In “Does Shaming Have a Place in Public Health” (CMAJ, Feb 2021), Dr. Naheed Dosani is
quoted as saying “it’s important for physicians to use their position and privilege to challenge
the “countercultural movement against science and evidence.”
It is long overdue for physicians to wade into the debate about nuclear power, especially with the recent promotion of a proliferation of small modular nuclear reactors. Nuclear reactors routinely emit ionizing radiation. We, as a profession, have been quiet about it.
We use radioactivity both diagnostically (x-rays, CT scans) and therapeutically (radiotherapy) and we walk the tightrope between damage and health. We routinely stand behind lead walls or use lead aprons in the vicinity of x-rays for our own or our patients’ safety.
But as a profession, we have had a careless past with the thoughtless overuse of radioactive imaging. We even may have used it when we didn’t know what else to do.
It took two researchers on two sides of the Atlantic to change that practice. In the 1950’s, both the UK and the USA were having “epidemics” of childhood leukaemia and had launched research teams. Dr. Alice Stewart was astounded to discover that leukaemia was doubled in children whose mother received x-rays in utero[i]. When the USA Tri-State Study came to the same conclusion a few years later, the practice of “pelvimetry” (measuring the size of the pelvis by the use of x-rays close to term) was brought to an end.
More recently, the routine use of CT scans on children with head injuries was challenged by research[ii]. A team in Montreal reviewed the health records of 80,000 patients receiving PET scans and found an increase of 3% cancers per 10 mSv exposure over the following five years[iii]. RISM (Radiation-induced Secondary Malignancies) has been acknowledged for decades among oncologistsfor an incidence of between 8 and 17%[iv].
It matters little if the ionizing radiation comes from an imaging machine in the form of x-rays or a nuclear reactor in the form of beta or alpha particles or gamma rays, the ionization of cellular proteins results in cellular damage.
During the 1950’s and 60’s, 528 bombs worldwide were tested in the atmosphere. Studies of thyroid cancers in the fallout zones in both the USA[v] and the Marshall Islands (where the USA conducted many of their tests) resulted eventually in a list of compensable illnesses[vi].
Fallout victims received doses of alpha and beta particles coming from the hundreds of broken bits of uranium, among them iodine-129, iodine-131, strontium-90, carbon-14, xenon-135.and caesium-137.
The RERF (Radiation Effects Research Foundation) is conducting a lifetime study on the victims of Hiroshima and Nagasaki. For all its flaws, the study indicates that cancers increase at the same ages as you would expect to find them in non-affected people. This suggests that the recent “cancer epidemic” described by the American Cancer Society might be the effect of fallout over 50 years ago!
How is this connected to nuclear power?
Nuclear power is neither clean nor green. The same radioisotopes that fall out of the sky from a nuclear bomb test are those which are intermittently but routinely released from nuclear power plants. The emissions are a health problem because the human body cannot distinguish between radioactive elements and non-radioactive elements. Routinely released tritium, radioactive hydrogen, can be incorporated into every cell of the body. Strontium-90 substitutes for calcium, caesium-137 for potassium, iodine 129 and 131 preferentially seek out the thyroid gland.
This was not the first time that the environmental and health effects of an industry have been ignored by the medical profession. It took decades before the profession supported Dr. Andrew Pipe’s call to put restrictions on the tobacco industry.
I’m old enough to recall the battle between the health care establishment and tobacco companies. Tobacco companies had parliamentarians and policy makers under their sway. Physicians, many of whom were addicted to tobacco, were complicit. The surgeons' lounge at Royal University Hospital, Saskatoon, was thick with cigarette smoke - so thick that we students scurried in for our coffee and stood drinking it in the hallway. The industry added filters to cigarettes, and increased advertising that equated cigarettes with individuality and freedom of choice. Smoking was healthy, safe and clean. They even marketed a so-called 'light' cigarette - a low tar cigarette[vii].
Like the tobacco industry then, the nuclear industry has compromised the medical profession. The industry has capitalized on our love of gadgetry, convincing many of us that nuclear medicine requires nuclear reactors when cyclotrons and accelerators are much more efficient and cost effective.
The small modular nuclear reactor is equivalent to today’s 'low tar cigarette' of the nuclear industry.
The Canadian Medical Association should take a strong stand on protecting health and the health of future generations by opposing the "light cigarette" of the nuclear industry. The CMA should take a strong position in opposition to nuclear power and promote clean-ups of existing radioactive waste sites. It should actively participate in the on-going process of decommissioning nuclear facilities. For far too long we've allowed the medical profession to be sidelined and our efforts on the behalf of the health of future generations to be minimized. We have the science and the evidence, so as Dr. Dosani says, we should be challenging the media spin and its pseudoscience on the topic of small modular nuclear reactors.
[i] Alice stewar, J. W. Webb, and David Hewitt, “A Survey of Childhood Malignancies,” British Medical Journal
(28 June 1958): 1495 – 1508.
[ii] Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, Early online publication: June 7, 2012. Available at: doi:10.1016/S0140-6736(12)60815-0.
[iii] Eisenberg, Afilalo, Lawler, Abramahamowicz, Righar, Pilote, “Cancer Risk Related to Low-Dose ionizing Radiation from Cardia Imagine in Patients after Acute Myocardial Infarction,” Canadian Medical Association Journal 183 (March 8, 20110: 430-436.
[iv] China Dracham, Abhash Shankar, Renu Madan, “Radiation induced secondary malignancies: a revew article. Radiat Oncol J. 2018 Jun; 36(2): 85–94. Published online 2018 Jun 29. doi: 10.3857/roj.2018.00290
[v] Maps of fallout in the USA. Note the distinctive cut-off at the 49th parallel https://www.google.com/search?rls=en&sxsrf=ALeKk02aqr8lf_6Sz2rx2gODbnbqRc3vnA:1615386601674&source=univ&tbm=isch&q=maps+of+radioactive+fallout+from+nuclear+bomb+testing&client=safari&sa=X&ved=2ahUKEwi068SE-KXvAhXDuZ4KHUYqD_gQjJkEegQIEBAB&biw=1120&bih=969#imgrc=0qnaZ_1Yx5gzDM
[vi] Marshallese islanders compensable damage: https://www.google.com/search?rls=en&sxsrf=ALeKk02aqr8lf_6Sz2rx2gODbnbqRc3vnA:1615386601674&source=univ&tbm=isch&q=maps+of+radioactive+fallout+from+nuclear+bomb+testing&client=safari&sa=X&ved=2ahUKEwi068SE-KXvAhXDuZ4KHUYqD_gQjJkEegQIEBAB&biw=1120&bih=969#imgrc=0qnaZ_1Yx5gzDM
[vii] See a collection of advertisements: https://www.pinterest.ca/pin/493144227921441876/
No comments:
Post a Comment