by Mary Logan
Recent news about Hanford leaks, a flurry of news surrounding the two-year anniversary of Fukushima, and today’s news about breast cancer rates in the US center my thoughts on blind spots in health research. I will use ionizing radiation again as an illustration of environmental linkages to disease, beginning with the trigger for this post, which was a new World Health Organization (WHO) report. Previous posts about nuclear hazards are linked here and here.
This week, the WHO published a preemptive report on Fukushima, only two years after the disaster. The WHO concluded that “for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.” This conclusion is from the same organization that has been muzzled on the topic of ionizing radiation contamination of our environment since 1959, when they agreed to misinform the public in subordination to the global nuclear governing body, the IAEA, to protect civil and military nuclear interests. If you believe that Fukushima has not increased background risk and there will be no increases in cancer rates, I have a bridge to sell you. Mark Twain’s maxim about lies, damn lies, and statistics can be applied here. The point of this post is to examine western medicine’s epistemology of disease, specifically examining how we select the risk factors that are involved in cancer and other diseases.
Epistemology is the study of the nature and scope of knowledge. Our society lacks a broad understanding of how ionizing radiation behaves once it is accidentally released into the environment. There are two main reasons for this. Bednarz (2010) describes Mitroff and Silvers’ discussion of Type 3 errors, where we unintentionally solve the wrong problems through our narrow worldview and reductionist focus in science, and Type 4 errors, where we intentionally solve the wrong problems, because we are pursuing goals such as profit that subverts the science. In our western system of medical research, we commit both Type 3 and Type 4 errors as a result of our narrow worldview and our economic mandate for profit and growth. These type 3 and 4 errors result in blind spots, especially regarding environmental linkages to disease.
In another medical report this week, a new epidemiological study of breast cancer reports increasing rates of breast cancer in young women (Johnson, Chien, & Bleyer, 2013). The pattern of increased incidence in younger patients would be compatible with the epidemiology of radiation-caused cancers, which are more common in the young who have faster cell division/turnover. The increased incidence could also be compatible with many other accumulating environmental toxins.
“The number of American women ages 25 to 39 diagnosed with metastatic breast cancer — which has already spread to other organs by the time it’s found — rose about 3.5% a year from 2000 to 2009, according to a study in today’s Journal of the American Medical Association. The trend began in the 1970s, although the most rapid increases occurred in about the last decade, the study says. The study doesn’t provide any clues about what might be driving the increase, says study author Rebecca Johnson, a pediatric and adolescent oncologist at Seattle Children’s Hospital. . . .
The number of women in this age range diagnosed with advanced disease rose from about 250 a year in 1976 to about 850 a year in 2009, Johnson says. The largest increases were in the youngest women, from ages 25 to 34, the study says. There were also slight increases in metastatic diagnoses among women ages 40 to 54, but no increase in older women” (USA Today, 2/27/13).
Western medicine’s emphasis on treatment and pharmaceuticals, with abandonment of science that is focused on prevention and risk factors in fields such as epidemiology, public health, and environmental medicine points to reductionist science and the influence of money in directing the focus of research. Recently, Dr. Susan Love said that “. . . her experience [of a recent diagnosis of acute myelogenous leukemia] has emboldened her in her quest to focus on the causes of disease rather than new drugs to treat it.” This aha! moment from a well-known breast cancer researcher illustrates our blind focus on research oriented towards treatment with increasingly costly drugs that may not cure. These days, our science is often directed by funding, and funding increasingly is directed by large corporations whose incentives are to increase profit. This research emphasis leads to a focus on tertiary treatment in high-tech healthcare centers, while blind spots develop about the causes of illness, especially environmental ones, including PCBs, heavy metals, radiation, and pesticides. In Love’s case, her leukemia is even more likely to be attributable to radiation exposure than other diseases. Strontium-90 is a bone-seeker, playing havoc with bone marrow. Should we be focusing on and funding genetic testing and treatment as the future of medicine, or should we be widening our view to encompass better science about preventive care and attention to burgeoning environmental risk factors? Especially since the cost of healthcare in America is now at 18% of GDP, and rising without brakes.
There is a sea change coming in our satisfaction with medicine and the focus for our research. The environmental risk factors of many of our diseases may be a driver for that shift. Evidence-based medicine values randomized, controlled clinical trials that use reductionist methods of statistics, so there can be blind spots in what we view as causation. Potentially, heart attacks and strokes, Type 1 Diabetes, thyroid disease in women, stress ulcers, many cancers, and some other immunodeficient-related disorders are at least in part caused by or made worse by the increasing problem of radioisotopes in the food chain, for example. The hazards take years to accumulate, and do not create immediate health effects. Our food safety organizations are increasingly helpless or avoidant about the risks. The corporate nuclear lobbies make sure that science is subverted. It is important to understand the risks and to protect yourself where possible. This post is a plea to healthcare scientists to begin considering radiation as a risk.
While most healthcare professionals think in reductionist terms of single causes to illness, I can’t help but take a more integrated approach. Could radiation be a contributing cause to many of our modern diseases? I was recently discussing the impacts of radiation on the body with a good friend who is a pathology professor (MD-PhD). The professor was unaware of most of them, including the nature of “cesium heart” which is well documented in Chernobyl victims. He wasn’t buying it.
As a side note, disturbingly, Bandazehvsky’s research on the topic of cardiac effects of cesium landed him in a Russian jail shortly after he published reports critical of official research. There is a long tradition of locking up scientists who threaten the status quo. For example, Dr. Semmelweis discovered in 1847 that childbed fever could be prevented by good handwashing. For his discovery, he was ridiculed, dismissed from his post, and committed to an asylum where he died shortly thereafter. And Galileo was threatened with torture and committed to house arrest for the last decade of his life for his heresy of heliocentrism. Bandazehvsky is in good company, and his imprisonment is suspicious–was his research was too threatening?
If you look at the long arc of many modern chronic diseases over time, Type 1 Diabetes (T1D), heart attacks, and other diseases became more common in the general population after the start of above ground nuclear testing around 1950. While correlation is not causation, when one examines epidemiology studies, radiation is nowhere in sight as a risk factor. These diseases have been commonly blamed on the stress or diet of our modern lifestyles or on genetics. Study after study where I search for radiation as a potential risk factor and find . . . nothing. We have rewritten the official party line about contributors to disease and what is important in medicine. Impacts from the environment are not a threat in this new storyline.
Biomagnification and the hierarchy of energy
Where is our vaunted western healthcare system on this issue of environmental pollution? Health professionals’ training regarding environmental pollutants is minimal. For example, during our education, physicians and nurses receive a brief lecture on radiation safety during radiotherapy cures, and the impact of some of our high-tech radiation treatments and diagnostics on tissues. That’s it. We are taught to believe that the formula Dose = time X distance X shielding = protection from radiation. Medical students only get detailed knowledge of radiation sources and tissue impacts if they go on to pursue residencies in things like radiology, radiation oncology, or nuclear medicine. Most Emergency Departments have a Geiger counter in their disaster inventory closet, but most healthcare professionals would have no idea what do with it or what the numbers mean. And instead of being taught ecological medicine, research dollars promote the wonders of small-scale genetic
technology and our ability to manipulate genetic cures. In my doctoral program in the mid 1990s, genetics was hailed as the future of healthcare. As usual, we look inwards at smaller and smaller pieces of the puzzle, never looking up from the microscope to see the bigger picture looming on the horizon. The dangers from radiation are very real, and they arise from accumulation of isotopes in the food chain. Western medicine pursues high-tech cures at the top of the emergy pyramid that only perpetuate the problem of environmental pollution, as technology requires expanding power use. Instead we should be teaching our healthcare professionals an entire course on environmental medicine. Ironies abound. We are spending considerable efforts to extract the last bit of cure from our advanced health care system, while ignoring the basic socioeconomic factors such as clean food, air, and water that gave us our longevity to begin with. We are hollowing out the base of the pyramid that supports our health while continuing to pile on technological complexity at the top. We need to do the best we can to learn how to protect ourselves.
Unfortunately, protecting yourself from radiation food hazards is an ever-expanding threat requiring the use of expensive technology. A decent Geiger counter costs about $500. Your regular Geiger counter will detect a part of the range of isotopes, which will give you a relative feel for contamination. But internal contamination is ten to hundreds of times as dangerous as external exposure, depending on the isotope involved and the age of the victim. The dangers of radiation are primarily from ingestion of internal emitters which have been concentrated in the food chain over time. Nuclear promoters discount this danger by suggesting that internal exposure from hot particles is the same as external exposure. Yet logic and physics dictate that if you internalize a cesium, strontium or plutonium hot particle, you may carry that particle around permanently if it is not excreted, subjecting you to continuous bombardment. External exposure means walking by an isotope with brief exposure–that isotope may or may not emit. But when we breathe, drink, or eat an isotope, it gets absorbed and taken up into different organs depending on the type of isotope and other factors, and is then carried around for months, years, or decades, while it continues to bombard tissues at very close range. So detection of contamination in food and water needs to be much more sensitive, and limits need to be much lower. Proper measurement is performed in a lab, by drying and ashing the food and using a high purity germanium detector (HPGED). The process is time-consuming and costly, and is better suited to research than to personal protection.
So if we will be exposed anyway, despite our best efforts, why try? While Japanese food exports are relatively negligible, some people will be exposed, either from Fukushima, or from future events. In November of 2012, the US reopened food imports from Japan. And while recent reports suggested that Fukushima fallout was gone with the wind, spent fuel has some very long half-lives in its make-up, so the isotopes are not gone with the wind. The isotopes have been dispersed by wind and water, with heavy isotopes settling close-by and the lighter stuff dispersed widely. Food chain dangers will most likely accumulate over time through biomagnification in the food chain, as more and more isotopes are released from more and more disasters. We need to try to limit our exposure, because short-term health effects will kill some of us, via leukemias, cancers, and weakened immune systems. Limiting our exposure limits longer term impacts to our children and their children.
Health impacts of unseen dangers
Each isotope has different rates of biomagnification and then uptake and also different impacts in the body. Strontium follows calcium pathways in the body, so it settles in bone marrow, replacing structure and weakening bones and teeth, and causing leukemia. Cesium follows potassium pathways, lodging in muscle such as the heart. Many other isotopes act in other damaging ways in the body.
The dangers are probably still small for most foods, but hazards are tenfold to a hundredfold for children, infants, and fetuses, who have the fastest rates of mitosis and development. Rapidly dividing cells in the young are most sensitive in any organism. Similarly, organs with rapidly dividing cells are affected (bone marrow, digestive tract, skin). So risk avoidance is most important for the young.
Some of the list of long-term impacts for human health include the following:
- Circulatory damage (high blood pressure, rhythm disturbances, MI, stroke, cardiomyopathies, rhythm disturbances artery spasm, especially during cardiac stress such as temperature extremes, physical/emotional stress) (Bandazhevsky, 2001)
- Hematologic problems (leukemias especially)
- Endocrine problems (especially Hypothyroidism, thyroid nodules/Cancer, and Diabetes)
- Immune system
- Uro-genital system
- Musculoskeletal system
- Dental problems as cesium replaces calcium in teeth and bones
- Central nervous system and psyche
- The eye (cataracts and retinopathies)
- Increase in congenital malformations
- Increase in cancers
- Accelerated aging
- Increased frequency of mutations
- Fertility problems and Change in secondary sex ratio (Yablokov, 2012)
Because exposure to radiation is invisible and difficult to detect, it is far under-represented as risk factor for disease. Causes of mortality for radiation exposure are difficult to track beyond the obviously linked leukemias and cancer. Manmade radiation from above-ground testing beginning in the 1950s has been added to by military depleted uranium from expanding use in the Middle East and expanding failures in the 435 nuclear power plants (NPPs) around the world, along with the reprocessing plants. Radiation is often ignored as a reason for immunosuppression, various cancers, and perhaps even endocrine dysfunction, especially thyroid. Because radiation impacts have not been measured in the general population, radiation’s contribution to cancers and other diseases go unnoticed. Women are more vulnerable than men, and children are at least ten to perhaps hundreds of times as vulnerable as adults, because of the rapid mitosis of their cells as they grow. Fetuses are even more vulnerable.
I would be very interested in seeing an epidemiological study that examines the relationship between Type 1 Diabetes, which typically appears in children, and radiation. Anecdotal reports from physicians at Fukushima of a big increase in T1D in their pediatric patients (Fernex, Independent WHO, 2012) set me to looking for evidence. A recent epidemiology describes T1D as “environmentally triggered autoimmune destruction of pancreatic beta cells occurs against the background of genetic risk, although alternate hypotheses exist” (Maahs et al., 2010). Yet if you look at the long-term epidemiology of T1D, a sharp upturn in the incidence occurred around 1950, at about the same time that above-ground nuclear testing began (Gale, 2002). Maahs et al. make no mention of radiation as a risk factor. It is simply off peoples’ radar. Instead, we’ll blame Diabetes on climate change, since we’re blaming everything else on climate change.
Similarly, there has been a rash of sudden deaths recently in young athletes during athletic events. It will be interesting to watch trends in cardiovascular mortality post-Fukushima. Cesium has an affinity for cardiac muscle, and stroke, aneurysms, and early heart attacks are sequelae of bioaccumulation. Instead we focus on cholesterol as a cause, at least as long as cholesterol drugs are the highest-profit patented drugs in the world. Now that most statins are off patent, the guidelines are suddenly deemphasizing cholesterol control–a clear example of a Type 4 error. One only needs to look at the history of cholesterol discovery and treatment, and the correlation between patented drugs and treatment guidelines to understand the direct relationship between corporate pressures and medical evidence.
Stomach cancer has been common in Japan specifically during the last 50 years, commonly associated with diet and place of birth. Stress ulcers have increased after Fukushima independent of common risk factors such as H. pylori and drugs such as aspirin. Might internal isotope ingestion be an unseen risk factor in both? Similarly, an increase in celiac disease is being blamed on gluten. From a recent New York Times article, “All of which may explain a curious historical phenomenon — an “epidemic” of celiac disease that struck Sweden some 30 years ago. Anneli Ivarsson, a pediatrician at Umea University, recalled a sudden wave of “terribly sick” infants.” Wasn’t that the same time that a wave of radiation from Chernobyl impacted Scandinavia? If we can’t see it, and don’t measure it, can we pretend that it isn’t there? From the same article, the author notes that Finland ranks first in the world for precedence of T1D–another connection to Chernobyl fallout? Who’s to say–I would really like to see an epidemiologist tackle some of these relationships.
The best science we have on the medical effects have come from Chernobyl, but very little of the information crosses over into western medicine–a combination of reductionist thinking, taboos, and growth memes where technology equals progress. We find explanations that fit our world view. We are now discovering that inflammation is a probable cause of coronary disease, in contrast to earlier theories. What if the idea that obesity as a risk factor for heart attacks is in part related to accumulation of background radiation and fallout? These things are not on practitioners’ radar.
Bioaccumulation will get worse over time
Bioaccumulation will be variable and patchy depending on rainout, and the impact beyond more cancers will be on general immunity of the population at large, probably eventually causing some large epidemic that overwhelms the healthcare system. Food and water security are going to become increasingly important, and food from a distance will be increasingly viewed as suspect, and we will need to know if the soil we grow on is safe; just one more reason for relocalization. Organic will need to be redefined. There is a rumor that uranium tailings are sometimes added to organic fertilizers–I do not know if that is true. Babies will need to be protected strenuously as a precautionary principle. In systems with limited resources, there will eventually be stigmas, taboos, or other cultural mechanisms that feedback to control family and population size, and radiation and other environmental pollutatnts may impact these behaviors. Toxic impacts on fetuses could also create hesitancy in childbirth, along with reduced fertility. Sexual taboos such as spaced births and limits on casual sex may also reemerge, limiting procreation (Osei, 2006).
The rate of change in our world is accelerating. For the US, we’ve got to mothball our clunker NPPs and cask the spent fuel in our spent fuel pools now, while we still have the fossil fuel supports. Otherwise we’ll end up just like Japan–what are the odds? And unless you’re wealthy and privileged, there is no place to run. Eventually, there will be no ‘there’ there anymore to run to, as countries clamp down on migration and the pollution effects from a number of sources multiply.
There is too much unquestioning acceptance of current reductionist, piecemeal science funded by the military-industrial complex in this country and globally. Focused science that examines pieces of problems but misses the big picture needs balance with better, less biased funding for environmental or ecological medicine so that we can learn how to protect ourselves. Traditional ecological knowledge will be helpful in accumulating wisdom about new values for working and living within nature’s limits.
Public health and a safe, adequate food supply are arguably an uphill battle against the limits of natural selection and population control–one that we’ve been winning for the past two centuries with the help of fossil fuels. Radioisotopes in our food may be one form of natural selection as we progress. Someone has to say it–those who stay in contaminated areas or have habits of eating food from a distance or processed food may become part of that natural selection process as our economies and populations contract. Instead of keeping everyone alive as long as possible, we need to be preparing a whole new way of caring for people that allows people to die gracefully when their time comes. Our current system of medical ethics attempts to keep everyone alive at all costs, no matter what the pain, as it is embedded in a system where more care creates more profit. In a future with much less healthcare, we will need a different form of bioethics, embedded in a new system of ecological medicine with different goals.
Header art: Salvador Dali, The Three Sphinxes of Bikini, 1947
Editor note June 2013: Many of the reference links have been broken since this article was published. Health articles appear to have shorter internet shelf-lives than other types of posts.