A Letter to the Editor Regarding the Mangano/Sherman/Busby Study on Post-Fukushima Congenital Hypothyroidism in California

The following letter was sent to the editor of Open Journal of Pediatrics (OJPed) regarding the congenital hypothyroidism study by Joseph Mangano, Janette Sherman and Christopher Busby.

The letter indicated that the actual count of confirmed cases of congenital hypothyroidism (CH) from the California Public Health Department does not match the authors' count because they disregarded the actual count given to them. Instead, the authors (1) invented their own definition of confirmed cases of CH, (2) misrepresented the real definition of CH, and (3) invented a fictitious diagnostic category of CH which they call "borderline cases.” 

OJPed's response was, "Thank you for your mails. However, the letter cannot be published. And the paper published in OJPED will not be withdrawn."

Critique of the related study by Mangano and Sherman, by Steve Wing, was published here. A letter to the editor regarding the same related study by Alfred Körblein, published here, was also rejected by OJPed.

The letter was the subject of this post by Jeffrey Beall who keeps track of predatory journals. 

Also, the video by Ian Goddard clearly explains issues regarding this study as well as　another study by two of the authors.

*****

April 14, 2014

A letter to the editor of Open Journal of Pediatrics

In the article, “Changes in confirmed plus borderline cases of congenital hypothyroidism in California as a function of environmental fallout from the Fukushima nuclear meltdown,” Mangano, et al. base their conclusion on erroneous and selective data interpretation regarding the number of confirmed congenital hypothyroidism (CH) cases in the study population.

The authors obtained the newborn screening data for congenital hypothyroidism (CH) from the Genetic Disease Screening Program at the California Department of Public Health (CDPH), including the number of confirmed cases and children screened, grouped by their thyroid stimulating hormone (TSH) levels from 2009 to 2012. The CDPH office was contacted to obtain a copy of the original data used by the authors in an attempt to replicate their findings.

In California, the cutoff for a preliminary indication of CH is a TSH value >=29 mIU/L, as seen in the Newborn Screening cutoff/reference ranges dated 09/11/2013.

However, the authors erroneously state,

     “The program confirms CH cases by using only TSH scores greater than 29.0 micro international units per milliliter (μIU/ml). Any child meeting this criterion is prescribed replacement thyroid hormone, to promote normal physical and mental development. On January 1, 2011, the state changed the assay method used to calculate TSH. Scores increased in most newborns, and thus the number of CH cases also increased.” (Note: μIU/mL is equivalent to mIU/L)

Authors make several errors in the study, beginning with the passage above. First, the only thing being measured by the Newborn Screening program is an elevated whole-blood TSH level which is not a diagnosis of CH as further clinical confirmation is required for a diagnosis of CH. TSH values over the cutoff of 29 μIU/ml only means “positive” screening, and it is not true that any child meeting this criterion is prescribed replacement hormone.

In e-mail correspondence with Robert J. Currier, Ph.D., Acting Chief, Program and Policy, from the CDPH Genetic Disease Screening Program, Currier stated,

     “A presumptive positive baby (for CH) takes a serum TSH testing and other optional tests   (clinicians’ choices) such as free T4. The baby is also referred to a state-approved   endocrinology center and seen by an endocrinology specialist. Repeating follow-up if needed. If the baby is a confirmed CH case, then an annual follow-up check with the endocrine center will be established.”

Thus, the definition used by the authors of “confirmed CH cases” is inaccurate, yet the authors use "positive" screening to erroneously count confirmed cases.

Second, as for the new assay method reportedly instituted on January 1, 2011, what increased was not “the number of CH cases” alluded by the authors, but the TSH cutoff value. As Currier also states,

     “Before 2011, the cutoff value for CH presumptive positives was 25 μIU/ml. In early 2011 our labs adopted a brand new technology for TSH testing. As a result, there had been a change in TSH values at populations basis and we adjusted the cutoff to 29 μIU/ml in April 2011. In other words, before April 2011, TSH screening >=25 μIU/ml were considered as CH positives. This information (of changed testing method) was supplied to Joe Mangano as well.”

Third, the authors further define “borderline cases” as “a cautious range of 19.0 - 28.9 μIU/ml,” and add the "borderline cases" to their estimate of total CH cases. But this definition is meaningless, as CH cases are only confirmed after follow-up clinical observation and further testing.

In fact, Currier states further,

     “We do not have any definition for 'borderline cases.' TSH testing is a screening tool and only clinically diagnosed CH cases are considered 'CH cases.'” Currier added, “It is possible, although very rare, that a confirmed case would have a TSH value below cutoff and was diagnosed later clinically.”

While the authors declare that California has "a consistent definition of the disorder," conjuring the ill-defined "borderline" category to be combined with mere "positive" screening cases represents an egregious introduction of bias.

This step appears to increase the 2011-2012 CH total from 658 to 4670, inflating the p value (p < 0.00000001 for “combined confirmed and borderline cases”) in the statistical analysis. In their Discussion the authors then write "...despite having to define borderline cases arbitrarily. In California, adding borderline cases (TSH between 19.0 and 28.9 μIU/ml) to those confirmed cases (TSH over 29.0) increases the number of cases by more than seven fold." This statement confirms how data selection was biased and that the authors consider "borderline" and "positive" screening to be equal to "confirmed cases" of CH.

Currier also provided the same two sets of data that were given to the authors (see Tables 1 and 2) and additional details about the CH screening program.

Currier indicated that the data on the confirmed case count table had been updated since it was given to authors, because “in rare cases, a baby who was misdiagnosed or diagnosed with a degree of uncertainty could be removed from our registry at a later date.” However, Currier assured that it should be very close to data initially provided to the authors. Currier also mentioned that “Mangano did not use the data from this table (Table 2) in his article.”

Table 1 TSH Value Breakdown from Initial Newborn Screening in California, 2009-2012

Table 2: Confirmed case count of Primary Congenital Hypothyroidism in California, 2009-2012

Alfred Körblein, a retired physicist and independent consultant in epidemiology in Germany, plotted the number of “confirmed” cases of congenital hypothyroidism per 100,000 (Figure 1). As can be seen, an increase in the confirmed cases in the period from March 17th to December 31st shows variation similar to other time periods.

Figure 1: Incidence of Confirmed Cases of CH 2009-2013

Fourth, the authors state, at the end of the Results section, “With much larger samples than just confirmed cases, a better understanding of the true change can be approached.” The desire for larger sample size by the authors of this paper suggests a limited understanding of the CH screening program in California.

In conclusion, the study by Mangano, Sherman and Busby has critical flaws: 1) incorrectly taking raw positive screenings (TSH >=29 μIU/ml) to be confirmed CH cases, thus disregarding the correct number of actually confirmed CH cases they received from the CDPH; 2) defining a meaningless diagnostic category of “borderline” cases that has no basis in the screening program or in medical practice; and 3) claiming that the faux rate they conjured (positive screening results plus "borderline" screening results) is a valid construct; and 4) claiming that the CH increase in 2011 was statistically significant, whereas the plotting of the number of actual clinically confirmed cases from 2009 to 2012 clearly shows no significant increase.

Sincerely,

Yuri Hiranuma, D.O.

Member, Radiation and Health Committee, Physicians for Social Responsibility

Comedienne/Journalist Mako Oshidori Exposes the Truths at the Press Conference in Germany

On March 4-7, 2014, shortly before the third anniversary of the Great East Japan earthquake and tsunami and the subsequent Fukushima nuclear accident, an international conference was held, 25 minutes outside of Frankfurt, on "Effects of Nuclear Disasters on Natural Environment and Human Health," co-organized by the German chapter of the International Physicians for Prevention of Nuclear War (IPPNW) and the Protestant Church in Hesse and Nassau. (Program PDF here).

Mako Oshidori, a Japanese comedienne and a freelance journalist, was part of the press conference on March 6, 2014. The Ustream video in Japanese can be found here, and her presentation begins around 5 minutes and 20 seconds into it. The press conference was attended by multiple German media outlets. This German article covered the content of her presentation well.

Mako Oshidori was enrolled in the School of Life Sciences at Tottori University Faculty of Medicine for three years, studying basics of medical research, before leaving school to go into comedy. Mako Oshidori is a regular at the TEPCO press conference, known for her sharp and tenacious questions. Mako Oshidori herself discovered a TEPCO memo telling officials to "cut Mako-chan('s question) short appropriately." As a freelance journalist, she covers not only the Fukushima nuclear accident but other important health issues such as Minamata disease and asbestos. Although she considers nuclear power plants unnecessary for Earth, she doesn't consider herself an anti-nuclear activist. She is simply a journalist investigating various health issues including the radiation exposure issues.

"Stunning Story from a Fukushima Daiichi Nuclear Power Plant Worker" is an example of her investigative report translated into English.

The transcript of her presentation has been translated into English below.
*****

My name is Mako Oshidori. I am sorry I speak in Japanese.

I would like to express my gratitude to the IPPNW, the Protestant church, and people in Germany, for giving me this opportunity to speak here today. This means a lot as there are not many opportunities given within Japan to widely publicize issues regarding the current situation in regards to the nuclear accident. Therefore, I was really surprised to discover, on this trip to Europe, that Europeans consider Japan as a free, democratic country.

As a journalist, I have attended the TEPCO press conferences more than anybody. I am considered a veteran journalist despite my younger age. The pressure is placed on me from different sources when I try to disseminate the information in media. 

If I write one article about the nuclear accident for a magazine, the utilities industry group would demand to have pro-nuclear articles to be published in the same magazine three times. At the end, the magazine ended up not publishing my article. There was also the pressure from sponsors not to let me use the words such as a “nuclear accident” and “Tokyo Electric (TEPCO)” at all on television, when I would talk about the TEPCO nuclear accident. As a result, I was not able to go on television. 

Japanese electric companies like to use nuclear power, and it was when the Japanese government decided to restart nuclear power plants, in order to continue using nuclear power last fall, that the government agents began following me for surveillance. I heard about it from researchers who were my friends as well as some government officials. I will show you a photo I secretly took of the agent, so you know what sort of surveillance I mean.

When I would talk to someone, a surveillance agent from the central government’s public police force would come very close, trying to eavesdrop on the conversation. The person I am talking to would ask me if the man was my manager. I would tell them that I had no idea who the man was and that I thought he was perhaps one of my groupies. Thus we are not given freedom of broadcasting whatever we want. There are some journalists belonging to major media outlets who do serious reporting on the nuclear accident, but they are under such pressure that the Japanese people are not informed of the realities of the nuclear accident even within Japan.

Next, I would like to talk a little about my interview of a nurse who used to work at Fukushima Daiichi nuclear power plant (NPP) after the accident. 

I would like to tell you about the realities of the nuclear power plant workers. He was a nurse at Fukushima Daiichi NPP in 2012. He quit his job with TEPCO in 2013, and that’s when I interviewed him. 

As of now, there are multiple NPP workers who have died, but only the ones who died on the job are reported publicly. Some of them have died suddenly while off work, for instance, during the weekend or in their sleep, but none of their deaths are reported. Not only that, they are not included in the worker death count. For example, there are some workers who quit the job after a lot of radiation exposure, such as 50, 60 to 70 mSv, and end up dying a month later, but none of these deaths are either reported, or included in the death toll. This is the reality of the NPP workers. There is too much pressure for me to write an article on this issue, so not many Japanese people know about it.

Next, I would like to briefly talk about when I interviewed some Fukushima mothers. 

They collect signatures for a petition appealing to the local government not to use foods produced in Fukushima in school lunches for their children. Currently, not many people are purchasing Fukushima produce for fear of radiation contamination. So the policy was established to feed it to children first to appeal the safety of the food. In Fukushima Prefecture, 70% of the areas was originally using Fukushima produce in school lunches prior to the accident. Even in the areas which were not using Fukushima produce before the accident, the policy now is to feed it to children in order to appeal to the public how safe the Fukushima produce is. The mothers are opposed to it and want to have officials use food from uncontaminated areas in school lunches. There are various arguments in regards to this, such as a need for measuring the radiation levels of food, but their claim is that it is wrong to take advantage of children in appealing the safety of food.

This is from when I visited Fukushima Prefecture in 2012 with a Belarusian researcher, Alexey Nesterenko, who is the head of BELRAD. 

He was most surprised about an elementary school in Date City, Fukushima Prefecture. As you can see, in the section right by the fence next to the swimming pool, the radiation monitor is registering 27.6 μSv/h. 

He asked me if the children at the school had evacuated, and I told him they were in class right then. He was extremely astonished and said that was the radiation level which would necessitate immediate, mandatory evacuation of the children in Belarus. He said he thought Japan was a wealthy country and wondered why children were in class there as if nothing ever happened. This area has an especially high radiation level. There are hot spots like this in Fukushima.

Next thing I would like to talk about is the health survey in Fukushima Prefecture. This is from when Fukushima Prefecture and International Atomic Energy Agency (IAEA), an organization which promotes peaceful use of nuclear energy, signed an agreement of cooperation in health survey and other information relating to the nuclear accident. It covered cooperation in the health survey and the decontamination effort. 

However, at the information session, Fukushima residents strongly opposed having IAEA, a pro-nuclear agency, involved with their health survey. After the press conference, I directly asked the Governor of Fukushima Prefecture what he thought of more than half the residents opposing to the cooperation between IAEA and Fukushima Prefecture. He answered that the residents would just have to understand it was necessary. 

The agreement by IAEA and Fukushima Prefecture is a problem, but there is another problematic document. This is a document which was released in May 2011 by the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology to universities, academic societies and research institutions all over Japan. I am really sorry this is only available in Japanese. 

This documents is in regards to various research such as health studies carried out in the disaster areas and the contaminated areas after the Great East Japan earthquake, and it basically says detailed study should not be done without permission for the reason of avoiding burden on the residents. Before this document was released in May 2011, various university researchers and research institutions were in Iitate Village and other heavily contaminated areas in Fukushima Prefecture in March and April. Many research teams left Fukushima after this document was released. Currently, a large-scale health survey in Japan is being conducted only at Fukushima Medical University, designated by the Japanese government. Other studies are hardly being conducted now.

Lastly, I would like to talk about the Act on Protection of Specified Secrets. Last December, the Diet passed the law called the Act on Protection of Specified Secrets, which actually has numerous issues. The government explains the law mostly concerns Specified Secrets about terrorism, but indeed it would punish not only government officials and national researchers who leak Specified Secrets designated by the government but also individuals who instigated the leak. The issue about this act is that it has not at all been decided what constitutes Specified Secrets or what kind of punishments will be applied to those who leak them. The details are to be determined over the course of this year: The only thing determined is that those who leak whatever is considered Specified Secrets, which is undecided at this point, would be punished. As you can see here, the nuclear accident isn’t the only thing that is bringing people out to a demonstration. This is a photo of the demonstration by the Japanese citizens against what-was-then the Specified Secrets Protection bill. 

Every night, quite a number of people would show up to demonstrate. This is an interesting photo, although I hesitated to show it to people in Germany. Demonstrators wanted to say the current cabinet resembled Nazis. In fact, last August, the deputy prime minister Taro Aso said they should begin altering the constitution inconspicuously as Nazis did. 

That prompted many demonstrations claiming the current cabinet was extremely problematic. 

As you can see, you can’t say democracy is protected and human rights are respected in current Japan, and there will be pressure placed on you if you try to broadcast it. Therefore, I really feel thankful for this opportunity to speak to all of you in Germany, courtesy of IPPNW.

*****

Transcription by Takashi Mizuno
Translation by @YuriHiranuma

Seven More Confirmed Thyroid Cancer Cases: Total of 33 Cancer in Fukushima Children--A Synopsis of Results

Fourteenth Prefectural Oversight Committee convened on February 7, 2014, releasing the results of the latest thyroid examination as part of the prefectural health management survey.

English translation of the results is available here.

A summary of the results is provided below:

Total number of children examined as of December 31, 2013: 269,354
Total number of children whose initial examination results are confirmed: 254,280
(up to the November 15, 2013 examination)
     
     Assessment A1  134,805 (53.0%) (no nodules or cysts found)
     Assessment A2  117,679 (46.3%) (nodules 5.0 mm or smaller or cysts 20.0 mm or smaller)
     Assessment B     1,795 (0.7%) (nodules 5.1 mm or larger or cysts 20.1 mm or larger)
     Assessment C         1 (0.0%) (requiring immediate secondary examination)

Initial examination progress status

Number and proportion of nodules and cysts

Secondary examination includes more detailed thyroid ultrasound, blood and urine tests, and fine-needle aspiration biopsy if warranted.
      1,796 are eligible for secondary examination
      1,490 have actually undergone secondary examination
      1,342 finished the secondary examination

Secondary examination progress status

Summary of fine-needle aspiration biopsy results (as of December 31, 2013)

In summary, there were 7 more cancer cases confirmed since the last report on November 12, 2013. One case was confirmed in a female from Namie Town, 5 in Koriyama City, and 1 in Izumizaki Village. 

The total number of cases confirmed or suspected of cancer is 75. Of these, 34 had surgeries as of December 31, 2013, and 1 turned out to be a benign nodule, 32 were confirmed to be papillary thyroid cancer, and 1 still has no confirmed cytological diagnosis but listed as poorly differentiated thyroid cancer. (The total number of cases confirmed or suspected of cancer is often reported as 74 in news report, excluding the case confirmed to be benign).

Shinichi Suzuki, a Fukushima Medical University physician in charge of the thyroid ultrasound examination, cautioned against jumping to the conclusion about this "poorly differentiated cancer" which normally is associated with a poor prognosis. Although he did not elaborate on details, he said the diagnostic criteria for poorly differentiated thyroid cancer have recently changed. This was the case which, initially thought of as papillary thyroid cancer, was undergoing cytological reevaluation by pathologists who are still not sure about the exact subtype. 

Interestingly, the first thing Suzuki mentioned, when it was his turn to present the thyroid examination results at the committee meeting, was the news post published today in multiple newspapers regarding the Fukushima Medical University beginning a genetic analysis of the cancer tissues. The news post states that Fukushima Medical University will use the thyroid cancer tissues, excised during surgeries, to analyze for genetic alterations to help figure out why the cancer originated. What was odd was that Suzuki, as if avoiding a swarm of questions, offered an explanation that such genetic analyses are routinely performed on adult cancer specimen using the special research money and approved by the University's ethics committee. He emphasized that the genetic analysis was totally separate from the thyroid ultrasound examination. He asked for an understanding as he felt it was the mission of Fukushima Medical University to conduct the genetic analysis in order to watch over the children's future.

As for the perceived "slow" speed of confirming the cancer cases, Suzuki said that some of the cases suspected of cancer did not warrant immediate surgeries, allowing for the children to live their lives with close monitoring. 

As usual, no information was offered such as the type of nodules and also details of each surgical case which, as part of regular medical care, are considered beyond the scope of the screening and thus inaccessible to the Health Management Survey team.

*****

Below is a reference table showing the 2008 thyroid cancer incidence rate per 100,000 in Japan, compiled from the National Cancer Center (2012) Cancer incidence from cancer registries in Japan (1975–2007) on the website of Center for Cancer Control and Information Services, National Cancer Center, Japan. Due to an intense interest, domestically and internationally, in the pediatric thyroid cancer occurrence in Japan, the tables focused on the relevant age groups.

Thyroid cancer incidence rate in Japan by age and sex (2008)　(per 100,000)

Source: Download “2. Incidence (National estimates)” and go to the “rate” tab on bottom. 

See lines #1775 for male and #1809 for female.

This shows “incidence,” representing the rate of occurrence of new cases in a given period. On the other hand, Fukushima thyroid examination is mass screening, which yields “prevalence,” the proportion of the total number of cases to the total population.

It is important to note that incidence and prevalence are not directly comparable, so the incidence rates shown above are only a relative measure of comparison.

Radiation Testing of Seafood by Washington State Seafood Companies: Radioactive Strontium and Cesium

Vital Choice Wild Seafood and Organics, a Washington state seafood company, has been conducting radiation testing on Pacific ocean fish since 2012. Recently they released the results of testing for strontium 90 in King Salmon, Sockeye Salmon, and Albacore Tuna, which are posted here with their permission.

No strontium found:
Article dated 1/09/2014 
Results PDF 
"Last summer, the first reports appeared suggesting that a longer-lived radionuclide called strontium 90 (Sr-90) was leaking from the stricken nuclear plant.
So to ensure safety, we sent more fish to be tested for Sr-90, in the fall of 2013."

Strontium testing was performed by Pace Analytical Services, Inc. Review was performed by SGS North America, Inc.

Received on 10/30/2013. Analyzed on 11/12/2013.

Sockeye Salmon   -0.00130 ± 0.0210 pCi/g (MDC 0.0513 pCi/g) or -0.0481 ± 0.777 Bq/kg   (MDC 1.8981 Bq/kg) 
King Salmon           0.0228 ± 0.0292 pCi/g (MDC 0.0635 pCi/g) or 0.8436 ± 1.0804 Bq/kg (MDC 2.3495 Bq/kg)
Albacore Tuna       -0.0151 ± 0.0167 pCi/g (MDC 0.0456 pCi/g) or -0.5587 ± 0.6179 Bq/kg (MDC 0.6247 Bq/kg)

※ Results are shown as the activity ± uncertainty. The original results in pCi/g are followed by values converted to Bq/kg (1 pCi = 0.037 Bq).
※ Entire fish, including skin and bone, was tested according to Vital Choice, which is important as strontium accumulates in the bone.
※ MDC is minimum detectable concentration. (Also described as MDA, minimum detectable activity). (Note 1)

Vital Choice seafood harvest areas are described on this page.

    ”All of our Pacific seafood – salmon, sablefish, halibut, cod, prawns, shrimp, Dungeness crab, mussels, and clams – is caught or harvested off Alaska, Washington State, Oregon, and British Columbia (BC), between 4,000 and 5,000 miles east of the nuclear plant.
    The sole exceptions are albacore tuna and king crab. Our albacore is caught off Midway Island, and our king crab is caught in the Bering Sea. Both areas are located about 2,500 miles east of the plant.”

Vital Choice has also done three rounds of radiation testing for iodine 131 and cesium 134 and 137.

1st test reported on 3/29/2012
"Eurofins Laboratories tested 15 species of fish and shellfish for cesium-134, cesium-137, and iodine-131, and found none."

Cesium 134: None to trace levels (MDA 1.0 Bq/kg)
    Most species  <1.0 Bq/kg
    Albacore 1.4 Bq/kg
    Halibut 1.3 Bq/kg

The trace levels found in our albacore and halibut are less than 15% of the maximum combined level of Cesium 137 + 134 normally found in fish (10 Bq/kg). (See Note 2)

And those trace levels are just 0.1% of the FDA’s level of concern (DIL) for combined Cesium 137 + 134 levels in foods (1200 Bq/kg). (See Note 3)

Cesium 137: None detected (MDA 1.0 Bq/kg)
Iodine 131: None detected (MDA 2.0 Bq/kg)
This means that all seafood tested contained less than 1.2% of the FDA’s Derived Intervention Level (DIL) for Iodine 131 (170 Bq/kg). Iodine 131 decays to safe forms within about two weeks after its creation. (See Note 3)

2nd test reported in September 2012
"Eurofins Laboratories tested our Pacific albacore and our Alaskan halibut, sockeye salmon, and cod. They found no cesium-134 or iodine 131, and only a barely detectable, clearly safe level of Cesium 137 in a sample of cod."

Cesium 134: None detected (MDA 1.0 Bq/kg)
Cesium 137: Cod 1.2 Bq/kg (MDA 1.0 Bq/kg)
Iodine 131: None detected (MDA 2.0 Bq/kg).

3rd test reported in September 2013
"Eurofins Laboratories tested our salmon (pink, king, sockeye, silver), tuna, cod, halibut, and sablefish for cesium-134, cesium-137, and iodine-131, and found none."

Cesium-134: None detected (MAD 1.0 Bq/kg)
Cesium-137: None detected (MDA 1.0 Bq/kg)
Iodine-131: None detected (MDA 2.0 Bq/kg)

*****

Also, Loki Fish Company in Seattle, Washington, just released their radiation test results conducted by Eurofins Analytical Laboratories.
A family owned and operated business, Loki Fish Company harvest wild salmon and halibut from southeast Alaska and Puget Sound. 

January 7, 2014 post by Loki Fish Company "No Elevated Levels of Radiation Found in North Pacific Salmon Samples"
Test results 
"Tests were conducted on Pink, Keta, Coho, Sockeye and King salmon from southeast Alaska, and Pink and Keta salmon from Puget Sound."

Cesium-134: Alaskan Pink Salmon 1.2 Bq/kg (MDA 1.0 Bq/kg)
Cesium-137: Alaskan Keta Salmon 1.4 Bq/kg (MDA 1.0 Bq/kg)
Iodine-131: None detected (MDA 2.0 Bq/kg)

*****
Note 1: For reference, MDC for strontium testing by the Japanese Fisheries Agency was in the range of 0.01-0.04 Bq/kg.

Note 2: Is it true that maximum of 10Bq/kg of combined Cs134 AND Cs137 can be found in fish under the normal circumstance? Should there be any Cs134 normally found in fish? Upon an inquiry, Vital Choice said this information came from Eurofins. According to this study, no Cs134 was detected and Cs137 was 1.4 Bq/kg in Pacific Blue Fin Tuna in 2008).

Note 3: US FDA's DIL (Derived Interventional Level)  is 160 Bq/kg for strontium 90, 170 Bq/kg for iodine 131, and 1,200 Bq/kg for cesium 134 and 137 for any food. Standard limits for radioactive cesium in Japan are 100 Bq/kg for general food and 50 Bq/kg for infant food and milk, taking into account the contribution from radioactive strontium and plutonium, etc. It should be noted that these limits are considered too high by those who believe internal radiation doses have stronger effects than equivalent external radiation exposure doses. For instance, report by foodwatch and German IPPNW (International Physicians for the Prevention of Nuclear War) calls for lowering of EU cesium limits of 600 Bq/kg for all foodstuffs and 370 Bq/kg for baby food and milk products to 16 Bq/kg and 8 Bq/kg, respectively.

Furthermore, on the Vital Choice information page, the section called "Radiation experts see no cause for concern," refers to a study called "Evaluation of radiation doses and associated risk from the Fukushima nuclear accident to marine biota and human consumers of seafood." 

Excerpt from the abstract:
"The additional dose from Fukushima radionuclides to humans consuming tainted PBFT in the United States was calculated to be 0.9 and 4.7 µSv for average consumers and subsistence fishermen, respectively. Such doses are comparable to, or less than, the dose all humans routinely obtain from naturally occurring radionuclides in many food items, medical treatments, air travel, or other background sources. Although uncertainties remain regarding the assessment of cancer risk at low doses of ionizing radiation to humans, the dose received from PBFT consumption by subsistence fishermen can be estimated to result in two additional fatal cancer cases per 10,000,000 similarly exposed people."

First of all, the internal dose described in μSv (microsievert) and applied to general population is misleading, as sensitivity to radiation can vary with age and gender. In addition, comparison of manmade fission products, such as radioactive cesium, to natural background radiation, such as radioactive potassium in bananas, is also misleading as such comparison tolerates and nearly justifies the environmental existence of the fission products. One must ask the question, "Should it really be there?" Also, exposure to medical diagnostic and therapeutic radiation (internal or external) is not exactly "background," and it is not harmless as seen in this study. Air travel is hardly comparable to ingestion of cesium as the former is external exposure while the latter internal.

One must understand these distinctions, often blurred in convenient explanations, to be able to make an intelligent decision about whether or not to consume contaminated foodstuff. Since there is no safe dose of radiation, it is ultimately an individual decision whether or not to accept the risk. However, a higher vulnerability of certain populations, such as babies, infants, children and pregnant women, and women with reproductive potential, should be taken into consideration. 

Note 4: In both Vital Choice and Loki Fish tests, Cs 134 was found alone without Cs 137 in some fish. This seemed odd, as the presence of Cs 134 is the signature for Fukushima radiation contamination as opposed to Cs 137 alone which could be due to past nuclear testing. When Vital Choice was asked about this, they had no information on it. They just stated that Eurofins was expert in radionuclide testing. 

US Physicians Claim Radiation Risks Due to the Fukushima Nuclear Accident

The following is the English translation of the The Wall Street Journal Japan Online article posted on November 13, 2013. Permission for translation was obtained from the author, Misako Hida.

Disclaimer: Wall Street Journal Japan Online is not responsible for the translation.

Note: Although most of the links were not part of the original article, they were provided within the translation for easy accessibility to appropriate information at the discretion of the translator.

******

NY Report by Misako Hida
November 13, 2013

US physicians claim radiation risks due to the Fukushima nuclear accident

Intake of radioactively contaminated air, water and food brings radioactive material inside the body, causing internal radiation contamination. It is a critical responsibility of adults to protect lives and health of children, who will carry on the future, from radiation exposure.

Last month, there was a symposium held in New York City to discuss the "Fukushima Report" by United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR). A former president of a non-governmental organization (NGO) "Physicians for Social Responsibility (PSR)" and Assistant Clinical Professor in Department of Medicine at University of Iowa, John W. Rachow, M.D., urged not to underestimate the risks of health effects on Fukushima children, by excerpting the following quote by President Kennedy.

"The number of children and grandchildren with cancer in their bones, with leukemia in their blood, or with poison in their lungs might seem statistically small to some, in comparison with natural health hazards. But this is not a natural health hazard-and it is not a statistical issue. The loss of even one human life, or the malformation of even one baby-who may be born long after all of us have gone-should be of concern to us all. Our children and grandchildren are not merely statistics towards which we can be indifferent."


This was part of the July 27th Radio and Television Address to the American People by President Kennedy, the day after the United States and the former USSR reached an agreement to sign the Partial Test Ban Treaty in 1963, in the midst of Cold War when the United States and the former USSR were engaged in the arms race.

A Fukushima child being tested for radiation exposure (March 13, 2013). (Photo courtesy of Reuters)

"A 50-year-old speech by President Kennedy fits the UNSCEAR report just right," says Rachow.

The symposium, co-sponsored by PSR and Human Rights Now, the Japanese human rights organization, places an emphasis on "human rights" rather than "statistics." It was held in response to the summary report by UNSCEAR, submitted to the Fourth Committee of the United Nations General Assembly (UNGA) in October 2013, which stated, "No discernible increased incidence of radiation-related health effects are expected among exposed members of the public." Its purpose was to demand that UNSCEAR re-recognize uncertainties accompanying estimation of exposure doses as well as health effects, and encourage improvements in the completion of the final report.

According to the critique about the report, co-authored by PSR and the German branch of the US NGO "International Physicians for the Prevention of Nuclear War (IPPNW)," UNSCEAR report failed to accurately portray the true extent of radiation exposure, ignored the ongoing radioactive emissions, and excluded non-cancer effects of radiation. 

Moreover, it also questions the reliability of TEPCO's worker dose assessment and the neutrality of the data used in the report, suggesting that monitoring should occur for non-cancer diseases and genetic radiation effects. The critique also sounds the alarm that the comparisons between nuclear fallout and background (natural) radiation, often used when minimizing the risks of radiation exposure, can be misleading.

According to Dr. Rachow, the critique was sent to UNSCEAR by e-mail, and "a polite and quick reply" was received. "I felt that our concerns and suggestions would be considered, and we felt encouraged."

In regards to the summary report, UNSCEAR released an interim report in May 2013, stating, "No immediate health risks were seen" from the Fukushima nuclear accident. This column also featured a two-part interview of Dr. Wolfgang Weiss, Chair of the UNSCEAR report and Head of the Department of Radiation Protection and Health of the Federal Office for Radiation Protection (BfS).

At first, the entire report was to be presented at UNGA this fall. However, after the interim report came out, it was revealed that the Japanese government and TEPCO did not have an accurate assessment of the status of worker exposure. In October, UNSCEAR announced the postponement of the completion of the report, citing the underestimation of internal exposure dose of workers by about 20% due to radioactive iodine 133 (half-life 20 hours) not being reflected in dose estimation of workers.

According to the United Nations press release, Carl-Magnus Larsson, the Chair of the UNSCEAR,  announced in a briefing at the Fourth Committee of UNGA, that just as in the interim report in May, human exposure to radiation was "low or generally low, with no immediate health effects."

However, regarding children, Larsson explained, because of "the difference between the ways atomic energy affected children as compared to adults," more caution was required. Consequently there had been a major thyroid screening program of 360,000 children conducted in Japan. However, it was unclear whether higher than usual rates of thyroid cancers and abnormalities detected were due to radiation exposure, as they are "indistinguishable" from cancers due to other causes.

Dr. Rachow dismisses UNSCEAR's views that it is not possible to prove increased cancer risks due to radiation exposure. "It is typical tautology to state, 'Since radiation-induced cancers are indistinguishable from cancers caused by other causes, in the case of Fukushima, increase in cancer attributable to radiation exposure is not expected'," says Rachow. (Tautology refers to repetition of synonymous words, guaranteeing the truth of the proposition in rhetoric).

The symposium also featured Anand Grover, Special Rapporteur to the United Nations Human Rights Council who submitted a report to the UN this May, recommending the Japanese government to strictly regulate radiation limits based on "human rights." He stated, "Nation should not breach 'the right for attainment of health' for citizens. It has the duty to respect and protect its people."

Meanwhile, briefings at the Fourth Committee of UNGA suggested unspoken pressure on UNSCEAR by the Japanese government. According to the UN press release mentioned earlier, the Japanese delegate indicated that UNSCEAR report had a possibility of "causing misunderstanding." It's because some Japanese media's articles "incorrectly" reported that "the report had concluded that the Government of Japan had underestimated the amount of internal exposure of workers at the plant.

A former president of a non-governmental organization (NGO) "Physicians for Social Responsibility (PSR)" and Assistant Clinical Professor in Department of Medicine at University of Iowa, John W. Rachow, M.D. (Photo courtesy of Dr. John Rachow)

Certainly, there is the fact that UNSCEAR indicated the possibility of underestimation after receiving new sets of data from TEPCO in regards to the workers, even though it is not the final report. It is a matter of fact to reflect any discrepancy in data. The statement by the Japanese delegate could be construed as indirectly demanding a change in "conclusion" in the final report.

In fact, according to the proceedings of Nuclear Safety Commission on September 9, 2011, Technical Advisor Kenzo Fujimoto and Expert Member Nobuhiko Ban made statements insinuating to restrain UNSCEAR's own data analysis at the first meeting of the "Domestic Support and Investigation Working Group for the UNSCEAR Fukushima Nuclear Accident Report," held prior to the start of the investigation by UNSCEAR.

"I say this out of concern, but if the Working Group makes efforts in collecting detailed and outstanding data and submitting them to UNSCEAR, foreigners will use them to make various assessments.(…) I think we have to assess them ourselves in Japan to prepare the data they can deal with, or else it would be embarrassing for us to appear as if we were a dependent country by submitting the data alone and leaving the assessment up to them.(…)" (Advisor Fujimoto).

In response to this, Expert Member Ban said, "I totally agree with what was just said." He continued on to say, "(…) it's something that should be approached with “the All Japan System,” which means we need to be careful with how and when the data should be submitted." In regards to the early exposure of thyroid gland to iodine, he referred to the necessity for the Japan side to do some analysis before asking for further analysis by UNSCEAR. He shared his concern, "If we simply submit the data, they might do whatever they want with the data, leading to the possibility that they might come out with some outrageous results."

In the first place, reliability of some data is questionable. For instance, according to the dust sampling measurement results by the Ministry of Education, Culture, Sports, Science and Technology dated June 7, 2011, radionuclides were detected at various places such as Fukushima University on March 18, 2011, immediately after the Great East Japan Earthquake. However, even though 9,100 to 17,000 Becquerel of short-lived iodine 132 (half-life of about 2 hours) was detected, the parent nuclide Tellurium 132 (half-life about 3 days) was "undetected." However, according to Dr. Rachow, it is customary for Tellurium 132 to be detected along with the daughter nuclide iodine 132.

As "uncertainty" lingers not only in scientific effects of radiation exposure but also in the amount and the quality of data itself, how far can UNSCEAR approach what Dr. Rachow calls "firm commitment to the truth"? We look forward to the final report.

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Addendum by the translator: 
Dust sampling measurement results mentioned above have also been translated as below. The questionable parts were contained within red squares.

Translation by @YuriHiranuma