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.

Mediation: Physicians' Role in Prevention of War

These are not my words. They are those of an eighty-eight year old physician who did what he could to prevent the violence in the Balkans in the 90's. He recruited physicians in the threatened areas to intervene for peace in what ever way they could. Ulrich doesn't travel long distances any more; his words are published here with his permission. It would be an enormous loss if his experience were not told.

Twenty Years “Bridges of Understanding“

Wuerzburg, IPPNW, August 28./29 2015.

Opening speech by Ulrich Gottstein

Dear friends,

Twenty years “Bridges of Understanding”, and today for the first time “Candles in the Night” in Wuerzburg. Twenty years filled with historical sad and hopeful events.

Walter Braun and Renate Geiser invited me to recall the beginning of the successful experiment of the Wuerzburg IPPNW group to bring together medical students from different regions of former Yugoslavia, to learn and work together, to remove enemy images and to build and enjoy friendship.

How did this start ? With great concern the world observed the political development in Yugoslavia after the first free elections in Slovenia and Croatia in April 1990. Our sorrows became true when the open war broke out, at first between Serbia and Slovenia followed by fighting between the Coalition of Croatia and Bosnia-Herzegovina with Serbia in June 1991. Many people in Yugoslavia, especially Medical Doctors were full of despair. Two of them decided to engage for dialogue, reconciliation and steps for a cease-fire, Dr. Vuk Stambolovic from Belgrade and Dr. Milan Kosuta from Zagreb. They founded the “ Peace initiative of Croatian and Serbian Physicians” and organized meetings in both cities. This was a “candle in the night” of chaos. Unfortunately nationalism remained stronger , war continued, the candle was blown out.

At that time I was IPPNW-Vice-President of Europe. IPPNW had received the Peace Nobel Prize about seven years before. I felt it my duty to support peace willing politicians and academicians and medical doctors in Croatia and Serbia and to prove our solidarity with them. In April 1992 I travelled to Zagreb and met with Dr.Milan Kosuta and professor of Cardiology Dzenana Rezakovic. At meetings with several members of the new Croatian government, e.g. the Minister of Foreign Affairs, the Minister for Refugees and the President of the Parliament I was informed about the difficult situation.. President Tudjman was not in the country, he sent me a letter. I urged for a cease-fire and steps for solving the problems without war. The President of the Croatian National Academy of Sciences and Arts invited me to explain the activities and philosophy of our international medical peace organisation “International Physicians for Peace and the Prevention of Nuclear War” .

Many of the people I met were afraid of a new large scale “Balkan War”, and especially the Medical Doctors showed willingness to support peace work. They gladly accepted our suggestion to found a doctors organisation cooperating with IPPNW, which they called “Physicians for Peace in Croatia”. They elected the professor of cardiology, Dzenana Rezakovic as the chair. With her we drove in a Red Cross car through destroyed villages and shelled cities and I spoke with Croatian soldiers at the front line. I was very sad and asked myself, why was this war necessary, could it not have been prevented by wisdom and dialogue? How can we help ? In Germany I reported to our government, to journalists and of course to our IPPNW.

In August 1992 I travelled to Belgrade and met with Dr. Vuk Stambolovic.He organized for me conversations with the leaders of the political parties in Belgrade. Very informative was a rather long talk with the leader of the Social Democratic Party Mr. Djinjic, who asked for diplomatic support from the German government.which so far he did not receive.

I had a two hour discussion with the President of Yugoslavia, Mr. Cosic. I urged him to use his influence to stop the bombardments of Sarajewo, but his power was reduced because the military responsibility was with the Serbian President Mr.Milosevic. I met with the Bishop of the Serbian Orthodox Church, and the Bishop of the Catholic Church and with different peace groups, as e.g. “the women in black”, or the “Belgrade Circle”, in which intellectuals who were opposed to the war and to Milosevic met and discussed. They all were grateful for my visit. I even got the opportunity to speak in a free channel of Radio Belgrade. I explained that Germany and the West was not against the Serbian people, but against the government´s policy to use military force against the other Yugoslav nations and Kosovo. Finally the group of medical doctors around Dr. Vuk Stambolovic founded the “Physicians for Peace in Serbia”. They elected Prof.Milan Popovic as their president. He was a well known Professor of Psychiatry and Psychology at the University of Belgrade. Dr. Vuk Stambolovic was a docent of Social Medicine. He was elected deputy and IPPNW- International Councillor.

Returned home I gave a detailed report to Foreign Minister Genscher and urged him to start dialogue with Mr. Djinjic and to support the peace movement in Serbia.

Again in December 1992 I visited the collegues of the Croatian Physicians for Peace in Zagreb and also Bosnian refugee camps near Zagreb, to which I brought medications and hygiene articles and blankets. The situation was very sad, war continued.

In April 1993 I travelled for the second time to Belgrade.With Prof. Popovic I visited Serbian refugee camps, and with Dr. Vuk Stambolovic I travelled to Pristina in Kosovo. Prof. Popovic had organized for me to give a speech in the Lecture hall of the University hospital for Internal Medicine. I spoke about the responsibility of medical doctors to prevent hostility and war and cited the Hippocratic Oath and our medical ethics. I urged for cooperation and reconciliation with the doctors of Kosovo. They listened but after my speech they did not ask questions to the theme, but only about treatment of special diseases. Since Albanian speaking medical students and professors had been dismissed from the university by Milosevic, my audience consisted only of Serbs.

Thereafter I met with a group of 12 Kosovar professors and doctors who informed me about their absolutely intolerable situation. They built a group called “ Physicians for Peace in Kosovo” and started contacts with IPPNW-Germany and international.

In December 1993 I visited our Croatian colleagues for the third time and continued my mission to Bosnia-Herzegovina. With an UNHCR special passport I was allowed to take a car to West-Mostar. The town had received many destructions during fighting the Serbian and lateron the Croatian army. The coalition of Croatia and Bosnia-Herzegovina was broken. The Bosnian army was defeated and almost only Croats were now living here. Mostar was no longer the famous city in which people with three or more different religions had lived friendly together.The world famous bridge connecting West and East Mostar was destroyed. I visited the two hospitals.In the City Hospital the multi ethnic life was still vivid. The Chief Surgeon was still a Serbian, the Internist a Croatian, the Anesthetist a Jewish Croatian from Zagreb and the Head Nurse a Bosnian. This group was really a “candle in the night”. The other hospital , named “On the White Hill” was newly built before the war but not yet finished. Patients were lying in the front floor. Croatian and Bosnian people together.

I wanted to bring medications and food to the besieged and shelled East Mostar and to visit the doctors and see their situation..In an armoured car of UNHCR together with a British soldier and the local driver who knew which roads were free of mines, we reached after having passed military Croatian controles the city. We heard artillery and machine gun fire close to us. Fighting between Croatian and Bosnian soldiers was going on. East-Mostar and its infrastructure was almost totally destroyed. In two partially ruined private houses the Bosnian doctors had improvised a Surgical hospital, where they performed all the operations, during fightings up to 60 per day. The operation room was in a cellar kitchen, lighted by a diesel generator. The operated patients had their beds in a deep dark cellar without any light. Only if urgently needed they were allowed to light one or two candles. This really was “candles in the night” !

The Bosnian Doctors were very desperate. I will not forget the sentence of the surgeon “Until May we were friends and now we have to be enemies”. Nationalism had won about conscience and humanity. I asked myself, what can our Medical Peace Movement IPPNW do except humanitarian support and solidarity with the men and women who also long for peace? Solidarity was a “candle in the night” to them.They were so grateful for my visit, I was the first visitor from Germany since outbreak of the war. It had been a dangerous trip, therefore I had been asked by the UNHCR officer before starting, “ are you really willing to dare the trip to East-Mostar?”. My answer was a clear yes. I wanted to demonstrate that our Bosnian colleagues were not forgotten and that I wanted to dare what the doctors and people in East-.Mostar had to live through every day. When I said good buye they asked me to inform the world about their desperate situation. That I did in many lectures and papers and reports to our German people and government.

In July 1994 doctors from Sarajewo who had been informed about my visit to Mostar asked me to come to their encircled, besieged and continously shelled town.Together with a Bosnian Surgeon and an IPPNW-friend from Holland we drove in a car on small roads over the Mount Igmam to reach finally Sarajewo. The trip really had been dangerous as several people had been killed by snipers or artillery the days before. Over night we stayed in a Hotel with broken windows. The artillery and Machine gun fire was loudly heard. At first we visited the medical doctors of the partly destroyed University Hospital who welcomed us cordially. We saw that the former Olympia field was now a grave yard with more than 500 crosses or stones.The next day we spoke with the Chief Surgeon of the City Hospital.The bullet hole in the wall besides his desk was shown to us We were welcomed very gratefully. It meant so much to them that colleagues from Germany and Holland had come to see, how much the population suffered from the siege and artillery shelling from the surrounding mountains. Already 10.000 people of all ages and religions had been killed, among them 1.600 children. We visited also other professors of the Medical Faculty and the Peace Center of Sarajewo. Everybody blamed Europe for not helping Sarajewo since aleady more than three years.

Back in Germany I informed our government and IPPNW at national and international conferences, and helt many speeches, and interviews.

On January 11^th in 1994 I was invited to speak in the New University of Wuerzburg.The theme of my lecture was “Engagement of IPPNW in former Yugoslavia” . After the speech and discussion the Wuerzburg group and I sat down in Restaurant Dionysos, “in order to discuss what can be done regionally” as was printed on the flyer. The possibilities proposed were “medical support for hospitals, financial support for reconciliation work, partnerships with hospitals in Bosnia”. I proposed to invite medical students from different regions of former Yugoslavia in order to start with reconciliation. That was the beginning of “bridges of understanding” in Wuerzburg, with the generous help of the “Missionsaerztliche Klinik”.

When I recollect my experiences on my trips to war zones of former Yugoslavia I see in my inner eyes the operated patients in the dark cellar. They lightened 2 candles, and now we could see each other. These “candles in the night” and the sentence of the Surgeon, “until May we were friends and now we have to be enemies”, I will never forget. And I cannot forget the grateful faces of the doctors in the front hospitals near Tuzla on our way to Sarajewo and of the lady pediatric psychiatrist on the university campus, when we donated the necessary finances to restore the rooms and promised to remain in supportive contact. I believe, that our visits meant “candles in the night” to them. In the darkness of war, there was a light of hope for the future.

Our IPPNW and I personally are very grateful that you, dear friends from Wuerzburg, have built and kept strong the “bridges of understanding”. How wonderful that now the “Candles in the Night” give light and create happiness to friends from different nations of former Yugoslavia, who have promised to work for peace and reconciliation. For Peace and Reconciliation in West Balkan but also Peace and Reconciliation are urgently needed between Russia and the USA and on all spots, where war is being waged.

Yes, we are and want to be the “International Physicians for Peace and the Prevention of Nuclear War”. The commitment of the world wide civil society is absolutely necessary to reach that goal.

We shall not forget that war is being waged every year in 15 to 25 countries. From such wars a nuclear war can escalate. Therefore prevention of war is the precondition for prevention of nuclear war. So let us be “propagandists and pioneers” for a policy of early observing where risks of war start in order to immediately help and to prevent the outbreak of fighting.

In Germany we have a strong army and a Ministry of Defense but as in all other countries no Ministry of Peace. We can afford to buy the most expensive weapons but are told that we don´t have enough financial resources to treat causes of war. I ask again, why don´t we have a Ministry for Peace with specialised peace researchers, diplomats, economists, psychologist and historians.Why do the Western and Eastern wealthy countries not engage in early observing dangerous crises, why don´t they help immediately and see the causes of war. That would prevent death and wounds of hundred thousands of innocent women, men and children and thereby also prevent their need to escape from their suffering countries !

Dear friends, take these questions home and discuss them with your friends and co-students and politicians. We are not only doctors for single patients, we must feel our responsibility for humanity, for the “Respect for Life”, as Albert Schweitzer, medical doctor, theologist, great humanist, receiver of the Peace Nobel Prize, our great example lectured and published. We must carry our candle for peace further !