2014/03/16

Thyroid Rage

It’s hard to imagine what motivates so many medical professionals to interpret epidemiological findings in a way that supports the views of the nuclear industry. It’s equally hard to understand why editors and journalists so readily go to such people and accept their glib denials that the nuclear disaster has had or will have any impact on public health.
photo from Al Jazeera
A case in point is this week’s National Geographic interview with Norman Kleiman of the Department of Environmental Health Sciences at the Columbia University Mailman School of Public Health in New York City.
The interviewer asked him to comment on the fact that there have been 33 confirmed cases of thyroid cancer in children in Fukushima prefecture since the nuclear catastrophe in 2011. The writer conveniently omits the detail that there are another 42 suspected cases, many of which will be confirmed at a more convenient time when the mass media is paying less attention to the issue. It should also be emphasized that for every cancer there are many more cases of damaged thyroid function, a fact which makes the nuclear accident a much more serious public health problem than it appears to be.
In any case, this finding of 33 cases among 245,000 children converts to a rate of  about 132 per million, a 61-fold increase over the normal rate of 2 per million (quoted in the National Geographic article). The American National Cancer Institute shows thyroid cancer occurring in 2010 at a rate of 1 per 100,000 for people under the age of 20. If this rate were taken as normal, then the finding of 33 cases per 245,000 equals a rate of 13 per 100,000.
The official line in Japan is that this increase can be put down to the screening effect. That is, if you go looking for a disease, you’ll find more of it than you would just by waiting for sick people to walk into a clinic. Norman Kleiman, along with the nuclear industry, agrees with this interpretation. Interestingly, they seem to assume, without presenting evidence, that the existing estimate of 2 per million was not a product of rigorous epidemiological research that screened a population. They suggest that the Fukushima survey was the first time that a population has ever been intensively screened for thyroid cancer.
Dr. Kleiman went on to even compare thyroid cancer to prostate cancer in older men. Increased screening for prostate cancer turns up more small, slow-growing tumors that patients would be better off ignoring because they will probably die from something else before the tumor becomes a problem.
It’s hard to know what to make of such an inappropriate comparison coming from a physician. I’m just an amateur, but I think I can see the differences between a child’s thyroid cancer and an old man’s prostate cancer. Cancers in children are known to grow more quickly than they do in adults over age 50. A child’s thyroid is a vital organ needed for proper development and endocrine functioning, whereas the prostate gland of a man over fifty is not so essential. It is extremely insensitive to equate a tumor in a child’s thyroid with a tumor in an old man’s prostate. The child needs to keep that organ healthy for seventy years, so the finding of a tumor in it is sure to be alarming. It is cold comfort for the parents or the child involved to be told what can be said to older men with prostate trouble--“just keep an eye on it, you’ll probably die of something else first.”
In addition, Dr. Kleiman gets a few of his facts wrong and shows only a passing familiarity with the Fukushima Daiichi catastrophe. He claimed that the Chernobyl research showed thyroid cancer appearing after four years, but in fact, several research projects showed that thyroid cancers started to appear within two to three years of the catastrophe. They were described as more aggressive and with an earlier onset than the thyroid cancers that arise from other causes.(1)
Dr. Kleiman's interpretation of Chernobyl research illustrates the ways that the Soviet response to Chernobyl gets twisted to be either terrible or wonderful, depending on the spin that is necessary. Dr. Kleiman says that the Soviets did a terrible job protecting children from consuming milk and water laced with radioactive iodine, but we are to believe that later on they were flawless in detecting every case of thyroid cancer.
Dr. Kleiman also naively believes that people in Fukushima did not consume products laced with radioactive iodine in the first weeks after the accident, and he fails to mention that a significant concern aside from ingestion is the inhalation dose. No one (except some medical personnel who took care of themselves) got prophylactic doses of stable iodine, and the situation was generally chaotic, just as it was in the USSR. People were not warned of the dangers, and false assurances went out, even though data on the fallout was not available. Delivery trucks came to a certain point, but drivers bailed out when they got close to the radiation and left many people further down the road without vital supplies. Perhaps some people got bottled water, but many more had to settle for whatever they could get when they got thirsty. Regardless, the inhalation doses were enough of a concern for even Dr. Yamashita of Fukushima University Hospital to admit his error. He finally saw the data long after he had assured people there was nothing to be concerned about.(2)(3)
Dr. Kleiman also falsely described what cesium does in the body. He described it as accumulating in “fatty tissue” when in fact it goes to all connective tissue such as tendons, ligaments, fascia, skin, fibrous tissues, and fat, and to muscles, nerves and blood vessels. This is just a bit of Wikipedia fact checking that a doctor could have done before he went on record in a high profile magazine. Likewise, the journalist could have done some checking before the article went to print.
The doctor finishes by regurgitating the standard condescending nonsense that comes from nuclear advocates–comparing fission products from a nuclear accident with the radiation found in granite counter tops, bananas and rays from the sun--as if that should make people relax when a nuclear reactor is melting down and exploding a few miles from their homes. Everything he said in this interview resembles numerous other pronouncements assuring the world that Fukushima will have no health consequences. They all seem to be getting their talking points from the same source. 
   He claims that no one in Fukushima is living there with any serious “concentration” that will lead to health effects. Such statements are always made in willful neglect of the real danger of internal contamination. Of course, he had to finish by adding that the real problem is the “anxiety and fear of living in what people perceive as a contaminated area.” He adds the word “perceive” to deny a fact which the IAEA, the nuclear industry and nuclear opponents agree on. There is no perception problem. The land is contaminated.
All in all, this is a shameful gloss of a deadly serious, large-scale public health problem caused by corporate malpractice and negligence. National Geographic is seen by many as an inspirational educational resource, so it is all the more regrettable that the magazine failed to do much better research on this subject and failed to consult with a medical professional who has direct experience and in-depth knowledge of the Fukushima catastrophe and its impact on the people there. But after all, this may be the desired slant of the publication. The magazine is still ostensibly managed independently by the National Geographic Society, but National Geographic Channel is owned by Rupert Murdoch's 21st Century Fox.
At one point Dr. Kleiman said, “I'm not a pediatric endocrinologist, and I don't want to speculate..,” which just makes me wonder why the interviewer didn’t stop there, forget the speculations and go find a pediatric endocrinologist. It’s not clear why the National Geographic staff chose to interview Dr. Kleiman, a person who appears to have read from a list of talking points, with little knowledge of the event he was asked to comment on. It seems like the editors just went to someone who was easy to find locally.
Finally, there is a glaringly obvious point overlooked by those who say that the high incidence of childhood thyroid cancer in Fukushima is due to the screening effect. If it is true that the same result would come from surveying any population anywhere else, then the health authorities in Fukushima have really made a shocking, high-impact medical discovery that people all over the world will want to know about. Thyroid cancer in children is 61 times more common than we once believed it was! Any proper scientific review of this finding would insist that the researchers at Fukushima Medical University attempt to replicate their findings on a population not affected by a massive release of Iodine 131. This is the only way to confirm their conclusion, but it’s a certainty that Japanese officials will avoid doing it all costs. Yet there is always the possibility that their conclusion is correct because there are a lot of pre-existing toxins all over the world that affect thyroid function. If this research on children in Fukushima truly does imply that the global rate of thyroid cancer is so high, then this is a finding that deserves much more attention than it has got so far.

Notes:

(1) Some quotes from sources listed below:

“The high incidence of childhood thyroid cancer in Belarus is suspected to be due to radiation exposure after the Chernobyl reactor accident…  All of the preceding thyroid carcinomas developed after longer latency periods, whereas tumors arising in the Chernobyl population began developing with surprising rapidity and short latency.” (Shirahige et. al.)

“… absence of marked latency period is another feature of radiation-induced thyroid cancers caused in Belarus as a result of this accident.” (Malko)

“[the latent period for thyroid cancer is] 2.5 years, based on low estimates used for lifetime risk modeling of low-level ionizing radiation studies.” (Howard)

(2) Dr. Shunichi Yamashita: I thought, "Oops..." After Seeing the SPEEDI Simulation Map on March 23, 2011. Ex-skf. November, 2011. http://ex-skf.blogspot.jp/2013/11/dr-shunichi-yamashita-i-thought-oops.html. This source is a translation of Asahi Shinbun’s in-depth report Trap of Prometheus on the chaos March 2011. The report tells how the head of the medical team overseeing the response to the catastrophe discovered too late that Iodine 131 levels were indeed very high and that stable iodine should have been given to the population immediately.

(3) Miyake et al. determined a very effective way to reconstruct the fallout of Iodine 131 after it has decayed away. Iodine 131 has a short half-life of eight days but a high energy rate that makes it very damaging to the thyroid gland. Since it is completely gone after about ten half-lives, it is difficult to determine what inhabitants were exposed to in particular areas. Miyake et al. found that Iodine 129, with a 16 million-year half-life and a proportionately much lower energy, was found in the Fukushima fallout in a fixed ratio with Iodine 131 of about 32:1. To know how much Iodine 131 fell in a particular place, one can determine the amount of Iodine 129 still in the soil. Thus there should be no fatalistic shrugging and talk of how we’ll never know what children were exposed to.

Sources:

John Howard. “Minimum Latency & Types or Categories of Cancer” Administrator World Trade Center Health Program, 9.11 Monitoring and Treatment, Revision: May 1, 2013.

Mikhail V. Malko. “Chernobyl Radiation-induced Thyroid Cancers in Belarus.”
Joint Institute of Power and Nuclear Research, National Academy of Sciences of Belarus. 2002.

Y. Shirahige, M. Ito, K. Ashizawa, T. Motomura, N. Yokoyama, H. Namba, S. Fukata, T. Yokozawa, N. Ishikawa, T. Mimura, S. Yamashita, I. Sekine, K. Kuma, K. Ito, S. Nagataki. “Childhood thyroid cancer: comparison of Japan and Belarus.” Endocrine Journal, 1998 Apr;45(2):203-9.

Justin McCurry. “Fukushima's children at centre of debate over rates of thyroid cancer.” The Guardian. March 9, 2014.


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