Guest post by Barbara Rose Johnston
I received last week copies of two very different publications reporting on outcomes from the scientific assessment of life in a nuclear warzone. These studies consider, first, the health experience of resident populations living in areas contaminated by nuclear weapons fallout, and, second, the health of people as affected by the low-level radiation that accompanies modern warfare.
The first is a set of eight papers published in the August 2010 issue of the journal Health Physics and reflects conclusions from US-government sponsored science about radiation and cancer risks.
The second, a study conducted by an international and independent team of scientists published in the International Journal of Environmental Research and Public Health, is about the health effects of war on the local population of Fallujah, Iraq.
Appropriate reading, since much news in the past few days has focused on the ceremonies surrounding the 65th anniversary of the bombing of Hiroshima and Nagasaki, and the human suffering associated with nuclear war.
Nuclear worries and concerns have been a major feature in world news for years, but especially so in this first decade of a new century.
A review of today’s global headlines finds reports of fear and accusations over the development of a nuclear weapon in Iran, as well as fears of nuclear war on the Korean peninsula and in Kashmir, the Himalayan territory that lies between Pakistan and India. Fidel Castro’s first address in four years to the Cuban Parliament warns of an imminent nuclear war if the US follows through on its threat of retaliation against Iran for not abiding nuclear-arms sanctions.
There are also hopeful reports on political promises and the potential progress in the struggle to further abolish nuclear weapons. Unfortunately, there are also reports on the lack of progress – for example, the news that the US Senate has again delayed its hearing on a new START Treaty.
The nuclear news also includes “peaceful uses” of atomic energy. The US is reportedly finalizing a nuclear cooperation agreement with Vietnam that would allow enrichment. There are reports of numerous proposals or approved plans for new nuclear power plants in Germany, Egypt, the US, Canada, the Philippines, India, Serbia, Bulgaria, and the UK.
The health effects of radiation exposure are also a featured subject in the coverage of the experiences of Hiroshima and Nagasaki survivors. And, largely in US and UK papers, sporadic reporting on scientific studies soothes consumer fears over low-level over radiation exposure via airport security scans, cell phone batteries, communications towers, and nuclear power generation.
Pennsylvania is providing free potassium iodide tablets for residents living near nuclear power plants in an effort to soothe citizen fears over the dangers of low-level radiation.
In Russia, hundreds of wildfires burn Chernobyl-contaminated lands and threaten new disasters at nuclear power, research and weapons facilities.
Reading through the headlines and the nuclear news you find a continuum in the nuclear narrative. Nuclear war is horrific, to be feared, to be avoided. And yet the various and sundry assaults from low-level exposures to radiation are specific to the individual, do not cause genetic and thus inter-generational harm, and, with modest interventions from the state, are manageable.
An article from The Hindu Times on the 65th anniversary of the Hiroshima bombing illustrates this “trust us, science has shown nuclear fears are overblown” mantra. The article begins by mentioning that in 1950 some 280,000 Japanese “claimed they were exposed to radiation.” It then briefly outlines a few studies conducted by the Radiation Effects Research Foundation (RERF) and its predecessor the Atomic Bomb Casualty Commission (ABBC) on the lifetime health experience of exposed survivors and their children, with specific attention to lung cancer, hypertension, heart disease, and thyroid cancer. For lung cancer and heart disease, incident rates were largely attributed to lifestyle: “Scientific study has determined that in these specific disease processes there is little indication of any radiation-associated excess risk.” As for the relationship between radiation exposure and thyroid disease (a treatable condition), the author acknowledges: “That exposure causes thyroid cancer is an established fact.” The article concludes with the assertion that “scientists have not observed genetic effects in the children of A-bomb survivors,” a statement based on the ABCC’s evaluation of “mutations at specific loci in the chromosomes” of exposed families and control families, and findings that the mutation rates observed were not statistically significant.”
The subtext asserted here? A casual reader might conclude that nuclear war, while deadly, does not present a lingering or inter-generational effect. The informed reader might do further research to find that the author of this article, K. S. Parthasarathy, may have a vested interest in such a framing, as a former Secretary of India’s Atomic Energy Regulatory Board. And, an obsessed reader, such as myself, might wonder about the source material.
The supporting study is J.V. Neel’s oft-cited assessment of Japanese pregnancy and outcomes data on congenital defects for the years 1948-54, collected by the ABCC with a protocol designed by Neel. The initial assessment, published by Neel and his associate W.J. Schull, found a statistically relevant change in the sex ratio. I first came across this study while going through the National Academy of Science archives on the Atomic Bomb Casualty Commission. Those files included copies of Neel’s research protocol, the study findings after five years of data collection, and the National Research Council critique of methods and conclusions, including the noted concern that a flawed control group might have been constituted. In this initial assessment of abnormal outcomes Neel assumed most birth defects to be the consequence of inbreeding and thus he added a discount factor to the protocol (rejecting data from parents who were first, second, or third cousins). Lacking pre-exposure data to compare outcome rates, the study relied upon a control population including people who resided outside of the blast zone (assuming fallout in the broader region is not relevant) and including residents of Kure, a town (visible from Hiroshima ground zero). Years later, in the RERF newsletter Update, Neel recalled that “a drastic drop in the live birth rate in 1954 led to the discontinuation of physical exams, though data on sex ratio and survival of newborns was still collected.”
The conclusions reached in this influential yet flawed study reflect the context of the times, state of knowledge, and cultural biases about populations and consanguinity (the distance between blood relatives) that permeated US science in the 1940’s and ’50s-era. The policy implications of this study have had a profound impact in explaining away experience and liability with regards to the reproductive and inter-generational effects of radiation exposure. For example, Neel’s study was cited as the scientific rationale for denying further study and treatment in the Marshall Islands when complaints of birth defects and other reproductive problems were filed decades ago.
Science, in its most literal sense (the Latin root scientia), is knowledge. In its practical application, science is a way of defining, defending, and asserting certain truths about the world in which we live. In the methodical, rational approach to developing and testing theories, collecting and assessing data, and producing statistically-relevant, verifiable findings, the scientific enterprise offers an objective means to discern and interpret reality.
Yet at each step of the scientific endeavor, subjective social and cultural factors are at work. Science – in its funding, in its production, and it is public policy application – is the product of social desire, cultural beliefs, and political economic aspirations.
Who shapes that knowledge? To address what questions? According to what notion of significant variables and relevant data sets? What assumptions are used in collecting, developing and assessing data, and determining significant findings? And, to what end does science serve?
Such questions come to mind as I read through these two newest contributions to the literature on nuclear militarism and its adverse effects on human health. Both studies address the question of radiogenic disease associated with US militarism. Both reflect the outcome of careful scientific research by respected scientists in their respective fields. Study methodologies, data sets, approaches to reporting, and conclusions, however, stand in sharp, almost contradictory, contrast.
The Simon et al. studies
The Simon et al. studies are the result of a reassessment of historical data collected in the Marshall Islands as part of a classified human radiation research study begun after the 1954 detonation of Bravo test of the hydrogen bomb and continuing through the mid-1990s. This National Cancer Institute study was initiated at the request of US Congress to inform Senate and House Hearings on the long-term consequences of hosting the US Nuclear Weapons Testing program in the Marshall Islands, specifically with regards to radiation-related illnesses. The NCI study included an effort to calculate measurable fallout to populated atolls from 66 weapons tests, specifically considering 63 “important dose-contributing radionuclides” with the goal of estimating the radiation absorbed doses to the red bone marrow, thyroid gland, stomach wall, and colon wall of atoll residents from internal and external exposure. Reconstructed annual doses and the population size at each atoll were used to develop estimates of cancer risk.
The findings? In a population of some 25,000 Marshallese, about 10,600 cancers “would spontaneously arise” (unrelated to radioactive fallout) and 170 cancers (radiation-related) would be expected to occur, with some 65 estimated cancers yet to be expressed. Among its conclusions: “as much as 1.6% of all cancers among those residents of the Marshall Islands alive between 1948 and 1970 might be attributable to radiation exposures resulting from nuclear testing fallout.” And, “98.4% of all cancer in the Marshallese population is due to other factors, many of which remain unknown.”
Hmmm. Taken at face value, this summation suggests that in a nation that hosted some 66 nuclear weapons tests, essentially simulating an intense 12-year long period of nuclear war, the long-term health outcome of living in with all the fallout, was not so bad.
A careful reading of the Simon et al. studies reveals that a number of key assumptions were taken – assumptions that arguably produced flawed conclusions. Authors assume that historical data on weapons detonation, plume, and fallout was accurate, complete, and sufficient to allow dose reconstruction for all elements, concluding that 46 of the 66 tests could be dismissed, as they did not produce measurable fallout on populated atolls. (In fact, as noted by the Marshall Islands Nuclear Claims Tribunal, 67 tests took place in the Marshall Islands). They assume that isotopes of concern are those with shorter decay rates as they produce higher levels of radiation exposure, and that a cut-off date of 1970 is an appropriate boundary to the analysis because “residual contamination had reached “negligible levels on most atolls.” In focusing on cancers affecting the thyroid, blood cells, and the stomach and colon walls, they assume that radiation-related cancers are the best and sole measure of the adverse health effects of the nuclear weapons testing program, ignoring other documented forms of radiation-related disease such as immune system vulnerability, cataract and glaucoma, hypertension and heart disease, calculus (stones) of the kidney and ureter, osteoporosis and other forms of premature aging, endocrine-disruption, reproductive disorders, genetic damage and intergenerational effects. The singular focus on US Government-generated science results in a failure to consider the patterns emerging from the Nuclear Claims Tribunal personal injury awards where the most common forms of injury are (1) thyroid cancer and disease, (2) bronchial cancer (including pulmonary and lung), (3) hematological malignancies, (4) breast cancer (male and female), and (5) cancers of the ovary. They assume that estimates of absorbed radiation-dose, rather than a broader concern for the toxic nature of the various elements, is sufficient when assessing fallout-related health effects. They assume their understanding of pathways of exposure — internal intake through food, utensils, hands and face, and drinking water — is sufficient, thus ignoring, for example, absorption through skin, inhalation exposure from wood and coconut hull-fires used to prepare food, or absorption through mucus membranes (women bathing daily in the contaminated waters of lagoon). And, they assume that the synergistic and cumulative effects from multiple exposures to fallout contaminants are not relevant.
At a more fundamental level, these studies reflect the assumption that cancer risk assessment, rather than actual lived experience, is the best approach for determining the scientific truth of the question ‘what are the health effects of exposure to nuclear weapons fallout?’ The absence of a comprehensive cancer incidence registry for the Marshall Islands, according to Simon et al., necessitates a risk assessment approach to estimating baseline cancer rates, thus the NCI team used age-specific rates developed from the Hawaii, US, and world cancer registries (rates that incorporate radiation-related cancers that occur as a result of “background” exposure to global fallout). This approach ignores Marshallese testimony on health and disease, including the emergence of medical conditions that have no name in the Marshallese language (evidence reflected in the historical, Congressional, and Nuclear Claims Tribunal records). And, it overlooks the historical records, including Japanese-era health survey data compiled in the 1930s, as well as the biomedical baseline established by the US Navy in public health surveys conducted in 1948 and 1951 involving 60% of the Marshall Islands population (including the residents of Utrik, one of the populated atolls on the northern part of the nation that was heavily contaminated with fallout). The Naval public health survey was conducted by officers aboard the USS Whidbey, a Naval hospital ship described as an “epidemiological disease control ship, becoming, in effect, a modern floating laboratory, with equipment and trained technicians capable of analyzing the most minute organism.” The medical survey included physical exams, x-rays, collection of blood samples, and reported the rare incidence of obvious signs of cancer and congenital defect, the aggregate data of which was published in 1959.
The Simon et al. studies support a flawed conclusion that the extremely high rates of cancer in the Marshall Islands are not the result of the experience of living in a nuclear weapons proving ground. Such findings are useful in supporting the political position that the US has fully met its obligation to the Marshallese, and thus, is within its rights to deny the bilateral request that US Congress fully-fund the Republic of the Marshall Islands Nuclear Claims Tribunal awards. Such findings may also be useful in supporting arguments for reducing liability in other contexts – be it the low-level radiation exposures associated with other forms of military training and militarism, or the low-level radiation exposures associated with mining and milling of uranium, processing of fuels, generation of nuclear power, and storage or reuse of nuclear waste.
The Busby et al. study
A very different set of questions, considerations, data, and findings on the health effects of radiation exposure are reported in the second study led by Chris Busby. This study was prompted by local recognition of abnormal conditions, with resulting research involving an epidemiological survey to document lived experiences while raising questions concerning the casual factors. It offers sharp contrast in perspective and approach from the above described predictive risk assessment with its’ conclusive statements that reduce or minimize lived experiences.
The Busby et al. study was initiated in November 2009, when a group of British and Iraqi doctors petitioned the United Nations to investigate a rise in birth defects in Fallujah, Iraq. Fallujah had been the site of heavy fighting in 2004, and anecdotal reports of an increase in cancer and leukemia began in 2005. Lacking any population-based epidemiological evidence, and lacking systematic disclosure and assessment of the amount and form of weaponry deployed during the US-led occupation, authors assert that population-based epidemiological evidence is the best strategy to assess conditions in ways that suggest answers to the question: what are the immediate and long-term health effects of hosting life in a modern battle zone where depleted uranium and other environmental hazards are common?
A product of independent investigation involving participatory and transparent engagement with human subjects, the article begins with a detailed discussion of problems, methods, data collection, and ethical issues and process. As is common in war-zones, official population, cancer, and birth data are lacking. In such situations lived experiences can provide the source of data, which in this instance were gathered using questionnaire survey methods. Busby et al. detail the ethical and practical challenges associated with gathering such information, and lacking the ability to obtain an Iraqi ethical committee approval for the study (no such body existed), used the provisions of the Helsinki protocol (informed consent was obtained, no coercion, assured confidentiality) to guide their efforts.
The authors also take care to discuss the relative strengths and weaknesses of their methodological approach, one weakness being the high potential for an underassessment resulting from population leakage (deaths and migration). To counter for this potential, a five year rather than ten year window was used. Another weaknesses noted is the difficulty in verifying household responses by securing independent confirmation, though it is noted that respondents gave medical identification numbers and names of the doctors or clinics where they were treated.
In January and February 2010 a team of 11 independent scientists worked with 711 households in Fallujah – selected by random sample in the study area – to develop family health histories. More than 60% of the total population participated in the assessment, completing a questionnaire in Arabic on cancer, birth defects and infant mortality over a five-year period (January 2005-January 2010). The final refusal rate per house visited was less than 30%, with lack of participation largely occurring in one single area visited early in the study before field protocol was refined (residents were suspicious of the study’s intent and team members knocked on the door with a translator, but no local person to vouch for the study).
As in the Simon et al. studies, aggregate data were compared with the relative risks for cancer according to age-standardized and compared to population-relevant rates, in this instance with rates from the Middle East Cancer Registry for 1999 and rates in Jordan 1996-2001. Infant mortality was based on the mean birth rate over the 4-year period 2006-2009 with 1/6th added for cases reported in January and February 2010. The mean birth sex-ratio was determined by comparing the ratio of boys to 1,000 girls in the 0-4, 5-9, 10-14 and 15-19 age cohorts in the Fallujah sample and contrasting this finding with ratio rates experienced in 2008 for Egypt, Jordan and Kuwait.
Busby et al. found high rates of cancer, leukemia and infant mortality (higher than the experience in Hiroshima and Nagasaki in 1945), and a statistically significant change in the ratio of female-to-male births. The human norm is 1,050 boys born for every 1,000 girls. In Fallujah, Busby et al. report a rate of 860 boys born for every 1,000 girls. Such findings are consistent with major mutagenic exposure.
Busby et al. present their conclusions with cautious qualifications: the results for cancer, infant mortality, and sex-ratios “seem to qualitatively support the existence of serious mutation-related health effects in Fallujah, owing to the structural problems associated with surveys of this kind, care should be exercised in interpreting the findings quantitatively.”
As to the question of causality – whether health experiences are indeed a causal outcome of living in a battle zone – authors offer a wide-ranging discussion of the possible interpretations. They conclude that the “reduction in the sex ratio in the cohort born one year after the fighting in 2004 identifies that year as the time of the environmental contamination.” They note, however, that the radiation-effects literature suggests a longer time frame between exposure and clinical expression of the cancer, leukemia or lymphoma than is the apparent case in Fallujah (onset following exposure to acute external low LET radiation for leukemia is about 5 to 7 years; for breast cancer and solid tumors as high as 15 to 20 years).
They also note that the genetic damage that occurs in an already stressed-population may create a high-potential vulnerability, a tipping point so to speak, when presented with a new stress. Thus the 2004 exposure may have created a “sudden (spike) introduction of a mutagenic stress” that added to a pre-existing potential in a population that hosted 1991 Gulf War.
In the Fallujah case, scientific study confirms that an adverse health outcome has occurred, though the identify of agent(s) – the causal source of illness – is not conclusively defined. Many suspect that depleted uranium plays a major role in this story. Depleted uranium, the uranium remaining after its use as nuclear reactor fuel, is a low-level emitting heavy metal (60% of the radioactivity of natural purified uranium). Due to its high density it is used as counterweights in aircraft, and radiation shields in medical radiation therapy machines. It is also used in military and police operations as defensive armor and armor-penetrating ordinance. According to the World Health Organization the behavior of depleted uranium in the body is identical to that of natural uranium. Many of the world’s citizens and soldiers have absorbed fragments of depleted uranium through inhalation or penetration. A toxic heavy metal that emits low-level radiation, depleted uranium can damage the lymph tissues and thus the immune system, kidneys, and developing fetuses. It can affect the bones, the reproductive organs, and the function of the brain and neurological system.
In Fallujah, where intense military action involved the use of DU-coated missiles, shells, bombs, ammunition and military armor. Detonation produced a fine, radioactive dust that blankets the earth and is carried on the winds, thus the civilian population is regularly and systematically exposed. While the formal U.S. military policy denies that breathing it is harmful – and thus there is no US obligation to compensate a civilian population for its exposure and resulting health damages – many scientists, including those who work with the US Veterans Administration, recognize DU as a highly toxic element.
The two sets of findings reviewed here, Simon et al. and Busby et al., are very different but address the same question: what are the health effects of hosting US militarism? Their answers, conclusive statements in Simon et al., and cautionary suggestions in Busby et al., point to very different uses of science to discern or assert relative truths of a given situation, with very different social implications.
One denies lived experience and serves to reduce political obligations and liabilities. The other opens the door for broader questions of harm, obligations and liability.
Barbara Rose Johnston is an environmental anthropologist and senior research fellow at the Center for Political Ecology, Santa Cruz, California. She has served as an expert witness in Marshall Islands Nuclear Claims Tribunal proceedings and continues to advise the tribunal on human radiation experimentation matters. She is adjunct Professor of Anthropology at Michigan State University and a lecturer in Sociology at UC Santa Cruz. Her research on radiation exposure and its consequences in the Marshall Islands, and on cultural bias and flaws in the methodologies used to assess the human health outcomes in the Japanese and Marshallese experiences are published in her contributions to Half-lives and Half Truths: Confronting the Radioactive Legacies of the Cold War (BR Johnston, ed., SAR Press 2007) and Consequential Damages of Nuclear War – The Rongelap Report (BR Johnston and HM Barker, Left Coast Press 2008). She can be contacted at firstname.lastname@example.org.