Asahi Shimbun's revealing "Prometheus Trap" series has been featuring previously unpublicized stories surrounding the Fukushima nuclear accident and its aftermath. Its latest series, called "Doctors Advance on Frontline," describes what was going on at Fukushima Medical University shortly after the Fukushima nuclear accident began to unfold.
Excerpted and translated from "Prometheus Trap: Doctors Advance on Frontline #18, #19 and #20," published on November 5, 6, and 7, 2013, respectively.
Fukushima Medical University is located in Fukushima City, 60 km west of Fukushima Daiichi nuclear power plant. Fukushima Medical University Hospital staff was not uninformed and inexperienced about the care of radiation-exposed patients despite its designation as a radiation exposure medical care facility. The hastily set up decontamination station was ill-equipped and poorly-staffed. In fact, physicians on staff at Fukushima Medical University Hospital felt betrayed and overwhelmed that, instead of the "super team" of radiation specialists promised to come to take care of the radiation exposed individuals, the burden was heavily and mercilessly placed upon their inexperienced shoulders. Anxiety and fear mounted amongst the staff, with some, especially women, wanting to leave the hospital and evacuate with their children.
Meanwhile, Fukushima Medical University’s own disaster response headquarters, located in the hospital president's office, began to consider the distribution of stable iodine to residents after the radiation levels at the entrance to Fukushima Daiichi nuclear power plant increased on March 12, 2011. Stable iodine saturates the thyroid gland with nonradioactive iodine to prevent the radioactive iodine uptake by thyroid gland, thus preventing radiation-induced thryoid cancer. Thyroid cancer incidence skyrocketed, especially in young children who rarely develop thyroid cancer, after the Chernobyl accident in 1986. Vice president of the hospital and pediatrician, Mitsuaki Hosoya, thought residents must be really anxious about the situation, considering that hospital staff evidenced fear of radiation. He thought they needed to establish a system for immediate administration of stable iodine to residents in case the need arose. They decided to have neighborhood pharmacies administer stable iodine, which would allow every Fukushima resident to take it.
Vice president of Fukushima Medical University Hospital and pediatrician, Mitsuaki Hosoya
(Photo from Asahi Shimbun)
On March 13, 2013, the head of the hospital pharmacy contacted the president of Fukushima Pharmacist Association, who immediately agreed to cooperate and quickly faxed an instruction on how to make iodine syrup for babies and infants to 850 pharmacies in Fukushima Prefecture. The hospital pharmacist learned from Fukushima Prefecture that there were 240,000 stable iodine tables and 6 kg of stable iodine powder, and additional 500,000 were being ordered. The pediatrics department at the hospital already knew how many children had evacuated from areas near the Fukushima Dai-ichi nuclear power plant: these children would be needing the stable iodine the most. They had decided to tell the residents on television to go to the nearest pharmacy for the stable iodine distribution and administration.
The fax button that sent an instruction on how to make pediatric-dose iodine syrup to 850 pharmacies in Fukushima Prefecture. (Photo from Asahi Shimbun)
However, Hosoya was prepared to ignore this statement, thinking the danger of thyroid cancer weighed more than the potential side effects, if the need ever arose.
Also in the morning of March 14, 2011, Fukushima Medical University administrators began to look for someone who could explain the danger of radiation to the staff to calm their fear of radiation. Shinichi Suzuki, an endocrine surgeon, said Shunichi Yamashita, an endocrinologist at Nagasaki University, who conducted thyroid research in Belarus after the Chernobyl accident, was "the only person who could explain about radiation in an easy-to-understand yet scientific manner." An official arrangement between Nagasaki University and Fukushima Prefecture was made for Yamashita to come to Fukushima Medical University, upon an official request by Fukushima Governor, to present accurate scientific knowledge of radiation.
Meanwhile, Fukushima Medical University was distributing stable iodine to the staff members in order to calm the fear, anxiety and confusion amongst them, especially in young women and those with children. Top priority was given to medical staff under age 40 who would be engaged in medical care of the radiation-exposed and personnel who were taking radiation measurements in the hospital. Next in line was staff in outpatient clinics under age 40, followed by female staff under age 40. The top priority group was given stable iodine beginning on March 12, out of 1,000 tablets in stock. By noon on March 15, 4,507 tablets were distributed as more stable iodine tablets came in from the pharmaceutical wholesaler. 4,000 tablets were received from Fukushima Prefecture on March 15, 2,000 more from the wholesaler on March 16, allowing distribution to Fukushima Medical University teaching faculty and office personnel. The timing of administration was left up to each work site, but many apparently took it as soon as it was distributed.
After a Hiroshima University professor from the acute radiation exposure medicine management headquarter set up by the Ministry of Education, Culture, Sports, Science and Technology told them there was a potential danger of Unit 4 exploding in the evening of March 15, a decision was made to distribute the stable iodine to children of the staff. Children were to be administered the stable iodine either "at the time of explosion" or "when the air dose rate is 100 μSv/h."
Everyone at Fukushima Medical University was to keep secret the fact the stable iodine was distributed.
Although the hospital staff appeared to calm down after the distribution of stable iodine, Fukushima Prefecture was not giving them permission for administration of stable iodine to residents as planned by the vice president of the hospital, Hosoya. He had to leave the decision to Shunichi Yamashita, who was to come to Fukushima Prefecture on March 18.
Nagasaki University Professor, Shunichi Yamashita
(Photo from Asahi Shimbun)
At 6 pm on March 18, Shunichi Yamashita did a presentation, along with two colleagues, Naoki Matsuda and Noboru Takamura, to about 300 staff members of Fukushima Medical University in a large conference room. Yamashita focused on the presumed necessity of stable iodine, insisting that it was not necessary to administer stable iodine:
1) Prevention of thyroid cancer by stable iodine is a misunderstanding and nothing more than "Iodine belief." Japanese people's thyroid glands would only absorb 15 to 25 % of radioactive iodine, whereas Belarusians would absorb 40 to 50 % of radioactive iodine.
2) Exposure dose to radioactive iodine in the 20 km zone and west of the 30 km zone would most likely be below 1 mSv. As this is significantly less than Chernobyl, the Japanese government would not order stable iodine administration.
3) The stable iodine administration manual should not be used as it contains many errors.
At the end of his presentation, Yamashita told the staff, "Please don't run away. Radiation exposure from this accident is a fate of Japan which promoted nuclear power plants despite being earthquake-prone.
Although Yamashita appeared confident, not all staff members were convinced: some physicians were obviously angry that the hospital administration arranged the presentation specifically for the purpose of calming down and soothing the hospital staff.
(End of the excerpt)
Significance of this story is multi-layered.
Why Fukushima Medical University Hospital was singled out as the facility to decontaminate and care for the radiation-exposed and injured individuals is a mystery. The hospital staff was overwhelmed due to inexperience and wondered why more experienced NIRS didn't handle the matter. Apparently, patients often were transported to NIRS after decontamination and stabilization anyway, leaving the mess of radiation contamination to be dealt with by Fukushima Medical University.
The fact that stable iodine was distributed to the Fukushima Medical University Hospital staff might be reasonable, considering they were expected to fulfill their duty on site, no matter how badly the patients might be contaminated. It could be considered not so much the privilege of being at the medical institution as the necessity for integrity of medical care structure and maintenance of moral needed to face difficult tasks. However, the fact the staff was sworn to secrecy could appear to make it all about privilege. If it is any consolation, at least the hospital staff was seriously considering taking care of the community, ascertaining easy access for every Fukushima resident to stable iodine. It is extremely unfortunate their effort could not be carried out due to an "order" by NIRS, the institution with the knowledge and expertise in handling radiation exposure. NIRS, incidentally, was the institution that funneled the data to UNSCEAR, the United Nations Science Committee on Effects of Atomic Radiation, on behalf of the Japanese government. Just what data NIRS gave to UNSCEAR is unknown as the full version of the UNSCEAR 2013 Fukushima report is not to be published until January 2014. Curiously, the chairman of the board at NIRS, Yoshiharu Yonekura, is not only the representative of the Japanese delegation to UNSCEAR but also the UNSCEAR rapporteur for the next two years, which seems odd considering Japan is the country that is the subject of UNSCEAR's report.
The fact that the hospital staff was not allowed to execute their plan to distribute stable iodine to every Fukushima resident has potentially significant implications for children.
As of July 31, 2013, there are 18 Fukushima children confirmed with thyroid cancer and 26 more were awaiting excisional biopsy (meaning surgery to remove thyroid tissue) to confirm the equivocal result of fine-needle aspiration biopsy (meaning thyroid cells aspirated suggested they could be cancer cells). The majority of over 360,000 Fukushima children were never given stable iodine. It is anybody's guess if these thyroid cancer cases would have arisen if the children would have been given stable iodine prophylaxis. For the time being, the Fukushima pediatric thyroid cancer cases are officially considered to reflect "the screening effect" due to mass screening of asymptomatic children with the use of highly sophisticated ultrasound equipments. In addition, it is "officially too soon" for radiation-induced thyroid cancer to be detected, as the Chernobyl cases had latency of 4 to 5 years.
Curiously, Fukushima Medical University is reluctant to release any extra information about these cancer cases such as estimated exposure dose for each case, citing patient confidentiality. Shinichi Suzuki has repeatedly stated that these cancer cases are the result of screening effect and thus unlikely to be associated with radiation exposure. The Japanese government also insists that Fukushima's thyroid abnormalities are from the screening effect, considering similar percentages of thyroid ultrasound abnormalities discovered in the Ministry of the Environment (MOE) survey of three other prefectures, Aomori, Yamanashi and Nagasaki. For clarification, the MOE survey was not exactly age- and gender-matched to the Fukushima cohort, and there is some doubt about the standardization of the ultrasound procedure itself. (Parents have noted the Fukushima Medical University examination is very short, possibly not finding every abnormality that might be detected in a more thorough examination. In other words, the amount of time spent conducting the ultrasound examination might not be consistent between the Fukushima and the MOE cohorts). In addition, it should be the rate of thyroid cancer being compared between the two cohorts, not so much so-called B assessment indicating nodules equal to and larger than 5.1 mm or cysts equal to or larger than 20.1 mm, as some of these findings can turn out to be benign conditions.
Is it medically acceptable to be drawing such conclusions when the first round of thyroid examination has not even concluded? Or, is it merely their wishful thinking for it to be a screening effect?
The truth is, we may not be able to draw any definite conclusion until the first round of thyroid examinations in all Fukushima children is complete at the end of this fiscal year. The overall findings might well establish a new baseline for the actual prevalence of thyroid cancer for future comparison, if the current finding did indeed represent a screening effect. However, medically speaking, we should reserve any hasty judgement and simply observe and record what we find, yet provide appropriate and compassionate medical care including any necessary tests to assess general health conditions of those exposed, not just limited to thyroid examination.
Needless to say, Yamashita's statement, "Please don't run away. Radiation exposure from this accident is a fate of Japan which promoted and built nuclear power plants despite being an earthquake-prone country." is not only inappropriate as a physician but deeply disturbing as a human being. It could very well have been the beginning of many other "statements" he would be making from this day on.
For now, we await the upcoming announcement of the latest results of the ongoing thyroid examination on November 12, 2013.