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Both the 100 years of radiologists and NSWS have strong pointsand weak points.
Title: Both the 100 years of radiologists and NSWS have
stron
Dear colleagues,
In
evaluating the importance of one publication compared to another, we
should expect differences. The British radiologists study is weak
because of essentially no dosimetry, the NSWS is weak because the
nuclear workers represents only about 20 years of occupational
exposure. The radiologists study has a much wider range of doses,
even though we don't know for sure what their doses were. The
NSWS should be extended from 1980 to 2000 but my guess is we
won't live to see it. Since important individuals or groups did not
want the NSWS published, they will not like to see it continued for
fear its statistical strength improves!
http://oc.itgo.com/kitsap/nuclear/public_health.htm included this item about NSWS being extended:
(underlining by me)
*
The Matanoski cohort mortality study of civilian naval
shipyard employees, including those at PNS, was funded by DOE. The
study followed approximately 700,000 nuclear Navy workers for 13
years, through 1981. An update of this study at this time would add
at least 15 years of mortality data for this cohort. Recently, the
DOE Office of Naval Reactors has requested that this large study be
updated. Following an analysis of existing information, which has
never been published, and related gaps, NIOSH will ascertain the
costs and merits as well as funding mechanisms for the study. The
proposed study would then require approval by the Advisory Committee
for Energy-Related Epidemiologic Research.
Even
though a double blind study may have problems, such a study extending
over 15 years or so of senior citizens (>75 years) in Gulf
States, such as I sugges, might resolve the uncertainty. I am
trying to get 0.1 Gy acute to my trunk as a one-person study to see
if it affects my immune system in any measurable way. My basic
concern is the chance that the mechanism for improved immune system
may not yet be known and thus a negative result on measuring present
components of the immune system may be negative even though my health
might improve. Jim Welsh, a rad. oncologist at UW is interested
in the possibility.
I
don't claim that either the radiologists study or the NSWS proves
anything. They provide encouragement for doing a double blind
study. A problem is to get unemotional discussion on the
issue.
Best wishes, John
It pains me to point out a problem with
a conclusion I like (radiation helped
radiologists) from a researcher for whom I have the highest respect (
John
Cameron), but I must to be consistent. So I enclose the comment I
sent John.
"I would question that the radiologist study is as impressive as
the NSWS because
of differences between radiologists and other physicians. When I
checked with my
friend Bob Cihak, Past President of our Association of American
Physicians and
Surgeons (more scientific than political like AMA) and a radiologist,
he said,
"Yes, I for one chose radiology to avoid the 80 hour work weeks
of other
residencies and specialties."
Radiologists are less type ":A", adrenergic, subject to
heart attacks. Using
other physicians as controls is as unsatisfactory as Field using c35%
smokers as
controls for lung cancer cases with c95% smokers."
Cameron is promoting a placebo-controlled trial, and Field made great
effort to
match controls, but it is difficult. You can't really PROVE
anything to a
properly skeptical epidemiologist, even using placebo, and with some
reason. I
give the current example of estrogen-progestin being declared bad for
the heart by
the huge Women's Health Initiative at many large Universities because
of 6 more
cases (1.3 times placebo). They did not report separately the
ever-smokers, who
had about 4.0 times never-smoker cardiovascular deaths, when both
took
estrogen-progestin after age 45 ( Layde PM, Beral V Further analyses
of mortality
in oral contraceptive users; Royal College of General
Practitioners’ Oral
Contraception Study Lancet 1981). WHI
didn't report data separated for
ever-smokers. When they do (quietly, with embarassment), I predict
never-smokers
will be found to have significantly LESS heart disease when taking
estrogen-progestin than placebo. What is true for some (radiologists)
may not be
true for others who seem the same (physicians generally).
I believe most Americans don't have enough ionizing radiation. We
need placebo
controlled trials. Will Bill Field and John Jacobus sign on to the
ethics?
Howard Long
Gary Isenhower wrote:
> I agree with Jerry 100%. Also, the discrepancy between
radiologists and
> non radiologists is very remarkable - so much so, that the lack
of any
> comment on it is equally remarkable.
>
>
_______________________________________________
>
> Gary
Isenhower
> 713-798-8353
>
garyi@bcm.tmc.edu
>
> Jerry Cohen wrote:
> >
> > Although I took a few courses in
the subject many years ago while in
> > grad school, I would also not consider myself an
epidemiologist. However, I
> > don't believe that the practice of epidemiology
requires abandonment of
> > common sense.
> > Of course, it is best to base
studies on the best data one can obtain.
> > Sometimes such data are simply unavailable and reasonable
assumptions must
> > be substituted.
> > In this regard, precise dosimetric data on radiation
exposure levels for
> > radiologists vs.
> > non radiologist physicians are unavailable. However,
isn't it reasonable to
> > assume that
> > radiologists generally experience significantly greater
radiation exposures
> > than do other specialists--- or that they do not
smoke significantly more
> > or less? Similarly, lacking precise data, isn't it
reasonable to assume that
> > smoking habits in high vs. low radon areas are about the
same?
> >
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--
John R. Cameron (jrcamero@facstaff.wisc.edu)
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