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Tales from a Distant Place                                          
              . . . with a Problem Very Close to All of Us

John W. Gofman, M.D., Ph.D., Fall 1991

          If health reports are true from Ukraine, Byelorussia (Byelarus), and western Russia -- the three republics most contaminated by the Chernobyl nuclear power accident in April 1986 -- then low-dose ionizing radiation is either more harmful in more ways than indicated by other irradiated populations, or the Chernobyl radiation doses were actually quite a bit higher than anyone has reported. Objective science means that our minds stay open to both possibilities.

1    *   Is a Health-Holocaust Occurring?

          We started by saying "if health reports are true . . . " As of 1991, reports from those republics claim an increased frequency after the accident of all of the following problems among Chernobyl-exposed people (the general public and 600,000 decontamination workers).

          If true, there is a health-holocaust occurring within five years of the accident. (Holocaust:   "Complete destruction of people or animals by fire;   any great or widespread destruction.") A Byelorussian visitor told me this summer:   "They are slicing off breasts like meat in the south of my country. It was not like that before the accident. My cousin was diagnosed with breast cancer in 1989, when she was 37 years old. Two weeks ago, the cancer killed her."

          To anyone who thinks that "Chernobyl is a distant problem," we say:   "No. Chernobyl is a distant place, but it is a problem extremely close to home." Authorized Personnel Only;  Says Who?

          Whatever is happening over there is directly relevant to our problems here from radioactive-waste dumps, contaminated sites, on-going nuclear activities, and planned de-regulation of nuclear waste, because in both places, the involuntary exposures to radiation are spread out slowly over a long period of time.

          The information which enters the textbooks about Chernobyl's radiation consequences will be crucial in the outcome of all the nuclear battles here and worldwide. We will describe our strategy for helping the triumph of truth, whatever it may be.

2    *   . . . Or Has "Nothing Happened" ?

          As descriptions of health problems from Chernobyl were reaching the press, governments around the world were assembling and sponsoring international teams of experts to issue their own statements about Chernobyl's health consequences.

          Where do the various types of radiation experts for such teams come from? With only the rarest exceptions, they are experts who meet the approval of the nuclear communities within their respective governments. Indeed, there are extremely few radiation experts in existence anywhere who do not meet the approval of their governments, because governments worldwide are not only the chief sponsors of nuclear power, but also the chief sponsors of radiation research inside government and outside (universities, foundations, medical centers). Due to lack of independent funding, independent expertise on the health effects of radiation is extremely scarce everywhere.

          In June 1989, the World Health Organization (WHO), which is one branch of the United Nations, sent a team of experts to the USSR. Their final report concluded among other things that " . . . scientists who are not well-versed in radiation effects have attributed various biological and health effects to radiation exposure. These changes cannot be attributed to radiation exposure . . . and are much more likely to be due to psychological factors and stress."

          The statement which flatly rules out some effects as capable of being caused by radiation appears to reveal prejudgment by WHO experts. The WHO team was visiting a population of all ages and both sexes which is exposed to appreciable levels of on-going irradiation of the entire body, and moreover, this exposure to radiation is super-imposed on an earlier and higher exposure of the thyroid gland (unlike the A-bomb survivors).

          No such population has ever been studied before. Were the WHO scientists entitled to decide in advance what effects this combination of exposure ean have, or can not have, during the first three years of exposure . . . and to disparage the local scientists for refusal to adopt the preconceptions of the international radiation community? Under most circumstances, pre-judgment is the opposite of objective science.

          In October 1989, the government of the USSR invited additional assistance from foreign governments. This time, it turned to the International Atomic Energy Agency (IAEA), a branch of the United Nations which is directly charged with attempting to make nuclear energy acceptably safe worldwide. The IAEA established an International Advisory Committee for "The International Chernobyl Project," and between March 1990 and January 1991, two hundred international experts completed "nearly 50 missions to the USSR" (IAEA 1991-a, p.7).

          On May 21, 1991, the IAEA released a 60-page summary of the conclusions reached by these traveling experts (IAEA 1991-a). The report itself was withheld and not made available for examination by the press or by independent analysts. The press release and summary resulted in newspaper headlines such as:

          It is a scandal for the IAEA Summary to be treated respectfully by the press as a scientifically valid study of radiation health effects from Chernobyl. The IAEA study was pre-destined to find no provable health differences between the study's so-called exposed and so called unexposed groups -- and hence no provable radiation-induced health effects -- because the IAEA used two groups which experienced only a negligible dose-difference. (See Part 5, below, Second and Third Rules.)

          Any study which was seriously attempting to find out whether the health problems listed in Part 1 were really related to radiation would have compared two groups with big dose-differences. Such groups certainly exist there.

          As for Chernobyl-induced cancers, the IAEA's survey during 1990 provides no basis whatsoever for changing our estimates of Chernobyl-induced cancers based on pre-Chernobyl studies (details in Gofman 1990, Chapter 24). Nonetheless, "somehow" the press received the impression that expectations did not materialize.

3    *   Who Will Control the New "Textbook Wisdom" ?

          A comparison of Parts 1 and 2 above shows that the world is hearing completely contradictory claims about the early radiation consequences from Chernobyl:   "A Holocaust Is Occurring" versus "Nothing Happened." Both sets of claims cannot be correct.

          Who will control what information becomes the new "textbook wisdom" about Chernobyl's radiation consequences? Obviously it makes a huge difference.

          The governments of the world, through WHO, have already organized a long-term study of Chernobyl called IPHECA:   International Program on the Health Effects of the Chernobyl Accident. Japan has already provided $20 million, and other governments are expected to provide $180 million more.

          The chief temptation of such nuclear-committed governments will be to focus their Chernobyl studies on the very low dose-range (below 10 rems of dose). The temptation will be to find that slowly received radiation in this dose-range is harmless or beneficial, and to make this the new "textbook wisdom" about ionizing radiation.

          We say that this will be their temptation -- because Chernobyl studies which they control offer them the opportunity to "discover" that even catastrophic failures like Chernobyl are tolerable . . . and therefore nations need not hesitate to forge ahead with nuclear power.

4    *   A Strategy to Block Bad Behavior

          A danger exists that truth will fare poorly if there are no "watchdogs" inside IPHECA. This danger arises from the universal human tendency to yield to temptation and unholy pressures whenever bad behavior is rewarded and good behavior is punished. Indeed, bad behavior is simply predictable when, simultaneously, appropriate deterrents to bad behavior are absent and real penalties for whistle-blowing are present.

          Can we conceive of any feasible deterrents to bad behavior in the IPHECA study? Yes, we can.

          One important deterrent would be widespread education in the three most affected republics and in American schools and colleges about the rules and principles which produce objective, scientifically credible studies. Science has long been realistic about bias in research, for a simple reason:   Scientists are only human. Even when they are incorruptible, they tend to have strong personal preferences about how a study "should" turn out.

          So over decades and centuries, science has established important barriers against bias -- rules which are widely disregarded today in radiation research. Adherence to these rules will not be demanded by the public, press, and other professions unless they are aware of them. Some of the basic principles will be listed in Part 5; an expanded version is part of Gofman 1994.

          A second and crucial deterrent to bias in studies of Chernobyl's radiation consequences would be authority to police IPHECA with independent "watchdogs" to make sure that the highest standards of objectivity are actually achieved. This is a way of ensuring that whistle-blowers not only exist within the study, but also are rewarded. Our proposal is described in Part 6. With the "new thinkers" coming to power in the three most affected republics, this proposal has a growing chance of actual adoption.

5    *   Some Necessary Ingredients for Credible Studies

          With only very rare exceptions, health effects induced by ionizing radiation look clinically identical to the same health problems induced by other causes. Therefore, the only way to find out that radiation can cause a particular type of health problem is to count the frequency of specific afflictions among comparable groups exposed to different amounts of radiation. For instance, if a postulated effect shows random changes in frequency while the radiation dose increases in a regular way, the idea of causation is badly weakened. But the hypothesis of causation becomes plausible if progressive increases in dose are followed by regular changes in response, in a properly done dose-response study.

          What follows is an extremely abbreviated review of some rules and conditions required to produce scientifically credible studies of Chernobyl's radiation consequences.

           * - First Rule:   Comparable Groups

          An essential condition for a credible dose-response study -- and a very difficult condition to meet -- is reasonable assurance that the compared groups would have the same rates of disease in the absence of radiation. Otherwise, one cannot identify radiation as the cause of a difference in disease-rates in one dose-group compared with another dose-group. (A zero-dose group is welcome but not essential for such studies.)

           * - Second Rule:   A Real Difference in Dose

          Another essential condition is reasonable certainty that the compared groups truly have appreciably different accumulated doses. Otherwise, when the First Rule has been met, it is pre-destined that analysts will find "no provable difference in disease-rates between dose-groups" if, in reality, the compared groups received nearly the same total amount of radiation.

          The IAEA study did not follow the Second Rule. On the contrary. The IAEA study sampled 7 "contaminated" and 6 "control" settlements (presumed less contaminated). According to the IAEA's own reasoning (p.22), the IAEA's chosen "exposed" group received organ-doses which may have been only half a rem higher than the organ-doses received by the so-called "controls" -- if higher at all. A comparison of such groups would guarantee in advance the IAEA's conclusion that (p.32) "There were significant non-radiation-related health disorders in the populations of both surveyed contaminated and surveyed control settlements studied under the Project, but no health disorders that could be attributed directly to the radiation exposure." The IAEA's fatally flawed study does not support its conclusion.

           * - Third Rule:   A Sufficiently Big Difference in Dose If You're Not Outraged... Then You're Not Paying Attention!

          The dose-differences between compared groups must be large enough to allow for statistically conclusive fundings despite the random variations in numbers and in population samples. How large is large enough? Analysts can cope with the random fluctuations of small numbers both by assuring large dose-differences between compared groups, and by assuring large numbers of people in each group. Studies can be destined to find "no provable radiation effect" before they even begin, if one or both of these conditions are not met. The IAEA survey met neither condition.

           * - Fourth Rule:   Careful Reconstruction of Dose

          It is not too late to figure out what total doses have been accumulated by individuals who will be in the IPHECA study. There is a class of techniques called "biological dosimetry" which can reveal a person's cumulative radiation dose even years after the initial dose was received. Although these techniques have some problems, their use would represent a huge improvement over their non-use.

          Chromosome analysis. Blood samples provide cells for estimating accumulated dose from the frequency of enduring (unrepaired or mis-repaired) chromosome damage.

          Glycophorin-A Testing. Blood samples provide cells for estimating accumulated dose from the frequency of cells which have a particular protein altered due to enduring (unrepaired or mis-repaired) genetic damage within such cells.

          Electronic Spin Resonance of Tooth Enamel. Extracted teeth are also biological dosimeters, and with the ESR technique, teeth can reveal a person's accumulated radiation dose years after the initial exposure occurred.

          It is essential that any credible study of Chernobyl's radiation effects make extensive use of biological dosimetry -- which was not done for the IAEA survey. During the first weeks of the accident, the complex nature of the releases and the shifting of winds mean that early doses -- and differences from region to region -- will not be reliably predictable from measurements of fallout contaminants made a year or more after the accident. Yet the early and variable doses could well exceed the entire doses which various groups in a study accumulate subsequently (Gofman 1994). In addition, there is the problem of exposure from enduring "hot spots," a topic on which the IAEA Summary admits (pp. 16-17) complete ignorance.

          In short, in the absence of biological dosimetry, it would even be possible to reverse the true doses of two compared groups -- with the presumed lower-dose group actually having the higher dose. Minced Words

          Current plans for the IPHECA study describe only very limited use of biological dosimetry. Why is IPHECA so badly under-scoping the use of biological dosimetry? There is certainly no shortage of under-employed, educated persons in the republics who could be trained in doing cell-studies of sufficient numbers of cells and in the other techniques of biological dosimetry. Unless IPHECA is willing to fund extensive use of biological dosimetry, it is better to do no study at all, for mistaken estimates of doses from Chernobyl will lead directly to false conclusions.


          Unless biological dosimetry itself improves appreciably over its current capabilities, it will never be possible in the very low dose-range below 10 rems to make reliable subdivisions of accumulated doses -- and we warn in the strongest terms against acceptance of studies which do so. Properly done Chernobyl studies can answer many questions of great importance for human health everywhere, but Chernobyl-exposed groups are not scientifically suitable for a credible dose-response study in the dose-range where governments will be most tempted to do one.

           * - Fifth Rule:   "Blinding" of Dose Analysts

          Every proper dose-response study has clearly provable barriers against the possibility that dose-analysts might raise or lower an estimated dose because the people are sick, or because they are healthy. Therefore the analysts who estimate doses in a valid dose-response study must have no idea what is the medical status of the individual or group on which they are working. The health status and dose-related data must never be present in the same file. In other words dose-analysts must do their work blind.

          Blinding must extend to the technicians who do the biological dosimetry. Such technicians must not know the medical status of individuals. Also they must not know whether individuals are decontamination workers, evacuees, or general public -- information which might influence the scoring of otherwise objective biological dosimetry.

          With regard to Chernobyl dose-response studies, dose estimates which have already been made without blinding can be re-done newly with proper blinding procedures. It is not too late. Blinding is regarded as a standard and essential barrier against both innocent and intentional bias.

          Another important aspect of dose reconstruction is frequent quality-control. When a sample (of blood, or tooth) is split, do two or more sets of technicians arrive at nearly the same dose-estimate from the same sample? This is a worldwide problem in research. In the USA, we have well-known problems with the reliability of lab work on blood cholesterol-levels, PAP smears, etc. Recently, an American company which is deeply involved in revising dose estimates for the A-bomb survivors confessed to falsifying results of lab tests in some of its other work (for the Environmental Protection Agency). Studies of Chernobyl's radiation consequences will not be credible unless they can assure the credibility of their key in-put data.

           * - Sixth Rule:   "Blinding" of Diagnostic Analysts

          In order to achieve scientific credibility, studies must show precautions against bias not only in the dose-input, but also against bias in the response-input. For instance, in studies of pharmaceuticals, procedures are carefully worked out so that the physicians, technicians, and patients who evaluate the response to a presumed medication have no way of knowing which patients received real doses and which patients received "dummy" zero-dose placebos.

          In Chernobyl dose-response studies, the principle of blinding must extend to all the analysts, physicians, and technicians who diagnose the health status of persons in the study. They must not know whether a person's radiation dose was high or low, and they must be denied information (like place of residence, or status as a decontamination worker) which would allow them to form a personal opinion about the likely dose. And one must always inquire about teams of "special experts" who may have "reviewed" and altered the diagnoses later -- unblinded. A proper study always states in detail how it avoids such opportunities for entry of bias. But in recent times, some very sloppy practices have been tolerated in radiation research.

           * - Seventh Rule:   No Chances after Results Are Known

          One of the fundamental rules in an on-going study is that no one is allowed to alter or discard input-data after any of the results are already known. Results refer to the correlation (if any) between changes in dose and changes in response.

          This rule is a crucial barrier to bias in databases because retroactive substitutions and other changes in a database can provide so many Orwellian opportunities to make the revised results fit a preference or prejudgment. A study becomes properly suspect if retroactive changes have been made in diagnosis or dose, if cases have been shuffled into new groupings (cohorts), if any data or cases have been suddenly dropped from the study, or new cases suddenly added "as needed."

          THE NEED FOR A "WATCHDOG" SYSTEM:   Once bias has been embedded into a radiation database, the injury to all humanity will spread via use of such a database later by completely innocent analysts worldwide. Because of the widespread conflict of interest in the sponsorship of radiation research, a radiation database is necessarily suspect unless its initial construction and any revisions are done in the open, with full access by independent "watchdogs." No such "watchdog" system exists -- yet -- anywhere in the world.

          Instead, in radiation research today, retroactive "fixing" of databases in secret is becoming common. Elsewhere (Gofman 1990), I have called attention to the retroactive changes in dose-estimates for the Ankylosing Spondylitic Study in Britain, and have protested in detail over the current handling of new dose-estimates for the A-Bomb Study database, where I have demonstrated a solution for acquiring the insights of possibly improved dose-estimates without compromising the credibility of the study.

          Meanwhile, numerous researchers are using computer tapes finally released by the U.S. Dept. of Energy (DOE) on occupational radiation exposures of nuclear workers. Over ten years ago, DOE was unhappy about the alarming results developed by independent analysts (including myself) from records on the nuclear workers at its Hanford Nuclear Reservation. The data were seized by DOE, impounded in secret by DOE for over ten years, and released on DOE-made tapes to independent analysts again only recently. There are charges from a committee of the U.S. Senate that DOE has destroyed many of the original records.

          Whether or not the original records were destroyed, any person with common sense must ask, "why were the data seized and kept in secrecy all these years, with access by only a favored few?"

          The Necessity Of Taking A Stand:   There have been both opportunity and motive for bias to enter the DOE database. This means the data are necessarily suspect. Maybe bias has already entered, and maybe it has not. But DOE's disregard for barriers against bias makes it impossible for scientists to have confidence in the objectivity of the database itself. Therefore I have said before any results were known from the recently liberated data, "No matter what the results may be, I cannot accept them."

          No objective scientists can think, "I will wait to criticize the database until I see what the results are." In other words, if they like the results they will keep silent about the taint.

          A study based on one section of the recently released DOE data is reporting an excess of cancer in exposed workers (Wing 1991). I do not accept the findings because there is no justification for me to accept the database itself. DOE's handling of it has rendered possibly valuable data scientifically worthless or worse, in my opinion.

          Similar handling must be prevented, and can be prevented, in studies of Chernobyl's radiation consequences.

           * - Eighth Rule:   No Excessive Subdivision of Data

          It lies in the nature of numbers that even the largest databases can be rendered inconclusive and misleading if analysts keep the data subdivided into too many categories or subsets (see Gofman 1990). Therefore, subdivision must be watched with a degree of suspicion. If analysts hope that a study will find no provable effects even if they are real, this result can be arranged by preserving excessive subdivisions throughout an analysis.

           * - Ninth Rule:   No Pre-Judgments

          Prejudgments are seldom compatible with objective inquiry. With respect to Chernobyl-studies, it is our duty to point out that some serious pre-judgments appear to be embedded in the inquiries by the WHO and the IAEA.

          For instance, the IAEA simply discarded (p.22) measurements which indicated some doses were higher than the preconceived notions of what the doses "must" be. Another pre-judgment is that radiation-induced solid cancers will not show up as soon as 1990. Elsewhere (Gofman 1994), we discuss evidence which suggests that an early wave of Chernobyl-induced cancers is plausible and should not be pre-judged as improbable.

          The most serious pre-judgment of all, mentioned in Part 2, is the WHO statement that radiation from Chernobyl cannot account for the long list of non-cancer disorders listed in Part 1. This pre-judgment was not in the slightest degree confirmed by the subsequent IAEA survey, which was scientifically meaningless because of the tiny dose-difference (if any) between the groups compared.

          Nonetheless, if WHO prevails, its IPHECA study will search only for traditionally expected radiation effects (IPHECA 1991-a, p.4, p.18). This plan seems both cruel and contemptuous toward the exposed populations where the "holocaust" claims are so worrisome. Indeed, the IPHECA plan seems to reflect contempt for all humanity, by wasting humanity's unique opportunity to learn something solid about early health effects from nuclear accidents.

6    *   The Bottom Line on the "Watchdog" Authority

          The nine rules described above used to be standard minimums. All nine are absolutely required for making studies of Chernobyl's radiation consequences believable -- for ruling out bias either toward underestimating or overestimating the consequences. Humanity as a whole benefits only by truth.

          We propose, therefore, that regimes led by "new thinkers" in the three most affected republics take a forceful stand regarding the use of their people and their territories by the IAEA, the WHO, and by other research groups. By elevating the standards in radiation research, the republics would do an enormous service for the whole world. The republics are surely entitled to proclaim:

          "What we envision for the world concerning Chernobyl's health effects are studies which are unequaled in their scientific quality, credibility, and objectivity. Such studies have not yet been done.

          "All of humanity needs believable studies of both the current situation and also the situation in the future. And so we expect the world to help us achieve such studies -- studies conducted by rules which will prevent exaggeration in either direction on the topic of health effects.

          "It is for the benefit of the world as well as our own people that we demand that internationally funded Chernobyl research and all other Chernobyl research must comply with rigorous scientific standards for producing credible, objective, and fully blinded studies, that the databases and the method of their construction must be continuously accessible and checkable by independent analysts from the republics and elsewhere, that there must be an end to past secrecy, and that there be no secrecy in the future.

          "As evidence of compliance, it is required that all tapes, documents, reports, and findings issued by IPHECA and others must include an independent assessment of the topic by an independent "watchdog group" accountable to the republics. Such participation at every step of the studies represents some meaningful peer-review. Truth speaking to Fiction:  ...Also I'm Much Stranger Than You!

          "We are proud of the scientific quality on which we are going to insist, for otherwise, the Chernobyl accident could produce another tragedy by polluting the world's big-medical literature with `information' which fails to meet standards for trustworthiness and which might be deadly misinformation harming many, many millions of additional persons worldwide over time.

          "We will not become accomplices to such an outcome. If the high research standards set and enforced by our "watchdogs" are not acceptable to the international and other groups doing research on our territories, the groups will be invited to leave."

7    *   The Fiercest Possible Defense of Databases

          To achieve the truth about Chernobyl's health effects will require some unprecedented measures. Secrecy and deception were the rule from the beginning. For instance:

          In short, the problems of falsified data, destroyed records, bias, conflict of interest, and lack of trust have never been more self-evident on a radiation issue than on Chernobyl's radiation consequences.

          Nonetheless, it is still possible to construct and conduct scientifically credible studies of Chernobyl's health effects -- provided that the republics are willing to intervene now and provided that the outside world supports such intervention. Is it worth the effort?

          If the world allows the truth about Chernobyl to become distorted by bias in the direction of underestimating its radiation consequences, it would be a warning that the truth about every chemical pollutant is also in danger of comparable distortion.

          And if all these hazards are systematically distorted by conflicts of interest in the research, humanity everywhere will face not only a vast harvest of radiation-induced misery from "permissible" nuclear pollution, but additional giant harvests from "permissible" chemical pollution of every type. And "mysteriously rising" rates of illness can occur even while the average length of life is growing.

          Therefore, one of the most vital activities in the field of citizen action and preventive medicine -- today, tomorrow, and forever -- is the fiercest possible defense of objective, untainted databases.

          There can be no activity more important for human health, for if the databases cannot be trusted and relied upon, then medical science can be turned on its head by mis-information, which can persist as textbook wisdom even for centuries.

# # # # #

References:   Gofman 1990 (book), Radiation-Induced Cancer from Low-Dose Exposure:   An Independent Analysis;   Gofman 1994 (book), see below;   IAEA 1991-a (60-page document) The International Chernobyl Project:   An Overview, May 1991;   IPHECA 1991-a (33-page document) The Task Group on the Initiation of IPHECA, prepared for its meeting 7-11 January 1991 in Obninsk, USSR;   Steve Wing, "Mortality among Workers at Oak Ridge National Laboratory," JAMA, Volume 265, March 20, 1991.

Author:   JWG is Chairman of CNR and author of four scholarly books on health effects from ionizing radiation (1981, 1985, 1990, and 1994 in preparation, Chernobyl Accident:   Radiation Consequences for This and Future Generations (Russian Language)).

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