>The New York Times
>January 28, 1999, Thursday, Late Edition - Final
>
>SECTION: Section A; Page 20; Column 5; National Desk
>HEADLINE: No Radiation Effect Found At Northwest Nuclear Site
>BYLINE:  By MATTHEW L. WALD
>DATELINE: WASHINGTON, Jan. 27
>
>   In research ordered by Congress after revelations of huge
>radioactive gas releases at the Hanford nuclear reservation during the
>cold war, an intensive study of 3,400 adults who grew up near the site
>has found no difference in thyroid abnormalities between those
>estimated to have received high doses and those believed to have
>gotten none.
>
>   The findings are to be released on Thursday at a meeting for people
>who live near the Hanford complex, in south-central Washington State.
>The main points of the study, which tried to track down an entire
>group and evaluate the health of its members, were described today by
>four people here who had been briefed on its results.
>
>      Thyroid nodules and thyroid cancers, especially in people
>exposed to radiation when they were children, are among the health
>effects most closely tied it. A byproduct of nuclear fission is
>radioactive iodine, which concentrates in the thyroid gland when
>humans are exposed to it. Failing to find a link contradicts
>expectations that were widely held when the study was ordered in 1988.
>
>   Senator Ron Wyden, Democrat of Oregon, whose staff was briefed on
>the results, said through an aide that he feared some people would try
>to use the findings to argue for reopening a plutonium reactor at
>Hanford that has been in mothballs.
>
>   "I remain deeply skeptical of the proposition that the world's
>largest radioactive waste site does not pose a health risk to the
>people that live around it," Mr. Wyden said.
>
>   The research was independent of the Energy Department, which, as
>the successor agency to the Atomic Energy Commission, operates
>Hanford. The study was performed by the Fred Hutchinson Cancer Center,
>of Seattle, acting as a contractor for the Centers for Disease Control
>and Prevention, part of the Department of Health and Human Services.
>It was carried out from 1992 to 1997.
>
>   People who were briefed on the study said researchers had recorded
>the names of 5,199 people born in the Hanford area from 1940 to 1944
>and set out to find them. In the research, 3,441 of these people were
>studied intensively, with sonograms and blood tests.
>
>   Each subject was examined by two doctors on separate occasions.
>Researchers tried to estimate the dose received by each person, based
>on such factors as where they grew up and whether their family grew
>their own vegetables or kept a cow. Radioactive iodine decays rapidly,
>but vegetables picked fresh from areas with radioactive fallout, or
>milk given by cows that grazed on contaminated grass, would have
>higher amounts.
>
>   Estimated doses of those in the study ranged from zero to about 280
>rads to the thyroid. In contrast, in case of a civilian power plant
>accident, the Federal Government advises consideration of an
>evacuation of the nearby population if the anticipated dose to the
>thyroid is 25 rads.
>
>   The report also drew comparisons with the rates of thyroid
>abnormalities for people outside the Hanford area. People briefed on
>the report were vague about that finding and said it was not as
>significant as the failure to find a correlation between thyroid
>health and estimated radiation dose among residents of the Hanford
>area.
>
>   People who question the accuracy of the results will probably look
>first to the quality of the dose estimates, said Timothy J. Connor, a
>leader of the Northwest Environmental Education Foundation, a
>nonprofit group in Spokane, Wash., and one of the first to seek money
>from Congress for a study of Hanford radiation effect, to be performed
>outside the Energy Department.
>
>   Mr. Connor, named by the disease control agency to an advisory
>committee that helped oversee the new study, said he had confidence in
>the independence of the researchers. But he said that no matter how
>good they were, and how accurate the earlier data they used, their
>"dose reconstruction" would not be as precise as doses recorded from
>sources like medical procedures.
>
>   Another issue, he said, is how the findings of this study would
>affect the current debate about a second study planned by some
>researchers. The Agency for Toxic Substances and Disease Registry, a
>sister agency of the Centers for Disease Control, would like to
>monitor about 14,000 people in the Pacific Northwest for signs of
>health damage from Hanford, under a provision of the Superfund law.
>
>   The Energy Department had said the study's costs were not
>justified, but later it proposed such a study to Congress. Congress
>instructed the Energy Department to negotiate with the Department of
>Health and Human Services on setting priorities on health worries
>around nuclear military sites.
>
>   The study being released on Thursday is more far-reaching than most
>epidemiological studies because it does not simply tryto count people
>with a disease, but examines those with no health complaints.
>
>   In the United States, no military or civilian site is believed to
>have emitted nearly as much radioactive iodine as Hanford. One release
>was deliberate, in an attempt to study how the material behaved in the
>environment and thus to draw conclusions about how much the former
>Soviet Union was releasing, and therefore how much nuclear weapons
>fuel it was making.
>
>   But most of the releases were simply a result of the frantic haste
>to build nuclear weapons. The scale of the releases was not clear
>until thousands of pages of government documents were declassified in
>the 1980's.
>END

The numbers tell the true story:

•  5,199 people were identified as exposed to Hanford radiation and sought for the study
•  541 of the 5,199 were Dead and not included
• 395 refused to participate because of "illness or impairment" (Noteworthy exclusion!)
• 3,441 were used as "living study evaluable participants"

•  thyroid cancers......................................................20
•  benign thyroid nodules........................................330
• Graves Disease......................................................50
• multi nodular goiter & simple goiter...................115
• hyperthyroidism...................................................196
• autoimmune thyroid disease (Hashimoto)...........674
• hypothyroidism.....................................................595
• hyperparathyroidism...............................................14
• other thyroid diseases.............................................26

 IN ADDITION-    1,596 ULTRASOUND ABNORMALITIES WERE FOUND!
 
Read this HTDS Summary comment carefully.  "This study found no evidence in any of the analyses that increasing dose to the thyroid from Hanford radiation was associated with an increased cumulative incidence of any of  the disease outcomes or thyroid laboratory tests."    That is all this study can conclude. Any other conclusion drawn is just a public relations
effort. "These results should consequently provide a substantial degree of reassurance to the population exposed to Hanford radiation that the exposures are not likely to have affected their thyroid or parathyroid health."   With over 2000 cases of thyroid disease found in 3441 study participants who were all exposed to Hanford's radiation, this is not a logical conclusion that can be scientifically supported by this limited, myopic study!
 
The study was completed in the fall, but the outcomes were not released until last week.  The time in between was spent on "risk communication," or how the study results should be presented to the public.  There is an obvious agenda here.  If there is no impact perceived from Hanford, there is no liability.  There are no downwinders.  This $18 million dollar study is a sham.

Tim Connor is a Spokane writer and author of "Burdens of Proof, Science and Public Accountability in the Field of Environmental Epidemiology." Since 1992 he has been a member of the federal Advisory Committee on Energy-Related Epidemiologic Research (ACERER) which advises the Secretary of Health and Human Services on federal radiation research policy and priorities. The following are a series of comments, statements, and memos Tim wrote concerning the Hanford Thyroid Disease Study. They contain a wealth of information and insight into the situation with the release of the HTDS.
 
 

From: Tim Connor, Northwest Environmental Education Foundation

February 4, 1999

Re: Hanford Thyroid Disease Study

        (Note: this version replaces an earlier version of these notes. It
corrects, belatedly, for a few typos and one minor error in the summary of how
the mortality pattern in the HTDS subject search was presented. TC)

        By the time I post this, there's a good chance much or all of it will
no longer be news but I wanted to pass on some observations about the findings
of the Hanford Thyroid Disease Study.
        There are some things I'm saving for later and among them is a strong
protest to CDC at the way this study was released. The way it was handled shows
that DOE has nothing over CDC when it comes to civility and respect for people
who were most affected by the Hanford emissions, the decades long secrecy about
these exposures, and the way in which the Hanford "downwinders' been treated
like an awnry group of statistics providers rather than citizens and taxpayers.
The scientists from Fred Hutchinson share much of the blame for this. I will
deal with this more at another time and place.
 
        My early take on the study, such as it is, is that the investigators
bet the epidemiological farm on a study design aimed squarely at detecting a
dose response pattern in the thyroid disease incidence. This, in fact, is a
literal summary of their null hypothesis (that no dose response would be
dectectable) and the alternative hypothesis (that the dose response would be
observable.) To be honest, I was among those who thought this was a reasonable
approach. When detailed dosimetry information was injected in to the analysis
of the so-called "Utah Cohort" in the early 1990s, it was like a dye that
revealed a statistically significant dose response for total neoplasms among a
similar sized (3,545 versus 3,441 for HTDS) and similarly dosed group.
        Obviously, the HTDS researchers don't see a dose response in any area
of thyroid disease outcome. If that outcome is surprising, what is more
surprising is the high confidence Ken Kopecky (the HTDS statistician) and the
other HTDS investigators voice in their strangling embrace of the null
hypothesis. This confidence is literally dependent upon the statistical power
of their analysis which, as Owen Hoffman has already pointed out in a timely
and detailed memo, is very suspect and in need of swift, well-aimed kicks from
reviewers. (We do many things here in the shop at the Northwest Environmental
Education Foundation, many of them involving calculations while trying to calm
screaming children. Alas, we do not perform power calculations).
 
 
        There is another thing striking about the conclusions the HTDS
investigators reach based on this study. It isn't just that they don't see an
effect from Hanford (by the way, they're perfectly entitled not to see an
effect, just as the old explorers were perfectly entitled to sail west without
detecting Native Americans). Where they wash themselves overboard, in my view,
is in their assertion that "these results provide rather strong evidence that
exposures to these levels of I-131 do not increase the risk of thyroid disease
or hyperparathyroidism."

        Part of this conclusion, by the way, is a fair amount of undocumented
arm-waving about how the findings in the Utah cohort are confounded by
exposures to external gammas and from uptake of shorter-lived (and more
energetic) radioiodines. It's also interesting (and puzzling) that so few of
the people included in the HTDS cohort received doses greater than 100 rad.
Assuming the dose calculations are accurate, only 6 of the 1,621 women of the
"in-area" group (the highest exposed group) received greater than 100 rad; of
the 1,569 men, only 18 received higher than 100 rad doses. It is an interesting
anamoly that three times as many men received more than 100 rad--because women
are so much more vulnerable to thyroid disease (including radiation-induced
thyroid disease) the investigators would obviously have preferred a higher
number of women in this high dose group. But, as in many other places of this
study, the investigators don't blink in print. Their aim is to persuade you
that this study is a powerful rebuke to notions that I-131 in the low dose
range are much of a health risk.

        I've spent much of today on the phone to the National Cancer Institute
making sure I understand their latest numbers on thyroid cancer incidence. The
reason I checked with NCI is that I was shocked by the high numbers of cancer
found in the HTDS cohort and wanted to make sure I wasn't missing something.

        Try this on:

        According to the most recent statistics published by NCI (based on
1994 cancer incidence rates) the number of thyroid cancers expected in the HTDS
cohort (a group almost exclusively composed of white females and males between
the ages of 50 and 55 at the time they were examined) is .32. That's right, a
third of a cancer.
        The number of thyroid cancers reported in the HTDS group is 20, with a
possibility that at least three other cases could be cancerous.

        For women in this age group, we would have expected .22 cancers among
the 1,748 in the HTDS cohort. The HTDS doctors found 13.

        For men, we would expect 0.1 cancers. The HTDS doctors found 7.

        Now, if this population is allowed to live out its lifetime, the
number of thyroid cancers expected goes up quite a bit and comes closer to the
numbers actually found in the HTDS. The lifetime risk for thyroid cancer for
women is 0.66 percent (1 in 152) so if the 1,748 women in the HTDS cohort had
been allowed to live out their lives, we would expect to see 11.5 cancers.
Again, we already are seeing 13.
        To be sure, there is a detection bias in bringing these folks in for
intense thyroid exams (the HTDS investigators report that only 8 cancers had
been diagnosed prior to the HTDS exams) but even with the 8 diagnosed, we see a
much higher number than we would have expected.

        If I can engage in a bit of modest understatement, these numbers beg
more of an explanation than the statistical shrug of the HTDS investigators who
were looking EXCLUSIVELY at the dose response curve and frankly ignoring the
INCIDENCE rate. I haven't finished reading the entire study yet but thus far I
see no expressed concerns about the high rates of thyroid cancer and other
thyroid diseases observed. Tom Hamilton did allow during one of the briefings
that the numbers were surprisingly high but clearly treated it as an
afterthought, rather than as something that warrants further analysis. To say
that I'm baffled about this is putting it mildly. I'm baffled in the way that
the Minnesota kid who put his warm wet tongue to a freezing metal pole last
week was inconvenienced while he was awaiting the paramedics.

        There are other little nuggets of confusion buried in this report but
I only have time to report one this afternoon, before the coffee wears off and
I have to go run errands.

        *Many of you have read about the unexplained 20% mortality rate of
among the 5,200 people originally sought for this cohort. What you may not have
yet read is that the largest excess of deaths was reported in Franklin County
which is immediately downwind of the Hanford site, the county where my mother's
family was living, where "downwinder #1" Tom Bailie was living, and where a
"death mile" was reported by Hanford downwinders doing doorstep epidemiology
back in the 1980s. (By the way, both my mom and grandmother have thyroxin
prescriptions, but I'm relieved that this is all just a grand coincidence now.)
        Oh and, "There was evidence that those born in the period 1945-'46
experienced a slightly higher excess mortality than thos born from 1940 to 1944
(prior to the Hanford releases) although the differences were not statistically
significant."

        Here we need to remind readers of this memo that the Hanford Thyroid
Disease Study was a thyroid study and not a mortality study. Perhaps that
explains the following excerpt which appeared on the same page (page 8 of the
"Discussion" section, for those of you lucky enough to have a copy):

        "Although it was not possible to estimate individual doses for the
deceased in this study, there is no evidence from the mortality analysis that
the excesses are concentrated in subgroups more likely to have had higher doses
{author's aside: Hmm, let's try locating Franklin County with our finger
again}. In fact, 74.2% of the deaths occurred prior to the beginning of Hanford
operations (1945) , reflecting in part the fact that approximately 36% of the
deaths occurred in children under one year of age."

        Now, some of you are thinking that I've made a typo, that I shouldn't
have written 74.2%--that maybe it should be 7.42 %. The typo is not mine, if it
is a typo. If it isn't a typo we have an unexplained holocaust whereby nearly 3
out of 4 of the deceased 541 people sought for this study died between the ages
of 0 and 4 years old. Something Biblical? Pharoahs out to kill young people? As
far as I know, no German or Japanese bombers were targeting the day care
centers of the inland Northwest during those years.
        If it's not a typo, I frankly don't know what is being reported here
and wonder how it is that a report that took nine years in the making could
contain such a hacked up piece of non-information. Those of you who can
translate it, please share the secret with the rest of us.

        In conclusion, I want to return to the refrain of this analysis that
has been offered to us. There is no external control population. The hunt for
the elusive dose response is the mark of this study. It is a cohort made up
almost entirely of persons in an area where they would have been exposed to
some degree from Hanford. The diagnostic attempt, again, was to ferret out the
dose response. It failed. And based on that failure the investigators reported
that it appears nothing really happened--that exposure to releases from Hanford
did not affect the thyroid injury pattern in Eastern Washington for people born
between 1940 and 1946. They are real sure about that. And the question is, in
light of all the thyroid disease, where does this confidence come from?

        All for now.

                        Tim Connor
 
 

February 8, 1999

From: Tim Connor, Northwest Environmental Education Foundation
To: Distribution

Re: The Hanford Thyroid Disease Study and the Case for Medical Monitoring

        In the wake of the first pronouncements about the "negative" results
of the Hanford Thyroid Disease Study (HTDS), the assumption is that the
inability of the HTDS researchers to connect thyroid disease to Hanford
radiation emissions spells doom for the Hanford Medical Monitoring Program
(HMMP).
        Even if one accepts the suspect dosimetry and statistical wizardry
that enabled the Fred Hutchinson researchers and the CDC to dismiss any Hanford
connection, there is one inalterable reality that won't go way. The medical
results on the HTDS study population revealed much more thyroid disease than
expected. Indeed, one of the most profound ironies here is that the HTDS
analysis could have found a very strong, statistically significant correlation
between Hanford radiation and thyroid disease with far FEWER thyroid casualties
than were actually observed by the HTDS investigators. What they found,
instead, was a surprising amount of thyroid carnage (and mortality) but no
clear dose response pattern to directly implicate Hanford iodine-131.
        My conclusion from this is that rather than undermining the case for
the Hanford Medical Monitoring Program, the results of the HTDS actually make
the strongest case for implementing it, and particularly that part of the HMMP
that will have the most public health benefit--the blood test screening for
thyroid disease and, particularly, hypothyroidism.
        In an earlier memo on this topic I noted with some degree of cynical
unamusement that the pronouncements by the Fred Hutchinson Cancer Research
Center investigators that there is no link between Hanford exposures and
thyroid disease don't pass the giggle test. Given the latest national incident
rates for the age group studied (mostly white people,  mostly between the ages
of 50 and 55) we would have expected to find a third of a cancer. All told, the
HTDS doctors found at least 20, with 12 being diagnosed for the first time as a
result of the HTDS clinical work up.     To be sure, the finding of this many
cancers has to be discounted, somewhat, by the act of looking so thoroughly for
them. Still, using more conservative lifetime cancer incidence rates for
thyroid cancer, one would have expected (based on 1994 incidence trends) that
11 of the 1,748 women in this cohort would have developed thyroid cancer in
their lifetimes. The HTDS found that 13 of them already have, or have had,
thyroid cancer. Because this age group is essentially at the middle of the
period in their lives where most thyroid cancer materializes, it is plausible
that the ultimate lifetime thyroid cancer incidence among women in the HTDS
cohort will be double that which we would expect from a random selection of
women in this age group. This would hold even if we make the rather
conservative assumption that no additional Hanford-related thyroid cancers
occur in this group.
        The HTDS investigators offer no explanation for why the thyroid cancer
incidence in this cohort is so high. They're just adamant that they see no
evidence (based on their dose-response analysis) that Hanford radioiodine is
the causative factor. (Incidentally, my new alternative hypothesis for this
apparent large excess in thyroid cancer among past and present Eastern
Washingtonians is that all were of child-bearing age during the reign of former
Governor Dixy Lee Ray. And for those of you who don't think I'm kidding, I am
kidding. On the other hand, neither the investigators at the Fred Hutchinson
center or their sponsors at the Centers for Disease Control are kidding.)
        Before the Hanford Thyroid Disease Study was declassified and released
last month, the main argument against going forward with the Hanford Medical
Monitoring Program was that the palpations and ultrasounds used to look for
neoplasms would ultimately result in a significant number of unnecessary
thyroidectomies and that few, if any, cancer deaths would be avoided. As some
of you know, I'm one of those who thinks that it is still responsible and
ethical to go forward even with this part of the HMMP, especially if
adjustments can be made in the protocal with regard to the use of diagnostic
ultrasounds.
        Still, no sound argument has been advanced by the Institute of
Medicine or anyone else for why the blood test screening part of the HMMP
should not proceed. These tests would allow the diagnosis of thyroiditis,
hypothyroidism, hyperthyroidism, and hyperparathyroidism without touching a
single neck.
        Of the above conditions, hypothyroidism is the one most clearly
associated with radiation exposure to the thyroid and the condition that we
would most expect. It is far more common than thyroid cancer and the
consequences, in some cases, can be far more severe than thyroid cancer--even
fatal.
        In justifying its case for the Hanford Medical Monitoring Program, the
Agency for Toxic Substances and Disease Registry (ATSDR) reported it expected
to find 45 cases of previously undiagnosed cases of hypothyroidism among the
first 6,000 people it examined under the HMMP. This is an incidence rate of .75
percent and (because ATSDR was reluctant to forecast additional,
radiation-induced cases based on the 10 rad exposure levels needed for HMMP
eligibility) the number of hypothyroid cases expected was based on the ambient
rate of the disease in a similarly aged population.
        Under the Hanford Thyroid Disease Study procedures, 3,441 people (the
vast majority of them receiving some exposure from Hanford with a mean dose of
18 rad) were examined. Of the 3,441, 595 were diagnosed with hypothyroidism (an
incidence rate of 17.3%) and 146 cases were first time detections (an incidence
rate of 4.2%).

        Comparing apples to apples here:

        The HMMP expected 45 undiagnosed cases among 6,000.

        The HTDS found 146 undiagnosed cases among 3,441 actually examined.

        What this means for the HTDS has already been commented upon. The
investigators see an infirmary overflowing with thyroid disease, but don't see
the Hanford connection. In my humble view, it is all the more evidence for why
this study was either poorly designed and/or the underlying dose estimates
smell of low tide.

        But it also means that ATSDR clearly UNDERSTATED--by about four
times--the humanitarian, public health benefit of just the hypothyroidism
portion of the Hanford Medical Monitoring Program. I don't blame ATSDR for
this. I think they've been unfairly hammered unfairly by the Institute of
Medicine for their plan and that the hypothyroid detect benefits were purposely
conservative (something, incidentally, that IOM gave them zero credit for).
What the results from HTDS show is that this program will be much more valuable
than ATSDR portrayed, that it is likely to improve the lives of 600 or more
people who are currently living with undiagnosed hypothyroidism.

        The most disingenuous and destructive effect the Hanford Thyroid
Disease Study is likely to have is to further delay, if not entirely derail,
the Hanford Medical Monitoring Program. If it happens, we will have the Fred
Hutchinson researchers and the CDC program managers to blame for this. As I
wrote in my earlier memo, researchers have a God-given right to test hypotheses
and to do studies that result in negative or inconclusive findings. The FHCRC
team went beyond that, however. They purposely held this study up as sound
evidence that not only is Hanford somehow blameless for the thyroid disease
that afflicts Hanford downwinders, they also clearly suggested that the results
were superior to previous research indicating a connection between I-131 and
thyroid disease. {According to USA TODAY, Scott Davis, the lead FHCRC
investigator said that he hoped the results of the HTDS will be used to "refine
[our] understanding of what the [NTS] doses might have meant."}

        The bottom line here is that not only is it premature to accept that
the HTDS tells us much of anything about the alleged non-relationship between
Hanford exposures and thyroid disease, the study itself has actually provided
the best evidence yet that implementing the Hanford Medical Monitoring Program
will produce a social benefit that far outweighs the cost.
 
        The only question then becomes whether the program is warranted and
that the people served by it, deserve the service. The answer on both counts is
emphatically yes.
        While it may be a puzzle that the HTDS missed the expected dose
response it is only a puzzle. It doesn't undo the basic facts that this
population was exposed, against its knowledge and consent, and that it is
remains at significantly greater risk for thyroid and other diseases as a
result of the exposures. The HTDS doesn't undo any of these basic facts and one
hopes, in time, it's anamolous non-conclusion will be put in proper scientific
perspective.
        In the meantime, the case for Hanford Medical Monitoring is, in fact,
stronger than it ever has been.
 

                                        Tim Connor
 

February 9, 1999

From: Tim Connor, Northwest Environmental Education Foundation
To: Distribution

Re: HTDS thyroid cancers

        It has come to my attention (cough) that the thyroid cancer risk in my first
memos dealing with the findings of the Hanford Thyroid Disease Study (HTDS)
were wrong. What I was trying to capture from National Cancer Institute
(SEER Program) age-adjusted incidence rates for thyroid cancer is the number
of thyroid cancers we would expect to see in the 3,441 HTDS cohort,
versus the 20+ thyroid cancers reported by HTDS investigators.
        In the memo, I reported that according to the NCI incidence rate for
the segment of the population represented in the HTDS cohort (predominately
white people, between the age of 50 and 54 at time of diagnosis) we would
expect .33 cancers (a third of a thyroid cancer). My new (and one hopes,
enlightened) understanding is that this is an annual incidence rate for that
population and not the cumulative incidence rate. Thus, the number .33 is far
too small to represent the number we would actually expect to see in the cohort
with the entirety of its 50 to 54 year risk period for thyroid cancer.
        The number I calculated for the 1,748 women in the cohort of 11.5
expected annual cancers, is based on NCI's estimate from August of 1997 that
the lifetime risk for thyroid cancer in women is .66 percent or "about 1 in
152". This still means that if we rush the 1,748 women in the Hanford cohort
through their statistical lifetimes, we would expect 11.5 thyroid cancers. The
HTDS doctors have already documented 13 and this group still has a couple
decades of higher risk years in front of them in which we would expect
approximately 3 to 5 additional cancers.
        Thus, two questions remain and I'll try to offer better answers. The
first is how many cancers would we have expected to see in this population if
it was allowed to live and report cancer incidence through the normal course of
events. The second is, how much did the intense clinical scrutiny affect the
cancer rate in the cohort and make it appear that more thyroid cancer than
expected is actually occurring.

        1) Going back to the NCI table (the 1990 to 1994 age-adjusted
incidence rates for whites) and calculating the expected number of thyroid
cancers for each year, my numbers show that from age 0 to 55 we would have
expected 9.5 thyroid cancers. The HTDS study reported 20+  with eight cancers
previously diagnosed. Thus, according to the SEER numbers the normally reported
incidence of thyroid cancer is about what you'd expect, overall. For women, the
NCI table accumulates through 55 years to an expected 7.2 thyroid cancers,
which is almost exactly how many (7) had been reported prior to the HTDS
examinations.

        2) It's clear that looking for the cancers in the way the HTDS study
sought them out results in a large bias upward and, for now at least, it
appears this bias explains what appears to be the large excess. Only time will
tell whether the overall rate of thyroid cancer in the cohort is really higher
than you'd expect based on the current SEER evidence. The best way of know this
would have been for the HTDS investigators to subject a similar sized and
relatively unexposed control population to the same rigorous medical
evaluations. Alas, this they did not do.

        Another insight into this comes from an August 1990 paper by  Jim
Ruttenber and Sara Cate where, based on SEER data from the 1970s, they
projected that the expected number of thyroid cancers for the 1943 to 1945
birth cohort of 1,931 Benton/Franklin County, Washington births (absent
exposure) would be 2.8 as diagnosed by 1987. They report that NCRP methods
would calculate a much higher number (8.3) of expected cases, absent exposures.
The 2.8 number is actually consistent with my calculation (above) based on the
more recent SEER numbers. The Benton/Franklin births were roughly half the size
of the HTDS cohort and had only aged between 42 and 44 years by 1987. (By my
calculations, the HTDS cohort, at about the same age, would expect 6 thyroid
cancers.)

        I apologize for the confusion created by my first memo and hope this
sheds more light.
 

                                        sincerely,

                                        Tim Connor
 

RUDI NUSSBAUM AND CHARLES GROSSMAN

02/09/99 Portland Oregonian SUNRISE Page B11 (Copyright (c) The Oregonian
1999)

The Fred Hutchinson Cancer Research Center of the University of Washington in
Seattle has formally announced: "Study Finds No Evidence That I-131 from
Hanford Increased Thyroid Disease." Thus the Hanford Thyroid Disease Study adds
another unfortunate link to a long chain of arrogant dismissals of tens of thousands
of downwinders' life experiences of excessive thyroid disease, cancers, infant
mortality, miscarriages and debilitating illnesses among their families and
friends.

"Downwinders" are residents of rural Oregon, Washington and Idaho who lived in
the path of the prevailing winds and storms, carrying massive radioactive emissions
from Hanford into the atmosphere and depositing them on crops and cattle feed. From
there, the radioactivity found its way into the human food chain. Several years ago,
an independent volunteer alliance between Hanford downwinders and physicians
and scientists, members of Oregon Physicians for Social Responsibility, including
the authors, was formed.

Northwest Radiation Health Alliance, using an effective network among downwinders,
distributed comprehensive health questionnaires and recently started to analyze the
data from more than 800 respondents with financial support from private foundations.
Findings have been reported in medical-scientific journals and at international
conferences.

The $18 million taxpayer-financed Hanford Thyroid Disease Study has contributed
nothing to answering the downwinders' serious and persistent health concerns. The
deliberately limited study design reflects a disregard for both the scientific literature on
health effects from radioactive fallout and for medical responsibility toward the people
who had pressured Congress to fund this study. There are, for example, several
reports in the medical literature that have linked hypothyroidism to excess miscarriages
and other adverse birth outcomes. Our alliance's findings confirmed this link among
Hanford downwinders, exposed to radioactive fallout.

Three years ago, the two of us presented these findings at a gathering of physicians,
including one of the principal investigators of the Hanford study. We asked him
whether they had corroborating data about adverse birth outcomes or possibly
radiation-related diseases from their extensive interviews with more than
1,600 exposed women. We were lectured that Congress had mandated the study to
examine thyroid glands only. How can respected physicians ignore the fact that
thyroid hormone affects all the cells of the body, and the fact that diseases that
produce too little or too much hormone affect many systems of the body?

A well-designed epidemiological study compares an exposed population to a large
unexposed control group. Guided by preconceived notions about what they expected to
find, scientists on the Hanford study did not bother to identify a sufficiently large control
group. Inadvertently, they found one anyway in their study cohort, which we explain below.

The validity of Hanford Thyroid Disease Study findings hinges on two critical assumptions:
(1) high dependability of clinical thyroid exams, and (2) validity of their individual thyroid
dose estimates.

In our judgment, the second assumption is wishful speculation. The study included no
verification of the reliability of the doses computed for individuals in their study cohort
(for instance, by blood tests for chromosome abnormalities). The doses were
calculated with the poorly validated Hanford Environmental Dose Reconstruction
model, which was developed by Department of Energy contracted scientists. The
model has been severely criticized and in part refuted by independent scientists.

One of its many flaws is its disregard for critical topographic features. Yet any farmer in
the arid agricultural lands of Eastern Oregon and Washington knows about large differences
in precipitation from one side of a canyon to the other, or from one field to the next. The
deposition of radioactive I-131 depends on highly variable local conditions and may vary
even more strongly than precipitation. Add to these enormous uncertainties the untested
assumption that the computer model can approximate how much deposited radioactivity was
ingested by each individual via food and water and how much eventually got lodged in their
thyroid.

These calculations hinge not only upon persons exactly remembering details of lifestyle, dietary
habits and time spent outdoors more than fifty years ago, but also upon many physical and
physiological processes, for which reliable scientific research does not exist.

The finding of no increase in observed rates for various thyroid diseases with increasing dose is
exactly what a statistician would expect if the computer-calculated individual doses could be
off the mark by factors of 10 to 100, invalidating the Hanford study dose groupings. In
summary, we believe that the errors in dose estimates, together with the errors from inaccurate
recall from half a century ago, make the Hanford Thyroid Disease Study's interpretation of its
data meaningless.

In addition, the Hanford study scientists committed a serious violation of scientific ethics:
They withheld from their conclusion and summary report any discussion of several glaring
discrepancies buried in their own data.

One example: If you compare observed rates for any of the listed thyroid diseases among the 248
study participants who had moved out of the exposed area before Hanford operations began (a small
but significant unexposed control group), with the observed rates for the same symptoms among the rest
of the exposed cohort, the controls show consistently lower rates.

In addition, for benign thyroid nodules, hyperthyroidism (overactive thyroid) and female hypothyroidism
(underactive thyroid) the rate differences between the exposed and the unexposed populations are so
large that there is negligible chance that this could be accidental. For female hypothyroidism, for example,
this chance is less than 1 in 1,000. The latter result confirms published findings from our alliance's
data among women, as well as data to be published shortly among juvenile Hanford and Chernobyl
downwinders.

To ignore or downplay such facts and to tell hundreds of thousands of injured and suffering people that
exposure to radioactive I-131 does not increase disease is grave injustice and plainly deceitful.

Nussbaum is professor emeritus of physics and environmental sciences at Portland State University.
Grossman is a practicing internist. Both are board members of Oregon Physicians for Social Responsibility.