Dr. Rosalie Bertell
Unites States Senate Committee
on Veterans' Affairs
10:00 am Room SR-418,
Russell Senate Office Building
Tuesday, 21 April 1998
My testimony addresses, in particular,
- Senate Bill S.1385 (Wellstone), to amend Title 38, United States Code, to expand the number of diseases presumed to be service connected with respect to radiation exposed veterans, and
- Senate Bill S.1822 (Specter et al) which would authorize the Veteran's Administration to provide medical care to veterans who were treated with nasopharyngeal radium irradiation to prevent ear injury caused by severe pressure changes encountered in submarine and flight duty.
By profession, I am a biometrician, which is a specialty in mathematics applied to biomedical problems, and am qualified to design and evaluate epidemiological research. I have worked in the area of the health effects of ionizing radiation, especially at low doses and slow dose rates, for the past 30 years and have produced and published books, and professional papers,,,, on the subject.
It seems to me to be very sad that US veterans exposed to the cleanup of Hiroshima and Nagasaki more than fifty years ago, those exposed to radium implants, and those exposed to the nuclear weapon testing in the 1950's and 1960's are still waiting for recognition. The first book on radiation related cancer was published in 1912 - almost 90 years ago. It would seem that the disputes which have surrounded this issue involve much more than straight forward scientific investigation and reporting. I hope to show that the poor design of the research, specially that done on the atomic bomb survivors, together with an arrogance which claimed that this was the definitive study against which all other radiation research was to be judged, has left the Congress without answers to the most fundamental and urgent questions facing the veterans.
Since many of the veterans exposed to nuclear fallout and debris or unwise medical experiments are now dead, I think that government policy with regard to survivors should be as broad as possible. In particular, I support the proposed extension of the list of presumptive diseases which can be radiation induced. The list is eminently reasonable and should have been recognized long ago. I strongly support both of these Bills, and would like to see the guidelines for medical care even boarder.
Lung cancer in particular has been a problem for the veterans because of the possible confounding effect of smoking. I was pleased to find this on the extended list. There has been a failure to recognize that radiation is not only able to initiate a cancer, but it is also able to increase susceptibility to and promote a cancer initiated by another carcinogen. Both the smoking and the radiation are responsible for lung disease. The confirmation that the veteran smoked is not a reason to disallow eligibility and responsibility for medical care.
There are two major questions which I would like to address in this testimony:
First, dose reconstruction does nothing to prove or disprove that a veteran's cancer or disease is related to their nuclear radiation exposure. It should be sufficient for a veteran to prove that he or she participated in a "radiation risk activity".
Second, there are non-cancer physical injuries suffered by the veterans and their offspring which have not yet been recognized as indicating eligibility for veteran medical care
FIRST MAJOR QUESTION:
THE USEFULNESS OF DOSE RECONSTRUCTION
IN DETERMINING CAUSALITY FOR CANCER
OR OTHER RADIATION RELATED DISEASES.
Dose reconstruction has become the practice because the US Government has failed to properly protect the records of veterans either through fire proof repositories or through preparing multiple copies kept in different locations. It is predicated on the argument that there is a cut-off below which cancer and other radiation effects will not be caused.
Normally, failure to retain evidence results in the assumption of maximum wrong doing. I doubt that the IRS would forgive all back taxes if the tax payer lost the records! In effect, hiring the government's radiation protection community to prepare dose reconstructions to replace the records which were lost is like asking the tax payer to guess his or her income which should be the basis of back taxes! In the case of the veteran, the government which has disproportionately more power, is using that power to disinvest the individual who placed his or her life on the line for patriotism.
Furthermore, there is no scientific evidence that a limiting dose of radiation exists below which there is little or no risk of developing a cancer or other health problem. In fact, there is peer reviewed published research which shows that excess cancers have occurred at dose levels which are within the maximum permissible dose levels set for workers and members of the public. Setting such a cut off for a veteran's eligibility for medical care is at best a subjective judgment, and at worst a deliberate ploy to pretend that standards are protective and to save money by denying the veteran health care. Radiation Protection Standards have never claimed to be health based, i.e., levels below which there is no harm. They are clearly the result of cost-benefit trade-offs, where the cost is cancer death and the benefits are social and economic. They are inappropriate for use as a criterion for government health care responsibility toward veterans!
"The Commission believes that this level (50 mSv or 5 rem radiation exposure over 30 years to the general public, an average of 1.67 mSv or 167 mrem per year, and 50 mSv or 5 rem per year for workers) provides reasonable latitude for the expansion of atomic energy programs in the forseeable future. It should be emphasized that the limit may not in fact represent a proper balance between possible harm and probable benefit because of the uncertainty in assessing the risks and benefits that would justify exposure." International Commission on Radiological Protection (ICRP) No. 26, 1965.
Atomic Bomb Research:
Research on the survivors of the atomic bombing of Hiroshima and Nagasaki is incapable of providing a scientific support for radiation protection standards.
Most people think that the Atomic Bomb survivors offer the ideal epidemiological data base for answering such questions, and indeed the US Government has poured billions of dollars into this research in order to obtain answers. However, a closer look shows why in actual fact this data can never answer the questions with respect to harmful exposures at low doses.
First of all, the hazard being studied by the ABCC (Atomic Bomb Casualty Commission) and its most recent replacement, the RERF (Radiation Effects Research Foundation) is not radiation, but it is the effect of the immediate irradiation from a nuclear bomb blast. In both Hiroshima and Nagasaki, the people were not only exposed to the immediate flash of the bomb, but also to the fallout, which they called Black Rain, the activation products induced by the blast, the resuspended radioactive particles which they breathed, and the contaminated food and water to which they were subsequently exposed. Later on, the Life Span Study involved medical diagnostic X-ray examination of the victims as part of research programs or the routine medical examination. However, the radiation doses assigned to the Hiroshima and Nagasaki survivors as a basis for the research, consists solely of the estimated dose from the original flash of the bomb. No other exposures are included.
The atomic bomb study radiation risk factors apply directly only to external radiation, high dose and fast dose rate exposure. This research says nothing about the internal contamination with radionuclides experienced by any veteran participating in the Hiroshima and Nagasaki cleanup, in atmospheric weapon testing, or in radium implants. This research says nothing about the incorporation of radionuclides into bone with the subsequent long term chronic irradiation of the surrounding tissue.
Secondly, this definition of "hazard" influenced the researcher's choice of "exposed" and "unexposed" persons for the Life-Span Study. The Life Span cohort, used for the atomic bomb research, consisted of 91,228 people identified in the 1950 Japanese Census as having been within 10 km of the hypocenter of either Hiroshima or Nagasaki at the time of the bombing. Of this number, 26,580 (29.1 percent) were "not in the city" at the time of bombing, but were residents of the city. Anyone located more than 2 km from the hypocenter in Nagasaki, or more than 1.6 km in Hiroshima, were designated "distally exposed". The ABCC did not routinely collect information on the shielding of these persons for the 1965 tentative (T65) dose estimates, therefore there was no information on this for input into the newer 1986 (DS86) dose estimates. In fact, only 18,517 (20.3 percent) of the Life Span Study participants had enough information collected for a dose estimate to be made in 1986.
The DS86 team assigned a dose of ZERO to any survivor with a calculated dose less than 10 mGy (1 rad), another 34,043 (37.3 percent). Therefore, by definition (not science) these low exposed persons were considered to be controls (norms) not exposed. Therefore the research which assumed their experience to be unaffected by radiation cannot be used to "prove" it was not related to radiation.
the Atomic Bomb Research was not designed to establish a dose below which exposure was "safe". Had this been the case, careful examination of the harm from low dose exposures would have been mandatory.
Moreover, since the Life Span participants were not assigned even tentative doses until 1965, the research could not have backed radiation protection guidelines set in 1952. The dates for determining dosimetry make this use of the data base research impossible. The doses were reassigned and changed in 1986.
The "unexposed" population, 34,043 (59.5 percent) of the Hiroshima and Nagasaki survivors in the Life Span study, consisted of those whose calculated direct dose of radiation from the flash of the bomb was less than 10 mSv (1 rem). They were assigned a dose of ZERO and called unexposed or "out of the city at the time of bombing". I know of one such women in the control group who lived within 1 km of the hypocenter but was at work, just 3 km away from the hypocenter when the bomb exploded. She went to her home as soon as it was possible after the explosion, and found her Mother, Father and Brother dead. Not knowing where to go, she stayed in what was left of her home for three days, burying the dead and trying to retrieve what she could of personal belongings. Later she had many of the expected radiation exposure symptoms but she is considered an "unexposed control" in the Atomic Bomb study. Contrast this with the current definition by the Senate of veterans who engaged in "radiation risk activity", namely those who were assigned to Hiroshima or Nagasaki anytime between the occupation of Japan (around the 19th of September 1945) and 1 July 1946. How can a veteran considered "exposed" at Hiroshima or Nagasaki, discover the health consequences of that exposure when the Japanese in the study with the same exposure were considered "unexposed"?
The atomic bomb researchers assumed (but did not demonstrate or prove) that below 1 rem exposure from the original bomb blast no radiation related cancers deaths would occur. Therefore this data base can tell us nothing about such low dose exposures because the researchers assumed their exposure was "safe" and did not test for an effect. In philosophy we call this "begging the question" and it results in an invalid "proof".
Moreover, these "unexposed" persons in the study would likely have had internal contamination due to fallout, resuspension of fallout particles, water and food contamination, leading to internal radiation doses also not calculated and assumed to be zero. Therefore the control population, the so called "normal" comparison group would contain most of the internally contaminated low dose exposed people - exactly the group needed to understand what happened to the majority of veterans who would have had internal contamination! Any Japanese with comparable exposures to the veterans, and some with more exposure because they went into the contaminated area to help survivors as soon as they could after the fires subsided, were considered to be the model for normal cancer occurrence in those not exposed to the atomic bomb.
The Senate is being asked to accept the assumptions of researchers as if these were scientific facts proven through the use of a scientific method of investigation. Based on this faulty study, veterans who suffered radiation injuries at low dose levels are being denied the medical assistance for their injuries. The assumption of injury should go to the veteran when the research has been designed so as not to include their situation in the study. They were deliberately excluded and there is no scientific basis for the claim that the research did not "show" any excess. By design, the research could not even address their situation.
There is no scientific basis in the atomic bomb research for denying medical care for radiation related injury to veterans whose calculated doses of radiation are below some arbitrary cut off.
in eligibility for medical programs:
(P < 5 percent)
BUT NOT SIGNIFICANTLY
|Wing 1991 (Oak Ridge) |
26 years follow-up. 1524 deaths; median dose
1.4 mSv (140 mrem)
|Leukemia||Prostate, Lymphoma, Reticulosarcoma, Hodgkins, Pancreatic and Brain Cancer, Lung Cancer among workers not monitored for radiation.|
|Checkoway 1985 (Oak Ridge) |
up to 21 years follow- up; 966 deaths; median dose below 20 mSv (2 rem)
|None||Leukemia, Prostate, Hodgkins and Stomach (significant relative to State of Tennessee)|
|Smith and Douglas 1986 (Sellafield, UK) 9 year av. Follow-up; 2,270 deaths; median dose 2 to 20 mSv (0.2 to 2 rem)||Bladder, Lymphatic and Hemopoietic Neoplasms, including Myeloma.||Ill defined cancers and secondary sites; Prostate.|
|Beral 1985; 16 year follow- up; 5,378 deaths; median dose 10 mSv (1 rem)||Prostate||Testicular Cancer; Leukemia; Thyroid Cancer; non- Hodgkins's Lymphoma, Uterine and Ovarian Cancer.|
|Mancuso, Stewart and Kneale (Hanford) 1984; 3,520 deaths; median dose 2 mSv (0.2 rem)||Myeloma, Pancreas and Lung||-|
|Gilbert 1989 (Hanford); 21 years follow-up; 4234 deaths; median dose 2.5 mSv (0.25 rem)||Myeloma, Female Genital Cancers All Female Cancers;||Lung Cancer in Males with more than 2 rem exposure.|
|Cragle 1988 (Savannah River) 1022 deaths; 20 year follow-up; median dose 4 mSv (0.4 rem)||Leukemia, Alukemia among a subset of workers with 5 to 15 years of employment.|
Lymphopoietic Cancers among all workers with 5 to 15 years of employment.
Among hourly employees: Pancreas, Leukemia and Aleukemia, and other Lymphatic Cancers.
|Among salaried workers: Pancreas|
Among all workers: All cancers combined, Lung Cancer and Respiratory Cancers.
|Wilkinson 1987 (Rocky Flats) 14 years follow-up; 406 deaths, median dose 10 mSv (1 rem)||None||External Radiation: Brain Tumors, Liver Cancer, Lymphosarcoma, Reticulosarcoma, Myeloid Leukemia|
Workers with >2nCi Plutonium: All causes of death, Leukemia, Multiple Myeloma, All Lymphopoietic Neoplasms (Leukemia and Multiple Myelomas) Digestive Cancers
Whole Cohort: Benign and unspecified Neoplasms; Intracranial Tumors.
These research findings were all peer reviewed and published in professional journals. All findings of significance were measured against the rate in the general public, although it is known that the "healthy worker effect" generally results in mortality ratios 20 percent below that of the public. Veterans, who were screened at the time of their enlistment would also be expected to show the "health worker effect".
One can only conclude that it is direct fault of the Atomic Bomb research itself which is being used to deny medical care to the veterans in their legitimate claims resulting from low dose exposures. Therefore it is a foolish and inhumane policy to prepared dose reconstructions, at considerable cost, in order to deny those claims.
It would be better to give that money currently wasted on dose reconstruction to the direct medical care and needs of veterans who were participants in the radiation risk activities.
SECOND MAJOR QUESTION:
THE NEED TO RECOGNIZE NON-CANCER ILLNESSES
AS RADIATION RELATED FOR VETERANS
WHO HAVE PARTICIPATED IN RADIATION-RISK ACTIVITY,
AS WELL AS CONGENITAL DISEASES OR DEFORMITIES
IN THEIR OFFSPRING.
Again, we find a fundamental flaw in the design of the Atomic Bomb studies, which have been relied upon by the Congress as identifying radiation related diseases and disabilities. Due to another research decision, these studies have focused on cancer death as the biological end point used to compare "exposed" with the "unexposed" population. Cancer death rates are also the basis for tissue weighting and calculation of effective doses used to judge the detriment of the reconstructed dose. For teratogenic effects in offspring, they recognize only severe mental retardation, i.e., inability to return a greeting or take care of basic life functions. Virtually all of those in utero at the time of the bombing and who survived, had some degree of mental retardation. Only severe genetic damage is counted by the ABCC and RERF, excluding multifactorial diseases.
The probability of damage occurring when someone is exposed to ionizing radiation is 100 percent. You can see, by the enclosed picture of the living cell, its complexity. The electron micrograph of a plutonium particle exploding in lung tissue gives you some idea of the destruction wrought by one "nuclear event" in living tissue. The energy needed to break the molecular bonds in the DNA is roughly 6 to 10 eV (electron volts), whereas the energy release in just one atomic transformation of a plutonium atom is about 5 MeV (million electron volts). The energy from one transformation of one radium atom is about the same, and the energy of cesium 137 and strontium 90 is about 0.5 MeV (five hundred thousand eV). There can be no question of the ability of the smallest particle of one of the radionuclides to disrupt the chemical bonds of the DNA. The probability that this damage will cause genomic instability in the cells affected is still high, just slightly less than 100 percent (since some cells die). This renders the surviving cells more susceptible to cancer initiation at a later time.
In one nuclear transformation striking living tissue, we expect some cells to be killed, some to be damaged and then repaired or misrepaired, and some to be permanently damaged yet able to reproduce. The misrepaired cells, which then misfunction, and the damaged cells able to reproduce their mutated DNA, can later result in ill health or cancer.
Atomic Bomb research generally assumes that the only damage one should care about (clearly a self-serving judgment not a scientific fact) is direct damage to DNA which results in a cancer which is fatal. More recently, they have included some non-fatal cancers (slighting breast and skin), genetic damage to offspring and severe mental retardation with in utero exposure. The Hiroshima and Nagasaki research on cancer incidence rates was not published until 1994. A comprehensive report on other chronic disease prevalence has never been forthcoming.
When the unrepaired or misrepaired damage due to radiation occurs in the germ cells, sperm (and stem cells which produce sperm) or ovum, that damage will be incorporated into every cell of the offspring made form that damaged DNA. It may show up as a miscarriage, still birth, teen age cancer or mid-life heart disease, but these are not considered to be "detriments' - another value judgment and not a scientific fact. Elimination of regulatory concern for diseases in offspring which are multifactorial reduced the number of genetic effects which would be counted. Even cancer and heart disease in offspring were eliminated. Guidelines today include only dominant and sex linked chromosomal damage, and polyploidy, obvious from birth.
The Committee's estimates of total genetic damage are highly uncertain, however, as they include no allowance for diseases of complex genetic origin, which are thought to comprise the largest category of genetically related diseases.
U.S. Academy of Sciences
The probability that the misrepaired or permanently damaged cell line will begin to proliferate is rare, and that it will survive the body's defenses and go on to become a diagnosable cancer still more rare. Then, to require that the person die of the cancer reduces this probability still further. The radiation risk factors currently in use are based on this rare event occurring, and it is these estimates of cancer death which are being used to estimate the probability of cancer incidence in the veterans. Death is too late for medical assistance and compensation!
Sixth Conclusion:What sort of damage generally occurs when a person is exposed to ionizing radiation? This is rather well covered in BEIR V (quoted above):
Atomic Bomb research on cancer death in atomic bomb survivors is inappropriate for judging the veterans claim to recognition as radiation related those cancers and other health problems which they or their offspring have suffered.
The initiating event more likely [than a specific single-locus mutation] appears to be an event that increases genomic instability of the cells in subsequent rounds of cell division....The hypothesized high-frequency initiating event could conceivably be a change in gene expression of a type that might occur in a large portion of irradiated cells; in Escherichia coli, for example, radiation induces an error prone DNA repair system which leads to mutations which would otherwise occur only rarely.
The human genome consists of the cellular DNA plus that in the mitochondria (derived from the mother). Radiation induced cancers are premised on specific single-locus mutations which result in a malignant cell line eventually resulting in a cancer. What else might we expect from genome instability?
Anyone who has seriously studied the health effects of low doses of radiation would tell you that it is unwise to try to extrapolate from the findings at high doses. The mechanisms are different at low dose, and direct damage to the DNA is of less importance because more rare. It is equally unscientific to try to extend the findings from low dose radiation studies to predict effects at high doses. Among some of the more important mechanisms which cause clinical effects on health after exposure to low doses of radiation are: effects on the functioning of the B Lymphocytes by inducing pathologic processes disrupting humoral immunity; free radical effects causing rupture of cell membranes at very low doses of radiation; damage at very low doses of radiation, below the level which triggers the cellular repair system; the inflammatory process at micro Gray doses; and the effect of internal radionuclides stored in bone on the stem cells in the bone marrow.
In a 1965 study conducted by Selser and Sartwell: "Occupational Exposure of Radiologists and Mortality", the cause of death for 16,808 physicians between the ages of 65 and 69 were studied. When these were normalized as death rates per 100,000, they found the following:
Death Rates per 100,000 Physicians by Specialty Cause of Death Radiologists Internists Ophthalmologists Cardiovascular renal 4,000 3,100 2,900
Cancer 1,000 800 700
All other causes 850 700 400
Overall death rate 6,800 4,500 3,900
What most people recall from this study is that leukemia cancer carried the highest relative risk for radiologists. However, a close look at the data shows that there was a large excess of cardiovascular disease, all cancers and other causes. It should be noted that because this study compared three medical specialties rather than comparing the radiologists with the general public, there is no "healthy worker effect" in this data.
In another study of 1,233 Atomic Bomb survivors of average age 59.5 years undertaken in 1986 by the Investigative Committee of Atomic Bomb Victims of Hannan Chuo Hospital, Osaka, Japan, comparison was made to the expected level of disease reported for the same age group by the Japanese Ministry of Health 1986 Report.
Ratio Between Illness in Atomic Bomb Survivors
and that in the General Japanese Public of the same Age Group
Relative Morbidity in A-bomb Survivors
Leukopenia 13.4 Liver Disease 6.4 Ocular Disease 5.0 Neuralgia and Myalgia 4.7 Ischemic Heart Disease 4.7 Gastro-duodenal Ulcer 4.7 Gastritis 4.5 Lumbago 3.6 Diabetes 2.7 Hypertension 1.7
It should be very clear that the Radiation Research which has been done by the ABCC and RERF has never clearly addressed the problems of non-cancer effects of exposure. Instead, they have relied on their earlier judgment that these other biological endpoints were "not of concern" and should not be studied. Cancer incidence rates were not even reported until 1994. Incidence rates for other chronic diseases has not yet even been collected in the data base, which is concerned with first cause of death. A disease like neuralgia is not likely to be a first cause of death!
Obviously non-study does not "prove" that such diseases have not been increased as part of the experience of the radiation exposed veterans. However, veterans will never be able to obtain medical benefits under the current inadequate Atomic Bomb research base. Some of these Japanese findings for atomic bomb survivors, researched outside of the official RERF supervision, have been confirmed in the survivors of the Chernobyl disaster. However, instead of documenting these Chernobyl findings in order to estimate dose-response relationships we find the radiation protection community (namely the International Atomic Energy Agency, assisted by the US radiation protection community) taking the lead in denying their existence! The term radiophobia was invented to belittle the suffering of the Chernobyl people. While I would strongly oppose assigning radiation as the cause of all ill health, I am forced to speak out against the pseudo-science which builds on ignorance and non-studies, while claiming to be the holder of the bench mark "classical" studies.
I would strongly encourage the Senate Committee on Veterans' Affairs in consideration of the US research failure to study biological endpoints of concern to the veterans, to extend radiation related medical care for all cancers and for the above list of other potentially radiogenic illnesses to all veterans without regard to dose reconstruction estimates. It is reasonable to presume that the genomic instability induced by radiation exposure left the individual survivor fragile in the face of normal environmental and life style insults, resulting in the observed premature chronic diseases and reduced quality of life. This is the least the government can do for the few survivors after years of denial of their injuries.
Redirect research money in order to provide relevant health information for veterans exposed to military technology. This would be more appropriate than trying to use the research into military effectiveness of specific weaponry, in this case, the atomic bomb technology, for evaluating the veterans health problems. The research goals and designs are different, and the information gathered by the military to evaluate weapon effectiveness is not appropriate for decision making with respect to the medical care of veterans.
This Committee, or a relevant Congressional oversight Committee of RERF, should strongly recommend that RERF make available to the Japanese researchers who are studying chronic diseases in the atomic bomb the survivors the DS86 dose estimates for those survivors. This would enable them to test whether or not disease prevalence increases with dose.
Require that administrative decisions of the radiation protection community, namely that only cancer deaths are "of concern" and that this cancer must be caused (not just promoted) by radiation, through direct damage to the DNA, be broadened to include the newest research on low dose radiation mechanisms and indirect or promotional causes of cancer. These are not scientific questions, they are discretionary judgments.
I would hope also that the Committee would revisit the question of genetic damage to the offspring of radiation exposed veterans. This is especially appropriate since the US Government has recently recognized such damage for the offspring of Viet Nam Veterans exposed to Agent Orange.
~ end of testimony ~
Response to Posthearing Questions
Concerning April 21, 1998 Hearing
For Senator John D. Rockefeller IV
Ranking Minority Member
Senate Committee on Veterans Affairs
From Rosalie Bertell Ph. D., GNSH
International Institute of Concern for Public Health
- Please comment on the accuracy and reliability of dose reconstruction as a means to determine exposure levels for compensating purposes. Specifically, do you think that the accuracy of dose reconstruction is reliable enough to distinguish between one or two rem exposure versus five or six rem?
This is really two questions: can dose reconstruction achieve an accurate estimate of the real life dose of ionizing radiation received by the veteran during his or her radiation risk activity while in service, and if so, does the dose accurately reflect the probability that the veterans illness is related to that exposure. Without a "yes" to the second question, the money being spent on dose construction is wasted. In my opinion, the money would be better spent helping the veteran.
At best, a dose reconstruction can estimate some of external radiation received by the veteran. Usually this is done through extrapolating from the few passive dosimeters distributed either among the participants or in the environment during a period of recognized risk, such as the explosion of a nuclear bomb. These dosimeters must be properly evaluated and the results retained. It should also be noted that monitoring 40 to 50 years ago was not as reliable as it is today. With the loss of most of the dosimeter records from nuclear tests, the amount of guessing done in a dose reconstruction is obviously significant. Even when records are available they fail to record unmonitored exposures such as that from residual resuspended fallout. Moreover, there would have been a varied amount of beta radiation dose poorly picked up on the dosimeters, and not easily reconstructed after the event. The internal exposure to radionuclides, ingested or inhaled by the veteran, would be even more difficult to estimate for an individual, since urine and feces analysis, and whole body counting was not undertaken for the veterans at the time of exposure. In addition, the attempt to further characterize this exposure in terms of "effective" whole body dose, average organ dose or bone dose, would be even less likely to be accurate.
None of this mathematical reconstruction actually measures the dose which really initiated a cancer process. This dose would likely be localized to a few dozen cells in the immediate vicinity of the internal radionuclide, and these cells would constitute a very small part of an organ or tissue. When this concentrated energy release is converted to an average dose to the whole organ, and that organ dose is weighted to give an estimate of effective equivalent whole body dose, the dose appears to be very small, but locally it is significant because of its concentration.
With respect to low level radiation exposures, the most significant factor in cancer promotion would likely be the causing of genome instability (BEIR V, 1990) which makes the individual susceptible to cancers caused by future radiation exposures and/or other carcinogens. Cellular genome instability would be the radiation related damage received in the line of duty.
The best detailed critique which I have read on dose reconstruction was written by William J. Brady. He was a Security Officer at the Nevada Test Site from 1952 on, and became a Radiation Safety Office in 1956. Over the following 36 years he acted as radiation monitor, supervisor, reactor branch leader, laboratory branch leader, dosimetry superintendent, senior health physicist, environmental sciences technical advisor and Principal Health Physicist with the prime support contractor for the Nevada Test Site. His report, prepared for a conference in June 25-30, 1995, at the University of Lethbridge, provides detailed first hand accounts of various nuclear tests, the official dose reconstructions for participants in those tests and the errors he finds in those dose reconstructions. Between 1978 and 1991, Mr. Brady represented his company at the Nuclear Test Personnel Review meetings held by the Defense Nuclear Agency Headquarters. If you do not have his paper available I will be glad to send you a copy .
Using the DNA dose reconstructions, it would be impossible to distinguish between the real exposures of veterans reported as having one or two rem exposure and those having five or six rem exposure. The error bars for both estimates would most likely overlap, indicating that the difference was not significant. The probability of a veterans cancer being radiation related would not differ significantly between a veteran having a dose reconstruction estimate of five rem exposure and one having a one rem exposure. Therefore compensating one and not the other makes little sense, even if the measurements are accurate.
The mechanism of cancer induction assumes that radiation related carcinogenesis involves the breaking or mutating of the DNA in a cell, damaging it but leaving it able to reproduce its damaged self in an uncontrolled way so that an overgrowth or tumor forms. The energy needed to break the bond in DNA is roughly between 6 and 10 electron volts. Radionuclides periodically induce miniature explosions, which release energy. These events are called "nuclear transformations". One energy transformation of one plutonium atom releases about 5 million electron volts, and one energy transformation of one atom of cesium 137 or strontium 90 releases about 500 thousand electron volts. This is more than sufficient to cause a cancer. Therefore, we know scientifically that one atom of these radioactive elements, properly placed in proximity to cells, can initiate a cancer. The organ dose from the nuclear transformation of one atom is not even measurable on the scale of rems or mrems!
The probability of cancer developing is related to the human response to the nuclear transformation event: the cell may die, it may be repaired or misrepaired, or it may survive the immune screening in the internal environment and go on to form a clinically detectable cancer or some other chronic illness. There is research which indicates that some cellular damage is too small to activate the cellular repair system, making exposures below this level more likely to cause cancer than those above the trigger point for repair. Human variability likely outweighs the direct dose effect at low doses. (The nuclear industry is using this observation to call exposures just above the trigger point "beneficial").
The Radiation Protection Regulations merely try to "limit" the radiation related cancers, not to eliminate them. A certain number of cancers are assumed to be "acceptable" to society for the economic and social benefits of the activity. This does not mean that such tolerated damage to an individual should not be compensated!
- If dose reconstruction should prove to be unreliable as a means to determine compensation, can you recommend an alternative mechanism for determining the validity of a veterans claim of radiation exposure?
The simplest test of a veteran's claim would be to accept the proof of participation in a service related radiation risk activity prior to the development of the cancer as determining the validity of the claim. In such a case, some veterans will be helped who did not have a service related illness.
However, since 50 percent of the atomic veterans are now dead, this would perhaps be outweighed by the number of atomic veterans, with genuine claims, who were not compensated.
There are some characteristics of the Japanese atomic bomb victims which we would expect to characterize those atomic veteran's who received relatively high doses of radiation. In 1985 a group of physicians and health care workers in Japan began to examine the general health of atomic bomb survivors. They found that 90 percent were under regular medical care for chronic illness by the average age of 59 years, this is 2.5 times more than is found in the general Japanese public of the same age. Even the RERF has now acknowledged that among atomic bomb survivors who were below the age of 40 at time of the bombings and whose calculated dose was more than 200 rem, there is significantly more circulatory disease (cerebro-vascular and cardiac diseases) and gastro-intestinal diseases (especially non-alcohol related liver cirrhosis). The presence of these diseases as well as cancer should strongly indicate high exposure and service related damage.
Another bioindicator of exposure is leukopenia, not explained by radiation or chemo-therapy in the treatment of a cancer. This could be determined by the veteran's medical records prior to diagnosis of cancer, since cancer treatment often obscures this effect. Atomic bomb survivors had more than 13 times the rate of leukopenia found in the general public. The atomic bomb survivors have average radiation doses of 17 rem from the nuclear bomb blast.
The human body carries a lifetime record of most of its significant experiences and hazardous exposures. I believe that looking for biomarkers of radiation exposure may prove to be the most just approach to this difficult question, which is question for the future as well as for the past. In the case of the atomic veterans, there are several possibilities, and the most direct would be (with family consent) to conduct radionulide analysis of bone taken from deceased veterans on autopsy. Some veterans have already had a bone analysis, and by studying the exposure record of these veterans and those deceased veterans with autopsy studies, other veterans with closely related service experiences could be assigned comparable levels of internal contamination. Since 50 percent of the atomic veterans are now dead it should be possible to randomly select some for bone analysis, and seek the requisite permissions.
Less invasive markers could be gathered with a careful medical history. It would be important to note the beginning signs of the veteran's diseases; the time between exposure and the appearance of symptoms; the presence or absence of signs of radiation exposure such as loss of hair or teeth, nausea, skin burns, etc., and the length of time between the exposure and the appearances of such symptoms. Most of the veterans can produce carefully kept personal medical records. Some illnesses such as that called by the Japanese Bura-Bura Disease appear to be specific to radiation exposure. This disease consists of many symptoms generally grouped into three categories, all of which are present in the patient:
tiredness, fatigue, damage to immune system (resulting in frequent infectious diseases);
- Autonomic Nervous System damage:
lack of control of whole internal organs, including the circulatory system (for example vertigo, palpitation or high blood pressure);
- Damage to Nervous and Motor systems:
including such complaints as stiff shoulder, neck pain, headache, lumbago, back pain, numbness of limbs, etc.
It is also possible to do blood chromosome analysis for residual abnormalities, using nuclear workers with known accumulated radiation doses as indicators of exposure level.
I would strongly recommend that a letter be sent from the Senate Committee on Veterans Affairs to the RERF, copied to Katsumi Furitsu, M.D., The Investigative Committee of Atomic Bomb Victims , Hannan Chou Hospital, Minamishinmachi, 3-3-28, Matsubara-shi, Osaka, 580 JAPAN, requesting that the RERF provide to this Investigative Committee the dose estimates which they have for the 1,233 atomic bomb survivors in the Hannan Chou Hospital data base. It is difficult for these Japanese researchers to provide dose response information on these biomarker diseases without such dose information. The RERF does not usually release this information to outside Japanese researchers. However, in view of ABCC-RERF failure to undertake such studies and the need for atomic veterans to verify their experience, release of the dose data is justified.
Thank you asking these questions, and for your concern for the veterans.
Dr. Rosalie Bertell
International Institute of Concern for Public Health
710-264 Queens Quay West
Toronto ON M5J 1B5 CANADA
Tel: 1-416-260-0575 Fax: 1-416-260-3404
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