PUBLIC HEALTH AGENCIES, ostensibly charged with protecting citizens against disease risks, have conducted very few surveys of disease among residents in areas where there is suspected contamination--either from toxic chemicals or radioactivity. Instead, these agencies have relied on the assurances of "no problem" issued by scientists contracted by the polluting industries or government agencies. (1) With respect to the small number of studies in which researchers have suggested that there is a possible association between increased incidence of disease and toxic releases into the environment--resulting from government or industrial waste disposal--there are well-documented histories of aggressive public attacks and ad hominem smear campaigns against the researchers (i.e., the bearers of "bad news"). (1,2) In most situations, such health studies have involved general populations exposed to unknown quantities of toxins (i.e., dose), for which the investigative tools of traditional, analytical epidemiology become somewhat insensitive and crude. (1) Moreover, credible population health surveys--particularly if they must include large geographic areas--can be very costly. Citizens, therefore, find themselves in a "Catch 22" bind: large-scale studies require financing by public agencies that have lost credibility with the public as a result of conflicts of interest. (2)
A few years after commencement of top-secret operations at a plutonium production facility in Hanford, Washington, individuals who raised cattle and grew various grain crops on the land downwind of the site, as well as residents of cities in the same area, began noticing an unexpected increase in cases of hypothyroid disease, spontaneous abortions, infant mortality, heart attacks, cancer deaths, and many other health anomalies among their families and neighbors. Suspicions grew concerning a possible association between the aforementioned diseases and the top-secret activities at Hartford. Demands by these "Downwinders" for reliable information met with denials that activities at Hanford could have any detrimental effect on the health of residents. Most local physicians among the affected populations knew nothing about the nature of activities at Hanford, or about the extensive but, in part, inconsistent literature on the effects of ionizing radiation on health. Investigative media reports supported Downwinders' suspicions of a link to Hanford's operation. (2) In 1986--after approximately 4 decades of deceit--the Hanford Education and Action League used the Freedom of Information Act to force the government to acknowledge that an atmospheric release of 730,000 curies of (131) (radioactive iodine) from the Hanford site had occurred during the time period from 1944 to 1951. Nonetheless, state and federal health agencies continued to deny any possible association between these atmospheric releases and serious health detriment(s). Questions raised by Downwinders in public meetings, and with their local physicians, were often met with suggestions that these individuals were suffering from "radiophobia."
Frustrated by these humiliations, a group of affected individuals appealed to Physicians for Social Responsibility in Oregon (PSR-OR) for independent validation of their concerns. In 1993, physician and scientist members of PSR-OR responded by forming the Northwest Radiation Health Alliance (NWRHA), which included Downwinders, social justice and environmental activists, physicians, and scientists. The group decided to conduct a voluntary health survey among as many individuals of the apparently affected population as NWRHA's grass-roots efforts could reach. (2)
The group's first task was to design a sufficiently comprehensive health questionnaire that was not too daunting to individuals who were unfamiliar with reporting information about their lifestyles and health, absent professional assistance. The choice of information requested, and the specific conditions to be reported, were informed by knowledge of the relevant scientific literature by the physician and scientist members of NWRHA, as well as by familiarity with the "rural life" of the Downwinders. Specific items on the questionnaire included the following for each respondent: vital statistics, years at and location of residence in the Hanford downwind area, smoking habits, sources of food ingested, a list of specific illnesses experienced, dates on which illnesses were diagnosed by a physician, and reproductive health history, including the number of children and their congenital defects (if any). Each of the 801 valid questionnaires received was checked for completeness and consistency by 2 members of a NWRHA volunteer force. In addition, these questionnaires were inspected for medical inconsistencies and/or correctness of terminology by 2 physicians. The resulting database represented approximately 50 yr of observation following the initiation of the Hanford, Washington, operations in 1944. The report "Cancers among Residents Downwind of the Hanford, Washington, Plutonium Production Site," on pages 267-74 in this issue, is based on the aforementioned data.
Analysis of a self-reported database lacking dosimetry cannot "prove" causal links between disease and exposure that accords with accepted epidemiological standards, inasmuch as reliable information about internal radiation exposures for respondents, and about individual variations in susceptibility to radiation damage, are unavailable. However, if the effects of environmental exposures (e.g., occurrence rates of cancers) are of a sufficient magnitude, and if--for diseases known to be least associated with these exposures--occurrence rates among the study population are consistent with those in unexposed populations, it is reasonable for one to consider the population sample studied to be approximately representative of the entire exposed population.
The Precautionary Principle, (3) as it applies to public health, advocates taking preventive action in the face of uncertainty, shifting the burden of proof to the proponents of an activity, exploring a wide range of alternatives to possibly harmful action, and increasing public participation in decisionmaking. In accordance with this principle, apparent large excesses in disease rates among Hanford Downwinders--compared with rates in reasonably similar populations unexposed to radioactive fallout--should be taken seriously when they suggest that a link may exist between disease and environmental exposures via internally lodged radioactivity--possibly in synergy with exposures to agricultural toxins.
(1.) Davis DL. When Smoke Ran Like Water: Tales of Environmental Deception and the Battle Against Pollution. New York: Basic Books, 2002.
(2.) Nussbaum RH, Hoover P, Grossman CM, et al. Community-based participatory health survey of Hanford, Washington, Downwinders: a model for citizen empowerment. Soc Nat Res (accepted for publication).
(3.) Kriebel D, Tickner J, Epstein P, et al. The Precautionary Principle in Environmental Science. Environ Health Perspect 2001; 109:871-76.
Rudi H. Nussbaum, Ph.D.
Department of Physics and Environmental Sciences
Portland State University
Portland, OR 97207
Charles M. Grossman, M.D.
Department of Medicine
Legacy Good Samaritan Hospital
Portland, OR 97210
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