Questioning
the Very Status of the Ministry of the Environment
Expert
Meeting Regarding
the
Status of Disaster Victims' Health Management
It
might have been a slip of a tongue, but Chairman Shigenobu Nagataki,
an emeritus professor at Nagasaki University, a former chairman of
Radiation Effects Research Foundation, and a mentor to infamous
Shunichi Yamashita, appeared to be speaking earnestly when he said,
"Committee members, please do not hesitate to ask questions.
Given what was just stated, it will be disastrous for this committee
to have to conclude that there is an actual increase in thyroid
cancer [due to the Fukushima accident]." Toshihide Tsuda, a
physician and an epidemiologist at Okayama University, has just
emphatically stated that in certain Fukushima municipalities there
was a clear evidence of a thyroid cancer epidemic in those who were
18 or younger at the time of the March 2011 accident. Calling this an
“outbreak, occurring only 3.1 to 3.2 years after the accident,”
Tsuda stressed that in the near future, thyroid cancer would begin to
appear in those with relatively longer latency periods, which means a
quick action is needed to secure adequate medical resources in order
to be able to provide diagnosis and treatment in a timely manner.
This
conversation happened during the eighth session of the Expert Meeting
Regarding the Status of Health Management of Residents Following the
Tokyo Electric Fukushima Daiichi Nuclear Power Plan Accident, held by
the Ministry of the Environment on July 16, 2014. The Expert Meeting
was originally established in order to discuss the health care and
radiation exposure aspects of the Children and Disaster Victims
Support Act, which was approved by the Diet in June 2012.
As
a background, Fukushima Prefecture is already conducing health
management survey for the residents utilizing a fund established by
the national government. However, the national government is in need
of discussing the current status of health management and its
challenges in Fukushima Prefecture as well as the surrounding
prefectures from a medical viewpoint. In addition, the Children and
Disaster Victims Support Act requires the national government to take
any necessary measures regarding surveys on radiation health effects.
Based on these needs, the Expert Meeting was established within the
Ministry of the Environment to discuss, from an expert perspective,
the status of measures for grasping and assessing exposure doses,
health management, and medical care.
Fundamentals
of the Children and Disaster Victims Support Act are summarized as
follows:
providing
accurate information;
supporting
the choice of residing, moving and returning based on the intention
of disaster victims;
making
efforts for prompt alleviation of health concerns from radiation
exposure;
giving
due consideration so that disaster victims do not face unwarranted
discrimination;
giving
special consideration for children (including fetuses) and pregnant
women;
and
continuing a long-term and reliable support for radiation effects as
long as needed.
Issues
discussed at the MOE Expert Meeting were in particular related to the
Article 13 of the Children and Disaster Victims Support Act, in
regards to the study on health effects of radiation exposure and the
provision of medical care. The Article 13 reads as follows:
In
order to clarify the situation of radiation exposure caused by the
Tokyo Electric nuclear accident, the national government shall take
measures such as estimating radiation exposure doses and assessing
exposure doses using tests effective for dose assessment, and any
other necessary measures.
The
national government shall take necessary measures in regards to
implementing regular medical checkups for the disaster victims and
conducting other surveys of health effects from radiation exposure
due to the Tokyo Electric nuclear accident. In this case, necessary
measures should be taken so that those who have resided in areas
with radiation levels measured above a certain threshold as children
(including those who were in utero when their mothers resided in
such areas), or those in equivalent circumstances, shall have
lifelong medical checkups.
In
relation to the medical expenses to be borne by children or pregnant
women who are disaster victims (excluding medical care relating to
injuries or illnesses not caused by radiation exposure due to the
Tokyo Electric nuclear accident), the national government shall take
necessary measures to reduce the financial burden or any other
measures relating to the provision of medical care to the disaster
victims.
A
point of contention at the MOE Expert Meeting, headed by Nagataki,
has been the dose assessment, especially the direct measurements of
thyroid glands of 1,080 children (age 0 to 15), conducted in late
March 2011. Nagataki seemed determined to utilize the direct
measurement data, which concluded that nobody exceeded 50 mSv,
despite critical issues such as a small sample size and high
background radiation levels. He has been trying to build an “expert
consensus” regarding the validity of the direct measurement data.
However, guest presentations by experts at the Expert Meeting have
revealed that the contamination level of clothing, not the background
air dose rate, was used as the background radiation level, which was
subtracted from the actual count to obtain the exposure dose. This
could have potentially resulted in underestimation.
In
addition, Nagataki emphasized how the high kombu (a type of seaweed
with especially high iodine content) consumption rate amongst the
Japanese offered protective effects against radioactive iodine, given
the fact the majority of children never received stable iodine
tablets for thyroid blocking before exposure to the radioactive
plume. However, the actual consumption amount of kombu in last 40
years has gone down, for reasons such as the introduction of western
food in the 1970s. According to Nagataki's presentation at the 2007
American Thyroid Association meeting, the average dietary iodine
intake from seaweeds was 1.2 mg/day in Japan.
However, kombu consumption appears to be decreasing each year,
especially in younger families with children which consumed one-third
of average amount of seaweed consumption, due to decreased
consumption of traditional foods. Children's dietary intake from
seaweeds might be a quarter to one-third of Nagataki's outdated
claim.
As
each session of the Expert Meeting progressed, Nagataki worked
towards building a consensus to “scientifically” validate the
1,080 screening data for dose assessment and thus the basis for
estimating health risks, despite its shortcomings. The exposure dose
estimate from the 1,080 screening data, well below 100 mSv, which is
widely regarded by regulators and radiation protection specialists as
the level cancers might increase, would allow the government to claim
that health risks is too low to necessitate expansion of medical
checkups to wider areas and age groups. At the seventh session held
on June 25, 2014, Nagataki pointed out
that “Times are different between now and when the Children and
Disaster Victims Support Act was approved. We now have more dose
assessment data which allow us to talk about the health risks
scientifically. This is a huge difference,” when Hiromi Ishikawa,
the executive director of Japan Medical Association, pressed for
consideration of introduction of medical checkups in hotspots outside
Fukushima Prefecture, such as Matsudo and Kamagaya in Chiba
Prefecture, based on the principle of the Children and Disaster
Victims Support Act.
As
a matter of fact, in his attempt to build an expert consensus,
Nagataki appeared not to take into consideration opinions of outside
experts if they differed from his. Even more, he appeared to be
trying to disregard the very mission of the Expert Meeting:
discussing radiation health effects and health management on the
basis of the Children and Disaster Victims Support Act.
This
became the most apparent at the July 16th
session, as depicted in the July 22 Tokyo Shimbun article, translated
into English here.
Tsuda,
one of the five expert witnesses invited, claims that the current
“outbreak” of thyroid cancers in Fukushima children cannot be
explained by the “screening effect,” when the data is analyzed
and compared with the national cancer statistics as well as within
Fukushima Prefecture against municipalities with the lowest exposure
dose.
Table
1 Comparison of thyroid cancer detection probabilities within Fukushima
Prefecture
(Prevalence
Odds Ratio determined against Aizu and Soma areas as the control).
Critical
of the commonly accepted notion that health effects do not occur
below 100 mSv, Tsuda presented numerous published studies that proved
otherwise. In fact, he by far exceeded 10 minutes allotted for each
of the five expert witnesses that day, and Nagataki had to nudge him
to wrap up more than twice. Tsuda defiantly replied, “This Expert
Meeting has not brought up these studies [as it should have], so I
must do it [for you],” and went on until he was done.
Tsuda
explained that in outbreak epidemiology, which was developed as an
investigative tool in studying disease outbreaks where the cause
isn't always apparent, the effect (disease) is what is studied and
dealt with. He called the Expert Meeting's fixation on dose
assessment “backwards” and “a mere laboratory method.” Tsuda
said to Nagataki, “We must remember that this is an issue of
humans.”
Tsuda
also said that the Expert Meeting should consider the fact that all
age groups including pregnant women were still being exposed to
radiation in Fukushima Prefecture. This drew an applause from the
audience of general public, which made Nagataki displeased. He said,
“Um, this applause...haven't the audience been asked not to
applause ahead of time?” This statement also appeared to startle
Nagataki and other members, such as Otsura Niwa, a retired Kyoto
University Professor who holds a position of Special Professor at
Fukushima Medical University. Both Nagataki and Niwa, in disbelief,
had to confirm with Tsuda what he meant. Tsuda said, “We are all
being exposed to radiation in Japan, except the air dose rate is
higher in Fukushima.”
During
the debate following the presentations by the witnesses, there were
some questions regarding Tsuda's presentation as described in this
post.
Tsuda insisted that the World Health Organization (WHO) report
clearly stated thyroid cancer, leukemia, breast cancer and other
solid cancers would increase. In response, Niwa talked
about the dilemma he faced as a member of the WHO Health Risk
Assessment Expert Group, which compiled Health
risk assessment from the nuclear accident after the 2011 Great East
Japan earthquake and tsunami, based on a preliminary dose estimation
in February 2013.
Niwa
felt that doses were overestimated due to various issues with
assumptions utilized in dose estimation. He repeatedly asked the
Expert Group to employ more realistic methods to estimate doses, but
the Expert Group chose to stick to higher estimate doses, taking a
conservative and cautious approach based on a radiation protection
concept. Niwa says he disagreed with the Expert Group's decision and
argued that the conservative approach certainly would be reasonable
and indeed very important in a prospective estimation, but that it
would not be appropriate to retrospectively estimate unnecessarily
high doses in those who were already exposed. Niwa disclosed during
the discussion that he suggested reducing the estimated doses by
one-tenth, but that the Expert Group never incorporated his
suggestion. (After the meeting was over, Tsuda and Niwa carried out
further, informal discussion on whether the thyroid cancer cases in
Fukushima were due to the screening effect or not. Tsuda asked Niwa
if he has ever read a single published study regarding a screening
effect. Niwa replied, “No, not myself.” Tsuda, speaking with a
freelance journalist, Oshidori Mako, expressed his disappointment and
frustration with the Expert Meeting, as the so-called experts were
not even familiar with studies published on health effects of
radiation below 100 mSv. Tsuda felt that it was impossible to carry
out sufficient arguments as the grasp of the basic knowledge differed
so much).
During
the concluding statement, Nagataki acknowledged that the consensus of
the Expert Meeting to accept United Nations Scientific Committee on
the Effects of Atomic Radiation's (UNSCEAR's) approach to assessing
health risks, based on dose estimation, appeared to differ vastly
from the opinions of the witnesses. He stated that the Expert Meeting
was taking a serious care to consider [the well-being of] the
disaster victims and earnestly discussing the best way to carry out
health management for them. This statement contradicts the statement
he made at the June 25 session, dismissing the Children and Disaster
Victims Support Act. Most of all, if the Expert Meeting were
seriously considerate of the disaster victims whose true exposure
doses are unknowable, due to the lack of sufficient early exposure
data, why would it be disastrous for this Expert Meeting to have a
conclusion that cases of thyroid cancers might be increasing? The
Expert Meeting would be truly serving the disaster victims if it
fully embraces its mission to expertly discuss radiation health
effects and health management, adhering to the principles of the
Article 13 of the Children and Disaster Victim Support Act, from the
viewpoint of precautionary principle, rather than having prejudged
conclusions.
Other
important issues to be raised about this Expert Meeting have to do
with the potential conflict of interest. For instance, Niwa, also a
member of International Committee on Radiation Protection (ICRP) , is
known to have received financial support from the Federation of
Electric Power Companies of Japan for his travel expenses to the ICRP
meetings.
Although the WHO Expert Group cleared his conflict of interests in
this matter, citing his expertise in molecular biology and radiation
biology, he certainly appears to have a conflict of interest for the
MOE Expert Meeting.
Niwa
is not the only one with the potential conflict of interest. Chairman
Nagataki is currently a chairman of the board of Radiation Effects
Foundation,
which arranged financial assistance from the Federation of Electric
Power Companies of Japan to Niwa. Some of the members, Nobuhiko Ban
and Toshimitsu Honma, were involved with the making of UNSCEAR
Fukushima report. Yasuhito Sasaki is a former committee chairmann of
UNSCEAR.
With
the deviation from its original mission and the apparently
predetermined conclusion to underestimate health risks, along with
the potential conflicts of interest in multiple members, is it not
time to question the very status of the Expert Meeting Regarding the
Status of Health Management of Residents Following the Tokyo Electric
Fukushima Daiichi Nuclear Power Plant Accident?
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