Stewart has demonstated errors. It, of course, cannot carry out its tha same problems with respect to the strategies unless human beings are willing adult data (5). I have pointed out that A bomb analyses have never corrected to handle radioactive materials. I had hoped Kelly Clifton would be more for the medical X-ray exposure of the humble and less defensive in the face of survivors, which has been liberally given the seriousness of a radiat;on health mis-since 1945 (sometimes just for the take. There is no place for defensiveness sake cf a research project). William when survival of the human race is at Loewe and Edgar Mendelsohn, Lawrence stake.
Livermore weapons laboratory, have esti.
mited that the neutron doses assigned to Hiroshima survivors were too high by a factor of 6 to 10, making the estimates cf cancers per rad exposure too low. A References physicist, John .Auxier, of the Oak Ridge 1. " Radiation Standards aid Public national weapons laboratory, responsible Health," Froceedings of a Second Congressional Seminar on Low-Level for the radiation dose estimates has said he cannot justify his numbers because Radiation, February 10,1978. Avail-his notes were accidentally fed to the able from: Environmental Policy in-stitute, 317 Pennsylvania Avenue, shredder (6).
in spite of the fact that controversy S.E., Washington, D.C. 20003.
over the reliability of atomic bomb data 2. ibid, reference 1.
has been raging since at least 1978, the 3. J. Rotblat, "The R/sks for Rad /o-U.S. National Academy of Science tion Workers." The Bulletin of the Committee on the Biological Effects of Atomic Scientist, September 1978.
lonizing Radiation (BEIR) produced an 4. " Effects orlonizing Radiation on the "auth:ritative" book on radiation health Dewloping Embryo and Fetus: A.
In 1980 (7). In 1981, the Chairperson Rev/ew." U.S. Department of Health cf the BEIR Committee, Edward Rad- and Human Services. HHS Publica-ford, epidemiologist at the University of tion' F DA 81 8170. August 1981.
Pittsburgh, declared the 1980 BEIR re- S. Alice Stewart, "Possible Sources of port cbsolete because of its unacceptable Error in Risk Estimates Based on riliance on atomic bomb data. A re-analy- A bomb Survivors." Regional Cancer sis cf atomic bomb data is now under- Resgistry, University of Birmingham, way under the sponsorsh,ip of the U.S. Birmingham, England. 13 March Department of Energy. It is again an "in 3979, hoase" study, and none of the scientists 6. News and Comments: "New A-bomb who have pointed out the serious prob- Studies After Radiation Estimates,"
lems with th,is research are part of the Science, Vol. 212, May 1981.
oversight committee. It is doubtful that 7. "The Effects on Populations of Ex-such controlled and secretive methods posure to Low Lewis of lonli/np will ever be acceptable to the cr,itics. Radiation: 1980." U.S. National it is certainly commendable that in Academy of Science Press.
1946, Secretary of the Navy James Forres-tal worried about the scope of ABCC/
RERF research, " involving as it does humanity in general." These good inten-June 1982 48 Environmental Health Review
. .. g 2,. -
l 00LKETED
- UEEC 6
'83 00131 NO M2 r FFi'- CT SECS / !"
$CSTD.] QEi'W JOURNAL OF~
JAPANESE SCIENTISTS CONTENTS February 1083 Vol.18 No. 2 On the International Symposium of Disarmament Education
.. . ... .. ... .. . ... ... .. . ... .. . .. . . .. .. . . . . . .. ... .. . . . . .. . ... .. . Nao mi Sho no - 3 Conversazione: Ikadiation Exposure Work and Atomic Power Plants (I) ,
Ikuro Anzai, Shoji Izawa, Yoshio Idei, Yasuzumi Iwao, Seiji Saito, Ichiro Takita and Makoto Yasuda-~ 4 Risks Expected from Radiation Exposure of Workers of .
Light-Water Power Reactors
~
................ ......................Ikuro Anzai and Rosalie Bertell-~16 Actual Conditions and Some Problems of the IIeavy Rain Disaster in Nagasaki-
....... ............. Disaster Committee of JSA Nagasaki Branch- 22 '
The Flood Disaster in Nagasaki City - ~~~~ -~Shogo Ohya- 29 .
Examination of "The Lectures of Japanese Capitalism Today" (4) Kenji Tominomori-~33 '
Reminiscences of my Researcher life . - - - ~~Isaaki Yokota i36 Present State and Outlook of Cancer Science: Mainly About i
Genes and its Manifestation ~~ - Tadanori Kameyama=~41 A Bo'ok and I .-~~ ~~~~~~~~..~~ ~~ Toshio Nohara ~ 47 l
The Situation of "Over Doctors" in Experimental Science l
............ ......... ...... ...... ......... . .. . .......~ Akihiko Yamagishi ~4 9 Book Reviews ~~ - - ~~ - ~~ ~~ - - -.. 52 Lette r *~~ * ~ ~ ~ ~~ ~ ** ~ ~~ ~ ~ ~~ ~~* ~~~ ~~ ~ * ~ ~55 .-
JSA Information ~~ ~~ ~~~~ - ~~~~ - - l- - - - 56 JSA Publication News ~~ - ~~~~ ~~ ~~ ~~ ~~ - - 60 Edited and Published by Japar. Scientists Associaton 1-9-16 Yushima. Bunkyo.k:r, Tokyo. Japan Dissrfbuted by Salyosha Publishing Co.
2-1-18 Koraku, Bunkyo ku, Tokyo, Japan
WORKER HEALTH EFFECTS EXPECTED FROM
- A 10,000 MAN-REM EXPOSURE TO IONIZING RADIATION For each rem exposure to ionizing radiation, about a billion photons are absorbed per square centimeter of the body. This absorbed 1 energy does damage to blood vessels and cell membranes; it forms harmful chemicals such as hydrogen peroxide; it damages cellular repair mechanisms and does direct damage to cell nuclei. This generalized damage will add to the cumulative effect of natural aging, most likely causing old age diseases such as diabetes, heart disease or arthritis, to occur at an earlier age. "Old age cancers" may also occur at a younger age.
l Some of the direct damage to the cell nucleus will result in radiation induced tumors, either malignant or non-malignant. There i is some disagreement as to the number of excess cancers which will 3
be caused per rem exposure, but no disagreement to the judgement I @is that 1s the worst somatic effect of exposure. Other health effects, 3
admittedly less severe, are more numerous and may be of concern to the workers.
i Table I lists several estimates of radiation induced excess cancers currently being used to predict the number over the lifetime of those exposed to 10,000 person-rem.
i Table II shows the derivation of the Bertell estimate, and Table III shows the derivation of the BEIR III estimate. For both I
estimates it was assumed that the 10,000 man-rem exposure was homogeneously distributed over.all ages, 20 to 60 years, and that all workers were male. 'The BEIR III estimate does not include the leukemias, lymphomas, bone or brain cancers expected ~to occur l prior to the "11 years after exposure" cut-off. It also fails to i
count those tumors which' occur more than 30 years after exposure.
l l
(
l
- . =. .-. _. - - _ ~ . .-
20 The lowest estimate of cancers come from the UNSCEAR Report 4
of 1977. The UNSCEAR calculated dose, based primarily on atomic i
bomb studies, was 2 per 10,000 man-rem. This estimate was based on observed cancers in persons who received more than 100 rem.
However to " correct for" the lower total individual radiation doses received by workers, this estimate was reduced to 1 per 10,000 man-j rem. Although the UNSCEAR report discusses the possibility that
! the low dose may yield a higher cancer rate per man-rem, this doubt 4
is not reflected in its recommended estimate.
The highest estimate of cancers comes from John Gofman's new i
i publication, Radiation and Human Health. It is made for a general
- population of one million people, containing children, women and 4
elderly. These fractions of a population are known to be at higher risk of radiation illness than the Standard Man, 20 to 30 years of age, weighing 70 kg., and in good health. Had the theoretical population been composed of Standard Men, the Gofman estimate of j cancer induction would have been reduced. Bertell has noted that in a normal mixed age population 79% of'the lifetime cancers will occur among those under age 20 at the time of exposure. She has also shown that about 57% of the cancers will occur in women.
Applying these correction factors to the Gofman estimates would l
reduce-them by 0.26, so that for'an all male adult population, i
l the expected number of excess cancers would be: 8.6 to-ll.2.
Table IV shows the comparative estimates by age, sex and cancer site, given by Bertell and by BEIR III. Some of the dif-ferences in estimate can be accounted for by the truncation of the BEIR III time period. The excess leukemia, lymphoma, bone and brain cancers diagnosed prior.to 11 years after exposure have been omitted
3.
in BEIR III. The BEIR III cancer expression is also shortened to b
20 years (11 to 30 years after exposure) rather than the usual 35 years to life duration of risk assumed by most researchers.
Granting these differences which are easily explained, there appear to be more serious differences in the estimates of liver cancer, renal and kidney cancer and brain cancer estimates. The BEIR committee depended primarily on data from the atomic bomb research in Hiroshima and Nagasaki, while Bertell estimates included information from the thorotrast research in Germany, Denmark and Portugal (corrected for alpha particle measurement), the British and Portugese studies of thorium dioxide (corrected for alpha particle measurement), studies of ankylosing spondylitis patients and studies of children exposed to radiation for tinnea capitis.
Since reproductive loss and serious genetic effects can result from parental exposure to ionizing radiation, these health effects should also be included in an estimate of damage to workers from 10,000 person rem. They are not usually covered by worker compen-sation. Table V gives the estimates for the more serious types of genetic damage, under the assumption that three-fourths of the worker l
radiation dose is received by workers who subsequently have children.
s This may also mean, conceptually, that about 7500 children are born of a group of workers receiving 7500 man-rem, and 2,500 man-rem was received by workers who did not later produce offspring.
j The estimates from UNSCEAR and BEIR III differ from the Bertell estimates primarily in what is omitted. It is rare that a hetero-l zygote does not show some degree of ill health for recessive mutations which are severe in the homozygous state. Therefore it i
seems better to include this category of milder ill health as of serious concern to public health and to future generations. Such !
1 l
l
O heterozygotes will be limited with respect to marriage partners, and I
will suffer hardships.
The category " irregularly inherited diseases" poses several problems. The estimate used by UNSCEAR 1977 is based on a British Columbia study of incidence rate of genetic diseases in persons under21 years of age, hence inherited diseases expressed in adult-hood are omitted. Both UNSCEAR and the BEIR III report made an arbitrary decision that 1.5% of constitutional and degenerative diseases are genetic. They included anemia, diabetes, schizophrenia and epilepsy, but excluded heart disease, ulcer and cancer. In additon, UNSCEAR dealt with only the first two generations of offspring rather than the per year genetic damage rate after equilibrium is reached. Both UNSCEAR and BEIR III assume that in the expression of the " irregularly inherited diseases", 5% is due to mutational factors and 95% environmental. Bertell described the equilibrium situation, and assumed a 50% mutational and 50% environ-mental component in these diseases.
In summary, the health effects of 10,000 man-rem exposure include 5.3 to 15.8 radiation induced cancers, 37.5 reproductive losses, and an eventual 3.8 to 79.7 genetic diseases per generation in offspring. There will be milder aging effects among those exposed and other probable effects in first generation offspring such as childhood cancers, asthma, allergies, and depressed immune systems. These latter effects will most likely be first generation effects only, and are difficult to quantify. However each is a unique personal and family tragedy.
Sof. a 7 , / WR
i TABLE I Source of Excess Cancers per Conditions 10,000 Man-Rem Estimate UNSCEAR - 1977 Not age or sex adjusted 1*
BEIR III - 1980 11 to 30 years after only; Age and sex adjusted 2.8**
J. Gofman - 1981 Not age or sex adjusted 33 to 43***
R. Bertell-1982 Age and sex adjusted Lifetime risk 5.3 to 15.8 ****
- p. 414, #318
- p. 198, Table V-14
- Radiation and Health, John W. Gofman, M.D.,
Sierra Club Books, San Francisco, U.S.A.
- Risikoorientierte Analyse zu'm SNR - 300, Zur Dosis - Wirkungs - Beziehung von -
Strahlenschaden. R. Bertell.
I.F.E.U., Heidelberg, F.R.G.
I f
l I
l l
w
eeu a-__ c, a t
___-_..v. ..-....v. or vv v4m
_. . "AND"5 TE'pOR"10,0D0 MAN-REMS r
Site Males Males Males 20-34 years 35-49 years 50-60 years Total-Thyroid Cancer 0.11 - 0.18 Nodules 0.06 - 0.10 --
0.17 - 0.28 0.34 - 0.54 0.18 - 0.29 ---
0.52 0.83 Lung 0.10 - 0.30 0.29 - 0.87
~
0.39 - 1.17 Liver 1.46 - 2.58 '
0.78 - 1.33 --
2.24 - 3.91 Leukemia 0.09 - 0.21 0.09 - 0.21 0.02 - 0.04 0.20 - 0.46 Esophogeal 0.00 - 0.05 0.01 - 0.02 --
0.01 - 0.07 Stomach 0.18 - 0.37 0.30 - 0.60 --
0.48 - 0.97 Intestine & Rectum 0.01 - 0.20 0.01 - 0.10 --
0.02 - 0.30 Pancreas 0.09 - 3.49 0.05 - 1.80 --
0.14 - 5.29 g Pharynx, Hypopharynx 0.04 - 0.08 0.01 - 0.02 -- >
and Larynx 0.05 - 0.10 g Salivary Gland m 0.01 - 0.01 0.00 - 0.00 Lymphoma
'0.01 - 0.01 y 0.01 - 0.03 0.01 - 0.03 0.00 - 0.01' O.02 - 0.07 Renal and Kidney 0.01 - 0.03 0.01 - 0.02 --
Bone 0.02 - 0.05 0.01 - 0.04 0.01 - 0.04 0.00 - 0.01 0.02 - 0.09 Paranasal Sinuses 0.01 - 0.02 0.00 - 0.01 and Mastoid --
0.01 - 0.03 Brain 0.50 - 0.82 0.35 - 0.48 0.04 - 0.06 0.89 - 1.36 Skin 0.05 - 0.51 0.02 - 0.26 --
0.07 - 0.77
- Total 3.02 - 9.46 2.18 - 6.18 0.06 - 0.12 5.3 - 15.8 m- - - _ - - - - - - _ _ _ _ _ _ - _ _ _ _ _ _ -
TABLE III EXPECTED CANCERS 11-30 YEARS AFTER EXPOSURE BY AGE AT TIME OF EXPOSURE AND SITE FOR 10,000 MAN-REMS Site Males Males Males 20-34 years 35-49 yearst 50-60 years Thyroid 0.16 0.16 0.11 0.43 Lung 0.18 0.38 0.34 0.90 Esophagus 0.01 0.02 0.03 0.06 Stomach 0.06 0.10 ,
0.17 0.33 Intestine 0.04 0.06 0.11 0.21 Liver 0.05 0.05 0.04 0.14 Pancreas 0.03 0.06 0.10 0.19 Urinary 0.04 0.07 0.08 0.19 Lymphoma 0.02 0.02 0.01 0.05 Other 0.08 0.10 0.14 0.32 i Total 0.67 1.02 1.13 2.82 i
I l .-
Biological Effects of Ionizing l Radiation III, U.S. National l
Academy of Science, 1980.
l I
l
TABLE IV COMPARISON OF BERTELL AND BEIR III ESTIMATES OF TOTAL CANCERS PER 10,000 MAN-REM ,
l Site Bertell BEIR III Thyroid Cancer 0.17 - 0.28 0.44 Nodules 0.52 - 0.83 Not counted Lung 0.39 - 1.17 0.90 Liver 2.24 - 3.91 0.14 Leukemia 0.20 - 0.46 -
Esophageal 0.01 - 0.07 0.06 Stomach 0.48 - 0.97 0.32 Intestine & Rectum 0.02 - 0.30 0.22 Pancreas 0.14 - 5.29 0.18 Pharynx, Hypopharynx and Larynx 0.05 - 0.10 -
Salivary Gland 0.01 - 0.01 -
Lymphoma 0.02 - 0.07 0.06 Renal and Kidney 0.02 - 0.05 0.18 Bone 0.02 - 0.09 -
Paranasal Sinuses 0.01 - 0.03 -
and Mastoid Brain 0.89 - 1.36 -
Skin 0.07 - 0.77 -
Other 0.34 Total. 5.3 - 15.8 2.8 N.B. Bertell estimated lifetime risk, BEIR III estimated 11 to 30 years after exposure only.
TABLE V e
EVENTUAL GENETIC DISEASE PER GENERATION
' EXPECTED TO RESULT FROM 7,500 MAN-REM EXPOSURE IN CHILD-BEARING YEARS
- 6 Bertell UNSCEAR BEIR III Disease 1980 1982 1977 Classification Autosomal Dominant 0.75 0.15 - 6.22 and x-linked 0.30 - 6.22 Recessive: 0.04 - 1.37 Homozygous 0.07 - 1.37 "Very 61 " Not counted Heterozygous 1.95 - 40.40 ease,,
Chromosomal 0.30 0.06 - 3.74 Diseases 0.12 - 3.74 Irregulary Inherited Diseases 1.35 - 28.01 0.34 0.68 - 28.01 Reduction in Not counted fertility 37.5 (first Not (i.e. lethal generation) Counted mutations) 41.3 - 117.2 1.39 0.93 - 39.34 Total:
- Assuming 7,500 live births among the workers who received the 10,000 man-rem, with 2,500 man-rem " wasted" with respect to offspring.
z ,
'DITOR'S NOTE: While going through the JOURNAL's review process. this article o etated a rek s
L H. Kstchars y ('
.an of Gubton a by Electra-
$ tadors'
- hstantialamount comments are invited. of heated They willcontroversy.
be published in Itisthe "expected comments. thatpublication
" section in a laterwillgensrate
,y1, even ) more Chem 37N i stue, together with the author's response. Comments shouldbe submittedin essay form rather f Il j tu as a letter to the editor.
.htman: Gas i Chlorinate:
'83 CCI 31 A10: T+&. j -
usent in Air - I tesearch on medical X-ray exposure sheds light on the health effects expected for p.j?
.. l
- . hem Scanc n0rkers exposed to ionizing radiation. Factualinformation confirming this relationship "D i pd also demonstrating the need for reviewing pc.rmissible exposure m I. M levels for worker'siW
- O Braman: Gas . ;Nen. Suggestions for more sophist.icated health monitoring of workers exposed to BRiNCH (t-
'hosgene are w tazardous technologies are made, and the quostion of occupational hazards which Med 28 9' '
l $reaten the worker's family is raised. Ql
- Y 1,s
'aby: Absolute g A g'-
r*ulsed Flon ? a-
.,7 s >
mad am , The nuclear worker and .ionizmg rad. t.ia ion Sy,i in Air by Gas, h*,
rophotornetry :0SALIE BERTELL, Ph D., G N.S H.
- $1 East Street. Buffalo. NY 14207
}/(, r-
..rities en Air tn
. Path and 10 .s y
p yg Assoc J 4 a Q #..'
+
rndustrial Gas i ...
- e introduction * +I'*-
l Since World War 11, there has been a growing exposure to ionizing radiation, as related to the [
ndency to tolerate worker ex posure to ionizing demand for excellence in judgment and motor
' m!iation from nuclear fission by-products and corarol w hen handling highly toxi: mateiial and ,
, }l%
- !ated industries, in order to experience the complicated t'echnology. The materiah being Senefits of nuclear generation of electricity. The handled are such that the ordinary wainings W h},I;
- ost obvious limiting factor in nuclear given by the eyes, cars, nost m other senses, are
, echnology is the ability of man to tolerate this ineffective for reporting danger. A worker must '*
8 adiation abuse. Because of the scope of the I,e convinced of the hazard intellectually. There .'r l poblems involved in this issue, I will have to may be a problem of physical adjustment to '
(
iimit my remarks to three points: the subtle chronic low doses of radiation exposurc which
.= nediate effects of worker ex posure to ionizing may well involve temporary motor and 'y '
ndiation in terms of managing a complicated judgment impairment. I ara suggesting the l' Tg' ed hazardous technology, the long-term slowly possibility of a "first exposure effect" of a mild nature, which is compensated far with time, and
- 2 teriorating health situation which is generated
- by this exposure, and the broader questions then reappears only at high radiation exposure 1
' gf ;
nised by the inadequate health monitoring levels.
kt l .F. l system under which the nuclear
- industry and The interface between man and technology, I
y'
- ost other industries currently operate. cspecially a sophisticated hazar dous technology, is of special concern. The assumption of a strict $
dose-response effect of a monctonic nature can f.:*M p%
- worker / technology interface lead one to miss a slight increase in response at the initial exposure. It may also be the case that lj
{ Most teown,of theoneacute radiation effxt mms toeffects be woikers are experiencing well such impairment are 16.'
but sm ceresolved in the h.w. This question s-lecting themselves out of this occupation. One p
.M involves the immediate effects of worker migl.t also dismiss evidence of such an effect, i atuibuting it to inexperience and youthfulness. 'Q Concentration on ' reducing administrative
! wiin...t.o.i.on ... .n.any supponed try Grant Number CA. PIolalemS, and on improving hardware duigt. so nsu. .... .s i>y the National Conce, institute. oHf W l
Copyright 1979. American induetost Hygiene Association He)5/79 m fi s May 1979 eentan Industnal Hyg:ene Assocaticn JOURNAL l
.y
e TABLE I f inels i 3 Comparison of Estimatsa of Radiation Exposure fiequired i cium to Double the incidence Rate of the Given Cancer ' ,[gcg Neoplesen "U '"
i U3Y "
j BEM neport Adjusted BEIR Report Hanford Study presuto 1
' Leunernea 26 16 to 6 5 1826 8 therD%
Breast 28 2 to 7 2977 I L urig 215 13:o54 iuppm 61106 ;
I 4 l ' i l
as to eliminate human error, will only be partial ce!!s when workers are exposed to permissr I Thu demo ~
safety solutions in a technology which is levels ofionizing radiatirm. These are sometic:.
j g {
ultimately dependent on the mar. on thejob and referred to as mild mutations (see ref 2pagee *, gyg i his or her interactions with the techriology. Cancer effect, have been most widely publicin;
- ni ,
Accident proneness for those experiencing and I would refer you to the study of it.! gg l low level radiation exposure was reported in llanford workers for the most current n ' , '
i studies of uranium miners.'" The miners, besides relevant estimaies of radiat.on related cancer '
the significant increases in both malignant and in this study, which considered only the f;r. gg ,
non-malignant respiratory dise.nes, had a cause of death as listed on the death certifica:
tions a !
signi6 cant increase both in motor vehicle bone marrow, pancreas, lung and breast canc' , radiati j ace;,ents and in other accidents, the latter deaths all exceeded the number predicted in tt.
pr .narily related to the miningitself. II,e suicide BEIR report.* fable I gives first the Deli; ordin...
head o.
and homicide rate among the miners, as estimates of the number of rads exposu , ,,
compared with U.S. male rates specific for age required to dauble the incidence rate of tt -
and calendar year, was significantly high among indicated cancer, secondly a reduction of tt '
i those employed in the mines for five yea rs or less. estimate by a factor of 4 to 16,and finally thern i 6 h{ '
These workers received a chronic dose of dose observed to cause doubling of rate fc mrad i f
radiation within the 5 rem per year hmit? This llanford workers. This reduction by a factor o r. I"V"[
, effect disappeared among those who worked to 16 seems reasonable to me on the basis of th-longer periods. Suicide was also a significantly ~ research of Dr. Jol.n Baum, of the Brookhaw .
i ! E"
' high cause of death among the 1920-29 ochort of National Laboratory. IIence theory at:
radiologists. This effect disappeared m the 1930 observation are both giving the same cautict
- i cohort, presumably because of decreased namely, that radiation related cancer death . '
occupational exposure levels. Unfortunately have been underestimated by the most wideh these levels are not quantified.* Ar. analysis of used predictive models.
the relative risk of suicide for A-bomb survivors Usni vs. those not in the city at time of bombing gave The BEIR estimates reduced by a factor of48-
'3 shown estirnates of 0.93 among Nagasaki sunivors and 16 match well with observed data except forlur leuken.-
f 1.43 among Iliroshima survivors (P < 0.05).* lt cancer. The lung cancer doubling dose fc:
statisti j j was the conclusion of the authos s that: 11 nf rd workers may reacci added exposuret-and em "Whatever the causes, therefore, the nature of the worker who inhales insoluble alpha particle! my re. ~
' the discrepancy is such that the highnt relative This mternal exposure would not be measur.e; biotop l r risk is seen among the A-bomb survivors by the worker *> badge, hence he would d4..
mHJ n
, exposed to the least radiation." The aserage actually received more exposure than wa- yearso.
i estimates of cumulative exposures due to rec rded. Moreover, the lung cancer doublir4 Lray .
) residual radiation only one meter abos e ground dose given in the BEIR report may wellindicar: rad ski..
for infinite time spent within 500 metus of the that radiation doses used in estimating it weres; the ahd hypocenter, were 8 to 32 rads in Nagasa ki and 20 high that they exceeded the maximum point et weie , '
! to 101 rads in Iliroshima? the dose response curve. No separate estimateof leuken.
l cancer of the par.creas was giver. in the BEIR
, j chroru.c damage to health These *
.s report, hence it does not appear in Table I. and to .
The second problem which I woul.! like to The revised doubling dose estituutes for thes- 11, I address has to do with damage to the DNA of cancers are well within peimbsibic expmr raoic, ;
I
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F
{g r.tis for persons who workability in the nuclear to maintain blood normaley breaks down dustry for one or two years. The degree to with age and also breaks down with exposure to L t
ibch such information is passed on to workers ionizing radiation. This would imply that ;
.' 2y well be questioned. As adults one may leukemia might well be a secondary [
I ;esume that they are competent to judge for manifestation of this bioreguhitory brcakdown l~
l 2emselves the relative merits of arguments in and that there may be other manifestations. If I; p i:; port of and in opposition to present this is true, then focusing on car.cer as the only ,
Miological exposure standards. radiation effect is concentrating on only a part of o.
"
- 5* " " ' " ' * '
I *E'**"'""" "E P#'*
There are also human data now available.
' temonstrating damage with measurable health " " ** **""' "" " E ""
b I' '"PP .ed by much quahtative cudence.
p W f : effects at the I in evel."' Exposures tothis 620 rangemradare now (bone ""*Imarrow" dose) "'Y '***" b ' " P' ## ** I'-
N P" *"' ;ermitted to the general public as well as to analytical test has been descloped and p:.
.tudy of the NRC licensing quani fying this aging effect has became >.
. current an[ i :egulations."*j nelear Data workers, under are from the adult leukemia P"* ** ** EY "" M ** b-
. .ted cancer.'
""
- N'T
- ases and random controls in the Tri-State ptei review at the 9th International Biometric p
, Leukemia Survey."" Medical X-ray examina- Conference m August 1976 and is published m reast cance l :cns expose the patient to low doses ofionizing the 1977journalarticle. The methodology can p{'
i radiation in a very short period of time. Some adicted .mtbe now' be used to test other hypotheses and identify Q
.st the BEIF. [ rdinary dose levels would be:
9 to 40 mrad fora ther radiation related health effects qk y g i eead or neck examination (averaging 3.9 films). Many of the previously reported radiation t-(J.
. rate of th, i : t 11 mr d for a chest examination (averaging rehted health effects did not foeo, exclusisely on
- etion of th$ ; 6 films), 18 to 620 mrad for spinal cances. In the study of ankylosing spondyhtis naminati ns (averaging 3.5 films) and 28 to '!00 paocnts treated with radiotherap), increased (N..g inallytherad j Jad to the fetus from ,
n of rate fe: . elvic exammation death rates of non-malignant gastro-intestinal These medical diseases, cerebrovascular discases, bronchitis, g y a f actor of 4 l meraging 3.5 films). yg
.e basis of the ; ; cedures give exposures well withm dose othcr circulatory diseases, ar d violence were k.
ticls permitted to workers and to the general reported in addition to the leukemias and Brookhase.
pb!ic under current NRC standards. These cancers in both the highly irrad:ated and hghtly theory and -
irradiated that tissues."" The aforementioned non- M<#
~
"** **N ( radards were set under the assumption i -
dere was no measurable human health damage. n.alignant diseases were expected to be normal
{ c thislevel of exposure - an assumption which ' or close to normal in mortality rate for these f
'N.
s to longer tenable. patients since these diseases have no known L' sing this Tri-State Leukemia data, I have connection with ankylosing spondylitis. [g
. factor of 4to L shown that the increase in non-lymphatic However, the total experience of such health ;jg
.eept forlung ( enkemia with exposure to medical X-ray can be effects was suTiciently great to mad these nom ; - [ ,f
.g dose for i r.atistically explained bya shiftinageof allcases mahgnant causes of death among irradiated (f.
t y{
! exposure to ed controls proportional to the amount of X- patients as highly s.igmficant. In the necent ,,
..ha particles av received."" By taking the point of view that studies of medical radiologists as compared to ther physician speciahsts, it is reparted that
- 6 <y be measured Nogical aging, or gradual accumulation of would hast f -i.d mutations, occurs with both the calendar early radiologists had a higher death rate for 'h than wu f.%
scars one has lived and the exposures to medical diabetes, all cardio-vascular renal diseases, cer doubling 1 h.rav one has had, I was able to show that one strol.e, hypertension, suicide and cancer than l ;y wellindicate raj skin exposure (mR in air at skin entrance) to did other medical specialists."'
mg it wereso j ee abdominal area and one year natural aging IMtish research on radiation and athero- ?A am point o: j acre equivalent for increasing the risk of sc:crasis has been recently clarified in the Ur.ited ie estimateof l 'rukemia among males over 45 years of age."" Stato. and evidence; exists which posits a r-n the BEIR nese results were extended to all medical X-ray mormelonal origin of humar, athera hi.
Table I. ed to both sexes over 15 years of agein theJuly piaques." Atherosclerosis can ni., be tes for these l 11, 1978 testimony."' l'resumably, the dociioed as a benign tumor of smooth rmie ..
ic exposure j :.oregulatory mechanism which controls the cells. Radiation-related occurrence ot , M*l g
5.:
ntay, M ' esm industna! Hygve Association 100%At HJJ5'79 M7 m.
r1 1
mr '
- 1 '
r i i _
- 1 a 6
a .
t p t j
- atherosclerotic plaques poses a serious public organ producing poison should be rema :whe tima j and worker health problem in a society where from the body, even though it is living a;. :1,o:ly ider. tit.
- } heart disease is the number one killer. functioning. Radiation can cause flaw
- .. . ne person d 3 All debilitating long-term chronic effects, operation on a cellula r level by ahering the Db
' wapational :
'I ;
known to be related to radiation exposurc, go or R N A. It is more difficult to locate and rerr 2 i e An esen 81 i
unmonitored in the nuclear industry. Ven few a cell producing altered and harmful en4L mbabihty th..
i i employees are aware that these diseases may be (biological misinformation), and its presence. .a radiation d
) !
occupationally related. Fewer still report non, n t often noticed until the faulty metabolt e ra;cptibles t-debilitating chronic diseases. Workers hase no becomes visible in the form of a chronicdisuu EJ mutation
'; 1 .
hope of receiving workman's compensation, and Another difficulty with the assumption th ,f a populatie.
J they might jeopardire their job or promotion control of cancer incidence is the key to conti. The Tri-St.
f 3
' prospects by such reporting. It has been of all other health effects, is the complicaty ardom part.
estimated that worker's health records pick up interaction of factors competing to cause den ethin the r,n.
2 only 29'c of the occupationally related chronic Elimination of one cause of death can make. . otters and
} ! diseases."D Death certificates may never even previously unnoticed effect become domirr ;rebability oi
- mention these complicating health problems 0 . either as cause of death or of chronic illness.h :ff>pring." ' li.
j hence they easily elude being detected in public assessing workplace risk it is necessary eem t. to hase or worker health research.
i consider the health costs of debilitating disease :elts. The ofL
! which while not causing death can make 1.!.
I ;elb had a fifts reliance on predictive models miserable. ,nd a five-felm I !
As was stated earlier, the nuclear in&tn is '
'" "' E" ""
$ currently operating under a predictive modci of variable human responses eciema, and .
health effects, basically that expressed in the Another aspect of the radiation worker hea:i:
- d#"'** f""
s l BEIR report, which attempted to estimate question which was not addressed by the BEli related to the cancer deaths in terms of exposure dose of report is the question of susceptible persons : "otcd above'
' ionizing radiation.* This report assumed that the population.* Only age differentials we: :adiation has 3
although there were other known health effects considered. In theory, persons who are aircad which will wi.
these would remain proportionally less than the damaged.or especially sensitive to radiatic; population as i i
cancer effects. Under this model, reducing might be expected to be at higher risk fro:: exp sed to ra i !
cancers would automatically reducc other healt h exposure than is the general healthis Under curro
- l protection for .
b .
cffects. Aside from the fact that the BEIR report Population. The most obvious example of higt!,
i can be shown to be non-conservative in its susceptible subgroups are fetuses and infants affspn,ng. Iht, 1
' estimates of some cancers, there is also eviden e I#' *"'
! I have tried to further identify penct.. I"'
that different health effects of radiation susceptible to radiation damage?' Among it:
- hildren. In i..
l exposure become dominant at different dose adults in the Tri-State Survey, the disau #**" # 8**
levels and rates of exposure. IIence there is no ***'*
indicators which showed increased susceptibh. I f assurance that reduction in one effect will red uce occupation an i all other effects. For example, incidence rates of to leukemia were asthma and other allergif I heart disease, diabetes and certain othe Jealmg with ,
' thyroid cancer have been shown to increase with bacterial and viral diseases."" Radiatiot radiation, boi!.
! exposure until an optimal' level of exposure is exposure has been related to increases or pith carbeof the u.
reached, and then decrease with increased occurrence in life of allergies, heart disease,ad (Neahn of tL l exposure."" Reducing the exposure levelin this diabetes. It also most probably causes immune rn nitored.
's I
.' case could actually increase the thyroid cancer suppression, leaving the person vulnerable t,.
l incis tce if doses were in the higher-thar.- infectious diseases. These health indicators a::
4 :
toward reath I
optimal range. At high radiation doses the evidences of the breakdown of the bioregulator, This brings n f percentage of cells which are killed or rendered mechanism, hence of mild mutationsyithincelb r.amely the mo sterile increases. At lower radiation doses more which can occur with either natural aging of it is obvious 11.
i damaged cells survive to function poorly within radiation expowre. I found that when bott l
trade off, whei i
the tissue and to reproduce themselves, chronological age and exposure to diagnost" sre balance, 8 perpetuating their flawed structure. It is well radiation were considered a susceptit ;olwants sc accepted in surgical medicine that ifpossible,an subgroup of the adult males under age 59, v. ahmty of si
!a i l 39S Am. Imt Hyg Assoc 1 W % nencan Industnal l,,
l < l
) -
ads.'M91st38%
M ':. v5 } ; Q f,h b, , ? l. l; .,
Y . ' .y .
~
y .,<
I s.
,f$..
m.
t
- _ . - - - - - - - - - _ - _ - - - - - _ _ _ _ _ _ - - - , . , - - _ m- - , - , - - - - , , - _ _ _ _ _ _ - - - _ _ - - - - - , - _ _ _ _ - - - - - - - -., . _ -
i remow? *se times the average leukemia risk, was mean money paid.out for w ork ma n's i.
living ar2 4 =arly identified.* Differential protection for ' compensation or insurance premiums, not the <
y.
ne flawet lil ::ese persons needs to be provided for in actoal costs experienced by the worker and his or g,'%
..gthe DNA k 3:qational standards. her family. It is imperative that these two i A.
and remon h An even greater problem is posed by the penpectives on costs be made to better coincide,
- .il enzymes f :r22bility that mild mutations in germ cells due especially when the more subtle cffcets of
- k)-hp (
. presence u p ;: .adiation damage will cause the number of radiation exposure show signs of a slow j8 y octabolism , uepubles to increase in future generations. dettrioration of the genetic strength of.the (3
l i.icdisease s
O mutations are less likely to be selected out population. I would suggest that persons A : because of non-viability, invohtd in industrial hygiene take imn.eJiate i
g ;
l a population l g p
.ption to contro'tha: . I (ne Tri-State Survey shows evidence thatin focus from accidentalinjury n tice of the shift ; . )g
, onplicatig / ndom parental pre-conception exposure, and immediately visible health effects such as Q,
l iusedead esir. the range of exposures now permitted radiation burns to the more subtle radiatwn ,
j3y an make .
- kers and the general public, has a 17c effects which may involve increased accident 3,a .
dominam ' ::bability of causing measurable damage in prmaness, chronic disease and offspring ill j ,
l . illness. Ir . fspring '"In this group, some mild mutations heahh or death. These must be researched p%
i . essary to ' em to have randomly occurred in the germ carefu'ly and a new approach to workman's .
2.'s. The offspring from these affected perm c m eensation devised whereby a health effect j
ag diseases make life .e"s had a fifty-fold increase in rate ofleukemia, w uld be compensated for at a rate propmtional . h[W,/Q rd a five-fold increase in other health effects to .the probability of its being occupationally ig h '
n:h as pneumonia, dvsentery, asthma, hives, related. Until these effects are comed by law,
~ .. W
- ema, and theumatic fever." These latter they will remain unnoticed. Untila sophisticated
. r.Wnces of mild germ cell mutations are closely and complicated technology is monitored by an lY]
4
- O
- e:a:ed to the adult indicators of susceptibility equally sophisticated and independent hurnan i
- ed above. The very real probability that health monitoring system,it is unsafe f or people! f. g,
- , station has these diverse kinds of effects, Workers' records should not oit! contain the f
record of exposures, but also his or her medical i#
.re alreads radiatica l, dich p:pulation will continue as increasing numbersto increase of persons the susceptible are history and reproductive history. Data on risk fro::: j :tp sed to radiation, must be recognized. offspring should be routinely collected. IIcalth Under current laws, workers have no financial records should be kept in perpuuity and not .-
)
healthier {
,. of highh i mtection for their non-working spouse or their destroyed after five years. They should move $
h."
.I infants.' j :ffspring. There is no workman's compensation with the worker asjob changes are made. Some -
o persoas Sr fetal wastage or malformed and sick prousion must be made to assure that the 1; 7
- hildren. In no nuclear plar.t are these effects worker will not be penalized either openly or y
, ,m '
unong the .,
t..e disease Den e DE m n re ew wm ers are em su rreWahng ca proWms. Pooling of *"
eptibili:s aware f the possible connection between their heahh data across industries with exposures to ;
y allergiel :ccupation and the health of their c!)ildren. In the same carcinogens should become routine so j iinothe} :ealing with environmental pollutants such as that sample sizes may be increased and caily '
..adiation adiati n, both the health of the worker and the warning of hazards may become possible. These , u ' g{ .+.
k
. or earlier te th of the offspring of the worker are at risk. are all general recommendations applicable to Neither of these effects is being properly all occupational hazards.
G [
, .ase, ad j.
immuno- zenit red. .P P l ..erable to neeJed organizational changes ,
1 ators are - teward realistic health assessment With respect to the radiation related Tulatory ithm ce!!s This brings me to the third and last point, occupations there are some special reccmmen-
.amely the monitoring of the healt.h of workers. dation:.. At present the health and safety of both h'S f*q l
aging or I:is obvious that w e are working in a cost-benefit workers and the general public at: under the
.icn both trade off, w here real health costs to the industry jurisdiction of the Nuclear Regulatory l riagnostic are balanced with real cost of reducing Commission and the Bureau of Radiati. n eeptible pol!utants so as to assure the overall profit and Health. flecause of the Joint Aton ic Energy Act , 5? 7 .
. 50, with nability of the industry. By "real health costs"I the usual groups involved in worker health,
- 1m k.?
m wtssmnwmemoum voisas sas R-
- n. t. ,
,
- Vi 4
S f * * ' ' d , 7 e -
N
- l w .. ,p ,. v.., .
4.ould be removed i vhe times the average leukemia risk, was mean money paid out for w or k ma n's b it is living and , dearly identified.* Differential protection for compensation or insurance premiums, not the .
.,n actual costs experienced by the worker and his or cause
) altering flawedxupational the DNA 7, >::sc persons standards. needs to be provided her family.forItin is imperatise that these two
. locate and remose An even greater problem is posed by the perspectives on costs he made to better coincide,
' harmful enzyme 5 nbability that mild mutations in germ cells due especially when the m ore subtle effect s of ind its presence is : radiation damage will cause the number of radiation exposure show signs of a slow iaulty metabolism r.sceptibles to increase in future generations. deterioration of the genctic strength of the a chronic disease. Eld mutations are less likely to be selected out population. I would suggest that persons e assumption that , :f a population because of non-viability. invohed in industrial hygiene take innmediate the key to control The Tri-State Survey shows evidence that n tice of the shift in focus fromaccidentalinjury the complicating udom parental pre-conception exposure, and immediately visible health effects such as mg to cause death. si:hin the range of exposures now permitted radiation burns to the more subtle radiation leath can make a orkers and the general public, has a 1% cffects which may involve increased accident become dominant ::cbability of causing measurable damage in pr neness, chronic disease and offspring ill
, hronic illness. In :ffspring.*' in this group, some mild mutations health or death. These must be researched is necessary to seem to have random!v occurred in the germ carefully and a new approach to workman's bilitating diseases elis. The offspring from these affected germ c mpensation devised whercLy a health effect
..th can make life xt!s had a fifty-fold increase in rate ofleukemia, would be compensated for at a rate proportional
, and a five-fold increase in other health effects to the probability of its being occupationally ,
I mch as pneumonia, dysentery, asthma, hives, related. Until these effects are coseret,1 by law, mema, and rheumatic fever.*' These lattei they will remain unnoticed. Ur.til a sophisticated ,
. nidences of mild germ cell mutations are closelv and complicated technology is monitored by an
, fed b t e r !ated to the adult indicators of susceptibilit[s equally sophisticated and independent human ptible persons in :,oted above. The very real probability that health monitoring system,it is unsafe for people!
,sifferentials were radiation has these diverse kinds of effects. Workers' records shou!d not only contain the
. who are alreads i r,hich will continue to increase the susceptible record of exposures, but also his or h:r medical I cpulation as increasing numbers of persons are history and reproductive history. Data on tive higher. risk to radiatio; from f e;xp sed to radiation, must beoffspring recognized.
should be routinely collected. IIcalth aeral healthier j Under current laws, workers have no financial records should be kept in perpetuity and not
- xample of highlv l ;rotection for their non-working spouse or thei
- destroyed after five years. They 3hould move ,
aes and infants.' t eff5Pring. There is no workman's compensation with the worker as job changes are made. Some identify persons fr etal wastage or malf rmed and sick provision must be made to assuie that the e,t" Among the children. In no nuclear plant are these effects worker will not be penalized either openly or
.;ey, the diseas, nen being momtored." ' Few workers are even subtly for revealing health problems. Pooling of aed susceptibilitf aware of the possible connection between their health data across industries with exposures to ,
.i other allergies' ceupation and the health of their children. In the same carcinogens should become routine so ,
I certain othe dealing with environmental pollutants such as that sample sizes may be increased and early j gio Radiation radiation, both the health of the worker and the warning of hazards may become possible. These ,
creases or earlier hea!th of the offspring of the. worker are at risk. are all general recommer.datic,ns applicable to xart disease, and .Neither of these effects is being properly all occupational hazards. .y;
- causes immuno. monitored.
~n vulnerable to needed organizational changes ,
i
'th indicators are toward realistic health assessment With respect to the radiation related
'he bioregulatory Ris brings me to the third and last point, occupations there are some special recommen-
, .tions within cel's namely the monitoring of the health of workers. dations. At present the health and safety of both
) ,atural aging or ! tis obvious that we are working in a cost-benefit workers and the general public are under the l
that when both trade off, where reat health costs to the industry jurisdiction of the Nuclear Regulatory te to dirgnostic are balanced with real cost of reducing Commission and the Buscau of Radiation I a susceptible pollutants so as to assure the overall profit and llealth. Because of the Jcint Atomic Enerry .b:t der age 50, with siability of the industry. By "real health costs" 1 the usual groups involved in werkct healt h, IF D tesan Industnal Hygiene Association JOURML (40) 5/79 353
.g . :
f .
OSIIA and NIOSil, have never assumed a resolution of the immediate concerns and c : 4d regulatory role relative to radiation workers. agreement on research goals for furth , ,J
} l p
1 The NRC views its function as seeing that resolution of substantive differences :t : *-
i l present regulations are enforced, not as interpretation by competent scientists. T, . " G"
, questioning the suitability of these regula- challenge to current standards is being cican
] ,
tions.""The Environmental Protecticn Agency made and documentation of claims is cci 3)},,
, I ,3, 8
has the power to make recommendauons to the public. It is time for serious reconsideration . a ti,.
i NRC but not the capability of adequately the standards foi radiation protection so as, Poi
' monitoring and enforcing those recommenda. avoid the possibly tragic consequences of . Rn N
.i I tions. The problem of radiation workers security not based on reality. Until t! U 8' i
demands immediate attention, and perhaps the controversy is resob ed, public policy should n : a (,"'
z American Industrial llygiene Association has error on the side of protection of human heah
- ana 4
enough power to initiate action on behalf of the rather than protection of corporate econot: Am i worker. An adjudicatory hearing relative to investment.
? t" I
lowering of permissible exposure ! acts for 15 E
'e , workers is badly needed. There h.ac been i requests for such a hearing on record for more references u, e ,,,
' y, than two years. It also seems desirable to allow 1 A'cher. V., D. Gillam and I. Wagone.
[ e 8
OSIIA and NIOSII broader Eowet to act on occupanonagarmogennis Respiram Dseau Mortahty Among Uran,um Mjners. Ann Ness Yow
~ l behalf of the worker exposed to ionizing A,,d se. 277.2e0 (1976)
, radiation.
f 2. The BEIR Committne has assumed that IWLMt.
miners snvolses 0 5 rad expcsure to the bronch,.
l' discussion stem cell layer. The formai name of the BEIR Repre is: The Effects cn Populanons of Esposare tale.
b I
' One might predict on historical grounds that the L#' #"#"'mg Radiso n Nan nal Acadenu A firs.
response of government and of the nuclear . Sciences. National Research Council, U S A g', (November 1972) industry to the heatrh-related factual eddence I Denni
- 3. Matanoski. G., R. sehser, et sta t he Cuner *
- . , and other researchers have presented will be an pers .
j attempt to hire someone to **re-analyic the data" Mortahty Rates of Radiologists and Other Physicise , under Speciahsts Am J Epidemiology 701.188 (1971
}
and blur the results, confusing the pablic and ,cco,{
i !
Deaths frorn All Causes and From Cance causing years of argument, delay and human 9
- i health damage. There has already been much
( 6[ H. Kato and c Land; studiesGiran c
i reaction to the paper on the llanford workers. Mortahty of A bomb survivors 4 Mortahty an: yearb
' Radiation Dose 195019ti6 Radiation Res 48 611 The criticisms to date are in my opinion either (1971) in 19/.
?
' univer:
unfounded or unduly defensive of the nuclear 5. Takeshita. K.: Dose Esnmates from Residual ar' I '*" "' gradu industry. With no suitable monitorinE of "*d***** # #'#" " # "*# "
Supplement 24 31 (1975) Quin.
t l workers and no scientific dialogue on the
- ! 6. Mancuso.T.. A. Sta, wast and G. Kneate. Radiatto. develos carefully analy7ed data already complettd, one Exposure of Hanford Woriters Dying from Caace.
I dean ct can expect the radiation problem to recch tragic and other Causes. Neart/. Phys. 29 1557(1977 Natural i
proportions before effective action is ta ken. The 1 Baum.h Cancer Risk Estimates and NeutronRy who ic .
i ' 885'd n Human hurden of iroof of safety should rest with u'e5 & N""8'A Radiation Pictection Association. Paris, France Occum e
- industry and government. It should not be (Apnl 24-30.1977). an.
l required of citizens or independent scientists to at Quo
- 8. Baum. J. W.: Population Heterogeneity Hypothess 6
definitively prove hazard before corrective on Radiation Induced Cancer. Health Phys 25 97 P'00'd'
)
- action is taken. (1973) utilize s
It is
. .in the tnterest of bridging the i 9. Bertelt. R.:MeasurableHealthEttectsudDiagnostic seriou; I xfay Esposure Testimony bef gre the U S. Houseof communication gap and stimulatiry further i !
constructive dialogue that this paper is w ritten.
Representatives Subcommittee on Health and the Environment. Paul Rogers Chairperson. July It
' l Faith in human worth, in the derno ratic 1978, I
I process, and in the Eower of life to triumI,l. over the power of death leads me to hope that prompt
* " U "# # *' Y
- App 1. See also Pierr uewvo of A a t ru 4 -
Esposure Applicac/c tc rn; om.c 4 ' +> br tu '
airing of the problem will lead to me;> table implemented December 1. t ais reser.i,isgiste, 400 A.irtad Hg Asx ) p]) May 1979
> I f 9
t p rmazaemenptrennert, ,
g h.~xJ'?
- ,Y i p
, 4. ; )>,1 c.
r . ..u -
o y
s p '
,',, . l'
....r. y.
- $ ,p \[> "'t
,3- %
.. ., . .+ . .
.'[ g . [1/ f s 1., S
f 42/9/ 2856 (January 13. 1977L These new Plaques. Proc. Nat Acad Sc U S A 60/611753
- ite concerns and a: J. standards, which are one twentieth (1/20) t'ie goals for furthe: ! (1973) present standards, do r ot affect standards far 17. Lassiter. D. V.: Labor-Monagement Participation m ove differences in $ worker e=posure Long Term invesogatian of Man Ann Aew vara tent scientists. The Ll !!Meth Graham. S., M. L Levin, A. Lilienfield, et Acad at : Sc. 269 43(1975) d I gical Problems and Designs of the Ti..
Lards is being Cleat.) 18. Upton, A. C., et al . Quanter.stne Emperirr, ental emia Survey Ann Nm vork Acad A.
u of Clairns is noa '
uh M
- e a n a nogWsa lAR FC7 557 (1963) reconsideration of . ?2 The Mean Active Bone Marrow Doso to the AAtt i protection so as tc Population of the U.S. from Diagnostic 19. Viadana. E. l. D. J. Bross. Use of Medtcal History consequences of a ,
Radiology. DHEW Pub (FDA) 77-8013(1977) to Predict the Future Occurrence cf Leukenu in
.cality. Until the i !) Bertall R.: X-Ray Exposure and Premature Aging Adults Prev Med 3 165 0 974)
Sc policy should risk I # #"'# U"### 8# 379 0 9778
~ "
20 Bross 1. D. J. and N. Natarajan. Genetic Damage an of hurnan heahy f o o't r Cause After Ra oth ay U" "
orporate econorn.: - Ankylosing Spondylitis Brit Med J 4 Dece'n.
ber1327 (1965) 21. Proceedings of a Conbros.ional Semenar on Low-
'5 Etheles. A.: Radioactmty m Calcified Athw level lonizing Radiation Subcommittee on Energy l scle'osss Brit J Radio 34 602(1961) and the Environment. of the Commsttee onInsular
[ :$ Benditt. E. P., J. M. Benditt. Evidence fca a A// airs U S House of Representatwes. 76 767 0, Monoclonal Origin of Human Atherosclercesc May 4.1976.
and I. Wagoner
. Respiratory Disease l' ""*"*d O'*". s. t us L1:ners Ann New Yore i i
L
.sumed that 1WLM fu I.
o ssure to the broncn.a $ I
.me of the BEIR Repw !
t.s of Exposure to Lca '
t National Academy c e
- A first in industrial hygione education .
.e ch Council. U.S A Denrus Girard of Guilford has become the first properly controlled, and graduate schools were
.il: The Curret :erson in the United States to earn sn simply not supplying tht> riumber of well trained log 188 ( 97[ t .ndergraduate degree in industrial hygierw. people urgently needed.' '
i s and From Cance-according to Richard A. Terry, president of
! Quinnipiac College- After receiving his degree, Girard began work as a staff industrial hygienist with the Electric Boat i C. Land: Studies a t Girard is the first graduate of the college's four- Division of General Dynamics Groton, CT. Girard rs. 4 Mortality a%: tear baccalaureate program in industrial hygieriu. was one of nine students enrolled in the
.adiation Res 48 613 ( ri1976. Quinnipiac became the first college or Quinnipiac program's initial cycle The college
.niversity in the country to initiate a full under expects to graduate eight more industrial *
. s from Residual anc ,
aduate program. hygienists in June, and in five years hopes to have untion Res. Vol 16
- I Quinnipiac's industrial hygiene program was 100 students enrolled in the program, graduating i G. K nule: R ad.atior feveloped through the efforts of Stanley S. Katz. 20 year year. l s Dymg from Cancer tean of Quinnipiac's School of Allied Health and '
A vital supporter in maintaining the program
.s 29 1557(1977) Natural Sciences, and scient$t Floyd A. Van Att<.. through its first four years has been United Tech-ses and Neutron REE ;
. 4th Internation4 eo formulated much of thelanguage of the 1970 nologies Corporation of Hartford in 1977, they :
Occupational Health and Safety Act. 7'
'" '" became the first contributor to Quinnipiac's i Van Atta, now a professor of industrial hygiera industrial hygiene scholarship program, funding rogeneity Hypothes1 at Quinnipiac, believes the undergraduata six scholarships through 1980.
Heatrh Phys 25 9; program was needed because, "many industries "I would not be in the job l have today without '
l Ltdize hundreds of toxic materials that can United Technologies." states Girard. They paid Effects o/Diagnost,c ,
seriously affect the health of workers if nat almost 100 percent of my tuition at Quinnipiac."
te the U S. House cv e on Health and tr's oairperson, July 11 i 8 ion 10CFR Part 50 )
, of New levels or '
sneral Public; to te
.'9 federalRegistro
. J (gp gg incocan Industnal Hygiene Association JOURN AL (40) $/79 401
(
s -
a
/ 233 '
1 00CXETED
, USNRC Volume 2 83 cci 31 mo :42 EFFECT OF RADIATION ON HUMAN HEALTH ~ '
Radiation llealth Effects of Medical and Diagnostic X Rays "
l HEARINGS BEFORE THE SUB00MMUTEE ON IIEALTII AND.TIIE ENVIRONMENT OF THE !
COMMITTEE ON .
INTERSTATE AND FOREIGN COMMERCE IIOUSE OF REPRESENTATIVES ,
NINETY-FIFTH CONGR, ESS SECOND SESSION ON CONCERN ABOUT THE OVER USE OF X RAYS, THE POTENTIAL
- HEALTH IIAZARDS POSED BY X RAYS AND TIIE ENISTING LEVELS OF X RAY ENPOSURES WHICH WE NOW CONSIDER SAFE 9
JULY 11,12,13, AND 14,1978 Serial No.95-180 i -
Printedforushof the Committee on Interstate and Fore!gn}'ommerce 3g- 6/8 .
(' - '
U.S. COVT.RN3!CNT PRINTING OFFICC SG-IN O WASIIINGTON,r 1979
['
For sale by the Superintenden ments, U.S. Covernment Printing Omce s
N s
.'y ). - ,. -
80 81 .
Introduettint
, NEASURABLE HEALTM IFFECTS OF DIAGW08f1C 1* RAY EXPOSURg .
- The living human being is a fantastically complex and Testimony before the sublcommittee ,
on Nealth and the Environment, U.S.
delicately balanced organism. It is espable of surviving in many different environments, since it can regulate its inner House of Representatives, July 11, 1978 ,
~
temperature,' acid-base balance, vascular pressure, level of
- blood cheatcals, hormone production, etc. Through these and other regulatory modifications, the human body can cope with the wide variety of foods, pollutants, physical esercise, and emotion, we inflict upon it. This characteristic, so important to noreral living, may be called resilienay. Wonderful as it i '
3 This investigation was partially supported by is, however, it does not, indic.ite that we are Invulnerable Crant Mus$er CA 11531, awarded by the National ,
) and can survivo any bodily insult. Realittic awareness of the
' Cancer Institute, DHDf.
limits of resiliency are necessary for continued survival of both the individual and of the race. Transcending these limits
~ '
I
/.
- overloads the coping mechanisms, causing debilitating chronie Boss 11e Berte11, PhD,GNSH diseases and ultimately, death.
l
- 151 East Street '
One of today's most prevalent body insults, threatening
- < 9uffalo, NY 11+207 its basic ability to cope, is ionising radiation. Ironically, it is in the pursuit of health that we subject the body most
- s. ,/*
i _
deliberately to X.vay. We are also exposed to loaising radiation through proliferation of nuclear weapons and generators, through a
home fire detectors, from TV and video-terminals, and many other products of the growing industrial and commerdial uses of this hasard.
i I
f l
82 X-ray,
- ha t results whteh i as reporting apply e'lse to standards.
th1191 will testify tnday primarily to the hasards of in n'y analysis of the Tri-State Data 1 as doing several diagnostle X-ray, these other sources of esposure and their things which are new. The most important methodological change, cummutativo effect on put1tc health is net to be under-estimated. .ts that I as measuring the effect of exposure to tenising radiation No credible'public hesith stance can condone general exposure against the familiar yard-stick of natural aging. Exposure to .
to th
- pulille* for naladous 'enaft ts, while condemning it for
- low level radiation is imperceptible, as is aging, but b6th have the Individual seeking medical help. idhere appropriate, I cumuistive effects which eventually beesee apparent even to the t:111 take the liberty of broadening my remarks to include the healthlest among us. All of the I-ray considered in this analysis whole Fante of ionising radiation exposures. necurred at least on e year pelor to the leukosta diagnosis for yar the past nine years I have been studying the environ. cases, or prior to interview for controls, hence it is the mental esuses of leukesta, as indleated by the adult portion non-repaired cumulative damage caused by this exposure which sf th) Tri-State Leukemia Survey. This survey included all is being measured.
leukemia whichoeeurred between 1979 and 1961, in New York State A word of esution to the bioesthematietans who any be toutside of New York etty$, Maryland and Minnesota, together
- present, is in order. The aging effect measured in my research ulth a random sample or the non-le sheele population. The adult is ~not the some as the " life shortening" effect utually used portion of the Survey covers 39 million person years, and to assess a hazard. Further discussion of this is in the appendix.
consists or detailed infor=atton on 2800 esses and controls. Only X-ray reports verified by the laboratory, doctor it is intern =ttonelly recognized for its excellence. or hospital records is included'in this analysis. In the Further detailed information on the Survey is contained Append!x T, details of this verification, and evidence that in Appendix 1. it does not t!as the findings are given.
It is obvious from the Tri-State data that exposure to Mathoutical dotatis will be relegated to Appendices, medtsal X-ray is the most important environmental cause of and the main body of the testimony will contain the findings leukeets studied in this survey. There is seasurable aging, only. Since my findings are at times sentrary to some of the 1.e., break.down of the body's ability to resist leukosta, assumptions currently accepted in the radiolosteal health field,
~
essr.1 ting free routine, so-called harmless, levels of exposure. .
I will point out where 1 differ, and the evidence wkteh supports Medicci diagnostic I-rays result in bone marrow exposures my conclusion.
between 1 and 168 rad (1), a level permitted to both workers Mathematical techniques which I an using are the standard techniques, put together in a new way. These techniques were and the general publie under Nuclear Regulatory Commission guide
- linea. idh11e these guidelines do not apply to medical use of
. i
.)
M M , .
submitted to peer review ct the IIt rnational Biometris Meeting, gggi,th yg,Legt,,1 31 fontaint Padiations August 2J, 1976. To my knowledge there has been ,na serious Neasured against the yardstick of human experience with stitialsa of this methodology. The findings on the aging effect natural aging, affects of esposurer.to diagnostic. K-ray yary.with cf capesure was presented at the November 1975 nationt.1 aceting the target arte. X-ray of the abdominal cavity or spine is gf the.Amerleen public Mealth Asseelation, and is published in most serious, followed by chest X-ray, and finally by the the August 1977 issue of the Journal of Surgical Oncology. dental and other non-trunk X-ray. This pr % sbly reflects the Additional new findings which I as reporting today follow the proportion of bone marrow irradiated, and the expssure of same analytic technique, and extend the findings. other mejor organs of the homopoietic system.
The costrersion factors used to change number of verified diagnostic X-ray exposures into the rad skin dose were 'taken -
from published values, appropriate to the time of the survey, from the U. S. Department of Health, Education and Welfare. (2)
These conversion factors are given in Table 1 Table 1.
w of n!!!!reentsens osed la calculotten of skia dose for cases and contret, based on: Populatten tapesure to Itars. U.S.1964. U.S. Dept. of lisalth.
Educaties and Welfare arad per fila site of 1.rar (at skin entrance) -
Dental 1.13s Chest 147 am 7se Entreattles - 1s2 (lactudes need and asck) 9
87 N
Ta 2 Tim corresponding bone marrow doses for diagnostic X-ray Tri-State a Survey procedures are given in the Append 1x.
yor dental X-ray, this
- Aglag Estimate of Diasseette X.reF to all Sites Saal.Destal dose is 1.1 to 3.l* arad, while for other medical procedures pelative Risks of usa-tymphetta 8h= with Espeouse it v rics from 3 9 mrad for a chest X-ray to 167 mrad for a .
of 15 or more sed. adjusted for espesure age
. Intervals: 15-44. 45-54. 55-64, GS-N , 75*
spinal X-ray. f Years Aging .- Ane Adf. set. afsks Age and Sea Using the skin dose given in Table 1. I calculated the sente reente adj. risk pretabilltF per one rad espe.
j meount of verified exposure in reds for each ease and control. 0.00 1.35 1.32 1.34 0021 3
T:blo 2 gives the results of twenty separate analyses of the 0.05 1.27 1.2y 3.27 .6136 snttro semple. The results of all of these separate analyses, 0.10 1.21 1.16 1.19 . .0724 placed in sequential order, reveal the aging pattern which I 0.15 1.10 1.11 1.11. .3893 ~
to trying te clarWy. The first line of the table shows the 0.29 1.05 1.sy 1.06 .5333
! reintive risk of exposure to more than 15 rad diagnostic X-ray, 0.25' 6.98 e.98 9.9e .3333 -
i when no aging effect is assumed. Relative risk any be thought 0.35 0.92 0.8F e.90 2543 of as the result of dividing the incidence rate of leukemia 0.40 0.89, 0.06 0.88 .1461 l caeng those persons in the population having more than 15 rad 0.45 0.89 0.84 9.57 .1199 suposure, by the incidence rate for those having less than ly 0.50 - 0.88 e.83 e.05 .0004 ,
rid exposure. Rates for both males and females are about 34% 0.85 0.83 9.84 .052s c.55 high r In the exposed group when age adjustaent is made. This 0.e6 0.s1 e.e4 .0452 0.60 .
result is significant on the 5% level. 0.s4 e.81 0.e4 .0455
- 0.65 On line two, the results of a second analysis of the entire 0.99 e.83 .0388 0.70 0.06 samplo are given. This time the age of each ease and each
- 0.79 8.83 .0294 e,75 0.35 eontrol was increased by 0.05 times the rad X-ray exposure they ~
e.82 .319e 0.80 0.84 0.70
+ had rceelved. The sneo process is followed and reported for e.81 .9121 0.85 ' O.84 0. M each new estimate of the aging due to K-r:y. The object of this 0135 0.90 0.35 0.76 . e.81 tedious process is to find the value for which the relative e.83 m 0.95 ,
0.87 0.76 risk of X-ray exposure becomes one, i.e. incidence rete of e.00 -
.e094 1.00 e.84 9.76 leukosta due to radiation exposure is equal to incidence rete dus ta natural esing. N.B.. separately In this Table each of the 8*50 esses and 824 cont evaluated for rads exposure, and age adjustaent.
1
89 .
88 . .
T:ble 3 This tractaelt of ths d:ta makes sever:1 things clear. -
seletive alsks of see. lymphatic Leukemia for Males -
Thers is a systematic reduction in relative risk, remarkablF -
over 45 Years of rapesure age '
with Tr e x-rer Empesure er 1 er nere a.ds si:11ar for both males and females, with gradual increase in 8 Years Asias Age Adj, set. sisks Probah111tr eging estimate. This reduction approximates one, i.e. the rer one red espe.
1.57 .get?
point at which incidence rate from radiation is the same as 0.00 g,gs 3,5, ,,,3; that from natural aging, when each rad is assigned 0.25 yrs.
0.10 1.51 .com esing. Since all radiation exposures, including dental were 0.15 1.44 .0181 included in this analysis, this effect can be understood as an 0.70 1.M .07s5 0.25 1.31 .0522 untargetted, primarily dental X-ray, aging effect. .322e 0.30 1.23 Another unusual findirg is that at this level of analysis 4.35 1.21 3553 1.16 .2706 l there is no difference between the male and female. e.48 e.45 1.06 .sose Previous analysis limited to trunk X-ray, and to males, 0.50 1.03 7952 showed an aging effect of one rad equivalent to 0.60 yrs. aging 0.55 1.03 7713 far chest I. ray, and one red equivalent to one year when the *0.6o 1.00 .s7sf tr.rget was abdominal. For completeness, the analysis of trunk 0.65 0.9s .m 0.70 0.94 .5978 X-r:y which was primarily in the chest area, and the summary 0.75 0.93 .5251 tging estimates for all analyses, are given in Tables 3 and 0.se 0.92 44M 0.90 .363s
' Figure 1. These results were published in the Journal of 0.s5 0.90 0.94 .Safs
, surgical encology, August 1977 0.95 0.92 43s2 For the remainder of this testimony, I will use the ters 1.00 0.93 5073 l g.os g,gg ,4ag3
- czposure age" to mean, for each ease and,each control, the 1.10 0.se .313s sua of three terms: chronological age plus number of trunk 0.90 .334s
,
- 1.15 rada exposure plus one fourth the ausber of madeinenktrudk 1.20 0.ss .3145 1.25 0.sf 300s
~
C2posure.
1.30 0.s6 .17s?
I will now show some of the characteristics of leukeata 1.35 0.s5 1325 risk within limited age and sex groups, and secondly, some of 1.40 0.a4 .113s 1.45 0.s2 .0sts the other illnesses related to this aging effect of radiat10a.
. 1.50 0.79 .0323 1.75 0.76 .0071 i 2.80 0.74 0020
- 2. = 0.7. 000.
l t
4
90 E
So'ne intuittv.* h gf, gg, Tet-State M Frequently mathematical presentations of research I
i findings are so " elegant *, that the ordinary reader has the fireling that the effect exists only 'in the mathematies and not in'the real world. For this reason, I as taeluding some g easily understood tables Msiehshow that the health effoots of E medical'X-rey are very real, they oeeur at each level of 3
&) ,
exposure, and they do not seem to deeresse with age.
o 3.00 (1, The male population for the three States surveyed includi1 X
gaj .
- 2,025,692 between 45 and 64 years of age, and 814,232.ever 65, o according to the 1960 census figures (3 ). Based on the propor-4 g
2.50 -
~
tion of controls for whos verified X-ray reports wore obtainable, g it would be expected that 1,269,691 anles 45 to 64 years, and 466,986 males over 65 years would have verified reports. The 2.00 -
o mole leukenta cases with verified X-ray reports ease free this E sub-population, and it is possible to estimate the ineidence
, O .
e
( rete or.non-lymphette leukeata per 100,000 within this gr'oup.
(/)
1.50 -
The appendix deals with the quartion of whether or zet the m -
4 '
X-ray verification process caused bias in the findir.gs. If
~. .~~~ anything, it under-estimated the leukemia ineidence rate and
--~~~~~~~~
ta.
I .O O D~~~~ V ~: ~ ~ ~* * .
.. made the findings conservative. Regardless of this technical i
' O '
aspect of the analysis, it should be obetous from direct gg; II ** *
.. examination of these ineidence rates that the ineresse la 0.50 -
leukemia is gradual. It cannot be said that a few individuals E --
with large exposure doses cause the effeet. By graluelly
>~ ~~
U3 I I I increasing the range of exposures la the population, the w 0.00 -
>l5 >5 >lO. >l5 - .
- 1aeraas- '" *** "a'lude mt br antroung the range
, RAD , . RAD RAD R A D *,
, T ALL SITES TRUNK ONLY .
- e
^
c ..w cf capos:res, the leukea1s rats could be lowered. '
- IL la also evident from the data that een ev:r 65 years y,g, y gg L
- Ratsa per 100,000 Popult. tion af ags are at least as' sensitive to radiation dassga as are the men between 45 and 64 years. This is direct evidence which w i Trunt us. nate equi. Iray* per to0.000/yr. ,5s inteNa refet:s the testimony of Ilr. Reginald Gotchy, made as recently or rate es May 24, 1978. Dr. Gotchy is a senior radiobiologist with the ,
by.6% 0 10 1 97 1.80 2.17 Radi:1ogical Assessment Branch of the Nuclear Regulatory Commission.
10 20 2. p. 1 93 3 76 T3 quote his testimony ( %):
- In addition. risk estimates generally decline as age 20 30 3 64 -
2.45 7*11 increases (simply an expression of the generalisation that the young are more sensitive to the effects of
- 30 f 33 3*gpg1*II radiation than the eld)."
d such sasual, untrue assu=ptions are seriously misleading both to the general public and to the medical profession wh1'ch has 65 0 10 6 91 6.02 8.11 i come to rely on the NBC for its information on the health 10 20 R.y1 y,99; 14.68 sfracts of tontaing radiation.
- 21 30 20 59 10 73 486.67 l 1 Tables 5 and 7 examine truncated populations 1er the effect 3o 21. 5F 11 54. infinity er increased range of trunk exposure. Tables 6 and 8 de the same for trunk equivalent exposure (trunk plus 1/4 r.on.tr.unk).
- i These t bles are for visual comprehension and 391 for
" r ft tes dess response curves. They are unsuited for calculating such on th ohh a curv:s, or for any standard statistical tests which require !
ind: pendent estimates of incidence rates. By comparing the IMATE M RESPONgE f incidende rates in Tables y through 8 with the incidence ra'tes A E ACE I5 TIE NMGORIEg tithin the population 'actually receiving the increased I. ray, Table 4, IS NOT GIVEN.
one can easily see how averaging masks the true tapact. The
}
increased leukemia occurs within the increased exposure group,
- and the same population average, achieved with a shorter range .
I cf caposures, could be espected to decrease tota 1 iscidence rate.
l l
94 95 Tela 1 Table 6.
Tri-State Leukenis Survey Tri.Sttte Leukosta Survey Non tymphatte Leukemia Rates by I. ray Exposure Nan.Lymphette Leukemia Rates by X. rey Exposure for Males 45 64 Years of Age for Males 45 64 Years of Age Rang 2 trunk Lias. rate 4 per 100 (rpo ures *
- Cases .. . .... ..... 3000 yr.
/
Range trunk # Caaes Lks. g g,
.. equiv. expo.e per 100,000/ yr.
30 1 59 O. 2 40 1.63 02 17 1 34 05 0 10 58 1 99 05 . 34 1.79 65 2.04 0 10 53 1 97 0 15 74 2 14 0 15 63 2.03 0 20 ,
0 25 81 2.26 0 20 69 . 2.08 82 *** **25 ?? 2 20 0 30 84 2.21 0 30 80 2.21 0 40 39 2 32 0A0 84 2.22 0 50 91 2 376 0 50 88 2.23 0 70 92 2 378 0 60 90 ' .35 2
0 80 '
93 2.404 0 70 91 2 37e..
0 120 9 2 378
- Nomber of X. rey plates used for chest or abdoettal or 0 120 93 2. 4 ather trunk X.rsy.
N0ft: THIS TABLE Cc30T pt USED FOR & DOSE RSSPONS3 ESTIMATE AYREE 2e WP of mn-y opmu (denta BEAUSE DOSE IS CIVEN IN WERLAFPING RANCES. , ,
DOSE FOR EACM RUCE, AND AYSAGE ADE FOR EACE RAllCE NOTE: THIS TABLE CANNOT BE USED FOR A DOSE RESPONSE ESTIMATE PECAUSE DOSE IS CITEN IN WDLAPFINO RANCES. AY B ACE-DOSE FOR EACH RANCE, AND AYERAGE ACE FOR EA::N RANCE ARE N0f CIVEN.
g :
Tat,lo A.
Table 7
- Trt.Stata Leukmia survey Trt. stat? Leuk tla survey Non.lymphette Leukeata Rates by X-ray Exposur3 ,
Non. lymphatic Leukeata R:tes by X-ray Exposiro for Males 65 of more Years of Age for Neles 65 or pore years of age .
Range trunk # Ceees Lka. Rate R .equiv. espo.* per 1CD,00Vyr.
Rangstg # Cases ,,
capesure . . . . ~ . . _ _
6.80 0 10 67 6.91
- o. 10 72 87 7 23 c. ly 81 6.83 0 15 0 70 99 7*ff - c. 20 93 7 30 107 8.05 c. 25 102 7 76
- o. 21 108 8.01 c. 30 108 8.01
- c. 36 c.1.o 110 7 85 c. ko llo 7 85 114 8 14 o. FC 114 8 14
- c. So
- c. 6c 116 8.28 c. 60 116 8.28 118 8.42 c. 70 118 8.42
- o. 70
- o. So 119 8.49 c. So 119 8.49 c.100 121 8.64 - o.100 120 8 57 0 110 121 8.64
- Trun exposures include all E. ray plates verified for ,
X-ray plates and one fourth the number of dental and other non-trunk 1. ray plates verified.
N0fE THIS TABLE CANNOT BE USED FOR A DOSE RESPONSE ESTINATE NOTE: TH[8 TABLE CANOT BE USED FOR A DOSE RESPONSE ESTINATE SECAUSE DOSE IS GIVEN IN OVERLAPPING RANGES. AYERACE BECAUSE DOSE IS CIVEN IN OVERLAPPING RANGES. AVERAGE DOSE FOR EACM SANGE, AND AVERADE ACE FOR 2ACH RANGE ARE, DOSE FOR EACH RANGE, AND AVERACE ACE FOR EACH RANGE AR1 i NOT GIVEN.
i i
t h
98 .' , 0-Est1 W te_tha Pubite Hmith 1*o9et of Iontrine Ra41stion in on nrticle published in 197*, Dr. Enrico Vladana and 1 in ey spproich to this question, 1 have tried to emphasize Dr. Irwin D.J. Dross identified certain diseases, ditanosed five ths nerd for differen'.131 protection. Some persons, such as years ormore prior to the diagnosis of leukeata (or interview, tr3gnant vocen, are et a greater risk thin others. I have for the controls), as indicators of susceptibility to tried to identify other sub-populations, not so well recognized leukeata(k). These diseases probably indicate a treak-down es nieding special protection, who show marked susceptibility in the body regulatory and immuno-systems, leaving the person to rrdistion damage. I believe that these persons need special vulnerable to the disease. In the Yiadana analysis, diseases were grouped as follows:
prsteet ton both from madical I-ray, and from emplo/ sent involving CROUP As Asthma, hay fever, hives, ecsema, gotter, diabete exposura to ionizing radiation. mellitus, herpes soster, psoriasis, neuroderaititis, TB.
ginea differential protection is often impossible in CROUP B Pneumonia, heart, theumatism.
routina X-ray practices, asas screening programs, esployment The selections from Table II,in this publication,WMek pertain
~
cad ho:pttal admission policies, etc., my remarks should be to non-1ymphatie leukemia are reproduced here for your conven-ttkin ss very critical of these mindless uses of radiation. 1ence.
I cm siso assuming that strict licensing of X-ray technicians, inspettions of equipment, reductions of per film exposures, STATUS LWKEMIA TYPE SEI REL.RIfK PROBABII. 1 i c11ctnstion of defensive radiology, taking of X-rays when trostrent cannot be improved with improved knowledf e, using one disease from Myeloid. Men 5 5$ o.co At one from B Myeloid Women 1 95 0.14 X-rey c;ulp-ant in order to =ake it cost effective, and other ~
One disease from Myeloid Men 1 72 0.16 sbusts will ba addressed by sthers who vill be giving testimony Al none from B Hyeloid Women 1.43 0.29 todry. .
One disease from Myeloid Men 1.87 0.01 El none from A Hyeloid vosen 3 33 o,o9 special knowledge gained fres study of the Tri-State Dats, which is not easily gained from any other source, will yhe intgr.aetion between disease and X-ray exposure in r i
,be emphasized in my testimony. ,
increasing the risk of non-1ymphatto leukemia was not attempted
- in the Y1adana analysis. As a first analysis of this inter-settor I did a standard analysis of the. adult sample, matching fot age, 4
s:x, and diseas2 category. Bymatchingesssswiththsdiscds3 Ther9 was strong indier. tion that both disiesi an.1 X-ray indiscters with controls with the disenso indicators, any were invsived is the mais 1suhimogenesis. I then did'a (sexs'of radiation esposure due to the indicator diseases is new analysis of the. entire sample, using exposure age, i.e.
controlled for la the analysis.* I used one year. prior to the an age adjusted for X-ray exposure (as previously described),
di: gnosis of leukemia, or prior to interview for the cases, instead of chronological age. In this analysis all relative es a cut-off point for indicator diseases. No diseases or X-ray risks were reduced to about one, as was expected. This coeurring after that cut-off was considered. Except for some change to exposure age effectively adjusts for the leukesogenic combinations of allergies, no case or control reported more effect of X-ray, enabling a disesse effect to be more directly than one of the diseases in Group A. The diseases in Group B evaluated. Table 11 shows the results of the analysis of the vers more common. The Tri-state Data contains detailed infor- risk of leukemia for persons having the indicator diseases antiin, and a time-line study of disease diagnosis and medical relative to those not having ths indicator diseases,for sales.
I-try would be possible if re-coding were undertaken. At the These findings are startling, and of great importance for
, present time such a detailed analysis is impossible. ,
designing radiation protection programs for public health.
The preliminary gross overview of the interaction of Table 11.
inditator diseases and X-ray exposure gave the following results: Reittive Risk'for Roaalydphatic !,eukesta for Males with Indicator Diseases,for Exposure Age Table 10. .
Exposure No. Cases No. Controls Rel. Risk Probability Attr Relative Risk of Non-lymphatic Leukemia With Age able Exposure to 15 rad or more Skin Dose Diagnostic 15-34 15 50 1 34 0 34 1:
j X-ray for persons with and without Indicator Diseases 35 44 13 22 11 78 0.00 7-WEIGHTED OVER REL. RISK PROBABILITY 45-54 16 53 7 27 0.00 7:
CATEORY 55-64 40 81 1.15 0 59 :
age / disease 1 79 0.00 Malo 65-74 50 63 1 58 0.12 21 y: male age / disease 1.09 0 52 75-84 44 35 .
1.22 0 56 1 With disease age / sex 1 59 0.00 0.44 85 or more 53 36 4.08 0.00 78 Without disease age / sex 1.12 Summary 231 340 1 91 0.00 3*
I Summary age / sex / disease 1.47 0.00 i
e
=
1 I _.
103 102 This is strong evidence that the younger men dying of highest risk for males, 2 30, occurred between 45 and $4 years, non-lymphatic leukenis v111 have had prior indications of . the period at which the least risk, 0 75, occurred for the modif.a1 break-down. These men can be precipitated into a risk female. The highest risk for the female occurred for a re eattgory 12 time that of other young men by ionising radiation. over 75 years of age, 2 75, wh,ile the corresponding male risk Diffsrential protectica of these young men is important. The was 0.71. The highest combined sele / female risk was 2.02.
czast diseases involved could be ibrther determined, but the After adjustment for exposure age there *** a marked prcsent evidence is sufficient for precautionary measures to similarity in the male and female risks, vita the combined be imediately taken. Young men with the disease indicators risk in the 45 to 54 exposure age category reaching 6.01.
listed on pae 19 of this testimony, should not have any obviously exposure age better identifies the high risk group, unn.cessary medical X-ray examinations, and should not be and matching on exposure age brings out the anle/ female espityed in industries dealing with radioactive material. similarity in risk very clearly.
N;edless to say, indiscriminate increase in background radiat'ton Again, exposure to ionising radiation hastens the from weapon testing or from the nuclear industry will hasten . onset of leukeata in these high risk people.
th) death of these young men. They are certainly among the Tables 12. and 13 give the results of this analysis.
most sensitive to the acceleration of aging due to this exposure. Table 12.
The inability to identify the combination 6f disease inditators as indicators of leukeata in the females may be Risk of Non-lymphatte Leukemia for persons With Heart disease Relative to persons sither a real difference or an artifact due to the X-ray v2rification process. I suspect that it is the latter. As cxplained in the Appendix, verification teeded to exclude Chronological Relative Risk Estimate Ace Male yesale Combined female leukemies more than males.
Since hes t disease was the most frequent disease amorg II*O 1.27 1.67 1.45 the indicator diseases identified by findana, I undertook a kI*S
- 2 30 " 0 75 1 50 separate analysis of the interaction of this disease with I-ray 57-64 2.17 " 1 77 2.02 "
exposure. yor this disease, male and female risks were guite 1.26 1.06 1;17 67-74 different when chronological age was used for matching. The 75 or more 0 71 3 7y g,99 Summary 1 38* 1 50* 1.W"
~
- Significant on $$ levels ** Significant en li level.
i I
l l
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100 104 ,
T;blo 13 g,i,ntt rv%e 1.ath h g b4tation M gg 1.e'ikemis 3g13g:
Risk cf Nex-lymphatis I,eukemia far Persons .,
Aging is a rather familiar process for Wee of us who' Uith Neart D,isease Relative to Persons ,
have lasted beyond age forty. ThereforeIhaveapposiedto Without Neart Disease ,
an intuitive sense of gradual break-down in the body's ability to cope, and thusfar just asasured exposure to ionising radiatiot -
D suro Relative Risk Estimate Combined Ago Male Female -
against that y&rdstick., It is possible, however, to go further, 1 04 0 95 and quantify that breakdown in terms of inesdance rate of gy.t.4 0.88 ,
6 01 " leukemia. In the appendix of my published paper: "X-ray Exposure ~
45.$4 6 33** 5 71 "
2.c9e 1 58* and Premature Aging", I have discussed this y oblem in detail.
55 64 1=33 1.16 1 07
- I will include that paper with my testimony.(f) 65-74 1 01 1.67 " The conclusion that I have reached is that the aging
.la79e 1 58 _
'75 er more~~
process in the U.S. during the time prior to the Tri-State
,7 1,43 1.47e 1.47" .
Survey, increased the individual risk of non-lymphatic e significant on the 5% levell " significant on the 15 level. , , 9 g, in the same way as does compound interest.
From these few examples it should be apparent that the Figures 2,.3 A4 are graphs showing the cumulative relative eersurecent of the aging effect of exposure to ionising radiation frequency of each age group in the survey area, based on infor-is useful. It certainly clarifies the relationship between
- mation in the 1960 census. The shaded band indicates the
?
! dis:ase indicators and wn-lymphatic leukeata in those under expected cumulative relative frequer.cy of non-lymphatic leukeata egs 50. The. implications of this research for clinical practice- ases under the assumption that incidence rate increases 5 to 6%
and for workers in radiation related industries should be ' * '
abvious. I would also conclude that monitoring these indicator separately. Figure 4 gives the combined cumulative frequencie,s.
diseases in a population aight be more useful, from a public B sing this method of relative frequency, difference between health po' int of view, than waiting until one can count deaths _ i male and female absolute incidence rates are blurred, and the from leukeata. Their incidence rates and age of occurrence commonality of the selection process highlighted. *
! cight be used as an early warning signal of deterioration of
~
c l the public health.
l l
l F .
1 1
- 106 107 i
Figure 2. Figure 3 1.00 RELATIVE CUMULATIVE FREQUENCY OF AGE FOR MALES -TRI-STATE I.OO -
AM, CM AND OTHER LEUKEMIA ATIVE CUMULATIVE FREQUENCY
.90 -CASE AND 1960 CENSUS DATA . F AGE FOR FEMALES-TRI-STATE FOR AREAS STUDIED .90 AM. CM AND OTHER LEUNEMIA CASES AND 1960 CENSUS DATA
> FOR AREAS STUDIED
.80 -
N >- .80 -
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2 Z
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SHADED BAND INDICATES RANGE OF EXPECTED VALUES FOR
.10 -
SHADED BAND INDICATES RANGE CASEg GIVEN (1.05)kTO .
.10 -
(1.06) RISK FOR AGE k OF EXPECTED 9ALUES FOR CASES GIVEN (1.05)k TO
. . . . . . =
(f.06)k RISK FOR AGE k 15 25 35 45 55 65 75 85 . . .' . , ,
15 25 35 45 55 65 AGE IN YEARS ,
75 as
- ~
' AGE IN YEARS.
.. .p %
l . CG . ' .
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In Figures 2, 3 & le, only th2 non-lymphatic 1duk: cia' Figuro 4. *"""'"'"I*#**#"'"**""*"'*** T"' "I" * * '" .
EXAMPLE OF A " COMPOUND INTEREST" I!ATilEMATICAL N0 DEL rate , holds also for the entire sample, and the use of this sub-set was both to, show that the ver}fication process had FOR PREDICTING THE AGE DISTRIBUTION OF WE not biased theage selection seriously, and to facilitate LEUKEMIA PATIENTS IN W E TRI-STATE SURVEY direct comparison of oging with verified X-ray exposures.
The next 7 figures show the Tri-State controls and a
- '****'*1""I*"'"'*******"*"I***""I'**"
1.00 RELATIVE CUMULATIVE FREQUENCY frequency of the cases on the assumptson that one trunk x-ray OF AGE-SEXES COMBINED TRl-STATE inenou ne risk er non-tymphatic leukemia 55, compounded.
.90 -CA ES ANDI O ENSUS TA
- The controls and predicted case eurn are the same in all FROM AREAS STUDIED ,
figures. This model is statistically acceptable for each of
>- .80 - the three leukeata types and 'each of the two age groups separately O
- and when combined. There is no other curve which will fit 2
!d each or these series of cases and nr.e groups separat.17 and D 70 -
1960 LKM. CASES 8 CENSUS (448) when combined.
The " official" estimates of dose response for le*2kemie
~ #
id
- with exposure to ionising radiation are made on a straight line -
b .
basis, and this does well as an approximation in a short range k .50 s
- of exposures. I suspect that the true sh pe of this e2rve to "
D . sigmoid, and that I am picking up the curve at a much *ower N. '"*""8*""*"**"*#**'""*"**"**""* ****""*
3 AO which I as observing will farm a plateau before reachi..g the iapper range of radiation exposures usually used to estimate.
.30 -
- kene the leukemia rate at this lower dos levet is higher than would be predicted by methods used in the BEIR report.
Q:: .20 - .
SHADEO BAND INDICATES RANGE
- 10 - OF EXPECTED VALUES FOR CASES GIVEN (1.05)k To (l.06)k .
RISK FOR AGE k 15 25 35 45 55 65 75 85 AGE IN YEARS
RELATIVE CUuutATIVE FREQUENCY RELATIVE CUMULATavt FREQUENCY "
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MILES GS 02 O!AE YEARS ,
D CMTu!LS VS, CM LEUKEmaA CASC$
g ; COMPOSITE GRAPH .
g .90 -
/ s MALES 4S OR MORE YEARS h
~50 CONTROLS t p>#"* ~~ , / g 1A0 -
CONTROLS VS. AM.CM. AND OThER LEUNEM:A g .So 8 JJ.W w WITH BETA .
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! NUMBER OF TRUNK X.-11AY PLATES REPORTE0 . .
A0 I , .
S 30 35 20 IS 30 33 40 4S+
NUMBER OF TRUNK X-RAY PLATES REPORTED Tigure 10.
' u MALES GS OR MORE YEARS 1
E CONTROLS VS. OTHER LEUKEMIA ~ CASES s
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NUCIR OF TRUNK X-RAY PLATES REPORTE0 4
-4 1
114 115 T;blo 14 Although I hwe not attempted a rigorous mathematted Tri-St4te Leukeata Data for proor In t.hls testtrony, It is not difficult to show that .
Miles 45-64 yrs.
- the Incransa in leukeete rfsk with X-ray must be both pro- .
portignal to the risk already accumulated by the individual, ~
7Te"rffied # CUis~~ T C'as' eI Impected # Cases eted tnd exponential rather than 11neer. The proportionality Chest X-ray Observed (null hypothesis) (1.04 ri late) sf ths risk has been amply demonstrated in the sub-population 28 28 et risk because of disease indicators, and in the estimates U*M 15 03 far risk increase with trunk I-ray.
12 10.02' lo e4 With respect to the linear hypothesis, I would make
- 12 11.17 13 06 the fallowing ot:servations: First, aging is obviously an .
U I'93 8.62
' exponential process, not a linear process. Second, the
~
O b*bb 7 99 most remarkable outcome of the analysis presenhd in Table 2 I r more' 3 1.22 3 26 sf this testimony, indicates that the under-lying snathematical proesss of radiation induced non-lymphatic leukemia -
sgM
, { 93 M.23 g@
fallows the same mathematical process as aging induced disease.
i Changing the ages of 450 leukemia cases and 824 controls in Chi-square test for the e ted auster of esses under the null '
hypothesis 14 78, with DF, which is significant en 3% level
- I o systematic way to'refleet their individual diagnostic I-ray ;
. Chi-square test for the expected number of eases under the hypothesis expertence could not bring about such consistent results if of a 1.04 relative risk per plates 2 72, with 4 DF, not significant. ,
the two characteristics, nstural, aging and radiation exposure, Notes Cases were taken over a three year period, and the expectations were for the sees period of time.
were not interchangeable.
l The following Tables give the expected numbers of non-lymphatte leukemia cases for the Tri-State area under This Table looks at chest X-ray data only. persons with .
the casumption that there is no increase in rate due to no verified chest X-ray may have had abdominal or non-tru-k
- g. ray exposure. The Chi Square test allows rejection of X-ray. As a rough estimate of extra leukemia eases in the this hyw thesis. The alternate hypothesis which assumes . verified chest X-ray eategories for this age group, one could a 4% ineresse in risk with each X-ray plate taken is shown subtract the number expected under the null hypothesis from the to be acceptable under the same Chi-8quare test. The tables actually observed number. There were 17 77 " extra
- esses, about cleo give estimates of the number of. extra cases which occurred . 191% of the total number observed.
because of the X-rsy. ,
- - - ~ - - -- - - - vw-- -- _ - _ _ _ - - ______._ _ _ _ -__ _ _ - - _ _ _ _ _ _ _ . . _ .
Table 16. -
Tcblo 15.
Tri-St:te f.eukemis Dats far Tri-Gtste scukemin A rvey Dsta Males 65 yrs. or more ,
Males 45-64 Years .
4 Trunk # Cases # Cases Exp. # Cases Exp.
- Cases Expected # Cases Expected Equiv. Observed (null hypothesis) (1 *04 riskfplate)
- V;rified # Cases X-ray Chest X-ray Observed (null hypothesis) * (1.04 risk / plate) 29 19 C-10 53 53 53 O 29
. 1 [ -20 '
16 12.42 18 36 1-2 42 38.25 40 57 e 20 -30 :
11 5 94 13 00 3-5 21 19 52 22 32 3f 13 4.80 15 54 6 10 18 10 59 14.21 7 04 822 93 76.16 99 90 11-20 9 3 91 1 34 . 3 56 Chi square test for the expected nuraber of cases under the null 21 or more 2 hypothesiss 19 35, with 2 DF, which is significant on 1% level.
M 121 102.61 116 7 Ctf1 square sest for the expected niander of cases under hypotheils of a 104 relative risk per trunk equivalent: 1.03, with1 CF, MS Chi-square test for the espected number of cases under the null Males 65 or more Yrs.
hypothesis: 12.62, with 4 DF, which is significant on 3% level. 4 Trunk # Cases # Cases Exp. # Cases Exp.
Chi-square test for the expected seeber of esses under the hypothesis Equiv.Xrey l Observed (null hypothesis) (1.04 risk /plste)
, of a 1 04 relative risk per plates 2 37, with 3 DF, not significant.
11 Not: Cases were taken over a three year period, and the expectations 0 -10 67 67 67 were fir the same period of time. .
10 -20 ; 26 21.10 31.23 20 -30 : 15 5 03 11,o3 This Table looks at verified chest X-ray only, for the , i There are 18 39 aextra" cases,
- II'93 salts over 65 years of age. i i
. [bov3thenumberpredictedbythenullhypothesis. This is Sua ; 121 96.81 121.19 chout 15 2% of the total. Cb.1 square test for the expected nuater of cases under the null hypothesiss 44 50, with 2 DF, significant on 1% level.
The story is essentially the same when one looks et Ch1 square test for the expected nuater of cases under hypothesis trunk equivalent X-ray instead of chest X-ray. 'This estimates o,f a 1 04 relative risk per trunk equivalent: 2.40, 1 LF, NS l c11'er the X-ray verified, using the four to one equivalence Nkte In the above tables observed and expected numbers are
- for the three year period.
l far non-trunk X-ray. Tables 16 and 17 present this information.
r h
118 119 A rsalistic public h?sith goal tight be to lir.it each persons X-ray exposure to one half trunk equivalent X-ran The main point of my testimony is to convey en important per year, on an average. In the Tri-State Survey, 69 6% of concept. Just as it would be ludicrous to try to convince thz male controls 45 to'64 years, and 69 2% of the male the general public that growing old is not *hernful" since eentrols over 65 were within this limit. As indicated in not every elderly person getsleukemia, so it is also ladierous 7:bles 16 and 17, this would prevent 18.1$ and 20.0$ of the to call exposure to ionising radiation " harmless" in teres of.
non-lystphatte leukemia cases in these two groups. This'aeans -
the number of leukemias it night be expected to cause. The preventing one out of five, or one out of six esses. If this mathemattes which are used should reflect the general nature were a cure rate it would be quite remarkablet Concern for of the biological breakdown slowly caused by exposure'to low pr:vention should be just as important as concern for cure. level radiation. I strongly proposs that natural aging be There would obviously be emergency situations which would used as the yardstick for this measurement. There seems to over-ride the above limit, but I believe that it is workable be no indleation that the advisory or regulatory bodies responsible
! es a guideline, for protecting the public health from radiation are even taking such a limitation would raise conscioasness about this the trouble to investigate this approach.
M::::rd, and *his is necessary because of all of the public % second important point is that the gathering of vital rel tions material now being circulated, which would elais statistics information in this country is designed to monitor that exposures of this order of magnitude offer negligible the public health problems of the past, namely infectious diseases, health risk. The medical profession cannot afford to take and is inadequate for monitoring environmentally caused diseases.
th) guldence of the nuclear industry in a public health issue This is not a lack of knowledge or ability to monitor such '
where they should be assuming the leadership. Limiting medical diseases. I en enclosing the title page of a recommendation X-reys, even when there is some benefit to the individual, recently modo to the National Center for Realth Statistles wh2n the overall risk exceeds the benefit, would put in a new by the U.S. National Committee on Vital and Realth Statisties ( f ).
perspective the risks being planned for workers and the general This publication supports my claims, as'does the present unfor-publie for nebulous
- growth of the economy" reasons. I as also tunate series of disputes over saccharine, sirer, pCB, PBS, kepone, fearful that medical X-ray will become a seapegoat, and needed red food dyes, and radiation. If information is properly gathered, uses of medieal I-ray will be sacrificed bee'ause of economie all of thete environmental hasards een be monitored. It is not glin hoped for in the use of nuclear power or nuclear weapons. , ,
This could beeone one more way of putting the public health s:cond to econoste, gain!
-, w _ - - - - - __ - -- - _ - _ _ _ _ _ _ _ _ _ _ . . _ _ _
~~
Another sourc2 af difficulty with respMt t3 FrEsarching
- In the asia body af my t:stimony, I havs s;t farth the ,
cavironneital hasards is tha govth af dIfensivs scione). By eine:pt af aging, 1.c. breakdown af W body r:gulattry' systems . ,
this, I mean seience specifically designed.to prows a commodity which gradually undermine the individual's ability to cope .
or technology " harmless *. 8seh sciones is often " bought" ~
with life, and esasured h biological damage done by tonistag i with the tax payer's money. science not supportive of a radiation against this yardstick. In the usual biostatistical course desired on an oceaonic basis is, on the other@and, Jargon, there is a terg: " life-shortening effect". This is penalised la many ways. Scientists should be able to work calculated by determining the number of premature deaths expected .
out:14e of the rewards and penishments of the " system". They
' in a population exposed to some hasard, estinating the number sho~.14 be aMe to report Wir findings, and let the chips of aan years lost by these premature deaths, and then dividing fall where they say. This is impossible especially for any
- this number of man years lost by the size of the population.
r:diation related research, since vested interests relative h a if two persons die 30 years prematurely la a population to this hasard encompass the military, the nuclear industry, of one million, 30/100, or 0.00003 yr. is " lost" per person.
banks, government agencies, foreign relations, the medical i In other words, the two premature deaths can be considered catablishment, insurance agencies, the American College of a 16 minute " life-shortening" for the population. What I as Radiologists, the Anettean Cancer Society, the American talking atout has gt relation to this myth. ,
Nuclear Society, etc. This has to be the most awsome lobby Table 17 gives the population base from the Tri. State j ev:e encountered in the history of American political There are more parts to this radiation story, eseetelly region from which the survey information was collected. It also gives the theoretteel cumulative relative frequency values th3 whole guestion of radiation damage of gers cells which ,
expected for the non-lymphatte leukosta cases under h hypothesis es,tse deleterious effcets apparent in subsequent generations.
'that risk increases at a rate of 55, and 6% per year of natural l I have also not touched on the special sensitivity of the fetus and young child. The effects of ionising radiation are better , aging. These numbers are the basis of the banded interval in known in these areas of research, and Dr. Bross has recently Figures 2,3 and 4 of this teattoony. A mathematical decription tJetified before this committee on these aspects. It has been of the way these numbers are generated is given in the appendiz of my published papers "X-ray esposure and Preenture Aging."
my purpose to provide you with informatica which you can get from no other sourse. With a complete lack of financial support '
even this service is not as complete as it could or should be. <
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Tatie 18.
Age distributtees by leukeata type -- 7:1 State Survey AN Of Ofl0 AM and Of AM.Os and ODI Iso. Ret. lee. Rel. lee. Rel. see. Ret lee. Rel.
Age Cnse. Cum. tk. Cum. Cum.
Preg. Freq. Freg. Freg.
Free.
. 15-24 19 5.7 9 3.5 7 3.1 28 4.7 35 4.3 25-34 27 13.8 15 9.3 12 8.5 42 11.9 54 10.9 35-44 25 21.3 29 20.6 17 14.1 54 21.0 71 19.7 45 54 48 35.7 32 33.1 26 27.7 80 34.4 106 32.7 55-64 65-74 79 85
$9.5 85.0 57 $5.3 41 44.0 136 57.6 177 54.4 g 72 85.3 62 75.7 157 84.2 219 45.3 75e se 100.0 43 100.0 59 100.0 93 100.0 152 '100.0 Sample Sise 333 . 257 224 500 814 8esen Age 57.67 59.37 62.31 58.41 59.48 seete: AN is acute myeleid or monocytic ledestel Of is chronic speleid er menecytic ledeolal and 0T18 Includes all non-tymphatic leukeata cases for 4tch one of the shove diagnoses could not be ande.
Tbe category AN and Of is referred to as 14-type leukemies, and the AN, Os and Orli category is referred to as non-tymphatic leukente, is the test. -
The control saapio used fcr the Tri-Stata survey was .
tbla 19
- based on a str.tified colection af households, dxes hist Tr1+ state teuheats searver - Ass Distribestians to the ctart af ist:rviewing. Study F.reas were stratified . .
solassver-sainner Test values meer hypothesis inte census tracts in cities and ints annumeratica districts of ensema esiderlylas distributions in rural and suburban areas. This was done on the basis of Belative Ce ntative . 8 U.S. eensus Saformation. All 1aformation was laitially
' *~
i:ollected la a double-blind interview, to preveat bias. If Census vs. AL 14.4 .00 the later-viewer discovered that the person interviewed had Census vs. CL 57.7 .00 leukemia, this was noted in the schedule at the point of .
Census vs. m as.e *so identification. There were extensive re-interviews for
{ Census vs. m 3s.2 .os reliability checks, and independent verification of verbal Census vs. O m 43.6 .00 reports. Each interview involved, on the average, tus calls i at a household. Some required as many as ten calls. There
- vs. 08 4.5 m.20 was a 12% refusal of interview, la the initial telephone' Census vs. m and os 36.7 .oo
.co contacts, but this was later reduced to 8% after personal ss.6 Census vs. m. Os and om contact with the selected subjects was made.
T5vs. m. Os and om 4.8 p.18 yurther detailed Laformation on the Tri-State survey 76vs. m. Os and om -3.s ..le isavailablelascientificliterature(f). It is later,e
! nationally recognized as an excellent data base.
- This uns a tuo semple test. All others are one samyte tests Of particular interest to my testimony on diagnostle since total aseous data gives accurate frequency laternatles. *
- X-ray exposures, are the verification techaigues used when The last two line of Table 19. show the close agreenert the.pgrson.inierviewed reported such ' exposure. At the end of ,
between the tuo theoretical curves posited in Table 17. and each interview the person was asked to sign a statement grantin j the actual observed curve representing observed non-lymphatic the study personnel permission to review their medical records leukeata cases la the Tri-State Survey. It should be noted in physicians offices and hospitals. Galy about 15 refused that all three survey. areas had tumor registries, so that . this permission. Cooperati.on from physicinas and hospitals
- i virtually all of the leukemia cases diagnosed over the three was eteellent, 69% responding with the first request, 15% more t with the second request. The remaining 13% were contacted by year period were included la this study.
telephone.
i I
126 127 Tab 13 20.
Eventually when all records were in on medical X-ray The Number and Percent of Non-lymphette r2ctived by the persons included in the sample, it was found Leukeets Cases and Controls in each Age Group that cbout 80% of the X-ray given by phystelans and dentists, Having Yorified I-ray cnd cbout 675 of that given in hospitals had not been reported by ths interviewee. There was also 19 3% of the reports of Age Males Females combined Cases No. $ No. J- No. J X-r y by physleians or dentists, and 42 9% of the reports of X-rry in hospitals which could not be verified. Mach of the 1 -2 7 30.4 3 25 0 10 28.6 lo:k of verification was due to a policy, set by the doctor or 25-34 14 48 3 12 48.0 26 48.1 hospital, of destroying patient X-ray records afte: five years. g g,g g, ,
It is obvious that reliance on interview data alone, A A6 M %5 without verification would have made the study completely g ingslid. Reliance on verified X-ray only runs the risk of . 59 0 4 63 127 58.0 some under-reporting.due to the verification itself. A decision 7- 39 50.6 41 54 7 80 52.6 was mad 2 prior to my involvement in the study, to confine the sus 261 55 9 189 54 5 450 55 3 analysis to verified reports only. I feel that in view of the important findings on radiation, and in view of the national Males seal e Combined ettention being given to this hasard at the present time, a ges new d:,ta processing should be initiated which would allow for 15-24 55 51 9 53 63 9 108 57 1 essessment of all 2-ray reports. The method of analysis which 25-34 36 50.0 40 70.2 76 58 9 1 havs used, since it involved an evaluation of each case and l
21 38 9 79 71 2 100 60.6 -
35 44 control individually, is probably best suited to the type of 45-$ 85 64.4 71 70 3 156 67 0 data withewhich I had to work. 60.6 55-64 106 63 1 86, 57 7 192 Table 20 gives the number and percent of the non-lymphatte 65-74 56 $9 6 82 . 61 7 138 60.8 esset and controls having verified X-ray reports. With one 75= 22 52.4 32 47 1 % 49 1 ezeeption, discussed later, there is no.evid'enee that'the verification procedure selected out esses at s' higher rate than Sue 381 57 0 %) 63 1 824 60.1 e'ontrols.
O e
Figures 2,) and Ie, in the main part cf the t:stimony '
- 1 .
I show tha cumul;tivs reir.tivs frequencias af the non-lymphatte 1eukosta cases with verified X-ray, against the previiusly determined expected values by age, determined by the entire Ig
,gm (o k*h o o ,
N a
.l non-lymphatte sample. The verification process did not ts.'g.4 g-cignifloahtly alter the age pattern. The over-representation 3 ,, ,
cf male cases in the 35 W age group with verified X-ray accounts 8 fir the slight deviation in the sale curve. The combined male. Ek'
-g e
femals sample is well within the expected boundaries, which were U a. { }Ih 5 E N I bared on observation of both verified and unverified X-ray 2"h E do
= %
E 22
,A d d d a caposure esses. ,
" g,g Ua .
5 Table 21. gives the estimates of incidence rate for "
- m.
non-1ymphatic leukemia in the general surveyed population, using the controls to estimate the proportion of the base
. 3 (3 w -
' gbaA.
- t. w w w population expected to have verified I-r./ rope.~.3 Except g
fir the sale CM 1eukosta, verificatt ,a see.4 to be selecting k$0D h *,, E } g popul tions with slightly h*- :.on-lymphatic leukemia than is j
= .k 5 h -
[ ,
true for the whole population, tinder-estination is greatest U $ *g 8 5
, f;r the females. .
loN s.
1 55 e 1 Ee T C
- tu n n m i yg3 ~= 3 :g 2 %9 9 <n 6g" g o o o E
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- , 181>
130 T;bla 22. -
, The time distribution of the exposure to diagnostic Time Distribution for Medical X-ray exposure for .
I rr.y is of special importance in clarifying the relationship Tri-State I,eukemia Survey Controle, Together with
, between exposure and clinical manifestation of disease. In Average R Rin Dese Exposure t*e coding of the data three time periods were designated, all 1 me:surements dating back in time from the date of intervist Time Intervals Average R Skin Dose per Year in Interva'l
< far centrols, and the date of diagnosis of leukeata for eases; h1. p.mata cambined
- 1. one to five years priorg No. R/yr. No. R/yr. No. R/yr.
- 2. six to ten years priort 1 only 141 1.266 154, 1 396 295 1 330
- 3. eleven or more years prior.
I and 2 only 78 1.471 80 1 308 158- 1 388 There was no verified X-rey more than twenty years prior to l
1, 2 and 3 $$ 1.661 80 1 904 137 1.805 l sither diagnosis or interview. The period of exposure and the .
1 and 3 only 39 0 792 34 1.16f* 73 0 966 cit: rags Roentgen skin dose X-ray per year during that time period 2 only 27 0.480 45 0.600 72 0.604 giras some indication of the exposure pattern of the general 2 and 3 only 11 0.479 18 0 771 29 0.660 publis in 1960. Appendix II will address some of the changes 3 only 30 0.870 32 0 972 62 0 922 in pattern of exposure for the U.S. population since 1960.
~~
Ia the averages given in Table 22., only periods in which I-rey A r is estually received are included. Since it can be assumed there was verified i X-ray 381 1.21 %) 1 32 824 1.27 that a time period without verified X-ray is a true radiation free period if there is verift,e4 X-ray reported prior to it,
{
one sea estimate that at least 28.6% of the control had such testimony, I examined the time of exposure for males in the
.an X-rty free period. About Ibf of the males, and 18% of the 31 to W year age group. In this group, 53% of the esses j females reported X-ray exposure in all three time periods. This reported exposure during a the sepend time period, 6-10 yrs.
group clso had the highest R per year exposure rate.
prior to diagnosis. The corresponding male controls reported 1 only 32f in the second time period. While this 1.s not conclusive,
.it is in line with the expected las time between exposure and I .
m: ,
W .
- AnnandiX_Il - 2333h in diaznostie X-zgr Exnosuret Glinical manifestetton cf diseass. I cleo noted that th:re was '
a higher percentage of former military personnel among the For completeness, I as adding a short appendiz gittag ceses between 35 and W years, than among the corresponding information on the basis trends in the use of medical X-ray ags group of male sentrols. In view of W present search for since the completion of the Tri-state Leukemia Survey. giace cilitary personnel lavolved in nuclear weapon testing, this this information is generally available through the Department e mle be an important find. These rather nebulous clues have ,
not been followed up partly because not all of the information my presentation. The body of my test 1aony dealt with my contataed in the Tri-state Data is coded and on tape, and own experience and analysis, asul this could not be gotten partly because of administrative limitations on ecsess to the from any other source at this time.
data. .
Table 23 gives the skin dose (aR in air at skin entrance),
The Tri-state Data has the potential of answering most and bone marrov' dose (arad) for cocaon diagnostic X-ray sf the questions presently being debated relative to exposures Procedures. Except for spinal and some abdominal X-ray to low lovel radiation. I refer primarily to the threshhold procedures, these esposures are within present guidelines hypothesis, the shape of the dose-response curve at low levels, for exposure of the public to ionishg radiation. Such and the relationship between dose and dose rate. In order to guidelines, while not applying to the medical use of X-ray, do this a complete re-coding and processing of the data is have certainly affected people's concept of " safe".
aanda tory. While the present retrievable inforantion on site in declaring these doses " unsafe", I as also claiming af X-ray is in four categories: chest, abdomen, extremities, that routine emaissions from auclear industries are unsafe and Ether (dental), the informatica available gives exact site. for people. The probles of worker exposure is, of course, With respect to chronic diseases discussed la the testimony, .even greater.
tho date'of diagnosis for each is given in the file folder, but is not available on tape. The same is true for each X-ray procedures, the rate of X-ray swaminations per 100 persons v:rified X-ray. The sequence of these events is of the utmost has increased. Table 24 shows the increases per type of taportanee la attempting any further analysis of this data.
- examination,and Table 25 the increase for each age and sex 2 would also suggest that more than one researcher be . grouping. The number of plates used for each examination desigasted to analyse this data. The broadest and most creative adds to the arposure probles, and Table 26 gives an estimate cyproaches are me.eded, and this means cooperation and sharing of bone marrow dose per examination, rather than per plate.
af i=1ghts, rather than professional competition.
~
134 r 135 Tablo 23 -
,[
' a.
" o* * . " . . . . e. . .........
Estimated Skin and Bone Harrow Dose From Diat*.nostle X-ray ",
,,,d h d4 fid AA 4 444444444 Body Area skin Dose in aR Bone Warrow Dose Average per film per film in arad (1970) I }m.g ** *aang****
en** et
- 1960 1970 g ee ** a . ee e eddeceae.
i n
... m ee, m 3 u.8 - 0 1 . .e _e.e .. . .. ..e_
3 1 j 44 f4dd 44 J 4444d4444 spina 1265 980- 10.8 - 65 7 ; ., .
Chest 45 W 0 75 - 6(8'2 g I ,, . . , , , , , , .... . ..
Abdomen 790 960 8 5 200.6 -
d P;1vis 610 5 x 829 7 93 -296.46. *
(to fetus) 13 3 == a nge, **
- ende* gent 3y a =J g,. . . == = =adeemeen f.73 - 53 68 , 4 g ,
Limbs 117 100 0.17 - 1.2 ) - I .. . . . . , .. . .... .. , ,
Dentti 1138 910 0.65 - 2.W "l *
.* 11 1 .
~.
.9 yaf
-- u... . . .-......a .,
De*.o in the above table was compiled free y AA find sa A 4A4A44444 ' '
/
' Population Exposures to I-ray U.S.190'e' - - <
' Population Exposure to K-ray U.S. 1970* DHElf Publ. (FDA) 73-8047 ,
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" Organ Doses in Diagnostic Radiology
- Dl1EW E I j g Publ. (FDA) 76-8030 g 3
- The Mean Active Bone Marrow Dose to the Adult 3 3 4 Population of the U.S. from Diagnostic Radiology
- l Jg 41,{1, I',8 ,, gj 2
[
DNai Publ. (FDA) 77-8013 .$ g gg 3
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References:
ex xination can be expected to significantly reduce the 'The Mean Active Bone
- 1. DHEW Publication (FDA) 77-8013 czposure rate for the individual. The common practice ,
Marrow Dose to the Adult Population of the United States from Diagnostie Radiology." Table 6, pp 19-20 (1964 in crdinary photography of taking an e$t'r a picture in case estimates) .
th2 first picture does not prove' satisfactory, should 2. DHEW Publication. " Population Exposure to X-rey United
. States 1964". Appendix B.
ney r become an X-ray policy! Trained, licensed X-ray Gibson,R.: Grahaui,8 3 Lilienfeld, A. et.al. " Irradiation 3
tsthnicians can reduce the number of repeat X-rays needed. in the Epidemiology of Leukemia among Adults.' Journal
~ Nat. Cancer Inst. 48:23 301-311. -
The impact of insurance, medicare and medicaid on 4. Y1adena,53/Bross,I.D.J. "Use of Medieel History'to" X-ray policy needs also to be investigated. Research grants Predict the Future Occurtence of Leukeatas in Adcits."
Preventive Medicine 3, 165-170 (1974).
- inusiving X-ray techniques used on a-symptomatic persons, Berte11,R.
5 "X-ray Exposure and premature Agin9: 379-391 (1977)g.'
er en diseased persons whose treatment cannot be improved Journal of Surgical,0ncology by further X-ray information, need scrutiny. 6. DHEW Publication No. (HRA) 77-1457. "Statisties needed for Determining the Effects of the Divironment on Health.'
A whole generation of Americans have been told wrontly th*.t low level radiation is not a health hasards, and all af the subsequent wrong decisions which have been made on the basis of this wrong information now need to be rever, sed.
Th3 place to begin this reversal is with medical X-ray, but this is by no scans tl.3 eradication of the problest , ,
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