Related Link: Institute of Medicine Recent Reports
September 25, 1998 The Spokesman-Review
Help owed for fallout, panel says
Government should step up, aid those exposed from Nevada N-bomb testsJennifer Pierson - The Spokesman-Review
WASHINGTON _ People exposed to radioactive fallout from Cold War nuclear bomb tests should be given government help and support, according to a federal health studies panel.
The U.S. Centers for Disease Control and Prevention advisory committee released its recommendations Thursday in Washington.
``The government has already admitted that it had an inappropriate relationship with the American public'' by exposing millions to fallout, said committee member David Ozonoff, professor of public health at Boston University.
The recommendations will be presented to U.S. Department of Health and Human Services Secretary Donna Shalala.
The panel -- formally known as the Advisory Committee on Energy-Related Epidemiologic Research -- also suggested the government should pay for treatment of thyroid problems affecting poor people.
``You can't go around harming people and then not take responsibility because you don't know who they are,'' Ozonoff said.
Thursday's advisory committee meeting was in response to a National Cancer Institute fallout study released last fall -- nearly 15 years after it was requested by Congress.
The report found millions of Americans nationwide were exposed to radioactive fallout from the Nevada-based tests. Up to 211,000 additional thyroid cancers are expected as a result of the exposure to iodine-131, according to NCI estimates.
In early September, the National Academy of Sciences and the Institute of Medicine made a recommendation against widespread screening for thyroid cancer but did not offer solutions about dealing with noncancerous thyroid problems caused by the fallout.
``They didn't do their homework and they didn't explain their recommendation not to act,'' said Tim Connor of Spokane, the CDC panel member charged with putting together the recommendations.
``The NAS/IOM review was a very lame scientific response to the question of medical screening, especially for the noncancerous cases,'' Connor said.
The federal government does not know exactly who the affected people are. The study released last year identifies ``hot spots'' where fallout was high, including sections of Montana and Idaho. But people exposed to the radiation may have moved out of those areas since the nuclear tests, which occurred from 1951 to 1962. Children were most affected by the fallout.
A Senate subcommittee hearing last week criticized the study for failing to include estimates of thyroid cancer risk, a concern shared by the CDC panel.
The 1983 law that authorized the study on iodine-131 called for thyroid cancer risk estimates, and the creation of tables looking at all cancer types and calculating risk based on exposure to fallout.
Dr. Ernest Mazzaferri, chairman of Ohio State University's Department of Internal Medicine, supports the recommendation against thyroid screening. That form of cancer is typically checked through a touch test on the neck, he said. Many people have small thyroid tumors that will never grow into full blown cancer.
Patients hear ``tiny cancer'' and they want the thyroid removed, even if there is no health risk, said Mazzaferri.
``There is really no information that screening for early detection would lower the mortality rate,'' he added.
The advisory panel, however, is concerned that 40 million Americans lack health insurance and won't get medical checkups that can identify fallout-related thyroid problems.
•Staff writer Karen Dorn Steele contributed to this report.
NOTE TO ALL READERS: WHILE THIS DOCUMENT REFLECTS THE SUBSTANTIVE FINAL
PRODUCT OF THE ADVISORY COMMITTEE, IT IS STILL BEING REVIEWED BY STAFF TO ENSURE
IT FULLY REFLECTS EDITORIAL CHANGES VOTED ON AT THE 9/23 MEETING. THE FOOTNOTES
ARE NUMERICALLY OUT OF ORDER BECAUSE THE DOCUMENT PRESENTATION MOVED THE
INTRODUCTION TO THE HISTORY AND BACKGROUND APPENDIX. FINALLY, THE CHANGES TO
THE HEADING ON RECOMMENDATION #3 ARE FROM MY NOTES AND MAY CHANGE SLIGHTLY IN
THE FINAL VERSION DEPENDING ON THE NOTES OF OTHERS.
Tim Connor, Chairman ACERER Subcommittee for Community Affairs, 9/25/98
RESOLUTION OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES ADVISORY COMMITTEE ON ENERGY-RELATED EPIDEMIOLOGIC RESEARCH WITH REGARD TO EXPOSURES OF THE AMERICAN PEOPLE TO FALLOUT FROM THE NEVADA TEST SITE
AS UNANIMOUSLY ADOPTED, SEPTEMBER 24, 1998
It is with the knowledge of the history and circumstances appended
to this document that the Committee approaches its recommendations as to how
the Department of Health and Human Services should respond to the October
1997 report from the National Cancer Institute. Because the Committee
advises the Secretary on the research agenda and related public health
activities, there is a limit to the scope of our recommendations. Given the
breadth of this particular issue, however, we think it appropriate to frame
our recommendations with the following findings.FINDINGS
FINDING #1: FEDERAL EFFORTS TO ADDRESS THE PUBLIC HEALTH CONSEQUENCES OF NEVADA TEST SITE FALLOUT ARE STILL INADEQUATE.
Despite the good intentions represented by the Radiation Exposure
Compensation Act of 1990, as amended, federal efforts to address the
continuing health risks of populations exposed to radiation from nuclear
weapons testing and nuclear materials production activities are clearly
inadequate. RECA is a limited monetary compensation effort that provides
$50,000 payments to people who can show they lived in "designated affected
areas" of Nevada, Utah, and Arizona during high fallout periods and who were
subsequently diagnosed with one of 13 types of cancer associated with radiation
exposures.4 As the 1997 NCI report on iodine-131 exposures from NTS fallout
makes clear, one didn't have to live in the designated areas of the
southwest to be exposed to fallout at levels that substantially increased
the risk for cancer. Nor is cancer the only disease for which people
exposed to fallout are at greater risk.FINDING #2: THE DIFFICULTIES IN IDENTIFYING SPECIFIC FALLOUT INJURIES DOES NOT ABSOLVE THE FEDERAL GOVERNMENT OF ITS RESPONSIBILITY TO SHAPE A MEANINGFUL PUBLIC HEALTH RESPONSE
Given the widespread nature of the fallout and the limitations of
epidemiology when it comes to identifying specific cases of low-dose
radiation injuries, there are inherent and formidable difficulties in
locating the people whose cancers or other health problems are attributable
to fallout exposures. Still, the difficulties in identifying individuals
whose injuries are caused by fallout exposures does not absolve the federal
government of its civil and moral responsibility to aid the injured. The general obligation of the Government to attend to the well-being of its citizens is, in this instance, profoundly enhanced by the facts that the Government is responsible for the exposures and for failing to give people the information necessary to avoid
or minimize the risks imposed upon them.It is not the role of this committee to make recommendations on the
delivery of health care. Based on the above principle, however, we
encourage the Secretary to work with the President and the Congress to:a) Improve the nation's capability to better identify the people
who've either been injured by radioactive fallout or who are at
substantially greater risk for injury due to their exposures. And,b) Take reasonable and prudent steps to enhance the diagnostic and
other health care services available to those who've been affected or who
are at appreciably greater risk for injuries due to their exposures.
FINDING #3: RESEARCH IS NOT A PUBLIC HEALTH RESPONSE.
The Committee will recommend additional research activities to
supplement the information provided in the 1997 NCI report on iodine-131 in
fallout. It is important for us to note, however, that research, by
itself, is not a substitute for the assistance that many exposed people
believe, with good reason, that the Government has a responsibility to
provide.FINDING #4: THE DELAYS IN SHARING IMPORTANT PUBLIC HEALTH INFORMATION ABOUT FALLOUT EXPOSURES HAVE REINFORCED PUBLIC CYNICISM TOWARD FEDERAL OFFICIALS.
Specifically with regard to the October 1997 NCI report on
iodine-131 exposures, the Committee is still troubled by the unnecessary
delays in sharing important information on exposures and risks with Congress
and the public. The request from Congress for this study came nearly 15
years before it was completed. The record and the literature indicates that
the data collection and analysis were essentially complete five years before
the study was released to the public. While we respect the deliberative and
administrative processes necessary to put together a report of this
magnitude, those requirements should neither have prevented nor discouraged
the communication of substantive information of clear public health importance
to Congress and the American people. Regrettably, the delays in releasing the
information that the NCI did finally share with the public in the last year
have only reinforced the cynicism of many citizens and exposed communities. It
increases the burden that many federal agencies share in trying to overcome the
suspicion that the Government is still unwilling to squarely acknowledge the harm caused by past policies and to commit resources to assist those who may have been injured as a result.RECOMMENDATIONS
RECOMMENDATION #1: FULFILL THE LEGISLATIVE INTENT OF PUBLIC LAW 97-414.
The Department of Health and Human Services should, without further
delay, take actions that are necessary to fulfill the substantive intent of
Public Law 97-414, Section 7 which Congress passed in January of 1983, more
than 15 years ago. This section of PL 97-414, the "Orphan Drug Act,"
provided the statutory mandate for the 1997 NCI study on iodine-131 in
fallout. As explained further in Attachment A, there are two parts of Section 7 that
apply to assessing the public health impacts of fallout from the Nevada Test
Site (NTS). Section 7(a) contains the mandate for iodine-131 and includes
stipulations for thyroid cancer risk estimates that were not provided in the
October 1997 NCI report. Section 7(b) called for the development of radio
epidemiological tables that would be inclusive of all cancer types and allow
the calculation of individual risks to all cancers from exposure. As a
first step, the Committee recommends that DHHS evaluate and seek to clarify
the levels of uncertainty in the estimation of thyroid and other radiation
doses attributable to NTS fallout.* This leads to our second
recommendation.*The Committee expects that with respect to the range of
biologically significant radionuclides broadcast by the NTS bomb tests that
the calculations of individual doses and risks can (as directed in Public
Law 97-414, Section 7) be provided to exposed individuals. The Committee
further expects that such estimates can be calculated with appropriate
subjective confidence intervals and that clear communication of the
qualifications and explanations of the uncertainties will be provided with
the individual dose estimates.RECOMMENDATION #2: COMPLETE A COMPREHENSIVE DOSE RECONSTRUCTION PROJECT FOR NEVADA TEST SITE FALLOUT.
The Department of Health and Human Services should, without further
delay, commit itself to extending the nationwide dose reconstruction data
base and dose assessment formulas for Nevada Test Site fallout beyond
iodine-131 to include all of the biologically significant radionuclides in
nuclear weapons test fallout. The goal of this project should be to fulfill
the
Congressional intent of PL 97-414 Section 7 and provide the American people
with the accessible means to calculate their full exposure (and consequent
health risks) to Nevada Test Site fallout. Among the first steps in this
process is a review of the methodology and data used by the NCI in producing
the 1997 report dealing with iodine-131, and an examination of the
Department of Energy's Offsite Radiation Exposure Review Project which
examined fallout distribution in counties near the Nevada Test Site. Given
the regrettable insularity and lack of public oversight of the NCI report on
iodine-131 in fallout, the Committee recommends that special attention be
given to the creation of an oversight committee. The selection and charter
of this oversight committee should be under the general supervision and
oversight of the ACERER and be modeled on the health effects subcommittees
that are monitoring health research activities and providing input to HHS
and ATSDR at various specific sites around the nation.RECOMMENDATION #3: NOTIFY AMERICANS OF THE FACTORS THE MIGHT HELP THEM TO DETERMINE WHETHER THEY RECEIVED SIGNIFICANT RADIATION DOSES FROM NTS FALLOUT.
The Department of Health and Human Services should, without further
delay, initiate a program to provide notification to Americans who are known
or expected to have received significant radiation doses as a result of
their exposure to fallout from the Nevada Test Site. This notification
effort should, among other things, make use of the physical, atmospheric and
meteorological analysis developed in support of the NCI report on iodine-131
exposures and be further guided by other known factors (i.e. age, sex, diet)
that would be expected to have a significant effect on exposure, dose, and
risk. At a minimum, this notification effort should have a high probability
of reaching those at greatest additional risk for cancer and other illnesses
(e.g. hypothyroidism) as a result of their exposure to NTS fallout.5 The
Committee strongly encourages that multiple methods be considered to make
initial notifications and that supplemental materials and processes be developed to
handle subsequent inquiries (see Recommendations #4 & #6). To the extent
practical, the notification process should make use of existing networks, relevant
community-based organizations, and entities such as the health effects
subcommittees organized to address health concerns at U.S. Department of
Energy facilities. The implementation of this program should be guided and
monitored by the advisory body addressed in Recommendation #2.RECOMMENDATION #4: CREATE A PUBLIC AND HEALTH CARE PROVIDER INFORMATION SERVICE ON NEVADA TEST SITE EXPOSURES AND RESULTING PUBLIC HEALTH CONCERNS.
Concurrent with the development and implementation of the
notification measures recommended above, the Committee strongly recommends
the creation of a service, or network of services, that can provide
information and education resources to those notified. While the Committee
strongly believes the Government has a moral responsibility to notify those
who are still at significant risk for injury because of their exposures to
fallout, we also believe this notification should be done responsibly, with adequate backup to answer immediate questions and provide broader education resources as necessary. It is plausible, for example, that notification without access
to additional information would unnecessarily heighten fears as to the
likelihood of cancer and other diseases. At worst, it might even lead to
unnecessary surgery (e.g. the removal of healthy thyroid glands).The Committee notes that the orientation, services, and materials
developed by the Hanford Health Information Network (HHIN) to serve people
exposed to radiation emissions (principally iodine-131) from the Hanford
nuclear facility in Washington state are a useful model for this purpose.
While the nature and scope of this service should be guided by input from
the advisory body referenced in Recommendation #2, we recommend that DHHS
begin assessing the costs, feasibility, and possible deployment of such a
service immediately so as to prevent any additional delays in the
notification effort.RECOMMENDATION #5: SUPPORT ARCHIVAL PROJECTS TO DOCUMENT
EXPERIENCES OF EXPOSED PEOPLESThe Committee recommends that the Department of Health and Human
Services lend its cooperation and support to archival and other projects
devoted to recording and preserving the histories of peoples exposed to
radiation from nuclear testing and nuclear weapons materials production.
Archival projects can yield important information that helps to shed light
on exposures and health effects (i.e. exposure pathways, disease
incidences). But the main reason to support these projects is that they can
help honor and, to some extent, help restore the dignity of those whose
experiences were overlooked or routinely disputed by the Government as it
pursued nuclear weapons production and testing.RECOMMENDATION #6: FURTHER EVALUATE SCREENING OPPORTUNITIES FOR THYROID CANCER. IT IS URGENT, IN THE MEANTIME, TO EVALUATE THE ADVISABILITY AND FEASIBILITY OF SCREENING FOR OTHER (NON CANCEROUS) THYROID AND PARATHYROID DISEASES, WITH A PRIORITY TO EVALUATE THIS SERVICE FOR THOSE AT HIGHEST RISK DUE TO THEIR EXPOSURES.
INTRODUCTION TO RECOMMENDATION #6
The Committee notes with interest and concern the decision of the Institute of Medicine's Guidelines on Cancer Screening Committee not to encourage medical screening as part of the nation's response to the NCI study of iodine-131 exposures to the American people.
Notwithstanding the uncertainties about individual doses, the documentation of the widespread pattern of fallout and the magnitude of thyroid doses provided by the NCI study lends considerable weight to public appeals for a public health response. In evaluating whether and how to provide such a response, government decision makers cannot avoid the historical and ethical context of these appeals. Not only are the health risks considerable, but the Government--by failing to warn and protect people from fallout exposures--bears direct responsibility for the ensuing injuries, even if it cannot be held legally accountable for them.
On the other hand, it is clear that the most direct response to the most common health effect--medical screening to detect thyroid cancers--is fraught with its own set of practical and ethical problems. There are legitimate and unresolved questions as to whether early detection of thyroid cancers can measurably improve the survival rate in the screened population. These questions must be weighed alongside the concern that thyroid cancer screening inevitably invites a significant number of inconclusive biopsy results, some of which will, in turn, lead to complete or partial removals of thyroid glands. Although some fraction of these removals will prevent the occurrence of thyroid cancers (a small percentage of which will be fatal cancers), most removals will not improve the health of individuals and all removals run the risk for potentially serious surgical complications. In short, it is not clear that a thyroid cancer screening program can be implemented in a way that, on whole, results in more physical good than harm. Thus, while the NCI study may have strengthened the moral argument that the Government "owes" exposed citizens a public health response, thyroid cancer screening could be the wrong response.
The paradox on the issue of thyroid cancer screening does not, however, end there. Even though there is no simple way to resolve just what public health response the Government should provide (and to whom it should be provided) there is an overriding moral obligation to inform people who are at significantly greater risk because of their exposures. Although this notification is not the same as offering enrollment in a thyroid cancer screening program, it inescapably invites many of the same ethical concerns. If, upon notification, individuals seek medical exams in response to their concerns about thyroid cancer, they are entering into the same realm of circumstances that could lead to the same diagnostic uncertainties and difficult decisions that so complicate the decision about whether to formally offer thyroid cancer screening.*
*On this point it is noteworthy that some authoritative health organizations--the American Thyroid Association and the Hanford Health Information Network--already encourage neck examinations for people who are concerned about their possible exposure to radioactive iodine from atmospheric nuclear weapons testing or nuclear facility releases.
This is an important consideration. If government decision makers were to decide that thyroid cancer screening is appropriate for some subset of persons exposed to NTS radioiodine, it is clear that screening would require a carefully prepared screening protocol and a medical outcomes decision path that, to the extent possible, acquaints people and their physicians with the best available information about risks and choices. It therefore stands to reason that if the Government is to undertake (as it should) a major effort to notify people about their risks from radioactive iodine exposures, it should be prepared to educate those notified about the questions and issues that await if those individuals seek a neck exam, and if that exam (palpation and/or ultrasound) results in detection of one or more nodules.
The Committee also notes with concern that the interpretation of case studies and the reasoning offered by the IOM panel on the thyroid cancer screening issue is squarely at odds with that applied by the Agency for Toxic Substances and Disease Registry (ATSDR) in its July 1997 proposal for carrying out the Hanford Medical Monitoring Program (HMMP).
The Committee has not yet been able to fully evaluate the differences in the circumstances and reasoning as applied by the ATSDR at Hanford and by the IOM Committee to the Nevada Test Site exposures. We believe these differences warrant careful evaluation before final decisions are made about what medical screening responses are appropriate to address radioiodine exposures attributable to NTS fallout.
One of our major concerns, in the meantime, is that the IOM recommendations could be used as justification for further delays in funding the Hanford Medical Monitoring Plan. We do not believe that funding should be delayed. While the Committee members are concerned about the provisions and consequences of the Hanford Medical Monitoring Plan, we respect the process by which ATSDR brought together scientists, expert consultants, and a diverse group of stakeholders to shape the scope and details of the plan.
Coupled with the U.S. Department of Energy's resistance to providing timely and adequate funding for the HMMP, we are also concerned about the public perception that the Government may once again be backing away from its responsibility to extend public health services to those who received significant exposures from federal nuclear weapons production and testing activities. In this instance, the plan proposed by ATSDR was carefully developed in accordance with ATSDR's mandate under the federal Superfund law to provide health surveillance to exposed communities when a significant increased risk of health effects has been demonstrated.
Finally, the Committee also believes it important to recognize basic differences in the techniques and issues related to screening for thyroid cancer and screening for hypothyroidism. In screening for thyroid cancer, any expected benefits for early detection of cancers must be weighed against the inevitable harm of instigating a certain number of unnecessary surgeries. This difficult trade-off should not, however, cloud the issue when it comes to making decisions about whether and how to implement screening for hypothyroidism. Because screening for hypothyroidism involves blood tests rather than direct examination of the thyroid by palpation, ultrasound and fine needle aspiration biopsy, and because treatment for hypothyroidism does not involve surgery, a hypothyroidism screening program can be implemented with a greatly diminished risk for promoting unnecessary surgery. Because undiagnosed hypothyroidism can be a seriously debilitating and sometimes lethal condition, and because the number of diagnoses and referrals for treatment could be substantial, the Committee believes it is important to evaluate screening for hypothyroidism separately from the evaluation of whether and when to implement screening for thyroid cancer.
6) DHHS should carefully evaluate the recommendations of the National Research Council's Review of the National Cancer Institute's Report on Exposure of the American People to I-131 from the Nevada Test Site with regard to screening for thyroid cancer and other thyroid diseases. In light of the IOM Committee's recommendations, and the substantive concerns about the negative consequences of implementing a large-scale screening program, the Committee recommends that DHHS look carefully at opportunities to implement screening efforts under circumstances that can reasonably be expected to promote more benefit than harm to those for whom the program would be available. In particular, we recommend DHHS independently evaluate the cost, feasibility,and expected outcomes of implementing screening programs for thyroid cancer and hypothyroidism.
With regard to screening for thyroid cancer, the Committee respects the reasoning that discourages moving forward quickly with a general thyroid cancer screening program. It is conceivable, however, that the anticipated harm to benefit ratio (namely, the number of unnecessary thyroid removals versus the number of confirmed thyroid cancers) could be significantly different among one or more subpopulations who received higher doses.
For this reason, we recommend that DHHS move with deliberate speed to evaluate the opportunities for, and feasibility of, identifying and locating high dose subpopulations for whom thyroid cancer screening would merit further consideration. In evaluating such subpopulation(s) for thyroid cancer screening, the Committee further recommends that protocols for identification and implementation address the following considerations:
a) dose
b) gender
c) genetic predisposition, including ethnicity
d) limited and discriminate use of ultra-sound
e) limited and discriminate use of biopsy (fine needle aspiration)
f) quality assurance
g) informed consent for followup surgeries
With respect to screening for hypothyroidism, the Committee recommends a much more proactive approach. On this subject, the key considerations are those of cost, quality, and post-diagnosis protocols for referral. In implementing screening for hypothyroidism, the Committee recommends that DHHS develop strategies to help ensure that those at highest risk for hypothyroidism have the earliest access to screening.
Finally, the Committee recommends that further evaluation of thyroid screening be done under the oversight and with the participation of the advisory body referenced in Recommendation #2. This advisory body should have an opportunity to make its own recommendations to the Secretary with respect to the feasibility and advisability of implementing screening programs.
The committee also draws attention to the fact that the full implementation of any screening and/or treatment programs will be seriously impaired by the unaddressed problems of the millions of exposed persons who lack health insurance, other means to pay for care, reasonable access to physicians, or all of these. If such plans are to be feasible, this issue should not continue to be ignored. If such plans are to be equitable, the government must assume responsibility for providing access to care and/or the costs of such care for those exposed persons who lack such access or the means to pay for it. (emphasis added)
HISTORY AND BACKGROUND FOR THESE RECOMMENDATIONS
Beginning with the war-time "Manhattan Project" in 1942, the U.S. Government opened a new chapter in human history. The scientific and technological feats that brought in the Atomic Age are as profound as the disquieting questions that followed, questions about how and whether societies can make use of nuclear technology while exercising the wisdom and restraint it so clearly requires.
There is, however, an important part of this history for Americans that is best informed by the experience of citizens who live downwind from the Nevada Test Site (NTS), the 1,350 square mile outpost in the seemingly isolated desert of southern Nevada. These were the people who, especially during the peak period (1951 through 1958) of above ground nuclear testing at NTS, found themselves in harm's way from radioactive fallout.
The hazard was physical in nature. Fallout particles drifted and rained down from the sky to irradiate on contact, to be inhaled, and to be ingested in water, milk, and foodstuffs. Today, the best scientific evidence supports the conclusion that the delayed effects of radioactive fallout were likely harmful to tens, if not hundreds, of thousands of people. Because of the latency between exposure and the onset of cancer and other diseases, the risks for these injuries continue to this day.
What the October 1997 National Cancer Institute report on radioactive iodine-131 exposures makes clear is that the hazards from weapons test fallout at NTS were not (ITALICIZE "NOT") confined to Nevada, Utah, and Arizona. People--and especially young children--living downwind of the test site from Idaho, to Texas, and in between, all the way to the eastern seaboard, were likely to have received significant radiation doses if they were drinking milk from cows or goats pastured in areas where the radioactive debris from bomb tests rained out in high concentrations.
As advisors to the U.S. Department of Health and Human Services responsible for making recommendations on how federal public health agencies should respond to information like that provided in the NCI report, we believe we have a two-fold obligation. To Secretary Shalala we owe our best efforts to make recommendations that will advance scientific knowledge about radiation effects and respond to legitimate occupational and public concerns about past and continuing exposures. To the American public we owe a basic commitment to understand the experiences of exposed communities and to be attentive to the legitimate expectations of these communities for honest and accurate information.
It is with these obligations in mind that we give our attention to the issues our nation still confronts with respect to the public health legacy of nuclear weapons testing. The testimonies and historical evidence brought before Congress and the courts over the past 40 years convey a deeply troubling story, one that is all the more disturbing because it took place in the world's oldest democracy. The record is clear that, at a minimum, officials of the U.S. Atomic Energy Commission (AEC) actively discouraged the dissemination of important information about radioactive fallout for fear that public concerns about health consequences would undermine public acceptance of nuclear weapons testing.
This history from the perspective of the "downwinders" is not just the history of delayed injury. It is also the history of being made nearly invisible. It is hard to "see" the injuries caused by radioactive fallout because even though the weight of science informs us that the injuries are numerous, serious and real, they can only be "detected" or "observed" in carefully constructed health studies. Because of the limits of health science, we are all but forced to see radiation injuries as anonymous statistics rather than in the faces and lives of those who are actually affected.
But the main reason for the near invisibility of the downwinders has little to do with the limits of science. Rather, it has to do with the unwritten but clear policy of neglect and isolation inflicted on them by their own government by its failure to warn and protect people from radioactive fallout.
Because the AEC spokesperson failed to acknowledge the nature and extent of health risks imposed on exposed people, some citizens filed claims in federal court. In these court cases, the Justice Department's position (in defense of the Atomic Energy Commission) was to strongly resist not just the specific claims of individual plaintiffs but the science that provided the general basis for the claims.
Rather than committing itself to a conscientious policy, the Government reacted in ways that perpetrated a serious injustice against a large number of its citizens. Only with the Radiation Exposure Compensation Act of 1990 (RECA) did Congress and the Administration finally take a limited step to make amends with an important but relatively small portion of those citizens who were put at greatest risk.
Much of what is disturbing about this experience is what it has done to public attitudes about scientists who work for and with government agencies involved with nuclear energy and the deep public skepticism toward their scientific work and statements. In trying to assuage public concerns about fallout, the then-Atomic Energy Commission essentially reversed the precautionary public health ethic of erring on the side of public protection.Although more is known today about the health effects of low dose radiation than was known in 1951, there were clear indications from the earliest days of the testing program that radioactive fallout would put scores of people at greater risk for cancer and other diseases. This information should have been used to inform and protect the public. It wasn't. Instead, as part of the public relations shield for the nuclear testing program, the science was distorted by government spokespersons to promote doubt about radiation hazards.
Among the regrettable historical facts that the Committee must acknowledge in addressing this issue is that during the 1950s officials of the U.S. Public Health Service were sometimes prohibited from communicating directly and freely to the American people about the risks posed by nuclear fallout.
This document is hereby forwarded to the full ACERER for its consideration and action.
Footnotes
1) As its primary defense against radiation injury claims from those exposed
to releases from nuclear materials production or weapons testing operations,
the government still asserts sovereign immunity under the Federal Tort
Claims Act. The government has argued, successfully, that under the FTC
even decisions about whether to warn downwind populations are within its
"discretionary" powers. This legal defense, by itself, raises profound
questions for a democracy, questions that the Administration and Congress
must continue to grapple with if they are sincere about wishing to correct
past injustices and avoid future such cases. Still, the government's
sovereign immunity defense has not diminished the intensity with which the
Justice Department strives to impeach the credibility of plaintiffs and
scientists willing to provide testimony in support of plaintiffs.2) One of the earliest acknowledgments of the threats posed by testing to
people downwind was presented in an October 9, 1946 memo from Colonel
Stafford Warren, the officer in charge of radiological safety at the
Operation Crossroads nuclear tests in the Pacific. In this memo, addressed
to General Leslie Groves, Col. Warren states that radioactive fragments from
exploded nuclear bombs will "in extremely small amounts deposited in the marrow will eventually cause progressive anemia and death years later." Further, the
material "mixed with these fission products, beta and gamma emitters, is an
insidious hazard--not immediately dangerous but if absorbed into the body it
produces a long time hazard...The amount necessary to cause this hazard is
minute--measured in millionths of a gram. The harmful effects occur years
later..I believe a frank statement of this sort should be made now to
professional and intelligent lay groups as part of the general discussion in
the effect of the bomb as a whole." In his 1986 book, (italics) Justice
Downwind, America's Atom Testing Program in the 1950s, University of Utah
Professor Howard Ball reports that this memo was part of the documentation
cited by the U.S. Department of Justice in Federal District Court in
California (Alice P. Broudy v. United States, et al.) to support its
contention--as part of a sovereign immunity defense--that "government
officials and scientists were aware of the hazards of radiation since the
inception of the nuclear weapons programs...specifically that fallout could
cause cancer."
After reviewing extensive Atomic Energy Commission records as part of a
1979 investigation, the Subcommittee on Oversight and Investigations of the
House Committee on Interstate and Foreign Commerce concluded that prior to
tests at the Nevada Test Site the government had ample information to show
that people downwind required protection. However, the Subcommittee
reported, "all evidence suggesting that radiation was having harmful effects,
be it on sheep or on people, was not only disregarded but actually suppressed."3) U.S. Congress, House Committee on Interstate and Foreign Commerce,
Subcommittee on Oversight and Investigations, and Senate Labor and Human
Resources Committee, Health and Scientific Research Subcommittee, and the
Committee on the Judiciary, (italics) Health Effects of Low-level Radiation,
Vol. 1, p. 221 96th Congress, 1979. {As reported in Caufield, Catherine;
Multiple Exposures, Chronicles of the Radiation Age, p. 118 (italics),
Martin Secker & Warburg, Ltd, 1989.} See, also, Ball, Howard, (italics)
Justice Downwind, America's Atomic Testing Program in the 1950s, pp. 43-48.
p. 109. See, also, Fuller, John G.; (italics) The Day we Bombed Utah, NAL
Books, 1984, p. 171-180. See, also, Wasserman, Solomon, Alvarez, Walters;
Killing Our Own (italics), Delacorte Press, 1982, p. 114.
4) RECA also provides monetary compensation for uranium miners who were
exposed to high levels of radon between 1947 and 1971 working in mines in
Colorado, Utah, New Mexico or Arizona and who've since developed lung cancer
or three other lung diseases. Eligibility for both sets of claims--from NTS
exposure and mining exposures--is limited to those who filed claims within
six years after enactment of the legislation.5) The ACERER recommendation on notification is consistent with the recent
conclusions of the National Academy of Sciences/Institute of Medicine
Committees that reviewed the National Cancer Institute report. The NAS/IOM
recommendation reads, in part: "Although most in the population have not been
significantly affected, those that have been affected, mainly be virtue of
their life style and birth date, should be appropriately informed." (p.68 of
pre-publication report).6) The Agency for Toxic Substances and Disease Registry (ATSDR) predicts
that if 6,000 eligible participants are enrolled for the first round of
screening under the Hanford Medical Monitoring Program that 45 cases of
previously undiagnosed hypothyroidism will be detected. In FOLLOW UP
communication with the Committee, ATSDR reports that in projecting the
number of cases of undiagnosed hypothyroidism they expect to find, their
model assumed no excess over the number expected if participants in the
program had not been exposed to radioactive iodine from Hanford. Although
the literature on radiation-induced auto immune thyroiditis (resulting in
hypothyroidism) indicates that a substantial number of people eligible for
the HMMP have received thyroid doses from radioactive iodine sufficient to
increase their risk for auto immune induced hypothyroidism, ATSDR has not
yet provided an estimate of the additional cases it expects based on the
radioiodine exposures.The committee recognizes and commends the ATSDR process for the way in
which it solicited and integrated stakeholder perspectives on benefits, harms, and
how to weigh and balance them.