Using Position and Privilege

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.

 

 

 

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[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 49^th 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/

Small Modular Reactors

“War as Disease”

When I was contacted this past winter about speaking at the CPRA conference in Regina, I said that I had been a keynote when the conference was in Fredericton and I hadn’t really done any further work on my thesis that “War is Disease” but that I had been giving a lot of thought to how that, War, had affected the environment and future generations.

So I offered the topic:

Rights for a Safe Environment for our children – clean air, clean water, clean playgrounds.  It seemed that children were the most affected by their warring parents and they had the least say in the matter.  So what we do with the environment and our behaviour in the world has a lot to do with whether children have clean air, clean water and safe playgrounds.

When I went back to prepare for today, I looked up the UN Convention on the Rights of Children (https://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx). I also asked children and their parents about the future. There didn’t seem to be anything that united my passion for peace, for a clean environment and for children’s rights. An item in the newpaper offered something that did – the sudden federal and Saskatchewan provincial love affair with Small Modular Nuclear Reactors and the vision of sprinkling these all over the country like microwave ovens.

Which segues to a particular type of pollution with which playgrounds of the world are already becoming affected. And what that type of pollution means for our children’s children’s children’s children – and so on.

 

This map was created using the Comprehensive Test Ban Treaty monitors and illustrates the spread of Caesium-137 after Fukushima.

Caesium-137 is a radioactive type of cesium, not a naturally occurring element, produced only by nuclear reactions. The presence of caesium-137 indicates that there has been a nuclear power plant accident or a detonated nuclear weapon. It is present in everyone who was born after the 1950’s.

Caesium-137 was picked up by the Comprehensive Test Ban Treaty monitors around the world after the Fukushima accident. In a month’s time no place on earth will not have received a dose of Cs-137. Non-radioactive or normal cesium-133 is considered mildly toxic to biological cells where it acts like potassium.

Caesium-137 has a half-life of about 30 years. This means that one half of the caesium-137 will have decayed to barium-137m through to non-radioactive barium in thirty years. Because it acts like potassium biologically, it has a biological half-life which is relatively short, between 50 and 150 days, but during which it emits beta particles and gamma rays to muscles, heart, pancreas and brain – in fact, no organ is unaffected.

Note that barium has no biological function; small amounts dissolved in water are toxic. It will substitute for calcium in bones and in muscle function. A human cell that is using caesium like potassium in ion exchange will have a sudden challenge because the caesium has changed into barium – which cannot perform the same action.

The nuclear industry – whether bombs or nuclear power – has never increased safety levels of radioactive exposure without civilian non-industry intervention.

In the 1950’s and 60’s, over 500 nuclear bomb tests spread caesium-137 and strontium-90 around the world and most heavily in areas referred to as “downwind”. It took the fury of thousands of people collecting the discarded baby teeth of their children to convince governments to shut down atmospheric bomb testing. Baby teeth contained strontium-90.

The human body can’t discriminate between calcium and strontium so strontium-90, once absorbed by the blood stream goes to bones and teeth, becoming part of the structure. Strontium-90 is a new element found only since the atmospheric testing.

Strontium-90 is a “bone seeker” and about 75% of ingested strontium – in cow or goat milk, meat, and vegetables – will simply pass through with feces but the remainder is preferentially deposited in bones and teeth. Its presence can cause bone cancer or leukemia.

As Strontium-90 decays, it becomes first another radioisotope, yttrium-90, and 64 hours later, zirconium-90. Yttrium is medically significant in the treatment of cancer because of its short half-life and high-energy β⁻ decay but this is not a useful attribute in normal cells. In short, strontium-90 has a decay step that is disruptive to normally operating human cells making strontium-90 doubly dangerous. 

The radioactive pollution from nuclear power plants and bombs includes iodine-131. This is probably the most feared and discussed part of the fall-out, everyone wondering whether or when they should take their iodine pills to try to prevent thyroid cancer. That there is a connection there is no doubt. Thyroid cancer sky-rockets wherever there is radioactive fall-out; usually peaking at about five years post-accident.

What does ionizing radiation do within biological structures? It changes them. It makes ions – it splits molecules into pieces. It doesn’t matter whether ionizing radiation is from the sun, from x-rays or from a nuclear power plant, and it doesn’t matter whether it is alpha, beta or gamma radiation. To some extent the ionizing radiation will change enzymes and other structures within the cell.

It has been known since 1927 that ionizing radiation caused mutations in the reproductive cells of fruit flies; Robert Muller received a Nobel Prize in the 1940’s for his discovery.

The scientific community had the opportunity to observe ionizing radiation and capitalism operate on populations as enormous health scam businesses developed in the early 1900’s, many became wealthy on the sale of radium-laced drinks – it glowed greenish in the dark so was attractive. Not until a prominent former athlete suffered a painful death from ionizing radiation-induced bone cancer in the 1930’s – from radium which acts like calcium in the body – did the US government move to try to create safe levels.

Meanwhile the medical community ran rampant with their new toy – x-rays! Which were tried on practically everything – x-rays were even advertised for acne.

Not until the bodies started piling up did the industry in ionizing radiation scramble to apply safety levels.

Rosalie Bertell & Alice Stewart, two researchers on the two sides of the Atlantic Ocean, independently and using very large populations were able to show that chest x-rays of the mother increased the chances of the baby having leukemia by a factor of two to three times. Prior to 1970, obstetricians used x-rays in pregnancy liberally for pelvimetry – a discredited attempt to determine pelvic size.

With the publishing of BEIR VII, the Biological Effects of Ionizing Radiation edition in 2007 established that exposure to any increase in Ionizing radiation over background radiation increases the incidences of disease.

One of my heroes is John Gofman, a doctor, a lipidologist, oddly enough studying fat cells. Gofman worked with the Manhattan Project, isolating radioisotopes and, at Oppenheimer’s request, he devised a method for isolating plutonium – and was the first person to isolate enough to see visibly.

He was instrumental in convincing the scientific community that ionizing radiation had risks to human health at much lower doses than before the exposure level reached that leading to death. He popularized the Linear No-Threshold (LNT) model as the foundation of the international guidelines for radiation protection.

Gofman was hired by the Atomic Energy Commission (AEC-US) to exam safety measures and became convinced that the guidelines needed to lowered by 90%. He believed that the industry would be horrified and immediately establish lower safety levels.

Instead, the AEC disputed their findings and he and Dr. Tamblin, who worked with him, were the ones who became horrified. He became a reluctant opponent even as he continued to support the development of nuclear power. In 1970, he testified in favor of a bill to ban commercial nuclear reactors in New York City and told the City Council that a reactor in an urban environment would be "equal in the opposite direction to all the medical advances put together in the last 25 years."^[9]

Now our governments are sinking more tax money into supporting the nuclear industry. Paying the industry to spread nuclear power – like toasters throughout the countryside – in Small Modular Reactors! Little – “small” is relative when speaking of nuclear reactors – ionizing radiation emanators producing ionizing radiation waste for which we have no storage – and always the potential for an accident.

I cannot really describe my fury over this latest nuclear industry scam.

We have contaminated enough – the fact is:  we cannot assure that our children and generations of children to come that the future will have less disease, less cancer, safe food and water and safe playgrounds. Fifty years and more than 2000 square miles of severely contaminated, unfit for human habitation for more than 200 years otherwise highly fertile land –is quite enough contamination.

My fury comes from impotence – in the face of knowledge, how can the monetary gain of a few be more important than the health of millions today and unendingly into the future.