Chernobyl deaths

[JMUCKERHEIDE@delphi.com]

Dr. Smart,

Attached below is a report on the Chernobyl accident that reflects the data
reported at all 3 of the Chernobyl conferences, including the most recent IAEA 
Conference, with an extract from the conference summary report. Needless to
say, it does not "substantiate this data" :-) 

> Hi Radsafers,
> 
> The Australian press published a report on the weekend from the Ukraine
> which included the following statement:
> 
> "Ukraine released figures showing that 2929 clean-up workers were among the
> 4229 people who had died in Ukraine as a result of the Chernobyl disaster."
> 
> Does anyone have any further information about these figures? Perhaps
> someone who was at the recent Chernobyl meeting in Vienna can substantiate
> this data. 
> 
> Regards
> 
> Richard Smart PhD
> Department of Nuclear Medicine
> St. George Hospital
> Kogarah, NSW 2217
> Australia
> Tel:61 2 350 3112
> Fax:61 2 350 3991
> Email:R.Smart@unsw.edu.au

=================================

Radsafers,

Coming back from a few days in Vienna, I'm amazed at the lack of information,
and egregious misperceptions, about the Chernobyl consequences that have
existed on the list. Since the reports on the Nov 1995 conference (presented
here at least from the Nuclear News report on the conf, along with refs to
other reports) it has been clear that there are only excess thyroid cancers.
These are in a particularly agressive form, and all in children between -6
months (ie, fetuses in the 2nd and 3rd trimesters) and mostly below 3 years
old, with a few among children as old as 5 at the time of the accident. 

The total of then-reported ~580 in a population of, if I recall correctly >4
million in the contaminated areas of Ukraine, Russia, and Belarus. This is now 
reported as 600-800 total cases. There are 3 associated deaths in this
population. Most (est 95%) of these cancers are treatable with no long term
adverse prognosis except the need for routine thyroid medication. The cases to 
date are limited to only the most highly-contaminated areas. Some increase is
yet possible, and expected, over the next few years, though the mean latency
of the cases is about 6 years with expression in the last 2 years lower than
the peak. 

It is not established that I-131 is a cause of the thyroid cancer. The
population was exposed to an undefinable source of short-lived isotopes,
including iodines, since the nuclear excursion produced an increase in the
'normal' steady-state core inventory of such short-lived isotopes (though it
had been at low power before the 'test') as it destroyed the building with an
ultimate 'quick-release' of the core inventory. The cases are not clearly
traceable to the longer-term milk-supply and other ingestion pathways of
radioiodine. External radiation may have played a strong role. (Esp since
I-131 in medical applications at the doses estimated for the cases does not
produce thyroid cancer in otherwise healthy patients, with much lower
sensitivity than from external radiation - see eg, BEIR V.)  The IAEA report
below is not adequate in addressing the uncertainty and status of addressing
this association in the health organizations (esp WHO). 

There is no excess leukemia in the population. There are cases of leukemia
deaths in the high-dose cleanup workers (100s of cGy) that are considered to
be associated with their exposure. These numbers bring the total deaths from
Chernobyl to estimates of 42 and 'less than 50' (including the original 31
deaths, 28 from acute radiation exposure). 

Since no one except Dr. John Goldsmith (thank you Dr. Goldsmith!) has provided 
substantive data from the official reports in response to the appalling
misperceptions and misrepresentations and lack of information, an extract from 
the IAEA summary on the health effects of Chernobyl is attached below. (This
was much better discussed on the CNS listserver.) 

It would help for the HP community to become more informed and less hysterical 
about the perceptions and misrepresentations of the health effects and 'risks' 
from Chernobyl, esp when considering also the potential future risks, either
from the sarcophagus or the current fires. Remember, there are no
radionuclides being produced. There are only the remaining long-lived
nuclides. If there are negligible consequences from the original inventory
with full reactor energy and graphite fires to disburse the short-lived core
inventory, clearly there are no significant risks from the residual
radioactivity. 

As has been reported, the population has been removed from the area at
concentrations/doses that are lower than natural high-dose regions of the
world, in which there are no increased adverse health effects (though with
many data showing positive health effects). As Dr. Jaworowski stated: "why
don't we evacuate all of Norway which has a higher MEAN dose than the
evacuation limit for Chernobyl?" much less the higher doses of the actual
high-dose areas. In blowing the residual Cs-137 around in the fires, or in a
collapse of the sarcophagus (considering the 'elephant-feet' forms of the
solidified core material, and the routine access to that facility that has
been going on for the last 10 years) there is no meaningful radiological
potential for adverse human health consequences. It's less a discharge than
from many mining operations, or spreading phosphate fertilizers, or... etc,
etc.  

Consider the actual concentrations and calculate the material releases and
compare to actual data before presuming adverse consequences - even if it is a 
million times more radioactivity than you are concerned about in your
regulatory limit-driven actions - remember also, those regulatory limits have
nothing to do with public or occupational heath risks either!  :-) 

There are still the possibility of solid tumors in the high-dose population,
primarily the cleanup workers (though eg, the Japanese fishermen exposed to
the 1954 Bikini test fallout for 4 1/2 hours with ash sticking to their skin
and 200-600 rad estimated doses have no adverse consequences - with 1 exposed
at an estimated 640 rad that died after 204 days). As noted, any tumors that
could be associated with the high general population doses are not likely to
be found in the normal cancer incidence. Certainly there can be none in
exposed populations at low level exposures, eg, <5-20 cGy. There are other
potential radiation-related health problems. Work must continue. It is also
thru that there are severe stresses in the population that are being expressed 
as health problems. 

It is also true that these severe stresses are primarily the direct result of
the misinformation on the nature and actuality of the risks faced by the
population, and the severe disruption of their lives, by the actions of the
"rad protection" authorities more than by the radiation (for which sufficient
medical and health effects knowledge existed before the accident to prevent
such misinformation - however fear mongering has become a way of life to the
bureaucracies and specialists, along with suppressing the access to the data
in the personnel trained to measure and follow the "rad protection policies"
absent understanding). 

The HPs say we must listen to the biologists and medical authorities, and then 
cover their ears (and shout and stamp their feet when faced with any
scientific evidence, and listen instead to the self-serving minions of the
policy agencies and their funded contractors. 

Note that Jaworowski, of UNSCEAR, in his articles reports on beneficial
effects in the data, but which are not being investigated, along with evidence 
by others; and even in the "CNN Presents" hash at the subject reported on the
very healthy animal populations living in the immediate vicinity of the plant, 
with their evidence of exposure (noting a 100 mr/day threshold!?), as is true
with high-dose human populations - eg, the high-dose Windscale cleanup workers 
being studied at the cellular level at Westlakes Research in the UK with the
ability to count cellular effects to show the exposure, but have no adverse
health effects, and noting that the 3 US scientists doing the work have no
meaningful research funds. This is while DOE is spending >>$100million for the 
Hanford and other totally-useless-except-for-fear-mongering "health effects
studies" (but well worth the price/investment measured in payback for public
support to spend $10s Billions at Hanford for "cleanup", and >$Trillion for
other "cleanup" work - and hey, if they can't build reactors, and can't make
bombs, they need to find something to stay in business! :-)  Remember, the
measure of success is not results, its program funding and billable hours. The 
path to promotion and importance. 

And FDA/CDC don't want to study 0.5-2 Million US children in the 50s and 60s
exposed to 2000 rad/series nasal radium exposures - some with multiple series
- that have 10s-200 rad to surrounding glands and tissues, with preliminary
evidence of adverse effects. 

But then a woman from DOE came on the CNN show at the end to say that this
evidence 'will change all we understand about radiation biology and health
effects' (paraphrased till we get the videotape). Does anyone know who's
following this research at DOE, or elsewhere? The lead researcher was from
Georgia. 

Thanks.

Regards, Jim Muckerheide
jmuckerheide@delphi.com
Radiation, Science, and Health, Inc.
=========================================

   Radiation doses 
   ---------------

 7. The 200,000 persons who participated in 1986-1987 in 'liquidation' of
the accident received average doses in the order of a hundred mSv. Around
10% of these received doses of the order of 250 mSv, a few percent
received doses greater than 500 mSv, while perhaps several tens of the
people who responded initially to the accident received potentially lethal
doses. 

 8. Among the public, the 116,000 people evacuated from the exclusion zone
in 1986 were among those who received the highest doses (10% received more
than 50 mSv and 5% more than 100 mSv). 

 9. The radioiodines delivered radiation doses to the thyroid gland.
Iodine, either inhaled from the initial radioactive cloud or ingested in
foodstuffs, mainly contaminated milk, was absorbed into the bloodstream
and accumulated in the thyroid gland. According to the measurements
carried out on 150,000 people in the Ukraine and also in Belarus and
Russia, the 1986 INSAG report on the accident, and according to all other
international evaluations to date, doses to the thyroid were suspected to
be particularly high compared with other body organs, especially those of
children. Equivalent doses to the thyroid were reported to be up to
several sievert or more*. It is difficult to reconstruct individual
thyroid doses for the entire population. 

 10. Doses to the populations in various countries of the northern
hemisphere caused by the accident have been assessed by UNSCEAR, including
average doses to various countries. This committee estimated that the
individual doses outside the former Soviet Union due to the accident have
been as follows: 

      - the highest national average first year dose was 0.8 mSv; 

      - the highest regional average committed dose over the 70 years to
        2056 was 1.2mSv

 11. The International Chernobyl Project, which was carried out in 1990 in
order to determine the safety of continued living on contaminated
territories, estimated that a committed dose (for the seventy years from
1986 to 2056) for people living in the most contaminated territories is
around 160 mSv. Recent more detailed studies have produced similar
results. For the time period from 1996 to 2056, the committed doses to the
population living in the areas with a contamination density of 185 - 555
kBq/m2 will be, with some exceptions, of the order of 5 to 20 mSv; for the
population living in the areas with a contamination density of 555 - 1480
kBq/m2 the doses in this period will be of the order of 20 to 50 mSv. 

   Clinically observed effects 
   ---------------------------

 12. The Chernobyl accident resulted in a total number of 237 individuals
who were suspected of suffering from acute radiation sickness (ARS). Of
these, 28 died due to radiation exposure. Two more individuals died due to
non-radiation causes at the accident site, bringing the total to 30
deaths. One additional death was thought to have been due to a coronary
thrombosis. 

 13. The diagnosis of ARS was confirmed in 134 cases of the 237 people
hospitalized. Of these 134, gastrointestinal damage was a severe problem
in 11 patients who received doses greater than 10 Gy, and resulted in
early and lethal changes in intestinal function. Deaths in 26 of the 28
patients who died in the first 3 months after exposure, were associated
with skin lesions involving over 50% of the total body surface area. 

 14. After this acute phase, 14 additional patients have died over the
last ten years. Their deaths do not correlate with the original severity
of ARS and may therefore not be directly attributable to the radiation
exposure. 

 15. There is little doubt that the ARS patients, also those with severe
skin injury, have received the best possible treatment in line with the
state of knowledge at the time in the most experienced centre available.
The therapy of bone marrow transplantation recommended at the time was of
little benefit. From today's knowledge this is very well understandable,
in view of the intrinsic immunological risks of the procedure, the
heterogeneous exposure characteristic for the accident situation and the
complicating other injury, such as unmanageable intestinal radiation
damage or skin lesions. The bone marrow damage can in future cases best be
managed by rapid administration of haemopoietic growth factors, of which
the most optimal combination and dose scheduling, however, still needs to
be worked out. Also for other damage, new diagnostic tools have become
available which may contribute to a more accurate prognosis and more
tailored treatment. 

 16. There is good evidence that the quality of life of the surviving
patients may be amenable to improvement. At least the more severely
affected patients suffer presently from multiple ailments and are in need
of up to date treatment and secondary prevention; also their mental health
might be affected. More has to be done in the future to distinguish among
the disease patterns encountered between those attributable to the
radiation exposure and those due to confounding factors intrinsic to the
population. The follow-up of these patients needs to be assured for the
forthcoming two to three decades. 

   Thyroid effects 
   ---------------

 17. Ten years after the Chernobyl accident, the highly significant
increase in thyroid cancer in those exposed as children in the three most
affected countries is the only evidence to date of a public health impact
of radiation exposure as a result of the accident. 

 18. This great increase in childhood thyroid cancer has been observed in
Belarus and Ukraine and to a lesser extent in the Russian Federation
following the Chernobyl accident. The number of reported cases up to the
end of 1995 are about 800 in children between 0-15 years old at the time
of diagnosis. More than 400 of these cases are observed in Belarus. The
diagnosis has been confirmed in most cases by international experts. 

 19. The increase has been observed only in children who were born or had
already been conceived before the time of the accident. The incidence of
thyroid cancer in children born more than 6 months after the accident
drops dramatically to the low levels expected in unexposed populations.
Most of the thyroid cancer cases are concentrated in areas that have been
heavily affected by radioactive contamination released by the damaged
reactor. Thus both temporal and geographical distribution clearly indicate
the relationship to radiation exposure due to the Chernobyl accident. 

 20. Analyses by cohort at age of exposure confirmed the hypothesis that
very young children were at the greatest risk. It is now believed that
there may be a continuing increase in the incidence of thyroid cancer
particularly in those exposed as young children. This could make thyroid
cancer relatively common in the three republics in the future, requiring
major resources to cope with the increase. 

 21. Radioiodine was one of the major radioactive components released by
the reactor. The fact that the thyroid gland concentrates iodine supports
the concept that one or more radioactive isotopes of iodine are the
causative agents. 

 22. The latency period between the accident and the diagnosis at present
ranges between 4 and 10 years, with a mean of about 6 years. This latency
period is a little earlier than expected on the basis of previous
experience related to acute exposure to external radiation. 

 23. At presentation the majority of the tumours were in an advanced stage
showing extension to tissues outside the thyroid gland and/or lymph node
metastases and less frequently distant metastases. This finding is strong
evidence that the observed increase cannot only be attributed to increased
ascertainment due to screening. 

 24. The pathology of virtually all the cases shows papillary carcinomas,
many with an unusual solid/follicular pattern of growth. The molecular
biology of the cases so far studied has not shown any major differences
from tumours of the same type in thyroids not exposed to radiation. 

 25. So far a very small number of children (three) have died of this
disease. Although only short term follow-up data are available at present,
these post-Chernobyl papillary thyroid cancers in children, in spite of
their aggressiveness, appear to respond favorably to standard therapeutic
procedures if appropriately applied. This emphasizes the need of an
accurate and continuing follow-up of the affected children in order to
establish adequate therapy. Life-long administration of L-thyroxine to
these children is mandatory after thyroidectomy. 

 26. Iodine prophylaxis through the distribution of pharmacological doses
of iodine is a recognized measure for reducing the thyroid exposure to
radioiodine and should be applied under strictly defined conditions to
populations at risk in the unfortunate case of a future accident. In any
case, correction of iodine deficiency prevalent in the affected areas is
recommended through the consumption of iodized salt in food. 

   Longer term health effects 
   --------------------------

 27. Apart from thyroid cancer, there has been no statistically
significant deviation in the incidence rates of other cancers attributable
to radiation exposure due to the accident. In particular, to date no
consistent attributable increase has been detected in the rate of
leukaemia, one of the major concerns after radiation exposure. Leukaemia
is a rare disease, and the estimated numbers of radiation induced leukemia
deaths according to predictive models (based on data from the Japanese
atomic bomb survivors and others) are small: of the order of 200 among the
3.7 million residents of the contaminated territories and 200 among the
200,000 liquidators (who worked in 1986-87). According to current models,
150 of these 200 excess leukemia cases among the liquidators, would have
been expected to have been seen in the first ten years. However, the
numbers actually observed are consistent with the spontaneous incidence of
leukemia for this period. 

 28. Increases in the frequency of a number of non-specific detrimental
health effects other than cancer among exposed populations, particularly
among liquidators, have been reported. It is difficult to interpret these
findings because exposed populations undergo a much more intensive and
active health follow-up than the general population. If real, these
increases may be attributable to stress and to anxiety resulting from the
accident. 

 29. Existing national registries should be strengthened by following, in
more detail, selected groups among the liquidators with carefully designed
protocols applied uniformly to analyse and possibly separate confounding
factors. 

   Other health related effects: psychological consequences, stress,
   -----------------------------------------------------------------
   anxiety etc. 
   ------------

 1. Several important studies and programmes have been conducted during
the past ten years in the area of social and psychological effects and
reactions to the Chernobyl accident. 

 2. There are significant non-radiation-related health disorders and
symptoms, such as anxiety, depression and various psychosomatic disorders
attributable to mental stress among the population in the region.
Psychosocial effects, unrelated to radiation exposure, resulted from the
lack of information immediately after the accident, the stress and trauma
of compulsory relocation, the breaking of social ties, and the fear that
radiation exposure is damaging and could damage their and their children's
health in the future. It is understandable that a population who had not
been told the complete truth for several years after the accident continue
to mistrust official statements and instead feel that all kinds of
illnesses that are now increased must be due to radiation. This
misperception of radiation risks and the resulting distress are extremely
damaging to the people. 

 3. The highly politicized handling of the accident s consequences has led
to psycho-social effects among the population that are extensive, serious
and long-lasting. Severe effects include a feeling of helplessness and
despair leading to social withdrawal, and little hope for a positive
future. The effects are being prolonged by the protracted debate over
radiation risks, necessary countermeasures and general social policy, and
also by the appearance of the thyroid cancers attributed to the early
exposures. It is extremely difficult to distinguish these effects from
effects associated with the collapse of the USSR and economic hardship. 

 4. There is an urgent need to develop trust the personal ability to
influence one's life situation and to induce positive change; to encourage
small-scale and communal projects aiming at positive development of the
local situation, and support organisations promoting rehabilitation of the
population concerned; to increase public knowledge of radiation and
protective behaviour; and to develop, integrate and sustain existing
networks involving local authorities, specialists and researchers in the
social and psychological field of activities.