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Responds to Expressing Concern Re Health Effects of Nuclear Power.Nrc & State & Local Govts Have Improved Response Mechanisms Around Nuclear Power Plants.Info Re Health Effects from Radiation Encl
	ML20126F590
Person / Time
Site:	Crane
Issue date:	03/11/1981
From:	Harold Denton; Office of Nuclear Reactor Regulation
To:	Sinclair M; AFFILIATION NOT ASSIGNED
References
	NUDOCS 8103181098
	Download: ML20126F590 (54)
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{{#Wiki_filter:j Q 37 .JL f\\ g + ecic ( b + MAR 1 I 1981 El ^' N ' J "s. Pary Sinclair 5711 Summerset Drive idland, Michigan 4P640 s

Dear Ms. Sinclair:

I am writing in response to your letter of February 6,1981 to Chairman Ahea rne. Dr. Gotchy is a well known and respected professional in the national community of individuals who are called upon to evaluate the risks associated with energy production. His talk at the annual neeting of American Associa-tion for the Advancement of Science was well received, and I am sorry to learn of your reaction that it was a whitewash of the risks of nuclear power. His analyses have been reviewed by his peers and occasionally challenged in adjudi-catory proceedings and have been improved by and withstood the implications of those challenges. With agard to risks of radiation and radioactivity, much nore is known than for risks associated with other potential pollutants, so that analyses such as Dr. Gotchy's can be carried out with relative accuracy and authenticity. To put his reported results in perspective, I'm enclosing recent sunmaries of comparative risks from the Congressional Research Service of the Library of Congress and the Health rad Safety Executive for the United Kingdom. You are concerned that Dr. Gotchy did not mention plutonium. However, plu-tonium is in the source term for releases from reprocessing plants and the radiological impact or risk of plutonium is therefore included in the risk analysis of his paper as part of reprocessing risks. You also characterize the conparison of Three Mile Island doses with Denver doses as misleading. Only inplant and effluent monitors at Three Mile Island were " going off scale." It is accurate to compare the doses that the people off site nearest to m plant received during the course of the accident with the increase in anam background dose that people get by living at the high altitude of Denver because the doses were about equivalent. Although potassium iodide was considered for distribution at TMI when it was feared that radioactive iodine might be a major release from the plant, the actual radioiodine release was very small and potassium iodide distribution would not have significantly changed the collective doses to the thyroids of people in the area. The enclosed report, " Population Dose and Health Impact of the Accident at the Three Mile Island Nuclear Station," NUREG-0558, describes the actual doses from the accident. We have read tha material you enclosed with your letter. Much has been done by NRC and by state and local governments to improve response mechanisms in the areas around all nuclear power plants and to conduct exercises to test i such mechanisms. This includes a thorough examination of the potassium iodide i stocking issue. Health effects studies have been followed up, and as can be I 8103180 8784

6 1-A. Jr.--u 4 1-u is "arv sinclair i 1 seen'from the attached paper from the U.C. Cer,ter for Disease Control rega,-ding neonatal hypothyroidism in Pennsylvania, have not shown a real-increase 'in-health effects around nuclear plants. The NRC has investigated many accusati ns-that there are adverse health ef fects in the vicinity of nuclear facilities and found them unsubstantiated by the medical. evidence. I cannot respond to'your notations on enclosures to your letter or Dr. PacLeod's charge that health o effects data has been withheld or falsified. However, I can assure-you that many of the recommendations made in' his paper have in fact been implemented i even before the preparation of his paper. 1 For.your further information, I've enclosed a copy of an article by Dr. Bernard. j Cohen who is on the staff of the University of Pittsburgh, as is Dr. MacLeod. Dr. Cohen has summarized very completely the carcer risk from low-level radiation. j I've also enclosed Dr. Fabrikant's recent. article on the health effects of the TMI accident. In closing, should you like to more fully evaluate Dr. Gotchy's estimates of the health risks of the nuclear fuel, cycle, the details of his assessment will be included as a chapter in the AAAS Symposium Series entitled i " Health Risk Associated with Energy Technology," schedultd for publication later this year. Sincerely, 9that Signed by l w 5,a.m ntes c Harold R. Denton, Director 1 Office of Nuclear Reactor Regulation

Enclosures:

1. Summaries frm Congressional Service, Library of Congress and Health and Safety Executive for the United Kingdom f 2. Paper on Neonatal Hypothyroidism in Southeastern Pennsylvania 3. Paper on the Cancer Risk frm Low-Level Radiation 4 ' Paper on the Health Effects of the Nuclear Accident at TMI t 5. NUREG-0558 cc: Chairman Hendrie Commissioner Gilinsky Commissioner Bradford Commissioner Ahearne Senator Don Riegle Senator Carl Levin Congressman Don Albosta P J 4..,.w., .<ne.-..- ,--<~~ --ec --c. m+.me-- e,owy, emes....+,.,-,m.-,-.<v,w.-m.wm.,e.er m u,,.w.m,s..r ..w w.w,,v w .m- .w

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/ 1 l ) A E..'. U Li Y.iii 1:1 hK ES!1:iTES Table 3 f llurtrates t. r;fc y :nd hc.lth deita on the risks associste d with i coal c.nd nuclear power pl-t s as J.arr{ hed in l' art B cf this report.*

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.acbers have been scaled shcrever. cccsary to indicate the h ealth risks that are expected to be associated with the eperation ofa 1000 esswatt \\ power station operating for one year at a load factor of 0 75 j For a coal co bustion plant of that size as typically equipped today, the "most proba ble " es ticat es of the total death risks rar.ge f rom about 25 to 257 fatalities per year of operatinn of an existing plant, or frne about 5 to 137 fatalities per year of operation ci a new plant, most of them aeong the general public as a result of emir,s tons of sulfur dioxide and particulates. The incidence of chronic and acute health problems a eng the cencral public is also expected to be high as a result of coal combustion at the generating plant. Apa rt from p._ ant emissions, deaths can be expected among the general public fr om two associated activities. The processing of the coal-1.e., the cleaning, crushing, and washing of t he coal, which is usually donc in t he vi cinity of the mine- =ay cause a nunber of deaths through local air pollut f on; and there may be about two deat hs resulting f rom highway accidents invniving private hauling trains. autos and coal-Occupational health risks associated with the op eration of a 1000 megawatt coal plant for a year may be substantially less than the risks to the general public. If the coal'is mined underground, one miner will die f rom accidental causes and as many as 3 5 may die on the average 4 Data in this table are from the references cited i l report. Sources used cost n part B of the The Direct Uce of Coal,- (2)orten ively were (1) the OTA report \\ !.? C r e ;..r t entitled in i:h ht arive document 3-M I 2 (9 L::.t'EG-0332 revised, as re;;rt ed (4), u:.-l.00. (see ref.r-m (*TSIC-0002, vol. 3). 11 - f 2. :i ' te entries.)

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l on the average, contract pneur.aconf oris per year of plant operati:.. ...e t i i.;r e s wi!! b2 Ic.er if the coal is rined. en the surf ace; a ciner :ay./!4 r"y e. ire four years, and a case of pneunoconinsis ray be contracted 'caly cycry t o years of plant operation. Another occupational health hazard is tha t:ansp:rta-tion of coal, where there may be a death as of ten as ev-ary two and one-half years of plant operation in moving the coal for one such generating plant'. ) ,) The health risks associated with the operation of a 1,000 megawatt nucicar 1 J pla nt are lover, if the estimates are reliable. Apart from the. possibility of nucicar accidents, estf eates imlicate that, among the general public, one person may die f or every ten yearr, of plant operation as a result of the gases released from mine tailings; and possibly one person might die for ea:h' year of plant operation as a resuit of rises released from mill tailings. Cperation l of the power plant itself has not teen estimated to be as large a hazard as the mining and milling tailings piles: approximately one death for every 50 years of plant operation anong the general public, according to;14 test \\ ~ estimates. The number of deaths through occupational hazards involving i I radioactivity is approximately equal to the number of deaths among the general [. public, though the sources of radiation exposure are different. The largest ~ i occupational risk from radioactivity is in the opgration of the generating plant j i itself, where one worker. may die f or every 16 years of plant operation. A slightly ' lower risk is associated with mining of the uranium. Occupation accidents (nct involving radiation) may cost about one life every five years of plant operation from mining, one life every five years of plant operation from fuel processing ' activities, and will cause aboot seven injuries f rom all activities related 4 a to the nuclear fuel cycle for each year of plant operation. l l l 1 I 1 i .J

-~.. l .t ? rs :. tat concern act rei..t 4. i ti. nucle:r pl:r.tr is, ef' t , t.... t of an accident.i n whi c h a 1.i r re ..n eu r, t of radiatien is.reless:4. .i ! !1c a number of studies have agreed that the methodology that has been w loped for a=serrir.g the risks of nucit ar accidents is appropriate ir. 't a principle, there is general agreemer.t that the results esiculated in the ~ one comprehensive ef fort conducted to date to deter =ine those risks are not reliable. The charge of unreliability does not icply that they are necessarily too high or too low in value, but rather that there is as [ y et no way, on the basis of detailed analysis, to determine the range of uncertainty in the figures. In other words, the results that were calculated may well lie within an appropriate range of values, but no i cae knows how wide the total range should he to depict accurately the r taxinum and minimum numbers of deaths, or illnesses, to be expected. Table 3 lists an upper value for the "most probable" average annual death rate to be expected f rom accidents associated with a year's operation of a 1000 megawatt power plant as 2.4, in agreement with the estimate of the Union of Concerned Scientists, and cites the calculated value of 0.02 from WASH-1400 as the lower "most probable" value.. This would pro-duce a naximum "most probable" estimate of the total average annual mortal-ity risk associated with a year's operation of a 1,000 MW nuclear plant (normal operations plus accidents) of about f our deaths, and a minimum "most probable" estimate of the total average annual mortality risk of about two deaths per year of plant operation. (" Ext reme =* values are sum-E eari ed in footnote I of the table). As noted throughout the discussion in this report, the risk figures rela:Ing to this entire subject area are uncertain. In some areas, as indi-cated by the shaded regions of table 3, the unrettainties are large enough i t ^"

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cf r.tcrini on the rubject of the risks and i: pacts assccicted with coal ec:burtior. and with nuclear energy is voluminous. While recent najor studies by groups c: scisntific and technical experts, both in end out of the Gov-crnment, are represented hcre with care, there has been no way to independently critique or evaluate alternative viewpoints by individuals-particularly by those cost strongly opposed to nuclear power. Even so, there are broad ranges of uncertainty in the data for both coal and nuclear power that merit e xam i na t ion. .i As stated in the text, the data on occupational health risks are based on health and accident records, occupational radiation dose recorJs or radia-tion dose regulations plus careful scientific analysis to determine the effects of low 1cvel radiation. The uncertainty in this information is rela-tively 5=all. and though there are points which could be argued, those who have attempted to assess the relative risks of coal and nuclear power plants have seemed to feel that other areas of uncertainty are more significant. It there-fore seems reasonable to regard these' statistics as fairly reliable. Similarly, i I the estimates of injuries and f atalities incurred in the transportation of coal and new nuclear fuel (the transportation of spent nuclear fuel is included in tab'le 3 under " waste disposal") are based on actual records lof performance and are therefore fairly reliable. The health risks to the general public f rom the normal operation of nuclear plants, including mining and fuel fabrication, have attracted considerable public concern. As outlined in this report, the calculations-leading to these f risk predictions are extremely complicated and are certain to contain errors. 2 4 = een== e i ep +4 e se e em -,.. mes e s. g a e-o,e .-g-- a sp-erv s

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r ( in tr.e The c,uertion is si etr.ur in se errc rs crc lii vly to be sier.ificant overall assessment of the relative risks of coal and nuclear energy. The references cited in Iart b diruct attention to other questitt.s as. icing of euch greater significance to this and at least the t. ext 3L, generations - of cankind--though there are dif f erences of opinion about whether, and how, time scale..For instance, the latest projections should be made beyond that calculations by the Nuclear Regulatory Commission of the mortality risks to the general public f rom the total' nuclear fuel cycle provided in la' REG-0332, include and correct the figures provided in GESMO and extend the

revised, analysis to include estiestes of the effects rf carbon-14 and radon e:issions 1000 years. They predi:t to this and future generations of tankind over the next the mortality risk exclusive of accidents f or each year' of operation of a to be 1.3 deaths among the general public at maxi =um, the einizac-nucicar plant i

Comparing this with the figure of about 2 deaths a ong I being 0.2 deaths. the general public which are much more certain to occur, on the average,' each i year from the rail transportation of coal for a distance of 300 miles to a, similar sized coal-fired plant, it is difficult to conclude from the sagnitudes of risk currently predicted, even with acknowledged uncertainties in the calca-i lations, that the health effects of the fueling and normal operation of nuclear power plants are likely to be a decisive factor in assessing the relative =erits i of coal and nuclear power. ) are most significant 1 Clearly, the safety and health uncertainties that 1 f to any assessment of the relative risks of coal and nuclear power are 1) the-health effects of the solid and gaseous combustion products of coal (plus l those that might be' implied if the hypothetical Greenhouse Effect co es to i In both cases, be substantiated), and 2) the effects of nuclear accidents. J of incse health tnpiets are large and very uncertain, 22:nic; 3 rr-!! rt ions l

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Consider firrt t he e 9 - cf con 1 r-farien r titlity rir". 7:ble *.. er ** 58 of this report, ;.recent - figures on coal cr.f r ri:ns ef fret s f rc: a :ational '[ r Acade=y of Scie.:es report, stating that. they could be !.i ;h by a factor of ten or low by a factor of two. Thus a renotely located plant (10001:N at 0.75 load factor) might produce as few as 2.2 deaths per year, or as =any as 44 deaths per year. (The rerote plant was hypothetically located 230 miles: up-wind f rom New York City.) A plant located in the vicinity of an urban area would produce b: tween 6.7 and 134 deaths annually. Howcver, the cuoted figures of 22 and 67 deaths annually were scaled to 1000 r.! plant size f rom figures I co puted to be the " cost probable" values by those who did the analysis, and _a' thus the figure of 22 deaths is entered as a lower "most probable" value in I the gpropriate place in table 3 and was e= ployed in the calculations used in this report. The upper "most probable" estimate provided in table 3 for 1 deaths among the pneral public from a 1000 KJ power plant was derived f rom es a study perf ormed by Brookhaven National Laboratory and calculated in the manner described on page 56 of this report. The Brookhaven study is highly j 'I sr statistical in its basic design, and calculates the probabilities of numbers .) its of morta11 ties over a range extending from zero mortalities to four times ) the number of mortalities found to be most likely to occur. While that study found that, for an existing plant, there was about 10 percent. probability of having zero mortality, and an equal probability of a mortality greater than 920, the "most probable" nueber predicted by the model was 240 deaths i to be expected f rom emissions f rom a 1000 r4 coal' plant for each year of operation. This figure of 240 is approxie:ately at the 50th percentile level: there is a 50 percent chance that the proper re ult should he less than OIC deaths l l ,. -. ~. _. ~......

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toe ::,urc, c: .-0 c;; :fted er + upper limit of the ran,e of :ast probable" values f or the average annual desth rate to be expected frc: an ext:. ting plent. As noted on page 57 of this repert, these results have been severely critici:ed. Presutably future studies will )., either validate or discredit this high figure, but fcr the present it would appear to reflect the most probabic upper value, and 22 the cost probably lower value, among a range of possible values that extends in the extreme from zero to 920 deaths per year as determined by two different and independent analyses. i Any health and safety impacts of nitrogen oxide and carbon dioxide e:lssions 'i that may exist have not been, and cannot be, esti=ated in present calculations. As noted in earlier sections, emissions of a coal plant meeting new source t' 6tandards might be expected to' cause f rom 4.4 to 120 deaths annually, with'un-certainties ranging' f rom perhaps zero to 480. 'For reference,'the recent CONAES rir,k study calculated emission deaths of 40 and 209 per plant year, depending on the method of analysis use. However, as outlined in Part B, all recent studies have' raised questions about the magnitude of health effecca to be expected from coal emissions, and some reports have questioned the existence of those effects at current pollution levels. The. uncertainties in estimates of the risk of nuclear power reactor acci-dents are equally great. According to the National Academy of Sciences litera-ture review entitled Risks Associated with Nuclear Power, our experience to date with reactor accidents (i.e., the total lack of accidents prior to the publication of the report) permits statistical inferences to be drawn about the 'possible maximum average numbers of cancer deaths per year to be expected from nuclear accidents.* The report provides estimates on,the basis of two .a different assumptions. t

1t should be noted that the radiation released by the accident at tree 4

M13c Island appears, on the basis of entrent i t.f orma t ion, to be in keeping vi:h t he pr dictions of".'AS11-1400 in t i rn tirin., of occurrence and reverity, I e

I j i i i .rsef:;r: :t. r.. s t r., ; r ;.. 1;;. .c c: nc ccrrce 1;. ;redicted the ,r;, c.ca s c_..-.c o r r f s.: ch s i: e of trelet e, t h. n t he absence cf accidents 'in 200 . rt ~ct:r,.;:rs vocid predict en avtr.c6 di th rate per plant of less than sbout l 1.1 par year, a cording to' this Academy re port. -On the.other hand, if it is. l Ver assumed that the lack of a major accident to date can only imply a maxicum ] o likelihood of the worst possible accident, but that the effects of releases of given ascunts of radioactivity have bee n calculated correctly in WASH-1400, i es. then the average death rate that cicht be inf erred f rom the absence of a celtdewn - ns. In OVU react;r years might be as great as 23 per plant year, according to ' the r r:rt. :;ow that 500 reactor ywars h..vc passed.without a celtdown, this n-caxf rue esti.ste would currently. bb about 9.2 deaths per plant year. (See cam- .E S ments relating to the resonabilities of the " worst-accident" assumption on

on page 100.) ~his figure is a taxisum uppur value, so ewhat co: parabia to'the I

fes ext reme ' upper estimates of coal emission health ' effects. Both cust be accepted. rom as indicating the extreme upper end of a possible range.of values. ' Since this

ts number was calculated on the basis' of the operating history of the nuclear power industry, it will diminish with each passing year in which no core meltdown occurs. The numbers just sta:cd are claimed'to be at a 63% confidence level.

a-A 95: confidence Icvel would require that they be three times larger. The findings of two other. major studies of nuclear power risks deserve ~ One is ' hat of the Union of Concerned particular attention in this review. t Scientists, which the NAS report describes as "the cost comprehensive and specific" of the cucaents that have been m:sde about VAS1!-140u,"by groups op-posed to the expansion of nuc3 car power production." The calculations of the r i UCS predicted an average, of 2.4 cancer deaths per plant year as being probable. The til.s r Ltudy is the " Ford-:!! DI" study, which stated, "In the v.-w--y.,- e<r. -y +., e- .,.aneed--+ e + w ,-w+----.ivav-U, r.,,, - .*~,*,e ,,,,w-ur,w, 4

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.c.:. u.: F.s: plant." (p. 241) On the other hand, in an adja:e.t sentence, the Ford-2 1!PI study said that t h e ',.'.S H-l a bo t s t i m i t e s .c::'c e.en te en the hi;h side as well." Thus it would seem that the maximum range of uncertainty in the predic-tions of the mortality risks of nuclear power extend is very broad: a total range of uncertainty in extreme estimates of nuclear risks are roughly equivalent to the range of uncertainty in extreme coal emission health risk esti=ates. These two ranges of uncertainty in ext reme risk esticates are not overlapping, however, except that the upper end (t he larger values) of the range of nuclear plant risks overlaps the lower end (t he smaller values) of the range of coal plant risks. Under these uncertain circumstances, which apply to both the coal and nuclear fuel cycles, a reasonable procedure would seem to be to limit con-sideration to those estimates that are regarded as probsble, rather than to those which are the most extreme possible. The general view and approach of this report are wes! summarized in the overview discussion presented in the recent CONAES study on pages 74 and 75. It reads as follows: The routine risks of nuclear power include the induction of cancer and genetic ef fects by ionizing radiation released throughout the nuclear encrcy cycle. These risks are very small in comparison to the overall incidence of cancer and genetic ef fects in the general population, and they could be significantly smaller yet if the most important source of radiation in the nuclear energy cycle-uranium mill tailings-- were generally better protected. There are also risks of severe accidents, whose prohibilities have been estimated with a great deal of uncertainty,, but whose severities could be comparable to those of large dam f ailures and liquefied natural gas storage system fires. There are also risks from the disposal of radioactive waste; these are less than those of the ofher parts of the nuclear energy cycle, but only if ap, repriate action is taken to f f nd suit able long-terr-J: to al sites and cethods. 3

- -.~ - i l i l l .m . u. a g hs, i.<.. r :- r. : : e-c r t.: n. ' i. :i ;h age, zign -:e ;ttri:,;tc:;e, ;, . s. cu " 1 1 cast Ar. p rt, to coal e,isslun., and that this fraction ay be lar;e then l eight ctr.crwisv be' in::ediately evident. Certainly the pr6-existing conditicns for pneu:snis, heart disease, ar?d so f orth' can take yests to develop, so { coal c=issions might play a cont ributory role. Thus it does not see: possible' to obtain agrececnt that coal emissions can'be clearly eli inated as a cen-' tributing f actor for deaths f rom those diseases in middle age and later. (Those who die f rom air pollution emergencies, of course would seem to be those who are infirm. On the other hand, coal e issions cay have centributed to soc;e of those infirmitics.) For the present, this question see=s to need much more study to understand the ef fects of both chronic and acute exposures to coal e:Issions. Though the following calculations would not see: to deserve great credence on the basis of current knowledge about the. health risks of either coal or nucicar plants, it seems appropriate to note for completeness 5 that the Nuclear Regulatory Commission reported the following average life-shortening for those exposed to the emissions of a 1000 :N coal or nuclear power plant, including all phases of the ' nuclear fuel cycle. The a"erage person's life-shortening due to a nuclear plant was predicted to be less than U.5 seconds per person, while the average life shorteoing due to a coal plant was predicted to be f rom 160 to 270 seconds per person from emissions, though it must be pointe) out that many more people are affected by the nue)2ar plant than the coal plant because of the differences in the two technologies. These data can be fcund in the ;iRC hearings on the Pebble Springs licensing action, Docket 50-514 and Docket 50-515, held on r June 8,1978 in Portland, Oregon. It must be erphasized that these predic-t ions should be riegard d.n hi r.b l y conjectural. L ,y yaL e%g.a-aa u+,wt-y ei b-gr e e e-a m ww fy"gr n+-e-w+---*-ee-e*'hv."- w er w'i'e'-'Pe#8 W Hae '.-7 4-V'#' 8* -#dE

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s .f..- e J. w. +... se - . of P.. .:[.i;.a.n .g(, g ,. g, 4 v r.eren: ,j W ater Re.,e;or or g g, uunsed no reason to .t... o N i ; apprr h mosth refer to the preNater F.eactor, thoug ent Mems i,... s,. some judgem his imphe3h n run rogethercompared t dly ddrerent For a specineins ai g m ih9mpm4.e fmdt the Boiling bcline that the conclu-ion

i s no-s: - rather t a ar e pos.iblelite nci.Me effects tpara would16arte

.u :ng the.- f ie. Su pee:... ; non..:n.mi nuelcai vr otherwise.th snormalstriet scrutiny be or r lo ' 1Ii so 1 ewmpsn from is gi.cn. to the bdiefs of sect o i ns unfd not be tywed. nnonar alternative 'for sv3 safety clearance 94 The conclusionis contraryis that only rec beyond prototype stage,orre too speculathe for h L estimates for onconu be consi-of the public.One reasontallations come to consider not yot para 12): Most of this note h employed toBut there is also evid whieh hae safety of non-nuclear ins a rgy conscrsation 9 tems. d neric dered with the same approacnuclea estimates,inbroad an ge k as aparisons to be drawn ( f the public perceive nuclear ris s n terms.of the risks of the three' con-3 h n the estimates of experts d nuclear,11 e .reforecompar s ht h e sprems - coal oil,anf whichisforeignbut,with ptical(paras 84-87).andt aev that some sections obeing signincantly high

her than speci e doubt the

_niionar alternatraws on espenence much owat,we have no reason to of uhich they may be scedifferent secti i i likely of such risksin dilTerent uay tionalexperience she pr 'ae obvious ea espressed as uons.

eneral conclu of marginaleffectsare 95 Only long and safe operamajority of the public t only be an ou Risks of entire >ptems c nsk of a decision to merall as erages. but e-timates convince the 87).

gthe must be taken tosafety is achievabic(para to more ppropriale for as-essm Care s marginal. Comparisons (parai ks indi. d 7.15L add to a spiem traras 6 a made of the quanti 6able r sof precision. the range o distinguish' aserage from f expert e For some I 14-54)can Ihen be cating the broad degreeremainingareas fignoranc.as to callin ques-I o is soimprecise igni6cance. { view, and the risks the quantineationted figures have any s tion whether the quo well understood oftenless The exis. ding nuclear risks (para 73).i ude.of some f the allege 91 Non nuclear risks are d non-o than the correspon l andin some nding teace let alone magn tnuclear risks is questionab e, minority.But g a d tained by cnly a (para 74)is needed of:f upper andlower limits to allege (a) the significance ochton;c sulphur effects;l ar waste effects,for whic t h here (b) long term non-nuc eis no evidence at present;rds associated with i (c) he potentialmajorhaaaverage risks of a system, / I non.nudcar plant: h marginal change. (d) the distinction betseenand the risk associated w discussed in paras 75-77.f haurd,whether in. 92 The quantir able risks areNone of the three systemsi otentialfor majorincident. estincident could norm.d operation.or in pFor coal burning systems, the larg For the other two ystemsll risk of involving s h cause hundreds of deat s. ii whole, there is a smad of deaths lleeau-e f the l m - o espres the ne a exh t.de it i benes tohtalh e termC up to isn-of thousan -

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S-I 6, 't - e 4 e t I t e s IetJe AI Fuelcairauton I a.enated annual conseqtsences to occupational aata;--4 health steen by the sartous studies for the estracteun. pniccuing and fabocation of fuel reyment l'*** M Me) stataon meerking al 75% load Cent OJ Nsateur Accidental Accidental Pneumoconiosis Pm.. u;.c s Acciden al Acredental Accidental Accidental Can(er 4 deaths ingenes** deaths! camt deaths injueses" deaths injunes" ham ldcaths) il5C Report 1.05 ~1 0 23 0075 i Norwegian 2.13 125 0 17 47 005-02 10-100 Swednh I.6 394 (4-20) 20 44 0.22 26 0 051 16 2 0 nr n wstttt 2t9 (21-56) 73 (56 or incre) inhaber 0.53-1.13 30-52.5 0 -2.6 041-062 0.11-1.28 11.3-90 006-043 2 55-12 n 16. 0 4 5 5 IHEV-8 & REV-3) (93) 05) 1% WA5tl 1224 0.9B 40$(60) 06 0 18 10 5 0 tr85 51 + remar & Suan"" 047-103 24 6-52 0-3.5 0 6-48 0 1-l.21 105at 0 0E 0 4 24 11 3 8101s n.s t l~.egnani & Maccia 1.05 1019 0-16 0 08 1i imeleon () 0.75 52 002-046*** 0 58-1.15* " .11.4 0 12 27 ei n' o 16 Is t se i s ll.rnsiton (i2) 0 24 3 3 (50) 0-7 20.5-27 l.12 74 0 25 lu 6 net its NRC(2*)? O l-0 66 4-40 I Ittack 4 Mehaus 0.50-0.55 2300 days 0 07 0.29 1920 days 0 07t t 14 t ilapt t tiewit u nl4 Rannayfti 0 33-0.99 66-132 3.3 007-023 IF 21 . p u? n i t Rente 0.33-2.13 24 6-1039 0-7* 0 41-48 0.1-1.28 4.7-90 005-043 I-27 0015 04s i

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~ u m. m m. .u. g/ f u n b. rm. i w wmm ( - The Record DATE February 28, 1980 t [ s. ' C. T.OM g k f N 3 !>BJECT: - Neonatal Hypothyroidism in Southeastern Pennsylvania x, The Chronic Diseases Division of CDC learned of a potentially unusual scattering of cases of. neonatal hypothyroidism in 3 counties'in southeast Pennsylvania. Information from the Pennsylvania Department of Health (Dr. Evelyn Bodin) and dosimetry data from the Nuclear Regulatory Commission reveals the following: Children born with thyroid defects were discovered through the normal operation of a neonatal metabolic screening program that has been operating since July 1978. These defects resulted in diagnoses of hypothyroidism. Although baseline incidence data on hypothyroidism are not available for Pennsylvania, the number of cases detected statewide in 1979 -.is no more than expected, b'ased on. previous studies in the United States and Canada, according to Dr. Evelyn' Bodin of the Pennsylvania De'partment of Health, .(... who heads,up the' screening program.- The purpose of the neonatal screening program is to. find' newborns with meta-bolic defects such'as phenylketonurea 'and ' hypothyroidism early enough af ter birth to prevent severe mental retardation. Several states, including New York, New Jersey and Maryland have similar programs. Hypothyroidism is detected in the program by looking for depressed levels of thyroid hormone and elevated levels of thyroid stimulating hormone in the infant's blood. Confirmation is done by thyroid scan. The thyroid scan can determine whether the hypothyroidism is due to the absence of a gland,. difficulty with hormone ' synthesis or'relea'se, or aisplacement of the gland from its normal: position. Sometimes, however, confirmatory studies are not done or not reported to the'. health department, resulting 1n the classification of the cause as " unknown ~ on.' scan." According to Dr. Bodin, the fourteen cases of hypothyroidism are - classified as follows: r M Lancaster County (7 cases) C.3 @j One was a case of severe multiple brain abnormalities. This child was born 3 months'af ter the accident,' therefore, all of. these defects would have come ' about prior to the radiation release, by at least 13 weeks. +;jl pj Two were cases of dysgenesis, i.e., the thyroids'were displaced from their j normal position. - One of these was from a pair of twins in an Amish family-the twins were discordant with regard to thyroid disease, therefore, non-supportive of etiology secondary to radiation exposure. S -,e .e. ..d.=ne. s.s---- eps.e +..c.,m-w., - - -.... - ,ee,a., rr ->cw.,mv- .-r+.'+ s -m.-,.u, ,..w,.,,wy ,.,m..c., ,,.--et-

~ / 2 (- One was a case of dyshormonogeneris, i.e., it is familial and inf.erited as an autosomal recessive. This case is in an Amish family with a.. probable high degree? of consanguinity. It is likely not to be related to radiation. e Three were " unknown on scan" (One of these occurred in January 1979, before the accident.) These patients were begun o'n the'ra'py without a scan. Bucks County (4 cases)_ e 3 were " unknown on scan". These cases were also begun on therapy 'without scan.- \\. 1 was a case of dysgenesis, i.e. displaced from its normal position. Lehigh County (3 cases) 1 was " unknown on scan". This patient was begun on therapy before a scan. 2 cases were twins who had no thyroids Except for those cases that were " unknown on scan", these types of anomalies are not expected to result from direct or indirect exposure of the fetus to radio-iodine.~ Lehigh and Bucks Counties are not adjacent to Dauphin County (where THI is located) and Lancaster County is southeast of the site. The Washington Post article reports -( that local groups c~ontend that " insufficient monitors were in place or not operat-ing at the time of the accident" and 'that " wind currents might have carried radioactive particles over nearby monitors and deposited them in faraway areas." This kind of reasoning would be necessary to explain the pattern of the reported excess incident. However, it should be noted that estimates of the radiciodine releases are not subje.ct to.the same' degree,o,f uncertainty that is associated - with the quantity of the noble gas activity release. The anount of radioiodine released has been estimated from the amounts retained on' the affluent particulate and charcoal filters. By analyzing the distribution of radiciodine with depth of the filter, it was possible to estimate the efi'iciency of the filteis and the 7:antity released. Both the NRC staff and Special Investigation Croiip (Rogovin hport) estimated that approximately 15 ctiries of radiciodine -131 were released, the maximum quantity estimated by the Rogovin group was 32 curies. Analysis of effluent air sample cartridges by the licensee gave estimates of 14.1 curies of iodine -131 and 2.6 curies of iodine -133. All estimates are for the period March 26 - April 30, 1979.. The total uncertainty is therefore within a factor of 2. i The maximum airborne iodine concentrations of 120-250 pCi/m *. occurred mid-April 3 in connection with repiccement of the aux 1111ary building charcoal filters. 4 The maximum predicted thyroid dose from inhalation was approximately 20 millirem ** to a child.*** Extensive milk monitoring was performed by EPA, FDA, NRC, the T e 10 CFR Part 20 concentration limit for continuous annual exposure is 100 pCi/m Ih 3

- for the period March 28 - April 30, 1979

(

- - NRC staff panel report to the Commission on Extraordinary Nucicar Occurrence (NUREG-0637), Appendix E, page 30 d

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t ( 3 State, and the licensee. The maximum radiciodine concentration in cow's milk waNpC1/11ter which would have resulted in a thyroid dose to an infant of less than 5 millirem. Higher radiciodine concentrations were observed in goat's milk (41 pC1/ liter and 110 pCi/1). Even though this milk was not used for hu=an consucption, the projected thyroid doses to infants would be, s 5 millirem and approximately 14 millirem, for the 41 and 110 pCi/ liter con, centrations. These values are under the 10 CFR Part 50, Appendix I design objective for normal operatien of 15 millirem per year per reactor unit. \\ Although the uptake physiological parameters for the fetus are not well-defined, a conservative upper bound estimate is that the thyroid dose to a fetus might be as high as 10 times the maternal adult dose. This would give a maxieum thy-roid dose to a fetus of 140 millirem from inhalation plus 50 millirem fron milk ingestion or approximately 200 millirem total fetal thyroid dose. Estimates of the health effects of thyroid irradiation are derived.from studies of persons irradinted for ringworm, Marshallese Islanders exposed *to fresh fallout, and atomic bomb victims. The risk estimate (based on children and teenagers) derived from the t!arshallese data is 175 thyroid cancers per million person-rem. These are from substantial doses, the average thyroid dose being 200 rem. The risk is believed to be higher in younger children. When adjusted for the U.S. population, an average 6 risk of 50-70 thyroid cancers per 10 person-rem would be more appropriate. When ( applied to the doses at Three Mile Island (3300 person-rem total body + 1280 thyroid-rem), approximately 0.27 potential thyroid cancers would be predicted using the population average risk and 0.8 potential cancers using the higher Marshallese risk value for children. Thy oid cancer' can be effectively treated and the fatality rate is less than 10 per cent. . Radioactive iodine Is routinely used.for therapy of hypepthyroidism (over-active thyroid) at do'ses of the order of 1000 rem or more and hypothyroidism is commonly obse*rve'd as a result, Impair'ed thyroid fu' c' tion '(hypothyroidism) has been found to n be prevalent in the exposed Marshallese at doses of about 50 rem (27-95 rem). Based upon a ' conservative upper bound estimated total collective dose at TMI of 4580 person-rem (3300 total body,1100 thyroid-rem from milk and 180 thyroid-rem from inhalation) the expected number of cases of hypothyroidism would be 0.6 (range 0,.1-2.8) based upor. NRC calculations using the Marshallese risk data. Certain factors which need' to be obtained in the case histories (as yet incomplete) include occupational exposure of parents, their ingestion of any $odine-related compounds,- (seafood or water), or dietary habits (vegetarians eating cabbage take in goitrin). Ingesting manganest, selenium, technesium, or any thiocyanates by the mother would also suppress th-thy mid of mother and child. A history of thyroid disorders (as yet unobtained) in a given family would be icportant in ruling out radiation-related hypothyroidism. (

r ' 4 ( Statistically, the ' significance ~ of an excessive number of cases in. all three counties is lacking as summarized in the following table (using Poisson dis tribution): N. County Observed

Expected
P value Lehigh 3

1 .P=0.0803 Eucks 4 1.8 0.1087' Lancaster 7 1.4 0.0006 (3) (1.4)' (0.1665) The expected rate is approximately 1 case of hypothyroidism in 4000 five births (Journal of Pediatrics 94:700, 1979). In Lancaster county only 3 cases can be categorized " observed" as 2 are chronolog-- ically not related to the TMI accident and one in an Amish family probably relates to consanguinity. ' In that case, the p value implies nonsignificance, sven though it would be significant if all seven case are considered. Although these statistics have considered rates based on 12 months (March,1979-March, 1980) they do not support a radiation etiology. The twins of Lehigh Ccunty may only be counted causally as one case if they are identical. One of the 13 cases' mothers was reported to have been on therapy for asthma which ( may have included potassium iodide as an expectorant. The geographical-gerrymandering obviously begs that all southeast Pennsylvania counties be examined. In summary, based on data from Dr. Evelyn Bodin of the Pennsylvania Depretent of Health, dosimetry data from Robert Goldsmith, Ph.D. (NRC) and our own clinical assessment of the genetics, the supporting evidence for radiation-induced hypo-thyroidism is lacking. Gary F. Stein, M.D. Prant. Greenberg, M.D. Cancer Branch Birth Defects Branch Chr'oa.$c Diseases Division Chronic Diseases Division Bureau, of Epidemiology Bureau of Epidemiology 4 ( 4 en-w e w, w #,- --.-.-w .-- - +-,, -,, em---,..=--ww- = .w, e c--,-swwar..*, +cw+.w.-, t. +,we w n wa -e,e e,, 4-----y--4-.g g e.. w s g.-- ogo,- eev..e,--pw,ve,g-y . wig -a

.f-M 3 ./ ENCLOS'JRE 3 1 \\ i ,.,.,_m.~.,,,m,. ,s.-,.. o. .-.... es. ..,~..._u... t I i THE CANCER RISK FROM LOW-LEVEL RADIATION BERNARD L COHEN University of Pittsburgh. Pittsburgh, PA 15260 (Retritvd 14 December 1979; accepted 10 March 1980) l l Abstract-The various lines of evidence that lead to current estimates of the cancer risk from lowdevel radiation are reviewed. It is first shown why it is wry difficult to get direct experimen-tal evidence, so that much reliance is pined on extrapolation of data from high lew! radiatiort De eddence that a linear extrapolation is conservative,it move likely to over. estimate than to under. estimate the risi at low levels is extensinly reviewed. The "new evidence" that has been t claimed to indicate that the linear extrapolation under. estimates effects at low lewis is exam-ined. Complications in deriving risks based on the linearity assumption are considered, and - fmal estimates from various sources are presented. 4 1 bone Cancer (Vs 0.1 expectedt About 1700 U.S. . ErrtcTs 4T n:CH LEvEts AND THE ustantTi Hi rorHEsis women employed during the 1920s in painting y THERE HAW been many situations in which radium on clock and watch dial numerals to

['; l large numbers of people have been exposed t make them self.lummous used their tongues to high levels of radiation, and through studies of put a fine tip on the brush. getting radium into g

them (NAS72; UN77) the health effects of - their bodies; their aserage - bone dose was e,: i [ high level radiation are rather well known. 17.000 rem and 48 of them died of bone cancer Some of these data are summarized m Table 1. (vs 0.4 expectedk Among 4100 U.S. uranium [,; Among the sunivors of the atomic bomb miners exposed to excess levels'of radon gas p attacks on Japan, there were 24.000 people due to poor mine sentilation, the average ex-y who received an average exposure of 130 rem. posure to bronchial surfaces was 4700 rem and

hl and about 120 extra cancers developed among up to 1972 there were 135 lung cancer deaths them up to 1972. There were 15,000 Briush among them vs 16 expected. There have been p

..

patients treated with X-rays for ankylosing several other miner groups which have experi-g spondylitis (arthritts of the spme) with doses enced excess lung cancers, like a group of 800 t. averagmg 370 rem, and they had about 115 Canadian fluorspar miners whose average extra cancers, Over 900 Germans were treated bronchial exposure was 2800 rem. resulting in f 5 for that sarne dise and for bone tuberculosts Si lung cancer deaths vs 2.8 expected. There with mjections of Ra giving an average dose haw been a number of situations in which to the bone of 4400 rem.* and 45 of them got there have been high exposures resulting in 1 something like 10 extra cancers, such as women in a Nova Scotia tuberculosis sanitor. 'For loose discussion as in this section, we use I rad = 10 rem (ICRP59) fer s. particle radiation of ium exposed to excessive X rays in the course j the lung and bone (with radium) of fluoroscopic examinations, U.S. women a 659 j 1 1 l l 1 ._A,e-1 ~ ".* *), . '~.. _ -,, ~.,, y y._

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.f.. m n. THE CAMIR RISK FROM 1.OW LEVEL. RADI ATION

n R

3. g. w Tame i Senerrs af mkamatoon on rust of sancerfrom raLatum t% A57:1 j

n.-- g, .m% q icars after Number As erage g g Type or Cause of esposure Ezresure esposure of dose Cases Cases Cases .~ -;.9*. cancer or X. ray treatenents date conudered subjects tremi observed espected 10* rem 31 gr '. ':S *: a.'. *.. = - A. bombs. Japan 1945 5-25 23.979 130 81 19 7 1.0 .g*,.[# ?*.U.- I.evkemia Spondyhus 1935-54 0 25 14.554 372 32 5.5 09

4....'. J..

Menor hag 2a 1940-40 0-24 2000 IM 6 1.3 I'

c. i. ' f 4 Ra88' intak e 1915-35 11-56 775 17.000 48 04 0 11 j

.. - f." Bone Ra88* treatments 1944-64 4-25 925 4410 45 01: 0 8J Spondyhus 1935-54 6-27 14.654 37: 4 0 63 0.10 i M'.".. *4 M@.' '. M'M A bombs. 3apan 1945 16-25 I:.000 125 26 119 09 k fl 'E-W.lj Breast Ruoroscopy 1940-.49 10-30 243 121 (22) 141 8.4 i "J 1 Masuus 1049 606 200 11 42 60 _J [f ~ [.7 -- or $., M T* ! < tframum mines 1900-63 b50 4146 4680 135 16 0 53 ,'. w "JEs Ruorspar mmes 1935-63 11-33 800 2770 51 18 I6 ?';,M.Y Lung Metal tmnes Ib37 1759 1720 45 16 0 67 h N MLr i.- spcodyhus 1935-54 &:7 14,554 400 $4 Il q i A. bombs. Japan 1945 Ib:5 19.472 133 71 57 0 60 j .. h.Ma. D.

'*# # V, Gastro.

A bombs. Japan 1945 '5 23.979 130 378 X3 0.52 miest Spondybus 1935-54 II 14.554 375 33 34 0 81 1

., J.Q.C,

' $'- ?, J *. ? l*". Q l KV m A-bombs. Japan 1945 & 24 4507 l12 19 19 1.6 Thymus X. rays 192&57 6 35 1451 65 6 1.0 3.0 t i l'N '* . '," l'f; Tima capms 1040 49 04: 2 483 30 4 09 34 h .'id * '

8' f

e h PS,W4 =

.2.Y # l treated with X-rayr for inflammation of the sensitive to radiation. As a first approximation 1

r: - - c-I 4

. M.'. F

i breasts following childbirth, women treated we might use the results of high level radiation

f. -7."M' with X-rays for gynecological maladies various studies that leukemias are induced at a rete of l

j QQ, types of pehic X-ray treatments. children about 1.0 x 10"/>T per rem of exposure. We g N.g'g. 7 treated with X-rays for enlargement of the would then expect 10.000 x 10 x 10" - 0.1 thymus gland, infants radiated with X-rays for extra leukemias per yt among this poup. In 2 .sp, $ 5 ' @y-;'f, ', [ '.*.j ringworm of the scalp. patients in sewral coun-the absence of radiation. one would expect 0.8S j { .% @ R tries fed a thorium compound to aid in X-ray leukemias if we take statistics for the entire g ?-22. M $' contrast studies and Marshall Island natives U.S. In the 23 yr over which radiation is effec-H lc/G $*b.". exposed to I-ilout from a nuclear bomb test. As tiw in causing leukemias, we then expect I a result of numerous studies of these poups. 22 4.7 cases from natural causes vs 2.5 from MT~$h. o'. << there is a peat deal of information available on the 10 rem radiation exposures. Clearly, the f ?'% 6?MD induction of cancer by high L:vels of radiation. statistics here are marginal at best. But the 2 This is periodically reviewed and updated by problem goes much deeper-the total U.S. t [MdN.h.l .i%.?{ T ; prestigious study-evaluation groups (NAS72; population is hardly a suitable control group. ..; c5. E.* t '.1 UNSCEAR771 Cancer is largely caused by environmental a[.<<.'ai If one seeks to find similar information on factors and hence is subiet to wide variations .. g%,c u.. 1 low level radiation, one is immediately con-in incidena rates. Even for entire states, the i 11t fronted with statistical limitations. For 0.SS cases given above as the opectation varies .[.j. N [ ?g-i.Sg.g. example, suppose one found a group of 10000 from 1.0 (MN. DC) to 0.77 (ME. NM1. In our p <.. white males who had received an extra 10 rem abow examples, this could vary the number of FW'M<Q.:"~ I of whole body radiation. The easiest evidence expected cases from 19 to 25. making it still -3 O N.--. @.- to find would be excess leukemias because that more difficult to ascertain that thers are 2 or 3 f ? g disease develops earliest and is among the most extra. Moreover, a group of people with 10 rem j

y. f.%{

? W: , s. o.w. 2-- Mricy'. 9 W Mi"...- ([ .e . ;, n..;

,. y i -

I .. r.. w ,. m. x.. g. +. x p. m. z. ~.. b.... y. :g.p g m ac.m.

C W.3 Q N : g ;.p y } *Q 3 @w-[: &] n @ &..,...E w

.

m...w..'*. s-

.i .h $;Qs,.,gT/;*f-?.QQ... _} ) 73.. x. ?.. ? s..e. e c_: M.. M....,v.,Mx. ~. e .u .. n. w~. n _a ~ ..;s - ....:.sv- .a w.o . ~ m x. m./ s.:.nwtm.y. -.:c;smss;u.yk:w.wws..xy.t.k..qw g e:

f. -

MI BERNARD L COHEN ^ 2l.,. ' of extra radi.ition would ()pically have more the it.voked scientific communit), altbough . [* s environmental factors in common than merely there is considerable variation in opinions of how much more likely the over-estimate is. "., 'f i living in the same state. There is a considerable body of opinion that Any experimental study of effects of low-the over estimate is gross say b) a factor of '. f.'^' ' level radiation would therefore need large 2-10. while there is also an important body of jQ.

A.&

populations like millions of subjects. and there opinion that linearity does not sin an would still be considerable difficulty in select- .',' "OtR-D. T. ing a control group. One way to achieve large estimate. We now turn to a review of the e numbers of subjects would be to use. variations dence behind these positions. it.:: '[ in natural radiation; for example citizens of %,f y ' -l; gf_,. Colorado. Wyoming and New Mexico are

r. Etiotwr mu ust4arry is Co\\stBumt exposed to about $ rem more than the U.S.

In this section we review the principal eve. ,.<N average over the. lifetimes. However, the leuk-dence bearing on whether the linearity assump-c.me - ;: ir .c-. e.... 1 emia rates in those states are considerably tion is conservatiw as a means of estimating .;g.g;;,7, below the U.S. average. 8.11 vs 8.81 x 10-5/yr cRecu of low-level radiation. This evidence g, for white males and 5.13 vs 5.74 for white corres from various sources each of which is '.c

v. n WW..

females. The same is true for all cancern the discussed in a separate section. '.O.' high natural radiation states have annual rate.s ' @$m.-- of 140 x 10-s for white males and 114 x 10-8 (A) Repair procesxs 3 v,.:. -.- for white females, while the U.S. average is 174 There sa a great deal of evidence that nature . v', and 130 respectively. The fact that states wnh provides mechanisms for repair of radiation

a..

high natural radiation have considerably lower damage to biological molecules. Here have t,

v. - a.;

cancer rates than average :s generally dismissed been many experiments in which it was shown ~..;.'" p. as indicating only that radiation is very far that single doses in the 1000 rem range cause 4..y Q ' from being the principal cause of cancer, and fatal radiation sickness in mim and otf cr ani-this ooint is logically correct. However, this mais whereas fractionating these doses over 4g>.+ author ts highly skeptical over whether that several days or more does not (Fo77L Perhaps cW..r' u ~ attitude would be accepted if states with high the best demonstration of repair mechan.sms .g3 natural radiation happened to have somewhat with regard to cancer is the dose rate efect, g (..: - 1, higher than aserage caner rates. -examples of which are shown in Figs. I and 2. 73

f.,

Smce there is little direct evidence on effects pji.*:.-[f ' oflow-level radiation. the simplest option is to $2p use our abundant data on effects of high-level f re-h; f-radiation to derin estimates of effects of low %5$?.dkg$ lewis by assuming a linear dose-eNect relation-er p S ~ ship, i.e. if some high level dose D causes a .o 3 b.M,c.? ' .L.',;N.. ". cancer risk R. we assume that a dose 0.lD will 2 t pps $ n - %-7, ' Cause a risk 0.lR. that a dose 0.01D will cause

to j/,,

e a risk 0.01R. ete down to extremely low doses. / '(~ ~ ~,.; ' U,2... :.{J.2.r.y.j mended by the National Academy of Sciences g EE;. This 'linearity hypothesis' was recom-l I 1 o r,3 - 0 20

00 600

. O;'{.9.f., Committee on Biological EKects of Ionizius D D'8 3 Radiation (BEIR) in 1972 (NAS72) with a V~; statement that it is a "conservatise" approach. Fic.1. Myeloid plus thymic leukemia in male RF .p.-_ -y more likely to over estimate than to under* mice exposed to X-or 7. rays (Up70L Plot shon per. ?. N j estimate the effects of low levels. This state-cent incidence vs total dose for a high dose rate I.N,47 6Q/[. ment seems to represent the general thinking in (80 rad mini and a low dose rate (0.004406 2'~r %%, P, -w. t .i%:..*.y T~.: *;a ~ <.10 1 y NW i O ? sc 'M,. *. 1 '...-* h'Y T Y k e k '.h *

h. U 3:*-ll,"! & "..

Y.{%.:.*u. k kh ~L ;.f5Ap*;+% *uW r 3;.l: CrD %~Df%.G<c i m.Mt., : %4 Q;-) 3

4, '.i. 6 4,

-J..- W~;' y $ 5. 4;;$ Q* y'.,~~4 g& Q :::i'. ; s y t; y..: ~ cM:%.; v.

q.-:.::

.= f... a,.- n z --A. f:., e ~:, ~ - g..%._%r..: > u~ v: :; ..~ s r;.: %.3 m y

r.,K..,..n. n W

-s; vc c

.. <.,.. L.? -. J.- M. - ~. : %u.. s n-W -Q ;;. ? . ' 3. a,,.. ~ * .. u 2.a..m.. ?.,+x Q. y. .;g;"4,,c 3 y.c.c ;. % ,J'f 7, t. y? n r-n 4 a .'-~ .,i.-c x. .e.,p. y..

Y,,5.c. %**..,lr!$,5ml$$Y0*j

,t n .- - -> * 'N;,L .h',,, _f'-". 'd.f 7.l, ed y Ms.- W W $l i .4 YN'Sk: .Mae

1 7HE CANCER RISK FROM LOELEVEL RADIATION l m hypothesis orcr-estimates eEccts of low level radiation. On the other hand, it is argued that 3o 1 p *0 [- large doses may kill cells, which prevents them from becoming cancerous; this could cause 3 3a I linearity to under-estimate eEects of small I' y

-O '

i 20 doses. Howewr, there is good evidence that .ef.% e 5,o cell killing is not an important efect below t about 100 rem (Mars 78; E167), so if data in the M g g ois;s 100 rem range is utilized. it would be difficult os Y " - E. o 'o oz noss to use cell killing as a reason for linearity O.'.'"8 2 ' cose - note t roo m.n l under-estimating cficcts of low-level radiation. J.,g-;gJ ' Rc. 2. Leukemia in CBA and C57B1 mice after a '. ~ f '. s ' ? :,;*:M pray dose of 1000 rad (MoS91 Plot shows percent (B) Mechardsmfor rad an.on mduen.on ofcancer %.i., N.," i incidence after 15 months vs dose rate. One of the strongest reasons for believing a fj-m 1 that the linear hypothesia is conservatin de-E. % rives from our understanding of the processes

n}4-jljj.',

T-c. S m 3 ~ We see there that a given dose of radiation is by which radiation induces cancer (Ke721 Radiation affects matter largely by knocking { T Ih-J, generally much less carcinogenic when spread electrons out of molecules and thereby distu out in time than when given rapidly; this im-fd {'M,:^- y j,'; ~. plies that damage from earlier doses was ing molecular structure. In the process, the i i'9. repaired before the later doses were adminis-radiation giws up energy, transferring it to the %liF tered. He dose rate :Kect is well established in material.ne number of electrons knocke %d '.'. many animal studies with X-rays and y-rays of position is proportional to this energy de- .'- - Y. _.. (Gr72; Sh66; Up70; MoS9) although there is posited, and the latter is the basis for defming { 4.f*' J some contrary evic.cnce with a-particle radi. radiation dose. If the biological effects of radi-a V%~d! ation (Spe7h May!8a) which will be explained ation were simply due to single electrons bei N- @. later. It has been pointed out (Brow 76) that knocked out of position-this is ca!!ed a U'In,1 n i efects from the high dose rates received by the " single hit" process-the cancer thk would be AMMc 4 Japanese A-bomb sursivars were no larger proportional to the total number of single hits,

t-j sf7 than from low dose rate medical exposures, but which is proportional to the energy deposited.

thi' could have other explanations. Increased regardless of the type of radiation. Howewr, f~a. M @b < efects of high dose rates are well established in this is well known not to be the case (ICRP59); W s 2 :.i' W studies of genetic effects, a mutagenic process for a ginn energy deposited. :-particles and -Y;. 3 $;h t somewhat linked to cancer induction (Rus72) neutrons (known as high LET-linear energy I' In addition to this indirect esidence from transfer-radiad9n) are an order of magnitude y-6. % - dose rate effects, there is direct evidence for more effective in doing biological damage than ~ "5 **-@xW %.':Mp.E, repair processes in that broken chromosomes 7-rays or electrons (low LETk This is strong QQg have been observed to re-unite into a single evidence that biological effr. cts of radiatien are strand (Le55; Wo61k Dere is also a vast not caused by single hits, but rather by f giggpe. ; amount ot evidence for DNA repair in bacteria multiple hits. l n', i.-W De basic difference between high and low d-(Fo73; E177; UNSCEAR72; Mc66; To731 D]?*"' ' I In view of the well established existence of LET radiation is that the former concentrates ? r 2.,N[ <.., repair mechanisms, there is a general feeling its damage within a much smaller volume of ] J fW [ that effects of low doses should be largely tissue. Since high LET is more effective, we r repaired. whereas repair of the much more may presume that effects are caused by mul-N M-@S. extensive damage from high doses would be far tiple hits very close together, within some small f ./d @ $, p.-,q less complete. His implies that the linearity sensitive volume. i g ...,e. g%. .l I l

w

. ; *;,l.f f,-. ~ ~2.", f E 1 ...E.., Q *,. ll o-n ,.p e* g

g

.a r.. .m..... ,,.,;...,: - ~. [ e e 1;. -[,...'. e 4 ... c s

n'. g..

,9 ; s L. }.J.Q,., -~ ~ -\\ . j 'ei 4;,. 4;): y, .. ' ~?y f. *. *,, : -e r... ~ T. U.;,'.,.. ;,f + y. y :. T.,. >.y . ; ** L%..e.J 4 . d' i. *. / M-4._j'

L,
y j N -

4-

e *.*[

.. ? g. 1. ',.'/..[ } *..

.7-1,*
s eb',
dent M

.eM. ~. ,k" Uh I. se e e b ee =E. [, e e =@E 4

.4 '4 BERNARD L COHEN

)

a p Confirmator) evidence for a multi hit pro-if it is I p in diameter as suggested by some . ;..y -"v cess derives from the dose rate dependence dis-experiments (Ke72; Sc73: Ke751 the dose for ,. i <,. cussed above. If cancer induction were a single an average of one hit within it is 8 rad for a .. i.".,'j ' hit process. it could not matter whether these !.MeV y-ray and 300 rad for a 5-MeV neutron ~ s -.. -,.c hits were close together or far apart in time; whereas if the sensitise volume is 5 in diam-

l D,: ~

each hit would haw a certain probability of eter, the size of an entire cell nucleus, the M.'T'-d

4 resulting in a cancer. However, as noted pre-required dose is 0.3 rad for a 1 MeV y-ray and 7

[W', ' viously in connection with Figs I and 2. erects 12 rad for a 5 MeV neutron. We don't really

0..%. T..",.

4 are much larger at high dose rate. With a know what the sensitive volume is, but these , : r_ f., multi-hit model, this is readily explainable by examples give the general impression that the ~~.t '? repair processes. If the two hits are well separ. transition from a linear to a quadratic depen-gMi?' { sted in time. damage from the first may be dence occurs at relatively low levels for p's and

v.. ' 2

R repaired before the second hit occurs, y's. and at relatively high lewls for z's and neu.

M.D. Granted that radiation induo:d cancer is a trens as shown in Fig. 3. nis rneans that over i

/~'

multi-hit process (we assume a two-hit pro-the range of principal interest, the dose.eNect F g.~Y'p.e cese the multiple hits may be by the same curves should be linear for the latter and con-

f. 3.. A j_.

particle of radiation or by separate particles. If cave upward (quadratic) for the former, which .],Tf.g they are by the sarne particle, e6ects are leads to the conclusion that appliention of the ,a. -;- linearly proportional to dose, with the propor-linear hypothesis based on data at high doses g - j [p tionality constant much larger for high LET will over-estimate eEcets of low doses for - i

.) fJ.,

than for low LET radiation because the former and -ray exposure. 7

"..'.L.

has a much better chance of making two hits I f., ;. -i p,., close ogether. " " --a e.; - ' On the other haad if the two hits are by 'r'. 8 f separate particles of radiation, efects are pro-( -.;( portional to the square of the number of single / J es,: p hits

2nd therefore proportional to the square e

,.,j.. Y., of the dose, regardless of whether the radiation f 7% is high LET or low LET. These considerations g,7,, 3 .g - w.'.,1 "L%F~i lead to dose-eNect curws like those shown in y e

q..,.,

Fig. 3: at very low doses the linear term must v '-%W} be predominant, and at wry high doses the .E s' ~ s :.s i . n /~,,~.;.., term propornonal to dose squared (quadrat c 3 ,ao= u ,s Y ;i*W P terms) must predominate. The transition a:cm? e ".'.M,f..!'d..;. between the two should occur at a dose where W M M-.C'ps.e it is not unreasonable to expect two hits by Nd7M separate particles of radiation within the sensi-e om c s.,i l~~'.b.k.2.N.. tive volume. This would occur somewhere near ,v'~~ .' L 'y y k the dose where there is an average of one hit g _, .~,.q u. ' l*G.*. per sensitive volume. The latter dose, of course, ~ l m..'. depends on the sensitin volume: for example, Fic. 3. Cancer incidence ss dose in a 2 hit model The ?N@r., t 2 stDOSEt term is da to the two hits coming from ~ di6erent partdes of radiation, while the s. DOSE . iiir M

For example. if there were 100 targets, the chance t:rms are ' rom both hits coming from the same par.
O 6,5 P of hitting a given pair in 10 shots is about t cle: the latter is much larger for -particles at.d neu-t :'. W ~i-,

d x & = 0.01, whereas in 20 shots it is about trons (z.n) than for fs and 7's (f.71 The total cancer -4*D & x & = 044. Note that it increases as the square incidence is the sum of the tw o terms, as shows by the '.*/.9M/;[- ~~. ] of the number of shots. solid lines for $.7 an for s.n. i , T n-l r - f. c.@p+.,c l n-. ..,. m _ 3:.1.n-t, IWi(a.$( 1 :.c. i _. q.y, '? g ,. ~;

:::.p. y.g,:y n-n. -m-7f@~.a. - S,w.;.:... E.}2y:v.ni:b-;; V.q.

.;[+. - ..j.. i - e.,'...' ' ? . m *. .. 4.T... :.'g r. W..;:-*g,~;'.J.7.3. m,.- :- - E w. < :L.= c.. :.p p m. M_ 3 - if.y.: m.g.t.-tv

.,. m n.--,-.. y.. q..,

.C' ?.* ... n.v. %w. 9 . d' i 7.r.. y.c.: n.;,. %..~.p.. &mf+. +;. - :..k ,,..,A.a-:/.y. .g 4 l s mn. .m .:s n. 9.~n:6%9.:. g:%. -% - 4,.:p., e.. -:. ; -: a <- r.;,p w:. s : y, p-p;u.. n.-. e ~.e... .1. ..?.. = s. ..n \\ s ~ - - x- ,M-- 1-o..... m. 1. . : x.......,,,. y,y.:.,n

.m. :. ;.a :.

m,. ,..y . ~... c.:. y- .a.. n. x. w ::.-n .s. r. ...,n ~ - w.- - i ne E

s I THE CANCER RISK FROM 1.0%~.1.IVEL RADIATION ~ 4:- . i <7 -.r 9 '.,.. y *. m I' p nSe 1 ,a ,,,.i +s. A g,.e, ee %.e 3 4 e e..~..,r.. I /, .~ e ' as, s l 2 s *- ,A

.**.'*~-

3* e s s.n see<eme e' i ' '\\/ j 2 *'- e . v '.3. 4 2 v C i .,, *.s,r ~c i 1 f f .m ) 'v-% i 4 i.~. I l 4:c a:c Q *e

, l-

.... w. ' * * * ~- A' . :./.; N: #s !. ro r. *S's ) I '.*J' s ' :;,j "N I. 4 i~ p [ "* '.'**'* j ..c..a." Fc i Oise:p se=cas pred,ned in CT! re:sie l m e j-ex:e by brair:cx.s eye =ce d "Se and **Cs as spr l a ba i. d I

e O.X'K-le vs c-

~~,./ -;.e. j % d274 tf86Il Ect shOs1 EE*:ee1 l j 7 "..I"["~,/ ((- I r25c.acmry xe,e:ted C:cuets had 003 tr.:::ces ;ce ' iI ,f'-f m:Asc. "Sr ca;ee:ess r. sed I10 =mer and 12 c=e 3 troh: res.us Ice 1143 aM LGig, as shc= a cc ..J.';f. ;Q i: :d,. r 'd de:*d *8 "-*" mi :"CA '?.~.pg, i

- A~ : i.*.k.

" i c a: n *: x t

~

w Ccu letil I

-;f *.*Q

P.m. ""

[.;. f G 4 h-A'%"* d 12n0*ts r.e0p'21:"'$ 2 ?.r3y 271 by in;*;-p gh$cgged gg h dideg K ee,g thgg ,aa "'I - dat:d =x:: (LT"61 as a fus xer d dese Eircr hats g3,3, m3 3., yg g., ,c.e, a 2aed en-s resis att cbse to 5: ear (52751 and de:s are ~- 1 SD Is a:::sses,i:-c:.1e := is =uch er ',.4-u h me Mrad is co-sed kacan sit:ation in shid the c..,' ...,, e. cbsened dose.eSe:: :ene is cm.;:a e 6:ss-3-rN (ShSt the latte-case inwebes -u~.=2ry 1... s ~. r. r*., can=-s in Sprague-Da a ky rats, a spe~.31 treed M' 11 =a'v be acted that the abost-or.:di ed dis-is shid aB k=aks at s

aDy ecum to de I-M'N cas:.oc usigns esost a-partide radance efecs cMat Escase ew in the absen= c(radadoc i
O-as dse to =shiple hits by the ss=e a-par 6de at espesi.:r:;it is widely re:cp.ized that this is as 5Y#f

' ' "'I'^iM the sa=e time. This impE s that there would be e2: pde~:al situancs in =24 ways $em, ' 'd ".g-/.3 no dese-r2te efect for :. particles, in ag:::me:t D "--21 dau Ice a$2:6de raisuco ~S w;th esperime:a1 eddence (Spem la fa:: im1Dy shew sceeth=g cbse to a Ene2: L,'. liv $[l there is sc=c eMdence that efe::s of 2.partides _1 -1;.:..'.'s

are in=tased at lower dose rates (May7lal

.:e - .A r.-c,,,5 N i 1 w ,.r.c, J. 3 y j a.: *. ~-

Q.Q.Q.:

(C) D:'a on career ir.d.e: ion by raL=a j . ]l f. -m ej

i-Q,;;

One bass for judging the 5256 y of the

j

"~,,.. 3 ..;E linearity hypothesis is to obserse how seS it 'y .* -1'.. 47 '?. J-5.'e' ~v e behaws in es-lainit:8 data dos: to the kra:st r a:.3a.'*... Gi r deses at shis e5:cs are sutisd:2!!y cra =g. n n

C f.-i Jh,3 ful.There is a rather lazg: bods of animal d.au
**' * " 5'" 0* " "*"

l ~i-W.2 OIYk er.end:g dess to the 10 rem regien with Fc L S:ee cas:= s L-d.c=d = =mc= by i:;e::x:s of f reasonab'e sutistical sig -iS:2rx:e These data

R2. Pot a p:eu =-^': w d tece sam is

. q y. y- .~Ji'iFj: for X. 7. and f-rays ;tepen:krandy =dx:ste dcse to here a nad. Fes e.cse n =M reper'-d m 7,'f.F M.~.N-i that imeanty a:c -estimates e5ects at kw lewh if491 ad.z;ed m may shS Nv.e t.c dese e;ms;- 1. a. m tg.r (1.,p61: DM;. bum; Ma!S; Maf0: May,,.1; ,.,3 m, n e,g. g 3,3 s.g.m a g j. exampks att shown in Fig. 4 fcr ext = a1 ra6-se rad sacos en the plot Duled n=e a es;en. e.., ee-ters s::::ps L:e fa to data. cv '~ rf. Oy h, ation,:nd is Eg. 5 kr expos:.::e to irradance r i.. 4.J: j .. = ~. I

. * -reeN-l

+* - ~ . %;.N. \\ y J,3.;.-. t T,. w e .e . u % l,

a*,l. :~t,'.*... ;

3;. e-. V-- - %#2'Q ;,* :. r..

. '< j., $c ***

',t @. %.. g-E.,,.,w.', % A @ 5.. 4 1; { g7 3,e,.E. O r* .o.s#.. ~. , P.%,. ;... _s .3,+ w.., r ;:..., '... : es. tm r: m. '.a. -...r ,. 3 'i , se ~;,.... s. m. s., r.3* X !' nC W,2. a..*- bM-j M.,c .c, ;,. .s y;... - .s ..$ m. y ;,.. ~... .. ' - * * " '.' ~.. .m N 2kh. t T.f*;G . ,M ~.- -s.,..,.e.n. y 'k, * +- .g -*,4..f.. ;,,.g& *,,'.'.-G l'$,s.. &,.x .Af C *.

F *:~, h h r ? S &.,' t

. u;~ .g i

9.9,m E

T & f2 .. +.. - a~.

~t. : v ~~ '

e 7,.;.. A l s:...w. f. Q..,.,., s. . ~ w~. %.. t. Q.-. - G '.. $ ? ? '-.~N]~$ D ?~'"..*.b.*', ' t o a $.~~'= s~ .- + &.. - -e ?

.A*.

" W.; y ?' * -i

b {,'.,';.).*~~'k.**' f.,$.f;a-l.y.0 ' % *5

=* .~.a.' ~u. ?.. h- .y. fK,;;. p.y _~ ~ <<y.g El. . -h = 7 -< e~ w :s.m:..>em h.t s.;. .>~t s ... - ~

BERNARD L COHEN 665 .'7. ) r' p thai these factors do not vary systematically i ., % !. _. ' - 9., y. L j with dose. It is esident that these data are o n.............i I.:.? S s much better fit to a straight line than are the j

3a.-.r............,,

mortality data for the " extended life span"

- ,, $.;,g

,J 3. +......i..........,, f O C7 ... f., 0. ~e.: @'; ' i. study. However, even the tumor registry data / i . -. @.Ld'. .r..M. _'.~-&....a.. ,, n o give no evidence that linearity under-estimates . c .a . r. 6 ?.M /. ,. f'W?.r. jj ght.m". hyc.i.' 2 / effects oflow level radiation. I Data on bone cancer among the' ra lium dial O ?[..$.I@.$7N j 4 4 ~~ j. ~~. ~ painters (Ro78) are plotted in Fig. E and we +

IY[,1 m.=, 3 6$ 20~-1"M 3

see there that the data points for low doses lie pr e4 h [rI-r @Q.Q'gj,g;ff .nz-consistently below the prediction of the linear. mo aoo soo aoo soo ity hypothesis. While the statistica! significance .S'{. Q.y. f. Dese Iroa1

li[ 3 Id r

- of this co,clusion is not very great. there is ~ 1. E ry/P *-5h.$h; ' (Fac. 7. Leukemia among Japanese A. bomb sur isors certainly good evidence her: th l+. V Be771 Solid circles are mortality data from leukemia hypothesis is, if anything. conservative. Note .7.p$g.hN.F~ ~ A.f Wk?.ip/. '*J. ] h among the " extended life span study

group chosen that these data are for 2 particle exposure.

j for careful analysis and follow-up, and solid line is a <-/4,. -74'.P~*(2* straight line between those data for high dose and O 7.%,.g%# N-zero dose (natural occurrence leven Other points are M I"N'"#NO"IO'" "##" '"d'0"#"#"'#I ## -3. W.T.K @%.i cb,T.l.D( ~ 1 5.t from the Hiroshima and Nagasaki leukemia registries Po.sure g' 'c " ' l analysed as described in text. Dashed line represents a The clearest evideno: that linearity over-m w!A'MAhf;f/M: ~ ' straight line through data from Nagasaki leukemia estimates effects of low doses, if the basic .e.,-.g.g 4 M f't.a "E25"7-assumptions of the study are accepted, comes W.-5:?. U. n 7,- from a comparison of radon-induced lung MMP b-%, f shown in Fig. 6. It should be noted that here. dependence (May79a); an example (Fi69) is cancer between miners exposed to high doses M; [, F.- Vr J.s and the non cigarette smoking members of the A %:, 6 1 .?'7,22'.....:fQ.~;~;.Ias in all other cases, there are no significant 7 . :.7Y. C.;a. data below abottt 100 rem ( 10 rad for s'st -U,p so ,I. .7 ', Probably the best human data is that for l ,3,2

N.., g:@>.* 7' -

leukemia among the Japanese A-bomb sur- -*y s-1 I.I~'1.6'.w.Jd'- . M. w.?- c W vivors (Be77), shown in Fig. 7. Unfortunately e !:*@,c(.f.[$ ? M Q.@p@.p-N .Y this has a controversial aspect. The mortality $30 / 4, data for subjects in the group chosen for care. / ~' M.~r'd.7@M.,Ma . ful follow-up-the so-called " extended life span 2 / 1%@2d.i. j'i.5M.W[' study"-are shown by the solid circles with !co "/ l ,/, 7 e D' .W error bars. and they seem to indicate that ,' h. o. #. 2 f. fh $u, y. linearity grossly over-estimates effects at low t ,f j fj?.N. iO.0"c.v.I Qf;.7,Q. i 5- ,@J.3y. Elf c4%$.'y~' doses. However, there are leukemia registries in h/ .p,7 ~ both Hiroshima and Nagasaki which keep g80 - { / s G j, M. N N,s h track of the number of cases of leukemia v l /J N.;,0.$.e/f;]i 4 54 among people living at various distances from H ?. 7y $.. Q~.; p.N:4. ' t $ CE K$p.l. the bomb explosion and compare them with S the total population living at these distances (in

d. p ioco aooo t

./".%. W.,9.- p' h *.e. (; 1950); the number of cases divided by the Ci of Ro h - w a ((G",*[h.-..[. ;c.a y? t 4,, f,,opulation is also plotted vs dose (as (L.,n.ed Fic. 8. Bo

LA. -

.,ggg.r. -. 4.:. m-p e . m the distance) m Fig. 7. There is no con

o l.

i r "2.. (Ro781 Main plot shows higher dose data used to .p!r.q d@d.sy y% ^C. ' d fe:W.*.' 2deration as to age distrtbution, Dumber of obtain straight line fit. and inset compares this Wf ? "'s wh ?d

~".- d.%

people who left the city, etc. but it is presumed straight line with the low dose data. i 1,s. -JW..-~ h J

,:.%*ls T*rJ&,;.W $ % % '

i'NbD h.N Y[ k j INN /-i .$. 'N'.Nhf .N *@?l*.W * ., a r.. -l%c. d $..-1';-

a..: - I.W r.~.

r:

.;zw.c. '

e L.. y, . :.w l ,.2s ..c + ' t .~. .g .,.l ,. [ ,e ~. k e.4 ) h. 5 'ZlYY $f:: $f;r; a w3.w. :.; :.9;e.y;w*.uwm...n$$ *m ;..n.. oe v. m :; c.. .u.; -dY: .h h" ik-hh

55 h.
): . %,, L.,. ; n. '.t # 4.',& c - i:'. 4 **Qh.' ik' W ~.* L.:.ff' : f**k..e:: r :

.e: Y.4. v. h' ~ *n' w 6. (s*:* L 's n l .y. ' ?.,u. ., i; .. :.,, $ 4~1q.., -.'. l 3..:/.....r ~....,,.: g i,,,. - .. N t s.* e. .,.,e..,"g....*.**

g. w b '

.? f.. .1 r,

- r' t,, :s-a

-.s

- - ' - ~ ' ' ' THE CANCTR 315% FROM LOELEVEL R ADIATION 666 general public export.d to natural radon in the um miner victims. the fraction of the excess c environment at low doses (CoS0k It turns out lung cancers that were SCU was 77*, for the .:2~~ that 70*, of the excess cancers among the lowest dose group, 68', for the intermediate '- V'.. miners were of one particular histological type, dose group. and 68', for the highest dose - 6. i. - small cell-undi6erentiated (SCU), and if linear. group (Ar74). e...d.f., ity is applied to this disease based on the miner The above outlined evidence would seem to .- ; f. c, ' data, the number of SCU lung can=rs due to justify the conclusion that a linear dose-erect ,. j v p,., normal environmental radon exposure among relationship normalized to the high dose data non smokers is oter-predicted by a factor of 8. on miners over-estimates the efects of environ- ,A?,'. 'C The sigmficance of this conclusion depends mental radon exposure by a factor of 8. ~;- 4 on some basic assumptions that require justin. De reason why this test is so sensitive is <.m i ~ N' cation. The most important assumption is that that average environmental radon exposures l radon induced lung cancer has the sarne risk are quite high, well over 1 rem />T to the bron-l . X f, $,_ ef J factor for smokers and non-smokers, i.e. that chial epithelium. The lowest dose range for Ar r, there is no synergism between smoking and which there is significant esidence on the . ~ ~T. fg'~O;,J radon exposure. Actually, there were indica-linearity hypothesis is leukemia caused b3 .; 3 .E.. o.r..'. 7 tions in the early U.S. miner data that smoking natural background,-rays lest!s of about ..., g,. yp 4 accentuated the efects of radon, but the most 0.1 rem /yr. L'e re=nt data do not seem to support that view-Radiation induced leukemia is much better (4 c.C:gu' point. One strong esidence against a smoking-understood than other types of radiocarcino-I -, -. ;.N.? ! radon synergism is that lung cancer incidence genesis because it develops much sooner after +. a -W vs radon exposure is wry similar between exposure; thus we know the age dependence -.. g l.-. modern U.S. miners and a group of 19th cen-rather well. It has been rather easily diagnosed -af E 7-[ tury miners in the Erz mountains of central since the 1890s, which allows us to go back in

d. :- F. - -: -

Europe who tuKered their fate before cigarette time to the early years of this century when it N[* smoking began (in early 20th century). Dere is was a much rarer disease than it is now. It is NJ,-';'c (.; independent evidence against a smoking-radon therefore possible to establish that a linear %[',' ?, synergism from the studies of the Japanese dose-efect relationship normalized to the high A. bomb survivors: the diferener in lung cancer dose data on Japanese A-bomb survivors and F M.G.. rates between those with very low and very radiation therapy patients requires that essen-4 N,.j.,QD,(.: ,':gi g. high exposure is the same for smokers and tially all of the leukemia obsersed among i,M ; $* '. - non-smokers, although the percentage increase 20-35-yr-old British females in the 1911-20 is only 40*; for smokers vs 200*; for non. time period was due to natural environmental J.k di'"[ a IT.jipjg.jg'. < smokers. If there were a synergism. the percet-y-ray exposure (CoSOL This is evidence that the {T.q,.jp.1c g. age increase should be about the same for the linear hypothesis does not under-estimate J W"; two groups. It may also be noted that the eEects of radiation levels in the 2-3 rem range. % 7:t.v$p' male / female ratio of excess lung cancer from @ &Y.T radiation was about unity. whereas that ratio tE) L2 rent period increases with decreasing dose ft".T i-d.C in the general population was about 3. due to An entirely separate reason for believing that ,.J'J,,f.$ heavier smoking by males. If there were a the linear hypothesis is conservatist derises ~ strong synergism. these ratios should be the from evidence that the latent period for radio-N,',-@g.,3-;;,; l' carcinogenesis. the delay between radiation ex-same. Another basic assumption in the high-level posure and deselopment of cancer symptoms. n.jp*jk i

/ M.: '

vs low-level radon comparison was that the increases as radiation dose decreases. There is =~:.pg ^ percentage of lung cancers that are SCU cell evidence for this from many animal experi- - m P,4-l type does not decrease with decreasing dose. ments (Up64; Hu67; Bu68: Do69: Hu69: Sh69: .j; ; . T4ti-The evidence for this is that among the urani-Ni701 An example is shown in Fig. 9 for injec- ':':- ~., . f. .x ,.f.W*,3,,A -.9 4, ce.... a .,t ,t ,,-; g w ...:: n,.:,- .9..- -. \\ y p.Ds:<; .T T "'i \\ e.F:.. ;. ~ . '.. " = .'?-Q~ Ww%...".y.-q.y@%;J.,. g,v V M N:W , J.M :&, r.. W; Sc:.. v k '., - *].f ' - ':.L..;- n r e. ,,3, :::; . M ~ 7 a,

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.-%.'s - } 1 -;.r,, [. q v y ' ~~.: S -; 4 + c ~L. '

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., ;~.

- y; , r. y., ( a . = +.;* -y .e ~. - w.- v.*.m m. H - :._... 2 E t.8 $ f 4 %. M.I.T;.~7.N /[Td d I. h

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~4[ -- Qe ,d [

i y e 667 BERNARD L COHEN V

s. -stw tuotscr tsmc4Ttsc usc4a i.

,.e ,,.,. &.l I ::,l Hirointsis nota tsTtstrits irrtcTs ' C 'l, ?. The news media have recently given heavy ',' o L ' " N,,, "

a.

. ' 5. J. d 6.,' .. ;., c.; w-+: s. \\. publicity to several reports from different i s 4 ~.. ?

,..%.,. + ; g.w.. <

s .Pc. N,N N sources purporting to indicate that the linear 3 m m-o ~ "

b,t 5) 3.,9,, 'M <

hypothesis grossly under-estimates health ,., N D, '.N. effects of low-level radiation. We here consider ....'"n. a a. > these reports. treating each in a separate -'r,2.V'gt.'.3..r,. ?- .,. : s gf -. 9 f m. l y section. r f,' ~ :.1;t'*-; ':' ;.:gg.. ' ?.Jf;.2p < io' ic ' so' so* io' .:;,N. '.w.'g'., (A) Mancuso-Stewart-Kneale (MSX) studi"s of Oase treat .L. ,-O a e, :Q.*' ' ga,5(o,g wo,Le,, 'shf f.,&f1 ~ no. 9. Survisal time for beagle dogs who developed Probably the best krswn report of the type -' W.'f D, M. Q. M.,:,~.[ bone cancer from injections of various a-emitting under discussion is a study of the effects of ..+. .-eW .g r. ~. radioacuve isotopes (Do69) vs dose to their bone at i occupational radiation exposure to workers at ,2. [.....$ 5;R X M h. a before death. Note that 2"Pu and 22'Th are much the Hanford Laboratory (near Richland. WA) inore effective than 22*Ra because the former concen- .i-M t. trate on the bone surfaces. These differences are taken by Mancuso et al. (Man 77), which we refer to .' L" "~$'el'fc/W;'y.C 1 3500 male deaths from the work force of into account in converting rad to rem. hereafter as MSK. It is based essentially on the . s'Wff.?'4L.$=Kyc. 4

n

.- v..:..ggs,., m.m.N, 25,000, searching for correlations between .3 .M, S z g y.' y-*. #.~. 7.. causes of death as obtained from death certif). s y;, ' tions of radioactivity into beagle dogs (Do69); cates and radiation exposures as recorded by ~,f,% 9 vs. ~.... . r. c. y+.,-fe ;

h..,L,'cach point represents the average time delay film badges. MSK found that those who died e

w. n

b;3,._. 4f1*WeF-7 for a number of dogs. all of whom died of bone of cancer had slightly higher radiation doses s d.--l-Q.. g.,0 d

.,.g:,' S 3 cancer. Dogs not injected (controls) had a post than those who died of other causes-.2.1 vs i l?.~f;.@'7Wi~ - f injection survival of II.3 yr, so we may infer 1.6 rad. and that those who received more radi- ". V M N % from Fig. 9 that doses very much below ation more frequently had cancer as their cause V,;O c W 100 rad to the bone would be totally ineffective. of death. Note that these statements do not .Kc .i d.7CiP$.Nh.-j data for the group of German ankylosing spon. radiation had a larger probabihty of dying of There is evidence on this effect from human necessarily imply that those who received more h*hp[Jg;.@,' 1 p, m.s -; e. dylitis patients injected with 22'Ra (May78a1 cancer. In fact that is not the case, at least ! ! f.e'*M..;.@D. ypYd 1',' fo'r skin cancer in japanese radiological .J. .7,. workers (Ki73k and for the U.S. radium dial . p. W y s. l..c.' Ps-e b,,, iJ" W@e eeN painters (Ev74L Data for the last. named group l so f.d.b.'.D@.MMQff; are given in Fig.10 which shows the time delay '., o N *..,. vs dose for each case: since there is no averag- , *. N,. c 'M, Q,.j.. @y, g ).# % ing. there are wide fluctuations, but when it is

i. ac

.t U Q

h. ** **

M.di -u.,~,.vw. z.n,. ... b.. .v -- 4< recogn eiz d that the data are cut off by time ,c M.=

3NMh.....A, W~.y!.;. 2?' * +hh '

about 55 yr,it is reasonably clear that the trend j N .~r limit 3tions on the study at an ordinate value of 1 - i v

~

.n $$,.,5 of the data are as shown by the line, sloping 6 - ,. c-:ey..f. a seo ao ao ./,.~dN.J. dk.[dQ.'4'D. @ w..I upward to the left. a. ocie *o sone la so: Rem If the latent period increases with decreasing S,g,C h.. 1 dose. at a rate even remotely approaching Eg. m Time between first radiadon exposure and P.c MAtG..r.N.MW:?$4Q'I those indicated in Fig. 9 and 10. at low doses develo 7d ~ W,htA J

%J th. latent period will far exceed the normal life painters (Ev74 Line shows average trend in data

+ d...'[@' k.'pM'*g.N-$*g$. fg%.M$i 4-a '. *M,.2 is M < span so there will be no cancers caused by low considenng that the ordinate is effectively cu i about 55 yr by the length of the follow-up. level radiation. '.g-- M.

p.

4 l h.,... .,A n. ~ A.rmp.,; e.. l p. c5 \\ ?*g. p' .s**.F.T.,h.w, n gn. < g f e 4 y.- = ' f. - $ 4.%'RI.s j f,. . _... g,.,,,/., 4. . p; hek .., M'. **, .b."*.'- ..F,r. ~a.q.,.."-?s ~........, a :.. m.h+, w,... ..y,, i ; + y,f.9. m.t'. . y 4.'.. ,n*" b.,,s:- ***.p. :. }..... e n s'y:** *:.. f<c yr,.~.. ~ 7..L.'.,; , g%.. ~,, _ , 3% -.o. r Q. g r -c y :. ; o.. : - cw... c >- q.y V' f,,u w.;.m..~-3 ; .y. a.2.. i ~ :; ~m.,p . ;, w-. n. w ~,. y& =;.,. . '.. m. w...g,., :.u.- W.,. :. r u 3.y wm..~,q e.M. g,,: .~ C. %:, c,. 9^ ' *..s... w w.k, n. m : w. m.. o,.'.; M.~ .. -lm e;% e.g;C..;g./...9;y.u;..u .a. c w&.. :..

7.,,...

. v.. .-..p M......... . 3...t ; $.g. .,..QM -~- .L . m.. _eq. %...,.. m .-a.'...\\.N ~. M,. k :P..t Q., m. ,i-c.9.%m..%,.....,-n

. ~.

.,.~...: ~. &. *1

..,. y.,- r,.

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g,.,...*,.u***'." ;. D. "~. e

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4~ *.-5' *g. r..c..H= -- - - - - - _ -

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4 668 THE CANCER RISK FROM 1.OW.I.EVEl. RADIATION .,.f within the statistical accuracy of the available wide variety of sources (Gi77: Gi76: Marl 78; data (Gi78): the aFe-adjusted cancer mortality Brod78; Sa73: Sa78a: K178; Re78a: Re78b: rates per yr per thousand white males aged Pa78; An78: NR76; NR78; Rub 78; Hu79; 25-70 were 1.7 0.4 for 0-2 rem exposure. Ta79; Co78; Mo78; Ge78; Spi?9; Gi?9: s.. 2.1 0.8 for 2-S tem. and 1.4 0.6 for Co80s). We attempt here to summarize u enly ~* l > 5 rem, as compared to 2.1 for the total U.S. brieftv.There has been widespread criticism of a. 2. ~ J, ' ] population ( denotes 95% confidence limits). the statistical methodology and handling of ...mC There are some tricky aspects in considering data; to cite one example, for m!tiple mye-U- ~ j;,'. only those who have died in that no consider-loma there were 8 cases among men with C.;' ] I ation is given to the great majority of those <1 rem exposure and 3 cases with about 7 .-:.X exposed since they are still alive. Moreover, a 30rern, and this was treated, using averaging. ' ~ En ",' higher proportion dying of cancer can mean as equivalent to !! cases with S rem each. This 9.;. - either a higher probability of cancer death or a procedure, plus some non-standard disease ' f,- lower probability of dying from other causes. grouping- " bone mari ow" cancer, which .? MSK break their data down in various ways, includes multiple myeloma, is not a standard - -' t-b; and when this is done they obviously find some classification-led to the estimate in Table 2 of .'. j. g i Q. ages, some employment periods, some time 9.7 radiation induced deaths due to bone mar- "g u W 1 interval between exposure and death, etc. row cancer whereas the 3 myeloma victims J. N ' ', which give larger results than average. This es. were the only ones v.ith appreciable exposure W-j$[~j pecially applies to types of cancer; for example, (An78). ' ii W. they find large excesses for cancer of the bone There was no consideration given to the ' ' g,.. marrow (22 observed vs 13.4 expected), pan- " healthy worker" cKect (Gi78)-the fact that , ;.l 7. < creas (49 obs. vs 37.3 exp.), and lung (192 obs. the Hanford workers had steady jobs muns ~.f.;,, vs 144 exp.); they give no further consideration that they had less chronic disease than average , '(. '. J ' to types where results are in the opposite direc-which would result in their dying less fre-

g... -e, ~ - I tion. as for lymphatic leukemia (3 obs. vs 9.4 quently from some other causes and hence

- t ', ' ' ;, j exp.), other RES neoplasms (5 obs. vs 203 exp.), relatively more frequently from cancer. MSK 1-;M' and genito-urinary cancers (15 obs. vs used 1960 national statistics for comparisons, (.p'W 30.9 exp4 although most of the worker deaths occurred F. 3. Since the diference in radiation dose closer to 1970; since lung amer was increasing %* d Mgy,, between cancer and non-cancer deaths is so rapidly over that period. this errrr alone .:1.V. small and they explain the entire efect by these explains their entire lung cancer efect (Hu79). f Gt'7 ;l small diKerences, they naturally find very small MSK paid no attention to the fact that dose .n Oyfy I " doubling doses". Some of these are listed in correlates with many other factors such as Table 2,in which we include also the resuhs of years of service, job type and socioeconomic i bd[-PJn,3jf:f M( I their hter revision (Kn78), class, and these in turn correlate with ex- .9.',W - The MSK work has drawn criticism from a posures to other carcinogens and to general 7V 4,,.n. -s .a.

7 TaMr 2. Results of studr of Hanford worisers br Mancuso et al. Table nsfrom (Rc78b)

,. y'yw- ..~ m Number of cases Doubling dose trad) W ~- i. - Cancer type Total Due to rad (Man 7U (Kn?8) 't '7.@k., 9.n '*l i Bonc marrow 14 9.7 a8 3.6 . t'.I,[t~ p "t

" " ; e MG,

Pancreas 31 6.0 7.4 !$ 6 Lung 13o 12.6 61 13.7 [* ' f.' W,, ' All RES 47 11.1 2.3 Att cancer 442 25.8 12.2 33.7 --,....,y'*... ... lfk b i .... -e

T m: . !

Lv.W : . g ~ M$ .W',-;',?-%....c$%f;' hM.y.> K,t-..$..,%; ewN.,, N k s'*Q%j, p, ,,.U. h Q!

&, n.,s., e.

.....w, . :. c...-

r.:. - ~ ~.

0 R;5 & @ Y.......,.;h T M.%:',-i.~.? K +- $.:

m. .??.... b;f..?Wi@t)$$ib.%k"*f. . -l : : Q ff,ii;.',Qr fM.us :.:m$.~zu.; %u. s, ~ ' my;.s ~ ..;.F:u. i; y, +y..g

t w.Tn,;y<y;,..,s.a. m, ;:

2. "

m.,t. p ;.

r ,.y:.$,,,%,..-a;.y. y.. u n ~. x.. vi ..v mp. _. w,.. -a

1. ;.'.4.' ihf.; t.-e'.M$.4.,. yz c%. a e -

w.. x.s - m~ _~kd. Qj.-S.d.c.. i ?3y'.l. .:,s.s, - a ywa a -... m,.e.- = y m .c. c.w ;z ix; m... :. ~. --

y BERNARD L COHEN e,69 .t s

U %..

rehtes with radiation dose such as exposure to i .i ~ ..? 3.* h..' L-usn chemical carcinogens. o t. ,.... 3. s.,,.y s4 One way of decidm.g whether radiation is the r ;.'],.: 2. 7. 2.4, ' ' causative agent is to check for evidence of these .?. h..~ ~tl'-- d j i, 3 f, U' (G-7s) diseases among other groups exposed to radi. / 9-7c< ation. Data on cancer of the pancreas among .[. Y;p;$4f 4.F. a, ; i,2001 Japanese A-bomb sur ivors are shown in Fig.11 ( J'i @j.iQ j y.. o L T along with the single data point from the Han. r {k 1j ford workers [taken from (Gi78)]. and the pre. '.3.> 'g.g 79. t 1 t{ } diction from the MSK doubling dose (CoS0a). x $.e,,f

j. q. g.<. c & ;"

It is clear that the MSK conclusion is grossly . m'n .A.e p'*-4(8.W.j - 'm rm sm 4x sm ..@ /? inconsistent with the A bomb survivor data. J.. l Do3e (tod ) . t The Japanese A-bomb survivor data on mul. 7N 'g,+ N F:c.11. Mortality from cancer of the pancreas among tiple myeloma (Ni73)are much more sparse--4 [",M.frW... Japanese A bomb survivors (black circles), among cases vs 1.9 expected up to 1965-but doub. y Hanford workers (Gi78. open squarek ed according ling dose is of the order of 100 rad which is 30 s,. y. g y ;t:< 9 to MSK (dashed hnek Point labelled (> 200) rep- .vA nV '* N e. a.D.l$ f " resents the average of a!! data abme 200 rad. From times the MSis, doubling dose for bone mar. .' $ d.., $ 1 0. M i%. (Co80bk row cancers. The rate derived for the A-bomb s- '2'3pA%g survivors was 3 x 10-* cases / man-rem. In ?~ 4%. studies of patients exposed in thorotrast treat.

5NT768.$,J,4),

f. J..,

ments, the rate was only 0.25 x 10-* cases / q :f a.s. m :_ p y mortah.ty from cancer; for example, techm..etans man-rem. and among the German patients a y %,f Q.q' l i *..?,.6-. l were exposed to much more radiation than treated for ankylosing spondylitis with 22'Ra. .G: office workers, and they were also exposed to there were 54 bone cancers but no cases of 1 ' j.3;jy..Q," far more chemical carcinogens. Several of the multiple myeloma which corresponds to less - W.r; 2. v 1.

j critics cited above pointed to lack of increased than 0.04 x 10-* cases / man-rem (May79b).

M.i.Q;61, leukemia incidence as a strong point against Castleman searched the X-ray exposure history b Tj ~( jur. the validity of the study. It was never made of multiple myeloma patients, and found no .,';y.?,QJ-:,At.;.P.. ',hv s... dose" as regards the role of natural back. very clear what MSK meant by " doubling correlations (Ca79). .. ~e 9's M... W.: w... cJ . ground radbtion, and in fact the derivation of t u l WF NA... g.M doubling doses below total background ex. MD. Posure has a ring of unreality. j ie l ?. 3:4'3Ryp$.~.: W 3 f. At least two independent analyses were = .s n l M.ipe*[fi ; made of the Hanford worker data used by iu.l 7 g, c

g,. y MSK (Gi78; Hu79), and the conclusions of j

l l l W.Mhr/g., 4 each were that the only results worthy of con. 2 e t, 1 j'%g.$.,.F.~ sideration were those for cancer of the pan. Y l / 34p:/. 3.# c. c-eas and multiple myeloma. For the former i m ~N.. M...... ; l a ; I ~ there were 5 cases with exposures above 10 rad 1 = i er Ae vs 1.4 expected, and for the latter there were 3 Q $yM'3 c,- o , i S Q f. cases vs 0.4 expected (Hu79); for exposures 'a 200 3N ** 5* %,8s.',.,,.. >...' above 15 rem there were 3 cases vs 1.0 expected Dese ttooi

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w- $ffM@g.;,;Op*.... G-for the former and 2 cases vs 0.4 expected for Fac.12. Mortality from all cancers except leukemia

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the latter (G.78). These results are clearly not among Japanese A bomb survivors, and according to

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explainable as statistical fluctuations, although MSK (dashed linet Point labelled (> 200) represents _N.>j. they could easily be due to a factor which cor. the average of all data above 200 rad. From (CoSoak ft..*M,.h.y. ;. rh s,r.'Fs~ Y. W.w :'.. ?" < le c-u.L.

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Tl!E CANCER RISK FROM LOW-LEVEL RADIATION 670 cludes that if there had been no early deaths By very complicated and questionable pro-cedures. MSK derived a doubling dose for all from injuries and trauma in the original bomb-i cancers as 12.2 rad (Man 77). later revised to ing episodes, the cancer deaths from radiation 33.7 rad (Kn78). The latter is shown in Fig.12 would have beer 5 times higher. 7 It is interesting to point out that the Rotblat ~, 1,, along with the data from the Japanese A-bomb effect should be very much larger for the high n survivors for all cancers except leukemia 4 i ) (Be77). Clearly there is an enormous discrep. dose cases than for the low dose cases, since 3 7 ;' fy. 4 ancy here, by about a factor of 30 in doubling the former were close to ground zero whik the -1 dose. It should be noted that MSK make no latter were far away and thus much less hkely effort to compare their results with those for to be directly injured by the blast, heat and 4 s f',,; the Japanese A-bomb survivors or with any of other effects of the bomb (CoS91 Thus. if

r v.t-Rotblat is correct, the data on the right side of

.- *:' 5 the other groups with high radiation exposure. Fig.12 would be moved up by an order of The reaction to MSK of the prestigious .5.;4 national and international groups charged with magnitude while the low dose data would be [' 4 $,~ evaluating health effects of radiation has been little affected. This would give a curve very cool The minutes of the Stockholm meeting of much concave upward. b any case, the effects X 3.' #g P2.3'h-ICRP states "the Commission has concluded of low doses would not be (nuch changed. that the informatica available up to May 1978 The Rotblat thesis has not been accepted by M @, % q I does not call for changes in the risk factor the prestigious evaluation groups, and there M' has been little indication of significant accept-1 4Wr'{ '. given in ICRP Publication 26. The latter was published in January 1977 and MSK was pub. ance by the scientific community. W& '. '.T. lished in November 1977. They made no men- [_ tion of MSK. The UKNRPB (Re78b) report on MSK con- (C) Najarian studies of workers at Portsmouth

f...a N' E cludes: -Despite the claims of the authors, a Navy Yard Nb wide body of experts agree that there is no Thomas Najarian, a physician practicing in NW evidence in the Hanford data to support the Boston, got the impression from discussions with patients, that there might be an excess of P.?

suggestion that ICRP [26] values do seriously leukemia among workers at the Portsmouth fj;,@N, underestimate the risk." The National Academy of Sciences BEIR (NH) Naval shipyard where nuclear ships are .,;2 p @ i Committee 1979 report has not yet appeared, serviced, and suspected that it might be due to Qf but in a press conference it was stated that it their occupational radiation exposure. With bqT)n found "no substance"in the MSK work. the help of a team of reporters from the Boston -Mi Globe, he cearched through 90,000 death cer-f,'y E~ tificates and found 1700 former Portsmouth @)i!b. ,1 (B) Rotblat comments on A-homb survicor dataworkers. Of these,22 died of leukemia as com- !].yh5h Rotblat has point:d out that the survivors of pared with only 5 expected, according to the A-bomb attacks on Japan are a select M.'d,$. group in that they survived the injuries and February 1978 story in the Boston Globe; :7-F.- W /J 9 I trauma of the attack (Ro78a). He points out according to a more scientific account pub-that for some types of cancer, evidence from lished in Lancet (Na781 there were 1450 $'D-workers identified, and among these there were .cd.'. i medical patients treated with radiation indi. l NU cates higher risks, and explains the difference 20 leulremias vs 10.8 expected. The latter "' t ? IN-as due to the fact that the A-bomb survivors number is subject to considerable variation ~4 are such a select group. He does not seem to depending on the control group chosen, as rd.,h i 4.WW consider the fact that the medical patients are explained in section 1 above. i Age distribution is also a sensitive parameter D@1 also a select group in that they are aircady (La78), as the leukemia rate increases rapidly f%., suffering from another serious disease. He con-iSfN. l 3 A.1,. *, ) b \\

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BERNARD L COHEN 01 .c 1 ~ f. ~- Q with mereaang age-the average age of Ports-areas of your stud), and the National Cancer h mouth workersis clearly abow the awrage age Institute has repudiated the third"(We791 of all males which includes children. It was not , ~ - .. w. ;.;, ; - 8 explained how the " expected" number was de-(D) Bross re-analysis of Tri. State Study \\ ,s .G r. 7,. ' 1,' ' I rived. It is also well known that rates for Bross and co!!aborators (Bros 79) reported a ...fr J. ?.,.,,.'. J.. l various cancer types show strong occupational re. analysis of the well known "Tri-State Study" -n. ? ; '.. C.).( correlations; in a study in Washington State carried out in NY, MD and MN in 1959-62 . k... / . ~.~, : '[:'fp y=~y'7, I (Mi76), poultrymen were found to have over (Gr66) They emphasize that diferent people .I (.__ double the awrage leukemia rate, and such respond to radiation in diferent ways, and ./. s h _W;. diserse groups as dairymen, bankers and bus attempt to take this into account by consider. -. 3:i,9"Tj.. j "O ^ 3-- drivers also seemed to suEer far abow average ing 5 diKerent categories of people-this mul- '.-, M S M ' M k.* leukemia rates. tiplies the number of parameters available for ' I. Najarian attempted to separate out radiation adjustment by 5. They then consider the triple .'Y[sM,~N {@ ; workers by asking their close relatives whether correlation between number of X-rays received. .:.:. g, W ; 5. m..4. 2 they remembered them wearing Sim badges, a cancer and heart disease. They treat the prob-

7.. -

o O' J.;,,.a:5.W-f.-U l somewhat marginal methodology. He thereby lem with wha: they call a new statistical meth-

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gF which there were 6 leukemias vs 1.1 expected.

They finally conclude that the linear hypothesis i@.M - 6.*$ M Q At this stage, data finally became available under-estimates the efects of low-level radi-4 WW,W9dg, on doses measured with film badges, and it ation by an order of magnitude. ' # QJ W ' N i turned out that only 3 of the 6 radiation Immediately following the Bross article in y A nW u

- 'i-worker leukemia victims had any radiation ex.

American Journal of Public Health, there was a .-d f.fp.?-@ff' posure, and the average exposure for the group scathing critique of it by Boice and Land 4/g g_p_.7,7, was 1.3 rem. This raises the question of the role (Bo79) of National Cancer Institute. It is ironic ~~ of natural and medical X-ray radiation, which that the New York Times published a long

~ '

. 1 i , lJ -J. ;. ; S., ' [c Q' ; the time of his death. How is it possible that no mention whatsoever of the Boice-Land [ [.9* i.. k.' exposed the average worker to about 10 rem by article on the Bross paper (NY79). but made M. L -.' V. ' p,,*~.i I e; f.t 10 rem causes at most 1.1 leukemias, whereas critique. d N..e,]h.:d. .W'y!.I.,.1, %...Jc. an extra 1.3 rem to make the total 11.3 rem Boice and I.and questioned the Bross stat-causes 6 leukemias? No imaginable dose-eEcet istical methodology and method of choosing .. f;... ~.. a- . ; c-relationship could explain such a situation, es. parameters (the latter seems to be highly arbi-R-M"- Tu $ $ pecially in view of the variability of natural trary). They note that there are c!carly too ."~ ~~.I.[ M si'O. % i d~.4, ' @ j. /9. Qty.; radiation with geography which is not corre-many parameters for the Individual values of lated with leukemia rates. M.TQ;$ each to have statistical significance. They point ic)[gp['q~ Y'.@@ j It may be noted that there are many chemi-out that there is a great deal of independent 7dE7 cal carcinogens in a shipyard ernironment, evidence that radiation does not cause heart

O' F.JftJ.

including benzene and other organic solvents, disease; for example, zmong the Japanese .*e'7M' hh3K 1 welding debris and asbestos. A-bomb survivors, there is no more heart dis- +t M Q4. O,4d;1 On 19 June 1979, Najarian, appearing before case among those exposed to >200 rad than .~ '(,.J-d M L j. M y@g'.,' Sen. Edward Kennedy's subcommittee, among those with less than I rad exposure. b..d N,L-10...-Nk.. withdrew most of his claims, and those not They point out many problems in the data . y. C~@ {@ N p% withdrawn were heavily criticized in other tes. collection process: X. rays may have been given timony. As reported in the Boston Globe for a pre-leukemic disease-half of all X-rays .MS which first promoted Najarian's work, a highly were made within the 5 yr previous to develop-Q$lm *4@gh[W p.Md agitated Sen. Kennedy chided Najarian with -I ment of leukemia; most information was ,a. AM don't think we ought to be alarming families obtained from inteniews with relatives, a ~ '.g sg.Nggrgg'gl unduly..we have seen you repudiate two generally unreliable source, with a strong tend- %F'EieW

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THE CANCER RISK FROM LOW LEVEL RADIATION 1 672 out (before and after those dates). Where a per-ency to look for causes; there may well have son's pre-leukemia years were partially during c. been a tendency for interviewers to probe low fallout and partially during high fallout harder for radiation information on those time periods, the re:,ponsibility for the leuke- ~' whom they knew to be leukemia victims than mia was divided proportionately between the d on controls; and the dosimetry was very crude. two. Their results on childhood leukemia mor-I;..,l They also point out that the Bross analysis ta!ity rates are shown in Table 3(at considers only 206 of the 399 cases in the Tri-There appears to be a large excess in the .c c4 State Study, and gives no explanation for not high fallout areas attributable to the high fall ,. ~ ' : ?' considering the others. .". i The National Academy of Sciences BEIR out time period which is not reflected in I data for the low fallout areas or for the total Committee Report considered the Bross paper U.S. If the earlier and later time periods are ..f.' > 4 ;' and reported in a press conference that it found assumed to represent the situation in the no substance"in the work. absence of fallout, this excess consists of 32 The 1979 paper by Bross and collaborators cases vs 13.1 expected, cn- .. is the culmination of a series of previous papers On the other hand, it should be noted that ^ .l'. J'-; re analping the Tri-State Study (Gi68; Bros 72: the statistical uncertainty is rather high. Bros 77). The evolution of these, as well as a enough so that even under the assumptions 9,,, ' preliminary version of the 1979 paper, were used there is a few percent chance that the 4 f'. a critiqued by Rothman (Ro78b) in entire effect is simply a statistical fluctuation. heavily ,d-l-F which he emphasized that the whole approach Moreover, the effect is not so much an excess f,j..:. was highly unscientific. Details of the Bross over the U.S. average during the high fallout l. ' -:-- 1972 paper were critiqued by MacMahon time period as it is a deficiency relative to the p

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Mac72) and by Mole (Mo14). U.S. average before and after the high fallout

1. -.. U.*

y?i (E) Lyon paper on excess childhood leukemia It is interesting to include data for other time period. 25< l :... down-windfrom Nerada Tesr Site childhood cancers as given in Table 3(b). Note 7 '[. a~ -9< mortality from childhood (age 0-14) leukemia the high fallout time period as compared with Lyon er al. (Ly79) reported an analysis of that there was a sharp drop in the rate during ^ '9 # if. @ J 7.4 in Utah, in which they divided the state into the before-after average. Land has pointed out areas of high fallout and low fallout from the q ~ ".].' I Nevada Test Site, and also considered time (La79a) that this drop has about the sa istical significance as the increase for leukemia. N W.J.9.% periods of high fallout (1951-58) and low fall- 'y fp ' :c : *t Table 34at Chsldhood leulemma mcwtahty rates m hmh fallous and low fallout areas of ~ it:.%%-

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Utah and m the U.S. FQures are rates per t0' populatuon. and indicates 2 5.D. ?

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p p< 1944-50 1951-58 1959-75 .b4**hVi Area High fallout 2.12 1.56 4.39 2 1.58 1.96 3 1.23 Low fallout 3.84 e 1.14 4.21 ; 0.70 3.28 : 0 64 3.2 3.5 3.1 C '. -@ ~ Total U.S ~~ j' '.~.%' a ' '..:.;, ' i'. !Wf t: 1,. Table kht ChilJh nni can< ers other than leukemw twe s opti<m Jhr Table ka>)

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1944-50 1951-58 1959-75 .O 4 y. Area ~ 1. ~ P High fa!)out U612.72 3.07 t.37 305 1.60 1 li', *, N I Low fatiout U2 1.25 4.33 0.68 309 2 0.62 M..r.' ~. '., .. u n ' r. ra ^ d Y s.;. m:. ,. a .; w F..

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p' s BERNARD L COHEN c3 ~ . J The Lyon p.tper actua!!3 has littk direct in any case it seerns char that the Smoky bearing on the question of e&ns of low kwl Test experien= sheds no light on the dese-radiation sine there are no data avaibbh on c&:t relationship for low-kul radiat2cr. al-doses. Howewr. the Utah situation has often though a linkap has frequently been impled 4 ~ been cited as edden= for inceased danpr in press reports. .-. IJ.,. i from low kwl radiation. and the Lyon paper is l.' 2'< the on!y one in the scienti5: hterature on that (G) Reported excess kLemia due to will t:ihngs -._..I' subject. There has been widespread publicity in Grand Junction. CO 4 .-/ cy' about edden= for incessed adult leukemia in T"re ABC-TV 'D-20" propam has more .n f:1 Southern Utah (PBS'9) due to falloot, but than one presented the viewpoint that low. T ~ ~-

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none of it seems to be of a quaEty worthy of kwl radiation is much mere danprous than it A..N... ~;. _ '- scienti5c considnation. is pnerally believed to be, wi:h heavy f,7.l> y,. m c 1 emphasis on a report that kukemia rates are . - w-H-35 doubk what is expected in Grand Junction. . m M.L (F) Smoky Ten CO (Cu?!) whee uranium ore-processhg mill

-; Sr;. &,.e, In 1957.32C0 soldiers participated in a tacti-tailings were used in cons: mcicct. The
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cal warfare exercise in whid they occupied an expened" rate is ik Colorado state awrap, m, '-$;Wm area in which a nuckar bomb had been deto-and the result is based on.81 cases n 231 'h nated shortly before. Their radiation exposure expected in Mesa County (which inebdes

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as obtained from film badges a crapd about Grand Junnion) between 1970 and 194 n~f n ". *. : I rem. It is widdy believed that most kukemias an A poup of these men w2s recently studied due is environmental faces, since. fa 'C f., e -/,}. < J and there were found to have been S leukemias examph, the U.S. mortality rate from that div 'f.'+ y" '~p I among them. The number of cases expeced is case hes increased by a fanor of Eve om the M,N'J-A ~,4 poorly known because this is highly sensitiw fast half century, and the rates in dderent

' '. i,;}.'

to their ap distribution whid cannot be states vary by as mud as 30% (with negligible -? reconstrue:ed be:ause reecrds were lost in a statistical unertaintyt it thus see=s re2 son-e 1 '.S'-N,c r,N[ fire in St. Louis. If their awrap ap was 22. able to conefude that there =ay be a kulemo-i only 1.8 cases would han been expected by paie agent in the Mesa County endronment. ~ .g @p 3.;, .y J., now, but if their awrap a;e was 35. there This of course, does not imply that it is ra6- ./j W. 'i', c.c.Q p would be 5 cases expected (Lap?95 ation. ~ If the facts as outlired were ccerect and thee A case.centrol study w2s carrkd cct (Cu?B1

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were S cases n roughly 3 expeced one is famd in which it was found that thee w2s no signi5-(L.}.' I.yq@y.~g*jg with the idea that natural pbs =rdical ex-cant di&res= between the kule=ia deti=s posures of 10 rem (pbs all other causes of kuk-and the control peeps as regards ex;csure to 17 W ~' emia) caused 3 cases whik I rem additional tailings. This would seem to inds: ate that ea-M.Wi:D caused 5 cases. No reasonabk pesen cecid posure to tailings is not the repensihk fa=or. r - 7 e'. beben in sud a dese-e&a relationsF'P, es-Furthe eddence for this is that the pr:ncipal . rep +.M.. 5 pe:ially in dew of the low hukemia rates in expe:ted radiation e&:t fro = =ill tailings is r w. e: .'C 2 states with high natural ba:Lpound. If the b=g caner (due to radon rwienst and there .: 1,;M.,..,.I.-N.,, .. r - extra leuiemias were indeed caused by ra6-s2s no cdden= for an in=rised kwl of Eng .3 4..W ation, there must have been an error in dosi. caner in Mesa County (Cu?SL ai-ans -3 n,5:vc 9'TW me:ry. It has been sus.ps: d that the soldiers Ewn after all of these facts te:a=e known. i M T;. 9 '.;. $., imched may haw inhahd er innsted radioa:- the ABC-TV ~20-20" pres-am ref red to them Pf.~'40.4h tidty; this would not afre:151m bady read-as-inconchsiw* and repeated their assessment '/.... f .5 7 ? ings, so their doses may have been much that miIl tailings are causing larp numbers of

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kukemias in Grand Junction.

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THE CANCER RISK FROM 1.OW 1.EVEL RADIATION e4 has been accepted by any of the prestigious (H) Excess fung cancer near Rocky Hars. CO The ABC-TV "24-20" propam also featured evaluation committees such as BEIR. ICRP. , ~,,y-esidence for increased cancer rates in Jefkrson etc. The publicity giwn to them by the news County, CO in which the Rocky Flats pluto-media thus seems to be compktely unwar-v .-7 ae.,~ nium processing plant is situated. Howewr, ranted. y' n.,4 4, these charges do not seem to be wrified by the .4-statistics (La79), ne total cancer mortality rate a tsmimos or tmcTs or ~ Q ~-,, in JeNerson County is just equal to the Color-We have renewed a peat deal of esidence t ow.t.ts ts. aioimos ., N. ',

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ado State average which is somewhat below -;.1 ',:3 c the U.S. aurage. Since the principal expected indicating that the linea.r hypothesis giw conservatin estimate of the cEects of low lew! effect of plutonium in the environment is lung cancer, statistics on that disease are also of radiation. This leaves us with the pro , i . '..< ;W. estimating risks per unit radiation dose for use Cf' % interest here: before the Rocky Rats plant was with the linear hypothesis. As indicated pre-Ny, built, the lung cancer rate in Jefferson County viously, this is done by analysing efects of ,(, ',.., i. was slightly peater than the U.S. awrage, but \\f.yO in recent years it has been signifcantly below high-level radiation situations. From the .,i ~..,' :*;1 the U.S. awrage. No information supporting analyses, one derives the number of fata ,,4,Q~.Y.[, the charges of increased cancer near Rocky per yr per rem of exposure. However. l fE Flats has appeared in the scientific literature. process of converting these numbers to a life-time risk, there are seseral complications: T. -{ )N-M L .-w 4 (1) Summary on "new evidence ~ ! j::Q* e..f. Ncne of the "new esidence' purporting to (1) Larent period the linear h pothesis under-The mortality rates from leukemia and from v:.;; !.. indicate that 3 . M.: CI..' all other cancers amon5 the J#Ianese A-bomb T estimates efkets oflow lewl radiation seems to ~.r stand up under scientiSc scrutiny. None of it sursivors are shown vs time in Fig.13

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that for the solid tumors the rate was relatively ,s 4,.;.

f-

~: s.M Iow until 1960, 15 37 after the exposure. and then suddenly jumped to a much higher lewl. ,a'. sa c* ?A(.#,Q ~ .. r.w.n .ih..s imah.es that there.is a long latent pcriod , e.6 fE. i e .. : v. u -.%., u, I during which cancers dewlop without present-e-

+I )'

ing symptoms. His must be taken into account e '

1. y; ; g y

l l 7 in any analysis. In many of the high radiation b.. 'yg;g$IIl NNi.i {s j incidents, as with miners exposed to radon or w l g 4* radium dial painters exposed to internally de. 4.:.cr.r -F 1 { r 'I posited radioactisity, the c.xposure takes place i.f.9.~MQ I owr a very long time priod, which peatly I M.7-Q.y &.I complicates the analysis. M Jh*-$, U ~ ~J (2) Duration of risk 1 6 -Wdr.'s.! i f' *c ' *S.k.e.? lW i Once the latent period is past and the risk approaches its full value, one must estimate --~. o.s 33 33 73 n -g,,;dt how long this risk will persist. Dere is reason- .7,rt.+, m, y f Fm.13. Variation of death rates from leukemia and able evidence for leukemia in Fig.13 th .:, p.r:9 '. from all other cancers mith time lor Japanese A-bomb risk falls oK with time and becomes much less f {-t'-14.E neums Exposure was m 1945. and data begin in after about 25 yr. For other cancers, however. i e* c ~ 3'.?M 1950. Ordmate is mortahty rate /10' rad. and error there is little direct esidence en this question. - Q..Qd bars indsste 90 % con 6dence limits. From '1 nere is a general impression that it lasts about (UNSCEAR771 ?.. a .7~ m...*I .7 a x..4+-m 1 1 .- ".T s. - 1 2.'c. %. h <.-m y, 4-- : Mj[..[ $ 2 c;bhD.h,.3.k-p.[];~]!.~ ,i.- ' ?,"J. fiy.$3~.[p &. -[t~* .;-. a *. a : s. y..; :N - L.s,;. ;,y%y... _ - - - 7. s. v.; ,y. W.:'r q~...c %..,... 1,..y =. n.',.. ;.....s : ',.2 4 ~~',.. w ~ m: e.' :.s %. s,.,,,;. T. .:..* -a =.. ., n. %c - p' : 2 ;. - w.... : ;.n t ... ; ' p > m.~p- .u.-- 7*-~ ~. ~~. a2 1. e, n.w. 7.7 t-y- ".. ~ 1 .,; V ~ - n. s-s w p.,. ;,. - N ?. % --Tu a ;~y '. ' p.. W'..,.... ; .L. o - . r.x.. .,* ~ w 7 xn, 4 ,.s..:., ' n.- .'t.- .e ' L % :. ~ s;. L=, ; ' w ~::.& .n - -;,,; r " e ~ 3' ;*-= s'. %,'.. d;:,;cv.sZ.,-;,,.;;;.'z.R.c.y.QQ. j;'. ygQ ,y.

.o BEkNARD L COHEN 6'S

5. m.

'3 .,...-..'..,4 g4 gj .,, g j .~ Jupuncsr A.humb suruuors of turnes eyes ur time of esposure. Datu ar from (N AS721 e ,3 m . [, [. 3 Approunate ",

7.k '

f te w7 N *. Age in numter of Average Caws Caws Number / e t h' 1945 subjects dow trem) obwrwd capected 10*.re m.yr fi,s [9. ' O.* * *; +" 42M"'

" C~. S *M.$y-

,4

Gjid" 0-9 5000 III 6

2.1 0.75 M..* ^.TY: c -. / 'i..W.t r/- - 10-19 5500 157 25 16.9 0.72 ! **r ;+.M ' 20 34 5500 134 15 63.9 3.1

*i " ? m 5 y jevh*

35-49 5800 I22 286 251 5.4 50 + 2500 106 221 210 5.3 i $ l,'b..*e%;k-];- l

f. 4 ".. '

s hdW ,c ys~. W '.,1?,4,s?;;J;. ; M ' 30yr, and this is often used in calculations. In a reasonable degree of consistency among the N;g, '.p ;, ? -+]-7, most cases. results would not be very much three estimates. ICRP gives less detail than the i IM'h).N lOf. diKerent if the risk persists throughout the other two, so more types of cancer are included N. J r.. *, f,.s.~? I emainder oflife. in the "other" category. / r It may be noted that the " totals", which rep. . 4,. -r.W.Y..,'-i,.. M.. C, A.V W eif M,.~~.,1 ,1 4. M 4'f.%.. (3) Age dependence resent the effect of radiation to the whole body. - fr. '1 There is evidence in Table 1 that young chil. are not equal to the sum of the risks to the i W D[ M - N e y@; W L QC dren develop leukemia at about double the various organs. Part of the reason for this is M[.g-9 adult rate for a given exposure. For other that the totals represent a male-female average, M i -;J.:ty: NGc.,. cancers. the situations seems to be reversed as whereas the breast cancer entry applies to ...j .7. 6C indicated by data for the Japanese A-bomb females only. When this is corrected for, there p. ;';Mf-{.C Q survivors in Table 4 where we see that those is still a considerable discrepancy for the ICRP .;... p-y.X. b.. - exposed as children experienced a lower rate and UNSCEAR estimates. but they offer no ~ ., 1.T-. _.' T, by nearly ar order of magnitude. On the other explanation for it. Actually they seem to derive , ~i -.c ? "*5.,y hand. it must be recognized that those exposed the totalindependently from summing the risks E fQ T.,<,mM i as children nave not yet reached the age range to each organ, and the uncertainties are large m 3 C':W h c. Q.. I where cancer is an important risk, whereas enough to cover the discrepancies. In any case. 4 Table 5 gives the best information available for 4 ange. exposed as adults are well into that age ". 'C' :C c.:j?..ij_ fD. 3 p 2.f.i gl' #;.C those r Because of this, the ratio of observed to estimating eEcets of low level radiation. WfY~d'.. W .1. ' expected numbers of cancers is actually higher An awrage radiation induced cancer i shortens the victim's life by about 20yr, so if % '*.7,J.%.Jf!/ 7". M;),gW.RD' among those exposed as children. It is an open question as to whether this high ratio or the we adopt the BEIR estimate,1 rem reduces life P'"2.46.9 low absolute incidence will persist when those expectancy by 180 x 10-* x 20 7 = 1.3 days, 3 = i.3 5.- M Q ( $. r d exposed as children reach the age of high nor. Tobir 5. Estimares ofcanc<r risk per 10* rem [y .

k "ti. %

fnal C3nCer risk.

V.<..N6. 7 Y:.f.Y. c 1 gN. F.2 i in treating the problems of latent periods. tralwanon groups (NA572. ICRP77: UNSCEAR77) R

,,,,,,,,, y,1 g,3,,,,3,,,,,.,,,y, $,ygh,K'...%/ duration of risk, and age dependence, one can Type of cane BEIR ICRP UNSCEAR W @h'.bi *.%.i adopt models (NAS72) or use piece meal estj. fr; ;j-R y.

nates (UNSCEAR77). In either case, it would w,,;,

25 20 1 5-25 $j (C:p;l:*f. ;CSI.t. I be unrealistic to expect any high degree of ac-1.ung 39 20 25-50 ,N.*/,[Of"-g euracy. Moreover, data from diKerent high y gemale) j ,60, B' 25 .([.1/4' a%.f.h!~TM 4 radiat on dose situations are often inconsistent-c.l iraci 30 25 5 5-15 - pf-as may be seen from Table 1. Thyroid ' ;p.@a.y. a.#6: e@ ' .KQr:'O. Nevertheless, BEIR, ICRP and UNSCEAR m her 30 50 45 I -n..., r

. c. M.e_* &. F e..s d. ; have all given estimates of age-averaged risks. tow 180 100 120 g.;. T.w " M;f'- $ # '.r_l '

f These are listed in Table 5. We see that there is h'A v.e aF Mi

* $ 'l-1E; ^'*

G .x:. e 1 7y., Ms '-d' fi.* * ' ? w-;;

...(***,.

L }.'..'.

a. ' e.

/f ' ,.~.!;. ~.,;. .g e. ' ".'..;

m..

w c. ~ *j, -; Y A. N -R -.,p.., ~. ~-+" ;.a, J ! ', - ~~-4.~.,

.~

9 , % m ' f ** + et * 'f ,e 4 ..,e.;.* '*,f., . *. p:

',a a

g 5.* '.,.

t* ' i **.. ".,' +

f* f.,.. r y....

iW,* *. t '[o. da,. a *j' 4.,**,;j
y. ;;. ^;,.,,. ". *. ", i 1

,".,. ' *., M;, **S.,,. - g , j.,'. ..,,.q,,

j,f,j 2-

,., * *...~** .-~ ... *...,.s '\\% s,,

e.

, *~.h

'(*

6' a

" &,Q. m ~ y,;

35i' .. *^ .t

'. ~

.L. f..{my; i.; ?A$ ~.

f;.
s.y,_g :.4fgy;ay g,_. ::.':g.,.:;, py y?...

s..

,.

n y,,.; y(. ' gr,

_ ~ ~; ; ,e.. L,. i,. v; ~~.;. L;...;;.*,,,, %,2,..

f, p THE CANCER RISK FROM 1.OW.I.EVEL RADIATION J 616 ..."L.. Tahle 6 Deashs from ra*>ous causes amona surrrsors e{ A. bomb ersacks on deaths 1950 'A [urpr* Inne) and rataa of these to the e.umbes espected nr she absence of ral.au

U ?.

column n she obwred etpected ratwfor the three kmhest Jose groers bnded by she obsess ed espected , - ~ ' ". - -., exposure group. Data a*e from iBe771 ^ .,.-g. Radtation dose re:ened trad) ~ ,l " fi:+"*'i. l 0 1-9 !!N9 50-99 100.I99 200 299 300 $99 400+ 200+ C ~ Docase T.' '.',,; ~ 'L.; 4 : .}.~ Leuterrua 31 23 20 7 16 15 12 20 17.5 .. ~ a 0.50 062 0 76 0 96 18 5.9 10.3 12.6 JW Other cancers 1556 881 704 202 159 to 21 58 ~Q 9$ 0.97 a97 I.02 LO3 1.14 1.39 1 05 1,58

.; i.'.G '! ~

J Ali non cancer 6M7 3652 2684 747 513 202 91 149 .w7-2ts; 0 1.01 LOI a99 a97 E97 Q95 492 1.11 N.."',M**F Cerebrosascular 1891 1080 800 228 !$9 57 27 35 0'*, ~* y s'$- -r - l.01 1.01 0.99 a99 1.03 a92 a94 0 89 8$U* A.i

. *'* U['"

Circulatory synem 1264 704 534 179 98 39 23 24 1 01 l.01 0 98 a98 1.17 a% 0 97 1.23 a93 'C ;13.R.:; Z Blood and blood. 40 23 23 7 9 6 3 6 D6 ~ '

- 1. ?"

forming or8ans a77 0.81 1.05 L12 1 04 3.19 3.59 5.44 Q =>l Digestive sptem 700 30 293 79 58 27 5 21 g 2 . ~ ' ' l.02 0.97 1.00 R95 1.01 1.16 0.47 1.40 .r;.Or,.g*..g: 4 i.' V5 ; Oe - Other natural 2059 1154 798 204 140 57 24 48 Ob, 2-4,. I.045 1221 0 94 a85 0.88 QI9 all I"O ."i.",U ^ci "' -!O'. causes Acodents. possens. 546 324 195 63 46 12 6 18 OI3 Y ~ 4 7 ? D "' W nolence 1.03 1.03 R90 1h4 197 0.57 0 64 1.37 fy ~, "Y ; Suic>de 183 122 50 22 15 1 0 2 gg 1.09 1.18 a71 1D9 0.91 al3 0 0 44 '. :... W *.

a........ ;

M W w.C One mrem then reduces life expectancy by esidence on leukemia and other cancers.

4. -[;. 'j' P.'E/.,

2 min. B; way of comparison. smoking a single see that, with the relatively minor e diseases of the blood and blood. forming -y.. Tc. TGi-yj$m ' cigarette reduces life expectancy by 10 min and organs which are closely relate .f [..J7j7;;7 ' an oserweight person reduces his life expect. there is no indication that any somatic effect r W..WMW,% ancy by 15 min for each extra 100 calories other than cancer is related to radiation. in sted (Co79a). M-..M..-q-@$g3.?' ' With present technology. Iow level radioac-Q@v.:sj .'a,. r. Q. ' tivity releases if all U.S. electric power were d strtarsets nuclear are estimated (APS78; Po76; NRC76a; Andan T. W.1978. NestrA Phn 35,743. M M;8 %. M. -T M i UNSCEAR77) to cause an average population

t. * ?- r An?8 Ar74 Archer V. E,54ccomanno G. and Jones J. H.

exposure of about 0.2 mrem /yr, or 40.000 man. 3974 % g g 3.t.,.%q? N,..g;0 '_, t~< , gg. rem'yr in the U.S. This rmght then be expected APS78 APS (Am. Phn Sock Study Group oc r. e. -.- * '.) 4M W.f.-Q 4.$', to cause 180 x 10-* x 40.000 - 7 additional Nuclear Fuel Cycles.1978. Rec. Mod Phys. 50, (11 Part 11. January.

i..,

cancers per yr among the public. This corre. Be77 Beebe G. W. Kato H. and Land C E, Ra6 Mdc@6NY sponds to a loss of life expectancy for the aver. ation E5ects Research Found Rep. RERF TRI.77, N2 4 R. Bo79 Boice J. D. and L.and C E,1979. Am. 4 P6 p* y" * $r6*/., ' age American of about 30 min. which r@ 3 G. %. t resents a risk equal to that of smokmg one lie Heahh 69.137. ~19.M f* d cigarette every 20 yr, or of an overweight per-Brod78 Brodsky A,1978. Testimony for U.S i Y $ N@ M of Representatives S;.bcommittee on Health and i"s son gaining an additional 0.01 oz. the Endronment 8 February. There has been speculation as to whether Bros 72 Bross L D. J. and Natarajan N 1971 Neu f '.p?;N8. 'py.".g. W.c ' radiation causes diseases other than cancer m 1 Mel 287.107. P -.- r.y those exposed. The best evidence on this is Bros 77 Bross t D. J. and Natarajan N.1977, J. An .,.pgry.gy.-{ from the Japanese A-bomb zurvivors. which is y,4 Assoc. 237. 2399. _. Mg(.Q:,M.f. listed in Table 6 and compared there with the Br76 Bron 1 M,1976. Heahh Phn 31. 231. g..e.f; Gall.- yf l.'.10 - l:... ?. ory1 ..,. n...x ~.... ,r p.-s v,. ~ ..;= p.. & ; ' ',..%., :7.;.k.. ;g?. e, %, '... ' ; 3 ~~. J:, f}.-..,:.. i'. *. : : -:q.3,. y ..? *t

:, %. f..f.... e..{ :
c.'** % *y: y 3 t.

...v.

.'7 ,.:;= C~z*}q.~t:,s [. .,. y.,, "gg a Q; - .~ ,- ;..~ - - . y,; ;,.....~. ~ :.~. ?.-. .. c.,.. : -.. g. 5... *..v.,..,:...., t ..~:. ' ? - ..s_ -2 ..o a

y..,

Q * *...,. ..:.:< :'.' f,,",'.:.* L. : %.. G . ~...f * ~~;.. g p 4.,..,,... r,, -;... y,.,.. a e s. m -,. . e....., g. ., y s.. y _. 4.s..3y-u,~.. a,4...... wr*N.. ..o<a

-2

BERNARD L COHEN 677 e 1. ' ['f.' /-. Bros 79 Bross 1 D. J, Ball M. and Falen S 1979 Gr72 Grahn D Fry R. J. M. and Lea R. A 1972. s'. .C 'a ~~ ~-- An J. Public Health 69,130. in: Lsfr Sciences and Space Rncarch. Vol. X (Edited f -b. Bu68 Burns F, J, Albert R. E. and Heimbach R. D. by Strickland A. C)(Berhn: Akademie.Verlagt ..[ ,I'...

},

1968. Rod. Res. 36,225. Hul67 Hulse E. V.1967. Br. J. Cancer 21. 531. Ca79 Castleman B,1979. Private communication. Hug 69 Hug O. Gossner W. Muller W. A. Luz A. .',.E'.'- Co78 Cohen B. L.1978. Health Phys. 35,582, and Hindringer B,1969. in: Radiation Induced , ~ ~.3, ( -. q. Co79a Cohen B. L,1979a. Bull Atomic Scientists Cancer, p. 393 (Vienna: lAEAL - -. A. J,,,f 51 February. Hut 79 Hu:chinson G. B. MacMahon B. Jablon S. 1 Co79b Cohen B. L and Lee L S.,1979b, Health and Land C E,1979, #calth Phys. 37,207. .y, p - - '~ 'W,;-. Phys. 36, 707. ICRP59 International Commission on Radiological _; _2 Co80a Cohen A. F. and Cohen B. L,1980. Health Prote: tion.1959 " Report of Comfruttee 11 on Per- .f :" - Phvs.38,53. missible Dose for Internal Radiation", ICRP Publi-1 .._ ' J Co80b Cohen B. L,"The Low. level Radiation Link cation 2. (New York: Pergamon Presst to Cancer of the Pancreas", Health Phys. 38,712. Ke72 Kellerer A. M. and Rossi H. H,1972. Current

, ' C - j -j,.

Cu?8 Cunningham M. C, Ferguson S. W. and Topics in Rod. Res. 8,85. 3 .e... Foreman T,1978, " Excess Cancer Incidence in Ke75 Kellerer A. M. and Rossi H. H,1975, in Mesa County. Colorado". Colorado Dept of Health Cancer (Edited by Becker F. F.L Vol.1, p. 405 (New 7'," ~. 2,_ Report. November. York: Plenum Presst ~ p c,- - J i.- Do69 Dougherty T. F. and Mays C. W,1969, in: Ki73 Kitabatake T, Watanabe T. and Koga S.1973. i ;i ;.r. R' Radiation Induced Cancer, p. 361 (Vienna: IAEA L Strahlentherapse 146, 599. .. '. " ~. - J. " E167 Elkind M. M. and Whitmore G. F,1%7, The K178 Kleitman D. J.1978. " Critique of Mancuso. 3 c.,g M M "" Radiobiology of Cultured Mammalian Cells, p. 219 Stewart Kneale Report". Submissic,n to U.S. Nucl. ,,4.j 3 f4.A,1 (New York: Gordon & Breacht Reg. Comm,2 March. i ,0~.~.S.i r:~f a 1 E177 Elkind M. M. and Redpath J. L, in: Cancer Kn78 Kneale G. Stewsrt A. and Mancuso T. F., e..:. (Edited by Bicker S. S.L Chap. 3, p. 5l (New York: 1978. IAEA Symp. on the Late Biological Efects ..230U.. Plenum Presst of loni:mg Radiation. Vienna. March (Vienna: - ' ' '. i.kt: Ev 74 Evans R. D.1974. Health Phys. 27,497. IAEA1 ,- [.'~ Q ' ~ Fi68 Finkel M. P. and Biskis B. O,1968. Prog. Exp. Lan?9 Land C. E,1979. New Eng. J. Mrd. 300. 8. ." m::. ?,&??;.T.\\, Tumor Res.10, 72. 431. 3 hJ.D.f. 4 Fi69 Finkel M. P, Biskis B. O. and Jenkms P. B. Lap 79 Lapp R. E. The Radiation Contro:rrsy ).0, M.~: ' in: Radiation Induced Cancer (Edited by Ericson (Greenwich. CT: Reddy Communicationsk 14Til' _', M, j a'- A.L p. 369 (Vienna: !AEA L Le55 Lea D. E.1955. Actions of Radiation on Laring 5 d.~ 72.O.,1,.S Fo73 Fox B. W. and Lajtha L G,1973 Br. Mrd. CrIls (London: Cambridge Univ. Presst j- -....G( m. < :,.f..c,'y ( " ' Bull. 29,16. Ly79 Lyon J. L. Klauber M. R Gardner J. W. and Fo77 Fowler J. F. and Denekamp J. in: Cancer Udall K. 5,1979. New i.ng. J. Mrd. 300,397. [' --M'c.$%g: 'T$ (Edited by Becker S. S.k Chap. 5, p.139 (New Mac72 MacMahon B. W72. New Eng. J. Mrd. 287, .;. ' - mi r..,. ;. York: Plenum PressL 144. . 5 V.] M,'J :* - Ge78 Gertz S. M,1978, Health Phys. 35,723. Mal 69 Maldague P.1%9. in: Radiation Induced f ?. - : ' -- ?.m - N. Gib68 Gibson R. W, Bross L D. J, Graham S., Cancer, p. 439 (Vienna: IAEAL i S_?".~ @id-(* ** D ; M: Lilienfeld A. Schumar. L M, LeWn M. L and Man 77 Mancuso T. F., Stewart A. and Kneale G, J. ;- . Q.'-' Dowd J. E.1968, New Eng. J. Med. 279,906. 1977, #calth Phys. 33,369 (referred to as MSK1 f_ G.". W ; p %.g C s-?.p Gil77 Gilbert E. S,1977, -Methods of Analyzing Mark 78 Marks S Gilbert E. S. and Breitenstein ,. g* 4 Mortality of Workers Exposed to Low. levels of B. D. " Cancer Mortality in Hanford Workers",

?W lonizing Radiation", Battelle Pacific Northwest IAEA Document IAEA.SM 224.

,d. 'll- ,hl*Cf'I' Laboratory Rep. BNWL-SA.634. May. Mars 78 Marshall J.,1978. Argonne National Labor. > Q Ib Gil78 Gilbert E. S,1978. Testimony for U.S. House atory. Private communication. ..,,K'u '3G e W.* 1 7 7n of Representatives Subcommittee on Health and May70 Mays C W. Dougherty T. F. Taylor G. N. a ,... J/.' e W.'..c the Environment: also available as Document Stover B. J, Jee W. S. S Christensen W. R. L:{.Q &,%[Q M.h *. I PNL.SA.6341 Rev. Dougherty J. H Ste; hens W. and Nabors C.1970, Gil19 Gilbert E. and Marks S,1979. Health Phys. Hrarings on Environ. Efects of Producmg Electric

,;, G Q #~.el 37,791.

Powrr Joint Corrt on Atomic Energy, U.S. Con- 'Mi D. 4 - ". *[.

M-N.~"LP Gr66 Graham S, Levin M. L, Lilienfeld A. M, gress. Vol. Il Part 2, p. 2192, f

i l Schuman L M. Gibson R Dowd J. E. and Hem. May72 Mays C. W. and Lloyd R D. in Biochemical m. -. j.N.. #M..' V 3h, pelmann L,1966. " Preconception. Intrauterine, Imtilications of Radiostrontium Exposure (Edited by i.C ', */ and PostnatalIrradiation as Related to Leukemia", Goldman M. and Bustad L K.L USAEC Rep.

.p. 4 h ;3% k d..

Natl Cancer Inst. Monograph 19, p. 347. CONF.710201. p I.'* 5.5 h, n..:.v.e ,.w,,. =.w s 2c.::s..;.e. v,.. e a.... ;J ~ .:..... 9 i u .. r.: .b) [' r +5 [. i j* 0

c. n.5mn..m r..m,;..:.*:m: -'.s.:.w+ :<..;c : ;..'

t

~

t .;,;w -? ~ ~- l, .,y p:. -c.:n.., :~ m;w.;;.:- ff. m

2 *,. n. c..,

L-

' % n.,s y?..p ~,. m :; n w.. 4.,,. M-:.y ~f::,.y:t ~ r

's-n,y--;.:..:p;y

, v... e. -

~ -.

-wc.

>= 4 4,:. -

... s -p. s... v y",; L. s

..,y..

.c. .~r y.,. w a. [..l'5 1 $ 5_;' .A Nb..- M.;.'. a m. >.: -;-.: a,r..... ~, ---s.- s ~:y = :- 9 ~~ l

c ~ - - l } THE CANCER RISK FROM LOW LEVEL RADIATION 6's Rotb's Ro<blas J.19't B.?L Arcesc Sarwints. kp -. q.,., May34 Man C W. Sperts H. and Gerst.ach A.

.ter.

Rothman K. J. 197L -Renew. of Dr. /'.~.,.J 1978. Hra!rk Fhrt 35. 83. 8 koth73 Mays C W.,197!. -D:scussico of Pbto. truut Bross' Prmstaten on Ra<ia:en Ea-esare M.*;.;. May3b '.- a '4 nium Toucity, Proc. 53mp. Natl Energy lames and Cancer Risk *. Ui Nac5 ear Reg. Cora g. 2@., c ' (Eited by Sachs R. G4 Argonne Nancesal Labora. 7 Apeil Rubcaste:n D.19't Report to US Nr. dear tory. Septembe. ... g.," May? C W. 1979, h eenne National R: b73 Regulatory Comm:ssica. May?9a '...,;,J1; _ l La%rasory S.imA on Naticetal Energy Iswes Rus*2 Russell W. L.1971 ' Pea:eful Uses of PLromwn er a Test Case (Edited by Sachs R. G L Alces Enern'. I AEA PAcanon ST! PUB 1.%0. '7*

?

Vol 13. p. 487 F--nna: l AEAt p.127 (Ba!hnper Presst Map C W.1979. Priv2te commuscanoe. Sag'3 Saysn L A.197L 'Les Lese! Raiathm ..* ' 71 t ,. ; l. May'9b McGrath R. A. and Wi: tie R. W.19M. E5e: s:The Manarso Study'. EPRI Report: Arom '. P l Mc66 Naturr212.534. 262. August. Miihrn S.1976. 'Oe:upational Mortality in Sanders B. S.19'l Hea?:h Phn 34. 521. 1. - + $~i' San 5 Mi?6 ."... ; ;-p. Washin; toc State 19%71*. Report to Des HEW. Sc73 Sch:md E. Rimpe G. and Baad:.inger M.1973. L NIOSH. Cince.nati. April R d. Res 57.2 3

A.,:

Mcie R. H.1959. Br. J. Rdd J:. 497. Shenabarre C L Bend V. P. Apecte G. E. . :c '7.~? Mo39 Sh66 Mole R. H.1974. Sr. J. C.mccr 30.199. and Creniite E. P.1H6. Cmcr* Res. 26. 509. Mo74 Mole R.193. Emccr 193.L $32. Shdaharter C J. Baed V. P. Crodite E P.

r '.

Mo'$ She9 Nanccal Academy of Scences.1972. The and Apcene G. E.1%9. in: R a ur a Indaced . '

1, -f r.;f, NAS72 Ef.rrs on Por.,larms ofEspezare to Low Leeels cf

.. --, y; y. Cancer. ;t 161 (Vienna:1AEAL Spc73 Speiss H and Mays C W.1973. in: Rde . s ' j.: L,. 4 Ims::ng Rdata (Washingten. DC: NASL '. '.5. Naprun T. and Cotton T.19't. Emccr Na3 aw*.de Carrmo9mes:s (Eited by Sandes C L er ai. USAEC Rep. CONF.720501 p. 437. 19'54 10lt NNcn A.19'O. Acro Radel T&rr. Phn Biol 2i #* ' i Spers F. W.19'9. Hee:s Pen 37. '84-Ni'O Sm79 Storer J. B.1975. m. C.mce #Eited by Be:ier .,V

9. 155.

505 ? ' t. ' Nishiy2ma H Anderson R. E Ishimaru T, F. F.1 Vol 1. Cha;t 16 p. 453 LNes York: P;enum '. ' ~ NJ3 Ishida K. Ii Y. and Okabe N.1973. Cmccr 32. PressL Tast G. W. C.1979. Hr.d:& Phn J7. 251. 1.101. Ta'9 NRC 6a To73 Toun C D. S=:S K. C ed Kaplas H. S. US Nact Reg. Cortm.19'6a. Sta5 Coss -.F.,c'r T mttte Report of Nesember 1976. 1973. Rd. Res. 52, 99. U1 Nuct Reg. Comm 1976b. NUREG-Uibnet R. L. Jercipe.L C. Ccsgrose. C E. ' r'gh ~., NRC'66 s UI76 CCO2. August. Satter6eid L C, Bo ies N. D. and Storer J. B. ' 9.' g. J NRC4 U1 Suct Reg. Comm 1978. 5445 Com. 1976. Rd. Res. 68.111 ,,;.. [,..., g-mittee Report of May 1978. UNSCEAR7 Umted Nanoes ScentiSc Com. .,p, i New York Tunes. :: February.1979. -truke. E5e:ts of Atomic Raiauen. 1972. NY79 mutee co mia is Linied to St.a!! Radianon'. Jom:m; Rdieriore f.erfs and E5cers We= York: <J ;,. Pa3 H on. Mr. Justx:e Parker. The it'mdscals f 'U?J'%y-U,N.1 I W Imotry. 26 January (London: HMSOL UNSCEAR77 United Nadoes Saent:fe Commrrier3 'G-W. Public Broadcast System.1979. PBS peo. ce E5ects of Atome Raiance.1977. Jourers m/ PES?9 >i @M'q."g j gram,-Paul Jacobs and the Nucica: Gang'. MarchE"ars oflom:mg Ads aon (New York: U N.1 Q Uptoo A. C.1%1. C.mccr Ra :1. 787. i s.'h* 1979. Pocha E. E. Esztmated Population Esposure Ugl Cpaoa A. C.1%l. Narl Cancer Insnt. Almog. .C, Po?6 Cp64 '^'Y.?? C

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ENCLOSURE 4 e N,str6 Phnes Vol 40 (Febniary). pp.114-161 00ttec78181/0201-0iL!sc2 00/0 Persarnee Pass I,kL.1981. Pnmed is the U.S.A. GUEST EDITORIAL HEALTH EFFECTS OF THE NUCLEAR ACCIDENT AT THREE MILE ISLANP* JACOR 1. FABRIKANT, M.D., Ph.D.t Donner Laboratory, University of California, Berkeley, Berkeley, CA 94720 and Department of Radiology, School of Medicine. Unhersity of California, San Francisco, CA 94102 (Received 8 August 1980) I INTRODUCTION To place this into perspective I shall describe MY ASSIGNMENT this morning is to try to oro-very briefly'what the major sources of ioniz. r vide some understanding of the real and ing radiations are, and how we are exposed to potential health effects of the nuclear reactor these natural background and man-made accident at Three Mile Island. This task is not radiations. I shall also try to discos the an easy one, since it involves two very com-scientific basis of the delayed or late bio-plex areas of scientific enquiry-the biologi-logical effects of ionizing radiations, pri-cal effects of low-level radiation, and the marily carcinogenesis, teratogenesis and behavioral response of populations and in-mutagenesis. To do this, I shall cite some dividuals under stress. I think the best thing nurr.bers to provide a limited understanding for me to do is to discuss our current know-of quantitative risk estimation of the potential ledge of the health effects of low level radia-health effects-radiation-induced

cancer, tion-what we know a. d what we do not developinental abnormalities in the newborn, know-and the potential risks to health of and genetically-related ill-health-and what such radiation in exposed human populations, such risk estimation may have to do with the affairs of mice, men and nuclear energy. To

\\ make this current and relevant to today's

Presented, as Invited Speaker, at the Con. discussion, I shall place all this in the ference on Environmental Regulation of the framework of the events of the nuclear ac-Nuclear Industry: A New Decade. Atomic In-cident at Three Mile Island.

i dustrial Forum, San Franciscu, California,1&-21 However, at that point my task is not Mzy 1980, completed until I discuss with you some Supported by the Office of Health and understanding of the most important health Environmental Research of the U.S. Department effect of the accident at Three Mile Island, of Energy (under Contract W-7405-ENG 48) and that of the mental stress and behavioral res-poputat.of the, individuals and the special tProf sso of adio og S h o o'f Medicine, p0"585 Dr. Fabrikant was Director, Public Health and , ions ltvmg m the area. To accomplish University of California. San Francisco. all this in the limited time available, I have Safety Task Force. President's Commission on the chosen to draw heavily from my personal Accident at Three Mile Island. scientific experiences as Director of the Pub-151 1

i 152 GUEST EDITORIA!. lic Health and Safety Task Force of the biological eNect is called teratogenesis, and President's Commission on the Accident at the health cKect, developmental abnormality Three Mile Island, and as a Member of the of the newborn. Committee on the Biological EKects of lon. Third, if the macromolecular lesion occurs iting Radiations of the Nationt,I Academy of in the reproductive cell of the testis or of the Sciences-National Research Council, ovary,the hereditary genome of the germ cell can be altered, and the injury can be expres-sed in the desceradants of the exposed in. WHAT ARE THE sot *RCES OF IONIZtNC dividual. His biological eNect is called RADIADONS? -mutagenesis, and the health efect, genetic-The major sources of ionizint, radiations to ally-related ill. health. which the general populatinn is exposed in There are a number of other biological and the U.S. are natural background and medical related health efects of ionizing radiation, applications of radiation (BEIR80). Natural such as cararact of the lens of the eye, or background radiation consists primarily of impairment of fertility, but these three im-galactic cosmic r diation from outer space, portant delayed or late efects--carcino-from terrestial radiation in the rocks and genesis, teratogenesis arvi mutagenesis-s soils, and our own internal radioactivity. In stand out as those of greatest concern. This is because a considerable amount of scientific all, the average whole. body dose rate - received by each American annually is~about information is known fron epidemiological 100mremlyr For a given person, the dose studies of exposed human populations and rate from natural background varies with al-from laboratory animal experiments. Fur-titude and geographic location, as well as thermore, we believe that any exposure to with living habits. Medical applications of radiation, even at very Mw levels of dose, radiation contribute similar doses each year may carry some increase in the risk of such to the various tissues of the body. Workers in deleterious efects. And as the dose of radia-nuclear and other industrial activities in tion increases abOve very low levels, the risk which radioactive materials or X-ray of these health efects increases in exposed equipment are used are occupationally human populations It is these latter obser-l exposed to levels of radiation that may vations that have been central to the public exceed background severalfold, and the concern about the potential health cNects of ) number of such workers is increasing. low. level radiation, and to the need of est-i l sblishing standards for the protection of the health of exposed populations. l l WHAT DO WE KNOW ABOUT THE HEALTH EFTECTS OF LOW. LEVEL RADIATION? j Low-level ionizing radiation can afect the %TiAT DO MT KNOW ASOLT RADtATION l cAncINOcEststs? cells and tissues of the body in three im. Cancers arising in a variety of organs and portant ways (Fa79a:Fa80a). First, if the tissues of the body are the principal late macromolecular lesion occurs in one or a few ~ cells, such as those of the hematopoietic tis-somatic efects of radiation exposure at low-sues, the irradiated cell can occasionally dose kvels (BEIR80). Organs and tissues transform into a cancer cell, and after a appear to diser greatly in their susceptibility to cancer induction by radiation. Induction of period of time there is an increased risk of leukemia by radiation stands out because of cancer developing in the exposed individual. I his biological eNect is called carcinogenesis, the natural rarity of the disease, the relative ease 'of its induction by radiatiot., and its and the health efect, cancer. Second,if the embryo or fetus are exposed short latent period. When the total risk of i during gestation, injury can occur to the radiation-induced c.sacer is considered, proliferating and diferentiating cells and tis-however, it is now clear that th risk of in-sues, leading to abnormal growth. This duced solid tu:nors (such as breast, thyroid e i 3 1

4 s 153 J.1. FABRIKANT and lung cancers) exceeds that of leukemia. populations is the relative risk model. The nis may not be the case for the fetus and relative risk is a measure of the change in incidence of a disease caused by an etiologic embryo, however. There is great utscertainty in regard to the agent in a population. It is the ratio of the risk shape of the dose-response relationsliips for in those persons exposed to the risk in those cancer induction by radiation, especially at.not exposed, or it is the ratio of the incidence of a disease, say, cancer, in the exposed low doses. Estimates of any excess cancer risk from radiation at low doses depend inore population to the incidence in a suitable on what is assumed about the nathematical unirradiated control population. form of the dose-response relationship then in any task to estimate the carcinogenic cn the epidemiological and ra/iobiological risk of low-dose, low LET (i.e. X and y-data themselves. There is now emerging rays) whole-body radiation, it must be among radittion scientists some general recognized that the scientific basis for making agreement that estimating the cancer risk from such estimates,in spite of all that is known, lowdosesoflow LETradiation,suchasX and remains inadequate. Accordingly, there is

7. rays, can be approached by using dose-justifiable reason to place emphasis on the response models that are felt to be consistent assumptions, procedures, and uncertainties with the vast amount of epidemiological and involved in the estimation process, and not on specific numerical estimates. This is radiobiological data. However, it is thb en-tweessary, since it must be recognized that certainty.probably more than any other, tat is policy decisions and the exercise of regula '

central to the controversy which has emerged over the potential health effects of low-level tory authority require a position on the, probable risks to health from low-dose radia-radiation exposure. nere is now consideraNe evidence from tion exposure. Since the epidemiological - surveys on exposures to whole body radia-human studies that age, both at exposure to tion at dose levels below 10 rad lack reliable radiation and at appearance of cances, and data bases and dose effect information to sex, are major determinants of radiation-in-derive quantitative estimation of cancer risk duced cancer risk (BEIR80). Furthermore, with any certainty, it may be considered ap-there is increasing recognition of human senotypes that confer increased cancer risk propriate to limit such risk estimation to after exposure to carcinogenic agents, in-whole body doses of 10 rad or higher. Thus, on the basis of the available epidemiological cluding ionizing radiations. studies and extensive radiobiological data, for However, we do not know the role of con-stitutional susceptibility to cancer-induction the lifetime risk of cancer mortality induced by environmental mutagens. Nor do we know by low-LET radiation from a single whole-the extent to which the cells and tissues of body exposure to 10 rad, the estimate of in-the body can and do repair sublethal radiation crease in cancer risk is about 0.5-1.4% of \\ damage. We are aware that reduction in dose the naturally-occurring cancer mortality rate may decrease the observed radiation (BEIR80). For example, if the naturally-effect per unit dose, and that this dose rate occurring lifetime cancer risk is about 160.000 effect affects the risk of cancer induction. cases per million persons, in the general This observation is well recognized in mam-population, the rate is 16%. An increase in malian radiobiology, but the information the cancer rate due to radiation of 10 rad of available on man is insufficient to adjust esti-whole body exposure equal to 0.5% of the natura! rate will result in an increase of mation of risk for it. Dere are a number of ways of deriving 160,000 cases x 0.5%, or 800 cases, i.e. 160.800 total cancer cases will occur. This quantitative estimates of excess cancer risk now represents a cancer rate of 16.08% after from radiation (BEIR72; BEIR77; BEIR79; radiation. For continuous lifetime exposure Fa79a; Fa80s; ICRP66; ICRP77, UN72; UN77). Among the most appropriate for epi-to I radlyr, the estimate of increase in cancer l demiological studies of exposed human risk is about 3-8%.

tu GUEST EDITORIAL It is not known whether dose vates of X-or was from highly damaging neutron radiation. y-rays of about 100 mradlyr. the range of At Nagasaki. on the other hand, w here almost natural background radiation. are detrimental the entire radiation was due to 7-rays. there to human health. Any somatic effects,if they was no significant increase in the frequency do occur, at these dose rales would be ma sk-of small head size at air doses below 150 rad; ed by environmental or other competing the average fetal dose would have been about factors-physical, chernical, or biological half of this value. factors-that produce the same types of Because a given gross malformation or health effects as does ionizing radiation. It is functional impairment probably resuhs from unlikely that carcinogenic effects of doses of damage to more than a single sensitive target, low-LET radiation administered at a dose e.g. more than a single cell or a clone of cells rate of about 100mradlyr will be demon-with a common progenitor, we can predict strable in the forseeable future, indeed, if that a threshold radiation dose er.ists below ever. The problem is, at the present time, too which that effect will not be observed. There complex for our methods of epidemiology, is evidence of such dose thresholds for radi-radiobiology, and mathematics and statistics ation. induced teratoger.esis, but the dose to decipher. However, for higher dose rates, levels vary widely depending on the e.g. a few rads per yr over a long period, a developmental abnormality (BEIR80). descernible carciugenic effect could become Observed dose rate effects may also be the manifest in exposed human populations; and result of multitarget or multicellular causation this appears relevant to problems of occupa-of these developmental abnormalities, i.e. tional exposure and the nuclear power in-cells can repair the dam:ge either by in-dustry. tracellular mechanisms or ce!!ular prr!ifera-tion, provided the dose rate is low enough. WHAT DO WE KNOW ABOllT RADIATION Furthermore, protraction of the radiation TERATOGENESIS? dose over a long period can reduce the tera-There is ample evidence from laboratory togenic effectiveness of any radiation dose by experiments, and to a limited extent in man, decreasing to below the threshold level the that the developmental effects of radiation in portion of the dose received during a parti- !he embryo and fetus are strongly related to cular radiosensitive period of gestation. ft.e gestational stage at which the radiation I exposure occurs (BEIR80; Mi76). Most in. WHAT DO WE KNOW ABOtlT OTHER formation on. such teratogenic effects is SOh!ATIC EFFECTS OF RADIATION? ' derived from laboratory animal studies, For somatic effects other than cancer and 'mainly from the laboratory mouse, but the developmental abnormalities (e.g. cataracts, human data are sufficient to indicate im-aging and infertility), the available epide-portant qualitative correspondence for miological and laboratory experimental data developmentally equivalent stages of do not suggest any increased risk of low-dose embryogenesis in mouse and man. In labora-low LET radiation exposur: (i.e. X-and y-tory animals, some developmental abnor-rays) in human populations (BEIR72; malities have been observed at dose levels BEIR77; BEIR79; Fa79a; Fa80a; ICRP66; just below 10 rad. The most extensive study ICRP77; UN72; UN77). available in the human experience is that of the atomic bomb data for Hiroshima, which WHAT DO WE KNOW ABOLTT RADtATION show that the frequency of small head size MllTAGENESIS? was significantly increased by acute air doses Radiation-induced transmitted genetic in the range of 10-19 rad kerma (the average effects have not been demonstrated in man, fetal dose would be the equivalent of about and it appears likely that adequate infor-10 rad of y-radiation) received during the mation on radiation-mutagenesis in man will most sensitive period of gestation (Mi?6). At not soon be forthcoming (BEIR80). Thus, Hiroshima, about 20% of the radiation dose estimation of the genetic risk of radiation 1 I f i

f t s L !. EABR!KANT 135 must be based on laboratory animal data, and nuclear proliferation and to the parallel in recent years almost exclusively on labora-commercial development of nuclear energy. tory mouse experiments. This necessarily There is no doubt that the events of the entails the uncertainty of extrapolation from nuclear accident at Three hiite Island have the laboratory mouse to man. However, there added enormously to a public awareness of is information on the nature of the basic the potential health effects of low-level radi-genetic lesions, which are believed to be ation. What happened at Three hiite Island? similar in all organisms; and several physical What were the radiation levels? And what are and biological variables of radiation the health implications, the radiation health mutagenesis have been experimentally effects, to be expected in the popubtion liv-examined in considerable detail. For these ing in and around the area of Three Mile reasons, some of the uncertainties arising in Island? the evaluation of somatic risks-carcino. Under normal conditions, and in the ab-genesis and teratogenesis-are absent in the sence of any additional nuclear radiation, the estimation of genetic risk. 2,163.000 persons living within a 50-mile The current estimate of the incidence of radius surrounding Three Mile Island would serious human disorders of genetic origin is each receive about 116 miem/yr, or an annual about 10.7%, or about 107,000 cases per mil-co!!cetive dose (i.e. the average yearly dose lion livebcrn offspring (BEIRS0). Estimation summed up for the entire popubtion) of of the genetic effects of radiation must take ~about 440,000 person. rem; about 240,000 into account those which are expressed in the person. rem would come from natural back-C:st generation. and those expressed in future ground radiation. In contrast, the collective generations at the time genetic equilibrium is dose to that population resulting from the reached and the effect is disseminated radioactive releases during the Three Mile throughout the population. In the first Island nuclear accident was approx. 0.5G of generation, it is estimated that I rad of low-the normal annual exposure rate, or about 1% LET radiation exposure to the parents of natural background radiation (Au79; throughout the general population will result Fa79b: Fa79c). in an increase of about 5-75 additional The collective dose to the population is a serious genetic disorders per million liveborn measure of the potential health impact resul-offspring. Such an exposure of I rad received ting from the total radiation dose received by in each generation is estimated to result, at the entire popubtion; for the Three Mile genetic equilibrium, in an increase of about Island experience, the popubtion living 60-1100 serious genetic disorders per million within the 50-mile radius of the nuclear reac-liveborn offspring (B EIRS0). These wide tor site, approx. 2,163,000 persons, were in-ranges of risk estimates emphasi:e the limi-cluded in the collective dose estimate cal-tations of our current understanding of the culations. Sir cc this value is obtained by genetic effects of radiation on human popo-sumtr.ing the estimated radiation doses, lations. However, even within this range of measured in rem, received by each person uncertainty, the genetic risk of radiation is living within the affected area, the collective nevertheless very sma!! in relation to the dose unit is the person-rem. De collective naturally-occurring ?07,000 cases of serious dose to all persons within a 50-mile radius of human disorders of genetic origin. perhaps an Three Mile island during the first 10 days and increase due to radiation equal to much less outdoors based on the reliable thermolu-than 0.1% of the natural rate. minescent dosimetry available was estimated to be 2S00 person-rem. Since most people HOW CAN WE APPLY THtS INFOR%tATION spent most of their time indoors and partially TO THE THREE sitLE ISI.AND EXPERIENCE? shielded by buildings, and assuming that the The heightened concern over the health radiation dose indoors was about three-effects of low-level radiation has been closely quarters of that outdoors, a mee accurate linked to the political developments of collective dose to this exposed population is A e.

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~ 1% G1;EST EDITORIAL estimated to be about 2000 reten. rem. The can:ers and 216.0 0 non-fatal caxerst The average dose to any indhidual in the popu-estimated tscess number of fatal a.d non-lation living within 50 miles of the nucicar fatal canau associated aith the ine ease is reactor plant, therefore, is estimated to be radiation exposure due to the axicar a:- about I mrem (Au?9). The aser:;c dose to an cMent is ememely low, probably c2n.ot be individual living within 10 mnes of the plant measured, and codd be zero, and it sould, is estimated to be about 6.5 miem. Almost all not be possible to detect or to distinpish this s recorded excess exposure abose background excess either in the population or in the in-levels occuned within a 10-mile radius. There diddual. The number of cacess caxers. if was no recordable radiation at levels above any did occur, and probably nor.c wi!h sould natural background at a distaxe greater than be so smaa that it would not be pesdb;e to 10 mDes from the nu: lear plant at any time detect such an incterse statisti: ally in oser during the accident. Thus, an average dose of half a mIEien cancers that would oc:ur in the 6.5 mrem to indhiduals thing within 10 miles population even if the Three MDe Ishad ac-of the nuclear plant is about 5% of the cident had not happened (Ab79). Furthcr-exposure from natural ba:k;rouxi radiatiion more, caxers caused by radiation are no annuany in Harrisburg. PA, and equhalent to diferent from any other cancers resdting that diference of living 2 weeks in Denver, from other causes; therefore, a particuhr CO. The average dose of ahcut 1 mrem to cancer cannot be distinguished as hasing individuals being within 50 mCes of the been caused by radiation. nuclear plant is less than 1% of the exposure Based on this information, we can con-from natural background radiation annually ciude, therefore, that size the total amount in Harrisburg, and equivalent to the of radioacthity released during the n= lear ? diference of thing about 4! days in Demer reactor accident at Three MDe Island sis so (Fa795; Fa79c). sman, and the total popuhtien caposed so What does this mean in regard to the esti-limited, that there may be no addidonal mation of the potential debyed or late health dete: table caxers res 2lting from the radia-efects of low-level radivion exposure and tion (Ab~9). lf therc are any additiona! cancer the pcpulation exposed at Three Mile Istand cases, howeser the number would be so There are three radiation health efects to smaD that it wiIl not be possible to demon-consider--radiation-induced caxer, genetic-strate this ex:ess or to disnnguish these cases ally-related IB-health and devebpmental ab-amoeg the 541,0C0 persous (of the 2 mirion nusmatities of the newborn. population) living wi:hm a SGmDe radius of ; It is estimated that the number of excess Three MB Ishnd, who for other reasons win fatal cancers,if any. that might o: cur os er the oorm2Dy develop cancer during the course of remaining lifetime of the 2 minion persons their lifetimes. living within 50 mDes of the Three MBe There is persuasive scienti5e evidence Ishnd nuclear phnt and exposed to an which suggests that if an average human average whole body dose of about I mrem is popuhtion w ere exposed to I rem (or much less than 1, if any at aI!; a simihr 1000 mrem) of irradiation during their numoer could be estimated for excess non-reproductive life span when they can prodxe i fatal cancers (Ab79). These numbers are children, about 5-75 cases of addisonal estimated to be only a scry small fraction of genetic 2Dy-rehted disetses (such as = ental I the potential lifetime risk of radiation-in-re:ardation or diabetes) might be expe:ted in duced cancer which may arise in this popo-I minion children born to the irradiated lation from natural ba:kground radiation parents (BEI?J!Oh Gened: ally-rehted in-beMth is extremely common in humans under exposure. The estimated number of cancer cases normal condi6cas; about 10.7% of aD lhe from all causes normany occurring in this births are afected Therefore, the ix case ! i population of about 2 million people over its due to 1000 miem of radiatien sould remaining lifetime is 541,000 (i.e. 325.000 fatal represent a very smaD number of cases of k 11 1 3 e I D e e e i

I t J. L FABRIKAhT 157 genedeally-related in-hedth in addition to the Ishnd. The estimated average indhidral 107.000 cases (an increase of only about radiadon dose (perhaps only 1/2 of I mrem) 1/1000th of IG) of genetic disorders expected to the fetus of pregnant women exposed dur-to deselep in that newborn popuhtion. ing the nudear reactor accident oss be!ow During the accident at Three MUe Island, any threshold dose level known to cause the cone:the dose to the reproductive ce!1s detectable cases of developmental r.bnor-of the testes and the ovaries of the 2 minion mality in the human embryo or fetus, or in i i persons thing widin 30 mHes of the nuclear laboratory animal experiments. In adJinon, power plant was es!Imated to be about 2C00 this estimated dose may still be too high. persorcrem, with an average indhidual dose since many pregnant women left the area of about I mrem (Au?9). In this population, within the 5-mile vicinity of the nuclear ;! ant. assuming a 30-yr generation time, we would We can ccadude, therefore, that no cae of nor=Mly expe t about 3000 cases of genetic-developmental abnormality can be expected ally-tm ated iIbhealth zmong the approx. to oe:ur in a newborn chGd as a result of 5,000 live children born each year. These radiation exposure of a pregn2nt wom:n froen cases would c::ur in the absence of any the accident at Three Mile Island (Ab79~). additional radiation exposure and wodd be unrelated to the radiation from the nudear mL47 wA.5 THE SLAJOR HEALTH ETTICT OF power plant a::ident. From an additional THE THREE Stil.I tStMD ACCtDENT! radiados dose of I crem above natural A!: hough no radiation. beslth efects background radiation resddng from the occurred during the nudear accident. and nudear a::ident, we sodd expert about probably no delayed or late radianon bealth 0.0001 to about 0.002 (i.e. abcut 1/10.C00- efects are to be expected, sh:1 emerged 2/ICO2h) additional radiation-induced cases : from this experience was that the cWor of geneticaDy-re!ated GI-health. This ad - heal:h efect of the a::ident appears to have didonal 2!!C00th case is an average number been en the me::tal health cf the peep!e living and is miniscule, representing less than I in in the region of Three Mile Ishnd and of the 10.000.000 !ive birds. Furthermore, this may workers at the nuclear reactor pbnt (Do79). result ultimately in a total of no more than There was immediate, short-thed ment:1 dis-about I additional case of genedcany-related trtss produced by the accident among certain iB-hea?!h in a mi!!!on liveborn children during groups of the general popuhnon lhing within a!! generations in the future. This number of 20 maes of nree Mile Island. The highest additional cases is so small that it can never levels of distress were four:d among adults be detected or disdng.dshed,if it does oe:ur. Iiving within 5 cdles of Three MBe isbad, or among the cases of gene 6:aDy-related iD-sith preschool chUdren: aref among teen:gers health in each generation during 20 future living midin 5 miles of Three MDe Ishnd, human existence. We can condude, there-with preschool siblings, or a hose families lef t g foee, it is probable that there will be no the area. Workers at the Three MSc Ishnd detectable cases of geneticaDy-rebted in-code 2r plant experienced more distress th:n hea!$ resdting from the radiation exposure workers at the Penh Bottom nude:r plant in to the general popuhtion foUowing the Pennsylvania which was studied for com-ac:ident at Three Mile Is!and (Ab79). parison purposes. This distress was higher In the :pprox. 2,160,0^0 people who the among the nonsupervisory em;Ioyees and ni11n the 50 ndle radius of Three M5e condnued in the months following the 2 - !shed, it was estimated, based on vital sta-cident. tistics data, about 23,000 chBdren were born But surprising!y, the main threr.t was not in 19 9. In this newborn popuhtion, about the fear of radianon exposure not the d:ngers 100 chadren would norm 2Dy be expected to of radiadon to health-oot how one w25 be born si$ dese!c; mental abnormalities in. threatened, but who 32s threstened. We have l de absence of any added radiation expesure found. in aR the behavioral studies, that the

s a result of the accident at Three Mae maict =casures cf obje:the dreat stemming i

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19 / GUEST EDITORIAL from the accident were whether a penon was plants also expressed a fairly low level of lising within or living outside the 5-mile concern about the threat of their work situa-radius of Three Mile Island; and having or tion to their physical health. However, wor-not having preschool age children in one's kers at the Three Mile I land plant were more isn "y. For the workers, an added measure of uncertain about health effects than urkers at objective threat was whether they worked at Peach Bottom plant. Household heads living the Three Mile Island nuclear plant, rather within 5 miles of Three Mile Island were than at the Peach Bottom plant, at the time of more uncertain than those living outside the the accident. For teenagers, an added ares. And mothers of preschool children in measure of objective threat was wheier the nree MUe Island area felt more un-their families left the area or not following certain than mothers of preschool children in the accident, because this was a factor out-Wilkes. Barre, the city studied for com-l side the control of the teenagers themselves. parison. Demoralization is a term used to describe Feelings in tha population within 20 miles the psychological symptoms and reactions a of nree Mile Island about continuing to live person is likely to develop when he finds that in the area were mixed and uncertain. Rela-he cannot meet the demands placed on him tively unfavorable attitudes, though still by his environment, and cannot extricate generally uncertain rather than negative, were himself from his predicament. Such sources expressed by people living within 5 mDes of, of intractable predicaments include, for Three Mile Island, and by mothers of pre-example, situations of extreme environmental school children. The only group with some-stress, such as combat or natural disasters, what negative attitudes was those at risk on and physical 01nesses, especia!!y those that two countst the mothers of preschool chil-are chronic. Demoralization is something like dren who lived within 5 mDes of nree Mile an elevated temperature of the bodyt it tells Island. us that there is something wrong, but it does Attitudes toward nuclear power and reac-not in itself tell us what is wrong. tivation of the Bree Mile Island nuclear Demoralization was sharply elevated im-power plants No. I and No. 2 in the general mediately after the nuclear accident, but dis-population living within 20 miles of the plant sipated rapidly among most groups. A sub-showed uncertainty, with a leaning toward stantial minority, about 10% of the heads of negative feelings. Mothers of preschool chil-households showed severe demoralization dren expressed the most negative attitudes. Among people living in the 20-mile area right after the accident that was directly around nree MDe Island distrust of federal attributable to the accident itself. The most demoralized persons were heads of house-and state authorities and of the utilities was holds and teenagers living within 5 miles of high immediately af ter the accident. Although Three Mile Island, and mothers and teenage it was somewhat lower in May, as early as siblings of preschool children. Teenagers who can be estimated, it continue.d to be higher left the area temporarily were more dis-than the average in the nation throughout the tressed than those who did not. Levels of period of the study. Workers' at both the demoralization among workers at the Bree Three MDe Island and the Peach Bottom Mile Island nuclear plant were high in com-nuclear power plants, like the general popu-parison to the Peach Bottom nuclear plant lation, expressed considerable distrust of workers, and in males in the general popu-federal and state authorities. ney diverged i lation, several months after the accident. from the general population, however, in Although the perceived threat to physical expressing generally trusting attitudes toward health from the nuclear accident was higher the utilities. Workers at both the Three Mile in the general population immediately after Island and the Peach Bottom nuclear plants the accident than later on, most people were expressed fairly low levels of corscern about considerably reassured by July. Workers at the future cf their occupation. ney also both the Three Mile Island and Peach Bottom were similar in perceiving people in their l 6 f _-w

L 1. F5BRIKANT 159 communities as, holding less than positive cleanup and recovery presents a special situ-attitudes toward them. Since there was no ation with regard to potential health effects, evidence of a diRerence between the workers since these activities present additional at the Three Mile Island and Peach Bottom sourcet of possible radiation exposure to the nuclear plants on these matters, neither of nuclear workers and to the general population these findings contributes to understanding living in the area. the basis for the elevated level of demoral. The major health effect of the accident at intion among the Three Mile Island nuclear Dree Mile Island was that of a pronounced norkers that continued to be evident in demoralizing effect on the general population August 1979 and throt'.;h Septembe: 1979 in the Three Mile Island area, including when the study ended. teenagers and mothers of preschool children, and the nuclear plant workers (Do79). WHAT CAS WE CONCIEDE ON THE HEAT lTH However, this effect proved transient in all EITECTS Of THE ACC. DENT AT THREE MILE groups studied except the nuclear workers, ISI M D? who continue to show relatively high levels Based on the bes available dosimetric and of demoralization months after the accident. demographic information,it is estimated that Moreover, the groups in the general popu. between 28 March and 15 April 1979, the lation and the workers, in their different collective dose resulting from the radioac-ways, have continuing problems of trust that tivity released to the population living within stem directly from the Tt ree Mile Island ac. ! F a 50-mile radius of the Three Mile Island cident. For both the nuclear werker, and ~ ~ nuclear plant was approx. 2000 person-rems. general population, the mental health and The estimated annual collective dose to this behavioral effects are understandable in population from natural background radiation terms of the objective realities of the threats i ... :c I" is about 210,000 person-rems. Thus, thei in-they faced during the nuclear accident at t crement of radiation d6se to persons living Three Mile Island. ~ within a 50-mile radius due to the accident But what have we learned about nuclear was somewhat less than 1G of the annual reactor safety and health frorn the experience natural background level. The average dose of Three Mile Island 7 ne present scientific to a person living within 5 miles of the evidence and the interpretation of the avail-nuclear plant was calculated to be about 10% able human data from epidemiological sur-of annual background radiation and probably veys can draw very few firm conclusions on was less. The maximum estimated radiation which to base scientific public health policy dose received by any one individual in the for protection standards for low-level radia-general population (excluding the nuclear tion in the nuclear industry. However, even plant workers) during the accident was in the normal operation of nt clear reactor 70 mrem. On the basis of present scientific plants for the generation of electricity, based knowledge, the radiation doses received by on the radiation risk estimates we have been g the general population as a result of exposure able to ascertain with reasonable reliability, to the radioactivity released during the ac-any lack of precision does not minimize the cident were so small that there will be no need to limit radiation exposure in all societal detectable additional cases of cancer, activities involving ionizing radiations to developmental abnormalities, or genetic ill. levels at which the risk to health are accept-h:alth as a consequence of the nuclear reac-able. Nor does, it minimize the conclusion tor accident at Three Mile Island (Ab79). that such risks to health are extremely small During the period frora 28 March to 30 when compared with those available from June thr:e nree Mile Island nuclear workers alternative options, and those normally ac-received radiation doses of about 3 4remt cepted by society as the hazards of everyday these levels exceeded the Nuclear Regulatory life. Commission's maximum permissible quar-But nuclear reactor accidents are not nor-terly dose of 3 rem (AuT9). He process of mal societal activities. Radiation is diderent. d 4 ,w- .-e+1 e-

~ GUEST EDITORIAL 160 lt is gratuitous and self. serving to conclude BEIR77 Advisory Committee on the Biologica j that more people die in coal. mining and oil. EKects of lonizing Radiatiuns,1977 Nationa 1 drilling accidents than in the nuclear energy Academy of Sciences-National Researc! 1 activities. And it is not enough to conclude Council," Considerations of Health B,enefit.Cos Analysis for Activities Involving zmg Radi a['n Exposure and Alternatives,lo that no one died at Three Mile Island. The ,W matters are complex and the solutions are elusive. When compared with the benefits BEIR80 Advisory Committee on the Biologica: that society has established as goals derived Effects of lonizing Radiations,1980, National from the necessary activities of energy . Academy of Sciences-National Pesearch Coun-l production, it is now both apparent and im- . cil,"The EKects on Populations of Exposure to perative that society must establish and Low Levels of lonizing Radiation", Washington, l maintain appropriate standards and seek ap. DC. propriate procedures which continue to Do79 Dohrenwend B. P., Dohrenwend B. S.. assure that its needs and services are met with Kast S. V. and Warheit G. J,1979," Technical Staf Analysis Report on Behavioral EKeets. the lowest.possible risks, both Io Ihe individual m: Report of the Public Health and Safety Tast and to society. Force to ne President's Commission on the Accident at Three Mile Island (Edited by J.1., r Fabrikant), 81 pp. (Washington, DC:- Govern-Aetnowledgements-1 am indebted to my-ment Printing Office ). scientific colleagues who shared in the work of the Fa79: Fabrikant J. L,1979, " Perspectives of l President's Commission on the Accident at Three, Decision. making and Estimation of Risk in I Mile Island and of the National Academy of Populations Exposed to Low Levels of lonizing. ' 1 Sciences-National Research Council Committee - Radiation", in Symp. Epidemiology Studies of. l t on the Biological EKects of lonizing Radiations. it Low-Level Radiation Exposure, AAAS Annual is from their labors that I have drawn freely for Meeting. Houston, TX, January, Lawrence \\ the preparation of this presentation. Berkeley Laboratory Rep. LBL-8M7, pp.1-.80. Fa79b Fabrikant J. I. (Ed.),1979, ne Public ' Health and Safety Task Force Report to the REFERENCES President's Commission on the Accident at Ab79 Abrahr,mson S., Bair W. J., Bender M. A., Drer Mile Island, 7 pp. (Washington, DC: Bloom A. D., Bond V. P...Casarett G. W. and Government Printing Office). Fabrikant J. I.,1979, " Technical Staf Analysis Fa79c Fabrikant J. I.,1979 Summary of the Report on Report of. thi Radiation Health Public Health and Safety Task Force Report to 1 I' Efects Task Group." in: Report of The Public the President's Commission on the Accident at 1 Heulth and Safety Task Force Report to ne nree Mile Island (Edited by 1. L Fabrikant), i President's Commission on the Accident at 32 pp. (Washington, DC:, Government Printing i Dree Mile Island (Edited by J. I. Fabrikant). Office ).' 98 pp. (Washington, DC: Government Printing Fason Fabrkant J. L, 1980, "The Bl!!R.Ill - Office). Report and the Health EKects of Low. level l Au79 Auxier J. A., Berger C. D., Eiunhauser C. Radiation", in: Symp. Nuclear Reactor Safety: M., Gesell T. F., Jones A. R. and Masterson M. A Current Perspectice, AAAS Ann. Meeting San E.,1979," Report of the Task Group of Health Francisco, To be published / Physics and Dosimetry,"in: Report of the Pub-Fa80b Fabrikant L L, 1980, "The' BEIR.!!! lic Health and Safety Task Force to ne Report and its Implications for Radiation Pro-President's Commission on the Accident at section and Public Health Policy," in: Prt>c. Int. nice Mile Islan'd (Edited by J. L Fabrikant.), Cong. IRPA Israel, Lawrence Berkeley Labora. 1% pp. (Washington, DC: Government Printing tory LBL Rep. LBL.10494, pp.1-20. Office). ICRP66 International Commission on Radiolo. BEIR72 Advison.' Committee on the Biological gicair Protection,1966,"The Evaluation of Risks EKects of lonizing Radiations,1972, National from Radiation," A reprt prepared for Com. Academy of Sciences-National Research mittee I of the ICRP, ICRP Publication. 8 I Council, "The Efects on Populations of (Oxford: Pergamon Press). l Exposure to Low Levels of lonizing Radiation," ICRP77 International Commission on Radiolo.. Washington, DC. sical Protectica,1977, " Recommendations of f il I ..n--_1

o,., - e g J. L FABRIKANT 16l the international Commission on Radiological the Efects of Atomic Radiation.1972,"lonizing - Prot:ction" (Adopted 17 January 1977), ICRP Radiation: Levels and Efects" (New York: Publication 26 (Oxford: Pergamon Press). UN). Mi76 Miller R. W. and Mulvihill J. J.,1976, UN77 United Nations Scientine Committee on "Small Head Size After Atomic Radiation", the Efects of Atomic Radiation,1977 " Sources Teratology 14,355-358. and ENects of ionizing Radiation" (New York: UN72 United Nations Scientine Committee on-UN). 1 9' 1 b4 ? 4 \\ l t l = _ - _ - _ _ - _ _ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ __-=--;-

' i '.. 5711 Summerset Drive Midland, Michigan 48640 February 6, 1981 John Ahearne, Chairman Nuclear Regulatory Commission Washington, D. C. 20000

Dear John Ahearne:

Decently I attended the annual meeting of the American As-j sociation for the Advancement of Science in Toronto. One of the seminars that I attended, called " Health Risks Associated with Energy Technologies," included Dr. Reginald L. Gotchy of the Nuclear Regulatory Commission. His topic was " Risk from Nuclear Power." ~ I was so incensed by the complete whitewash of the health' risks of nuclear power that I am moved to write to you about it. One fission product of greatest concera iw plutonium. Incredibly, Dr. Gotchy did not even mention the word. Comparing radiation doses frna Three Mile Island with what people get in Denver every day is also 5rossly misleading. Moni-tors are not going off scale in Denver as they did at Three Mile Island. No one is considering passing out vfals of potassium io-dide to block iodine-131 uptake in the thyroid as they did at Three Mile Island. Dr Gotchy mentioned none of these facts--nor the Commission recommended people around every feet that the Enneny'sium iodide to take in case of accidental re-plant be given potas leases. Dr. Gotchy's In contrast to:/' misleading kind of information on a sub-ject of utmost importance to the people of this country, I am send-ing you documentation that I have received from Dr. Gordon MacLeod and friends in Pennsylvania. Dr. MacLeod was director of public l health of Pennsylvania when the Three Milo Island accident oc-curred, and was appointed only three weeks prior to the accident l by Governor Thornburg for that office because of his exceptional j qualifications for the position. j Dr. MacLeod's attempts to do a responsible job of gathering and making public health data following that accident were re-pressed and he was forced to resign. He has pursued the problem of the serious deficiencies in public health care in relation to The address he gave before the Physicians for So-l nuclear power. cial Responsibility at Columbia University on November 22, 1980 (enclosed), clearly describes those deficiencies and also analyzes the defects and cover-ups of the official position that the Dept. of Public Health of Pennsylvania has taken on the health data re-aa 9/OI:7DOD

.

Page Two John Ahearne February 6, 1981 lated to Three MHe Island. He also points out how negligent the NRC has been in following up health effects data immediately fol-lowing the accident which could have been an important source of data for better public health care following accidents. The NRC is doing a grave disservice to the people of this country by sending out whitewash artists like Dr. Gotchy to dis-cuss health risks of nuclear power. How can you believe you can get away with that type of presentation before a knowledgable au-dience such as you have at AAAS meetings? The fact that the pub-lic at large is routinely given this type of information by NRC spokespersons sickens me. This is a major reason why the public distrusts the NRC and the nuclear industry--they increasingly are i discovering from accidents and severe harm to people to what an extent members of the nuclear establishment are misrepresenting and have been misrepresenting to people the health risks of nuclear power for years. Those of us who study the technical literature redlize to what an extent the NRC is failing to act upon scientific medical information to protect the public as the NRC is charged to do. Dr. MacLeod makes some definite and sensible suggestions for improving public health care in the area of nuclear power plants. I hope you will act on it. While I am sending copies of this letter to all other com-missioners of the NRC, I am not including all the enclosures. I hope that you will make those available to them. Yours sincerely, L:c diY Mary Sin air d l MS/sh i Encis. Cc: Joseph Hendrie Peter Bradford Victor Gilinsky Senator Don Riegle. SenatorsChr1 Levin Congressnan Don Albosta l l l

1f h\\ y%e p n a ne e0tiIiCS Grg ( N %s) 0F PUBUC KDP AD g BY /.) GORDON K. IhCLEOD, M.D., F.A.C.P.** r A NEAR NUCLEAR CATASTROPHE OCCURRED JUST OVER A YEAR N O A HALF AGO AT IHREE MILE ISLNO. IT WAS AN ACCIDENT THAT JUST COULDN'T EMPPEN-AFTER ALL, NUCLEAR POER PLANTS WERE BUILT SO SAFELY THEY COULD NOT POSSIBLY AFFECT THE PUBLIC'S HEALTH. YOUR BEING HERE REFLECTS A CONCERN ON YOUR PART FOR THE HEALTH IPPACT OF THAT ACCIDEffT, ESPECIALLY AS ET COULD RELATE TO THE NUCLEAR POWER PLANT ATIf01ANPOINT. A 0, I C0fi'Et0 YOU FOR THAT C0tlCERN. SHORTLYBEFORETHEACCIDENTATIHREEMILEISLAto,IWASPERSUADED BY THE fGI COVERNOR OF PDJNSYLVANIA TO TAKE A WO-YEAR LEAVE OF ABSENCE FRCN '..E UNIVERSITY OF PITTSBuRGH TO secciE PBJNSYLVANIA's SECRETARY OF HEALE. I ACCEPTED THE APPOINTIEflT Ifl THE SPIRIT THAT PUBLIC SERVICE IS BOTH A PRIVILEGE NO AN CBLIGATION. THEPENNSYLVANIAHEALTHDEPARTMENT WAS PATED BY ONE COLLEAGUE AS SOTH OUT OF 50 AND NEEDED TO BE RESTRUCTURED. $PTER ALL, 7T HAD NO PLACE TO G0, BUT UP. JUST TWELVE DAYS AFTER BEING SWORN IN AS SECRETARY OF HEALTH, I PAD TO FACE THE TMI ACCIDENT, THE LIKES OF WHICH HAD NEVER BEEN THRUST UPON A PUBLIC HEALTH OFFICER ANYWHERE IN WE WORLD.

PREPARD FOR PRESENTATI0fl FOR THE IhM YORK CITY nO OLD WES Y

QMPTERS OF YdYSICIANS FOR SOCIAL PESPONSIBIL[TY ON NOVEtGJR d, 8TH AT COLLIGIA UNIVERSITY INTERNATIONAL [7 FAIRS AUDITORIUM, WO WEST STREET,I!EW YORK CITY.

- PROFESSOR NO CHAIR l%N OF HEALB SERVICES AMINISTRATICU,ORADUATE SCHOOL OF PusiIC HEALTH AfD ASSOLIATE O INICAL PRcF.SSOR 0; MEDICINE, SCHOOL OFMEDICIflE,UNIVERSITYOFPITTSBuRGH,PITTSBURGH, A15261.

2 Il0RE THN1 ANY OmER SINGLE EVENT, IMI P0ltlTED UP VERY ABRUPTLY-f4MOST EXPLOSIVELY-THE DEFICIENCIES IN AT LEAST ONE OF THE NATION'S HEALTHDEPAREEi!TS. BUREAUCRATIC AfD POLITICAL DECISIONS HAD CARVED UP WE PalNSYLVAtlIA DEPARTVBITOFHEALTHOVERTHEPAST10TO15 YEARS. QtE EFFECT OF THE POLITICS OF PUBLIC HEALTH CAN BE SEEN ON THE FIRST SLIDE WHICH SHOWS THE DECREASING PERCENTAGE OF TOTAL STATE DOU.ARS ALLOCATED TO THE HEALTH DEPARTMENT. (SLIDE #1 - PERCBITAGE OF STATE DOLURS TO HEALE) Mial I WAS CALLED APnUT THE ACCIDENT EARLY IN THE MORNIf!G OF IAARCH28, j 1979,WHATDIDIFIf0? THERE WAS NOT EVEN A BOOK ON RADIATION PEDICINE IN WE DEPARTPSIT. WORSE YET, THE PEDICAL LIBRARY HAD BEEN CmPLETELY DISBANDED TWO YEARS PRE-VIOUSLY FOR BUDGETARY REASONS. THERE WAS NO 3UREAU OF RADIATION HEALE IN BE HEALE DEPARTP5fr. IMT WAS IN THE DEPARTMENT OF EtNIRONMENTAL PESOURCES. NO 0FFICE OF l ENTAL HEALTH THAT WAS IN THE DEPARWBd 0F WELFARE. NOOCCUPATIONALHEALE. ITWASALSOINTHEDEPARTMENTOFEru1R0t:'EfTAL RESOURCES--WITH tJO PHYSICIANS ON ITS STAFF. NOR DID THE GOVERNOR HAVE THE CAPACITY TO BRING TOGEW ER PBf4SY SCATTERED HEALTH RESOURCES. DESPITETHEINTENSEMENTALSTRESSDURINGTHE lIil CRISIS,10 ONE FRCM THE OFFICE OF MENTAL HEALE EVER SAT IN ON A BRIEFING SESSION WITH THE GOVEPfl0R. IN SHORTS THERE WAS LITTLE OR to CAPACITY WITHIN THE DEPARTMENT CF HEALTH-t10R ELSEWHERE IN WE STATE-T0 DEAL Wim THE EXTRAORDINARILY SERIOUS HEALTH PROBLEMS FACING US. t

(Slide Cl) i i W i i i i PERCENTAGE OF TOTAL STATE DOLLARS ALLOCATED TO THE HEALTH DEPARTMENT

2.5% -

l 7 I 2% - l f' j 1 i i t P N 6 I i m i m l U .t u { 1,, l .j- 'i 1 '? j 1% - i i 't i l 1 ^ ;< 4 o 1 w 1 H { l l 3 l l ~ L-I H j i m e w i I l ~ u E L i . l l _ l__ [ l i i i I I i 1908 1969 1970 1971 1972 1973 1974 1915 1976 1977 1978 1979 i ~

From 1968 to 1978 the state budget incicased from 2.D16 to 5.886 billion dollars.

j sounct: suac.,a or rascot Anurayanent. Ismsv ar4 Desurernent of loearth r k 1 i s..

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3 THE tentAGEMEllT OF THE ACCIDErlT WAS LEFT--NO CONTIi1UES TO BE LEFT-ALL TOO MUCH TO ENGINEERS Ato PHYSICISTS--N;0THER POLITICAL DECISION. THERE WAS LITTLE OR t10 PHYSICIAN It!PUT BY STATE NO FEDEPAL GOVERtPEllT INTO THE PAf# DECISIONS MADE PRIOR TO THE ACCIDENT. THEREWASLITTLEOR f10 PHYSICIAN INPJT INTO DECISIONS PADE Ifl THE DAYS Iti'EDIATELY FOLLOWING THE ACCIDENT. AfD I A'i SORRY TO SAY, TFERE REPAlt1S LITTLE OR NO PHYSICIAN IrlPUT IfRO DECISIONS t'ADE EVEN TODAY RELATIVE TO THE FRiNETIC ATTEMPTS TO CLEN1 UP RADICACTIVE DEBRIS FRGi THE ACCIDEtT. IN FACT, RADIATION HEALTH PROTECTICil WAS, IS, NO PROBABLY WILL BE DOWNPLAYED UNTIL WE HAVE A NUCLEAR ACCIDENT WITH VISIBLE SIGNS OF PADIATICN DN/ AGE OR UNTIL CITIZENS SERVED BY STATE NO LOCAL HEALTH DEPARTt'EtHS BECOPE SUFFICIENTLY CONCERf1ED TO DO SO"ETHING ABOUT PADIATION PROTECTION. LWS BRIEFLY REVI&I THE EXTENT TO WHICH PUBLIC HEALTH IS BEING IGt;ORED IN THIS NUCLEAR AGE. FIRST LET'S GO BACK If1 HISTORY-TO THE 1950S. Sa4E OF YOU WILL RECALL THE NEAR ECSTASY WITH WHICH A4ERICANS wrLCa ED THE tiATION'S C0441TMENT TO NUCLEAR Ef;ERGY. IbCH OF THE ECSTASY WAS SPAWNED BY THE FROMISE TrMT hE HAD EMBARKED GJ A NEW MISSION "ATUiS FOR PEACE-IT WAS CALLED. A'O TFE PRODUCT OF Tr%T MISSION WOULD BE CLEAN, SAFE NO CHEAP ENERGY FOR ALL. ANDWEBELIEVEDTHATPRGi!SE. AND UNTIL RECENTLY, WE KN&l TPAT fiUCLEAR ENERGY WAS SAFE. OR I SHOULD SAY, WE THOUGHT IT WAS SAFE. THIS TOTAL ASSURAtlCE OF SAFET/ STILL PREVAILS IN 1WN CUARTERS TODAY. BUT THAT ASSURAtJCE OF SAFETY WAS SHATTERED BY IHREE MILE ISLUO WITH POTEtRIALLY SERICUS CONSEQUENCES If1 THE DAYS Ato MONTHS FOLLCWIf;G MARCH 28,1979. I y--... m w

l} IN FACE OF THE RELEASE OF LOW LEVELS OF RADI0 ACTIVITY, IT SEEMED THAT NO OFFICIALS OUTSIDE OF PROFESSIONAL HEALTH CIRCLES COULD APPRECIATE THE POTENTIAL FOR HEALTH HA7A DS FROM THE ACCIDENT. THEYNEEDEDTOSEEPEOPLE BEING CARTED OFF VGi! TING FROM RADIATION SICKNESS. OR,PUTANOTHERWAY-- THERE WAS NO BLAST, S0 THERE WAS NO HEALTH HAZARD. IHAT'STHEATTITUDETHAT SEEMED TO REIGN N40NG N'JCLEAR ENGINEERS NO RADIATION PHYSICISTS. AND MAT IS THE ATTITUDE THAT I CONFRONTED AFTER BEING Sh0RN IN AS SECRETARYOFHEALTH. FOR YEARS, WE HAD BEEN S0 THOROUGHLY IMBUED WITH W E IDEA 0F SAFE NUCLEAR POWER W AT WE HADN'T EVEN ALLOWED OURSELVES TO'THINK ABOUT A NUCLEAR ACCIDENT-LC_T ALONE PREPARE FOR ONE. EVEN WOUGH WE HAVE HAD NUCLEAR REACTORS IN PENNSYLVANIA FOR YEARS, EERE WAS NO REGULARLY EMPLOYED PHYSICIAN EXPERT IN RADIATION MEDICINE IN THE HEALTH DEPARTMENT, NOR N4WHERE ELSE IN PENNSYLVANIA STATE GOVERNMENT. WE WERE NOT PREPARED TO GRAPPLE WITH THE HEALTH CONSEQUENCES OF N'JCLEAR RADIATION EXPOSURE, BECAUSE THE STATE HEALTH DEPARmENT HAD DONE to PRIOR PLANNING FOR SUCH AN EVENT. SHORTLYAFTERTHEONSETOFTHEACCIDENT,IPROPOSEDTHEESTABLISWENT OFADIVISIONOFRADIATIONHEALTHWITHINTHEDEPARTMENT. REGRETTABLY-- THE GOVERNOR'S OFFICE REJECTED THIS PROPOSAL ON THE BASIS OF CONSIDERATIONS HAVING NOTHING WHATEVER TO D0 Wim HEALTH STATUS--YET NOTHER POLITICAL DECISION. DENIAL OF MY PROPOSAL TO STAFF A DIVISION OF PADIATION HEALTH HAS STRIPPED PUBLIC HEALE IN PENNSYLVANIA 0F ITS MANDATE TO PROTECT BE HEALTH OF ITS PEOPLE NO TO PREVENT DISEASE-PARTICULARLY IN CASE OF A NUCLEAR ACCIDENT. ,o---.- y-c, rm-

5 WHAT WE HOPED TO D0 WAS TO ASSIST PHYSICIANS NO HOSPITALS STATEWI IN ADDRESSING A VAST ARRAY OF TECHNICAL ISSUES--MORAL DILEMMS IF YOU WILL-THAT HAVE BEEN THRUST UPON THE MEDICAL PROFESSION BY A TECHNOLOGY THAT HAS OUTSTRIPPED PREVIOUS GUIDELINES AND C0f!CEPTS GOVERNIf!G OUR PROFESSIONAL BEHAVIOR. LET US BRIEFLY CONSIDER THE FUNCTION OF STATE AND LOCAL HEALTH DEPARTI'ENTS IN PLANNING AND DIRECTING RESPONSES TO RADIOLOGIC EMERGENCIES. THE PRif%RY ROLE OF STATE AND LOCAL HEALTH DEPARTMENTS IS THE PROT OF THE PUBLIC'S HEALTH. IN CASE OF RADIATION EXPOSURE. HEALTH DEPARTMENTS MUST GIVE PARA ATTENTION TO ITS EFFECTS ON HUMANS, AND THEY MUST ALSO WORK COOPERATIVELY WITH THOSE AGENCIES THAT COLLECT DATA # D MEASURE CONTAMINATION OF AIR, WATER, SOIL, FOOD--AFFECTING OUR HOMES, OUR CHILDREN, OUR CROPS, OUR AN!fMLS, ET CETERA. IN EMERGENCY PLANNING FOR A RADIATION EMERGENCY, THE RESPONSIBILITY OF HEALTH DEPARTfENTS IS TO ENSURE THAT THERE ARE SUFFICIENT PROFESSIONAL AND ORGANIZATIONAL RESOURCES AT THE STATE OR LOCAL LEVEL TO MEET WHATEVER HEALTH EMERGENCIES f%Y OCCUR, SUCH PLANNING IfNOLVES AN IfNEffr0RY OF BOTH PUBLIC AND PRIVATE RESOU AND THE INITIATION OF APPROPRIATE STEPS TO Ef1SURE THEIR AVAILABILITY IN AN EMERGENCY. l HEALTHPROFESSIONALRESOURCESAREESSENTIALANDMUSTBEREADILY AVAILABLE FOR A RADIOLOGICAL EMERGENCY PLAN TO WORK. IN PLANNING FOR A RADIATION EMERGENCY, THE FIRST QUESTION TO ASK IS WFAT ARE THE IfEEDIATE AND LONG-TERM EFFECTS ON THE PUBLIC'S HEALTH. THIS REQUIRES PREPLANNING USING BASELINE DATA AVAILABLE TO MOST HEALTH DEPARTMENTS. HERE WE CAN CALL UPON MORBIDITY DATA NO VITAL STATISTICS: PRIf%RILY LIVE BIRTHS, INFANT DEATH RATES, AND HYPOTHYROIDISM RATES. w r .~,_

6 s IN ADDITION, PREPIRINING REQUIRES KNOVLEDGE OF MMT HEALTH DATA IS TO BE COLLECTED, OF THE DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION AT RISK, AS WELL AS THE AVAILABILITY OF HOSPITALS, PHYSICIN4S, OTHER MEDICAL ATO LOGISTICAL RESOURCES NEEDED TO HNIDLE A RADIOLOGIC EMERGENCY. SUCH BASELINE REFERENCE DATA SHOULD BE COLLECTED AR00t0 EACH NUCLEAR FACILITY EVEN BEFORE IT IS INSTALLED--ND IN THE CASE OF ItalAN Porta, CERTAINLY BEFORE IT RESUMES OPERATING. IN ESSENCE, THEN, PREPLANNfNG FOR A RADIATION EMERGENCY PROVIDES A DATA BASE FOR DECISION MAKING BEFORE, DURING, At0 AFTER THE EMERGENCY. AT THIS P0lNT, LET ME STATE MY POSITION CLEARLY. ALE QUGH I Ni UNALTERABLY OPPOSED TO NUCLEAR WARFARE, I DO NOT HAVE A BIAS AGAINST NUCLEAR ENERGY. flHILE MANY OF YOU MAY fOT SHARE MY POSITION TOWARD NUCLEAR POVER, I N4 SURE WE WOULD ALL AGREE TO BE PREPARED IN CASE A RADIATION EMERGENCY WERE TO OCCUR. I PERS0k' ALLY PELIEVE THAT NUCLEAR POWER CAN BE MADE RELATIVEL SAFE IF WE DON'T IGNCRE THE PUBLIC HEALTH LESSONS OF THE PAST. IN OTHER WORDS, I BELIEVE THAT HEALE PROFESSIONALS HAVE A RESPONSIBILIT/- AND SOCIETY THE RIGHT-TO KtOV HOW RADIATION ATO THE PRODUCTION OF NUCLEAR ENERGY AFFECTS THE hut %N BODY AND ITS BEHAVIOR INSOFAR AS WE KNOV IT. BUT, WHAT DO WE KNOW? flE KNOW THAT DIAGNOSITC RADIATION HAS BEEN A BOON TO MANKIt0-BUT IT CAN RESULT IN FETAL ABNORf%LITIES. flE KNOW THAT THERAPEUTIC RADIATION HAS PROLONGED LIFE IN MANY INSTANCES-BUT IT CAN RESULT IN RADIATION SICKNESS, INCREASED BLEEDING, NO INFECTION. AND, TO DATE, WE KNO1 THAT NUCLEAR POWER PLANTS HAVE BEEN RELATIVELY SAFE--BUT THEY CAN HAVE ACCIDENTS WHICH RESULT IN PHYSICAL AtO PSYCHOLOGICAL DN4 AGE OVER A WIDE GEOGRAPHIC AREA. ~. me .g ._..y .,u v, m.m

~ l 7 WHAT'S MORE, WE KtDI FROM THE UNITED NATIONS SCIENTIFIC C014ITTEE ON THE EFFECTS OF ATa41C RADIATION THAT THE MOST IMPORTANT EFFECT OF " lod + DOSES OF RADIATION IS THE OCCASIONAL INDUCTION OF MALIGNANT DISEASES." EVEN WITH ALL WE KNOW, THERE IS MUCH WE DON'T KfDI. WE DON'T KNOV MUCH ABOUT AGE-REl.ATED RESPONSES TO lod DOSE RADIATION EXPOSURE, WE DON'T KNOW MUCH ABOUT THE RESPONSE TO ONE-TIME EXPOSURE VERSUS CONTIflUCUS EXPOSURE, AND, MOST IMPORTNITLY, WE DON'T KNOV VERY MUCH AT ALL ABOUT THE PATHOLOGICAL RESPONSE TO THE INTERACTION OF LOW DOSE RADIATION WITH OTHER EXPOSURES. WITHOUT ANY PROFESSIONALLY C04PETENT RADIATION MEDICINE PERSONNEL IN PENNSYLVANIA'S DEPARTMENT OF HEALTH, WE lERE-NO STILL ARE--ILL-EQUIPPED TO RESPOND TO THE EFFEC 1S OF EITHER LOW OR HIGH DOSE RADIATION EXPOSURE FRGi A NUCLEAR REACTOR ACCIDENT. IN ANY STATE OR LOCALE AT RISK OF EXPOSURE TO A NUCLEAR REACTOR ACCIDENT, A RADIOLOGICAL HEALTH UNIT NOV MUST BE DEEMED TO BE AN ESSENTIAL PUBLIC HEALTH ACTIVITY. ANY RADIOLOGICAL EMERGENCY RESPONSE FLAN MUST NOT OVERLOOK POPULATION DENSIT( FOR AT LEAST 20 MILES NO MAYBE UP TO 50 MILES AROUf0 EXISTING OR PROPOSED NUCLEAR REACTOR SITES. IN LIGHT OF PENNSYLVAflIA'S LACK OF PREPAREDNESS FOR A NUCLEAR ACCIDENT EVEN AFTER TMI, THE PUBLIC HEALTH AND SAFETf 0F MILLIONS OF NEW YORKERS WOULD BE AT RISK IF AN ACCIDENT WERE TO OCCURATINDIANPOINT. AS A FIRST STEP TOWARD DEVELOPING AN EMERGENCY RESPONSE PLAN, WERY STATE AND LOCAL HEALTH OFFICER IN THE VICINITY OF A NUCLEAR REACTOR SHOULD LEARN THE CLINICAL EFFECTS OF ACUTE IONIZING RADIATION DOSES. (SLIDEt/2-SUt44ARYOFCLINICALEFFECTS) THIS PARTICULAR CHART SHOWS RADIATION EFFECTS AT VARIOUS LEVELS OF EXPOSURE, BUT DOES NOT INCLUDE ACUTE RADIATION THYROIDITIS OR FETAL EFFECTS. -a. -a,

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SUMMARY

OF CLINICT,L EFFECTS OF ACUTE IONIZING RADIATION D9SES ~ i DOSE (REM) i '~ 0-100 100-200 200-600 600-1000 1000-5000 OVER 5000 1 VOMITING NONE 5-50% 50-100% 100% 100%- 100% 4 3 HR. 2 HR. 1 HR. 30 MIN. 30 MIN. ONSET OF V0MITING l PRINCIPAL ORGAN C NTRAL. HEMATOPOIETIC TISSUE------------ GASTROINTESTIONAL SYSTEM AFFECTED NONE E TRACT NERVOUS i SYSTEM SEVERE LEUKOP$NIA;-- DIARRHEA; FEVERJ CONVULSIONSJ ISIGNS NONs MODERATE LEUK 0PENIA PURPURAJ HEMORRHAGEJ ELECTP.0 LYTE TREMORSJ INFECTIONJ EPILATION DISTURBANCE ATAXIAJ LETHARGY ~ CRITICAL POST-II-6 WEEKS------ 5-111 DAYS 1 '!8 HR. ' EXPOSURE PERIOD PROGNOSIS EXCELLENT EXCELLENT GOOD GUARDED HOPELESS HOPELESS CONVALESCENCE NONE WEEKS MONTHS LONG ~ -- DEATHS NONE NONE 0-80% 80-100% 90-100% 90-100% 2 MONTHS------- 2 WEEKS

2. DAYS Tj.IMETILDEATH

--HEMORRHACEJINFECTION-SHOCK RESPIRATORY 4' 'CAUSE OF DEATH FAILUREJ CERE3RAL i EDEMA ~ i FROM: EISENBUDI ENVin0NMENTAL Ran10AcTivivv. 1973. m + 7 . 7I B e K6 ---'T M4 gggge ggy g4 ,e

8 i NOR DOES IT SFDW LONG TERM EFFECTS ON THE THYROID GLAf0, THE GENETIC APPARATUS, OR THE LIFE SPAN. NOR DOES IT SHOW SUCH DEFECTS AS REDUCED BODY SIZE, MICROCEPHALY, AND MENTAL RETARDATICN. NOR DOES IT SHOW THE LONG TERM CARCINOGENIC EFFECT LEADING TO SOLID TUMORS NO LEUKEMIA. DURING THE ACCIDENT, THE MAXIMUM ESTIMATED RADIATION DOSE OFF SITE WAS CALCULATED TO BE LESS THAN 100 MILLIREM. BECAUSE OF THIS VERY LOW LEVEL OF EXPOSURE, I STILL BELIEVE WE MAY NOT BE ABLE TO MEASURE RADIATION EFFECTS ON THE EXPOSED POPULATION EVEN WOUGH IN APRIL 1979 mE SECRETARY OF THE THEN DEPARTMENT OF HEALTH, EDUCATION At0 WELFARE ANNOUNCED THERE WOULD BE BETWEEN ONE AND TEN FATAL CANCERS AND THE SN4E NUMBER OF NON-FATAL CANCERS IN THE EXPOSEDPOPULATIONTOIIil. IN FACE OF REPEATED HUMAN ERROR AT THE REACTOR SITE AfD ELSEWHERE, EVEN WITH MY LIMITED KfDILEDGE OF RADIATION EFFECTS, I WAS LOATHE TO ACCEPT ENGINEERING ESTIMATES OF THE SAFETY OF TMI. ON DAY WO OF THE ACCIDENT, I RECOMMEf0ED AND ON DAY THREE URGED THE GOVERNOR IN THE STRONGEST POSSIBLE TERMS TO CALL FOR THE DEPARTURE OF PREGNANT WOMEN AfD YOUNG CHILDREN FROM AN AREA WITHIN FIVE MILES OF BE IMI PLANT. BUT-AND I HOPE YOU GRASP THE SIGNIFICANCE OF THIS-THE STATE S RADIATION PHYSICISTS AfD NUCLEAR ENGINEERS DID NOT AGREE WITH MY REC 0FNEt0ATION. LIKE SO f%NY OTHER TECHNICIANS RESPONSIBLE FOR MONITORING BE ADVERSE EFFECTS OF TECHNOLOGY, THEY THRUST THEMSELVES INTO THE POSITION OF MAKIt!G MEDICAL AND PUBLIC HEALTH JUDGMENTS. ON DAY WO, NON-MEDICAL JUDGMENT WAS ACCEPTED IN THIS fMTTER, WHICH INDEED SHOULD HAVE BEEN DECIDED ON NO OTHER BASIS BUT THE PUBLIC'S HEALTH. FlfMLLY,ITTOOKTHEEt00RSEMENTOFTHE NUCLEAR REGULATORY C&NISSION'S CHAIRMAN, JOSEPH HEf0RIE, A NUCLEAR ENGINEER, TO CONV!fCE THE GOVERNOR TO ISSUE HIS DIRECTIVE FOR THE DEPARTURE OF PREGNANT WOMEN At0 YOUNG CHILDREN ONE DAY LATER.

9 .s ISN'TTHATINTERESTING. A PHYSICIAN N O PUBLIC HEALTH PROFESSIONAL WARNS OF POTENTIAL HEALTH IMPACTS OF RADIATION At0 THE WARNING C-0ES UNHEEDED. Il0T UNTIL A NUCLEAR ENGifiEER SUPPORTS THE WARtlING ARE THEY ACCEPTED. CERTAINLY AN ALICE IN W0f0ERLN O APPROACH TO SOUND PUBLIC HEALTH DECISIONS. THE DG1! NANCE OF ENGINEERING N O PHYSICS OVER HEALTH DID NOT FLAG AFTER THE ACCIDENT. $1X MONES AFTER THE ACCIDENT, THE GOVERNOR CALLED TOGETHER SEVERAL STATE OFFICIALS TO PLAN FOR THE CLEAN-UP PROCEDURE AT Pil. NOBODY FROM THE DEPARTMENT OF HEALTH WAS PRESENT. BECAUSE NO ONE FROM THE DEPARTMENT OF HEALE WAS INVITED. MY RECGNENDATION FOR PREGNAffT WOMEN NO YOUNG CHILDREN TO LEAVE THE AREA WAS BASED UPON SEVERAL CONSIDEPATIONS. IO BEGIN WITH, WE WERE DEALING WITH TOO MANY UNKNOINS--NOT THE LEAST OF WHICH STE'EED FRG4 CONFLICTING REPORTS OF LEVELS OF RADIATION EPANATING FRai EE PLANT. FURTHER, VE WERE COMMITTED TO EXERCISItG EXTREME CAUTION IN THE INTEREST OF THE PUBLIC'S HEALTH. MOST PEOPLE KNEW ENOUGH TO BE CONCERNED ABOUT CONGENITAL MALFORMATIONS AND CANCER THAT COULD RESULT FRG1 RADIATION. BUT WHAT THE PUBLIC DID NOT KNOW--NO DOESN'T REALLY KNOW YET-IS TPAT RADIOISOTOPES OF IODINE ARE AMONG THE MOST ABUDNANT BY-PRODUCTS OF NUCLEAR FISSION. lbR DID PREGNANT WOMEN KNOW THAT HIGH LEVELS OF RADIOACTIVE IODINE CAN PAVE SUCH A DEVASTATING EFFECT ON THE FETAL THYROID GLAtO WHICH, IF DESTROYED CAN CAUSE CRETINISM WITH SEVERE PENTAL RETAR'DATION IN INFANTS IN THE FIRST FEW MONTHS OF LIFE. ~ ~ ^ ^

39 THERE WAS At0THER THREAT PRESENT AT Bil-PERHAPS A MORE SIGNIFICAtlT THREAT THAN POSSIBLE THYROID DN%GE, WHICH IS TREATABLE. ASHEALTH OFFICIALS, WE WERE FULLY AWARE OF THE RISING LEVEL OF CONCERN-IN SOME CASES OUTRIGHT PNIIC--NONG THE GENERAL PUBLIC AS CONFLICTING REPORTS OF RADIATION FALLOUT FOUNTED IN THE NEdS MEDIA. WE KNEW FULL WELL THAT FEAR OF RADIATION-HOWEVER UNREASONABLE THAT FEAR MAY HAVE BEEN--COULD CAUSE HEALTH IMPACTS AS DAt%GING AS ACTUAL RADIATION ITSELF. SUCH FEAR CAN PRODUCE REAL PSYCHOLOGICAL, IF NOT, PHYSIOLOGICAL, CHANGE. MORE THAN A YEAR AFTER THE ACCIDENT, A HERSHEY iiEDICAL CENTER STUDY REPORTED A SURPRISING PERSISTENCE OF ANXIETY NONG A LARGE PART OF THE POPULATION NEAR THREE ii!LE ISLAND. THE HEALTH EFFECTS OF THIS DISTRESS INCLUDEDINCREASESOF113PERCENTINTHENUMBEROFPERSONSUSINGSLEEPIllG PILLS AND 80 PERCENT Ill THOSE USING TRANQUILLIZERS. ALSO 14 PERCEtG USED MOREALCOHOLAND32PERCEffTSMOKEDtORECIGARttteS. ELOQUENTTESTIMONY,INDEED,TOTHESTRESSTHATGRFdOUTOFTHEATMOSPHERE SURROUNDINGIIil. IHAVEGONEIhTOSOMEDETAILONTHEREASONSFORREtOVINGYOUNGCHILDREN ANDPREGNANTWOMENFROMTHEIIilAREABECAUSEITHINKIT,BETTERTHANANY OTHER EXAMPLE-POINTS UP A DANGEROUS ATTITUDE TOLIARD PUBLIC HEALTH-- AN ATTITUDE THAT SURFACED ALL TOO OFTEN DURING THE ACCIDENT AT TMI. A THAT ATTITUDE--WHICH STILL PERSISTS-SAYS THAT ENGINEERING EXPEDIENCY TAKES PRECEDENCE OVER PUBLIC HEALTH. I FOUND IT INTERESTING THAT IN TESTIM 0tN BEFORE THE PRESIDENT'S C0fHI ON IIll, ONE OF THE STATE'S RADIATION PHYSICISTS EXPRESSED STR0tJG OPPOSITION TO THE IDEA THAT RADIATIDN HEALTH ACTIVITIES SHOULD FALL UtOER THE AEGIS OF THE PENNSYLVANIA DEPARTMEf6 OF HEALTH. St0 TO DATE HIS POSITION HAS PREVAILED AS I SHALL EXPLAIN LATER.

11 He TOLD THE C0ffilSS10N THAT BECAUSE A DOCTOR WOULD BE IN CHARGE, i HE, AS A RADIATION PHYSICIST IN CHARGE OF RADIATION PROTECTION WITHIN W E DEPARTMENT OF HEALTH, WOULD HAVE TO BE NICE TO DOCTORS WHO OPERATE X-RAY EQUIPMEtU. APPARENTLY HE NEVER REFLECTED UPON THE FAR GREATER LIKELIHOOD OF RADIATION PHYSICISTS Af0 NUCLEAR ENGINEERS BEING NICE TO THOSE WORK!tiG AT NUCLEAR POWER PLANTS. ICITETHISEXAMPLESIMPLYBECAUSEITHINKITEX9FLIFIESANOTHER POLITICAL PROBLEM--AN EXAMPLE OF BUREAUCRATIC JEALOUSY WITHOUT REGAPF FOR HEALTH CARE. DESPITE THE CONSEQUENCES OF RADIATION BOTH TO THE HUMAN BODY At0 THE . SPIRIT, SUCH DEFICIENCIES ARE NOT LIMITED TO STATE GOVERfE4EtU. EARLY IN THE ACCIDENT WE URGED THE FEDERAL GOVERNMENT'S' NUCLEAR REGULATORY COMMISSION TO PROVIDE THE ON-SIE SERVICES OF.A PHYSICIAN EXPERT IN THE FIELD OF RADIATION HEALTH. I PERSISTED IN MY REQUEST TO NRC'S HAROLD DENTON, ONLY TO BE IflFORED FOR SEVERAL DAYS THAT NRC JUST COULD NOT FIND SUCH A PERSON. I WAS TOLD, AND I THINK THIS IS SIGNIFICANT, TFMT NRC HAD NO PHYSICIANS ON ITS STAFF, MUCH LESS A PHYSICIAN SCHOOLED IN THE FIELD OF RADIATION MEDICINE. NO PHYSICIANS DIRECTLY EMPLOYED BY NRC-AGAIN A SAD C0f14ENTARY ON W E PRIORITY GIVEN TO PUBLIC HEALTH MATTERS INVOLVING NUCLEAR REGULATION. OUR JOB-AND I DON'T HAVE TO TELL YC#J WIS-WAS TO PREVENT THE HARMFUL EFFECTS OF ANY POSSIBLE RADIATION, NOT SIMPLY ALLOW FALLOUT TO OCCUR AND THEN HAVE TO DEPEND ON MEDICAL THERAPY TO CORRECT THE CONSEQUENCES OF EXPOSURE. ANOTHER EXAMPLE OF THE LACK OF PUBLIC HEALTH EMPHASIS IN THE AFTERMATH OF IMI IS HOW LITTLE ATTENTION HAS BEEM PAID TO BE FEASIBILITY OF STOCK-PILING POTASSIUM IODINE AS A PROTECTIVE AGENT AGAINST RADI0 ACTIVE 10 DINES. . 1

12 s ALTHOUGH I HAD PREPARED LENGTlU TESTiti'*N ON THIS MATTER FOR THE PRESIDENT'S C0fli!SSICN, IT WAS AU40ST ENTIRELY PREOCCUPIED WITH THE fiUCLEAR Et1GitiEERING At0 EVACUATIOf1 LOGISTICS-IN FACT I WASN'T ASKED A SINGLE QUESTION ABOUT POTASSIUM 10DIDE AS AN EFFECTIVE FREVENTIVE MEDICINE AGAINST RADI0 ACTIVE 10DIf;E. WHEN I INQUIRED INTO THE REASCN FOR THIS GLARIfiG OMISSION, WE C0441SSIG1 CHAIRFAN, DR. JOHN KErsu, WROTE PE THAT THE C0f fi!SSION JUST t DIDN'T HAVE TIfC TO DISCUSS POTASSIUi ICDIDE. APPARENTLY, TOO PAfU IMPORTANT f;0N-HEALTH ISSUES TCOK UP ITS TIME. BUT LET VE TELL YOU THE POTASSIU4 10DIDE STORY. WE KNOW THAT A IJaGE FILEASE OF RADICACTIVE ICDINE INTO BE ATMOSPHERE FROM A NUCLEAR PCWER REACTCR WOULD RESULT IN THE PUBLIC'S If HALING OR l INGESTING AMOUhTS WHICH COULD PRODUCE AC'JTE, CONTIfluff!G, OR LATE THYROID EFFECTS. THESE EFFECTS RANGE FRCM 111LD WYROIDITIS TO HYPOTHRYOIDISM TO BENIGN THYROID NEOPLASMS, NCDULES, ND CAf1CER. FETAL HYPONYR0! DIS'i ASSCCIATED WIm CRETINISM IS OF PARTICULAR CONCERN DUE TO THE INVERSE RELATIONSHIP BETWEEN 10DIf?E UPTAVE Af1D AGE. APART FRU4 EVACUATICN At0 SHELTER TO PROTECT AGAlf1ST RADI0 ACTIVE IODINE EMISSIONS, PHARMACOLOGICAL AGENTS THAT BLOCK ACCUMULATIG10F RADIO IODINE BY THE THYROID GLA'O PRESENT THE MOST CCMPLETE PROTECTION AGAINS. i THE HAZARDS OF INHALIf;G OR INGESTING I-131. l POTASSIU4 IODIDE (Ki) WAS F00fD TO'EE E'41NENTLY SUITABLE FOR THYROID l BLOCKING PURPOSES. FOR WO OR MORE YEARS PRIOR T0lill, EE DEPARTPBff 0F f.fNIR0fl4 ENTAL RESOURCES IN pef:JSYLVANIA HAD EEEN FRUSTRATED If1 C'BTAINING STOCKPILES OF POTASSIU4 ICDIDE FROM NE FEDERAL GOVERff'ENT. l l l ( .~.~

13 ITHINKITINTERESTitlGTOSPECULATEONWHETHERTHEDEPARTMENTOF HEALTH WOULD HAVE MET WITH EARLIER SUCCESS IF THE RESPONSIBILITY FOA THE f%TTER MD NOT BEEN LODGED THERE RATHER TIMN IN THE DEPARTMENT OF ENVIRONMENTALRESOURCES. }Ff4EDIATELY AFTER THE ACCIDENT, THE STATE'S DEPARTMEfU OF ErulRotr4 ENTAL RESOURCES AGAIN REQUESTED POTASSIU4 IODIDE FRGi THE FEDERAL DEPARTMENT OF HEALTH ED'JCATION NO WELFARE. IT TOOK MORE THAN 60 HOURS AFTER TMAT JUST FOR THE THEN SECRETARY OF Df 6 TO GIVE THE ORDER TO INITIATE STEPS TO SHIPPOTASSIUiIODIDETOHARRISBURG. FIVE DAYS AFTER THE ACCIDETU BEGAN THE FIRST SHIPMENT OF 11, @ LITTLE BROWN VIALS ARRIVED: -6,010F THOSE 11,000 VIALS WERE UNLABELED; -EACH DROPPED YIELDED ONLY ONE HALF THE CORRECT DOSAGEJ -THE DROPPERS DID NOT FIT THE VIALS) AND --ihNY OF THE VIALS CONTAINED HAIRLIKE FILAMENTOUS fMTERIAL NO OTHER PARTICULATE fMTTER. SEVEN DAYS AFTER THE ACCIDENT BEGAN, WE RECEIVED INSTRUCTIONS FR04 SECRETARY CALIFANO TO ADilNISTER POTASSIUM IODIDE TO ALL WORKERS AT THE SITE NO TO DISTRIBUTE IT TO ALL RESIDENTS WITHIN A TEN-MILE RADIUS. THIS, AGAIN, WAS A RECOMMEfDATION BASED UPON A TOTAL LACK OF UtOER-STNOING OF THE REAL PROBLEM. BY THIS TIME WE HAD RECEIVED ASSURANCES FRai HAROLD DENTON THAT THE NUCLEAR ENGINEERING ASPECTS OF THE ACCIDENT WERE Uf0ER CONTROL AfD THE REACTOR WAS PROGRESSING TOWARD A COLD SHUT DOE IHE VERY NEXT DAY, THE POLITICS OF PUBLIC HEALTH MUST M VE PRaiPTED SECRETARY CALIFN10 TO APPEAR BEFORE SENATOR KENNEDY TO FAULT THE STATE FOR NOT ADMINISTERING THE DRUG. A ._.__m,- -._.,r,m-w. _,.,,m m.,..

14 h4 IMPORTNiT FACTOR IN OBTAINING SATISFACTORY BLOCKIfG OF RADICACTIVE 10DIf1E UPTAKE IS TE SPEED WITH WHICH KI IS A341NISTERED FOLLO41NG EXPOSURE TO RAD 10 IODINE. WImitt 30 MINUTES AFTER ORAL ADMINISTRATION, KI BLOCKS TE UPTAKE CF M OF 1-131 FOR 24 HOURS. STNOARD UPTAKE CURVES DE!CISTRATE TPAT THE BULK OF THE RADICACTIVE 10 DINE FR04 A SINGLE EXPOSURE WILL HAVE BITEPID T E W YROID WITHIN 10 TO 12 HOURSJ LITTLE BBIEFIT PAY BE EXPECTED BY BLOCKlf1G BEYGO THAT TIVE. SIGNIFICNiT BENEFIT (A BLOCK OF 50%) IS ATTAINABLE DURiflG TE FIRST 3 TO 4 HOURS. OTHER FACTORS MILITATED AGAINST THE ADMitlISTRATION NO DISTRIBUTIGI 0F POTASSIUi IODIDE.

1) THE KNOVN IfCIDENCE OF SIDE EFFECTS SUCH AS 10DISPr-A SEVERE SKIN RASH--PLUS THYROID DISEASESJ AfD N1 OCCASIONAL CARDIAC DEAm IN THE ELDERLY HAS BcEN REPCRTED--PRESU' ABLY FR01 EXCESS POTASSIL74.

2) THE LIKELlHOCD OF PRECIPITATING UNNECESSARY PNilC AMONG TE POPULACE AFTER 6 DAYS OF IffTENSE STRESS NO STRAIN.

TWS, WE AVOIDED A FIASCO SIMILAR TO BE SWINE FLU PASS IFTU4IZATION WHERE THE CENTER FOR DISEASE CONTROL ATTEMPTED TO PREVENT AN EPICEMIC TFAT NEVER EXISTED. NO WE WERE READY TO RESPOND INSTNiTLY TO REAL NO If4EDIATE PUBLIC A HEALTH PROBLEMS. BUT HAD WE EXPERIBCED THE PASSIVE FALLOUT TPAT FW1Y PEOPLE FEARED WOULD RESULT FRai EE ACCIDBfT DURif1G TE FIRST FEW DAYS, WE WOULD FAVE BEEN WITHOUT B E Q LY. PROVEN EFFECTIVE PREVENTIVE MEDICINE AGAlftST THE ACCUMULATIG10F RADICACTIVE 10DillE IN TE THROID GLNOs EVEN AS WE ARE TODAY. I ~..

15 LET US CONSIDER A MORAL ISSUE AT STAKE MANY MONTHS FOLLOWING THE NUCLEAR ACCIDEf1T--THE RIGHT TO KNO1 THE TRUE. POUR MONTHS A HAD RESIGNED AS SECRETARY, I WAS CALLED ABOUT AN UNUSUAL CLUSTER OF THYROID DEFICIENCY CASES IN PENNSYLVANIA. AFTER SEVERAL DAYS OF REFUSAL BY THE HEALE DEPARTMENT TO ALERT PUBLICTOTHISPREVENTABLEILLNESSINNEWBORNS,1ASKEDAREPORTTOLOOK INTO THE MATTER. IN MID-1978, THE STATE HEALTH DEPARTMENT FORTUITIOUSLY BEGAN SCREENING NEWBORNS FOR THYROID DEFICIENCY. SEVENTEEN CASES OF DEPRESSED THYROID FUNCTION WERE REPORTED AND TREATED IN THE NINE MONTHS PRIOR TO TH SURPRISINGLY, THE NUiGER OF CASES JUMPED TO 27 DURING WE NINE MONTHS FOLLOWING THE ACCIDErrr. THE INCREASE WAS CONCENTRATED DGVtMIND OF TH REACTORS AT lill no PEACHBOTi34. OF IflTEREST, THE NUMBER OF CASES DOWINItO HASREMAINEDELEVATEDDURING1980. (SLIDES /!3, 4 Ato 5 - INCIDENCE OF HYPOTHYROIDISM BEFORE AND AFTER TMI) SINCE THE IIll ACCIDENT, MAJOR CONCENTRATION OF TWROID DEFICIENCY CASES HAVE OCCURRED IN WCASTER COUNTY-IMMEDIATELY D04tMIND OF THE COUNT CONTAINING Iill AND PEACHBOTTG4 REACTORS. IHESECASESAREA TO 12 TIMES WHAT WOULD BE EXPECTED IN PENNSYLVANIA. EVEN THOUG ARE SMALL, THEY WARRANT FURTHER EPIDEMIOLOGICAL ItNESTIGATION WHETHER FROM INBREEDING, FROM EtNIRONMENTAL CAUSES SUCH AS CHEMICAL CONTAMINATION OF WATER AND FOOD, OR FRG4 INDUSTRIAL OR MEDICAL RADIATION SOURCES. IT'S PREMATURE TO BLNSE THEM ON RADICACTIVE IODINE BUT IT CANNOT YET (SLIDE #6 - RATIO OF HYPOTHYROID CASES TO NEWBORNS) ONCE AGAIN, THE POLITICS OF PUBLIC HEALTH PREVAILED. THEHEALTH DEPARTMENT HAS REFUSED TO EXAMINE THE RELATIONSHIP OF TH TO THIS DRAMATIC INCREASE IN HYPOTHYROIDISM. (SLIDE f/ - MARCH 28,1980 PENNSYLVANIACAPITALUPDATE)

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I (Slide #6), I RATIO 0F IE0 NATAL HYRTDIYiDIDIT T0 FEhRnPNS IN PBf!SYLV#1IA i i:! WESTERNPA EASTERNPA i, JUNE 20,1978TO 1: 6,805 1: 6RA i MARCH 28,1979 i MARCH 28,1979TO 1 1 7,955 1: 3,021 DECEMBER 31,1979 1 5 i JANUARY 1,1980TO 1 7,231 1: 2,716 i AUGUST 31,1980 ii 4 i i1 ALL NEWBORN HYPOTHYROID CASES REPORTED BY PENNSYLVANIA IlEPARTMENT .i1' 0F HEALTH SINCE INITIATION OF NEONATAL HYPOTHYROID SCREENING PROGRAM, JUNE 20,1978 UNTILAUGUST31,1980, i t 4 +

(r>lide #7) 4, BR213 RRNR99 --PENNSYLVNilA CAPIT0L UPDATE-OMRRISBURG) -- A C0FiilTIEE TO IfNESTIGATE ilYP0111YR0lDISM IN PFRISYLVNIIA ET FOR llE FIRST TIE 10IMY... BUT llE RADIATION EFECTS OF TIE THEE MILE ISt#0 ACCIENT LEE NOT ON ITS AINDA. DOCTOR DONALD [ID - WAD OF TIE 114 EMBER PNEL - SAID TE A GROUP WILL NOT DISWSS ElllER TlE PRD OR CON SIE OF WlMT IMY O NOT IMVE OCWR[D SINE TE 111RE MILE ISLR1D ACCIIE1T. E SAID TIE EDICAL EXPERTS WILL CONDUCT N1 UNBIASED OBICTIVE STUDY OF MlY 34 PENNSYLVN11A INFANTS SUMtED FRGi ilYP0 THYROIDISM IN 1979. TE DIS 0 PIER IS A BIRTH EFECT TIMT, IF LEFT [NTEATED, CAUSES fBITAL [TARDATIW. IT C#1 E CAUSED BY A VARIETY OF ERDITARY #1D BlVIR0[fENTAL FACTORS... INCLUDIl4G RADIATION. f' TlE CGTilTTEE OF EDICAL EXPERTS FROM PHILADElfHIA, PITTSBUPai, HERSIEY N1D ATL#1TA WAS FORFED AFIER 1979 FIGUES RVEALED SIX CASES j OF HYP0lliRDIDISM IN LN1 CASTER COUNTY. l ONE OTTER CASE liAS BEEN EPORTED THIS YEAR IN TE C0lNTY... Wilm IS LOCATED EAR T[ CRIPPLED NUCLEAR PL4fT. y EID SAID TlE Ntf1BER OF CASES IS NOT liluSUAL... BLIT TE CLUSTERING IS. AD-PX-0327 1400EST B214 i

16 ITWASOURGOODFORTUNETHATTHEREWASNOIMMEDIATELOSSOFLIFE, BUT LACK OF ADECUATE COMMUNICATION WITH THE PUBLIC DURING NO AFTER THE ACCIDENT AT TMI LED TO A LOSS OF CONFIDENCE IN OUR PUBLIC OFFICIALS. PuBLic HEALTH IS NOW IN JEOPARDY OF LOSING ITS CREDIBILITY AS HEALTH DATA BEC04E AVAILABLE AND ARE NOT RELEASED OR ARE CARELESSLY COMPILED. SINCE MY RESIGNATION AS SECRETARY OF HEALTH, SEVERAL CONCERNED HEALTH DEPARTMENT EMPLOYEES HAVE CALLED ME REPEATEDLY TO COMPLAIN THAT ABNOPfiAL HEALTH DATA WERE NOT BEING MADE AVAILABLE TO THE PUBLIC. MORE THAN A YEAR AFTER THE ACCIDENT AT TMI, I RELEASED LONG OVERDUE INFANT MORTALITY STATISTICS WHICH I WAS TOLD WERE NOT GOING TO BE TELEASED BY THE HEALTH DEPARTMENT, MYPUBLICANNOUNCEMENTPROMPTEDTHESTATETO RELEASEINFANTDEATHRATESWITHIN72 HOURS. THESE DATA SHOULD HAVE BEEN MADE FUBLIC f0NTHS BEFORE. REGRETTABLY SGE WERE CONVINCED BY THE HEALTH DEPARTMENT THAT THESE DATA SHOWED CONCLUSIVELY THAT THE NUCLEAR ACCIDENT AT Ell HAD CAUSED NO DAMAGE TO UNr.ORN CHILDREN RESULTING IN BIRTH DEFECTS OR DEATH DURING INFANCY. WHILE TH1S IS ENTIRELY POSSIBLE, IT IS PREMATURE TO CONCLUDE THIS FROM THE PENNSYLVANIA HEALTH DEPARTMENT DATA. FOR IN ITS EAGERNESS TO REPORT NO INCREASE IN INFANT DEAWS, THE HEALTH DEPARTMENT DATA UNFORTUNATELY WERE UNRELIABLE BECAUSE THEY WERE FLAWED BY ERRORS AND INTERNAL INCONSISTENCIES, (SLIDE #8 - FETAL, NEONATAL AND INFANT DEATH RATES BY MONTH 1979) (SLIDE #9 - FETAL, UEONATAL AND INFANT DEATH RATES BY QJARTERS 1977-79) WITHOUT CAREFUL CaiPILATION OF DATA, SGE MATHEMATICAL IMPOSSIBILITIES WERE FOUND IN THE DATA RELEASED BY THE HEALTH DEPARTMENT. FOR10 MILES AROUto IMI, THE TOTAL FETAL DEATH RATE FOR JANUARY IS LOWER THAN THE TWO COMPONELTS WHICH COMPRISE THE TOTAL. ALSO, THE NEONATAL AND INFANT DEATH RATES FOR OCTOBER Are NOVEMBER VARY, EVEN THOUGH THE TWO COMPONENTS E. 1 T zzzzrr

(Slide #8) t 4 FETAL, UEONATAL, AND INFANT DEATH RATES BY }10N111: PENNSYLVANIA. TEN MILE TifI AREA C01BFJNITIES (INCLUDING AND EXCLUDING HARRISBURG CITY) AND HARRISBURC CITY, JANUARY DECEMBER, 1979 I Reported by Pennsylvania Department of Health Month Ceographic Area Geographic Area TMI Harrisburg TMI TMI Harrisburg TML Pa. (10 }ule) City (Excl. HbR.) Pa. (10 Mile) City (Excl. Hbg.) ( Fetal Death (Totsi) Rates Feral Death (Excluding Abortions) Rates Jouu o I4.4 23.3 31.9 33.340--- 15.3 26.9 21.5 33.3 February 22.3 23.4 45'.0 10.6 12.5 23.4 45.0 10.6 March 25.4 21.9 48.5 9.2 13.1 13.8 39.2 9.2 April 23.3 16.5 32.3 9.5 13.0 16.5 32.3 9.5 May 25.1 11.2 9.3 12.0 15.5 8.5 12.0-i .' June 22.7~ 9.3 19.2 4.5 13.4 9.3 19.2 4.5 July 20.8 13.4 29.4 7.4 12.9 13.4 29.4 7.4 i August 22.8 15.3 20.6 13.1 13.3 35.3 20.6 13.1 l l-October 21.0 1d.8 42.1

8. 9' 11.7 18.2 44.2 4.6 Sept ember -

22.8 18.7 44.2 4.6 13.2 18.8 42.1 8.1 November 2q.4 21.3 42.1 12.8 12.3 21.3 47.1 12.8 Decenger 24.6 6.5 9.4 15.3 6.5 9.4 Jan. - Dec. 23.0 17.1 30.6 11.1 13.4 16.3 28.2 11.1 Neonatal Death Rates Infant Death Rates January 9.8 21.5 33.0 17.1 14.8 21.5 33.0 17.1 Feb rua ry 10.0 10.3 28.3 13.7 13.7 28.3 5.4 March B.2 19.2 40.8 _ 9.3 11.5 22.4 40.8 14.0 Anril 10.7 ~20.1 33.3 14.4 14.1 20.1 33.3 14.4 luy 9.8 17.0 18.9 16.3 14.1-17.0 18.9 16.3 June 10.7 18.7 39.2 9.1 13.2 18.7. 39.2 9.1 July 10.0 5.4 10.1 3.7 11.9 10.8 10.1 11.1 l August 7.3 6.2 8.8 10.2 12.5 13.3 Septe.mber 9.8 12.3 9.3 13.9 12.9 15.4 9.3 18.5 t October 9.9 .Ji> 9.6 11.0 9. 0(e"" 13.7.Jg> 12.7 11.0

9. 0 d' "

6.2 22.0 <cr= 14.8 4 9.3 22.0 cs Noverber 10.5 4~

... -Deccaber 10.9 13.1 31.3 4.8 16.1 19.6 31.3 9.5 Jan. - Dec.

9.8 13.2 23.0 8.9 13.3 16.1 23.0 11.5 l ~ i f.

Note:

Figures for 19 /9 are provisional. -~

(Slide 09) t FETAL, !!EO::ATAL. AMD INFA?:t DEAT11 PATES BY QUARTER: PD:NSYl.VANIA AND TEN !!ILP. T!!I ARE4 Qt!cfUNITIE.4,1977 - 1979 I i Heported by Penrmylvania Department or llealth Tetal Deaths 2) Year / Quarter Feral Deatha-Total ) Exc lud tut!.ha r t.!onn floonstal Daaths ) Infant Deaths ) l 3 3 T.'I ' 7::I T?tt TML Pa. (Ten ?!! Ic) l'a. (Ten M_i_le) Pa. (Ten Mile) Pn. '(Ten Mile)_ 1977 Jan.-ttarch 23.0 17.7 11.4 16.6 10.7 12.4 14.7 14.7 April-June 23.2 1 3. 11. 12.4 '9.5 11.1 8.5 14.4 llA July-Sept. 24.9 2.'3. 0) 13.1 22.0 10.1 6.1-12.9 9,1 * ~ Get.-Dec. 25.1 ~23.5 12.7 16.6 10.1 10.5 13.7 14.'7 1978 Jan.-March 26.3 15.9 13.0 12.8 9.9 3.6 14.3 14.0 Aptil-June 23.0 22.3 !!.. ~4 ' 15.0 11.1 7.6 14.0 9.3 l July-Sept. 24.5 19.1 11.4 35.3 9.3 1.0 11.8 4.9 i Cet.-Dec. 25.7 22.? l '4.1 14.9 19.5 10.8 13.6 15.1 l 1979 Jan..% rch 24.1 13.2 l'I. 6 '23.1 '). 3 17.2 13 3 19.4-Ap r i.1 -Juurs 23 7 12.2 14.0 J3.2 10./ 13.6 k ~ ~' 13.8 13,5 4 July-Sept. ?2.1 .M. S 13.1 35.5 9.0 7.9 11.7 .12. 8-Oct.-Dec. 21.9 15.7. 13.0 13.7, 10.4

9. 6.

14.8 13.8 3)Ceuth rates per 1.000 deliverlen (live a,td fetal deaths). 2)cs.ath re. ten per 1.000 deliverien (live births and fetal deaths - excluding abortions).

3) Death ratec per 1.000 live births, s.

Noten: Data for 1979 are provisional. N e s g e

17 (HARRISBURG NO OUTSIDE HARRISBURG) WHICH SFO'JLD COMPRISE THE TOTAL ARE IDENTICAL. FUREERf DRE, TABULAT10:1 OF fiE0 NATAL NO INFNIT DEATH RATES WE FOR HARRISBURG DURING 1979 ARE IDENTICAL DURING THE ENTIRE YEAR. ARE LED TO BELIEVE THEN THAT ALL IflFN1T DEATHS IN HARRISBURG, l.E., THOSE IN THE FIRST YEAR OF LIFE, OCCURRED NECfMTALLY IN THE FIRST 28 DAYS OF LIFE. ON SLIDE 9, mE SEC0fD OUARTER NEONATAL DEATH PATE IS HIGHER THAN THE SN4 OJARTER INFANT DEATH RATE EVEN THOUGH SLIDE 3 SHO!S THE TWO RATES DURING THE SNE PERIOD TO BE IDENTICAL, YET TO BE EXPLAlfiED IS WHY FIVE-AfD-TEN MILE It!FNIT DEATH RATES DURiflG THE SIX MONTHS FOLLOWING THE ACCIDENT CLliGED SHARPLY COMPARED TO THE SAME PERIOD IN FREVIOUS YEARS. THEINCREASECOULDEEANCRMALSTATISTICAL VARIATICN OR COU D BE IfDUCED BY CAUSE. 80E OF THESE FlfDINGS ARE STATISTICALLY HIGHLY SIGNIFIC#li NO SURELY WARRN1T CAREFUL ATTENTION IF NOT FURTHER STUDY. LATER DATA REVEAL; INCREASES IN NECRATAL DEATHS AFTER THE ACCIDENT MAY BE EVEN l' ORE SIGNIFIC#fT THAN INCREASES IN INFANT DEATHS. (SLIDE #10 - INF/':tr DEATH RATES - APRIL-SEPTEMBER,1979) FIVE-MILE RATES lERE 6.7, 2.3 No 16.2 INFR1T DEATHS PER THOUSNO LIVE BIRTHS FOR TIME FRAMES FROM APRIL THROUGH SE?TEMEER IN 1977,1978AND 1979,RESPECTIvELY. WITHIN THEN MILES-INCUJDING HARRISSURG--DEATH RATES WERE 10.5, 7.2 AND 15.7 DURING LIKE TIME FFAFES. STATEWIDE LEVELS FOR THE SNE THREE YFARS WERE 13.9,13.5 No 13.6, RESPECTIVELY. IHEHEALTH DEPARTMENT SUBSEQUENTLY Bl>4ED mE 1979 ELEVATION ABOVE THE STATS 41DE LEVEL IN THE TEIM41LE RATE ON HIGH IfiFRIT MORTALITY N'CNG HARRISBU BUTITISALSOKNOWNTHATMINCRITYDATAWEREPRESENTIN1977OR BLACKS. 1978 BEFORE THE NUCLEAR ACCIDEt(T OCCURRED. HAD WE INFN!T DEATH RATE REMAINED UNCHANGED OR EVEN DECREASED, I TRUST THOSE FINDINGS WOU W HAVE BEEN WELL PUBLIClZED. ~~ _____-_-_______-__--_--_XLL~~~~~~

(Slide #10) 4 INFANT DEATHS PER 1,000 LIVE BIRTHS A/ (ACTUAL DEATHS IN PARENTHESES) 5 MILES FROM TMI 10 t11LES FROM TMI ALL PENNSYLVANIA 1977 6.7 (3) 10.5 (20) 13.9El 1978 2.3 (1) 7.2 (14) 13.5E/ 1979 16.1 (7) 15.7 (31) 13,6C/ A/ APRIL THROUGH SEPTEMBER H/ ANNUAL RATES E/ JANUARY THROUGH SEPTEMBER 1979

~ 18 ACCORDING TO A f1EWSPAPER REPORT, A HEALTH DEPARTMEfiT SPOKESPAN ALSO REPORTED THAT A RADIATI0ft EFFECT-REVERSI!!G THE SEX RATIO N10NG flEWBORflS-DID MIT. OCCUR IN WE fCITHS AFTER THE ACCIDENT. UtlFORTUtlATELY, EE DATA fECESSARY TO DRAW THIS C0fCLUSION WERE fOT C04PLETE. THERADIATIONEFFECT IS UPON POST-MEIOTIC SPERI%T0 GENESIS AFTER THE lIil ACCIDENT. IT IS CUST0fMRY TO COUNT f%LE-FEPALE SEX RATIOS IN EXPOSED PERSONS POR 50 AFTER EXPOSURE NiD PRIOR TO CONCEPTION. ACCORDINGLY, A DECREASE Ifl THE PROPORTION OF IMLE BIRTHS FR0fi RADIATION CN1 OrlLY EE FOUND BY COUNTING THE SEX DISTRIBUTION FOR ABOUT FOUR VEEKS ON EITHER SIDE OF THE 320TH DAY A THE PARCH 23,1979 ACCIDENT. THESEDATAWERENOTAVAILABLEWHENTHESTORY WAS RELEASED. ALSO OF CONCERN IS THE 041SSION OF 88 INFNiT DEATHS FR04 DEPARTr>ENT OFHEALTHDATA. (SuDE 11 - C04 PARIS 0N OF FEDERAL VITAL STATISTICS WITH HEALE DEPARTMENT DATA) ANUNEXPLAINEDABSENCEOF88INFNITDEATHSFROMPEfiflSYLVANIAHEALTH DEPARTMENT DATA OCCURRED IN THE THIRD QUARTER OF 1979. THIS REDUCED fuiB OF INFANT DEATHS IS FOUfD BY C04 PARING IT TO THE NUMBER LISTED IN W E FEDERAL GOVERfFOTT'S hTAL STATISTICS FOR 1979. THIS DISCREPANCY RAISES FURmER QUESTIONS ABOUT THE RELIABILITY OF HEALTH DEPARTMENT DATA. IN LIGHT OF THOSE MAtlY DISCREPANCIES, IT IS DIFFICULT, IF f0T IMPOSSIBLE, TO Uf0ERSTAfD HOW, IN PAY OF 1980, THE HEALm DEPARTPENT COULD STATE, "AFTER CAREFUL STUDY OF ALL AVAILABLE INFOPFATI0ft WE CONTINUE TO Flie No i EVIDENCE TO DATE THAT RADIATION FROM THE NUCLEAR PCWER PLANT RESULTED IN AN IfCREASED NUMBER OF FETAL, NEONATAL OR INFANT DEATHS." THE RELEASE OF INEXACT DATA ONCE AGAIN REFLECTS UP0ft THE LACK OF HEALTH INPUT INTO PLANNING FOR THE NEXT NUCLEAR ACCIDENT. AfD THERE BEEN NO PUBLIC CORRECTION OF THESE fMNY ERRORS. l L.,- = .i

(Slide Oll) IUTER OF LIVE BIRIllS NiD INFNR IEA111S FEPORTED IN IBriSYLVNilA AFlER lilEE MILE ISlM0 ACCl[ENT OF iMROI 29,1979 A CmPARISION BETWEEN U.S. VITAL STATISTICS N4D DATA EROM PA DEPARTMENT OF flEAL111 (D011) 1979 VIDIS* 1979 D/HIS* 1979 PAD 0ll** ExC MS (DEFICIT) llVE 3IRT11S NFNiT MATilS NFNIT UEATils OF 'm OVER U.b. Argit 1 - 38,01tl 527 525 (2) Jue 30,1979 JULY l - I12,873 589 501 (88) SEPT.30,1979 Ocr.1-38,303 565 567 2 DEC. 31, 1979 l "U.S. thullLY VITAL STATISTICS REPORTS D/lHIS NATIONAL CENTER FOR llEALTil STATISTICS i

- DATA RELEASED BY PA DEPAR ME T OF}IEALTil, APRIL,1980 T N AEL 1979 FIGURES ARE PROVISIONAL 1

1 0 l l \\

i 1 1 19 l ASSu'i!NG THAT THE t'ATHEMATICAL IMPOSSIBILITIES, TABULATION OF ERR 0NEOUS DATA, THE PRESENTATION OF INCOMPLETE DATA, AfD THE STATE S REPORTING OF 88 FEWER INFANT DEATHS THAN THAT REPORTED BY THE FEDERAL GOVERtf4ENT WERE ALL ACCIDENTS OF C04PILAT10N, OR ELSE CARELESSNESS, IT MUST PROMPT US TO URGE STATE Af0 FEDERAL HEALTH AGENCIES TO IMPROVE THEIR EFFORTS TO COLLECT HEALE DATA EEFORE, DURING, Ato AFTER NUCLEAR ACCIDENTS. ALTHOUGH I DO THINK THE AVAILABLE DATA ARE NON-CONCLUSIVE IN THEIR PRESDIT FORM, SUCH UNUSUAL PATTERNS OF HYPOTHYROIDISM AND INFANT DEATH RATES FOLLOWING THE NUCLEAR ACCIDENT AT IMI WARRANT C04PLETE CAf00R AND DISCLOSU,RE, NOT DELAY AfD DENIAL. A LACK OF CONFIDENCE IN N -/tm.4uasso PRG4 PTS ME TO URGE AN INVESTIGATION OF PENNSYLVANIA HEALTH DATA FOLLOWING IMI BY A GROUP OF CUALIFIED EPIDEMIOLOGICAL ItNESTIGATORS. UNLESS DEPART 7 DENTS OF HEALTH ARE REMOVED FROM THE POLITICAL ARENA, THEY WILL PROBABLY NOT BE ABLE TO OPERATE MUCH DIFFERENTLY FROM HOW WE HAD TO OPERATE IN RESPONSE TO TMI FOR UNTIL HEALTH RELATED ACTIVITIES OF STATE GOVERtf4ENT ARE BROUGEff UtOER THE WING OF COMPETENT HEALTH DEPARTMENTS, WE WILL CONTINUE TO GROPE FOR DIRECTION Ato SUPPORT IN OUR EFFORTS TO ADDRESS THE HEALTH IMPACTS OF SUCH AN ACCIDENT. BUT,PERHAPSTHEREIS A WAY THAT THIS CAN BE DONE. PERHAPS THERE IS A WAY TO BRING A COMMON EFFORT TO hMATEVER COMMITMENTS TO PUBLIC HEALTH MAY REMAIN IN STATE GOVERNMENT. I DON'T THINK IT CAN BE ACCOMPLISHED UNDER THE PRESENT STRUCTURE. THE HEALTH It0USTRY HAS GR0dN TO SUCH TREMEt00US SCOPE AtO SIZE 1 THAT IT POSES INFINITE TEMPTATIONS FOR POLITICAL CCNTROL. AND ANY ONE ItOlVIDUAL ENTRUSTED WITH THE RESPONSIBILIT( OF OVERSEEING SUCH A MASSIVE ItOUSTRY FROM WITHIN STATE GOVERtFENT IS GOING TO BE SUBJECTED TO l UNBELIEVABLE POLITICAL PRESSURES FROM THOSE WHO SEEK TO SHARE IN SUCH l l CONTROL.

20 IT IS OfiLY FAIR TO SAY THE GOVERtJORS WHO GENERALLY HAVE NO HEALTH PROFESSIONAL OUALIFICATIONS ARE NOW VICTIMS OF THE POLITICS AFFECT!?JG THE HEALTH lt00STRY. THERE ARE JUST TOO MANY FACTIONS PULLING NO TUGGING AT POLITICIN4S FOR THEIR OWil BETTER INTERESTS. At0 THESE FORC EXERT TREt'Ef000S PRESSURES ON N4YONE TRYING TO PARTICIPATE IN A RATIONAL DECIS10t1 f% KING PROCESS. IHAT PRESSURE IS TRN4SMITTED TO SECRETARIES 1 0F HEALTH WHO SERVE AT THE PLEASURE OF W E GOVERfl0RS. IN RECENT YEARS, IT HAS BECGE FAIRLY ROUTINE FOR NEW GOVERNORS-NO SOETitES flew PAYORS-UPG4 ELECTION TO REPLACE THE ENTIRE ADMINISTRATIVE LEADERSHIP IN HEALE DEPARTMENTS. IF, IN FACTS WE ARE GOING TO ACCEPT SOME DEGREE OF POLITIClZATION OF HEALTH DEPARTMENTS, PEPJiAPS WE SHOULD I FOLLOW THE TREND IN THE EXECUTIVE AND JUDICIARY BRANCHES IN PENNSY NO ELECT A STATE SURGEON GENERAL ON THE POPULAR BALLOT--ALOf7J WITH THE JUDGES, THE IREASURER, THE AUDIT 0a GENERAL, NO NOW, THE ATTORNEY 6ENERAL. AS WITH THE JUDICIARY, A TEN YEAR TERM FOR THE CHIEF HEALTH OFFICER COULD PROMOTE PROFESSIONAL PERFORMANCE. GR PERHAPS HEALTH ACTIVITIES 110W C0f0UCTED THROUGHOUT STATE GOVERt?GNT COULD BE PLACED UtOER NE DIRECT CONTROL OF A HEALTH C&NISSION SELECTED BY THE GOVERNOR FRCM A PNJEL OF PHYSICIN4S NOMINATED FOR A 5 TO 1 APPOINTMENTSBY A STATEWIDE PANEL OF MEDICAL SCHOOL DEN 4S NO LEADERS OF MEDICAL PROFESSIONAL SOCIETIES. BECAUSE OF THE MAGNIWDE OF THE HEALTH CARE It0VSTRY NO THE WIDE DISPERSION OF PUBLIC HEALTH SERVICES, INCLUDING U DIATION HEALTH, THE CHIEF HEALTH OFFICER CN1NOT EFFECTIVELY OPERATE PROFESSIONALLY Uf0ER THE DIRECT 4 SUPERVISION OF THE GOVERNOR. NOR SHOULD THE GOVERf0R BE SUBJECTED TO T CONSTANT POLITICAL PRESSURES EXERTED BY SPECIAL INTERESTS WITHIN NO OUTISDE THE HEALTH It0USTRY. w

21 THE REALITY OF POLITICS SAYS THAT WIm HIGH DOLLAR VOLUME, SPECIAL IfREREST PRESSURES ARE EXERTED FROM A MYRIAD OF DIRECTIONS IN BOTH PUBLIC AND PRIVATE SECTORS, THE COMMITMENT TO PUBLIC HEALTH CAN QUICKLY CRUMBLE IN THE PROCESS. SO NOW WE C0fE TO THE LAST SERIOUS ISSUE. WHAT HAPPENS IN THE EVENT OF ANY FUTURE NUCLEAR ACCIDENTS? HOW DO WE PROTECT THE PUBLIC'S HEALE ? SHORT OF IMMEDIATE CESSATION OF ALL NUCLEAR ACTIVITY WHICH I THINK IS WELL NIGH IMPOSSIBLE, THE NATION MUST BE PREPARED NOT TO REPEAT THE MISTAKES TO IMI AND TO BE FAR BETTER PREPARED E AN PENNSYLVANIA IS AT B E PRESENT TIME. BUT LET ME WARN THAT THE PEOPLE OF PENNSYLVANIA ARE NO BETTER OFF TODAY AND PERHAPS WORSE OFF THAN THEY WERE THE DAY BEFORE THE RADIATION RELEASE AT IMI ON MARCH 28. THERE IS STILL NO DIVISION OF RADIATION HEALTH. NORESOURCESFORHEALTHRADIATIONPREPAREDNESS. NOPOTASSIUM IODIDE FOR DEPLOYMENT IN CASE OF ANOTHER ACCIDENT. l THEPEOPLEOFPENNSYLVANIAAREUNIQUELYSENSITIZEDTGTHEPSYCHOLOGICAL STRESS OF A NUCLEAR ACCIDENT. WERE EERE TO BE ANOTHER ACCIDENT IN ANY ONEOFPENNSYLVANIA'SNUCLEARREACTORSINOURPRESENTSTATEOFUNPREPAREDNESS, IRREPARABLE PSYCHOLOGICAL DAMAGE COULD OCCUR. THE LACK OF PUBLIC lEALTH PREPAREDNESS FOR ANOTHER NUCLEAR ACCIDENT HAS BEEN REPEATEDLY CITED--BUT TO NO AVAIL. 1 BASEDUPONSOMEOFTHELESSONSLEARNEDFROMTMI,LETMESUGGESTSOME ~ ITEMS FOR CONSIDERATION BY PUBLIC HEALTH DEPARTMENTS IN PLANNING FOR A RADIATION EMERGENCY. l 1 i

. = -_ b n ? EVERYHEALTHDEPARTMENTSHOULDHo$/EACCESSTOEXPERTISEINRADIATION MEDICINE. ONE GOOD MODEL CAN BE FOUtO AT PASSACHJSETTS INSTITUTE OF TECHf0 LOGY, WHERE A HELL REGARDED SPECIALIST IN ItRERtML MEDICINE IS i PERMAfSITLY APPO!tRED TO CH4IR A C0141TTEE C0ff0 SED OF RADIOLOGISTS, i ENVIRafEfRAL HEALTH SPECIALISTS, NUCLEAR ENGINEERS, RAD 10 BIOLOGISTS, NUCEAR fEDICINE SPECIALISTS, NUCLEAR PN(SICISTS, NO RADIATION HEALTH PHYSICISTS. A SIMILAR C0f44ITTEE UtOER STATE GOVERff1ENT AUSPICES MIGHT l BE CALED UPON TO OVERSEE HEALTH TRAINIt)3 PROGRAMS FOR BfLDYEES, i COHUNITY PHYSICIANS, AfD OTHER HEALTH CARE PROVIDERS NO BE AVAILABE j TO ASSIST IN THE MANAGEMENT OF A NUCLEAR ACCIDENT WERE ONE TO RECUR. = i i EVERY HEALTH DEPARTVE?JT SHJULD BE INFOR'ED ABOUT PREVEtEI'E OR l PROTECTIVE PROGRAMS IN ORDER TO AVOID OR ALLEVIATE RADIATION It00CED DISEASES. IN THIS REGARD, P0TASSILI4 IODIDE IS REC 0fEDOED TO BE AVAILABE i FOR DEPLOYMENT AtO DISTRIBUTION TO ALL PERSG4S AT RISK OF EXPOSUPI TO A RADIOLOGICAL B ERG 8;CY. [ t BOTH STATE AfD LOCAL HEALTH DEPARTENTS IN TE VICINITY OF A NLELEAR REACTOR SHOULD INITIATE OR WORK COOPERATIVELY WITH THE MANAGEMENT OF THE PLAtU TO C0f00CT RADIATION DRILLS SIfilLATING RADIOLOGIC EMERGENCIES. THROUGH SUCH #1 EXERCISE STUDENTS COULD LEARN A GREAT DEAL ABOUT DISASTcR PANAGEMENT. i EVERY HEALTH DEPAR1NENT SHOULD DE'ELOP.A RADIOLOGICAL EMERGENCY RESPONSE PLAN FOR THE HEALTH ASPECTS OF A NUCEAR ACCIDEttr. TE PLAN i SHOULD ENCOMPASS CNERALL EVACUATION NO SPECIAL PROCEDURES FOR SPECIFIC j SECTORS OF SOCIETY, PARTICULARLY INSTITUTIONALIZED OR HCriE-BOUND PATIENTS. l Hud.1H DEPARTENTS SKXJLD PROMOTE AGE-SPECIFIC C0tRINUING HEALTH I t EDUCATION PROGRAMS PERTAINING TO RADIATION FOR ALL AGE GROUPS, ESPECIALLY l 3 FOR PUBERTY Af0 PREGNANCY. j. I ~=e e--- ,i-e v. v, m. ice y.,--+---.aw--.- .-m,. mw--me--y i,--,,, -+-ee a -- - - + -.---w- -,n-e- .-----m-- -, + -

e

~ l 23 OPEll C01EllCATICf1 WITH WE MEDICAL C04Hi!TY, THE RELIGIOUS CQ1Ul!T( NO THE GDIERAL PUBLIC WILL HELP TO DELIMIT PSYCH 0 LOGIC /L l DAI' AGE WHICH WE HAVE SE91 FISULT FR04 TE IMI ACCIDSIT. [60VE ALL, THE FUBLIC HAS TE RIGHT TO KtKM TE RISKS NO DNEERS FRGi A PADIOLOGICAL EMERGBCY AS HELL AS FRG4 ALL OTER CATASTROPHES T m T Call AFFECT THE PUBLIC HEALW. AS S00fl AS POSSIBLE AFTER TE ACCIDDIT, IT SWJLD BE Atti10V!CED THAT HEALTH DATA SHALL BE COLLECTED NO RELEASED PRCffTLY TO TE CITIZEfiRY AFFECTED BY THE EMERGO CY. THE tGDICAL CCUSECUBCES, hPATEVER THEY PAY BE, SH3ULD BE FRG'PTLY IflTE?fRETED NO FURTHER STUDIES D0fiE AS ItOICATED. THE PUBUC HAS BECOE ItCREASIfGLY SOPHISTICATED Ift IllTErsPRETIf6 DATA ABOUT PADIOLOGICAL BERGBCIES. OfiLY TECUGH EFFORTS TO DEVELOP A SOUtO SYSTE4 0F PUBLIC i#ALTH TrROLGUJT TriE CCCITRY WIU hE EVER EE AELE TO ADDRESS EFFECTIVELY TriE i MAliY HEALTH FR03LE4S THAT COULD PISULT. FRGi NOTER f.'UCLEAR ACCID 9iT. A'O UtiLESS hE DO ADDRESS THESE PROBLEMS-#D ADDFISS TrEi flGt-WE PAY WELL FItO CUT HEALTH TO HAVE DuetIORATED TE1 OR Tn?iTf YEARS HalCE PGOERIfG TE SNE PU771 FA TIMT ARE C001 FRONTING US HERE TODAY. IHNIXYOU. i k I F m. .3-- e., .-_m... .w. - ~ - - -

R& dear StateinAscendancy i By Anna Mayo l Has anybody here seen my old friend womic and preschool. age children (also at TMt (Kemeny) Commission. MacLeod rnsha.i. i>hr.sc.: d.ms. i. h.....d 1=.: tt Gordon? rink), from a five. mile radius around the enumerated several serious "missta te-I'd*"'* P"*"[w .ne N -Con you tell me where he's gonef plant. (The official presittential com-ments" and " misrepresentations" In s let-c.rerei urvii y by ami.s.Sr h wa 3h. ty ll'c just couldn't gag him. so ice had to mission report on Three Mile Island re. ter to the Kemeny body. (For instance, '.I h tth d.=.s. detected i.e h.. b a r.r-j i.w., terni.d..ch ntie. bag him. constructs the call just as MacLeod re-one state committee report omitted data '"*'Y,*,'f"', ***,",Pj. ngHsn m.d giublae -f just looArd around and he was gorie, -From a skit presented at the 1980 !!ar-calls it, sn, ough Thornburgh press aide from a presumably high release of radio-n Italand Pages, a former New York Times active iodine that occurred in mid-April ad.tia...a.lcohol for '. lief. Deir .ie's could r...i.a di.ir ed toe monih. ..d ,t.d i. risburg press corps show, to be sung by man, denies it took place. "If it did take when the TMI auxiliary building charcoal *,",',# N,",$"[,$f[,'t,",[*,,[*"*}'"dC Dick Thornburgh to the tune of place, and I doubt it,' he said, "there filters were being replaced.) " Abraham, Martin, and John". wasn't necessarily some mythical person MacLeod called Environmental Ite. T8w =<=t **r =.= ch.rs. h bee. th.t not-w..,d. b...d .<..i., di.i.,i.4 d... Dick Thornburgh is the present gov-y yn de butenant govnnors office par-sources peeretary " Cliff" Jones to recom-O' *"bor, b die.. Th re.e. . err.cii..iy i.id t. ,"",,'U,',",PP['d "*','"j',*hy"'l*irN ernor of the great-and berserk-Com-ticipating. And if there cros somebody, he mend that whoever in his department was i h didn't necessarily tell the governor what responsible for the " misstatements" be int by ..t. ..d F.d.r.1 he.ith 1.mtse. tori. 99 hor burgh fi e D Gordon MacLeod recommended, if he did recom-reprimanded. Jones became furious. Lat- "L'""*d j" **,,*"","F i'L"'*d[ m it.iic..h i..i.c m.. n... j 7 *,',"' MacLeod, his secretary of health' who had mend anythmg. ) Not until late the next er, the closest thing to a reason the gov-morning, nearly a full day and an un-ernor would offer for firing MacLeod was d**th. *ithia. tea-mi1= '.diu. r th. re.< tor.rt th. .h.,.r i.r nf mat on he h al e fects known number of curies of radioactive that he had been discucaing the latter*a [,','dl"'s','"l[",.,"rlior..i deathe r...i.e nuclear accident at Three Mite lsland six ne aftn hlacLeod s warnmg, when " differences m institutional style" with J seph llendr,e, chairman of the.U.S. Jones and several other members of the or t, inh.. n r., months earlier. Since the firing, and with i 8,iagr;tgegyn thgd *;a the connivance of the pronuclear media- , Nuclear llegulatory Commission, told admmntratmn. What did he mean by ,,,,,;,,,,,,,,,,,,,,,,,,,,,,,g,,,,,,,,,,,y in particular* as we shall see* The N. ew ornburgh on tk Aone from Washing-umt. MacLeod asked,,it,a hard to ex- .ieh thyroid d.r.cs.. not i sis.si. me.: a ton that if his wife were [tregnant he'd get plain," Thornburgh responded. "It's just thm c. .er..itnbuied to her.dii.ry a.r.ci.., t at on ha ngagei in systemat c her the hell out, did the governor make his that we operate differently," pression and manipulation of health data reluctant, not-to. panic announcement llis tour of public service formally over, yN'Z,'m"*,',h,T"m th "[$**' *

8
h.d

..ch c . ra. ' under the banner of " preventing com-

v n % p'a W %7gc'u' mci m- -

munity breakdown"-business faillirca, b 'W r 'W fi1 ([ . sinking property values, people fleeity the I , 'k..m.g[l@73,QM ' area, riots, civil war, and so on. ' y, 'dD1*Y . t ., " h"- ]pJ:' \\ h h The firing stunned MacLeod. Only a f 3 t , J- ~t j ,l W ' }' >h few months earlier, Thornburgh had 1-- m -m P ** l?:[ff i !/ 8 Y wanted him badly. Ile would have pre-.T 4I fp; 'f $g d ~7 ,\\II ferred to stay in academia, but the gov- . ff L

c..

s ,3 h; ,h L .r y ernor wouldn't take no for an answer. f Q i ..l d C j t i p i needing MacLeod as a symbol of cam. '.O f i 'j l,{({ ". k Ig 5

2 m**

poign promises fulfilled, of depoliticiza.

7, f.

1 Y,$. [W# g' p. yh 1 @d i N A tion of the health department, of clean }ry - {.;' O / L -l e W ..Ip{ ' t, { h,, g i government, of a new era of reform. .;g ,"1 1 y is llullshit, of course: one straight arrow 3 1 . c I gl ', y 1 'yl i 4~ Ep [ ( i cabinet official was hardly going to change 9 l .O

u-F I

l) 'l i torically encrusted with patronsgo and F.I k

i., '- f, the character of a state government his-E* 's H.

h I i ,i2 [t[ l f e j i ,h['jl / l

i

{ j3 s ' [;i(,( E corruption, where lottery scandals have jLh ,~ . f y- '( come to be expected, and elected officials [), ' e{I f h$. '~~ - have, over the years, checked in and out I 4 -of nearby Allenwood Penitentiary so fast j p r,.

I, i k

J k j3 i{ p Q it's known as Harrisburg East. '"** ie"rle*d J,I , h fh i Q t I 4 .I' p h .I .? t -te_ -tm,s_m. _h-ie a _s i.., N d ea s o t ,a g

governraent, et a new cro of reform. p[ "1 I h[ \\ h .h f ,) i. I Dullshit, of course: ons etraight.strow

t l

f%j i ; . 6 i . cabinet offici:1 wie hardly going to changs ' i} ,s. i-n. + h ,.[ ? ( tha chorecter of a state government bla.

7..

o r D a, 1 ? k yl i i torie:lly cncrusted with pstrontgs cnd ' 3,I k % ;, ah(i ~ .d T i r

f. ]f(l,

)/ ' j,' corruption, where lottery scandale have ,t [L .I j I cdme to be espected, and elected official. i"; .~ f q t .s M, 9 ig e i n....--

u.,

hqve, over the years, checked in and out /* ) tl p 'N a,( g'p . i d of nearby Allenwood Penitentiar IE, J

, [

P it.jne,wn.. n.rri.bu,g e... y so fast j g, i x 'I J t J( p,n q,, 7 y c metea..ne..t. was. eine..et. ne f pf . i mp J g W' " ', 7' - i I. d. < g i l' I t .I ' I { S,, 4 ! q.,3 ) k .k ismo frone the rarefied, high level ,,dr ( . J dh c 7' q tenching ho=pital world-he had been a M if '1 d j 4 . aQ Y i Menschusette General llarvard Medical l' D { l '..l l' t 'h(j1 p j /(/t ,d[4 ', ..' ' ?..'f'( ((( (hl , i, .fl School Fellow, chief of the Yale Dingnostic ! W -) i .f, ( h t Clinie of Internal Medicine, senistant to p. .,,, 4:. y Ic j j$ p l .,4 i y p- ,$ ', { n; Eliot Illchardson when he was secretary of s m h, y )g,,t.$ q

f P.h d I G;?,

O e p { hesith, education,, and welfsre, and in now p [ q.. m. el m I i i ,) i b. lj g.,1 t.h[ju. I.D 'I i - j, t/ feilow of the Amerienn College of Phyni-1! - (@M.~ * { / [(r [ 1 ' y ..};fhp! cisne, immediate peat president of the g*f, ,( O ' i,Q. ( g,g 1 k.: + 5 h,j-(l g f '. .g ,i '[%jl:v[-[* ] 1 ,U.S. Metlical Administrators' Conference, Yr Q'S $- ,gQ y g,d[ls y Q'f l glb f ; .j. I .,j I \\ \\ l> f chxtrman of the Department of Health d;., ~ 3 5 y. g. ggg L;.;@(QL,3%d.: p 7n ta{fj.; f. . L, @.f{ 7 ?g j 1 Services of the Univernity of Pittsburgh. Q h.Q c d faculty rnember ofits School of Medi. g p , Gordon MncLeod: fired for making public henith information public a "When,'the governor called me In," that "iri case ttfeituation got worne"-he "his people" forced out with him, lu art ce tarern der.,miti. a r.rm..imet. MacLeod recalled in a recent telephone avoided any suggention that the situation MacLeod returned to Pittsburgh's c ,'"d *[',', f tll,, ,**, ,6",",'),""'*["' a", "';',*d, . Interview. "I anumed be wanted to din-was already dangerous-it would be " wine academic life. But the purge was in. 3, 7 ' cues a nursing home investigntion we were for pregnant women and pre school chil. complete. One February morning he was econian-au..borunes Ar ci.n twe eruci re...a ..,..i. i o mth i,,.,,,y,. 6...titia,, h., involved in et the time-nome workers had dren to evacunte." awakened by a confidential cnll from liar- '" * "" "d d'" d"' ha :i'"7 b*h'"- barrie:ded themselves and patiente in a MacLeod was not eo sure all wng well. rinburg; there had been a rise in thyroid '"', ih,"a" *iN *r"/',,,j I,"O"'r'i', d"'r'irI,".,"",e home in Philadelphin. Ilut when I got into Heenuse of inatrument malfunctioning at defects among babies born since the acci, l..t May and rua enty ro. -iih.ny uno...i pn h. hia ofrice, he started telling me a rambling TMI, radiation levein went unmensured. dent... the information should have long ' '",j [gl,,th',,',igygg*lgy,','"[,,',' l j enecdote, something about a derelict who And he was haunted by the story of the since been relenned... it wo dc he held 3 took some checks from the governor's Neic, day reporter whe upon returning te back indefinitely, "For several days I tie eret icas in=.' dia.re.titi vader -.r. nvi ,,,,ia,,,,,r, a,.i a...... i m:ntion which were later found in a Long Inlw.d after covering the accident, made every effort to get the data out '" ""l'h',P",bh l*",pl*,"'"' d",'b ",'y; , f, j, church-it didn't erem to have any point. became concerned over the irradintion of officintly," MncLeod enid. " Finally, I I thought, maybe he feeln like panning the the fetun she won carrying. On her phyni. tipped off a UPI man and he was able to me, ha. been nenheible: da he.ith erreriat. -h ro, ih. notico, i,as,c,y.6,.., ih.i,.a.. . a... tims of day, when all of a nutiden, out of cian's advice, she had an abortion, then obtnin the figures. The ntory went on the

* ' * '"""'" ' h* P"hhi' "'"F
"d ""'"" "

nowhere, he asked for my resignation." wrote !!arrisburg henith officints, offering wire and received wide piny " N' '. no't.tit n. urica i. the tennier er "'"""*"'""""*"d'"* MtcLeod had been sworn in as secre-to ship them the aborted fetus for ex. In March the rninister of Pittabu, rgh's whet 6 tity, the state's highent health post (sup-amination. First Unitarian Church invited MacLeod ""i" *ha h"' i"f'*d r*hr '"" b' ** h"' ponedlyl, on March 16,1979. Twelve dayn Throughout the spring and summer to spenk on "TM1, One Year Later." From "!."",'ol,*i, M."d' *,*,i.$,,rii$h.7,U.7,r* / 11ttr, radiometive hell broke loone on an MacLemi net up studies to determine if the pulpit, Mncl. cod dincloned that the the wo*at but -u 1.in rmed to ev ima by the Ist;nd in the noble, if coittaminated. Sus-there had been any henfth effecta fre a the infnnt denth rate in the vicinity of the y,",",,;,,'y],P"hh"',*d [;, ",g 'h' ",,] quehinna Iliver. accident and worked up a llenithDepart, reactor had rinen sharply and that accord. Physician MacLeod wee acutely aware ment reorganirntion plan. "The governor ing to n high DOli pource thene datn, then a atar :==n. w wraed by n+=te.t haeth aviher ete. in. 3:,., 3,,,,,,...,,,,,,..i,., r. re n n a ia i that fetal espo.ure tri radionctive iodine seemed enthuninntic," MacLeod recalled. nix monthis old, were also not going to be '""h*h"'s dai. ta d"acna'r.t e heatih d.m se mty esune infant denth or mental retardn. Ilut the regularn er vuaing at Catalan'a released. "."'l opened the mornine paper and tion snd stunted growth. The day nfter the Itentnurant guffawe-I at the profecor froin Ile hnd hit a nerva.The nuclear entab. roccident, in one of thoae hectic four wny Pittsburgh: " Marl. cod the Cloud" they li=hment untenshed its degn. On April 19 conference call screaming contents that called him, or "the Iene F.ngle." They The Neic York Times ran an unusuntly thin thing wam," said Macial. "What wers the modes operandi of the crinis knew he'd never innt. hysterical editorial: made me angrient was the Tirnes editorint. prriod, he strenuou.ly urged the lieuten. On October 4 the governor's specini ist had never called rne. And a reporter rh..em.n.,,n.t. oui ndi.tien d..re rmm cnt governor *n representative. John Pierre, TMI inve=tigatory commianlon convened. th+ *erideat named Jane Drody had referred to my '",',',')QI..t 1 hen Md. w.ad 8= tjng.i'vig g,, f','N', ~ taho, he understor4, carried reportn'of all' D r' nit s bf committee pp} orts 7 gentemente in.-e w. ptnrv t efort,the d; ' l,

' " *d i

were high levyl, hectin' git, (l,(he governori, to ,,jitorinlawhich Isnly an(e.iktrone,and 4 l cartulnted for comment prmr to cha..rieWhe.tih 1ticie i.eds e i h ie heesi as.i.e.'r'd hs nhe had never entled ine eitherf cdyin the governor to evacuate pregnant ~ patching finni copieg to Presnient Carter's Il meiae m*.tedue.a...i ihr uMwe Jive ermarut ,_,,,,7 ontemn.d eer nret rmre v w

.. _ _. ~ I Contir.: cd from p eceding page Macleod dashed oH a letter to the i 1 papar with a note to Max Frankel, ednori Q: What data should she have waited for? el page editor: "

Dear Mr. Frankel:

Does a A: The way to determine if then has been ~ P #

aez reversal after exposun to radiation inJ ht'. article, said he had Whed to penon castigated by the Nes have -a nght to reply? In all fairneen the Dme is to allow 50 days-that's the time it U

E s should retract its obloquy and correct th takes for the ra6ation to afect the e rnistakes in Ms. Brody's arti:le...." adult male a -f had become convinced that MacLeod l (Macl.4od was al.so aggravated by the 270 days for gna$, E the "hard figures" p d g ou 3 Time's failun to prmt an earlier letter in I h, n y g unsy unia OH. u days You count au bab[' faIfr cham had defined "pennatal deaths".

'* ka which be had corrected mistatements in before and four wee b

an April 2 article by Times reponer David Thus, you wouldn't have been able to lenths owing to miscarriages and elec. Burn. ham ) - obae:ve nez nversal until March 11. abortions up to the age c(23 days offer i

h. Asked whether this wu perhaps a Macbod phoned repeat y to tN ted statistics

^ > graphical error,, he bumbled: "I can't en in ary i letten page editor, wbone eecntary finally ly say... I don t remember. Say, what told lu= his second letter was being held Q: Would you comment on Brody's perinatal deaths anyway?" Burnham up by s:icoce editor, William Stocktm. "I statement that the Health Department missed the esmtial point: The Penn. finally got Stocktoc on & phone " said data shows 31 deaths in the six menths ania DOH had added in fetal deaths, MacLeod. "He said, 'Oh, I know an' about i U wing the accident as against 20 ch are no known to be aHected by low. you.' His tone was not =elcoming. I had during the corresponding period in 11 radiat,on, as ir.fant deaths are. Thus, i the impression be did not want to print my 1978 and 14 in 19777 ame up with a reassuringly low total letter. He said that if I wanted it pub-A: She has it wreeg. The sequence was 20 hso* Inhed. I would have to rewrite it, leaving deaths in 1977.14 in 1978 and 31 in Bumham had swallowed. W out a correction I had znade of a point in Brody's anicle and klno my infant monal. ' 1979. In other words'h befon & acci. 4 " cent the ir.fant deat rate was g i ity data, that is to say, the cruz cf the' down, as it was in the not of t whe!e argument. I asked him why, and be country. Ih

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I said he found my data 'codusing'. I had dical can. etc. But what new factor had him talk with a biostatistician here at the 4 'he Emes editorial claims that Penn. sed the 1979 infant death rate to in. univeniry, Dr. Howard Rockette. When I sylvania Agriculture Depanment stud. ne beyond the two precedm, g years? spoke to Stockton later, he told tne Rock. nes done in May 1979 show that radi. ] only had one day to write the arti. ette had convinced him rny data were sta o did not aHect farm animals. Burnham said. 'It,s the sort of piece sound. But he s A: Most of the reponed animal aHecta 2ng to print., tiU found them too'confus. ~ 'w got i ou ) abowed up s/ter May. In the case of It diEi need morelime, and censidering p a,dult animals, they could have taken mharm's long record of accurate nuclear Q: l>r. MacLeod, the 7Imer editorial time to develop. And few animals ex. ,ortage and that he uTote the MacLeod claimed your data on infant deaths was posed to radiation in utero during the ce under the stress of a major career " meaningless" ainee there was an in. accident would have been born in May. .mge-t wn the eve of his resignation ~ creue in the toto! number of birtha ao Q: The Times accuses you of "ir. ',re the Times-he would have been off that & rcte of infant monality n. responsibility" and " inflaming public book. Except that he uncha rac. meined the same. It said, as fea rs." istically shouted, "This guy M ac. Burnham's aniele had, that you failed Ifh d p Es cff the wall!I hope you print that! ^' to censider the forcl number of birtha. I' #

m t bo b ek nd dis.

A: But of coune I did. Baths simply do torta infor=ation. If it beccmes politic. g$.#ha e t e ec:r lete ta Y ae not go up and down sigmficantly from sted, the department icoes credibility. l year to year. As a matter of fact,in the How can one believe anything it says? to realize that there's terrible fear in that 3.. five. mile radius around the tractor I personally do not oppone the develop. communi:y! j bre was actually an insignificant de. ment of nuclear energy, but I do be. In another interview, 7imes sc2ence; crecsc in the total number of births heve the public should know what the writer Jane Brody was a ked if she still felt-But ! certainly would not use it tol health effects will be. I n! eased the her statements about TMI health eHects. boiner my argument any rme than I infant mortahty rain because I was

"' C "'Ct-would expect the Health Depanment, told that they would othe* wise have "My feelings have.nothm.g to do with to do what it is doing, whieb is to usei kun suppressed. I discloseo the ir..

it," she replied. "I write about scientific ormation o'n thyroid defects primanly forts. not about what I ferf." a statisticaDy insignificant inenase in 8 the total number of births in the 10 to encourage early detection lest an Why didn't she interview MacLeod? mile radius to justify its argument. untreated infant become a cretin. Not "Why should I have?" she asked sharp. ~ Either way is wrong. fo release such information is it. ly. "He never did any acgentific investiga. Q: You say the Timn nfused to print al cesponsible. After all, public Acolth tion. I only interview scientists." (As an data beforts to the pubhe. M.D., MacLeod has had training in criticism you made of Brody's article. epidemiologycin fact, over the years it has 8 A: Bmdy claimed that the nor=al 106 ben one of his special interesta.]. male to 100 female ratio per 1000 births Brody had quoted a scientist from the was not reversed followmg Thne Mile Federal Center for Disease Control in At. Island. Entish studies have shown that l lanta to the effect that "all other areas d it can be reverned (presumably on ac. the United Statas that have acreening pro. I count of irradiation of the testicles). In grams" had higher rates of hypo- ~ my stneut letter, I pointed out that thyroidism than Pennsylvania." But Moo-4 whzn Brody said bre was no revenal tana and Idaho have much lowee rates. r;be did not have 6 fulldata on which

The CDC scientist was talking about to bue her statement. And they say nationcI compositaa," said Brody, sound.

I'm inesponsible! I ing as though she.was about to hang up. l 'Contirudd an nes't'poir

~ ~ i....... '"' ""4'CD C4 81 DMTUF95 Prevent ecmmunity breakdowT.? In Srs mu toic that say ec: tor t.ad ukec "*hysician (security clea' red) at tne I, ' that sht be interviewed so she could gtve as a p Hamsburg. community breakdown has al. ' her rm.le of the story. %,ar CoHege. Some wonder how M...er ready happened The TMI cleanup pro. can find time to carry out his dutio as cess now underway entails iarge releases ef "Oh. so you were going to try to get secretary, f r while his % ar Codese pg is radiation. The possibility of another ma}or away mth not letting me tell my side. wnkends only 010E pu annmc he ensis is very real. Hundreds of families U.ct's the kind of reporter you are!" New York Times science editor William also cccinues to ae! as chairrnan of tne have fled the area. Others would like to Divis:on of Emergency Medicine (S2LOCC) split but are unable to sell their homes. At Stockton was cooler m tone. Asked if he at Hershey Medical Center. sorne point they might haoe to go, they had told Macleod to delete his infant r::ortshty dat - Neause it was "confus_ Thornburgh's lieutenant governor-he feel, so they keep their savings in the ing," he rephed thst no, "not because it !hinks of lum as a son-is William % onh' bank. As a result, sales of consumer goods was et nfusing, but becaun it was incor. mgton Scranton III. Scranton IIrs actual are off, smad busir.eues are in trouble, rect. h was wrong.' He denied telling fathu a formn Pennsylvania gonrnF and newspaper advenising revenues are Mactud that biostatistician Rockette Wiuiam Scranton, member of David dow n. had ccavinced him of the significance of R cafeUn a Trustnal Com=issjon and There are no 'riota-instead, people of the board of The New York Tsmes M a cLe od's infant monality statistics. tum anger in against the=selves and their , ten Thomburgh is out of town eon' families. The incidence of alcoholism, "Rockette was on the fener," he said,"and ring, two membus of ha capinet wife. and child beating, and other disturb. un we talked with some of our people and it can the shots-his secretary of envtron-ng psychological reactions has increased. beca ne apparent that MacLeod was Inent:1 res urces, " Cliff' Jones, who w** The critics rnaligned by the Times did wrong. We checked the story before publi. influential m the firing of Macleod, and not cause the breakdown. They are only cation and we've checked it since and we stand r>y it." his eecretary of budget and admm, is. the messer gers who brought the bad news. (Rm aette Told the Voice that while he tratien, Robert Wilburn. Jones used to be Doctors do not as a rule challenge the peid executive, for various industry establishment of which they are so com. a could not say what the health implications n rgannatius 4, de Gnatn fortably a pan. But the MacLeod firing of the data were, there was no question but ' Hazine Chambu of Commace and gnawed at principles buie to the effective t that they were statistically significant.) Canoo Ined He was also stan Re' Wasn't it true that the data base for eez practice of medicine. In Decernber, the publican chairman and denves ha power House of Delegates of the Pennsylvania determination wa s' incomplete when Bysy wrote bn an ele? 'h'1*",,Ij']dras Medical S ciety vindicated Macleod t Grand O through a spects1 commendation for his Pany Blond and jutjawed Wi! bum-re, " %.e stand by our story. B' ut.. [he ponns hanging out in the Senate Saloon bandling of the TM1 crists. The Allegheny General Hospital trmted him to grand hesitated for a fraction of a secced).. er call him " Captain America"-is a former .. we intend to do another story this fall vice. president of Devid Rockefeuer's rounds, the American Public Health As. when the data is complete." Chase Manhattan Bank, prime source cf sociation, public health equivalent of the American Medical Association, invited funding of the cevelopment of capital iru Suppression of information can be seen g him to speak at its annual conference, es an intnnaic feature of Hamsburg a new and in the spring he was feted at the Thomburgh himself used to be an at-annual conference of the Allegheny Health paramilitary style. From the start, the tomey and adviser to the Mellon fa= ly o, Depanment. When his succewor, the ca. Thornburgn administration has been studded with er. FBI agents and ntired [p t 3]s,{Premin -at on t - jor-doctor, said combatinly that he would f army colonels. At the time of the accident, user of nuclear. generated electrietty not release any TMI information until it for example, the chief of the Pennsylvama g, p gp 'g was " absolutely clear" to him, the emi.

nergency Management Service w a.s Mellon family contributes to the T:s.

nent physicians there auembled made it Colone! (U.S.A, Ret.) Ch a.n K. Henderson. kno=Ti, in a dignified, throat clearing publican Party and has its own Big Bank Hen had been commander of the is, naturaUy, pmteet(ve (it==ediately af. g manner, that they depl meady into nukuh pf which Thornbegh i bdgade involved in the My Lai mauaere.. As yet MacLeod, like the majority of Absolved o! responsibility for that episode, he re: ired to the Pennsylvania job In a tg his election, he wipad out the modest old boy dtecs, does.not oppose the use of ler:stative co=mittee hearing last opdng, nmr=s of the previous administ:qon nuciear power. I may change any mind and stacked the State Employee's Retire-eventually, he muses. "The other day a " Hen" made the mistake of insinuatmg ment Board with appointeen who n-reponer from Canada asked me a very that the gos emor had erred in rejecting his recommendation for mass evacuation. The instayed Mellon Bana as stateworkers, provocative question. He wanted to know fund manager). A self4 yled what would make me antinuelear. I old Mylai veteran resigned before he was " pens.en i R chefeller liberal," darling of The An thought it over. Finally, I told tum that if f~nd M Times, former deputy attorney gen-I ever become convinced that nuclear ( To replace Henderson, Thornburgh eral un,er Gerald Ford (invited to stay on energy would harm future gennations, t called up big brass: Lieutenant General by Trilateral Commiunon prendent Jim. then I would oppose it. Dewitt C. Smith, commandant of the my Caner) Thornburgh, not m:mentaUy, The pro-nuke machine in Harrisburg prestigious U.S. Army War Co!!ege in.is also e close perscnal friend of Roben has no rocm for people with hmits. What Carliale, 20 miles west of Harrisburg, a graduate achool for futun generala, and, Kirby, chairman of the board of West. the nuclear state in ascendancy demands although not much rnentioned, CIA inghouse, World's Largest Manufacturer is fanatie loyalty, willingness to take cas-I Nuclear Reactors. ualties, military secrecy, an end to demo. agents. Before the War Couere post, Tn.23. then. is the pubb,e servant who cratic forms, the cold embrace of tryanny. Smith graced the Pentagon as a top aide will decide such life and death matters as E to Seentary of Defense Cyrus Vance and whether pubbe information shall be made General Maxwell Taylor. Ominously for pubbe, whether, m future crises, evee-the future of Harrisburg, the presa release unti o is advis,able, whether a cleanup e.nnouncing his appointment puffs his long pr cedure that is cost effective is prefer-record of combat esperience as an emeen. aMe to one that is less dangemis, and tial requirement (ni upcoming nuclear whether the state will countenance opera. errancin tion of the four power reactore now in Anotber fnah neruit from the military '"N C'

"E

" "II"# "D" "" d " tary, k)eleod's successor sa health seen. c onst m' etion, and rutan of the two is M

t. Arnold Muller, an ex army major lun ns n ne laland.

who, although bis official curriculum vitae 9

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1-i ..h i ~ l THE NEW YORK TIMES, SATURDAY, DECEMBER 2% 1990 t L 1 1 I Letters l f { An N.R.C. Plan to Allow Just a 1,ittle More Cancer l To the Editor: smallquantitles of tritium and carbon. Ing "very small if no one bothers to I In recent weelts, the Nuclear Regu. 14 could be discarded in corrnunity look for any damage? j /. A Draft Environmental Statemend latory Commission has, without fan. Inuffills. fare, proposed certain changes in its These two changes would reduce the by the N.R.C. (NUREG4518) stresses /\\ regulation of low-leyel radioactive cosM of mdioactive disposal by an the financial sayings that would result ! waste dispnsal that may set a prece. estin$nted $16 million per year for the from this perverted forrn of conserva. tion of scarte resources. INbile can. dent for future distribution of large licens+es. bg quantitles of contaminated materials A swond Federal Register notice, ments on the draft will be received without l6 censing, monitoring or any on Oct. 27 (4S FR 70874), clarlfles be. until Dec.22. Once established, such a policy of l follow up studies of possible conse. yond any doubt the intent of the N.R.C.

- dispersinn and dilution" for solld '

quences for pubile health. To our to " solve" the troublesome low. level l luewledge, the press has not beer radioactive waste problem by derego. low-level radioactive wastes wondo be 1 j j rnade aware of the implicatteris of lation, dispersion, dilutlos and diths. readily eatended to other contami. noted materials freen the nuclear I l these propmed changes, and we be. elen. lleve that your resdcrs may wish to in it the commission pmposes to power industry, riot just medical, ro. submit comments to the N.R.C. and to allow the recycling of metals caritami. search and weapons.related redloac. l elected officials. aated with technetium-SD (half.Ilfe, tive wastes. It would pave the way for The Oct. 8 Federal Register (45 FR 210.000 years) and towastriched ura. classifying other ** low. level" but anne. t In018) proposes to deregulate certain ahms from the Department of Ener. theless dangeroes radioactive maters. als as " safe enough for the landfill" or rnedical and researth wastes and per. gy's gaseous diffuelort plante. Con. as ** recyclable scarce resources? mit their disposal in sewage oystems taminated scrap copper. Iron and and sanita ry land fills. Liquid acintilla-nickel would be perraitted to be There would then never be a conk } tion media contaltting tritium (with a smelted and raised with uncontaml. Prehensive assessment of the lenpact, a half life of about 12 years) and carbon. sated materials frorn other searces for upon people and their envirortment. ! because no one would be able to trace i 14 (with a half.llfe in excess of S.000 subsequent use in all manner of can. I these contaminants. Just a little enere years) in an organic solvent (toluene, sumer articles, cancer. A few more defective children. I which is highly tonic) would be dereg. Appliances, toys, futniture, cars, ulated, conserving some 400,000 cubic cotr:2, cooking utensils, machinery and This is grassly improper rvgulation, feet of licensed low level waste dis. construction matertais are cited by the which wholly vloistes both the man. date of the Atomic Energy Act to pro. } pnsat space for other radioactive N.R.C. as possible consumer itema tect the public healih and safety and i, that would be permitted to contahn / At present use rates, some 200.000 to low. level redlonctive cemitamination. the requtrements of the Natlemis! Envt. wastes. ronmental Polley Act. l l 4m.cno gallons of contaminated ma. The commission empresses some con. JuDtTu H.Jomesavo g terial are involved, 43 percent of the cem about " health ef fects" on foundry Co Directer Environmental / volume of low-level radioactive w astes workers but concludes that the dans. Coelltlen on Nuclear Power ] from medical and research sources. In . age to the public would be "de mini. State College, Pa,.Dec. 9,1980 addition, animal carcasses centanning snus," which is an N.R.C. terne sneen. ) s .~,,.. _. ~..,.....+.~.. -.~..-.... .g e e ~ ~' 1 m.

D - p, QM io,y~ ld .i . g.9) f , gi.- JOr kji6 \\$f M 04 Consensus la$ king a $ To the edi:or:" /O" gg ggP'eCflVe n i ^ J * "d

h*l' '8' *** # ******

r: took place at Three Male Islan'd, and To the editor: D we all began to learn n. ore about r.u-f In reply to Miss Andrea K., Wilson,'s i clear power. Perhaps most impor. letter of Oct. 24. I would ilke to submit I tantly we have learned how misch we the fo!! ewing information. ,;i 9 still don't know. On May 19, the Pennsylvar.Ia* Dept. of Health released a report of it. fast,

?

Thm as general mus,in de neonatal and fetal death rates that is-J 1 s&oune community 2.at the radiation cluded statisites for the efittre year of. 5 exposure to the public at TMI was not i 1979, before and after the,Three Mile. my high. But consensus is lacking a ~ Island (TMI) accident. the effects of this low 4evel radiation. n The figures in the report show the in. 4 " Me Healc Wes in hansy m O'~ fant death rate (deaths under the age, of one year) to be 11.5 per 1.000 liveg

nsa at the time d me accuent, &

births within a !$. mile radius of TMI. 2 kased these infant mortality stah-The statewide hgure for the same peri. for the area wgg M aher the-od of time was 13.3 infant deaths per.(,t rep 19*3 accident. natal' death rate (deaths N'aI[nN*aed 4:l Ps ! e n within the firs.f 2 days of hfe) was L30 3 isn s> io 3 ud per 1.000 live birtAs within a IS. mile g 3"8 2.3 7.2 M radiu of TMI. The statewide figure i NT,*. tif u.i w was 9J deaths. Figt:res for fetal deaths (stillborn, miscarriages or voluntary abortions Dr. Welied cautions against draw. after 16 weeka of gestation 1 showed a l tag hard-and-fast conclusions from semilar trend. The total death

rate [

such rough data yet feels they war. mithin a 10-mile radius of TMI wa 11.1 rant careful attention d not further per 1.000 hve births. The statewsde h study. rate was 22.0. His main cocern is that this ir. forma-Eaciud.ng voluntary abortons, the tice had not been made public untal his state fetal death rate was 13.4 per 1000 t disebsure a. year after the accident. inve birtas, while the 10 mile radiga fig. ; "Had the infant death rate remained ure remained at 11.1 unchanged, or even decreased. I trust The Pennsylvar.sa Dept. of HM i X that those findings would have been well publicized." he said. Wied that "after careful study c1 att Babies esposed to the radsatica at snformation avaalable. we continue ta thest most critical fetal stage are now fmd no evidence % date that radiataan nearing one year old. Let us hope that from the nuclear power plant resulted the ts an e@ m dMsons being m an increased number of fetal. neo. , made about what the public "should" natal or tafant deaths." i or "should not** know concernmg radi- ! hope the above information will - stion effects. place the debate in clearer perspective ? We are a thinking people, capable of for your readers. ,1 careful ar.alysis, and are more con. ~~ LR. HOWELL cerned when informataca is not forth. f\\ 4C07 Washingto, coming (Ran when we are gnen the h ,; full story. ANDR EA K. WILSON y L. f } ~# ,v m Ea,t isam.m <w J V <f Yf w,V x c \\ ff .# \\, ) >,h[ N .g,e/, W Aq y '\\pd .r Q Ur l

/ r 'b ~ stattb d Serggg, W g %3 Depsivr=rsnt of Healch H Am At68umo 717-787-5264 October 27, 1980 Ms. Barbara Stamiris 5795 N. River Freeland, Michigan 48623

Dear Ms. Stamiris:

Your recent letter to the State Health Department regarding infant mortality was first referred to Mr. Lindeberg, Press Secretary, who subse-quently referred your inquiry to my office for reply. Infant mortality is defined conventionally as the number of infants dying during their first year of life, which is usually expressed per 1,000 live births in a given year in a given population. However, this statistic does not really represent the true probability of dying of the original cohort (infants) born in' a given year because of the following reasons: (a) some infants born in the previous year are included in the current death statistics; and (b) some infants born in the current year are included in the following year death statistics. [ We do have more recent data on infant mortality rates (computed by the conventional method), i.e., we have analyzed the entire 12-month period of 1979 by quarters. Please keep in sind that these 1979 statistics are still provisional for the reasons mentioned above. Several important observations have been noted. 1. Infant mortality rate per 1,000 live births for 1979 gradually declined from 19.4 (January-March) to 18.5 (April-June) and 12.8 (July-September), and remained relatively stable for the fourth quarter,13.8 within the 10-mile radius (including Harrisburg) of the TMI reactor. 2. A similar pattern was also seen for both 1978 and 1977 within the same geographic area, as well as for the State as a whole. 3. While the second quarter rate for 1979 was higher than the comparable period for 1978 or 1577, there was even a highe,- infant death rate already registered during the first quarter of 1979, immediately prior to the TMI accident. Thus, the high second quarter rate in 1979 cannot be attributable to TMI. / /* / P.O. 50X 90. MAmmtsaume, PA 17120 ,~ ..--v-m m eu p,em-p,w.ww p w,,m,,, n a -- ~ m

e Ms. Barbara Stamiris 2-October 27, 1980 4. If Harrisburg (a large majority of population actually reside beyond the 10-mile ring) is excluded from the 10-mile radius, the infant mortality rate becomes much lower; this is primarily because of the large nonwhite population in Harrisburg, contributing to a higher average infant mortality rate. 5. If the TMI accident had a significant impact upon infant mortality, those infants born during the fourth quarter of 1979 (exposure in early period of gestation) would have had a greater risk of death. Our data do not support such speculation. In fact, the fourth quarter rate was lower for 1979 than for 1978 or 1977. When all these observations are considered together, it cannot be con-cluded that the TMI accident has caused a higher infant mortality in the area. I might also mention that our careful analysis of the available data indicates no relationship between the incidence of congenital hypothyroidism and the TMI accident. I trust these remarks are useful for your purpose. Sincerely, George Tokuhata, Dr.P.H., Ph.D. Director Division of Epidemiological Research GKT:h cc: Mr. Lindeberg Mr. Ireland Dr. Gens Dr. Reid 1 ' " M**4 $ 9h j' .e pe,.y p gp e.e pee ge-em

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g A 10 The Washingtod Siar s a.,. v a.1979 Ilut since that time law-level radia-tion has continued to be released.and Pennsylventa llealth Secretary the latest estirrates from a team of MacLeod personally fects that tbe Q hg feder.d experts arc slightly higher for

most important health effect is the

, Q stress of having lived throvt;h to days the total radiation exposure to the of tension, apprehension,and rqorts population in a 54 mile radius of the plant. Ilut sources indicated ycsterday of a somewhat confusing nature at titres" the govcrament's overall estimate of in the meantime. given the events 7% M2 (. minimal lontierm risk to the gener.d of the past weck, few will feel rea:- A MA bu pubhc in the area of the plant toi sured by the language in a promo-mains the same, Pe % UEL'Is Questions have been raised, how-tional booklet put out before 'he acci. Affl O Q'))8 OD3 ever, abcut the f ragmentary and dent by Metropcatan Edison, the utthty responsible for opcrating the % %Is %RA sometimes conflicting infurnatinu Three Mdelsland plant. artilabic to date on the attual expo. By Cristine Russell "The reco:nmendation for pregnant sure Icvcts. And tiie risk estimates of It ends with "a word about safety miurcio sear si.n s-mr women and children was made as an low-Icvel radiation exposure are ... The record speaks for itself. The When Dr' Gordon K MacLeod Icft excess of caution since we Fnow that thc mulves controversial. nuclear Industry has logged millions his ost at the Unive'sity of Pitts. fetuses and young children are poten-Ahn Villforth. the head of ITEW's of hours in oyration. In all that tune, r there has bech no instance of radia-but b recc utly to become Pennsylva, tially more sensitive to low levels of Dureau et Radiotopical IIcalth, mid tion injury to any workers an the con-I t of heelth hehardi ex. ex sure," he added. yesterday that the federal ten:n fol-ct to t nfrcnied with a t ajor cral heaMa cfHeials appear to Wng Um bcW conquences d mercial nuclear generating stations. nuticcr accident ~ beve agreed in general with the state the accident was taking these cci,There is also no evidence of radiation Once he v as. be ickly found tisat actions, although the state did reject cerns into cecount and would adjust damage to plants,wildhfe or gop:e in the events at Three file island forced advice from the Department of the risk estimates accordingly. Eut he the environs of a station." him and other officials, including lleahh, Education and Welfare that a did not feel that additional calcula-drug celled potassium lodide should tiens now under way would "sicciti-it a anci ac ast y s ugh to be made availabb to workers and peo. ly" change the estimates already ca protect public health without causing pie livmg in the vicinity of the plant, m a I""u It is intendcd to protect against thy-Decisions had 12 be made on rold cancer should radioactive lodine MOST OF Tile recorded emissions s whether to evacuate the area around leve increasesharply into the air have been radioactive the damaged plant, whether to admin-Outside critics are a' Iso concerned ga:cs such as neuoo. In addition. W ister a me-licatien to protect egainst not otily that the radioactive emis. Ipyt!!4 of radionctive lodine have been ' thyroid cancer, and what to tell the slons may have been higher than re. 'tlctectqd in milk sntuples in Pennsyl ' rted but that the public has ben sula in the past week. Ilealth o!!i-public about thc health dangers. . {lled into thinking that the situatton clats there contir:ue to say that the CIVEN REPORTS of lorlevel but atTbree Mi:e lstand is safer than er is. Icvels picked up are so small that constant radioactive emissions from At a press confercece yest'.rday thc shere is no concern about drinking the }.lant. the state advised regricnt Environmental Policy Center and milk somen and pre-school chi dren la several Washington-bascd anti nu. And on Friday President Carter. stay out of the five-mile radius of the clear and environrcental groups even felt it necessary to issue a state. accident. Evacuation orders,were put charged that there has been a "nu. toent from the White flouse saying in recdines but never trirgered. clearwhitewash of the health ri3ks. I'dcral officials have found "abso- "Xe had to be care ful not to alarm lutely no dancer" f rom food produced people over*y." MacLeod recalled in W WEEK at a Senete health sub. in the sea of the crirried plant. an interview. To have donc more committee hearing. l!EW experts pre. Mile the present and future could possibly have been unproduc. dicted t hat, b1 sed o:s exposure hecipi danger f rom the nuclear acci-tive. If everyone had been ordered to Information available to date, therel dent has largely been minimized by leave-it could have caused sheer would not be a sit gle additional can, those in ch1rge. even the officials in-hatroc and panic. cer in the general public due to the volved feel that it would be foolish to radiation released from the damcge,I be overly confident about the long-plant. range haalth consequence 1

_ - _ ~ _.. _ _ _ _.. _. - +j e p *.* 4 8 > WILLIAM BLOCK and PAUL BLOCK JR. Publishers e s JOHN C. CRAIC JR. l Editor WILL!AM E. DE!BLER. Manaeng Editor Ct.ARKE'rHOMAs. Asociate E6ter NICK WALL ACE. News E& tor MICHAEL McCOUCH. Associate Editor CERARD A. PATrERsON, City Ed ter JAMES E. ALEXANDER. Awstant to the Pubisher RAYMOND N. BURNETr. Business Magr If There'Were Another TMI Five months after the Three Mile Island General Richard Scott told the House com-puclear incident, the state still does not mittee that many guardsmen could net be have a cohesive plan for coping with such reached during the T.',11 incident to go on emergencies. alert status for possible mass evacuation i The Thornburgh administration admit. duty because they were moving their own i tedly has had its hands full since then; ad. families out of the area. ministration officials from the governor on General Scott also told the House com-down have had to devote a good deal of mittee that the Guard has r.o protective their time to testifyin; at various state and federal hearings on the March 28 accident.' clothine; or adequate equipment to detect But it is still distressing, on the anniversa* low level radiation. In fact, Scott recently sent out a memorandum to his men: "You ry today of that event, to find not only that can assure your wives and families that ao comprehensive pihn has been fashioned , but also that administration officials seem the adjutant general of Pennsylvania will not, I repeat, will not assign Pennsylvania . to be unsure of just what their respective National Guard personnel to mission', or s departments roles should be in such emer-in ereas, where the possibility exists that

Fndes, they might be exposed to dangerous levels After a hearing held last week by the of radiation or fa!!out."

state House of Representatives panel prob. Ing the affair, Rep. Ivan Itkin of Pitts. That raises the question of just who in burgh commented:"If an emergency was case of another nuclear accident would declared today, we'd have pandemonium." handle the emergency duties which are the Civil Defense agency plant for erample, Guard's peacetime reason for existence. In ~ call for all evacuation traffic to move in fact, that quesdon was posed to Gov. the same direction along four. lane high

Thornburgh when he appeared in Washing-i ways. But State Pollec Commissioner Dan-ton before President Carter's TMIinvesti,

l 3*el Dunn told the committee he doubted gatory commission. t ~. that would be possible. ... Alluding to General Scott's memoran - The Education Department's bureau of dum, commission member Anne Trunk of. management services was asked by the Middletown, Pa., asked, "How far away committee who makes the decisions about, would the National Guard be in the case of elosing and. opening schools during a crisis, a more serious accident?" It turned out. l A spokesman said,"We do not have a re-that Mr. Thornburgh was unaware of Gen. quired closing and opening plan." .eral Scott's report and couldn't answer the A Civil Defense 20. mile evneuation plan query. ? l calls for parents to stay away from schools All of this suggests that the adididistra-( and let their children be bused home. But tion should be pressing ahead with a com-another secilon of the same plan desig-Prehensive plan. At the least, the stovernor i-mates schools as pick.up points for people - who has hcid only two cabinet meetings l to gather for evacuations, since taking office in January - should - Penrose Hallowell, secretary of agricul-call his department heads together to get a. ture, was asked what he would tell farm-few common understandings. ,. -],7 ers to do about their animals. "I can't an. Pennsylvanians can hope that there nev " j swer that now," he replied. er will be an emergency requiring such a a /, Perhaps the most staatling gap of all t c t u! bei A t'Id bjg g concerns the. National Guard.. Adiutant i. a e..n -. u - i... a n. --... --..

f. y,* - Eight Months Lost %@ @1@. ~ It's enough to make a psychologist weep ries fade or begin to distort what actually - and a lot of other people, too. happened." The state is finally launching a study of So what happens? Not five weeks but the inhabitants of the area around Three eight months have been lost. Mile Islad to assess the effects on their It's hardly reassuring to have state Wel-mental health of the March 28 nuclear ac-fare Secretary Helen O' Bannon explain cident therc. The work will be donc under that " coming eight months after the Three l the aegis of the state Department of Public Mile Island accident, at a time when the i Welfare with a federal contract of initial traums has subsided, this study will $375,000 from the National Institute of be particularly valuable because it will ex-Mental Health. amine mental health impacts from a long-Citen the obvious usefulness of such a range viewpoint." survey, it is all but incredible that it has Actually, questions should be raised as taken eight months to get it launched. Put>. to why the grant was made to the Depart-I lie officials can't say they haven't been ment of Public Welfare, rather than to the warned. In the aftermath of the accident. Department of Health. Presut ably it was then. Secretary of Health Gordon MacLeod because mental health respor hilities in urged that a survey be launched immedi-Pennsylvania lie with the DPW.. Jut if this ately, while the events still were in the isn't a health matter, what is? minds of residents. But the matter got tan-Fortunately, the study has been devised gled in jurisdictional disputes between fed-and will be directed by someone in the psy- - eral and state authorities over who should chlatric field - Dr. Evelyn J. Brommett, conduct the survey and how and who an assistant professor of psychiatry and should pay for it. epidemiology at Western Psychiatric Insti. On May 4. in an editorial entitled *Five 'tute and Clinic at the University of Pitts. Weeks Lost?", this newspaper noted; burgh. Dr. Brommett has hired 30 inter- " Time is especially of 'he essence in ob-viewers who will interview 700 persons taining and recording information about living within 10 miles of Three Mde Island the psychological effects of the Three Mile and another comparison group of 350 per-Island incident Experiments have shown was who live within 10 miles of the Ship-that as early as three weeks after hospital-pingport reactor in Beaver County, ization, some patients begin to be hazy Dr. Brommett and her interviewers about details of their stay in the hospital ought to be wished the trest of success. But and their treatment there. For many the it is a tragic disservice to science that a Three Mile Island accident and the uncer-one-time-only opportunity for immediate tainty for four days thereafter made for a study of people caught in America's first traumatic experience - all the more rea-such nuclear fiasco was missed - and by son for early interviewing before memo-eight long months. } / 4 'e F = g

~ ' y . f h t) L > $91/f// h.ilM/$1/P /k/A k'K uclear accident precautiori progress called nil CINCINNATI (AP)- Preparations to deal Mact, cod resigned in a dispute over the of radioactive lodine can lead to thyroid dis- ' with nuclear accidents are no better in the handling of Pennsylvania's health services case. he said. United States now than last March 28 when the seven months aller the accident. lic is now a t The U.S. Department of Ilcalth. Education Three Mile Island accident occurred according professor of medicine and health services to Pennsylvania's secretary of health at the administration at the liniversity of l'ittsburgh. and Welfare ignored Pennsylvania's requests for time. the chemical for two years before the acontent, MacLeod criticized both federal and state McLemi said. "And I do think we*II have nuclear acci-governments for not providing stockpiles of When the chemicals finally were sent - 7 dents in the future," Dr. Gordon K. MacI, cod potassium lodide, which he called an antidote after the accident - the dosages were short told a seminar yesterday at the University of for the accumulation of radioactive lodine in and the equipruent to administer them was Cincinnati. thyroid glands. The abserhlion of large amounts wrong, he said, adding: " Sadder yet to say, we still don't have a Medical checks asked for people near 3 Mile Island supply of potassium iodide in Penns3 vania or 1 es - c - i o -

7 e se sed i ise eve t t

of aaother nuclear accident. IIAltitISitUltG, Pa. ( AP) - A federal following the Mart h 2R accident. magistrate recommended yesterday that II.S. The General Services Administration gave District Court consider a claim fer medical ..The unknown but menacing qualitics of !!EW responsibility for planning such a stock-radiation require the court to address the con-pile, but the agency has not done that yet. Mac-detection services sought by people living near , the Three Mile Island nucicar plant-cerns which form the basis of these fears," Leod said. llavas wrote in his report The claim fer monclary damages, part of a

If the federM government is not ready to e

Any party involved has 20 days to file come forth with financial support for stockpil-class action suit filed on beha!f of 650,000 peo-plc, sccks a screening for cancer and other in-objections to lisvas' report. The court must Ing potassium imlide. then we must find re-then decide whether to accept his sources elsewhere, c'ther from the utilities , juries because of radiation exposure, recommendations. themsdves or from state legislatures " he said. , At the same time, the magistrate recom-mended that the federal court not certify class. - action claims sccking damages for negligent in- ' filetion of mental stress, present physical in-l l l ' juries and latent physicalinjuries. l { Defendants named in the sult are General ! Public Utilities Cerp., the plant's owner, Metro-i polltdn Edison Cb, the plant's operator, and - } Babcock and Wilcox Co-, the plant's designer. F > IWagistrate John llavas pointed out that ! I many area residents fear they were harmed by 8 (radioactive gases which leaked from the plant. W i t .,.. ~ .~. .e

s l I' D r i ll.,*. s s. / l%_ 2 Tuesday..Ianuary 29.198o the News Record Former Pennsylvania h9alth secretary gives warning l MacLeod says US not prepared for nuclear accidents Py Deborah Taylor medical des ee from tCin 1960 and sylvarua's Depanment of Heaith.* protect the public's heahh** $ hor. of M Leff is now a professor at the Umversity of said MacLeod, who said thers was immediate cessauon of all nue' ear ac '

My main concern with respect to Pittst'urgh, became secretary of not a sinale book on radiation enny which I ch nk is usi!-r:c :m-the public health aspect of nuclear health m Pennsylvania 12 days medssine m the health department.

ponibk. the natr:n m::st te ; ses.ed energy is that we be prepared the next t'cfore inc accident a: Three Mile

ln short, tlwre was little or no not to repeat the mutakas of TMI" tune we have a nuclear accider:t. and liiand (TMI). He resigned seven capacity within the Department of said MacLeod.

I do think we will have a nuclear acct-months later in a coneroversy over Health nor ebewhere in tne state,to "For the present ums.* he con-

aid Gordon the nesich e'reets of that accioem deal with the estraordinarily serious tinusd. *l know of no nucle ar ;.a::t in dent in the future.

s MacLeod. former Pernsylvarua health problems facing us.* saad the country that would reruy be ,,I know of no nuclest MacLeod. ready for the next nuclear tscicent." secretary of hcanth, at a discussion held Thursday in the Environmenut plant in the country that When asked if he felt that the M ac Leod called for a self., Research Center Auditorium. would really be ready for Pennsylvania health depsttment eaamination by the or6.s in The docussion sponsored by the the next nuclest accident.= was typical of other state health charge of the Nuclear Regacry Environmental Protecuan Agency departments. he said. *M y presurnp-Commission. saying they were and UC. used the Thrn Mile Island According to MacLeod. TM! tion is that sorne of these problems

going to have to ask themseives incident to exemphfy the lack of pointed out the defrunces in Penn-esist in other state health enat is their funcuan in the fature, pubhc health preparedness in the sylvania's departmerit of health.

departmentC MacLeod sasd he and I think the Amerr.an puhuc a* suns of another nuricar accide::r. " Political. so professional believes that il problems like this going to force them to answer :ms. MacLeod. mho reserwd his decisions had sarwd up Peen. are not faced now we will be io no better position to deal with the "Short of letmediate I bealth impacts of future, nuclear cessation of all nuclear accidents than Pennsylvania was to deal with those related to TMI. actirity the nation mt:st

!! seemed that no one outsida of be prepared not to repeat professional heaJth ctreks could ap-the mistakes of.Three preciate the potennal for the health Mile Island."

bazards of the TMI accident unless they saw people berig carred off to in the recantime. MacLeec caded I bespitals vonuting from radiation for the imp cmentation of a rc.=ber sackasas. There was no blast. No of safery measures. inchid.r.g under. maltdown. So there was no health standmg by the medral comr*ansy . hazard." said MacLeod. *that's the of how to manage the pnysr.al a2J netstude that seemed to reign among pavchologicalconsequences of an ac-muclear engmeers and radiation tident; a betterinformed pvEs as to health phys ciss throughout the ncca-what it mesas to have an acc-dest. preparauon of pomasium indice for dent

While the departure of pregnant deployment and distrib ution women and young chaldren, both around nuclear reactors, resentth partcularly susceptible to rad.o-for antidotes and clituca! macage-actiw iodine, one of the most abun-ment against other fauonab;e pro-dont of the fission products, was ducts besides iodinet and the rede.

recommended by MacLeod almost signmg of hospitals as la: lout - ' immediately after the accident. the shelters for treatment O( pauents I governor did not issue this directiw with radioacave caposure. until a day later because of a dispute "Unless we do address these betweca recation health pnysicists.' problems.and address thern now said MacLut. may wet find our health to have MacLeod raised the following deteriorated 10 or 20 years heter questions to his a:adence; *What' pondenng the satae puz:les that are happetra in the event of those future confronung us here today.* sauf i neckar scendenud.' and "how do we MacLeod. i 4 5 i C' I t-I s 2

I A-Plaat hvolved in Probe of r. q,p&y ^ wu m w-s y By Victor Cohn

of Iodine 131 was released from the told gland, a cond!tlen not !!kely to be-wae.iar.en Pm s.str wer'r plant by the end of April, giving a caused by radic.t:on, Lodin ns,d The A new controversy over the nucle r "I

accident at Three 3like Island appears maalmum radiation dose of the th> i are sull unde'#'# r study, but cue was a likalv to arise frem the discovery that ds of ana residets of 8 to M mini-twin wnose twin did not get the dis. an abriormal number of children were rems. ease "so it's untlikely" thr*u;b not im-born with serious thyroid defects in Br.ci;round radiation 'provides 100 possible, she said, that the cause in three Penne!vania counties in the lat. millirem per ) ear. Tests of area resi_ this case was environ:r.cntal. s' nee ter-part of last year. dents revea!cd no iodinc in their bod. The condition !s know as hyoothy. les, andJose was detected in area.ane roldtsm, which arises when the thy-istals or in cows' miDc. Bod said. To Another health authorarv said that roid gland is either ab*ent or doesn't

Ticct Tettacs bern since the accident many populatacns. suen u the Am:sh, produce normal hormone levels. It would hr.vc required a pickup of iod-in Pennsylvania ba.v a nyh canceu-car. lead to grave mental retardation ine.

tration of geneticauy rvlateo c;seases. and stunted growth unless it is quickly treated. We would certainly not expeat any "I don't think there's any cause nnd effect on fetal thyroids from these effect" connected to Three Mile la-State health officials confirrned res-levels." Peterson said. land, Bodtn said. Dr. Feley agreed, terday that during the last nine but called the timing 'oncuh,ar and A as kesman for General Publie curious." and said "the fact that it did months cf 1979. 13 hypothyroid babies des Inc, parnt company of the follow the accident raw an issue" were bcrn in three counties that micht ordinaraly expect three such utility that owns Three Mile Island, that m';st be settled. births durinc that length of time. said r.o lodine measurements taken g ne can' existence was disclosed They said thy are about to start an U.Mer hl@ nough to cause htal in an interview yestircay by Dr. Gor-epidemiclocical insesti;ation that "of th3 Told problems. don MacLeod, who was Tennsylvania ceurse' will have to censider low level However, ses eral local groups have health secretary at the tin 2e of the nu-radiation from the accident at Three chauenred the offlefal radiation read-clear accident. Male Island-located adjacent to one in;s, alleging th:t Insufficient moni-MacLeod became the etate's chief of the countisc-as cne possible cause. tors were in place or operating at the health officer Cn Maren 16, only 12 But they-as well as Dr. Themas time of the accident. Wind currents days before the accident. Last Oct.10 Toley of Pittsburgh Children's Hoep,. mi;ht have estried radicactive parti-he said-after critic;:ing the state s tal, an authority on hypoth>Toldsm-cles over nearby monitors and depos-handling of the problera-that he was a!! said that the condluons could have Ited them in faraway areas without asked by Gov. Itachard Thornburgh to many possible causes. the normal dispersal effect, taese They raid they know of no esses of groups have said. hypothyroidism ever caused by radia. None of the hypothyroid cases were resign. Ile returned to his job as a tion at the low level emitted by the in areas that have been described as wen. regarded profess r of put11e crippled reactor, though there is a in the main " plume" or downwind di. health adm:ntsiration at the Uniser. l s ell.ertablished association between rection cf the Three Mile Island radia. saty of Pittsburgh. high doses of radioactive iodine-one tion. MacLeod, too. agreed that "it is im-chemical emitted b.v the disabled reac-Six cases occurred 14. Lancaster possible" to assign any common cause ter-and thyroid disease. Radioactive County, which is east of Dauphin to for the thyrolu defects. But he said iodine tends to concentrate in the thy-County. the reactor site. Tour were in he was shomed that the health de. rold gland, with destruative effects Bucks County and three in Lehigh pa rtment hed made no public an. 3nen the done as high enough. County. nouncement and had not started an, Radiation specialists from the Presi-Ordinari!y one baby in 5.000 is born esugaben of pessMe causes. ne dent's Commission on Three Mlle Is-with hypothyroinism. In 1978 (the last i the afsected LancaMer County i land and the Nutlear Regulatory year for which full birth statistics bo[th]"n Jul[, and one each in August, Commission said flatly yesterday th:t were available yesterday) Lancaster o U "* "* lodice emissions from the March acel-County bad 5.5W live births. Ducha dent were far too low to have had any County,6.433, and Lehigh. 3,TS. MacLeod : Iso said it is " urgent" to auch eff ect. look for a ty possibly undetected cases "There cannot be any connection: I ab. t ors some mes occur in m and t er en lv n ans ho &seaws.saW h M h, W ofters ch hortie dehveries. i to P n s ciate firector o the Brookhaven Nadonal Laboratories.retary of health in Harris urF" Thyrold problems turned up among for biomedical and environmertal sei. Also, said both Dr. Tuley and Dr. Marshall Isitedcas who w ere exposed enees, a member of the prendential Evelyn Bodin, a Peonsylvania health to radiation from the fallout of a U.S. commission task force on rzdtation departaient pedtatrac.aa, a more loiti-hydro;en bomb test in the Pacific on her.lth eficcts. "For thyroid effects cal explanation than rautation has biarch 1,1951 the doses would base to have been been found it, three and possibly fou* The first ca es dtseovered nine r Cju years later were two children, under 5, es, the thoussuds of times higher than they o La e s

mere, at the titre of expesure, whose thyrcid 4 11arold Peterson of the NRC's office One had a familial or in5crited con-

.giands had disappeared. i sf standards said a tstal of 15 curies dition and two had a misplaced thy-Staff smters Walter Pine 1Ls and Jnan. se Oneng contributed to thss report.

'f a

?." -

3 1 Q Pitt: burg'n Press,Tnurs.,Feb.21,1930 Thyroid Eness n 1.F.ho Area au. e Urider %dy HARRISBURG (Uffl - Medical detectives are irriestigating the powibility - telieved cow to he re=ote - ttat an af. parent 7.rowth is tr.e r:te of thyrcid th:ormalities was caused ty the Three Mile I.Jacd suelear accide:L The Pennsylvania Health Depart =e:t said it had t.egun the investi;stien after a rout::e survey showed the it.cidence of hypottyrcietsm was five L:mes greater in some areas ear de nuclear piar.t. laitialbd;me:ts by a variety of dyroid ex;erts was dat the Three Mile Is;2nd accident procably did cot cause the ocentre:ees becatse de radicactive e=w sions duri:g the accidect mere too s= ail to do such da:nage. t Ober possitte causes, such as heredity.1:dustrial or - medical radation sources a:c chemicals in f:Mst:ffs, were also under i:vestigation by state epide=:ciogisc, said Dr. George Tetu:ata, drector os state herdth research. "Deniis a remote poscility thafrad.ation was the cisme; and mere are esay other.possitie indoos. We dbtft have e:ec;h evidence to make any con:!csices, eacept t: say the rate (cf hypocyroida:=1 is appare:tly higher than actraal is th:s area l* said Tckt:sta. The remote possibil.:y of a ce :ect:en to Taree Mile Island rested with co,vs that gra:ed en e :::am=ated pastures. State autter.t:es reported a r:t:acuve todce level of 41 picoeur:es per liter i: mis frem a nearby farm a few days af ter the cuclear acede:t.The federal health limit is 1.000 pteocuries per I; tar, Bypothyroidism is a dsorder which cas lead to mental retardation. It can be cansed by rasoac:ive lodine. Dr. Thomas Foley of Children's Hospital in Pitts. l burgh, who monitors hypottyrcitsm as a co::sultant to the state, said he d:d not teheve the latest cc::trences ( were related to Three Mile Islani He explained that some of t:e cares were differ::t types of hypothyroid:sm, i:dicating taat a s:ng! envi-ronmental source such as nuclear radation was ect t:e cause. The reuti:e state survey revealed that the ky;cthyroidi' t rate in 1.a: ewer County. acjetnin tre nuclear plano nas tive times gmu than ev=al. Five counties cownwiad from the cuclear plant a!so showed higher than-oormal rates. g,.. .e g

Q g 9 ews O ,3 . r.. 3 c:: o O $ LaGO liil i Mfr0!G PT000 Ea MDW (4JTiiCE00 2 m u u N llAltitlSill*liG it:Pt 6 - Dr. Grn don State health t.flicialt as wc;l as natmur.lly llypWhyroidam, w!uch cati he caused by those sho ucre r:ct totcJ '! vaid have bec*t f Plact.end. the former stat.* health secretacy, ren.gr.ir.x! thy:<.hkl..gi..ts, in heve there is rad.nc.rtn c likli ie. is a ihsterder that can lead i,ug ht i,t.t inn.:cJiatei) !vc u r.. ra.;c g Thur: day criticiten ll.e Taurulaugh ad-only a n molems.d ly cf h ut brtween tl.e ta irrotal e rtaritat.o1 II.' Ith eiticiah: ra:d a; cmps acre terg - rnhik.trc:ina I.ccau.se it dcia)cd for II.tce hyp;hyroidr m.umitherrleasesaf rai;.oatwe W;vt c.a:ses of hypa:hyrohm. such as taaje ta ducen thee nat tened ra;.tlacty ! O nit,nths la investigatin,t a passitale link of a lailine in tte Threc !. lite Islutd nuticar ac-ir.iimari:l n1 aaed. cal radiat.on. finut pad..ospitals. such aa h t.er s Nra 1: te..r. 4 ar.a beredity. u crc also being iat esti %tod I y the pa:t r.ts who o*@ei d o th im.c.a hgica $ ths ro.ddacase toThcre ILlife istnl cident Starih 7:;. l'ai9 t t y lictith De,1ritment of;icials ackr.owledged "I nm prosaurdiy ecurcraed almt the fact l'ealth Depact.nenti pri.be. stat-J tJ take ;rn.r.dt The nox.Ler t.! aildren inverd o., the th:ee tr.onth la; at a n"t.s conferenre. A that informa:k.n nas not made publ.c t.ntil inuyears a as a; pacemly ro." w e rh.n ; fe. ht:cdred t.i chis'cr of h rthyroMism tr.scs in neutscrn giow." s. tid Mul.re d a prof.ssar i.f heal;h The d.3,artmer. f:rst re;Wed the caus Od ct.cci said t.- 1:c;I.h ik;<.ri.vr.t's 3 @ tabtes rear '!bec Side isl.:.d scre first servicts at the t'nivecstly of P:it.burgr. Wedne:.d.sy tt kaid therc haJ tua a tdal uf M delay e ss tucer.a it.c T:tu r.c r; h ad can s na the r cte, t.ut tha: Imcaster Ceurdy.nh.s! Min c;at n;l pbc.* c:.ph.s!.i c.3 e g d:srote:sd in Otto.cr. b:: a mttical in- -Ya.t: s; ion.ld investe: ate as sooa as yua know _ ve;!igatu.n was r.t.t t,qun enSI this rnon.h. ahnut the rlJsICr.Hg " near Three 2.hle isLar.1 had rencried sesra c.cahh icla'ed;a:cetsof th*Tl:rd.. lei;*a..J d.,,J parent. Qild aivl >chool h:alth, sai.! the Dr. De:rn 8(,uien the state's drrector of Nacitud said he a;; reed the chance of a cases. eaer dvc t.:aes tiac crera;'c of 1 in 5. coa nuclearaccident lhl to t he r.uclear accident was nut great. hut hve t,is ths ile cr;ticind the adannistratios. for rxt E department delayed becra:se it placed was dismayd by the delay in prot,ing to f:nd Titrough a state IIcaith Departnient.stabbhin.t J ro; hats:a 1.ralth ot.re.ra t.n&r d c.! greater pciority in dealing u hh the ca:es it c,ther ponib!e cases in the newtorn 1.rogram. virtua:ty a:1 newoorn babtes are ;te ;! cal:t Deprt:aca: ber.;ure "it nat t.e h! had discovered. IIcalth Secretary Arnold populationiaecauseitcanteesser.tlallytured screened for hypothyroidism. itu' MacleoJ sensitive" to st:ch th:r.;> :s an inescaae is @ Mal;er was unavailable for comment. , itdia;;nosedearlyinh!c. said th( clustering of cases mada it c! car hypothyroidismcases --~ m e ti e Don't Snub TMI-Thyroid Tie., Pitt's MacLeod Urges By llENRY W. PIERCE

By contrast, Allegheny and Eric counties have been carried out that suggest even a very defects last week.

W

- - '*55*""

reported only I case each after March 28. small increase in the exposure levels will add Tokuhata said there was only a reme; l Former state lleilth secretary Gordon Mac- = During the last six months of 1978. only 3 sliglitly to the number of thyroid cases in a possibdity the defects were related to t: le~l, yesterday warned agamst a toohtsty cases were reported throughout the state, large population. But some authorities con-radiation leaks. g dismissal of figures that may show an increase But a state health official, Dr..Evelyn sider such hgures inconclusive. MacLeod resig.ed as health secretary O< in thyrcid defects among habies born near the Boudin. called MacLeod's interpretation "ti-Dr. Donald Reid, deputy secretary of pro-12 and returnn1 to his job as professor < l f Three Mde Island nuclear plant siter the logical" and stated flatly; grams for the state llcalth Department. and public health sdmimstration at the ticivers!- l radiation leak March 28. We do not have a data base which is - Dr. George Tokuhata, llcalth Department epi-of Pittsburgt. Since resignmg he has been. j f Macleod, who said he reviewed the thyroid sufficient to make the kinds of claims being demiologist, minimized any aweriation be-strong critic of the state's handhrg of 11 l sa. figures in dctail for the first time vesterday-made?' tween Three Mile Island ard the thyroid health aspec.s of the Three Mile Island affai. j in.asted that coincidence alone can't recount Dr. Boudin pointed to an absence of thyroid for an argurent upsurge in cases in Lancaster. defects from Cumberland and York counties ~ .g lehigh, Ucrks and Butks counties af ter March which also are near Three Mdc Island. and in

28. All are rclatively near the site of ti.e Three Montgomery County. Iarther east.

j g Mile Island radiation lea \\. t Dr. Boudm said, however. that state healp. l C "There's alwavs a possibility some other d " factor. surb as inI1ustrial toxins or contamina-oHieials are reviewing the data,the way we would m any pubhc health program. < tion of the water, could account for it," he At least some cases appear to be a result of 9 $ conceded. inheritance, she said. But he pointed to the<e figures, H is known that raJioactive lodine 131, 9 o Eight cases were reported statewide be-which was raong the most feared of the fore Mars b 28. and 26 more were reported subst nces insed during the Three Mile. J: ring the remaimng anonths of 1979. Island meident, cm cause thyroid abnormah-o Of the 26 ccses,15 were in conatics not ties in babies. fit from 'thrce Mile Island. Lancaster re-portal 6 sases, and 3 each were reported in What is not knmen is precirrly how much of Lehlgh. Brris and Bucks Cotmtics. ao fru rease it takes to cause damage. Studics

i i l Q L't. i JU MW WLX dCf'Ubu k/La l at s A ;. uw QfiMh l? fnaf;'iy s@uuQ-9& alll f W b du "o)Lt, li Uf '~ +us J 4 d al n ll ' O '. p' O r ,n fj jj fq' p ( (, m f fb t.:/))uu N I s,. ua u o u_, ou o o -\\ LONis health crusader has l Dy LESLIE MANE l aware. Dr McLeod believes publie "I ca n't imagine why the is that maybe I percent of babies I won his battle for an investiga. ness of the dangers of the llcattli Department did no! in-born at home have this conmtion tion inta the possibility that the public health administration at the defect is important, cspecially be-vestigate the cases. I asked is to and their parents aren't aware of Three Mile Island nue' lear acci. University of Pittsburgh, said the cause many of Pennsylvania's es-release the information and it did it," he added. dent is responsible for an number of babics born with timated 140.000 members of the not do so. "We would want to find these l alarming rise in babies born thyroid defects from two to eight Amish religious sect favor home "I told them I was profoundly. other newborns as soon as possible months after last March's acci-births. dismayed people did not have this and run tests on them." with serious thyroid defects. dent was astoundmg. This could reduce chances of information." The professor explainoi that which can lead to mental re-Thirteen habies born in five the defect being found before it Dr. McLeod described as a radioactive iothne f(ll from the tardation. counties near the nuclear plant causes penmanent damage, he matter of luck the fact that the sky onto the grars eaten by cows i Dr. Gordon McLeod, former were su!iering irom pomted out. birth defect cluster was dis-and got into the cow's milk. Pennsylvania secretary of health, hypothyroidism, a condition in "It is a correctable disease if covered. The milk is subsequently drunk has been told that state officials which the th> roid g!and is missing found early," Dr. McLeod said. Pennsylvania has conducted a by the pregnant mother and

f. ave begun what is expected to be or produces.too httle hormone.

"After the child luts been treated routine screening program for circulated to the fetus, which con-a two-year pcobe to Lnd the cause Normally, only three babies for two years, the r.cgative eff ects hypothyroidism since 1978. centrates iodine at 10 times the of the defcets. would have been born in those can be prevented." Af ter the Three Mile Island ac. rate of an adult. lie claims health department areas with such a condition during While he stressed that his s esig-cident, ti;c screening revealed Some heahh authorities argua officials became aware of the that time. Dr. McLeod claimed. nation as secretary of health was there were seven cases alone in that the IcVel of radiation sticased cluster birth defects after he re-lie said previous tests had unrelated to the thyroid issue, Dr. Lancaster and Lebanon counties, by the Three Mile Island accident signed hst October, but mys-shown that radioactive iodine can McLeod said he became frustrated the two countries directly down-was too low to cause the thyroid ter.cusly had kept the informatwn cause f.ypothyroidism, which can and angry when he f ound that state wind of the nuclear facility, Dr. defects. from the ythlie. lead to both grave mertal retarda-officials. were withholding in-McLeod said. Dr. Victor P. Bond, associate Dr. Melut, r.on professor of tion and stunted growth. formation about the birth defects. " Basically, the major concern dtrec;or of the Erwkhne n Na-tional Laboratories. I!pton. ILY., and a member of the presidential comminion task fence on radi-ation health effects, raid. " Fur thyroid effects, the doses wouhl have to have been thousands of timcs higher than they were ' lie adtisd that tests reve.& 1 no iodire in budits ei rcs' dents hting near 'Ihree Mile Island and none in animals or cow's milk.

-g Dr. Thomas Foley of Pitts-B 1

burgh Gldrea llespital, an au-p i thority of hypothyroidism, sa d at ;$ i least four of the Pennssivr.nia a cases were probably unrelhtel to radiatien, but adinitted an in-2 vestigation was needed. "The fact that the outbreak did q follow the accident raises an issue 6 that must be settled." he said. M i w v

l s' 4 Wednewlay, April 2.1980 Philadelphia Inquirer 3B Baby death rate 3 fl T5 T Ct S e e t t e lt 1_ L2:4 u. e. n,. w i / 4. .r. = ST,RZ,e G 8010S08 E By Vernon locb State officials haya not disc!ased **""*""*='88"'= the cause of any of the infants' HARRISBURG - The State Health dealhs. Because it is just possibic ttat Department has reported a signiff, the deaths are related to the aces-cant increase in infant deaths near dent, the official said,"everything is ' the Three Mlle Island nuclear plarit being Inple checked." and is investigating whether there is The data on increased infant rqor. any relation between the deaths and tality.around TM! is reminiscent of the nation's worst nuclear accident the department's disclosure that,a there. highcr than normal incidencept The Three Mile Island (TMD accl. hypothyroidism-a birth defect IEst dent began March 28 last year, and can Icad to mental retardation -Was Monday the department released found last year in lancaster County, figures showlng 1 hat 31 infants died downwind from the nacicar plant k within 10 miles of the plant from Hypothyroidism, a disorder lue l April 1 to Sept 30. In the same six-thyroid gland, can be caused by the I month period of 1978, there were 14 kind of radioactive fodine released infant deaths, and there were 20 in during the nuclear accident. HQh the same period in 1977, the depart-officials however, said they d?, cot ment said. believe that the increase in hypotby. Health officials also found that roidism was telated to thc accidctC within five miles of the plant seven "I persons!!y don't think we're 9n infants died during that six month to anything conclusive." saidlDr. period last year, compared with one Gordon K. Macleod, health secr?tfy s*th death in 1978 and three in 1977. during the TMI accident.rcierntT1o On the other hand. the department the increased incidences of trifant found that the number of stillborn mortahty and hypothyroidism sear infants decreased from four during the plant. Macleod, a professorof the s1x months in 1977 and six in 1978 health-services administration akihe to three last ycar. University of Pittsburgtt. Said?.Ent State, health officials said they "infarmenesCpuntiansk to hoped to finish an analysis this week t luinMs_2eadamastal that might tell them what,if any,Ihe "'hekstbs1h6saassus relationship between the accident e M.1 _- *,1s essamitast M d% and the increased infant death rate iarHiiis j might be and what role might have Wespekc1!"t'ntic of govern. - been played by psycholoC cal stress ment's response at all levels to the i I during pregnancy and the release of health questions raised by the acci. I low-level radiation from the nuclear dent. Macleod was dismissed by Gov. plant. Thornburgh last fall, and he has said - "There are any numb (r of ways he believes his dismissal was caused that a child could have died that by his statements. ~ would have no rclation to three Mlle "The whole emphasis both locally, Island," a llealth Department off6cial and nationally has licen to downplay said. "Stalittiently, 11 rr.c fir,ures the health concerns ed this acct. art n't e art h ant 1ning - dent " Warf tw!eid. ~ p. s.e

- F

.u. A18 '(M1 rg y 1-p j k j 1: b1b Majority Oppose Reactivation e In the five mlie radius cf what Dr. Muller called "this radioactive citadel,"I a 1 r1 a p T m fr1 4 i 4 i i 4, w lb d, h I the report said that, based on interviewsl conducted in January,60 percent did notJ approve of reactivating the plant and 5( percent said they would " evacuate im. Persistence of Anxiety Surprises-meejar eiy" in another nuciear ensis. I The survey, financed in part by a . Expert nSttidy of Residents

m. coo grant frcm ee electise utsty in.

i dustry, mvolved two waves of teiephoned NearThree Mile 1 send interviews, the nnst tast auiy ed a sec. cnd in Janusry. The Thrae Mile fstand I accident and the weeks of tension that fol. By BEN.. FRANEUh . towed it began on March 25.1979. "I was very surpnsed to see that the spem:to w-P3 -'-- 2 distress of these people had lasted into HARRISBURG, d,' n,.r!T 17 -,' The j July," Mr. Houts safd today. "In Janu. State Health Departed.t rJ-ii'fe: cased ary,I was even more surpnsed." the results of a psychciegical study dis. T*#.nty percent of the respondents who cicsing what its authcr cal:ed a "suryns. !!ve withm 10 miles of the plar.t reported ing" persistence of amiety among a 2n January that the acc: der.t had " dis. large part of the pcpu'atten near the d:s-rupted their lives during the previous abled Three Mile lsj and nuclear reactor, nine months." The figure was 10 percent "%'hst begin as a b :ef cr: sir has be. for those living wi:hin 15 miles. Zated on come a continuous and, fcr seme, a these percentages. the survey suggested chronically disturbing s:tuation." :he 23-that as tr.any as 40.000 pecple had experi. page report said.Thesaidysaidthatthahia..trhsnurzaet enced some form c' stress reacti:n. - - -. ~ "The d: stress. as we define it, has per. this*ht includedhcreases ed 113 sisted nine menths, out to a distance of 15 h the muhe. Ap===msing miles. Mr.Houtssaid. _ pfWauf J8;.percene la tbsse ' Psychosomatic Effects' udng!~-"hAlsa,Rpettant.ssed &%32 percent; sack! Among the 1,000 persons questioned in 'ensrs(1 = w aald. the latest survey last January, the report .,gure

"The s:udy director, Peter S. Houts, a said that, when asked about " physical behavioral scientist at the nearoy Her.

symptoms of stress," nearly nalf said shey Medical Center of Pennsylvania they had experienced one er more of what State Univers:ty, told a news conference Mr. Houts today called " psychosomatic that another tnding of the su'vey's tele-effects" - headache, for example, or phone interviews was that ner.rly 13 per-diartnea, loss of appetite, sweattr4 or cent of the 37,000 pceple living mthm a rash. five-mile radius et Three Mile Island hac "Dese are not at all symptoms that would cause them to be referred for psy-become antmuclear activists.The State Secretary of Health. Dr. H.I ? - chiatric care."he said. Arno!d Muller, said that this kind of1 Both the President's cornmission on the " emotional involvemer.t" reperted in the Three Mile Island accident and a similar survey dropped to ~, per.cnt among PS ' el appointed by Gov. Dick Thorn-h concluded c.or.ths ago that health ple 15 m!!es from the resetor and to lets than 1 percent beyond 25 miles. He called e!!ects related to radiation were expected the 13 percent iigure in tre group cictest to be barely measurab:e but that mental to the plant "very large" and "very sig-bes!th e.!f ects were likely to be the lasting nificant." publicimpaethere, a., 9

t 2,..,. THE NEil YORK TIMES, Friday, April 18, 1980 l I TT, n1 M.~, T.h b [11 -a S ~ a d4.mua .a. cw u.m i. circumstances predating the nuclear accident. Feur Those ser.re :teries cheut r::110t!:n d:=::: frem counties equally c!:se to the rc:ctor, or cle er, had :s the er:h'ent at Th".: Mi!O !!!:.n 10 'tinerrtra!? f:1 fetched. Fed:ral of nel. tis h.ve said :1 eler.g that litt!e such cares et all. Reports of bizarre detonnit!:s amen; farm.u!- radiation escapcti, posin; virtually to th: tat to pub!!c mais and wildlife have also been circulatin;. Werried health. Tt:Ir jn:' m nt h2s tmn symrted by all farmers and at least one vetennartan have descnia.1 major Inves "raticas of the accident. Jut rumors of r.n!=a!s tcrn with le,s or eyes missing, stillbirms, frl;hicnir:3 phpical d:m.;c to human r.nc :nimd in-spontaneous cbertions, defecuve bene stn:ctures a-d f;nts p:n.i:,t. strange sudden deaths. Many blame the res:ter. But None of these al!erations have he!d up under care-ful scrutiny by dictmerested authenties.The cnly real the Fennsylvania Department of A;-icu!run inv;sti-health damt.ge de ceted :o far has tc:n psychole;ical, g:ted E f arms within five miles of the reacter last For enample. o rcport e:de pubhe yes:erday says ttat May and found only five with any unutur1 pret! cms 8 many of the commumty's residents remained dis-among the livc:tet't. These were attributed to viral in-tressed for months and rescried to sedatives and alco. fections crto feed and poor natriticn; there was no evi. ~l hol for re!!cf. Th:!r nr.xiety could cmy have been denceof radiationdama ce. heightened by the "cx;:ns" and cr:ti:s wno have Severallong-term studies are still under way. But 1ssued alarming ::atcme:ts about raciat4cn har.artis for now the public can dnw censidera::le reassunn = from the:e ne; tive findings. It is n:t caly aplo ps s b:sedon scant ordistertcd cata. for the nuclear industry v.t.o ssy that rad!: tion de.ma:e The me:t wet.isor.tc charge has teen that radia-tion frcm the crtpp!cd reactor h:s alre:dy caused an has been negligtb e; so do health efficials whese m:.n in rcaseininfantrnon:!ityand thyroid de:ects in new-concern is the public's : icty, :.nd s;riculture of20:.1s born baNet.Th sa fcars were e4fectively laid to rest by whose missionis pmtectin;!ar= cts and !!v :tock. state and Federal haahh investigatore, as reponed in The Timcs by Jan: Brody. The cencern about infr.nt What is not at ell reassurin; is the behavio; cf "e :- mortality was bascd Mrscly on raw st:tistics snowing perts"who have infktmed public fears by de:11c; rech-an inerda te in the numter of int:st d:sths w: thin a ten-Icssly with statistics. Dr. Gordon MacLeod, who wr.s mile radius of the reactor aher the ace! dent. But those Pennsylvania's Secretary of Eccith at the time cf the numbers in themselves are meanin;!ess; there was accident but was later forced to resign by the Gover-I also en incrc:se in the total number of births.The rcte nor,irresMnsibly publicized some of the raw data Su;. ofinfant derths rentained normal. gesting the existence of health problems. And Dr. Er. Similarly, the conecrn over thyrcid disease was based on unevaluated statistics showinc. in three coun-nest Stem;1 ass, a perenmal campaigner a;;ainst nu-clear power,is accu:cd by neutral hes!th author: ties cf ties, a persib!y abnormal number of chddren born with =!:handliny, data to demonstratc hcalti. Mge. :'v:n thyroid defect. L.1 on investigation, mer.t of these in nuclear f ab!cs there are pcopie who cry wolf. l cases were attributed to hereditary defects or other M W 6 f

From t te BULI.1;TD of the Alle teny County 1hdical Society, April 26, 980, Vol 69,No 8 """' " "," 'l" ' "' 3 "' " """"' d I "" "".u"o"n' has.f mrn 1977 t,1,in uirh 5cptember 1979 IM3 and tht te lear Regulatory ( omme ticen speaany tanutatro oy ine HeaIj-h d 3 p g n gn C hate thiu.t the inwlves mto the pimtion health department. Data coller ted aber L n05U2Ma of makmg in<du al and publu health septernher m 1979. a c not yet avadable judgun nts poor tu. dormg and Jiter the for tabulation 50. the ent' ant death rate attiderit int those hahies espo(ed to low level While 1 personally beliese that nin lear rachation duong embryonit development tn ia g pimer e an be made as wife, il not safer in the brst trimester of pregnantg es not than maaiy other forms of energy I also get known helseve that so(iety h.w the nght to know T he chart below c ompares infant DUCiear a e L the health ellet ts troin tlie produt tion of deaths per thoistind in e bittlis os er the nud _ en,y p. duce,c r n ef._.hesh ing Some tet hno< rats have cavahedy dis-uithin 5 and Illimlm of IMI from Apnl 1 miswd out-oi hand any powhle dangers to $eptember 10 Pennntsantaiannual from the IMI at tident or problems in-mlant death rate n aho bsted Technocrats not health professionals. As then Secretary of llealth. I recom. herent m the (leanup pror en As a while thatuations m inf ant death rates made most health decisions during the mended and eventually orged in the resuh. niany engmeets and physicists o< c ur. these patterns and trends (er-rmlear reactor accident beginning strongest possible terms that pregnant Si'nply no longer have any degt ee_ of tainly warrant (arefut anah sis and Mart h 28.1979. at Uwee Mile Island women ar:d young (hildeen leave an araa onhhiht y with the people in the Ihree possibt f urther mvestigation of the inf ant )eath rate in the tourth quarter of M'I" Idd"d area (IMI) - a sad wmmentary for the medi-withm hve miles of the lhace Mile Idand ctl profession renow ned for preventing plant. Ilut - the Commomscattii s radia-Ihe capid pxe of our gallogung 1979. disease, heahng the sick, and restoring tion physicists and nuc lear engmeers, tn hnology reymres us to ine head on Premature deemphasi, on the beakh good health. ignoring the health (omequences of uxteaungly (omplex issues of a rnedical elletts of the nuclear anident under-There was and stillis no radiation psyt hological stress did not agree with nature llcalth decisions must be made standably inc reases ansioy about the health unit in the Pennsgivania Depart-this decision. Like so many other tech-and t on(erns arwwered by a flow of solid re! case of radioat t ne gases in the TMt ment of llealth. A radiation protection nicians responsible f or monitoring the infonnation from physicians and pubhc cleanup protest lhe ottienry around unit - technical in nature - is located adverse ettet ts of technology, they health professionals wnrking T hree Mile Island has become ttuite in the Department of Environmental Re-thrust themselves into the tumtion of cooperatively with nu(fear engineers, sophistic ated in handhng data.. sources. It didn't and still doesn't employ making medical udgmentt Non-radiation biologists. radiation physicists Unfortunately, the people ditt not know t asingle physician. The Nuclear Regula-medic al judgment was ampted in tin,s and the hke that a Mwcial study of births and mf ant trwy Commission so disregards health matter, whn h indeed should have been Nudear reac tors have been shown to death rates was undernay and that data preptredness for nuclear reactor acci-de(ided on no other basis than the he relativeh safe but thev do have could soon be made available 1est dents that it also doesn't employ any pubhc's health. Iinally, it took the inherent risks. possibly for infants. resentment about not releasmg health Y endorsement of the Nudcar Regulatory Whde it has been predic ted that low data lead to a loss of nedibihty for physicians. let alone speciahsts. in radia. tion medicine. Comnussion s (hairman. Joseph llendne. level radiation f rom IMI will hase a health professionals. {m10KWrJttglyp Un helilthila1Hholulti bs pttrrigifl ntiunddandiaterprtledtdthe!)yil g C a nudcar engineer himself. for the direc-negligible elfe(t on the physical heahh twe to be mued for piegnant women,and of mihviduals we must continue to ub c ,f 7, y,. 3..m... ~. ~. -.q-young < hildren to lease the area 11 his analyie data of inf ant mewtality around Three Mle Island,increas4 wif e were pregnant. he said, he would in hopes of soothing the puhhis etnphasis in announcing corhEvngy I' ..* Q '( e, m. g. L ^ rec ommend that she leave the area. unrest over the (ontemplated cleanup h6alth dab promptly and resDoinnbly 'F lsn't that intesesting A physioan proccu at 1Ml. the health department on only help to restore the wello - 5 f.b 'J/ 1 warns of potential health impacts of has somewhat prematurely (onduded deserved confldence we have had Itt sur g I-j radiation and the warning goes un-that there is no sign ficant change in public servants. 3C; heeded An engineer supports the warn-inf ant death sates before and af ter the p .v ing and it is accepted Again. a ter hno-accident. T he inf ant death rate around Cordon K. MacLeod. M D. I A ,3, regard for the pubhc's heahh 1here is infant Death Rates oat makes a methcal deosion without ) 6 Q gs obviously a need for both nudear en- \\ gineers and physniam to be involved in Year 5 Miles 10 Miles All PA ^ T f l 1p % handhng nur lear auidents - nedcar 1977 67 10 5 13 9 t e ii-engineers should work with the nuclear 1978 2.3 7.2 13 5 1979 16 2 15.7 13 6 hardware - physicians shouhl work with ,f.y \\'b radiation health Out, hke so many other s.t Y "m \\ i technicians respons:ble for monitoring o\\ and managing the adverse etfetts of The opinions empressed in the Ederorials are those of the writer and da not necessarily r D('. l technology, technocrats from the re!!ect the opinion or she Editorial soord. the suttEnN or the Allegheny CountfMeducol / i ,[

r Soc!*ry.

m, e .m hMW VE w &O lContinuedon page 691 159 m a

o THE NEW YORK T!.!ES, WEDNESDAY, :.:AY It. nu Unanswered Quedons About Three I.Tue Island and Infant Deaths To the Ec:cr: 'hdarttt. cam rates followtag a nsh r:ews anacle, Dr. Gree.ber ; m:s:sk. Ycur Apn! !! cct:n 1:::.: sic:: me Atact:r ::! dent 1rarrants comp;ete enly s: tes the Pe=si3.:ms had cf te!!ing :::! ear ses e st:nes and c2trder i:-4 dir:!acurtfnet~dclay acd fewer rewicm.s vnth thyr;d deicca dealing ree?Jessly m1!h sis!: sues is

'131.?:d : d?r-f?! l-!=: d- :hs th:n ":'l the ara's en Ne.e Amen =

flawed my erm-s of cmi:st=s and ag. cae rad. I tre it v.=!J hsve !mn with scree.:rg pre,y::ms.- notancecf thefsets. w.c4y ;.chcaM. That simpiy as raf true. In the Feb. The etten:1. Msed en Jane Brody's D::::::: :r.J shcr:ct:m.nas in Br <fy's ruary IS 3 ime !! Pec:t-s. tc a news t:ory t rec t.23:s cather. can omy ar.:::e. ste contrad. cts your ec:: nst M:::sta and Id ho had far iower rem ;a211 f s:rnes ever data han-under.::=e rr.e fer rec).Jessly li.. king r2:es of tavre:d de'ects i- : w*es Smg by state and Federal o!ne:al:. tarr: d d:! ens to r:c::::n re!ctsed th= Per sylv:= bd im ; : e Red J=e sr:dy er y=r ed:en:hst m. fmm tr e:---!M re:c:: s.She su:M. =c:er ae::de-t. A!ro. Fra:deeria teniewed me. I cou:d have :::d them

- 0r. h*::.e<.d. h:ww r, d J ::: at.

2"d T:!*dtrP I' v* !:wcr '*-s Cf immeca:e!y test i 2m : t e-cted to inhte tr.e cas:s to t:::acedent.a thy?=d defects in f.ewborns tr.s a'l cf the use c! u:: car ener;y A 4 I c ctd I Md ev:rrs:M co. e a :tc;; s' Pem ylv=ia. have rrpested th : it 15 p*em:ture to th ee m:=*.s' dasy ty de Pe=sylva. As a puthe he2hh profest. cal, rey tiame de c!:s:enng ef tem:d defect: ma Hez:m Dc;2nme.t m a=cunc=g plea c:r.:mues to be I:r redm ::sta and :he tr. crease La 1 f20: c ms en = unu:ual cht::ct of 12 t:mes *e ex. c Ce a:n. I als1 u ga tre me:y ra-a the at:ident at T*uee MCe Isized: h: pet:ed rumter of hyymyreid c:ses in lease cf au fi-din;s 5.nc a: uy2:e a-d 1: ca=:: be rt: led cut yet. as Federal the ce=*y i !=et:r.tely d:r. re.nd of FrC=ElinitrTT Cil S Cf m M 31cCD-and s:::e c:h:: sis have tnad ta ca. nice Mde Is!=d. My dv:ce was at. secuence to the c::::etry. ! sm e!pe. More thr.n a year :::er : e =:lest curately reported at tn' e 1:me a5 m::M c:auy cen:*rted accu: these c: :e":s a accides:I re!essed r:w infan:.rterub c:!y to e..: ur:re culv d:::ction o' in C?~1:~I Ff23!T'3'2 wh1 have W 1:y r:stistics shien were taen 1:x thy: :d dehce:5v ft:-5 ::y cause : CC'Ud'*C'13 the crM. d:y of c!nn:1 znenths old. My ar.mecement u.s:rcened nes:tr.s les: an ur> s.ateme:S sm:e the accat eve a prcmpte.; the s:ste tu retense an'a.: treated infact te:c:-e a cretia. yearago. deats per e:, sand eve s:nh, w::hm The er,eam:y of 23 cffi= i ees <. ooxmesx.x^::.tce Me. 7: Imts. A 2=7): bc2 s :::5*d al that radia::c: fr:m tre accdent cou d PWburgh,elay Us4 zncasures are at bast de men::::s have acy effec: weats ever en in j The wrtter is prefersa ef e :!:6. se m. of inf t des:as, ter J'3uld _haig e) ::d 3! :1s 'was c =dM by r.L ices Cd":.:str:De't cad C!s0c: !C teen snade:puhlte-Chehrc. er-t ms::e b/ an erdemicle;ist frem cim:::! professor of r.ca et tar mers;pubG_c he.a.l..th Jta.t.t. heGensto the Center for D:se:s: Cct: trol. In the Ur.:.ersity cf Piusbm. a "There 'da*. however, a e incenclu.

tve W se they d: ::: In:!ude

., g.x,,,.,,.st*.rtz. h sti stwrycan Ga cwma habies exposed to rads::e. dunng the

ii tx: :.ga x4;rsex.% den Drst three menths cf pre nancy. ahen was ud so.ro cea m " xAx s e th N 8=L*8 the develc;=; em:;ryo is eJpecci!Y TheNewYcrkTime me.e. nap r,--w semitive to r:$23:n. Act:rdepy,

~ ~ CVT CARACTO I". "MN the cifictal conc!:510-5 hased on exist. bCPN y [ D^ 1:3 da:a that there was to health sm.

= h: cJ S:..u :3:05 raro DM'xcxr m. Fa f'-rwa 8 pact from the ac::d:n: w:ll remain nr.

scu:2:c.: s, 44 :;;9 tv.&u.wy 7:l:v=t t=1:1 th; news Depar* ment ocmst z. rtr:::::a.Mosw releases infart C=:3 rates beyond t Septer"ber19~9- & New Yd T"***

C# D' "** ##'" I" h#**'

Yet to be cr;! sized is why 5 and m 3;ca;gw AScea 5a Fwraf. cut 5 om m :s th r*cm*=t

10. mile t.fsnt des:h rues ircur.d JA naces.Ja. ra r - W Three Mile Island cunct: the sts months following the accdent cittnbcd A4Greg CMAa.J3 EL WW: rad. b*n P, ment i

sharelvY Compared wiih the s.arnC penDi.! m' prirvluus yPars..,A IJCt. the Joem a. uAra xn. I<e 7makW g gg, ;, p.,mgng merca<es m t e !> 1, mian dearh rates over 15 3 mere st:ttst:cally fughly ayocoz u v e r.:nt 3 Rificant. h w w er r y

a Nea Ycrk Times l'ay 20,1980

nfari': Deaths Lower

=

p. %

, g ,a . 1 Q"1Q 'I O r ., u l a. v v.'.s L,Q..O.1. 2.L, - v P9 NARR15 BURG, May 19 (UPI) live birls wi$210 miles c1ThreeMile ,L j - The state Hed2 Dnart. Is12-4 cc= pared to 13.3 deaths per 'U rne-:t tMay released 1:fa-t 1.000 live tarths m the rest cf Pql-1 tret ality he-.tres for 1979 warj a. showmg that desth rates were 17wer in TNecnstal deeth rates, er dea 2s t tha area arved the Three Mile Isla. J wiefs the f rrt :S days cf !!!e. w=re 3.9 ~ suclear plant than the rest of Pe '*.syl-per 1.M !!ve birds cear the Dauptm earla. Cour:ry nuclear plant ce= pared to 9.8 Health Secretary Dr. H. Ar'x>1d deams r.atewide. MGer said tae f.r=ts included da:a 9Fe'.al deaths, or st!Ebor=. miscar. for the last Ga: er cf IS"?. whi:5 was riages er veh.tary abordons after 16 mot tecluded in a sirsilar re;rfriisr.wd weer.s of gestatien, were 11.1 per 1.CP/) esriier this year. 1% births oest the nu:! ear p! ant, wtAle Mr.Mullersaid the M1 rescrtcc 173 the statewide rate was 23.0 destr.s. Efant. cec 2tal r.ad fetal death rates Ezebing Wh=tary atx:rJ 23. the cccpares sta:rs:de firures to tscse ob-statewide fe'.aj dead rate was 13.4 per tabed b the eret wit:s 13 rn:!es cf 1//J) live bir.ts ce=*.*. red to 11J Three Mile Islam. excludeg the ci:y c f dea:hs near Ttree MileIsiac1 Earrisburg.The city is not cou.:ed, be-Mr. Muner said the deper. ce=t cause 1:.s cor=any tiger dea:s rate exd ecc.t:rrae to cor2:or 1:fu:t. sea:s would skew the flg.;res. ratesit.ot.goutlino. Three Mne Islam was the xece of the cation's w:rst ece=ert:i:1 1% dent en March 23,173. wten Govern-meet eff.4.sais said relat:vay s=an Nuclear Waste Studv amounts of raiation were Tc: eased

[ h [ gayg.ber aM WASHINGTON. May 12 (AP)- 7te Decerater sta:w.ics tsaftrm the fe:d.

space? gency aw:rded a ccetra:t to the bgs for tha hrst n:ne mon as of 13"9." W parytoday as a first sty b Mr Mdersaid, deterrthi.ag if nuclet: wastes can be rxteted deepinte rpa:e f:r cs.rsal. "After careh;l s-My cf r.Il available The T?3,000 ceatrset kicks etI a four. 1:formsti =." said Mr. Muller. '*we year preg am ai=ed at lear:mg if cocteue to Ibd to evtde ce te dr.te that pxt: ;any dar;;er?.:s wtras can be radiati:rt f; cts the rr.aclear p wer plata reed mto eterr.a] c.-tnt start the r.=, rerfted b an incre vd nu=ber of 1 ta re.:ther solar syste=t er e.sewhe:t fetal, r.w.:stal or mfent ceatts." b the t:tverse. The Health Dr,4rtment flg.tres show The prt=;; ram is a fot:t ef*:f. by the that: Na* Jacal Aerte:autics a*_d Space Ad. q!:fant 6eath rates, cr deaths 1.Mer mitstration aM the Depar.:nent of the age of cme year, were 11.5 ;er 1,0C0 Energy. I e ~wnaa-, .s. ,~ <w.--

s" i.,e., = r 47361sland"", DangW4 '. mjYrf*s&.\\ 0# " neb 1N$$$$8$$$\\ t ^ d 4 1 , eper2:g ee Presigst.s 7,c.g2m re5acas of d81*I'* i 4 .. ceces a te=s-1 ces M Ut d ce d2 cad 7,313= cient \\ or g .ca'd'.gr.end**t* Te*r be F" U~y**" a t cerncil, SY' 'Nst $ $N c d.. .'S# ,4, w a.as.. ,ty ,,sst*.. 3: (c.,j,c.nese gg ,p g cy.,p n9es%;,,;,4**- s se u.>.see st ce M ,gey are W T.*astes se*'bc.:s "tT* 5**d$7tecem **ffa[sr%. ', Nuf'1 w eed up p,r 5n.t h.. i t=- g ** Nr,id7 **Wbj$,w^h 't {MM c m7 e = % g.u a ,,c.. a.?. cr

- 1 cwa

,g.L for R* oa -

y,n,11,1W., ,e, b' aN . % % - [~

M

,e ..,x.-;..saa'* .ss*,,,....,s...,- e 4 e e e a 9 9 f

POST-CAZETTE: Sar. July 19,19c0-7 TE simulated accident bares flaws IIARRISBL'itC (AP) - At ! cast two Dep:,rtment ecmplamed that it operated frern the p:blic. "That ref ects on credi. state.geet:es fatied to follow the script te a vacuum through rne:t of the eight. bihty, whteh is impc tant in a tsaster dunct this weei' s sirc:!ated ace: dent at hour caercise. situanoc," he said the Three hhle Island etelear plant. "We waited, and waited. and waitei Henderson, who has attnh,;ted com. offic:.:s said yesterday at a entique of We trere ready to swing into action b t municat:on prob; ems to cadentafhng the dnll-we heard notsing" said.'che Ccx. the duneg the exeretse said the drill fai:ed Based oc mformaticr. from 7.ietropoli-Health Npartment's emergency man.to accomplish all its object:ves. tan Ed: son Co.. ope 2:or of the plant, the agement direct:r. He said that may have been becacw state Bereau of Ratation Proternen "The Health Departme:t thould cct the scerano was too c:= plicated, the (BRPi recemmecded an esaccaden at 3 an have been s:ttmg in that entacle waiting pace was too fast and N many arenezes for information," Henderson com. were invehei Smaller scale dre wt!! ~ However, the scenano uritten for the mented. fate enns did cot est! for such a be conducted in the f:tcre. particularly Maj. George Evans of the state police to test BRP teams and equipmecto be. recoctme:dauon enul :.00 PA said cee aspect of the com=c.: cation said.

We tned to play the exercise as if it situatioc en Wednesday "was an exact Steven Sholly, research coordnator was a teat event. We cd net want or. duelicatics of the March incident. The for the Threc 2:e Island Pubhe Interest receive acy informat:en en it ahead of meia and the ;;blic were being ad.ised Reso::ree Center, co:: tended the dni! was time. That was a etstake," saic BRP pner to state agencies."

"an academic exercise" that revealed D:rteto* Tom Gen:s:ty Consecuently, Evacs said lus office sencus flaws in the plans and the man. Oran Her.de:scn. Crector of the Pen-sylvania c.mergeecy Management was not equipped to answer quesuo::s ner in which they are tested. Agency (PE'.:A), said he feared t!.at the evacuat:oc reconimendat:en would tnng the::mulated emergency to a premat:re e!*e. "It was a centro!!ed exere:se There were censin object:yes to be cbtain:d at each step of the way," Henderson said The drill was desiped to test tae state's abihty to respo-d to a nue! ear l emergency such as the heh 28.1979, accider.t ti.at enppled a reactor at Three 21e Island. It was the nstion's worst commercial nuclear power accident. Gentsky said the informat)on flow to his bureau was excellent, but the Health i e 9

l 9ttishn et (la t rio t Nrtt",. pnert. b. hrmt 31 lf%B 13 Hundreds Moved Permanently From Area of TMI, Study Finds ~ cause of Three Mile Island. They said duct the " Mobility Study " .iundreds of residents withm a five-t so." said Tokuhata, adding that the to- "But while analyzing the census mile radius of the Three Mile Island tal number of persons who lef t the area d.ta and looking at these p*cp8e who Nue! ear Generating Station moved vjithin the five-mile radius "was in the moved out, we got to talking that we away permanently af ter the 1979 acci-hundreds." really should find out more about the dent at the facihty, a state Health De-partmen censu :indientes. Tokuhata said the preliminary find. movers." he said. With t!.e coperation on the U.S. ings suggested that many of those who Tokuhata said some persons may Postel SeMce. the state Bureau of moved out of their homes remained in have given up good Jobs and lir.e homes Health Rerearch this rno :th beg:'n a tne Harnsburg area. The nuclear plant for reasons nut justified by the facts of study to track down resicents who lef t is located 10 miles south of the state the af termath of the Three fMe Island the area. bureau Director Dr. George capital. accident. Since the nuclear plant was Tokuhata said. Interviewed during the census. brought to a safe shutdown a month Tokuhata,in disclosing the prelimi-which was completed last fall, were af ter the March 25.1979. mishap. it has narv finding. said it was known that YE Of the 38.000 residents who not been in operation and its future is lived with.in the five-mile radius. The clouded. at least so:w of the persur.s who moved out of their hornes rear Three 21e Is-official findings of the census will not Tokuhata said the results of the ' land did so bacausa of emotonal stress be released until later this year. study may help social plancers in com !, related to t! e numar accident. Tokuhata explained the Health De-munity counsehng in the event of an-

- Obv:ously some p91e moved be-partment originally did not plan to con.

other naclear accident elsewhere. POST-GAZETTE: Fri., Oct. 31. 1984)- 2 9 TMI caused stress to mothers, study shows of the nree Mi:e island nuclear acci-in the two regic :s. Sy Henry W. Pierce dent - and events subsequent to it - set was there much eifference in the P:sMa e e Sta"Vme, has been on mothe-s hytng in the TMI amoet of strets reported by chents at Mothers were psychelegically upset area, especally tnose living within a rnental health agencies in each dstnet. by the Three Ele Island episode. but g3y,.mue ratus of the plant." ateording But mom aM preg ant wem nobody is scre how poor old dad fared. to a statement tssued by Western Psych. d " [a A study of residents near Three 21e The s.atement was modified some-oe,t gte t i e ept . Island snowed mothers were emouonally what durtrg a later press conference one year later hard-hit duneg the cuelear accident 19 when questions were raised about the More of 'ac TMI Mers @* help effect on fathers. Eght not fathers have from psychologists and psyclustrtsts. months ago. Compared with mothers in another been affected even more than mothers? nuclear com nunity. the Shippingport "These were the finings from this Dose hardest hit were the ones w$o area of Beaver County, they showed tugh parucular study." quahfied Evelyn Bro-got least scpF* from fnends and who levels of anI2ety ano depress.on. met, pnncipal investigator. had sought help from a psychiatnst before. The one-year study was based on But dad? No one has a elest answer because. interviews with m Three Ele Island Fathers were not studed sepa ately although mothus were stated as a residents and 312 Beaver Cocty people. from other men. Bromet saic, because separate group. f athers were not. The The researchers examined the ace >. "we enly had one internewer per ncese-hold - we coulca't afford more - and fathers were lun: ped wah all the se dent's mental health effects in hcht of mothers were the ones who had been jects in the other two grours stuted - residents' pnor psychiatne probicms. specifically warned by the governor to nuclear workers and chen;s of mental emoticnal support frem relauves and health chmes. Inends. and *other stresses assoetated leave the area. Results of the 137!i.000 project were with hving near a nuclear power The study. financed by the National announced 3esterday at Western Psyche facility." Institute of ;4 ental Health, wt!! be con-att c 1 stitute and Chme. Not much &fference was found in the tinued. "We don't know how long the "The stror. gest mental health impact mental health of the worters employed symptoms wul perust." Bromet said. .P v}}

ML20126F590

Contents

Text

Dear Ms. Sinclair:

Enclosures:

Dear John Ahearne:

.

SUMMARY

Dear Mr. Frankel:

Dear Ms. Stamiris:

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ML20126F590

Text

Dear Ms. Sinclair:

Enclosures:

Dear John Ahearne:

.

SUMMARY

Dear Mr. Frankel:

Dear Ms. Stamiris:

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