Questioning the Very Status of the Ministry of the Environment Expert Meeting Regarding the Status of Disaster Victims' Health Management



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:

  1. 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.
  2. 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.
  3. 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 Japan1. 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 out2 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 talked3 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 estimation4 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 meetings5. 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 Foundation6, 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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