Radiation health effects for medical doctors
Misinformation about radiation health effects does not just affect the nuclear industry and dramatically increase the costs associated with all nuclear energy technologies. It is also having a deleterious effect on the beneficial use of radiation and radioactive materials in medical diagnosis and treatment.
Throughout their training programs, medical doctors have been taught to do everything they can to minimize radiation exposure. This message has become so intense in recent decades that many medical professionals shy away from ordering tests that would help them do their jobs better and provide better patient outcomes.
Recently, I was privy to an email conversation between several people who are working hard to spread more accurate information about radiation health effects to busy medical doctors. I have obtained permission from the participants in that private conversation to share some of it with you in hopes of continuing the mission of helping more people understand the balance between benefits and risks of using radiation and radioactive materials.
The conversation started on June 6, when Dr. Jerry Cuttler shared the following story.
At 7 am this morning, I gave a Round to a group of ten very busy surgeons who order up many CT scans. They appreciated my presentation very much — a big surprise for them because they are constantly being hounded to minimize radiation-induced cancer risks, especially to young patients.
I brought copies of four articles, including the SARI Open Letter on LD TBI treatment.
They were very interested in Dr. Sakamoto’s data that showed peak immune system stimulation at 150 mGy (15 rad) and the LD HBI protocol of repeated stimulatory doses of 150 mGy, twice a week for 5 weeks. I carefully explained the important difference between an acute dose and a continuous dose-rate.
They believed that each CT (acute) exposure adds to cancer risk. I explained that the patient recovers from each CT exposure, due to the action of the very powerful adaptive protection systems.
The physicians were not aware of the enormous rate of DNA damage, due to the endogenous processes, and the restorative functions of the protection systems.
(Dr. Cuttler’s presentation is titled Remedy for Radiation Fear Beneficial Effects of Low Radiation by Jerry M. Cuttler D.Sc., P.Eng. Cuttler & Associates Inc. Mississauga, Ontario)
Cuttler’s message was answered by two people, Les Corrice and Robert Hargraves. Corrice publishes the well-respected nuclear energy focused-blog, Hiroshima Syndrome. He was a health physics professional, both in the Navy and in the commercial nuclear power industry.
Good job. I did something similar with some available radiation brochures in the mid-1980s. I gave them to interested doctors and dentists, and answered their questions. I was working for a nuke plant, and hormesis was a verboten topic, back then. Regardless, even the old-school relative-risk angle was very helpful to the medical and dental professionals. I’m sure you found the experience rewarding.
Hargraves has been a guest author here at Atomic Insights. is the author of a useful pamphlet and presentation titled Radiation, The Facts.
Could you share that presentation with this group? Could it be made simple enough and self-explanatory enough that we could make similar presentations at local hospitals. I know doctors at the Dartmouth Hitchcock Clinic, and I’ve had the radiation safety officer talk to my class, so I might be able to give a presentation if it’s short enough not to embarrass myself, and if I had some papers to distribute.
Cuttler’s response is direct and informative. His message describing the communications challenge needs to be well-understood.
I’ve given about ten presentations to medical staff, including medical physicists at the Memorial Sloan-Kettering Cancer Center in New York.
No I cannot make it simple. I’ve been studying this subject since 1995, when Dr. Myron Pollycove got me started with his centennial lecture on Roentgen’s discovery of x-rays.
The subject is complex, and the physicians ask difficult questions. If the speaker does not give rapid, authoritative answers then credibility vanishes.
Many nuclear professionals harbor the notion that irrational fears about radiation are limited to the uneducated portions of the population. They need to recognize that the effort to spread unwarranted fear, uncertainty and doubt has been intensive and widespread and includes a substantial effort within the education establishment. That means there are many very well educated people who have been taught incorrect information about radiation and the way that it affects human biology.
It is important to make the effort to get the attention and gain the trust of these well-educated people so that they listen to what will be, to them, new information that contradicts most of what they have been told in the past. This is a different kind of challenge from teaching people who have no preconceived notions and who thirst for knowledge because they recognize that they do not know much about a topic.
Hargraves responded to Cuttler’s message with a link to a recently published study that might help convince open-minded, curious medical doctors to question their previously taught knowledge and open their minds to new — to them — information. The study is titled Drosophila Melanogaster Show A Threshold Effect In Response To Radiation. It documents modern experiments conducted on the same “fruit flies” that Herman Muller used in the 1940s, but it reaches a completely different conclusion about the effects of low dose radiation than Muller did.
(Note: If the direct link to the paper leads you to the Dose-Response Journal home page, just search for “drosophila melanogaster” to get a working link to the paper. Responses vary depending on browser setup and prior use of the site.)
It might be too much to hope for, but perhaps even Dr. Helen Caldicott would take a new look at radiation health effects if she learned that Muller’s research on drosophila melanogaster had been redone using modern tools with significantly different results. After all, she has informed us all that her views on radiation were substantially influenced when she learned about Muller’s fruit fly experiments during her first year of medical school.
That new Drosophila Melanogaster study really seems interesting, but I regret it’s authors chose to publish it inside Dose-Response. It will be simply ignored whatever it’s value. Getting it published in a journal that usually strongly defends the LNT could have convinced many that they had to get a better look at it.
Why do you help the opposition by implying that Dose-Response is somehow a marginalized journal? It is one of the few organizations and journals that is made up of people who are using experiments and measurements to find out what the real responses are instead of using one-sided statistical analysis and epidemiology studies to “prove” what they assume the responses should be based on a physics model, vice a biological model, of living organisms.
No, it’s a shoddy “journal” concocted by Ed Calabrese, for people who can’t do real science. It’s like the NIPPCC cult that doesn’t like the IPCC. Cuttler & Calabrese have been in science denial for decades, just like some people deny evolution or climate change.
I’m not saying it’s shoddy, what I’ve read in it seems quite valid, but yes indeed it has marginalized itself by being *the* journal where all those who doubt LNT will publish.
Perhaps credibility should be increased a notch by noting that the lead author has a Nobel prize in physics.
There seems to be a math error in Dr. Cuttler’s presentation, on the page describing the results of Ogura et. al. 2009. The abstract mentions a group receiving 500 µGy as being significantly lower than the controls, but this seems to come out as .005 Gy (=5 mGy, =5000 µGy) in Cuttler’s table, a factor of 10 difference. Unfortunately the paper is not available outside the paywall and I cannot determine the truth of it.
Yes there is an error in my table. The lowest dose is 0.5 mGy; the graph is correct. I will change the dose in the table from 0.005 to 0.0005.
I sent a revised pdf of the presentation to Rod. Slide 11 shows the lowest dose as 0.0005 Gy.
Thanks for a rapid and accurate response!
The corrected presentation has been loaded and the post revised to point to the correct URL. The superseded presentation will be removed.
The “Radiation: The Facts” presentation will be premiered at the ANS NY NE section annual meeting June 19 at the Edison Club. I’ll post it afterward. Here’s the promo:
Clean, safe, affordable energy from nuclear power can help lift developing nations out of energy poverty and also address global environmental problems from burning fossil fuels. But unwarranted fear of radiation from nuclear power plants, accidents and waste created opposition to nuclear power. The root cause of the fear is unscientific, politicized analysis, stratification, and cherry-picking of radiation and health effects observations. Opponents and regulators ignored contrary evidence to heighten public horror of global nuclear warfare. Cascades of scientific papers now are founded on deceptive publications dating back to 1956. This presentation reviews the old bad science, reanalyzes old data, and describes new understandings of biological response to radiation. Replacing the politicized science of LNT and ALARA with radiation safety limits will roll back unfound fears and unnecessary regulations, enabling world civilizations to prosper using nuclear power.
What aggrieves me most is that anti-nuclears have the ear of the media to influence energy policy with unchallenged mostly bogus assertions yet they have zero-responsibility regarding the energy welfare of a entire nation (ours and worst, third-worlders) whom they’ve taken upon themselves as being champions of.
That the public is so openly and blatantly deceived by anti-nukers wielding “facts” and “proof” and assertions yet are skittishly and maliciously coy of them being grilled in debate disturbs me greatly and is the number-one issue facing the nuclear community to me, beyond reactor types or even waste. Enlighten the public on nuclear fact and history and those issues will neatly fall into place by de-fanged fear and public acceptance.
What gets me is that ironically this massive PR and nuclear mal-perception problem can be put to bed in mere months without re-inventing the PR wheel via a phone call to a reputable Madison Ave Ad firm, preferably those who got Tylenol and BP Gulf out of the PR pits. If members of atomic unions and nuclear professional groups passed the hat to fund that, 80% of the problems nuclear energy faces right now could turn around in no time.
Again there’s startling precedent to that, but someone at the helm has to pick up the phone first. No deep Saturn-V lectures needed; Just citing that the infamous perky gas Ad lady doesn’t mention squat about greenhouse is ammo enough — but don’t stop there! Nuclear’s merits are a slam dunk but its own community just keeps dropping the ball decade after decade. Let Pros fix your image! Until the EPA’s latest clear air report jots down new nukes on the dotted line, it’s all just token vapor praise to me, especially when they’re still happily juicing up other green projects even as we talk.
I think this subject is what bothers me most about LNT proponents. If they push it for personal gain or just as an anti nuke strategy, the spill over effect hits the med field. I look at radiation the same way I look at water. When I was single handing my sailboat from Florida to the Bahamas every winter if I went overboard in the Gulf Stream, on auto pilot, the outcome was 100% assured, the water would kill me. Now I’m a land lubber in the Arizona desert and if I extrapolate the Gulf Stream data backwards, and totally avoid water because at high doses it kills, my fate is the same as I’ll die. Everyone in the US at my age (3 score and 10) knows several people whose life has been extended by med radiation. Yet the irrational fear exists, just because it suits the agenda of folks who push it. My disconnect comes when I think they have to know this.
I might also mention that although I could not find the referenced Evans 1972, I did find a similar reference Evans 1974 as follows:
Evans, Robley D. “Radium in man.” Health Physics 27.5 (1974): 497-510.
The abstract strongly disputes LNT, although the entire paper is not online. However, the key figure from Evans 1974, matching Cuttler’s referenced graph exactly, can be found here:
WoW, an abstract from 1974! Now that’s cutting edge!
The pro-LNT opponents of Cohen have admitted that it’s correct that a threshold was found for radium worker :
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939694/ JS Puskin “Letter to the Editor: Reply to Cohen’s Response to EPA Position on Cancer Risk from Low Level Radiation”
– “While it is true that the dose response for bone cancer induction in radium dial painters appears to be sublinear, and that no osteosarcomas have been observed among subjects receiving less than 10 Gy, …”
And how odd that Puskin 2010 (linked above) cites Heath et al. 2004 and WHO 2009 to support his contention that “[case-controlled] studies demonstrate a risk from relatively low concentrations of indoor radon” — yet he fails to cite Thompson et al. 2008 that found precisely the reverse.
Would you support research on the effects of radiation as a replacement / additional therapy to Chemo Therapy for someone who has had cancer?
Would you support research into the health effects of low level radiation outside of the studies done on Hiroshima and Nagasaki?
How do you view the comparative risks of CT scan with other normal human activities?
And Muller in the 1950’s is more cutting edge how exactly, Bob?
LOL – I wouldn’t hold my breath on Helen Caldicott. She lives in something of a closed information system where any scientific findings which contradict her anti-nuke hysteria are the result of a massive conspiracy by the big bad “nuclear industry.”
I’m guessing you were probably just saying that rhetorically though 😉
28 – http://www.unscear.org/unscear/en/chernobyl.html. The guest post “Radiation Superstition” has been corrected.
Physics models are used for converting absorbed energy into a calculated dose and dose rate, but they are not necessarily accurate models of the long term health effect of those doses. They do not take any defensive or recovery mechanisms into account.
What defensive or recovery mechanisms?
One example is adaptive response.
From your link:
Probably the most frequently studied
adaptive reponse system in eukaryotic cells
involves radiation. These studies were originally
carried out by Olivieri et al. (13).
These authors reported that human lymphocytes
exposed to low level beta-radiation
in the form of incorporated tritiated
thymidine are more resistant to chromosomal
damage caused by high dose X-rays.
Since chromosomal damage was used as an
endpoint in this study, it was once again
assumed that an induction in DNA repair
was responsible for this adaptation. It was
subsequently demonstrated that the adaptive
response was sustained through three
cell cycles following the low dose exposure,
after which the cells again became sensitive
to high dose irradiation (14).
Is this what you were referring to?
I sure hope not. Cancer etiology (and human immune system responses to stimulated rates of oncongenically transformed cells) in humans is very different than in fruit flies (with life spans on order of 3 months). If there is relevance of non-linearities at low doses in fruit flies to cancer end points in humans, I would hope this is a matter for careful investigation and subsequent research (as appropriately recommended by open minded researchers in this area) … “the issue of beneficial/harmful effects should not be a part of the definition of hormesis, but reserved to a subsequent evaluation of the biological and ecological context of the response” (Calabrese and Baldwin). I would hope medical doctors don’t throw out previously taught knowledge on human cancer (biology, case control, and population studies) in light of such highly speculative, and even contradictory, research as this.
You may not have listened to Dr. Helen Caldicott as often as I have, so perhaps the allusion didn’t make as much sense as I wanted it to. According to Dr. Caldicott, the main influences that led her to a life of antinuclear activism were reading Neville Shute’s “On the Beach” as a teenager and then learning about Muller’s fruit fly experiments in her first year as a pre-medical student.
And, as we have been reminded countless times by the good doctor herself, she is a pediatrician and knows everything there is to know about radiation.
I wouldn’t let her near my kids.
One reason why I wasn’t jumping up and down about the (Green Obamalized) EPA’s supposedly great clean air news for nukes:
Thanks James Conca
In the Drosophila Paper by Leon N Cooper I am a bit puzzled by the need to convert the incident dose (in Sievert) to an absorbed dose. The calculation of appendix 1 gives an absorbtion factor of below 1%. This is because drosophila are rather small. However, isn’t that low probability of interaction already included in the unit of the incident dose, which is expressed in Sievert? If you place a kg of water into a homogeneous gamma field of say 1Sv/day it will absorb 1J/day. A gram of water in the same field will absorb 1mJ/day, etc. The only effect that you may need to correct for is that the flies are so small that some of the recoil energy of compton-scattered electrons will not be absorbed in the fly. But they do this estimation and conclude that almost all electron recoil energy will be absorbed in the fly.
So I think the doses in the paper are much larger than quoted. Obviously I hate to argue this with a noble prize winning physicist.
Interesting timing. My Sunday paper has a half page essay, “Are we giving ourselves cancer?” The essay by Rita Redberg and Rebecca Smith-Redman appeared in the NYT earlier this year. While making positive points about the hazards of misuse and poorly calibrated equipment, the essay also includes statements like, “A single CT scan exposes a patient to the amount of radiation that epidemologic evidence shows can be cancer-causing.”
In February 2014, Atomic Insights published a guest post response to the original essay from the New York Times signed by 13 members of the Scientists for Accurate Radiation Information (SARI).
Bottom line – Ms Redberg and Ms Smith-Redman are wrong and misinformed.
Relative to CT scans and cancer patients, has anyone studied the effect of the state of a cancer patient’s immune system on the adaptive recovery from CT scans? My question is related to the essay by Rita Redberg and Rebecca Smith-Redman essay in the NYTimes.I am an engineer totally ignorant about cell biology.
In a direct way, the effect of radiations has no relation with the immune system.
Radiations cause ionization inside the cell, and the free radicals created by this ionization break some of the DNA strands. Then the repair mechanisms of the damaged cells will try to reconstruct the DNA strands, successfully in many case, and most of the time when they fail, this will start a mechanism of self-destruction of the cell called apoptosis.
In some circumstances, the DNA may be instead repaired incorrectly which could cause the cell to become cancerous. At this level, immune system may have a role, because it should identify and destroy cells that have became cancerous.
But when one talks about the recovery from radiation exposure, it’s mostly about the first step of repairing the DNA, not the second step which may happen much later, and at a smaller scale, of elimination of deviant cells by the immune system.
The description of this process explains why it’s quite likely that there is a threshold, since as long as the amount of damage is low, the repair mechanism will work much more efficiently (this has been tested and demonstrated correct). Also some results seem to show that apoptosis will be preferred when the number of damage cell is not too high, and an incorrect repair more frequently done when the number of damaged cell is overwhelming. This is also not incompatible with the hormesis effect, a positive effect at low dose, if the stimulation of the repair mechanism at low dose ends up making them more efficient and lowering the risk of the cell becoming damaged because of the natural oxidation mechanisms. All in one, the linear postulate is extremely unlikely to hold truth given what is known today about biological repair mechanism.
However the complexity of all of this should not be underestimated. It’s known today that everybody doesn’t have the same repair mechanisms efficiency, the genetic heritage of some people may give them much more efficient ones, or reciprocally much weaker. There’s also one experiment that showed the effect of two successive 2 mSv irradiation may be stronger than one of 4 mSv.
So I can understand why some health professionals prefer the simplicity of the LNT to saying we don’t know, and there’s probably not a really universal rule.
The trouble is when the large amount of evidence that exposure of a large population to a low number mSv does not seem to result in any visible increase of the number of cancers is ignored in favor of mathematically applying LNT at very low dose (which the UNSCEAR strongly warns against). And also with the ease with which the LNT postulate of a risk at low dose is transformed for the public into the idea that a low dose is just as dangerous as a high dose, or is somehow much more dangerous than the countless other carcinogenic agent or factor with have in our environment, tobacco, alcohol, read meat, salt, overweight. I’m listing only the very major ones, the ones responsible for millions of cancer deaths worldly, every year.
I have recieved several ct brain scans. The reports indicate that I recieved 43 mGy of radiation the last two times, however I don’t know what it was before that. Ct scans are at least an order of magnitude faster than they were in the late 1970’s. That would mean a lower dose if the dose rate hasn’t changed to offset that, however I don’t know if that is the case. I am more concerned about cataracts than cancer. I read that the lens is one of the most radio sensitive tissues. I hope that my vision is reasonably good on Aug. 21, 2017, and that I’m able to travel to the proper location in order to see a total solar eclipse. I was born 1951 so at least early cataracts would be expected.
I’ve had cataracts removed from both eyes. A piece of cake. I know that some patients experience complications; so if you need the operation, talk to people who have gone through it all.
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