Sep 7, 2012

Regarding Comments Made by IPPNW Physicians About Fukushima Thyroid Examination Results

There was a press conference in Tokyo, Japan, on August 29, 2012, by members of the International Physicians for Prevention of Nuclear War (IPPNW).  This followed the delegation’s visit to Fukushima Prefecture after the IPPNW World Congress was held in Hiroshima from August 24 through 26.

IPPNW delegation’s statement: International physicians’ recommendations for protecting health after the Fukushima nuclear disaster (English) (German)


IPPNW’s recommendations such as medically, socially and financially supporting those with anticipated exposure over 5 mSv (1 mSv for children and pregnant women), based on actual radiation exposure levels, and lowering the annual radiation exposure limit to 1 mSv are logical and appropriate.

However, statements made by two physicians regarding the high number of thyroid abnormalities found in Fukushima children raise some concern.

As you can see in the following article, which is a complete English translation of the thyroid examination section of the Fukushima Prefecture Health Management Survey, 35% of 38,114 children tested so far, out of 360,000 eligible Fukushima children, have been found to have thyroid nodules and/or cysts upon thyroid ultrasound examination.

Below is a transcript of statements made by Dr. Tilman Ruff, a co-president-elect of IPPNW and an Australian physician specializing in infectious diseases and public health, and Dr. Peter Karamoskos, an Australian nuclear radiologist.

Q:  What do you think about the high number of thyroid abnormalities found in Fukushima children?

”So these data are clearly important and need to be conducted and compiled and these surveys repeated on a regular basis.  We think that’s entirely appropriate.  The results of such studies are dependent on the method.  And what will be important in relation to the follow-up of those affected in Fukushima will be the trends over time and the comparison to the other areas which have not been so contaminated.

It’s true this survey is almost certainly a baseline survey.  We won’t expect from biology or experience in Chernobyl or anywhere else that thyroid abnormalities will be evident so soon after the accident.  The diagnostic criteria that are used are very important and must be consistent and comparable between studies.  Most of these cysts and nodules are very small.  We think that the decision to conduct a study in the near future in a less affected area of Japan is a good decision.”

“The study that showed the number of nodules is commensurate with what we know about thyroid glands and previous studies.  Contrary to the popular opinion, nodules are quite common in children.  Most children don’t have them, of course, but they are quite common and the more sensitive the ultrasound modality that we use the more we detect.  Certainly this proportion of nodules in children we are seeing is well within the bounds of what we know to be common in children.  

In fact, Dr. Suzuki in Fukushima said that they were actually including nodules which were 1 mm in diameter.  Most studies in the past have not included these.  I am not surprised they found 35% of cases with nodules.  

Finally, it’s important to underscore that nodules and cysts in thyroid are not necessarily diseases.  They are actually part of the normal evolution of the thyroid gland.  So families with children with nodules and cysts should not be overly concerned.  This is a baseline study.  We want to establish what the baseline is to follow these people up in the future to determine whether any of them will develop thyroid cancer in the future.  It’s not that they have diseases at the moment.”

Q:  Any controversy between Fukushima Medical University doctors and IPPNW doctors regarding how it was difficult for Fukushima residents to obtain a second opinion?

“It is certainly the basic right of patients to request a second opinion.  Nobody will deny that right.”

“I just want to conclude this or at least to make a comment that it’s clear that thyroid abnormalities are a significant concern here.  The experience of a rapid increase in thyroid cancer in children, unexpectedly early after Chernobyl, is a very important lesson.  And the recent WHO report of radiation doses in Fukushima estimates thyroid doses for children well in the range where stable iodine should be given by international guidelines.  And it was not used in Japan.  So that increases the importance of follow-up of thyroid issues.”

Q: After your visit to Fukushima yesterday, what do they think about Fukushima residents, adults and children, still continuing to live there especially with the accident still going on, in consideration of low-dose radiation exposure?

“I think given the well-recognized and documented increase in susceptibility of children to the long-term adverse consequences of radiation, it’s certainly appropriate that priority be given to them and also to pregnant women.

I think it’s important that we have consistent, objective criteria for assisting people who choose to relocate, especially with children.  This should be based on the likely dose they may be exposed to.  This is an important issue of social equity because we found that many people would choose to relocate if they were able to do so.”

With all due respect, neither Ruff nor Karamoskos is a pediatrician or a thyroid specialist.  
Nor do they really have a firm grasp of the level of contamination that has spread not only in Fukushima but the neighboring prefectures, and actually all over Japan.  Nor do they realize what is really going on with people in Fukushima and neighboring prefectures, behind the charade put on by the government officials and Fukushima Medical University.

Are they aware of the pressure exerted on thyroid specialists by a letter from Shunichi Yamashita, Fukushima Prefecture Radiation Health Risk Management Adviser, vice president of Fukushima Medical University, and president of the Japan Thyroid Association?  Even though Fukushima Medical University insists that patients are not prohibited from seeking a second opinion, the fact is that it is exceedingly difficult to find a physician who is willing to do it.  There have been anecdotal reports from people who were told by physicians outside Fukushima, “We have been told not to examine people who came from Fukushima.”

Actually, it is not just in Fukushima.  People in Tokyo and surrounding Kanto region are complaining of thyroid abnormalities:  Some families who evacuated to western Japan were dismayed to learn that their children had thyroid nodules and/or cysts upon ultrasound examination.  When they take their children to “thyroid specialists.” they are told “It’s natural.” “It’s congenital.” and they are often not even given copies of the ultrasound images, which they are entitled to.  Some hospitals blatantly refuse to provide medical care to people who would like to have thyroid examination done due to concerns regarding radiation exposure.  A recent Mainichi Shimbun article describing some of these issues has been translated here:

The above article refers to the government’s decision to implement a comparative thyroid examination in places other than Fukushima to be used as a control, as referred to by Ruff.  Indeed it is a necessary study, and it makes sense to keep conditions as similar to the Fukushima study as possible, in terms of equipments and examiners, but it would be wise to have a neutral party to oversee the study, as Fukushima Medical University seems to lack transparency.

Karamoskos refers to a statement by Shinichi Suzuki, a Professor in Regulatory Organ Surgery, a physician in charge of thyroid examination, and also a co-signer of the aforementioned letter from the Japan Thyroid Association.  

Suzuki told Karamoskos that nodules with 1 mm in diameter were included in the 35% result, detectable due to sensitivity of the ultrasound equipments used.  However, the result published so far does not offer a size breakdown below 5 mm, as you can see in these tables excerpted from pages 14 and 15 of the Seventh Report of the Fukushima Prefecture Health Management Survey.

English translation of the thyroid examination result is available as PDF here.

Breakdown of thyroid nodules by size:  201 had nodules equal to or smaller than 5.0 mm, but there is no further breakdown to show how many had 1.0 mm nodules.

Breakdown of thyroid cysts by size:  12,414 had cysts equal to or smaller than 5.0 mm, but there is no further breakdown to show how many had 1.0 mm cysts.

How the guideline used for the Fukushima thyroid examination was established is a bit unclear.  According to this guideline, children with nodules 5.0 mm or smaller or cysts 20.0 mm or smaller are to be followed up in two years.

A planning committee for "Fukushima Prefecture Health Management Survey" consists of members from Fukushima Medical University, National Institute of Radiological Sciences (NIRS), Radiation Effects Research Foundation (RERF), Hiroshima University and Nagasaki University.  Reading through the minutes of the proceedings of the planning committee for Fukushima Prefecture Health Management Survey, it was mentioned that "Diagnostic Criteria Inquiry Subcommittee of Thyroid Examination Advisory Committee" was established consisting of the following seven organizations.

Japan Thyroid Association
Japan Association of Endocrine Surgeons
Japan Association of Thyroid Surgery
The Japan Society of Ultrasonics in Medicine
The Japan Society of Sonographers
The Japanese Society for Pediatric Endocrinology
Japan Association of Breast and Thyroid Sonology

However, no record could be found, at least on the Internet, regarding minutes of proceedings of the “Diagnostic Criteria Inquiry Subcommittee of Thyroid Examination Advisory Committee,” and the Subcommittee seems to lack transparency.  (Incidentally, Japan Association of Breast and Thyroid Sonology has been commissioned to the comparative study project as of August 31, 2012, after apparently winning an open competitive bidding.  Will there be transparency?)

Thus there are too many reasons for the Japanese public to fully trust Fukushima Medical University to act in good faith and with transparency.  And when hearing about individual cases, through story after story by involved families, regarding the lack of care and information given to their children, the 35% ceases to be just a number.

At least Ruff points out the fact that stable iodine was not administered even though “Preliminary dose estimation from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami “ published by World Health Organization, estimated thyroid doses for children “well in the range qualifying for stable iodine by international guidelines.”  He cautions that thyroid needs followed up even more closely because of it.  However, the estimated thyroid doses by the WHO report might be underestimated for various reasons.

Objectivity is certainly important in “science.”  However, what about if “objective data” being used possibly lacks accuracy?  It might be inevitable that foreigners should rely on “official” information sources, such as “Preliminary dose estimation from the nuclear accident after the 2011 Great East Japan Earthquake and Tsunami “ for “objective data,” largely because of a language barrier and also due to its “official” status.  Even though a lot of reliable information regarding contamination might be available online, through privately funded soil and food testing, non-Japanese speakers might have difficulty accessing them.

“Official” radiation measurements do not mean they are truthful.  For instance, it was a surprise to many Japanese that the WHO report assumed that nearby residents were “immediately” evacuated, but that did not actually happen.  Because the government did not release the radioactive plume forecast, some residents fled in the direction of the plume, unbeknownst to them at the time, with children in tow.  Local residents have many stories about their own experiences, yet such valuable information cannot be converted into objective data, and thus disappear beneath all the numbers and calculations.  Dose estimation based on inaccurate premises cannot produce reliable results, but that is what is referred to by scientists and researchers.  Sadly, any studies published, based on the WHO report or government reports, might lack validity and reliability due to inaccuracies of the original data.

Moreover, ambient radiation levels now regularly reported in many municipalities in Japan are only an indication of contamination near the monitoring posts.  It certainly is important to know how contaminated the air is that you are breathing, but it usually only measures gamma radiation immediately around the monitoring post, and thus not a true reflection of what a person might be exposed to.  Soil and water need tested for any potential radionuclides that may be there, not just radioactive cesium, and of course food needs tested, as internal radiation exposure from internal emitters ingested or inhaled is very harmful to the body.  

Even though there were many radionuclides released from Fukushima Dai-ichi nuclear power plant, they have only routinely tested radioactive iodine and cesium.  Strontium and plutonium fallout data was recently released, which showed a more extensive spread of fission products released than originally thought.

The WHO report only considers Iodine-131(I-131) in terms of the estimated thyroid doses, not taking into consideration Iodine-129 (I-129), a long-lived fission product with a half life of 157 million years.  I-129 is a decay product of Te-129 (t1/2 69.6 min) and Te-129m (t1/2 33.6 d), quite a bit of which was released from Fukushima Dai-ichi, according to pages 4-6 of this report by Comprehensive Nuclear-Test-Ban Treaty Organization Takasaki Station in Gunma, Japan.

Ministry of Education, Culture, Sports, Science and Technology released a map of Te-129m concentration in soil on October 31, 2011, based on soil samples collected in June and July, 2011.

I-129 can be used in reconstructing the I-131 distribution as described in the following study.
“Isotopic ratio of radioactive iodine (129I/131I) released from Fukushima Daiichi NPP accident.”

However, the effect of I-129 does not seem to be included in considering damage to thyroid after radiation exposure, but publications such as these suggest that I-129 is indeed not harmless.

“Radiological and Chemical Fact Sheets to Support Health Risk Analyses for Contaminated Areas: Iodine”

“Iodine-129 Handling Precautions”

US EPA classifies all radionuclides as Group A (known human) carcinogens.  In fact, I-129 is included in the list for mortality and morbidity risk coefficients in the EPA Publication 402-R-99-011   Cancer Risk Coefficients for Environmental Exposure to Radionuclides: Federal Report No. 13.

Moreover, there are other radionuclides, in addition to radioactive iodine, which are known to affect thyroid gland, such as Cesium-137, as described by an exiled Belarusian anatomical pathologist, Yury Bandazhevsky in his study, “Chronic Cs-137 incorporation in children’s organs.” (Revised version)

In conclusion, is it truly reasonable to say that the thyroid ultrasound abnormalities found in Fukushima children so far are simply part of “the normal evolution of thyroid gland” as described by Karamoskos, considering all the known and unknown facts and factors in this extraordinary circumstance?  Will Ruff and Karamoskos maintain their positions if it were their own children in the position of Fukushima children, still living in contaminated areas, with “glass badges” around their necks to measure cumulative radiation doses (while the radiation damages their bodies all along), breathing contaminated air and dust particles, eating contaminated food and drinking contaminated milk in their school lunches?  

The human body is being used to validate the reaction that such a massive amount of radiation contamination has on it.  This is hugely deviating from the true purpose of “science”:  a tool to benefit the collective knowledge and well-being of mankind, neither at the expense of the other.

This is, indeed, an unprecedented situation where a large number of adults and children are being observed for effects of radiation exposure, in situ.  Allowing such an inhumane, inexcusable act, could not be compatible with the movement away from nuclear power and toward truly safe energy production.

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