What Do Doctors Say About Ionizing Radiation?

Good morning and thank you,

I would like to thank the organizers for inviting me to submit a session to this conference. I wish to extend my thanks to the members and ancestors of Treaty six upon whose land we meet. 

When I looked at the program and saw myself bookended between Drs Alan Waltar and Neil Alexander, I had to admit that I didn’t feel particularly comfortable. However, in this world of increasing uncertainty, what better time to combine our efforts for a safer world?

My career has been that of a rural family physician, a jack of all trades and a master of many. I was working in Ile-A-la Crosse where I and my colleagues had four patients, all uranium mine workers with lupus (systemic lupus erythematosus); it is not a common disease and even less common in men. There was no data on the incidence of the disease among First Nations. A Board of Inquiry was in Northern Saskatchewan as part of the environmental and social assessment before the opening of a series of new mines, McLean Lake being one of them. We presented our idea that, should the mining proposal go forward as we expected it would, monies be set aside for a prospective study of the health of those working in the mine and the populations affected. It would be something that had never been done, a prospective population health study. It was not done but in 2012 several publications linked lupus to uranium – likely to properties of the metal itself and not to its radioactivity.

In March 2011, as Executive Director of Physicians for Global Survival, the Canadian affiliate of IPPNW, our office was suddenly in demand for comments on the expected health effects of the Fukushima accident. It was frustrating to deal with public ignorance but it was equally frustrating to get information out of physicists, regulators, and waste management specialists.

We started with the idea of information pamphlets but then collated our material, eventually publishing a book, “From Hiroshima to Fukushima to You”, A Primer on Radiation and Health, published in 2014.

A flurry of emails confirmed that we had filled a gap – among the letters, five physicists who self-identified as having worked in the nuclear industry wrote detailed critiques of it. All of them complemented us upon tackling the difficult subject, all of them disagreed with our position on nuclear power.

So “What do doctors say about ionizing radiation?”

Frankly most physicians don’t say a lot. Ionizing radiation is lumped in with pesticides, heavy metals and other environmental contaminants – the belief being that “you shouldn’t get too much of it”. Several recent studies illustrated frightening knowledge gaps – for example only 55% of physician respondents in one study knew that MRI’s did not employ ionizing radiation. Another study, indicated that almost 80% did not know the doses of usual imaging and almost the same number did not know that MRIs and ultra-sounds do not use ionizing radiation.

This is a little worrisome; radiation exposure from medical imaging is accumulative. Physicians are responsible for the largest body burden of the effects of ionizing radiation that most people carry.

What do the members of IPPNW (International Physicians for Prevention of Nuclear War) and their colleagues have to say about ionizing radiation?

We believe that you cannot really get too little of it. We believe in the precautionary principle in that, if you don’t know the effects over a long time, you shouldn’t do it. An overwhelming percentage of the membership are radiologists. We share your concern about the safe handling of radioactive materials including those that are medically indicated. We think that it is presumptive for anyone to believe that they know everything about ionizing radiation.

Starting from the same place

In 1895, Wilhelm Roentgen discovered rays that penetrated paper and wood and made history by imaging his wife’s hand complete with wedding ring. He called the rays “x-rays” after “x”, the unknown quantity in algebra.

In 1896, Henri Becquerel put his experimental equipment – unexposed photographic film and a rock containing uranium – into a drawer. To his surprise, the rock left an image on the photographic paper and he had discovered radioactivity.

Marie Curie working on her doctoral thesis, was exploring the phenomenon that Becquerel had discovered. She and her husband, Pierre, were first to call the rays “radioactive”. When she isolated uranium, the remaining ore was even more radioactive than the uranium so she began the painstaking process of isolating elements and found both polonium and radium in 1898.

Uranium has atomic number 92 and, in its most common radioisotope with 46 neutrons in the nucleus, an atomic weight of 238.  It undergoes alpha decay, losing 2 protons and 2 neutrons to become Thorium-234.

Removing uranium, a weak alpha and gamma emitter, effectively concentrates the radioactivity in the remaining ore.

Polonium-210 is probably the most lethal element on earth. Its alpha particles convey 6000 times the radiation energy as those of radium. You might recall the double spy, Litvinenko, who experienced deliberate radioactive poisoning in the UK. The dose was probably no larger than a grain of sugar or salt.

Uranium is a common metal found throughout the earth’s crust so we all carry a few of each of the molecules within ourselves – we are living walking uranium decay chains.

The radium that Marie found was fascinating. It glowed green in the dark so found use in dial painting for clocks and watches through the 1920’s.

Because of its mysterious qualities, radium became a hot commodity amongst doctors and a variety of healers. Radium-laced products were sold for health improvement, in cosmetics, and, ironically, for cancer prevention. After radon was discovered in 1900, it, too, entered the circus.

X-rays also experienced commercial success. Doctors were thrilled to adapt and adopt x-rays – both diagnostically and therapeutically. Within a year, reports surfaced of skin damage directly attributed to radiation; and by the turn of the century, the link between x-rays and cancer was already known. Radiologists, typically using an unprotected left hand for focusing beams, developed skin cancer at such an alarming rate that the connection was strikingly obvious.

The early twentieth century was notable for its free-for-all human experimentation; people were remarkably silly about their experiments – one man put his head under an x-ray tube for an entire hour subsequently losing his hair. The picture acquired was useless but it unleashed to a host of charlatans using x-rays for cosmetic hair removal.

Enter Regulators

In 1928, the International X-Ray and Radium Protection Committee (IXRPC) was founded to propose guidelines on radiation protection. In 1934 it established the concept of “tolerance dose”. Scientists from the Manhattan project recommended that the US create a committee to monitor radiation protection and the National Committee on Radiation Protection (NRCP) was formed.

In 1950, the IXRPC was renamed the International Commission on Radiological Protection (ICRP).

It is also in the mid-1950’s that physicians and regulators begin to drift apart. My talk is not to mend the rift but I thought that I would open the discussion about two areas of disagreement:

1. Conflict of Interest

The website for the Canadian Radiation Protection Association says:

“Our Mission: we strive to ensure the safe use of radiation by providing scientific knowledge, education, expertise and policy guidance for radiation protection.

Our vision: To be the expert voice of Canadian radiation safety professionals, both nationally and internationally”

And additionally: “We strive to ensure the safe use of radiation by providing scientific knowledge, education, expertise and policy guidance for radiation protection.”

No one amongst the organizations that I represent would fault these goals; in fact, you should take pride in them.

Your conference brochure illustrates a problem strikingly similar to that about which physicians have been struggling for years. Your meeting here is sponsored largely by the very industry that your organization is purported to regulate.

The IAEA, the International Atomic Energy Agency, is mandated to license and regulate while simultaneously promoting the use of nuclear energy. That this is not generally seen as a conflict of interest is amazing.

2. the Bomb Studies: RERF

In 1945, the US dropped atomic bombs on Hiroshima and Nagasaki.

Tens of thousands of people died instantly followed by tens of thousands over the next months. There was absolute chaos among the survivors. They had no idea what had hit them. Physicians and other health care providers entered the area to care for the wounded not knowing what they were dealing with, Physicians were in constant contact with one another – puzzled over what kind of disease they were seeing? People badly burned. People seemingly to improve then develop black spots and die. And then, they themselves suffering easy exhaustion.

For the first couple of years, the US imposed a complete black-out on information and restricted reporters to Japan. Japanese medical journals were censored. The first winter after the bombs was brutally cold, and food was scarce. No outside aid was permitted.

Americans treated the Japanese as scum, with disrespect and disdain. The Japanese viewed them with suspicion.

In this environment, in 1947, the Atomic Bomb Casualty Commission was formed. It began its work in 1950 and, over the next ten years registered 195,000 survivors in the Life Span Study. It is a longitudinal epidemiological study that followed and still follows the lives of atomic bomb survivors. The name was changed in 1975 to the Radiation Effects Research Foundation (RERF).

Ihe ICRP (International Commission on Radiation Protection), the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), and the International Atomic Energy Agency (IAEA) all believe that the RERF estimates are applicable to all situations involving radiation risks including workers and medical x-rays. The US committee on Biological Effects of Ionizing Radiation (BEIR) based its results on RERF as well until 2006.

We disagree and believe that there are problems with the data.

1. Based on the fact that the death rate had returned to normal among survivors, the commission assumed a normal population. A geneticist who had been in the studies from the beginning stated that “we all assumed that there would be a strong selection effect, and we had all kinds of meetings about how we were going to handle it. But we found nothing. So we assumed that it had disappeared.”

2. The studies were initiated late - after the deaths from infections, early leukemias and deaths from destroyed immunity, some people being registered as long as 14 years after the bombs exploded.

3. Children under ten and elderly were under-represented so the population doesn’t represent normal demographics.

4. The commission represented the enemy. It was faced with enormous suspicion by Japanese victims, who thought that they were being treated as “guinea pigs”. The commission was set up to study, not treat, and autopsies were part of the study.

5. There was shame attached to being a victim and social pressures for hibakusha to remain silent so there is no certainty that a representative sample was obtained.

6. It was insensitive to the study population. People were summoned for examination during working hours costing them a day’s wages.

7. Segregation of facilities - the American and Japanese doctors dined separately.

8. Data collected by Japanese physicians who had first-hand experience was dismissed, their medical journals heavily censored, factor which increased suspicion about the ABCC.

9. The scatter of doses of radiation was based upon the fall-out from the Nevada where Japanese style houses were built and the subsequent exposures estimated. The individual doses were assigned on the memories of the victims - where they were at the time of the blast. No account was made of their activities immediately thereafter or whether they ate or drank any radioactive materials.

10. Since the US exchanged amnesty to doctors who conducted human experimentation for their data, it was rumoured that the Japanese investigators were from that cohort. (As US politics shows us, a rumour need not be based on truth to affect peoples’ behavior.)

11. The Commission was composed of health physicists, nuclear physicists, radiobiologists and biostatisticians so the rather unusual situation existed where those on the ground examining victims as physicians were discounted and those coming to collect data had little or no medical training. To our knowledge no epidemiologists were employed.

12. The RERF did not and does not examine non-cancer deaths except for aplastic anemia which was reclassified as leukemia. The largest category of deaths amongst the survivors were classified as “a precise diagnosis was not made”. The assumption that the only long term effect of ionizing radiation exposure is cancer was erroneous. It will have missed all deaths due to infectious disease that may have had an underlying cancer or pre-cancerous condition.

13. Finally, we contend that the health effects from a single, external, high-energy blast of radiation and the untold numbers of short-lived, artificially created radioisotopes are different that the usual low-dose and/or chronic exposure from nuclear power plants or technical devices.

Conclusion:

Let me answer the question, how should the nuclear industry improve public confidence?

Whether or not there is an actual conflict of interest, regulatory agencies should be distanced from industry. Currently it appears that regulatory agencies are in bed with industry. Admittedly there are only so many nuclear physicists available, people move from positions in one organization or company to another, much like ex-politicians. A phenomenon of “regulatory creep” occurs where the regulatory bodies move closer and closer to those they regulate.

Question Authority, in this case, the continued use of the RERF statistics without questioning their application to environmental standards. Most of us would not 1950’s physics as having the final word on nuclear radiation – we are being asked to accept research set up with 1950’s techniques and standards?

Finally, you should be congratulated for choosing career paths that have an assured future. Should all use of ionizing radiation in industry, medicine, power and military arms end tomorrow, your association will continue to exist – in fact, given the radioactive waste produced in the last 60 years, you might have the most envied job security, universally legal, of any career on earth.

Should the UN support a nuclear weapons ban treaty, dismantling, re-purposing and storage would provide increased job opportunities. Should every nuclear power plant be shut down tomorrow, there are probably not enough of you to work on regulatory issues surrounding the decommissioning, an entirely wide-open field of research.

In fact, you may take any political position you wish with regard to ionizing radiation - you be opposed to nuclear bombs, nuclear energy and uranium mining, even medical use of ionizing radiation, and your jobs will still be with you.

We all want a safe world, let us combine our efforts to make it so.