NEJM piece on nuclear plant accidents health impacts

Dr. Glatstein,

I was just sent the New England Journal of Medicine piece entitled: "Short-term and Long-term Health Risks of Nuclear-Power-Plant Accidents." (http://www.nejm.org/doi/full/10.1056/NEJMra1103676?query=featured_home). You are listed as one of the authors.

I don't know anything about you or the other authors but I cannot fathom how you can use dose level numbers in connection with the Chernobyl and Three Mile Island events that completely ignore important health impact studies on those accidents. I am surprised the NEJM would publish an article with such blatant omissions.

You prominently cite two International Atomic Energy Agency (IAEA) studies in making the claim that "the Chernobyl accident resulted in 28 deaths related to radiation exposure in the year after the accident." The first of these studies states that "The accident caused the deaths within a few days or weeks of 30 ChNPP employees and firemen (including 28 deaths that were due to radiation exposure)" (http://www-pub.iaea.org/mtcd/publications/pdf/te_1300_web.pdf, page 5) However, this study focused on the "600 emergency workers who were on the site of the Chernobyl power plant during the night of the accident," and not the exposed population at large. In particular, it followed less than 100 emergency workers who had been confirmed with acute radiation sickness. If the NEJM article was about the health risks to the "Fukushima 50," it would be a relevant study to cite. It is not relevant to an article on the radiation risks to the general population.

As for the second study, it only attempts to look at five million people in parts of Belarus, Russia, and Ukraine that were classified as 'contaminated'. Even so, this IAEA study confesses that just in this limited area several thousand Chernobyl-caused cancer deaths would be "very difficult to detect." "The projections indicate that, among the most exposed populations (liquidators, evacuees and residents of the so-called 'strict control zones') total cancer mortality might increase by up to a few per cent owing to Chernobyl related radiation exposure. Such an increase could mean eventually up to several thousand fatal cancers in addition to perhaps one hundred thousand cancer deaths expected in these populations from all other causes. An increase of this magnitude would be very difficult to detect, even with very careful long term epidemiological studies." (http://www.iaea.org/Publications/Booklets/Chernobyl/chernobyl.pdf, page 8)

Of course, the IAEA was never intended to protect the public from the dangers of nuclear power plants. It is not part of its mission. The statute of the IAEA states that: "[t]he Agency shall seek to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world.  It shall ensure, so far as it is able, that assistance provided by it or at its request or under its supervision or control is not used in such a way as to further any military purpose." (http://www.iaea.org/About/statute.html#A1.1). Thus, the IAEA was created to PROMOTE nuclear power while checking the proliferation of nuclear weapons. It therefore is cannot be considered an unbiased or authoritative source of information on the health risks of nuclear power.

The article is misleading or inaccurate in other instances. For instance, there is too much discussion of whole body radiation, which is really only relevant to the emergency workers. The article acknowledges that it is not whole body radiation, but rather internal contamination that is "the primary mechanism through which large populations around a reactor accident can be exposed to radiation." Why talk about whole body radiation if it is not the mechanism through which populations are endangered? Because it sets up a long and irrelevant discussion about acute radiation sickness, which is a distraction since the threat to the general public is mainly from cancer.

There is another major omission in the author's discussion of radiation. Your mention beta and gamma radiation, but not alpha radiation. However, that does not stop you from dismissing the danger of plutonium contamination, which is dangerous precisely because it is an alpha emitter. You state that "Radioisotopes with a ... very long half-life (e.g., 24,400 years for plutonium-239) ... do not cause substantial internal or external contamination in reactor accidents." The authors are either lying or ignorant. The danger from plutonium-239 has nothing to do with its half-life (long half-lives indicate slower radioactive decay). Plutonium, if ingested internally, is dangerous because the large and heavy alpha particles it emits are the most damaging to DNA and the most likely to cause cancer.

It is especially inconceivable that a study of the consequences of radiation exposure from Chernobyl would ignore the seminal work done by the Russian National Academy of Sciences. Please see "Chernobyl: Consequences of the Catastrophe for People and the Environment," Alexey V. Yablokov, Vassily B. Nesterenko, Alexey V. Nesterenko - 2010 - Nature - 400. Also available at: Annals of the New York Academy of Sciences, Vol. 1181.

This team of scientists from Russia and Belarus studied health data, radiological surveys and 5,000 scientific reports from 1986 to 2004 and estimated that the Chernobyl accident caused the deaths of 985,000 people worldwide. In a March 25 press conference in Washington, DC, Dr. Yablokov pointed out that because of the multiple nuclear power plants and spent fuel pools involved in the Fukushima accident, coupled with the density of the population there, the human toll could eventually be far worse than Chernobyl.

A June 1991 Columbia University Health Study (Susser-Hatch) of the health impacts from the TMI accident published results its findings in the American Journal of Public Health. The study actually shows a more than doubling of all observed cancers after the accident at TMI-2, including: lymphoma, leukemia, colon and the hormonal category of breast, endometrium, ovary, prostate and testis. For leukemia and lung cancers in the six to 12 km distance, the number observed was almost four times greater. In the 0-six km range, colon cancer was four times greater. The study found "a statistically significant relationship between incidence rates after the accident and residential proximity to the plant."

Attached is a peer reviewed map of cancer incidence in the Harrisburg area after the Three Mile Island accident developed by Dr. Steve Wing of the University of North Carolina. It graphically shows higher incidences of cancer up and down the Susquehanna River Valley, which was the direction of the prevailing wind at the time of the 1979 accident.  Details supporting the map are available at: www.tmia.com.

In addition to these omissions, your piece appears to be an attempt to minimize the chances of adverse health impacts from a nuclear plant accident, especially when compared to an atomic bomb explosion, due mainly to (1)the containment and (2)the different types of radiation released at nuclear plants. It's seems rather odd to me that a study or paper that purportedly is intended to measure the health impacts of radiation exposure from a nuclear plant accident would attempt to minimize those impacts by comparing such an accident to an entirely different situation.

Your description of the containment at US nuclear plants as "airtight" ignores the fact that there are serious problems with steel liner through holes and cracks in concrete in containments at several US plants. I assume, maybe wrongly, that you and the other authors are not experts on reactor containment systems, which may explain why you rely on nuclear industry language and claims.

Another example of minimizing potential health impacts of a nuclear plant accident is this statement in connection with the accident at Fukushima: "[a]lthough the radioactivity in seawater close to the plant may be transiently higher than usual by several orders of magnitude, it diffuses rapidly with distance and decays over time, according to half-life, both before and after ingestion by marine life."

Japan has a massive fishing industry, because, along with rice, fish are the staple of the Japanese diet. Any release of radiation into coastal fishing grounds will wind up being concentrated through biological processes as it works its way up the food chain and eventually to the Japanese dinner table. However, The key words here are "decays over time" which glosses over exactly how much time. We know this to be thousands of years for some types of radiation. The impact on health from releases into the ocean cannot be so lightly dismissed.

There are other examples of attempts to minimize the potential adverse consequences of a nuclear plant accident, but this email is long enough. Suffice it to day that the  subjective statements the authors make, coupled with the blatant disregard for the available scientific evidence re health impacts from the Chernobyl and TMI accidents, certainly call into question your expertise on the subject matter. However, I see that your disclosure forms for the NEJM show no conflict of interest. I certainly hope that is the case.

Yours truly,

David Hughes
President
Citizen Power
2121 Murray Avenue
Pittsburgh, PA 15217
(412) 421-6072 x 213
Fax: (412) 421-6162
www.citizenpower.com

Download map of cancer incidence in the Harrisburg area