American Journal of Industrial Medicine 22:1%133
(1992)
HISTORICAL PERSPECTIVES IN OCCUPATIONAL MEDICINE
Health Physics: Its Development, Successes, Failures, and Eccentricities Karl 2. Morgan, PhD
Health Physics began at the University of Chicago as a science and profession during the early World War 11 years. It was initiated by Drs. A.H. Compton and R.S. Stone, director and associate director, respectively, of the early Plutonium Project cryptically called the Metallurgical Laboratory. It was to be a science and profession to protect radiation workers and members of the public from exposure to ionizing radiation. It succeeded to some extent in this objective but during the past decade in the United States,it has reverted into an organization primarily to protect the nuclear industry from liability resulting from radiation exposure. o 1992 wiey-Liss, I ~ C . Key words: history of medicine, low level ionizing exposure, IRCP, health physicists
INITIAL AWARENESS OF RADIATION EFFECTS
On January 4, 1896, the public press heralded Roentgen’s discovery of X-rays and only 23 days later Mr. Grubbe, a manufacturer in Chicago of Cookes tubes, sought medical aid for a radiation burn on his hand [Morgan and Turner, 19671. In the years that followed, many radiologists, physicists, and particularly radium dial painters suffered damage from radiation exposure and a number of them died of radiation-induced cancer. Little consideration, however, was given to possible chronic forms of radiation damage until the advent of the profession of health physics in 1943. For example, radiologists and dentists were not concerned until the radiation erythremiaon their hands and face became painful or they had received what was then called an erythema dose. As an illustration of my ignorance and unconcern, during the period 1931-43, the only radiation protection measure I observed as a cosmic ray physicist was to carry the radium sources used to calibrate my Geiger counters by allowing them to dangle by a string and not hold them in my hands for more than a few minutes at a time. On December 2, 1942, the first man-made nuclear reactor became critical. It International Commission on Radiological Protection. Address reprint requests to Dr.Karl Z. Morgan, 1984 Castleway Drive, Atlanta, GA 30345. This article was drawn from an address at the colloquium “Victims of Radiation” in Hiroshima, Japan, October 9, 1989. Dr.Morgan addressed the colloquium representing the International Physicians for the Prevention of Nuclear War. Accepted for publication December 13, 1991.
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was a crude assembly of blocks of graphite and uranium located in the west athletic stands at the University of Chicago. Early in 1943, shortly after this historic event, I was called to the University of Chicago by Drs. A.H. Compton (a Nobel cosmic ray physicist) and R.S.Stone (a leading radiologist from San Francisco). Compton was director of the cryptically called Metallurgical Laboratory, and Stone was his associate director of health. The program was later referred to as the Plutonium Project (after the word “plutonium” was declassified). Compton and Stone explained to me (after I received proper security clearance) that a program was under way to make an atomic bomb using a new element (later called plutonium) that they planned to transmute from uranium in piles (later called reactors). At that time, the war was going badly for the Allies of the United States and I was reminded that Hahn, Strassman, and Meitner of Germany were the discoverers of uranium fission, and, presumably, Hitler’s scientists and engineers were hard at work and far ahead of us in a race to develop this powerful weapon, which was expected to have the punch of thousands of tons of TNT, and the first to win this race would likely win the war. But Stone explained there was a very serious unsolved problem. Dr. Joe Hamilton, using a few micrograms of this new element (plutonium, made in his case with the Berkeley cyclotron), had exposed three rats to this new element and found that it was even more dangerous and carcinogenic than radium. At that time, all the radium that was available in the world to doctors and scientists amounted to only about 2 pounds, but in a single pile (reactor), which we planned to build, the radiation (alpha, beta, and gamma) would be equivalent to that from thousands of tons of radium. To make matters worse, this would be an intense neutron source. Stone explained we must beat this race with Hitler but he and Compton were determined to do this dangerous job safely. He said the piles would be surrounded by 8 foot thick concrete enclosures, and the work to remove this new element (plutonium) from numerous associated fission radionuclides would be done as far as possible by remote control but this was not enough. In addition, a new professional group was needed to set permissible exposure levels, to develop new and better radiation detection and monitoring instruments, to monitor the radiation of workers and their environment, to prevent and keep track of environmental contamination, to dispose of radioactive waste, and to conduct research to determine (hopefully) the levels of exposure (external and internal) below which there would be no (or negligible) somatic and genetic damage to humans. To meet this challenge, they were forming a new group of scientists (mostly physicists), which they were calling health physicists. HEALTH PHYSICS U.S.A.
This first group consisted of Drs. E.O. Wollan (cosmic ray physicist), C.C. Gamersfelder (recent physics graduate), K.Z.Morgan (cosmic ray physicist), and J.C. Hart (chemist). (There were others who had a short residence in this first health physics group such as R.R. Coveyou, O.G. Landsverk, and L.A. Pardue). In September, 1943, the five of us moved to a new town under construction in the cornfields near Clinton, Tennessee. It became known as Oak Ridge, and here Wollan left health physics and returned to physics; in 1944, Parker, Gamertsfelder, and Hart moved to Richland, Washington, where they were the beginning of a large health program at the Hanford plutonium production plant. At this time, I became director of the Health Physics (HP) Division of Oak Ridge National Laboratory (ORNL) and held this
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position until October 1972, when I reached the age of retirement. Our ORNL-HP program expanded rapidly into many research and applied (survey and monitoring) operations; by the time I retired, there were in the Health Physics Division about 100 employees in applied health physics and over 300 employees in health physics research. The applied operations involved personnel monitoring (meters worn by workers), area monitoring, urine and fecal analysis, whole body counting, etc. The research included radiation ecology, radioactive waste disposal (hydrofracturing disposal in deep underground shale formations, open pit seepage disposal, disposal in bedded salt mines in Kansas, etc.), measurement of radiation dose received by survivors of atomic bombings of Hiroshima and Nagasaki, determination of permissible fast and thermal neutron doses and of permissible concentration of radionuclides in air, water, and food, development of new radiation detection instruments, etc. My principal interest (in addition to duties as HP division director) were the education and training of hundreds of new health physicists, and the setting of permissible concentrations of about 300 radionuclides in air, water, and food. Our first training programs were in-house under the direction of Drs. R.S. Thackery, E.E. Anderson, M.F. Fair, and myself, but by 1949 these programs were established at the graduate level at Vanderbilt University and the University of Rochester, and by 1960 these programs were operating in many universities. The early work in setting radiation exposure standards was rather crude. For example, as chairman of the Internal Dose Committees of both the National (US) Council on Radiation Protection (NCRP) and of the International Commission on Radiation Protection (ICRP), I had no choice, in preparing the Internal Dose Handbook and setting the levels for plutonium, other than to base them on studies of the three rats Hamilton had exposed to plutonium-these were the only data on biological effects of plutonium in existence at that time. Before 1950 it was a Herculean task for me to obtain funds from the US Atomic Energy Commission (AEC-the source of funds for ORNL operations) for research. For example, Dr. 0. Park (an ecology professor at Northwestern University), E.G. Struxness (assistant director of the HP Division of ORNL),and I went to Washington, DC to seek funding support from the AEC for research programs on radioactive waste disposal and radiation ecology. When we asked for two million dollars to start these programs, the response was hilarious laughter around the conference table. We felt it was necessary to protect humans not only directly from the hazards of external and internal exposure to radioactive waste but also by protecting the environment (ecosystem or the food web in which humans exist). We believed we must protect the arthropods, bacteria, fungi, trees, animals, etc . We believed we should explore disposal of high level radioactive waste in salt (NaCl) and other rock formations and this two million dollars was what we needed to get under way. One retort from an AEC official at this meeting was that “Man is the thing we should be interested in protecting; we should protect him and forget about these microorganisms and other forms of life. After all it would be a good thing if radiation destroyed all microorganisms.” We were shocked. Our financial supporters apparently did not realize that humans could not survive without these organisms in the body and in the environment. Another absurd objection was: “Karl, why not just dilute the radioactive waste to the occupational maximum permissible concentration level, discharge it into Clinch River via White Oak Creek and forget it?” Fortunately, we already had studies indicating certain radionuclides would be
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concentrated by factors of 100 to 1,OOO by some of the plants and animals living in White Oak Lake. Some years later, Dr. H.M. Parker reported that phosphorus-32 was found to be concentrated by a factor of 1 million in whitefish in the Columbia River near Hanford, Washington. Another objection to our request was: “Man is the most radiosensitive element in the ecosystem. Protect him and forget about microorganisms many of which take 100,OOO R to destroy them.” This turned out to be untrue. For example, we found that pine trees are destroyed at about 100 rem, whereas the mid-lethal dose for humans (for acute death) is between 200 and 400 rem. Although health physics (initially a profession of physicists concerned with health) was conceived and born as ultraconservativein the eyes of many of our close associates in engineering, many of the standards we set and a number of the protective measures we followed 50 years ago would be considered reckless in the extreme in comparison with precautions and exposure levels that are considered appropriate in 1991. For example, in 1943, when I was faced with setting the maximum permissible concentration of radioactive material in White Oak Lake, which initially impounded the liquid radioactive waste discharged from Oak Ridge National Laboratory, the only standard I had to go by was the occupational exposure level of 0.1 Wday set by the forerunner of the US National Council on Radiation Protection in 1934 and continued in general use until 1950. Some of my engineering friends at ORNL insisted I should set the level for water in White Oak Lake at 100 Wday because of the rather unlikely event persons would drink or swim in this water before it emptied into and was diluted by Clinch River. We recognize now that had we used this 100 Wday level, it would have been 7 million times the 5 mredy level our US Atomic Energy Commission published as a Guide to be followed in meeting the criterion of keeping radiation exposures “as low as practicable.” This 5 mredy is the maximum total body dose to an individual living in the vicinity of a 1,OOO MWe light-water cooled nuclear power plant. The US Environmental Protection Agency @PA) some years later set the level for potable water at 4 m r e d y . In practice, we are expected today to keep the average population exposure from the operation of these nuclear power plants to no more than 1 mredy. On present day standards, I deserve no credit today that, as a stubborn health physicist I held out for and used the 0.1 Wday maximum level for White Oak Lake in 1943, for it is 7,000 times the present 5 m r e d y AEC Guide. RESISTANCE TO DOCUMENTATION OF HAZARDS
The monotonic trend of increasing conservatism (reducing permissible radiation exposure levels) continued among health physics organizations until about 1975, but then, with greatly expanded nuclear power and nuclear weapons industries, things began to change. Up until then the nuclear industry had not worried much about repercussions set off in some medical circles by publications of Dr.H.J.Muller in the 1930s suggesting genetic damages at low levels of X-ray exposure, or the Oxford studies of Dr. Alice Stewart in the 1950s indicating a cancer risk to children who had received in utero X-ray exposure. After all, they reasoned, Muller’s studies were on flies and mice, and very few pregnant women would be employed where they would receive appreciable radiation exposure. The major shock came to the nuclear industry when Drs. T.F. Mancuso, A. Stewart, and G. Kneale in November, 1977 published the paper “Radiation Exposures of Hanford Workers Dying From Cancer and Other Causes.” This paper showed an increase of statistical significance in cancer of the
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pancreas and multiple myeloma from average exposures of only about 3 rem, and confirmed earlier studies of Dr. S. Milham [1976], who had found a significant increase in these same two cancers among Hanford workers in comparison with the rest of the state of Washington. Now industry began to take closer looks at the earlier studies of Dr. A. Stewart (1956-61) and colleagues who found a significant increase in childhood cancers of many types from a single in utero X-ray at less than 1 rem to the fetus. The studies of Dr. B. Modan et al. [1974], showing an increased risk of head and neck tumors at doses less than 9 rem, and a few other studies put the nuclear industry and its allies on edge and very much on the defensive. It was then that major efforts were initiated to try to convince the public that there is no risk from exposures at the level permissible for radiation workers. It was no surprise that the US Department of Energy (successor to the USAEC) took sides with the nuclear industry because it was still in a bit of shock from the blow caused when public opinion forced a discontinuance in atmospheric testing of nuclear weapons and because, from the very beginning, it had behaved as a zealot in support of both military and industrial applications of nuclear energy. A finishing blow seemed to come when several radiation injury cases were decided in favor of the plaintiff (e.g., the Silkwood case, the Krumbeck cases, and the Three Mile Class Action suit) even though the exposures had been within the so-called permissible limits. The US Department of Justice (DOJ) took up the battle with the US Department of Energy (DOE), and together they fought for what they seemed to believe was survival of the nuclear industry in numerous cases of radiation injury that were flooding the courts. As a result, in the court cases that followed, injured plaintiffs, who were lucky to scrape up enough money to pay their lawyers, had to battle a defense that had literally dozens of lawyers and endless resources. One might have thought that health physicists would rally behind those injured from radiation exposure (both radiation workers and members of the public), but sadly, to the contrary, they came to the defense of DOE and the nuclear industry. It was a great disappointment to me to see this change in health physics, an organization in which I had been a principal organizer. I was the first president of the Health Physics Society (1955-57) and I believed (then and until about 1975) it to be a professional and scientific organization to protect people from exposure to ionizing radiation. Now it became clear that this was no longer the case. Health physicists (at least in the US) refuse to bite the hand that feeds them (the DOE). It saddens me to say that this Society, for whose growth and development I once worked so hard, now is demonstrating that its primary purpose is not to protect the employee or members of the neighboring public but to protect the company that signs the pay check. A few years earlier, Dr.D.W. Moeller [1972], the president of the Health Physics Society, in his presidential message urged health physicists to “Speak out and make known our positions on such issues as nuclear power safety and radiation protection guides” and “let’s put our mouth where our money is.” I had heard this message with disbelief, but, alas, now I realized health physicists have no Hippocratic oath of ethics and, for many at least, the size of the numbers on the pay check from the nuclear industry is what counts. The DOJ perhaps is the last branch of our government one would expect would join the DOE in court and fight against a worker or member of the public seeking compensation for radiation injury, but this is how it is. There are a few of us who dare to try to defend in court persons with radiation injury (e.g., Drs. J.W. Gofman, A. Stewart, J. Cobb, E.P. Radford, the late C.J. Johnson, T.B. Cochran, and myself), but there are thousands of health physicists anxiously volun-
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teering to defend the nuclear industry and the DOE [Morgan, 19881. The Department of Justice, under the initiative of its senior staff member, Mr. Don Jose, has given classes in several cities for lawyers and health physicists indicating how to win these court cases and prevent compensation to those who claim radiation injury. In the courts, he has acted as the principal defense lawyer in a number of cases and in these cases it is amazing what happens [Morgan, 1985-861. Some health physicists testify to things that defy basic laws of physics, chemistry, and biology. If the government (e.g., DOE) is a defendant, the case is always before a federal judge--not before a jury. Character assassination of those who dare testify for the plaintiffs (those injured by radiation) is the name of the game. For example, in his written decision Judge Kelly blasted and smeared the characters of Drs. C.J. Johnson, J.W. Gofman, and myself, who had testified for five persons who had been injured by radiation exposures. Then, after stating he had not understood my testimony and “It might just as well have been written in Greek,” he stated his reason for hearing the case: “The paramount and obvious overriding interest has been to put to rest once and for all the likes of Drs. Gofman, Morgan and Johnson.” Thus, the judge was cowing and threatening any health physicist who might testify against the government in radiation injury cases. It is with great reluctance and regret that I now must recognize that the US profession of health physics has become essentially a labor union for the nuclear industry-not a profession of scientists dedicated to protect the worker and members of the public from radiation injury. INTERNATIONAL SCOPE
When the Health Physics Society was organized in 1955, we intended that it be an international organization of scientists and professionals. To some extent this came about; in 1963 it had 3,000 members in 45 countries (e.g., 39 in Japan, 28 in France, 27 in Canada, 19 in England, and lesser numbers in other countries). However, it was primarily a US society. The president of the Health Physics Society, Dr.W.T. Ham, asked me to investigate the possibility of forming an international Society. I wrote letters to over 1,OOO interested parties in many countries of the world and as a result, in December, 1964, the fvst General Assembly of the International Radiation Protection Association (IRPA) was held. By 1988, there were 32 national societies comprising IRPA with over 30,000 members. I am not able to judge whether or not any of these other societies have fallen into the pattern of the US-HPS but I sincerely hope not. I hope and expect the US-HPS will recover and will adopt its own Hippocratic oath. DEPRECIATION OF PROFESSIONAL STANDARDS
Unfortunately, the current crusade of the nuclear industry to depreciate the risk of exposure to ionizing radiation has had its influence in many organizations such as the US Environmental Protection Agency (EPA), the National Council on Radiation Protection (NCRP), and even the National Academy of Sciences, which transmits the money supplied by the DOE to the Radiation Effects Research Foundation (WRFand formerly the ABCC) for the US contribution to support. Space will not permit discussion of how this radiation risk depreciationeffort has influenced activities of these and other similar organizations, but I will conclude with brief mention of the effect
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this had had on the decisions and publications of the International Commission on Radiological Protection (ICRP) [Morgan, 19871. The ICRP has a long history of recommending radiation protection standards that consistently are adopted and incorporated into radiation protection codes of practice, guides, rules, regulations, and laws of most countries of the world. It has a rather illustrious history, and through the early years had many men of stature on its Main Commission (to mention a few, there were Sir Ernest Rock Carling, W. Binks, and M.V. Mayneord of the UK; A.J. Cipriani of Canada; R.M. Sievert of Sweden; and G. Failla and H.J. Muller of the United States). I had the privilege of serving on the ICRP Main Commission for 20 years and now am one of its four emeritus members. In addition to its 13 members on the Main Commission, it has many committees and subcommittees comprising up to 100 members. Unfortunately, many members of ICRP have what I consider a conflict of interest, i.e., promote nuclear power and weapons production vs. radiation safety and health. One can look at the affiliation of each member or check from where each gets research funds to confirm this conflict of interest, but I believe a better criterion is to take a look at some actions and publications of the ICRP during the past d e c a d e 1 will mention three. First, in 1962, Dr.H.J. Muller (the world’s most outstanding geneticist at the time) and I worked hard and developed enough support so the the ICRP adopted the Ten-Day-Rule. This rule urged that diagnostic pelvic and abdominal X-rays to women in the child-bearing age be delayed in most cases, and given in the 10-day interval following the beginning of menstruation unless the delay were harmful to the woman. In spite of the almost universal acceptance of the findings of Alice Stewart, the ICRP weakened and essentially rescinded this rule during the past 20 years. Second, during this period there have been many publications [Modan et al., 1974; Mancuso et al., 1977; Jones and Southwood, 1987; Nussbaum, 1987; Morgan, 1987; Gofman, 1989) indicating that the cancer dose coefficient, i.e., fatal cancers per person rem, is more than 10 times what it was considered to be when the ICRP-2 Handbook on Internal Dose was published in 1959. (I was chairman of the ICRP Committee that published it.) Yet, during this period, the ICRP has increased the permissible exposure levels instead of reducing them. An even more compelling reason why the present maximum permissible exposure levels are too high is the convincing evidence given in many publications in support of the supralinear relationship between radiation dose and cancer induction, i.e., there are more cancers produced per unit dose (per rem) at low doses than at high doses. In spite of this information, ICRP in its Handbooks 26 [ 19771and 30 [ 19791increased the maximum permissible concentration (MPC) of most of the radionuclides in air, water, and food [Morgan, 19871. Because of convincing evidence that the cancer coefficient can be no (one fatal cancer per 1,OOO person rem) instead of less than when ICRP-2 was published in 1959, all MPC values should have been decreased and not increased in 1977. Third, during the past decade, corrections to the RERF data have shown that the cancer coefficient is at least three times the value used earlier by the ICRP in setting external exposure limits. At its meeting in Como, Italy in September 1987, the ICRP admitted that refinements of the RERF Japanese radiation survivor data indicated the cancer coefficient was at least three times its value in earlier reports and used by ICRP in setting its radiation exposure limits, yet concluded “This information alone is not sufficient to warrant an immediate change in the dose limits.” In other words, it
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wishes to count more bodies before making radiation exposure limits more restrictive and increasing the burden on the nuclear industry. A number of publications [Nussbaum, 1989; Morgan, 1989; Gofman, 19891 have shown that the Japanese data but it appears that supindicate the dose coefficient should not be less than porters of the nuclear industry (including ICRF’ and RERF) are desperately massaging these survivor data to find out how to keep the dose coefficient closer to than I doubt, however, they will be successful because at to the Japanese data are now in line with the findings of A. Stewart et al. [ 19561of a high risk of all forms of cancer from in utero X-ray exposure; findings by Mancuso et al. [1977] of an increased risk of multiple myeloma and cancer of the pancreas among Hanford radiation workers; findings by Modan et al. [1974] of an increase of head and neck tumors following X-ray treatment of ringworm; and findings of Wing et al. [1991] that the radiation-cancer dose response among Oak Ridge National Laboratory employees (the laboratory where I worked for 29 years) is ten times higher than the R E W estimates of cancer among survivors of atomic bombings of Hiroshima and Nagasaki. CONCLUSIONS
I express my gratification that Physicians for Social Responsibility (PSR) and International Physicians for Prevention of Nuclear War (IPPNW) have joined the fight to reduce unnecessary exposure to ionizing radiation. For years, a handful of us fought to reduce unnecessary medical diagnostic exposure with little, if any, help from the medical professions. For example, we (i.e., my ORNL division) found that the equipment and techniques of the mass chest X-ray program were deplorable. Our measurements of a number of these programs indicated they were delivering an average of 2,000 to 3,000 mrem surface dose to the child per X-ray, while at the same time, my facility at ORNL was delivering an average of only 6 mrem per chest X-ray of our employees. After 20 years of frustrating failures, it was a highlight of my life’s work when I was invited to the White House to witness President Johnson sign the bill to reduce such excessive medical exposures. The paper of Dr. J.L. McClenahan in 1970 calling for less “wasted diagnostic X-rays” probably caused many departments of radiology to take measures in reducing the number of unnecessary chest X-rays and may have reduced the number of X-rays given in the office of practioners. The ongoing struggle Dr.F.M. Medwedeff and I have pursued over a period of 30 years to reduce dental X-rayexposure has been only partially successful [19621. The tragic experience of the many thousands of US military service men who are suffering and dying (GIs exposed at the South Pacific test site, at the Nevada test site, on early entry into Hiroshima and Nagasaki, etc.) from cancer and other ailments caused by low level exposure to ionizing radiation is a sad page in American history. Our government and the Veterans Administration have spent more time and money to prevent these men and their widows from receiving compensation than in providing it. The US treatment of natives in the Islands of the South Pacific who were relocated and seriously overexposed from weapons testing fallout is shameful, and appropriate compensation may never be possible or forthcoming. The case of radiation-induced cancer among employees at US National Laboratories and among employees of the nuclear power plants is both interesting and pathetic. Many of these radiation workers have sought compensation in our courts for radiation injury, only to find it a losing
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battle, because here they have had to face a battery of DOE, DOJ,and company lawyers (some trained by Mr. Jose). Most frustrating and defeating, it has been impossible to win against the testimony of health physicists who testify that the radiation exposure did not occur or was insufficient to cause such injury. Now, however, the tables are slowly turning. Chronic low level exposure (the type received mostly by health physicists in their work) is much more likely to produce solid tumors than leukemia, and the delay time following exposure before these tumors are diagnosed is usually 30 to 40 years. Perhaps the tables are turning because increasing numbers of health physicists are seeking compensation in court for their own radiation injury. Maybe, finally, the chickens are coming home but finding no place to roost! I am gratified that in 1990, ICRP reduced the occupational exposure level from 5 r edyr to 2 rem/yr (averaged over any 5 year period) and its level for the public from 500 mredyr to 100 mrem/yr. In its publication ICRP-61 [1990], many of the MPC values were reduced but in most cases they came only half way. I hope and pray that shortly they will come all the way. REFERENCES Gofman JW (1989): Warning from A-bomb study about low and slow radiation exposures. Health Phys 56~117-120. ICRP (1959): “Recommendations of the International Commission on Radiological Protection.” ICRP Pub 2. Oxford Pergamon Press. ICRP (1977): “Recommendations of the International Commission on Radiological Protection.” ICRP Pub 26. Oxford: Pergamon Press. ICRP (1979-88): “Limits for Intakes of Radionuclides by Workers.” ICRP Pub 3 0 Vol2, No 3/4, 1979; Vol 6, No 1, 1981; Vol 6, No U3, 1981; and Vol 19, No 4, 1988. Oxford. Pergamon Press. ICRP (1990): “Annual Limits on Intake of Radionuclides by Workers.” Based on 1990 recommendations. ICRP Pub 61. Oxford: Pergamon Press. Jones RR, Southwood R (1987): “Radiation and Health.” New York John Wiley & Sons. Mancuso TF, Stewart A, Kneale GW (1977): Radiation exposures of Hanford workers dying from cancer and other causes. Health Phys 33:369-384. McClenahan JL (1970): Wasted X-rays. Radiology %:453-457. Medwedeff FM, Knox WH (1962): Radiation reduction in children. J Tenn State Dental Assoc 42. Milham S Jr (1976): “Occupational Mortality in Washington State 1950-71.” Cincinnati, O H DHEW (NIOSH), Pub. 76-175. Modan B, Mart H, Baidatz D, Steinitz R, Levin SG (1974): Radiation-induced head and neck tumors. Lancet i:277-279. Moeller DW (1971-72): “The President’s Message.” Health Physics Society Membership Handbook,
XI. Morgan KZ, Turner JE (1967): “Principles of Radiation Protection.” New York: John Wiley & Sons. Morgan, KZ (1985-86): A rebuttal from K.Z. (A rebuttal to the 150 page decision of Judge Kelly in case Johnson vs. UniredSrates, filed Nov. 15, 1984). Health Physics 13 (Dec 2, ’85), 14 (Jan 1, ’86; Feb 1, ’86; Mar 1, ’86; Apr 1, ’86; May 1, ’86), The Newsletter. Morgan KZ (1987): ICRP risk estimates-an alternative view. In Jones RR, Southwood R (eds): “Radiation and Health.” New York: John Wiley & Sons. pp 125-154. Morgan KZ (1988): The viewpoint and experience of a scientist who has been a plaintiffs’ expert witness in many radiation cases. Int Perspect Public Health 4:7-10. Morgan KZ (1989): The effect of low level radiation. Health Phys 56964. Nussbaum RH (1989): New data inconsistent with scientific consensus on low-level radiation cancer risks. Health Phys 56:961-962. Stewart A, Webb J, Giles D, Hewitt D (1956): Preliminary communication: Malignant disease in childhood and diagnostic irradiation in utero. Lancet ii:447-448. Wing S, Shy CM, Wood JL, Wolf S, Cragle DL. Frome EL (1991): Mortality among workers at Oak Ridge National Laboratories. JAMA 265: 1397-1402.
(1992)
HISTORICAL PERSPECTIVES IN OCCUPATIONAL MEDICINE
Health Physics: Its Development, Successes, Failures, and Eccentricities Karl 2. Morgan, PhD
Health Physics began at the University of Chicago as a science and profession during the early World War 11 years. It was initiated by Drs. A.H. Compton and R.S. Stone, director and associate director, respectively, of the early Plutonium Project cryptically called the Metallurgical Laboratory. It was to be a science and profession to protect radiation workers and members of the public from exposure to ionizing radiation. It succeeded to some extent in this objective but during the past decade in the United States,it has reverted into an organization primarily to protect the nuclear industry from liability resulting from radiation exposure. o 1992 wiey-Liss, I ~ C . Key words: history of medicine, low level ionizing exposure, IRCP, health physicists
INITIAL AWARENESS OF RADIATION EFFECTS
On January 4, 1896, the public press heralded Roentgen’s discovery of X-rays and only 23 days later Mr. Grubbe, a manufacturer in Chicago of Cookes tubes, sought medical aid for a radiation burn on his hand [Morgan and Turner, 19671. In the years that followed, many radiologists, physicists, and particularly radium dial painters suffered damage from radiation exposure and a number of them died of radiation-induced cancer. Little consideration, however, was given to possible chronic forms of radiation damage until the advent of the profession of health physics in 1943. For example, radiologists and dentists were not concerned until the radiation erythremiaon their hands and face became painful or they had received what was then called an erythema dose. As an illustration of my ignorance and unconcern, during the period 1931-43, the only radiation protection measure I observed as a cosmic ray physicist was to carry the radium sources used to calibrate my Geiger counters by allowing them to dangle by a string and not hold them in my hands for more than a few minutes at a time. On December 2, 1942, the first man-made nuclear reactor became critical. It International Commission on Radiological Protection. Address reprint requests to Dr.Karl Z. Morgan, 1984 Castleway Drive, Atlanta, GA 30345. This article was drawn from an address at the colloquium “Victims of Radiation” in Hiroshima, Japan, October 9, 1989. Dr.Morgan addressed the colloquium representing the International Physicians for the Prevention of Nuclear War. Accepted for publication December 13, 1991.
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was a crude assembly of blocks of graphite and uranium located in the west athletic stands at the University of Chicago. Early in 1943, shortly after this historic event, I was called to the University of Chicago by Drs. A.H. Compton (a Nobel cosmic ray physicist) and R.S.Stone (a leading radiologist from San Francisco). Compton was director of the cryptically called Metallurgical Laboratory, and Stone was his associate director of health. The program was later referred to as the Plutonium Project (after the word “plutonium” was declassified). Compton and Stone explained to me (after I received proper security clearance) that a program was under way to make an atomic bomb using a new element (later called plutonium) that they planned to transmute from uranium in piles (later called reactors). At that time, the war was going badly for the Allies of the United States and I was reminded that Hahn, Strassman, and Meitner of Germany were the discoverers of uranium fission, and, presumably, Hitler’s scientists and engineers were hard at work and far ahead of us in a race to develop this powerful weapon, which was expected to have the punch of thousands of tons of TNT, and the first to win this race would likely win the war. But Stone explained there was a very serious unsolved problem. Dr. Joe Hamilton, using a few micrograms of this new element (plutonium, made in his case with the Berkeley cyclotron), had exposed three rats to this new element and found that it was even more dangerous and carcinogenic than radium. At that time, all the radium that was available in the world to doctors and scientists amounted to only about 2 pounds, but in a single pile (reactor), which we planned to build, the radiation (alpha, beta, and gamma) would be equivalent to that from thousands of tons of radium. To make matters worse, this would be an intense neutron source. Stone explained we must beat this race with Hitler but he and Compton were determined to do this dangerous job safely. He said the piles would be surrounded by 8 foot thick concrete enclosures, and the work to remove this new element (plutonium) from numerous associated fission radionuclides would be done as far as possible by remote control but this was not enough. In addition, a new professional group was needed to set permissible exposure levels, to develop new and better radiation detection and monitoring instruments, to monitor the radiation of workers and their environment, to prevent and keep track of environmental contamination, to dispose of radioactive waste, and to conduct research to determine (hopefully) the levels of exposure (external and internal) below which there would be no (or negligible) somatic and genetic damage to humans. To meet this challenge, they were forming a new group of scientists (mostly physicists), which they were calling health physicists. HEALTH PHYSICS U.S.A.
This first group consisted of Drs. E.O. Wollan (cosmic ray physicist), C.C. Gamersfelder (recent physics graduate), K.Z.Morgan (cosmic ray physicist), and J.C. Hart (chemist). (There were others who had a short residence in this first health physics group such as R.R. Coveyou, O.G. Landsverk, and L.A. Pardue). In September, 1943, the five of us moved to a new town under construction in the cornfields near Clinton, Tennessee. It became known as Oak Ridge, and here Wollan left health physics and returned to physics; in 1944, Parker, Gamertsfelder, and Hart moved to Richland, Washington, where they were the beginning of a large health program at the Hanford plutonium production plant. At this time, I became director of the Health Physics (HP) Division of Oak Ridge National Laboratory (ORNL) and held this
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position until October 1972, when I reached the age of retirement. Our ORNL-HP program expanded rapidly into many research and applied (survey and monitoring) operations; by the time I retired, there were in the Health Physics Division about 100 employees in applied health physics and over 300 employees in health physics research. The applied operations involved personnel monitoring (meters worn by workers), area monitoring, urine and fecal analysis, whole body counting, etc. The research included radiation ecology, radioactive waste disposal (hydrofracturing disposal in deep underground shale formations, open pit seepage disposal, disposal in bedded salt mines in Kansas, etc.), measurement of radiation dose received by survivors of atomic bombings of Hiroshima and Nagasaki, determination of permissible fast and thermal neutron doses and of permissible concentration of radionuclides in air, water, and food, development of new radiation detection instruments, etc. My principal interest (in addition to duties as HP division director) were the education and training of hundreds of new health physicists, and the setting of permissible concentrations of about 300 radionuclides in air, water, and food. Our first training programs were in-house under the direction of Drs. R.S. Thackery, E.E. Anderson, M.F. Fair, and myself, but by 1949 these programs were established at the graduate level at Vanderbilt University and the University of Rochester, and by 1960 these programs were operating in many universities. The early work in setting radiation exposure standards was rather crude. For example, as chairman of the Internal Dose Committees of both the National (US) Council on Radiation Protection (NCRP) and of the International Commission on Radiation Protection (ICRP), I had no choice, in preparing the Internal Dose Handbook and setting the levels for plutonium, other than to base them on studies of the three rats Hamilton had exposed to plutonium-these were the only data on biological effects of plutonium in existence at that time. Before 1950 it was a Herculean task for me to obtain funds from the US Atomic Energy Commission (AEC-the source of funds for ORNL operations) for research. For example, Dr. 0. Park (an ecology professor at Northwestern University), E.G. Struxness (assistant director of the HP Division of ORNL),and I went to Washington, DC to seek funding support from the AEC for research programs on radioactive waste disposal and radiation ecology. When we asked for two million dollars to start these programs, the response was hilarious laughter around the conference table. We felt it was necessary to protect humans not only directly from the hazards of external and internal exposure to radioactive waste but also by protecting the environment (ecosystem or the food web in which humans exist). We believed we must protect the arthropods, bacteria, fungi, trees, animals, etc . We believed we should explore disposal of high level radioactive waste in salt (NaCl) and other rock formations and this two million dollars was what we needed to get under way. One retort from an AEC official at this meeting was that “Man is the thing we should be interested in protecting; we should protect him and forget about these microorganisms and other forms of life. After all it would be a good thing if radiation destroyed all microorganisms.” We were shocked. Our financial supporters apparently did not realize that humans could not survive without these organisms in the body and in the environment. Another absurd objection was: “Karl, why not just dilute the radioactive waste to the occupational maximum permissible concentration level, discharge it into Clinch River via White Oak Creek and forget it?” Fortunately, we already had studies indicating certain radionuclides would be
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concentrated by factors of 100 to 1,OOO by some of the plants and animals living in White Oak Lake. Some years later, Dr. H.M. Parker reported that phosphorus-32 was found to be concentrated by a factor of 1 million in whitefish in the Columbia River near Hanford, Washington. Another objection to our request was: “Man is the most radiosensitive element in the ecosystem. Protect him and forget about microorganisms many of which take 100,OOO R to destroy them.” This turned out to be untrue. For example, we found that pine trees are destroyed at about 100 rem, whereas the mid-lethal dose for humans (for acute death) is between 200 and 400 rem. Although health physics (initially a profession of physicists concerned with health) was conceived and born as ultraconservativein the eyes of many of our close associates in engineering, many of the standards we set and a number of the protective measures we followed 50 years ago would be considered reckless in the extreme in comparison with precautions and exposure levels that are considered appropriate in 1991. For example, in 1943, when I was faced with setting the maximum permissible concentration of radioactive material in White Oak Lake, which initially impounded the liquid radioactive waste discharged from Oak Ridge National Laboratory, the only standard I had to go by was the occupational exposure level of 0.1 Wday set by the forerunner of the US National Council on Radiation Protection in 1934 and continued in general use until 1950. Some of my engineering friends at ORNL insisted I should set the level for water in White Oak Lake at 100 Wday because of the rather unlikely event persons would drink or swim in this water before it emptied into and was diluted by Clinch River. We recognize now that had we used this 100 Wday level, it would have been 7 million times the 5 mredy level our US Atomic Energy Commission published as a Guide to be followed in meeting the criterion of keeping radiation exposures “as low as practicable.” This 5 mredy is the maximum total body dose to an individual living in the vicinity of a 1,OOO MWe light-water cooled nuclear power plant. The US Environmental Protection Agency @PA) some years later set the level for potable water at 4 m r e d y . In practice, we are expected today to keep the average population exposure from the operation of these nuclear power plants to no more than 1 mredy. On present day standards, I deserve no credit today that, as a stubborn health physicist I held out for and used the 0.1 Wday maximum level for White Oak Lake in 1943, for it is 7,000 times the present 5 m r e d y AEC Guide. RESISTANCE TO DOCUMENTATION OF HAZARDS
The monotonic trend of increasing conservatism (reducing permissible radiation exposure levels) continued among health physics organizations until about 1975, but then, with greatly expanded nuclear power and nuclear weapons industries, things began to change. Up until then the nuclear industry had not worried much about repercussions set off in some medical circles by publications of Dr.H.J.Muller in the 1930s suggesting genetic damages at low levels of X-ray exposure, or the Oxford studies of Dr. Alice Stewart in the 1950s indicating a cancer risk to children who had received in utero X-ray exposure. After all, they reasoned, Muller’s studies were on flies and mice, and very few pregnant women would be employed where they would receive appreciable radiation exposure. The major shock came to the nuclear industry when Drs. T.F. Mancuso, A. Stewart, and G. Kneale in November, 1977 published the paper “Radiation Exposures of Hanford Workers Dying From Cancer and Other Causes.” This paper showed an increase of statistical significance in cancer of the
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pancreas and multiple myeloma from average exposures of only about 3 rem, and confirmed earlier studies of Dr. S. Milham [1976], who had found a significant increase in these same two cancers among Hanford workers in comparison with the rest of the state of Washington. Now industry began to take closer looks at the earlier studies of Dr. A. Stewart (1956-61) and colleagues who found a significant increase in childhood cancers of many types from a single in utero X-ray at less than 1 rem to the fetus. The studies of Dr. B. Modan et al. [1974], showing an increased risk of head and neck tumors at doses less than 9 rem, and a few other studies put the nuclear industry and its allies on edge and very much on the defensive. It was then that major efforts were initiated to try to convince the public that there is no risk from exposures at the level permissible for radiation workers. It was no surprise that the US Department of Energy (successor to the USAEC) took sides with the nuclear industry because it was still in a bit of shock from the blow caused when public opinion forced a discontinuance in atmospheric testing of nuclear weapons and because, from the very beginning, it had behaved as a zealot in support of both military and industrial applications of nuclear energy. A finishing blow seemed to come when several radiation injury cases were decided in favor of the plaintiff (e.g., the Silkwood case, the Krumbeck cases, and the Three Mile Class Action suit) even though the exposures had been within the so-called permissible limits. The US Department of Justice (DOJ) took up the battle with the US Department of Energy (DOE), and together they fought for what they seemed to believe was survival of the nuclear industry in numerous cases of radiation injury that were flooding the courts. As a result, in the court cases that followed, injured plaintiffs, who were lucky to scrape up enough money to pay their lawyers, had to battle a defense that had literally dozens of lawyers and endless resources. One might have thought that health physicists would rally behind those injured from radiation exposure (both radiation workers and members of the public), but sadly, to the contrary, they came to the defense of DOE and the nuclear industry. It was a great disappointment to me to see this change in health physics, an organization in which I had been a principal organizer. I was the first president of the Health Physics Society (1955-57) and I believed (then and until about 1975) it to be a professional and scientific organization to protect people from exposure to ionizing radiation. Now it became clear that this was no longer the case. Health physicists (at least in the US) refuse to bite the hand that feeds them (the DOE). It saddens me to say that this Society, for whose growth and development I once worked so hard, now is demonstrating that its primary purpose is not to protect the employee or members of the neighboring public but to protect the company that signs the pay check. A few years earlier, Dr.D.W. Moeller [1972], the president of the Health Physics Society, in his presidential message urged health physicists to “Speak out and make known our positions on such issues as nuclear power safety and radiation protection guides” and “let’s put our mouth where our money is.” I had heard this message with disbelief, but, alas, now I realized health physicists have no Hippocratic oath of ethics and, for many at least, the size of the numbers on the pay check from the nuclear industry is what counts. The DOJ perhaps is the last branch of our government one would expect would join the DOE in court and fight against a worker or member of the public seeking compensation for radiation injury, but this is how it is. There are a few of us who dare to try to defend in court persons with radiation injury (e.g., Drs. J.W. Gofman, A. Stewart, J. Cobb, E.P. Radford, the late C.J. Johnson, T.B. Cochran, and myself), but there are thousands of health physicists anxiously volun-
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teering to defend the nuclear industry and the DOE [Morgan, 19881. The Department of Justice, under the initiative of its senior staff member, Mr. Don Jose, has given classes in several cities for lawyers and health physicists indicating how to win these court cases and prevent compensation to those who claim radiation injury. In the courts, he has acted as the principal defense lawyer in a number of cases and in these cases it is amazing what happens [Morgan, 1985-861. Some health physicists testify to things that defy basic laws of physics, chemistry, and biology. If the government (e.g., DOE) is a defendant, the case is always before a federal judge--not before a jury. Character assassination of those who dare testify for the plaintiffs (those injured by radiation) is the name of the game. For example, in his written decision Judge Kelly blasted and smeared the characters of Drs. C.J. Johnson, J.W. Gofman, and myself, who had testified for five persons who had been injured by radiation exposures. Then, after stating he had not understood my testimony and “It might just as well have been written in Greek,” he stated his reason for hearing the case: “The paramount and obvious overriding interest has been to put to rest once and for all the likes of Drs. Gofman, Morgan and Johnson.” Thus, the judge was cowing and threatening any health physicist who might testify against the government in radiation injury cases. It is with great reluctance and regret that I now must recognize that the US profession of health physics has become essentially a labor union for the nuclear industry-not a profession of scientists dedicated to protect the worker and members of the public from radiation injury. INTERNATIONAL SCOPE
When the Health Physics Society was organized in 1955, we intended that it be an international organization of scientists and professionals. To some extent this came about; in 1963 it had 3,000 members in 45 countries (e.g., 39 in Japan, 28 in France, 27 in Canada, 19 in England, and lesser numbers in other countries). However, it was primarily a US society. The president of the Health Physics Society, Dr.W.T. Ham, asked me to investigate the possibility of forming an international Society. I wrote letters to over 1,OOO interested parties in many countries of the world and as a result, in December, 1964, the fvst General Assembly of the International Radiation Protection Association (IRPA) was held. By 1988, there were 32 national societies comprising IRPA with over 30,000 members. I am not able to judge whether or not any of these other societies have fallen into the pattern of the US-HPS but I sincerely hope not. I hope and expect the US-HPS will recover and will adopt its own Hippocratic oath. DEPRECIATION OF PROFESSIONAL STANDARDS
Unfortunately, the current crusade of the nuclear industry to depreciate the risk of exposure to ionizing radiation has had its influence in many organizations such as the US Environmental Protection Agency (EPA), the National Council on Radiation Protection (NCRP), and even the National Academy of Sciences, which transmits the money supplied by the DOE to the Radiation Effects Research Foundation (WRFand formerly the ABCC) for the US contribution to support. Space will not permit discussion of how this radiation risk depreciationeffort has influenced activities of these and other similar organizations, but I will conclude with brief mention of the effect
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this had had on the decisions and publications of the International Commission on Radiological Protection (ICRP) [Morgan, 19871. The ICRP has a long history of recommending radiation protection standards that consistently are adopted and incorporated into radiation protection codes of practice, guides, rules, regulations, and laws of most countries of the world. It has a rather illustrious history, and through the early years had many men of stature on its Main Commission (to mention a few, there were Sir Ernest Rock Carling, W. Binks, and M.V. Mayneord of the UK; A.J. Cipriani of Canada; R.M. Sievert of Sweden; and G. Failla and H.J. Muller of the United States). I had the privilege of serving on the ICRP Main Commission for 20 years and now am one of its four emeritus members. In addition to its 13 members on the Main Commission, it has many committees and subcommittees comprising up to 100 members. Unfortunately, many members of ICRP have what I consider a conflict of interest, i.e., promote nuclear power and weapons production vs. radiation safety and health. One can look at the affiliation of each member or check from where each gets research funds to confirm this conflict of interest, but I believe a better criterion is to take a look at some actions and publications of the ICRP during the past d e c a d e 1 will mention three. First, in 1962, Dr.H.J. Muller (the world’s most outstanding geneticist at the time) and I worked hard and developed enough support so the the ICRP adopted the Ten-Day-Rule. This rule urged that diagnostic pelvic and abdominal X-rays to women in the child-bearing age be delayed in most cases, and given in the 10-day interval following the beginning of menstruation unless the delay were harmful to the woman. In spite of the almost universal acceptance of the findings of Alice Stewart, the ICRP weakened and essentially rescinded this rule during the past 20 years. Second, during this period there have been many publications [Modan et al., 1974; Mancuso et al., 1977; Jones and Southwood, 1987; Nussbaum, 1987; Morgan, 1987; Gofman, 1989) indicating that the cancer dose coefficient, i.e., fatal cancers per person rem, is more than 10 times what it was considered to be when the ICRP-2 Handbook on Internal Dose was published in 1959. (I was chairman of the ICRP Committee that published it.) Yet, during this period, the ICRP has increased the permissible exposure levels instead of reducing them. An even more compelling reason why the present maximum permissible exposure levels are too high is the convincing evidence given in many publications in support of the supralinear relationship between radiation dose and cancer induction, i.e., there are more cancers produced per unit dose (per rem) at low doses than at high doses. In spite of this information, ICRP in its Handbooks 26 [ 19771and 30 [ 19791increased the maximum permissible concentration (MPC) of most of the radionuclides in air, water, and food [Morgan, 19871. Because of convincing evidence that the cancer coefficient can be no (one fatal cancer per 1,OOO person rem) instead of less than when ICRP-2 was published in 1959, all MPC values should have been decreased and not increased in 1977. Third, during the past decade, corrections to the RERF data have shown that the cancer coefficient is at least three times the value used earlier by the ICRP in setting external exposure limits. At its meeting in Como, Italy in September 1987, the ICRP admitted that refinements of the RERF Japanese radiation survivor data indicated the cancer coefficient was at least three times its value in earlier reports and used by ICRP in setting its radiation exposure limits, yet concluded “This information alone is not sufficient to warrant an immediate change in the dose limits.” In other words, it
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wishes to count more bodies before making radiation exposure limits more restrictive and increasing the burden on the nuclear industry. A number of publications [Nussbaum, 1989; Morgan, 1989; Gofman, 19891 have shown that the Japanese data but it appears that supindicate the dose coefficient should not be less than porters of the nuclear industry (including ICRF’ and RERF) are desperately massaging these survivor data to find out how to keep the dose coefficient closer to than I doubt, however, they will be successful because at to the Japanese data are now in line with the findings of A. Stewart et al. [ 19561of a high risk of all forms of cancer from in utero X-ray exposure; findings by Mancuso et al. [1977] of an increased risk of multiple myeloma and cancer of the pancreas among Hanford radiation workers; findings by Modan et al. [1974] of an increase of head and neck tumors following X-ray treatment of ringworm; and findings of Wing et al. [1991] that the radiation-cancer dose response among Oak Ridge National Laboratory employees (the laboratory where I worked for 29 years) is ten times higher than the R E W estimates of cancer among survivors of atomic bombings of Hiroshima and Nagasaki. CONCLUSIONS
I express my gratification that Physicians for Social Responsibility (PSR) and International Physicians for Prevention of Nuclear War (IPPNW) have joined the fight to reduce unnecessary exposure to ionizing radiation. For years, a handful of us fought to reduce unnecessary medical diagnostic exposure with little, if any, help from the medical professions. For example, we (i.e., my ORNL division) found that the equipment and techniques of the mass chest X-ray program were deplorable. Our measurements of a number of these programs indicated they were delivering an average of 2,000 to 3,000 mrem surface dose to the child per X-ray, while at the same time, my facility at ORNL was delivering an average of only 6 mrem per chest X-ray of our employees. After 20 years of frustrating failures, it was a highlight of my life’s work when I was invited to the White House to witness President Johnson sign the bill to reduce such excessive medical exposures. The paper of Dr. J.L. McClenahan in 1970 calling for less “wasted diagnostic X-rays” probably caused many departments of radiology to take measures in reducing the number of unnecessary chest X-rays and may have reduced the number of X-rays given in the office of practioners. The ongoing struggle Dr.F.M. Medwedeff and I have pursued over a period of 30 years to reduce dental X-rayexposure has been only partially successful [19621. The tragic experience of the many thousands of US military service men who are suffering and dying (GIs exposed at the South Pacific test site, at the Nevada test site, on early entry into Hiroshima and Nagasaki, etc.) from cancer and other ailments caused by low level exposure to ionizing radiation is a sad page in American history. Our government and the Veterans Administration have spent more time and money to prevent these men and their widows from receiving compensation than in providing it. The US treatment of natives in the Islands of the South Pacific who were relocated and seriously overexposed from weapons testing fallout is shameful, and appropriate compensation may never be possible or forthcoming. The case of radiation-induced cancer among employees at US National Laboratories and among employees of the nuclear power plants is both interesting and pathetic. Many of these radiation workers have sought compensation in our courts for radiation injury, only to find it a losing
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battle, because here they have had to face a battery of DOE, DOJ,and company lawyers (some trained by Mr. Jose). Most frustrating and defeating, it has been impossible to win against the testimony of health physicists who testify that the radiation exposure did not occur or was insufficient to cause such injury. Now, however, the tables are slowly turning. Chronic low level exposure (the type received mostly by health physicists in their work) is much more likely to produce solid tumors than leukemia, and the delay time following exposure before these tumors are diagnosed is usually 30 to 40 years. Perhaps the tables are turning because increasing numbers of health physicists are seeking compensation in court for their own radiation injury. Maybe, finally, the chickens are coming home but finding no place to roost! I am gratified that in 1990, ICRP reduced the occupational exposure level from 5 r edyr to 2 rem/yr (averaged over any 5 year period) and its level for the public from 500 mredyr to 100 mrem/yr. In its publication ICRP-61 [1990], many of the MPC values were reduced but in most cases they came only half way. I hope and pray that shortly they will come all the way. REFERENCES Gofman JW (1989): Warning from A-bomb study about low and slow radiation exposures. Health Phys 56~117-120. ICRP (1959): “Recommendations of the International Commission on Radiological Protection.” ICRP Pub 2. Oxford Pergamon Press. ICRP (1977): “Recommendations of the International Commission on Radiological Protection.” ICRP Pub 26. Oxford: Pergamon Press. ICRP (1979-88): “Limits for Intakes of Radionuclides by Workers.” ICRP Pub 3 0 Vol2, No 3/4, 1979; Vol 6, No 1, 1981; Vol 6, No U3, 1981; and Vol 19, No 4, 1988. Oxford. Pergamon Press. ICRP (1990): “Annual Limits on Intake of Radionuclides by Workers.” Based on 1990 recommendations. ICRP Pub 61. Oxford: Pergamon Press. Jones RR, Southwood R (1987): “Radiation and Health.” New York John Wiley & Sons. Mancuso TF, Stewart A, Kneale GW (1977): Radiation exposures of Hanford workers dying from cancer and other causes. Health Phys 33:369-384. McClenahan JL (1970): Wasted X-rays. Radiology %:453-457. Medwedeff FM, Knox WH (1962): Radiation reduction in children. J Tenn State Dental Assoc 42. Milham S Jr (1976): “Occupational Mortality in Washington State 1950-71.” Cincinnati, O H DHEW (NIOSH), Pub. 76-175. Modan B, Mart H, Baidatz D, Steinitz R, Levin SG (1974): Radiation-induced head and neck tumors. Lancet i:277-279. Moeller DW (1971-72): “The President’s Message.” Health Physics Society Membership Handbook,
XI. Morgan KZ, Turner JE (1967): “Principles of Radiation Protection.” New York: John Wiley & Sons. Morgan, KZ (1985-86): A rebuttal from K.Z. (A rebuttal to the 150 page decision of Judge Kelly in case Johnson vs. UniredSrates, filed Nov. 15, 1984). Health Physics 13 (Dec 2, ’85), 14 (Jan 1, ’86; Feb 1, ’86; Mar 1, ’86; Apr 1, ’86; May 1, ’86), The Newsletter. Morgan KZ (1987): ICRP risk estimates-an alternative view. In Jones RR, Southwood R (eds): “Radiation and Health.” New York: John Wiley & Sons. pp 125-154. Morgan KZ (1988): The viewpoint and experience of a scientist who has been a plaintiffs’ expert witness in many radiation cases. Int Perspect Public Health 4:7-10. Morgan KZ (1989): The effect of low level radiation. Health Phys 56964. Nussbaum RH (1989): New data inconsistent with scientific consensus on low-level radiation cancer risks. Health Phys 56:961-962. Stewart A, Webb J, Giles D, Hewitt D (1956): Preliminary communication: Malignant disease in childhood and diagnostic irradiation in utero. Lancet ii:447-448. Wing S, Shy CM, Wood JL, Wolf S, Cragle DL. Frome EL (1991): Mortality among workers at Oak Ridge National Laboratories. JAMA 265: 1397-1402.
