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expert reaction to Lancet series of reviews on impacts of nuclear disasters, around the 70th anniversary of the atomic bombs in Hiroshima and Nagasaki

The health effects and lessons learnt from nuclear disasters is the subject of three papers published in The Lancet. The papers report that survivors of such events have an increased risk of developing negative physical, psychological and social effects including cancer and post-traumatic stress disorder. The papers concludethat physicians should receive training in how to deal with nuclear disasters, in order for them to provide decision aids to protect workers, vulnerable people and residents following a disaster.

 

Commenting on the psychological aspect, Dr James Thompson, Honorary Senior Lecturer in Psychology, UCL and Clinical Psychologist, said:

“From the paper I note the following: The targeted population was 210,189 in fiscal year 2011 (FY2011) and 211,615 in fiscal year 2012 (FY2012). Questionnaires have been mailed since January 2012, and subsequently, January 2013, 10 and 22 months after the disaster. Among them, children 63.4%, adults 40.7% for FY2011, and children 41.0%, adults 29.7% for FY2012 responded to the questionnaires mailed. This is not too bad for a health survey, and reasonable for children in 2011, but not high enough in subsequent years, which probably tells its own story. The 41% response for adults is too low to get population estimates of trauma, and should be considered a probable over-estimate.

“The Kessler 6 scale which has been used is like any other scale: it does a reasonable screening task among willing responders. The whole approach would have been tighter if there had been even a small population studied in depth as then one can look at their responses, including what those few who bothered to fill in the Kessler scales were like compared to the majority who did not. Of course, those who showed high scores need to be helped, but these results cannot determine the real dose-response relationship.

“On a broader canvas, we need another paper, with a more operations- and decisions-focussed approach. I can see that, if in doubt about nuclear leak, the authorities will recommend evacuation, if only to protect themselves politically. However, we need to have some better guidelines as to what levels of radiation really merit the significant social disruption of evacuation, particularly for the ill and elderly. My gut feeling is that evacuations and alarms have been triggered too easily. The psychological consequences of ‘damage to sense of health’ can be very significant, even if those consequences are hard to estimate when response rates to questionnaires are low.”

 

Prof. David Ireland, Professor of Physics and Head of Nuclear Physics Research Group, University of Glasgow, said:

“The 70th anniversary of the nuclear attack on Hiroshima seems an appropriate juncture at which to summarise what is known about the health effects of exposure to radiation. It is also important to review how to improve the response to serious accidents at nuclear power plants.

“However, as pointed out in the thoughtful opinion piece accompanying the three articles, comparing Hiroshima and Nagasaki (deployment of weapons of mass destruction) to Fukushima (an accident caused by a natural disaster) seems inappropriate. The common thread is the exposure to radiation and yet, as mentioned several times in the papers, the main problems in the case of accidents at nuclear power plants arise from psychological stress and forced evacuation.

“Many adverse health effects can be attributed to what happens in the aftermath of a nuclear accident, but these will also be prevalent in disasters of different origins, both man made (e.g. chemical or oil spills) and natural (e.g. hurricanes or indeed tsunamis). In other words, the problem with nuclear disasters is ‘disaster’, not ‘nuclear’.

“An important point is highlighted in one of the papers: the Japanese concept of ‘Fuhyohigai’, meaning the socioeconomic damage caused by a vague and unfounded negative reputation. The reason for this occurring is almost certainly the sensationalised reporting by the media. In that respect, it would be good if press coverage of these current articles does not turn out to be yet another nuclear scare story. Remember, the tsunami in 2011 caused over 15000 deaths; there have been zero deaths as a direct result of the Fukushima accident.”

 

Prof. Dudley Goodhead, Visiting Professor, MRC Harwell, said:

“This series of papers provides a very useful summary of current knowledge as well as proposals for managing future accidents.  They highlight the fact that, although the direct risks of health effects from ionizing radiation are well understood, the wider individual and societal impacts of accidents can be extensive and difficult to predict.”

 

Commenting on the psychological aspect, Prof. Sir Simon Wessely, President of the Royal College of Psychiatrists and Professor of Psychological Medicine, King’s College London’s Institute of Psychiatry, Psychology and Neuroscience, said:

“This shows that the psychological and social consequences of nuclear accidents are more profound, long-lasting, divisive and difficult to manage than the more direct consequences of radiation leaks.

“In future, far more attention needs to be given to community engagement and choice, and less to the extreme risk-aversion which currently dominates thinking. Over-precaution and over-reaction can have just as serious long-term reactions as under-reaction. For example, do we really need to evacuate everyone including those at very low risk, or perhaps allow them to exercise their own judgements after they have been given the most accurate information, including the risks of evacuation?

“We have known for a long time that radiation is associated in the minds of the public with particular fear and dread, but that is no excuse for policy makers and emergency planners to react in similar fashion.”

 

Prof. Geraldine Thomas, Professor of Molecular Pathology, Imperial College London, said:

“The three papers by Ohtsuru et al., Hasegawa et al., and Kamiya et al., review the large body of scientific studies that have been conducted to understand the health risks of exposure to radiation. Of most concern to the general public are long term health risks such as cancer. The atomic bombings in Hiroshima and Nagasaki occurred 70 years ago and a wealth of data has accrued over this period of time. The Nuclear Power plant accident in Chernobyl was nearly 30 years ago, so some uncertainties remain about life time effects, but we do have sufficient data to start to draw some firm conclusions. The two exposures were very different both in terms of dose to individual members of the population and the type of radiation to which those populations were exposed. There is a dose-response relationship with any toxic substance to which our bodies are exposed, and radiation is no different in this respect to any other type of toxic substance. The problem in terms of protecting the public is the shape of that dose response relationship. At present, we assume that the relationship is a linear one, as we do not have the scientific evidence to disprove this. This results in the conclusion that no dose of radiation is safe, and that therefore protection from even the smallest dose should be our goal. These papers however suggest that the measures that we put in place (long term evacuation etc.) to protect ourselves from what may be a health risk, which is not definable at low doses, may be creating a greater health risk, unrelated to the dose of radiation, but related to our human responses to the situation. Perhaps the biggest lesson we need to learn from past releases of radiation is how to communicate the real potential risks in the case of any future accidents. The major effect on health of the general population from both Chernobyl and Fukushima is not related to the actual effects of radiation, but the fear of radiation.  Multiple factors govern our health, and understanding the relative risks from these factors and putting risks from a single factor in context with others is important.

“The lesson we need to learn from Fukushima is that communication of the real risk rather than the perceived health risk is key. Both the media and the scientific community have a role to play in this. The contradictory scenarios reported and the use of highly emotive language used in the headlines at the time certainly did not help the residents of Fukushima at the time of the accident. The media stories that do not put the real risks into context are not helping even now. However, journalists are not specialists and need access to those who are in order to do their job responsibly. In addition, long term engagement with those whose lives have been affected by our responses to the accident will be required to provide the psychological support that is required to rebuild trust and communities affected. The Fukushima population has been subjected to huge societal dislocation and loss of life – but we should not forget that the loss of life has been due to a natural disaster and our response to a man-made one, not due to the industrial accident itself. We should learn from the accident itself in order not to make the same mistakes again, but an over-reaction can produce risks in its own right that may be greater than the health risks posed following the accident itself.

“How we produce our energy has an important effect on our health. An inability to keep cool in summer and warm in winter takes a large toll on our elderly population and climate change will affect us all. We may have to accept that the real health risks posed by a very rare event, an accident at a nuclear power plant, are much smaller than we allowed ourselves to believe, and take responsibility for our own miscommunication of the real risks of radiation. If we don’t take note of the lessons to be learned from Fukushima and Chernobyl around risk communication, we may exclude a valuable way of powering our future, which may have a much more detrimental effect on the health of future generations.”

 

Three papers and a Viewpoint piece:

1: ‘From Hiroshima and Nagasaki to Fukushima 1.  Long-term effects of radiation exposure on health’ by Kenji Kamiya et al. published in the Lancet on Friday 31 July 2015.

2: ‘From Hiroshima and Nagasaki to Fukushima 2.  Health effects of radiation and other health problems in the aftermath of nuclear accidents, with an emphasis on Fukushima’ by Arifumi Hasegawa et al. published in the Lancet on Friday 31 July 2015.

3: ‘From Hiroshima and Nagasaki to Fukushima 3.  Nuclear disasters and health: lessons learned, challenges, and proposals’ by Akira Ohtsuru et al. published in the Lancet on Friday 31 July 2015.

Viewpoint: ‘Towards long-term responses in Fukushima’ by Michael R Reich and Aya Goto published in the Lancet on Friday 31 July 2015.

 

Declared interests

Prof. David Ireland: “I currently have a research contract with the National Nuclear Laboratory and Sellafield Ltd to develop a detector system that can image intermediate level radioactive waste barrels.”

Prof. Dudley Goodhead declares no interests.

None others received.

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