Circumstances Regarding the Japan-Sponsored IARC Expert Group on Thyroid Monitoring After Nuclear Accidents (TM-NUC)

On October 23-25, 2017, the Expert Group on Thyroid Monitoring after Nuclear Accidents (TM-NUC) met in Lyon, France for the first of two planned sessions (see this PDF for the agenda). The TM-NUC project was established by the International Agency for Research on Cancer (IARC) in order to "develop strategies and recommendations on how to plan and implement thyroid monitoring in populations possibly affected by radiation exposure due to nuclear accidents." 

The aims of the TM-NUC project are to: 

assess the latest scientific evidence on the epidemiology, natural history, and clinical management of thyroid cancer, to develop principles for thyroid ultrasound examinations after nuclear accidents. This includes reviewing the scientific literature and compiling knowledge and experience from relevant countries. 

identify unmet research needs and propose epidemiological study designs to address these gaps in knowledge.          

According to the TM-NUC website, 

The Expert Group consists of 16 international experts from a variety of fields, including cancer screening, radiation epidemiology, radiation dosimetry, pathology, oncology, endocrinology, and surgery, and is supported by a Scientific Secretariat (Chair and Scientific Coordinator) from the IARC Section of Environment and Radiation.  

The primary goal of the Thyroid Monitoring after Nuclear Accidents (TM-NUC) project is to use current scientific evidence and past experience to develop principles for thyroid monitoring in populations possibly affected by radiation exposure due to nuclear accidents. Such principles will help guide policy-makers and health professionals in planning thyroid monitoring in case of nuclear accidents.

The TM-NUC project is funded by the Ministry of the Environment of Japan.     

Next meeting is scheduled for February 21-23, 2018, and the final recommendations are expected by the end of April 2018.

The first day of the first meeting coincided with the 28th Oversight Committee for the Fukushima Health Management Survey (FHMS) held in Fukushima City, Fukushima on October 23, 2017. That the Oversight Committee—nearly 2 months overdue and rumored to have been originally scheduled for October 16—convened on the first day of the TM-NUC Expert Group meeting may be purely coincidental. Nevertheless, circumstances leading to the birth of the TM-NUC are curious enough to warrant further consideration.

At the 26th Oversight Committee meeting held on December 27, 2016, Chairman Hokuto Hoshi stunned everyone by unexpectedly calling for a new "international, third-party, neutral, scientific, up-to-date and evidence-based" expert committee. This expert committee would discuss issues surrounding the Thyroid Ultrasound Examination (TUE) and present information in a manner that would "aid the understanding by Fukushima residents." This proposal apparently originated from the October 31, 2016 recommendations (PDF link here) by the 5th International Expert Symposium on Radiation and Health held on September 26-27, 2016. An excerpt from the item 4 of the recommendations reads as follows:

One possibility would be to convene expert working groups on issues related to the mitigation of health impacts of the Fukushima Daiichi NPP accident, and health monitoring. One of the expert working groups on “Nuclear Disasters and Health Monitoring”, especially focusing on thyroid problems, could provide professional recommendations to the current TUE in Fukushima in future. The international consensus should be shared with all stakeholders, such as national and local governments and public representatives of the affected communities, to improve the current TUE program.

Hoshi's proposal was received skeptically by some committee members as well as journalists but quickly embraced by Tamami Umeda, a committee member representing the Ministry of the Environment (MOE). According to the minutes of the proceedings (in Japanese), a committee member Fumiko Kasuga suggested an expanded role for the Thyroid Examination Assessment Subcommittee (referred as the "Subcommittee" herein) instead, with input from invited international experts, rather than establishing a brand new expert group. Kasuga's suggestion made sense if the new expert group was actually going to focus on Fukushima's TUE, especially when the Subcommittee hadn't met since March 24, 2015 and no official discussion hasn't been conducted beyond the first round results. During the press conference, some journalists questioned why a new committee was even necessary and if the need for a new committee implied that the Oversight Committee wasn't scientific enough.

Two months later, at the 26th Oversight Committee meeting held on February 20, 2017, a prefectural official stated that this "third-party" committee with a neutral standpoint was expected to organize the latest knowledge to be incorporated into discussions at the Oversight Committee and the Subcommittee. He stated that prefectural officials, assisted by the central government, were consulting with international organizations in establishing a third-party committee. Representing the MOE, Umeda stated that she envisioned a new expert group to be separate from yet supplemental to the Subcommittee. 

Three months later, on May 31, 2017, an establishment of a new international expert committee was announced in the Fukushima Minpo article (archived here). According to the article, the international expert committee, established by Fukushima Prefecture and Ministry of the Environment, would investigate causality between the nuclear accident and thyroid cancer. The article stated that selection of the committee members would be based upon recommendations from relevant academic societies within Japan as well as from international organizations specializing in radiation protection or medicine and health. Fukushima Prefecture was to explain about the plan at the June 5th Oversight Committee meeting. 

Five days later, the story took a sharp turn when a new development was revealed at the 27th Oversight Committee meeting held on June 5, 2017. This is described in more detail in this post, under the subheading "The status of the new third-party committee." In short, Umeda was searching for a World Health Organization (WHO) agency that might be a good candidate as an expert committee, when she came across an already planned international expert group by IARC that was tasked with investigation of thyroid monitoring after nuclear accidents. Umeda thought this expert group by IARC might be a good match even though it would not be actually analyzing Fukushima's TUE data. (See the minutes of the proceedings in Japanese here). Her fluent explanation of finding a planned IARC expert group made it sound as if it were a happenstance, but the details that emerged 2 days later suggest otherwise: It is very likely that this was a done deal merely being reported to the Oversight Committee.

Two days later on June 7, 2017, Umeda posted on the MOE website an open competitive bidding notice for a commissioned project involving administrative support services for the IARC expert group. A draft contract for the commissioned project (PDF in Japanese available here) is quite revealing and suggests that this might have been planned by the MOE for some time. 

The draft contract explains that IARC has proposed an establishment of an international expert group aiming to offer scientific information and advice on radiation health effects to policy makers and medical professionals in "countries" (probably means "WHO member states"). It claims that the purpose of the commissioned project is to collect information necessary for discussions regarding the FHMS by supporting the IARC expert group. The project is necessary for translation of two reports to be compiled by the IARC expert group and for compilation of a summary report and a manual. The commissioned project is expected to last until the end of December 2018, encompassing two fiscal years—FY2017 to FY2018. 

Two reports to be created by the IARC expert group already have titles: 

• Report 1: Review the latest scientific evidence and development of principles of TUE as long-term health monitoring instrument for populations possibly affected by radiation exposure due to the nuclear accidents. Research agenda how to address gaps in scientific knowledge. 
• Report 2: Detailing study and features for activities from the research agenda. 

According to the job description, the commissioned project consists of three parts: 

1. administrative work related to holding two expert group meetings and translating the final reports into Japanese
2. administrative work related to a visit to Fukushima Prefecture by the expert group (including a site visit to FDNPP and the TUE facilities, and a panel discussion with domestic experts) and creating a summary report
3. side-by-side English/Japanese translation of reports from the expert meetings and from the visit to Fukushima, with technical supervision from the standpoint of radiation health effects

The job description also lays out concrete details such as the amount of stipend to be paid to each expert member (17,700 yen or 155 USD daily), and the coverage of reimbursable travel costs (business class tickets on direct flights or flights with the fewest number of connections to Tokyo). Group members are to be about 15—4 from France, 1 from Finland, 3 from the U.S., 1 from Japan, 1 from South Korea, 1 from Germany, 1 from Ukraine, 1 from the U.K., 1 from Italy and 1 from Switzerland. 

Most administrative duties related to the expert group are to be outsourced to the IARC for 281,700 Euro. These duties include member selection and invitation, setting up and running the expert meeting, compiling meeting materials, and making payments to members for travel costs and stipends. Further, one of the FY2018 duties for the commissioned project includes making a payment of 80,700 Euro to IARC to cover the cost of the meeting. In total, the Japanese government is paying 362,400 Euro (over 422,000 USD) to cover the entire cost of the IARC expert group in the TC-NUC project. 

It is doubtful if the TM-NUC project, fully funded by the Japanese government, actually fulfills qualities originally proposed by Chairman Hoshi—international, third-party, neutral, scientific, up-to-date and evidence-based. It certainly is "international." A quick glance at the member list shows some "familiar names" such as Geraldine Thomas, casting doubt on its neutrality. A critical examination of the member composition reveals connections with entities with potential biases such as United Nations Scientific Committee on Atomic Radiation (UNSCEAR), Radiation Effects Research Foundation (RERF), and the 5th International Expert Symposium on Radiation and Health sponsored by the Nippon Foundation. 

The Expert Group may appear "third-party" to Fukushima Medical University (FMU) that conducts the TUE, with an exception of an FMU official, Hiroki Shimura. However, IARC itself has had a close relationship with FMU, visiting FMU as early as November 2012, signing Letter of Collaboration with FMU in January 2013, and conducting a joint workshop at FMU as well as a special seminar to the Fukushima Medical Association in October 2013. A report of the 2013 joint workshop has been published. 

There is also an inherent problem in the seemingly "closed" field of radiation protection with a premise to allow the use of radiation, medical or industrial. Radiation risk assessment relies on the atomic bomb survivor data as the "gold standard." However, this gold standard is actually far from perfect with missing data and disregard for internal exposure from the black rain and neutron-activated radioactive manganese 56. Any "evidence" built upon faulty assumptions is faulty by default, yet it is exceedingly difficult for "outsiders" to gain insight into such inconsistencies.

Some of the researchers may appear "neutral," yet their research interests might encompass "overdiagnosis" which is what Fukushima's cases are being attributed to by FMU officials despite lacking proper analysis of data with scientific integrity and transparency as described below. 

Included in the TM-NUC agenda is a presentation on Fukushima's TUE by Shimura. Most likely the Expert Group was given only officially released information, which is missing data on at least one unreported thyroid cancer case and potentially more. Existence of the missing data implies any studies published by FMU using the TUE data potentially lack scientific integrity. Consequently, any international organizations—UNSCEAR, WHO, IAEA, to name a few—relying on such studies would not be able to conduct proper analysis on health effects of radiation exposure. FMU officials so far have not documented the issue of missing data in English publications. Long before the missing data surfaced, members of the Oversight Committee and the Subcommittee have repeatedly asked for more detailed information on the TUE data to no avail. It is notable that even UNSCEAR has urged a release of more pertinent information, such as "more detailed breakdowns of the numbers of young people screened, and of confirmed/suspected thyroid cancers by tumour size, and by age at irradiation, and age at screening, and sex," in the 2017 White Paper (see paragraph 123).

The TM-NUC agenda also includes a presentation on EC-funded SHAMISEN project ("SHAMISEN" is a reverse acronym for "Nuclear Emergency Situations Improvement of Medical and Health Surveillance") which issued a recommendation against systematic thyroid cancer screening. (Click on "R25" here for details. See the whole recommendations here). This presentation was given by Evgenia Ostroumova and Ausrele Kesminiene from IARC's Section of Environment and Radiation. Timing of the presentation towards the end of the meeting by members affiliated with IARC—which constitutes the core of the Expert Group—easily leads to speculation that IARC might be facilitating political, rather than scientific, decision-making. 

Even at this point when the first meeting has already occurred, no official announcement has been made in Japan regarding the progress of the IARC Expert Group or its member composition. Moreover, existence of the SHAMISEN project itself has not been officially announced to the general public in Japan. 

The SHAMISEN recommendations are supposedly based on science but actually characterized by a political overtone prioritizing psychological, social, and economic effects. They appear to be directed towards political policy-making. Ironically, contrary to the notion put forth by Umeda that the Expert Group would not be actually analyzing Fukushima's TUE data, the SHAMISEN recommendations, part of the presentation, already incorporate Fukushima's incomplete and biased data. It appears that IARC's TM-NUC Expert Group may be a vehicle for the SHAMISEN recommendations to be distorted into scientifically neutral recommendations to form an international consensus, with a strong potential to influence situations in post-Fukushima Japan where the future of the TUE is in debate.

Chairman Hoshi's original proposal has morphed into something far from the international committee he envisioned. What the MOE and the Japanese government will likely gain from the TM-NUC Expert Group may be an international consensus built on faulty assumptions and biased data, but perhaps that is exactly what is sought by the reconstruction-hungry government and thus totally worth 362,400 Euro.