Re: e-mail addresses, JCAHO, and the Tr

[JMUCKERHEIDE@delphi.com]

Russ Meyer wrote:
> 
> > Date:          Fri, 27 Jan 95 03:03:40 -0600
> > Reply-to:      radsafe@romulus.ehs.uiuc.edu
> > From:          John Goldsmith <gjohn@bgumail.bgu.ac.il>
> > To:            Multiple recipients of list <radsafe@romulus.ehs.uiuc.edu>
> > Subject:       Re: e-mail addresses, JCAHO, and the Trilateral Committee
> 
> >     Some of us readers may not know the nature, status, or authority
> > of JCAHO..is it the Joint Com mittee on  Alternative Health Outcomes ?
> > If health based standards are being seriously considered, by what mechanism
> > does epidemiological input get considered ?  Close as some of us in
> > epidemiology feel to public health, there is sometimes the feeling that
> > neatness and short term effects are the bywords of purely engineering-based
> > exposure standards, and that protection from possible long-term effects
> > is given second place, partly because of the real difficulties in
> > interpreting epidemiological data.  In my view, the only answer that
> > makes sense is to include epidemiologists in the group  evaluating and
> > recommending standards, and to get away from body-counting and put more
> > emphasis on biological indicators of exposure and effect.
> >                              John Goldsmith, M.D., Epidemiology Unit
> >                              Ben Gurion U. of the Negev, Beer Sheva
> >                              Israel
> dear dr. goldsmith,
> 
> you should be so lucky as to live to 86 and die of an hypothetical
> case of cancer!  in a world where safety requlations are truly based
> on risk, even people who had received Sv size doses would not
> qualify for concern. death from Pb-206 is much more of a reality in
> yours and my countries, than E-2 per Sv.  in a world of limited
> financial resources, it is criminal to spend money on assumptions
> layered upon hypothesis when so many people are dying from real and
> preventable causes.  wouldn't you agree?
> 
> Russ
 
Thanks Russ. We have a tendency to miss the essentials in the balance between
risk and cost. If anything you have grasciously understated the case. 

If the epidemiology were taken seriously, we would have achieved high
confidence from the population exposure data at moderate to high doses that
health effects from radiation exposure in the Japanese survivors, in
radiologists, in miners, in occupational groups, in medical patients, in high
natural background sources, including radium and radon, etc., are found only
above relatively high doses. ANY resources expended beyond some monitoring and 
research to verify data of important exposed populations, is money utterly
wasted for public health benefit. We ignore that substantial populations at
100-1000 times that dose level demonstrate NO adverse effects, but call them
"indeterminate" by those who would spend (con the public out of) $ millions to 
chase these results as though the null result meant we don't know if there is
an effect instead of that we actually find NO effect in moderately sized
populations at exposures 100s of times higher than the levels we are
interested in. 

EVEN accepting the highly conservative linear assumption (eg, E-2/Sv) almost
all the money we are spending for public protection is reducing <1% of
population exposure to <<1% of population exposure, producing essentially zero 
health benefit to the population for massive resources spent. This is now most 
egregious in radwaste and decommissioning where $100s Billions are being spent 
to reduce potential exposures from an actual negligible mr (calculated to a
few mr by unrealistic models), to <negligible mr. 

This is actually defrauding the public of vast resources while real health
problems are not being adequately addressed! 

Epidemiology should be applied to quantify the magnitude of risks from actual
data. When, as Dr. Goldsmith proposes, we look to "markers" for exposure
because no effects can be found, we must first determine that the markers
reflect health effects. Just because I have a skin blemish from some exposure
doesn't mean I have a reduced qualtiy or length of life; and current cellular
and molecular biology and genetics demonstrates that neither does the record
of radiation exposure, measured by counting rings and dicentrics, etc, have an 
effect on monitoring or measuring health and long term effects (the very high, 
Sv+, exposure populations demonstrate such results). Its reasonable to fund
basic research on the matter, but not reasonable to expend substantial public
health funds on the presumption that tracking such populations relates to
managing potential health risks. 

Regards, Jim Muckerheide