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Counterattack at Hanford

IN MAY 1969, for the first time in over fifteen years, as a result of growing concern among radiobiologists, there was to be a symposium dedicated to the effects of radiation on the developing mammal, including the human infant, both prior to and immediately after birth.

Not since the detonation of the first hydrogen bombs in 1953 had such a conference been sponsored by the Atomic Energy Commission. In the ensuing years, a vast amount of data had been accumulated on the biological effects of radiation given to animals at doses comparable to those that would be expected in a nuclear war. But even by 1969, almost nothing had been published on the more subtle effects of lower radiation doses, comparable to those from fallout, given over long periods of time. And there still had been no publication of any largescale statistical studies of populations exposed to fallout.

It was true that the AEC had initiated a large-scale statistical study of some 20,000 persons exposed to long-term, low-level radiation in AEC laboratories. But the study population included only adults in their period of least sensitivity to radiation, receiving the best medical care available, and working under carefully controlled and monitored conditions designed to minimize any chance of absorbing isotopes into their bodies. Since the control population consisted of individuals in the same families, communities, and installations who were not exposed to the radiation in the plant but who consumed the same fallout-contaminated food and inhaled the same fallout particles as the exposed test population, no effects from the fallout in the environment could in principle be detected by this study. More important, the study population did not include the children of the radiation laboratory workers. There was no search for unusual rises in stillbirths, infant deaths, congenital malformations, or cancer deaths among these children. When I inquired as to why this type of information was not sought, I was told that it was left out on the grounds that such questions might unduly alarm AEC employees.

There was clearly no need for the AEC to restrict its studies to so limited a population. In 1966 large statistical studies had been published regarding the very small amount of naturally occurring radium in drinking water in the states of Iowa and Illinois. In these studies a definite increase in bone cancer had been observed for the areas with high radium levels, clearly suggesting that the effects of very low levels of longterm radiation on large populations could in fact be detected, and, furthermore, that there was no evidence for a safe threshold even at the doses received from natural background radiation.

A letter from the Surgeon General of the United States, Dr. Jesse L. Steinfeld, to Representative William S. Moorhead of Pittsburgh made it clear that no large-scale epidemiological studies of possible low-level fallout effects were ever carried out or published by either the AEC or the U.S. Public Health Service, despite the fact that such studies had been specifically requested by congressmen Holifield and Price in the course of the 1963 congressional hearings and then promised by the Surgeon General then in office, Luther L. Terry. The exact words used by the present Surgeon General, Steinfeld, were:

. . . studies to determine the feasibility of a national program to analyze morbidity and mortality data of thyroid cancer, leukemia, and congenital malformations in relation to radiation exposure led to the decision that a national program was not indicated.

The letter added that "the feasibility studies were not published," and ended with the following statement:

Some effects on human populations from levels of radiation of the magnitude encountered during nuclear warfare or from direct high-level radiation therapy have been well established. Effects from low-level radiation have not been as clearly delineated and further research into these problems is needed. The Service welcomes the opportunity to work with those who desire to construct and execute scientifically based plans for studies of human effects from low-level radiation exposure.

Thus, in all the years since 1963 no large-scale study of the effects of low-level radiation from fallout had evidently been undertaken.

The Surgeon General's letter did say that studies of fallout-exposed schoolchildren in Utah were being conducted by Dr. G. D. Carlyle Thompson of the Utah State Department of Health and that Dr. Thompson had published some preliminary data on thyroid cancers among these children in the October 1967 American Journal of Public Health. "Progress reports to date," wrote Surgeon General Steinfeld, "show no unusual increased incidence of leukemia and no cases of thyroid cancer among children who reside in the selected `exposed' area of Utah-Nevada."

Examination of Thompson's article, however, showed that, although Steinfeld's statement as phrased was literally true, it was misleading in its implication. For although Thompson's paper indeed indicated no increase in thyroid cancers in these children relative to their counterparts in New York State when both sexes were combined, there was in fact a significant increase among girls zero to 19 years of age. Among this group there was a total of ten cases for 1958-62, as compared to four cases expected. For young women aged 20 to 29 years old, the number was twenty as compared to nine expected. Still more significant, the rate of thyroid cancers per 100,000 young women under age 30 in Utah had increased almost 400 percent -- from 0.6 in 1948-52, before the Nevada tests, to 2.3 in 1958-62.

Since no figures on leukemia deaths in Utah were given in Thompson's article, it was necessary to consult the U.S. Vital Statistics, and what they showed was quite unbelievable. For the age group 5 to 14 years, there were large percentage rises in leukemia deaths exactly three to five years after each of the major test series that deposited fallout in the Utah area. Between 1949 and 1967, the annual number had increased four-fold in successive peaks from 1.5 to 6.2 per 100,000 children. But since leukemia rates for children 5 to 14 years in New York State and elsewhere also went up when fallout became widespread, although not as much as in Utah, a statistician could perhaps say that there was "no unusual increase of leukemia" in Utah.

This, then, was the situation in May 1969 on the eve of the Hanford conference. According to the preliminary program of the symposium, Dr. Alice Stewart would be present. The conference was to take place at Hanford, Washington, the site where the plutonium for the Trinity bomb had been produced in 1944. A few days before I was scheduled to leave for Hanford, I watched the computer print out map after map of rising infant mortality stretching eastward from the Hanford reactors and from the Trinity site at Alamogordo, New Mexico.

At about this time, a completely unexpected letter arrived by special delivery from the New York State Health Department's Bureau of Cancer Control:

April 30, 1969

Dear Dr. Sternglass:

Doctor James Yamazaki of the University of California School of Medicine has written to me about your approaching presentation at the Ninth Annual Hanford Biology Symposium. In his letter, Doctor Yamazaki requested information about environmental factors in the Albany-Schenectady-Rensselaer country areas in the early 1950s. As you can see from my response, a copy of which is enclosed, this Bureau has reviewed some of the data upon which your June 1968 presentation in Denver was based. The results of this preliminary analysis are noted in the letter to Doctor Yamazaki. It is my opinion these data are too inaccurate for the type of analysis you have done. We are planning to restudy this subject and would be happy to have you take part.

I hope this reaches you before the May 5th conference.

The enclosed letter which Greenwald had written to Yamazaki indicated that J. H. Lade of the New York State Health Department had apparently made some errors in his data on leukemia in Albany-Troy, published years before in Science in the attempt to prove that there had been no effect from the fallout of April 1953. As Greenwald put it, "While it is unfortunate that this Health Department may have erred in not clearly describing the possible inaccuracies in this table it is clear that they should now be pointed out." Upon examining Greenwald's revised table, I discovered a remarkable coincidence: These newly found inaccuracies concerned only the cases born in 1953, the year the fallout arrived. Greenwald's new figures showed a greatly reduced number of leukemia cases in that year, thus making it now possible to argue that there had been no significant effect from the fallout.

At the end of Greenwald's letter was the notation:

cc: Dr. Sternglass
     Dr. Sagan

And on the preliminary program of the Hanford meeting, listed below my name, was:

                  L. A. Sagan
                  Palo Alto Medical Clinic

This was Dr. Leonard Sagan, who had long been working for the AEC's Division of Biology and Medicine. He was apparently scheduled to be discussant, or critic, for my paper at Hanford. Why was he listed as being affiliated only with the Palo Alto Medical Clinic? Interestingly, my paper was the only one in that session for which a discussant had been listed in the final program. The co-chairman of the session was Dr. J. N. Yamazaki of the University of California, the same individual who had just requested information on the Troy rainout from the New York State Health Department. Dr. Yamazaki had published a number of papers while working for the Atomic Bomb Casualty Commission that argued for the absence of significant leukemia rises among offspring born to the survivors of Hiroshima.

Upon arriving at Hanford, I was interested to discover the summary of a paper written by Dr. Y. I. Moskalev and his colleagues at the Institute for Biophysics in Moscow. This group of Russian scientists had studied the effects of low-level radiation -- of the type produced by fallout -- from strontium 90 and other isotopes when given to various animals before and during pregnancy. Their observations on the offspring of all types of animals, ranging in size from rats, rabbits, and dogs to sheep and cows, appeared to show effects similar to those I had postulated for human infants. There was no spectacular increase in gross malformations at low levels of strontium 90. Instead there was a small reduction in weight at birth, a decline in fertility, and an increase in the number of fetal deaths. And the earlier the radioactivity was fed to the pregnant animals, the more pronounced were the effects, just exactly as the studies of diagnostic X-rays given during pregnancy had indicated in the case of humans.

Unexpected difficulties, however, developed, and the Russian scientists were unable to attend. This was a great disappointment, for the studies of Dr. Moskalev and his group were the first published work I was aware of that appeared to offer the kind of crucial laboratory confirmation of the statistical evidence for the damaging effects of fallout on the newborn.

Early in the conference, however, other evidence was presented, in session after session, that internal radiation from isotopes of the type that occurred in fallout was particularly hazardous to the ova and the early embryo and fetus. These were levels much lower than those that led to lethal effects in mature animals.

First on the program on the evening my paper was scheduled was a paper by Dr. M. L. Griem of the University of Chicago School of Medicine. Dr. Griem indicated that in his careful study of children X-rayed while in the womb there was no evidence for a difference in the number of leukemia cases between the irradiated children and the two control groups who had not received any radiation. But as soon as Dr. Griem had begun his talk, it became apparent that the number of children X-rayed was only 1008, a group in which one would normally not expect more than one case of leukemia in ten years of life. Thus, even a doubling would at most result in one extra leukemia case, clearly too small an effect to be readily observed with any statistical certainty. As Dr. Alice Stewart herself pointed out in the ensuing discussion, "the reality of juvenile leukemia is such that no one could hope to do a followup like this and detect an increase of 50 percent of the normal incidence without being prepared to follow out 900,000 children for ten years, and no one has done that." She herself had to interview the families of over 7000 children who had died of cancer out of a total of nearly nineteen million children born in order to establish a clear causal connection.

Interestingly, however, Dr. Griem's study actually lent support to the hypothesis of other effects from low-dose radiation, even in so small a study population as 1008 children. His data showed that, although there was no detectable increase in leukemia, there was a significant increase in benign tumors and certain types of congenital birth defects, especially severely disfiguring birthmarks. Furthermore, Griem's study revealed that stillbirths had nearly doubled -- from eight and nine cases in the two control groups to sixteen among those who had received X-rays in the womb. And according to Griem, the X-rays were given mainly in the less sensitive second and third trimesters of pregnancy, with doses of only 1 to 3 rads to the fetuses. But Dr. Stewart had found the sensitivity to be some ten times greater in the first three months of pregnancy. Thus, Griem's study indicated that if the X-rays had instead been given in the earliest developmental phase, a dose only about one-tenth as large, or a mere 100 to 300 millirads, would have produced a doubling of stillbirths and genetic defects. These were, in fact, the general doses that had been received by large numbers of unborn children from fallout. So Griem's study actually provided, for the first time, direct observational evidence in humans for my statistical findings on fetal mortality.

Soon it was Dr. Stewart's turn. As her opening paragraph made clear, it was the opposition to her findings that drove her to find more and more convincing evidence:

More than ten years ago, a retrospective approach to the problem of cancer etiology led to the conclusion that about one in twenty of the 600 cancer deaths that were taking yearly tolls of the seven million children living in Britain were being caused by obstetric X-ray examinations. So far as the investigators themselves were concerned, the matter would probably have rested there had it not been for the general skepticism that greeted this suggestion.

However, so many clinicians and experimentalists refused to accept the necessarily epidemiological evidence that it was finally decided to remove all grounds for doubt by isolating groups of mainly radiogenic cases (i.e. X-rayed cases) and wholly non-radiogenic cases (i.e. non X-rayed cases) and observing the ages of the two groups of children when symptoms developed.

She then went on to present new evidence that leukemia cases among children X-rayed while in the womb showed a clearly recognizable, narrow age range of between three and five years after birth, evidence that supported the hypothesis that the excess cases in Albany-Troy among the children irradiated in the womb were caused by radiation, since they too showed the same abnormal pattern of age at death.

Dr. Stewart also observed that all types of cellular defects produced by radiation "were felt with equal force by all systems and organs" in the fetal stage, a point crucial in explaining how radiation could cause subtle types of damage that would lead to such biochemical defects as the inability to resist infections early in infancy or childhood. And in her conclusion, she pointed out that her evidence clearly showed that the effects that prove fatal before the age of 10 years are mainly initiated before birth, and often in the most sensitive period of early development. Thus Dr. Stewart's paper had greatly strengthened my statistical findings on the effect of fallout radiation.

I then presented my evidence, concluding with the estimate that some 400,000 infants of less than one year of age probably had died as the result of nuclear fallout between 1950 and 1965. The chairman then announced that there would be no discussion until Dr. Sagan of the Palo Alto Medical Clinic had commented on the paper. Dr. Sagan took the microphone.

He began by showing the slides of the material collected for him by the co-chairman of the session, Dr. Yamazaki, from the New York State Health Department. Sagan made the point that the data were too unreliable for the type of study I had done. He next cited an estimated figure for the expected number of leukemia cases in a population exposed to a radiation dose of 1 rad, namely one case per year among each million persons. Therefore, he concluded, the doses in the Troy area, with its 130,000 children, were some 1000 times too small to produce even a single extra leukemia case. Sagan's estimated figure, however, was the one for the mature adult, who is least sensitive of all to radiation. It was evident from Dr. Stewart's and Dr. MacMahon's work, as well as from the paper just delivered by Griem, that the fetus and especially the early embryo were many hundreds of times as sensitive as the adult. Furthermore, the total dose from internal radiation in Troy was at least five times the external dose measured by the AEC's Health and Safety Laboratory -- which Sagan had used in his argument.

He next cited Harley's invalidated "gummed film" fallout measurements to discredit any association of fallout with the infant mortality rises in the wet areas of the South and East. He did this despite the fact that the Public Health Service's data for strontium in the milk that I had just presented correlated perfectly with the changes in infant mortality in every state for which the Service had published data.

The discussion was then opened to the floor, and a long and often heated debate began. Some AEC scientists had slides that showed that miniature swine fed fairly large doses of strontium did not seem to show detectable reductions in weight and litter size. This was in apparent contradiction to the findings of Moskalev, who was unfortunately not present to defend his work. But then Dr. T. K. Ellis of the University of Utah reported that in beagle dogs given small amounts of strontium 90, surprisingly strong effects on male hormone production had been found, as well as changes in reproductive cells. Dr. Harold Rosenthal, who had made measurements on baby teeth collected from all over the United States, indicated that for Texas, St. Louis, Toronto, Detroit, Chicago, and California he had found a close correlation between levels of strontium in the teeth and the levels reported for the milk. This showed that the Public Health Service's milk measurements that I used in my work were indeed a good indication of the amount of exposure received by infants in various areas.

The evidence supporting unexpectedly severe effects on the early embryo and fetus from internal radiation sources continued to accumulate until the close of the conference. And afterward, when I was able to examine the original manuscript submitted by Dr. Moskalev, I found that his studies did in fact confirm the most crucial points at issue in the whole fallout controversy. His group had found that when various of the isotopes contained in fallout were fed to female animals during pregnancy, large fractions were transferred through the placenta to the developing fetus. For example, up to 38 percent was transferred in the case of strontium given to rats and up to 66 percent in the case of cesium given to a litter of dogs. Furthermore, the amounts reaching the developing fetus were many times greater for continuous, slow intake (such as occurs with fallout in food) than for a large single dose.

More significant, Moskalev had found a direct relationship between the size of the doses of isotopes given just before pregnancy and the percent of the offspring that died -- even for doses as small as 4-billionths of a curie per gram of body weight. This dose was well within the range of doses from fallout delivered to the early human fetus by the accumulated strontium in the mothers' bones. Thus, the argument that there might not be any effects at all from long-term, low-level radiation as opposed to doses given all at once, like diagnostic X-rays, had now been disproven by direct experiments.

Moskalev's results also showed that, regardless of whether a given amount of isotopes was fed to a mouse weighing 20 grams or to a dog weighing many thousands of grams, approximately the same fraction of the total amount would always concentrate in the rapidly growing embryo. This was one reason why, in all species, the fetus was so much more sensitive to fallout radiation than the adult. A given tiny amount of an isotope in the body of an adult might be quite tolerable if it was evenly distributed throughout the 70,000 grams of an average woman's body weight. But if even only one one-hundredth of this amount in the mother's body goes to the embryo during the first two to four weeks of development, when the embryo weighs less than a hundredth of a gram, then the concentration of radioactivity in the embryonic tissue would be the same as if the entire original amount had been given to a 1-gram embryo. Instead of the relatively minor radiation dose produced by this original amount distributed in the 70,000 grams of body weight typical of the adult, there would be a concentration 70,000 times greater in the early embryo. And added to this was the fact that the embryo was already hundreds of times more likely to develop cancer or other forms of biochemical damage than the much more resistant, fully mature adult, as paper after paper presented at the conference showed. Thus, the low external doses given by fallout to the body of an adult, doses on which the world's radiation protection agencies had based their assumption that fallout was harmless, were actually highly lethal doses for the early embryo.

It was not our physics and technology that had been inadequate, but our knowledge of biological systems and their enormous ability to concentrate toxic agents. Just as in the case of DDT, it was not the amount distributed throughout the environment that was so serious. It was the selective concentration in the food chain and then in the newly forming organs of the rapidly developing young embryo. Since all higher animals, including man, must pass through this critically sensitive phase, it was clear that, unless the problem was widely recognized and acted upon, man could extinguish himself and all other animals, not through the effect of radiation on the adult, but through the effect on the weakest link in the chain of life -- the unborn and the very young.

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