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The March 2011 Japanese tsunami and subsequent disaster at the Fukuskima Daiichi nuclear power plant renewed international concerns about the impact of radiation on human and planetary health.  Even months later, there is much speculation but little certainty about the short- and long-term implications of the nuclear radiation leak.  Concerns raised include the increased risk of cancer in those exposed locally and generational effects on pregnant women and children, as well as on food and water supplies. 
 
In order to gain perspective on this complex situation, I interviewed Dr. Ira Helfand, Past President of the Physicians for Social Responsibility, U.S. affiliate of the International Physicians for the Prevention of Nuclear War (recipients of the 1985 Nobel Peace Prize).
Dr. Helfand recently participated in an informative partnership call (LINK: http://www.healthandenvironment.org/partnership_calls/8885) for the Collaborative on Health and the Environment on this issue.
 
 Dr. Larry Rosen: Dr. Helfand, what would you say are the major short-term health issues raised by this event?
 
Dr. Ira Helfand: Short term, there should not be major health effects for the general public if the radiation levels reported to the public are accurate.  The levels fall well below those that would cause acute radiation sickness.  Workers at the reactors may have received doses high enough to cause radiation sickness and apparently several were hospitalized in the early days of the disaster for evaluation and treatment.
 
LR: What would you say are the major long-term health issues?
 
IH: Long term, the situation is much more serious.  The authoritative BEIR 7 (Biological Effects of Ionizing Radiation) report of the US National Research Council concluded that there is no safe dose of radiation.  Any exposure, including background radiation from natural sources, increases one's risk of getting cancer.  Specifically, a dose of 10 mSv gives a one in 1000 risk of getting cancer from that exposure.  It is hard to know at this point how many people have been exposed and to what dose.  But the Japanese government is raising the permissible exposure for children to 20 mSv.  An adult exposed to that much radiation would have a 1 in 500 risk of getting cancer from that exposure.  Children are at least 2 to 3 times more sensitive to the oncogenic effects of radiation.  Children exposed to 20 mSV would have a risk of at least one in 200 of getting cancer.
 
In addition, the studies of people around Chernobyl showed a large number of other health effects:  increased numbers of miscarriages, still births, congenital malformations, thyroid disease, and delayed mental development.
 
LR: How can we best protect ourselves here in U.S. in the event of a nuclear disaster?
 
We can't protect ourselves very well, which is why it is so important to make sure that a disaster of this type never takes place.  The key point is the old maxim that, as physicians, we must prevent that which we cannot treat.  But there are a few measures that might lessen the impact of a disaster:
 
a) There should be adequate plans to evacuate people or to shelter them in place during the periods of greatest radioactive exposure.  The US government now says that the evacuation zone would need to extend 50 miles from a plant experiencing a major meltdown like Fukushima.  We have no such plans at this time, and we cannot design adequate plans for reactors in densely populated areas like the Indian Point reactor where an accident would require the evacuation of 17 million people.
 
b) Potassium iodide does provide some protection against the uptake of iodine-131 and there should be larger stockpiles of it available and more clearly delineated plans for administering it to the public.
 
c) There needs to be reliable monitoring of radiation in the event of an accident so people know in real time how much they are being exposed to and whether food and water are contaminated.  Decisions about what to tell the public need to be based on what is necessary to protect public health, not what is necessary to protect the nuclear industry.  The revelations that Japanese officials underplayed the initial releases to "avoid panic" are particularly disturbing.
 
Dr. Helfand’s key point – that prevention is much more effective than treatment – is worth repeating.  This precautionary principle is an ideal approach for environmental health risks in general.  Sadly, we have learned that lesson with lead poisoning and with cigarette smoke effects; it is much more difficult (and costly) to treat the problems resulting from these exposures than to prevent them in the first place.
 
I was also fortunate to connect with Dr. Michael Golay, Professor of Nuclear Science and Engineering at the Massachusetts Institute of Technology and one of the world’s leading experts on nuclear policy.  During the course of our conversation, Dr. Golay raised a provocative point.  “Society is inconsistent,” he offered.  “When radiation is associated with a technology we desire, we tolerate it.”  In other words, in the case of nuclear power, many people will weigh potential risks and benefits differently than for cell phones (which emit microwave radiation) or for medical radiology technology.  In fact, a recent study, “Use of Medical Imaging Procedures With Ionizing Radiation in Children” (LINK: http://archpedi.ama-assn.org/cgi/content/short/archpediatrics.2010.270) published in the Archives of Pediatric and Adolescent Medicine questioned the high rate of higher-radiation CT scans, concluding, “Exposure to ionizing radiation from medical diagnostic imaging procedures may occur frequently among children. Efforts to optimize and ensure appropriate use of these procedures in the pediatric population should be encouraged.”  The radiation exposure to children from medical procedures poses a far greater threat to health, on average, than nuclear radiation.  Yet, until recently, we have generally looked the other way, tolerating the risk for a perceived benefit of early diagnosis.  Are these more common risks worth these possible benefits?  As more studies question the value of high-radiation, low-yield radiological procedures, we are left to wonder.  While undoubtedly we should maintain vigilance regarding nuclear energy safety, we must not forget to address more prevalent radiation exposures.
 
 
dr._rosen_2About Dr. Lawrence Rosen
 
Clinical Assistant Professor of Pediatrics, New Jersey Medical School; Chair, AAP Section on Complementary and Integrative Medicine;  Medical Advisor, The Deirdre Imus Environmental Health Center™.  
 
Dr. Lawrence D. Rosen is a board-certified general pediatrician committed to family-centered, holistic child health care. He is the founder of one of the country's first green, integrative primary care practices -- Whole Child Center (wholechildcenter.org) -- in Oradell, NJ. He serves as Medical Advisor to The Deirdre Imus Environmental Health Center™.
 
Dr. Rosen is a nationally recognized expert in Pediatric Integrative Medicine. He is a founding member and Chair of the American Academy of Pediatrics Section on Complementary and Integrative Medicine. He is appointed as clinical assistant professor in Pediatrics at UMDNJ/New Jersey Medical School. Dr. Rosen is a graduate of New York Medical College and the Massachusetts Institute of Technology. He completed his residency and chief residency in pediatrics at Mount Sinai Medical Center in New York.  
 
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