Rekindled passion: fire and fallout
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3270 (Published 14 August 2009) Cite this as: BMJ 2009;339:b3270
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The topic started by the rapid response [1] was further developed in the letter [2]. The following comment might be of importance for the public health. I am sincerely grateful to Prof. Andreas Nidecker for his response [3] to my letter [2], and agree to his remarks, in particular, to the following:
"Several critiques expressed in the letter to the editor make no sense, especially the one indicating that elimination of Cs-137 is only effective when the food continues to be contaminated with Cs-137. This is clearly wrong; the principal reason for the efficacy in this case is due to the important biliary excretion of Cs-137, where it would be immediately reabsorbed: in the absence of pectin in the bowel, the elimination of Cs-137 is only 13.9% within three weeks, which would allow the calculation of the biological half-life of radiocaesium in these children; (The biological half-life of radiocaesium varies from 60 to 150 days, depending on the publications, and could be calculated from the findings of the group receiving placebo)." [3]
This comment is correct, and it was caused by an omission on my part. It was also written additionally in the letter [2]: "The sorbents, if they are indeed efficient, would absorb all caesium isotopes equally, because the isotopes have identical chemical properties and only slight differences in atomic weight. Considering the above, the biological half-life of the stable and radioactive caesium must be practically equal. In conclusion, as it was stated in the letter [2], if pectin indeed absorbs Cs+ ions so efficiently that their concentration in body fluids declines, it can induce compensatory retention of the whole caesium, including Cs-137 accumulated previously, when its contents in the environment and foodstuffs was higher: all children in the studies [4,5] came from the areas contaminated after the Chernobyl accident. Moreover, excessive loss of caesium may cause its increased assimilation (including Cs-137) after the return of the children to the contaminated areas. Paradoxically, if the sorbent treatment [4,5] is indeed efficient, its final effect can be opposite to the desired one.
References
1. Jargin SV. Publications exaggerating Chernobyl consequences: some examples. BMJ Rapid Response of 22 August 2009.
2. Jargin SV. Reduction of radiocaesium load: supplementation of Cs versus it's depletion by enterosorbents. Swiss Med Wkly 2011;141:w13166.
3. Nidecker A. Reply to the letter to the Editor "Reduction of radiocaesium load" by Sergei V. Jargin. Swiss Med Wkly 2011;141:w13164.
4. Nesterenko VB, Nesterenko AV, Babenko VI, Yerkovich TV, Babenko IV. Reducing the 137Cs-load in the organism of "Chernobyl" children with apple-pectin. Swiss Med Wkly 2004;134:24-7.
5. Bandazhevskaya GS, Nesterenko VB, Babenko VI, Yerkovich TV, Bandazhevsky YI. Relationship between caesium (137Cs) load, cardiovascular symptoms, and source of food in 'Chernobyl' children - preliminary observations after intake of oral apple pectin. Swiss Med Wkly 2004;134:725-9.
Competing interests: No competing interests
Aggressiveness or invasiveness of Chernobyl-related thyroid carcinoma (TC) was reported in many publications [1-7]. Some more are referenced in [8]; while in this particular study no increased aggressiveness of TC, developed after radiotherapy, was demonstrated [8]. The following was stated in [9]: "Despite early reports suggesting that the paediatric thyroid cancer cases that developed after exposure to Chernobyl fallout were particularly aggressive, it now seems that the initial presentation and early clinical course of most of these cases are very similar to... non-radiation-associated paediatric thyroid cancers..." Furthermore, "at diagnosis, 60-70% of the Chernobyl-related paediatric thyroid cancers had clinically evident cervical lymph node metastases" [9]. These figures are comparable with some data on paediatric TC [10] and higher than metastasizing percentages reported by other researchers [11,12], being obviously high enough not to contradict to the concept of aggressiveness of Chernobyl-related TC or, alternatively, of an advanced stage at diagnosis. Another statement from [9]:"With regard to the size of the primary tumour, 77% were greater than 1 cm, suggesting that these were not incidental thyroid cancers detected by aggressive screening." It can be understood as an argument against the screening-effect. In fact, mass screening detected not only small incidental cancers but also advanced TC, previously neglected because of the incomplete coverage of the population by medical checkups before the accident, shortage of modern equipment, etc. [13] This concept is confirmed by the reports that TC found at an earlier date after the Chernobyl accident had on average greater diameter and were histologically less differentiated than TC detected later [5], and that "increasing latency" was associated with a decrease in invasiveness [7]. In conclusion, some features of Chernobyl-related TC are associated not with ionizing radiation but with longer disease duration and tumour progression because of the on average later detection of malignancies in the former Soviet Union [14].
References
1. Nikiforov Y, Gnepp DR. Pediatric thyroid cancer after the Chernobyl disaster. Pathomorphologic study of 84 cases (1991-1992) from the Republic of Belarus. Cancer 1994;74:748-66.
2. Ito M, Yamashita S, Ashizawa K, et al. Histopathological characteristics of childhood thyroid cancer in Gomel, Belarus. Int J Cancer 1996;65:29-33.
3. Pacini F, Vorontsova T, Molinaro E, et al. Thyroid consequences of the Chernobyl nuclear
accident. Acta Paediatr Suppl 1999;88:23-7.
4. Tronko MD, Bogdanova TI, Komissarenko IV, et al. Thyroid carcinoma in children and adolescents in Ukraine after the Chernobyl nuclear accident: statistical data and clinicomorphologic characteristics. Cancer 1999;86:149-56.
5. Williams ED, Abrosimov A, Bogdanova T, et al. Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness. Br J Cancer 2004;90:2219-24.
6. Boltze C, Riecke A, Ruf CG, et al. Sporadic and radiation-associated papillary thyroid cancers can be distinguished using routine immunohistochemistry. Oncol Rep 2009;22:459-67.
7. Tronko M, Bogdanova T, Voskoboynyk L, et al. Radiation induced thyroid cancer: fundamental and applied aspects. Exp Oncol 2010;32:200-4.
8. Naing S, Collins BJ, Schneider AB. Clinical behavior of radiation-induced thyroid cancer: factors related to recurrence. Thyroid 2009;19:479-85.
9. Tuttle RM, Vaisman F, Tronko MD. Clinical presentation and clinical outcomes in Chernobyl-related paediatric thyroid cancers: what do we know now? What can we expect in the future? Clin Oncol (R Coll Radiol) 2011;23:268-75.
10. Feinmesser R, Lubin E, Segal K, Noyek A. Carcinoma of the thyroid in children - a review. J Pediatr Endocrinol Metab 1997;10:561-8.
11. Gow KW, Lensing S, Hill DA, et al. Thyroid carcinoma presenting in childhood or after treatment of childhood malignancies: An institutional experience and review of the literature. J Pediatr Surg 2003;38:1574-80.
12. Jarzab B, Handkiewicz-Junak D. Differentiated thyroid cancer in children and adults: same or distinct disease? Hormones (Athens) 2007;6:200-9.
13. Jargin SV. Thyroid cancer after chernobyl: obfuscated truth. Dose Response. 2011;9(4):471-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315168/
14. Jargin S. Some aspects of medical education in the former Soviet Union. Sao Paulo Med J. 2012;130(1):65-6.
Competing interests: No competing interests
Causes and mechanisms of the registered incidence increase of
pediatric thyroid carcinoma after the Chernobyl accident, unrelated to the
ionizing radiation, were recently reviewed by Z. Jaworowski (2010). The
main body of evidence (Cardis et al. 2005; Tronko et al. 2006; Davis et
al. 2004) in favor of the cause-effect relationship between ionizing
radiation and thyroid carcinoma among children and adolescents after the
Chernobyl accident is provided by the epidemiologic studies (Ron 2009).
The case-control study (Cardis et al. 2005) was based on a retrospective
estimation of doses by questioning. 'Chernobyl victim syndrome' (Bay and
Oughton 2005) was a widespread phenomenon: many patients strived for
higher dose estimations to support their status of Chernobyl victims, and
provided biased information. Cancer patients should have remembered
circumstances related to the exposure better than the controls. The study
by Davis et al. (2004) was similar in design. In the cohort study by
Tronko et al. (2006), along with questioning, the data of thyroid
dosimetry performed within the period of 2 months (a half-life of 131I is
about 8 days) after the accident were used for estimation of individual
doses. The study design included, if indicated, repetitive examinations in
the central clinics in Kiev (Tronko et al. 2006). Persons with higher dose
estimates must have been, on average, more interested in further
examinations. In the health care system of the former Soviet Union, an
extent of a medical checkup has sometimes depended on a patient's
initiative. The recent study (Zablotska et al. 2010) is analogous in
design to that by Tronko et al. (2006). Other epidemiologic studies were
probably loaded with these and other biases (Jaworowski 2010), typical for
research on stochastic effects of low level radiation (Watanabe et al.
2008). After the accident appeared many poorly substantiated publications,
where spontaneous diseases in Chernobyl clean-up workers or inhabitants of
radiocontaminated areas, sometimes quite distant from Chernobyl, were a
priori considered to be radiogenic (e.g. Grobova and Chernikov 1996;
Chuchalin et al. 1997; Kogan et al. 1999; Derizhanova 2000; Degtiarova
2000; Lysenko et al. 2000). Previously we discussed several publications
overestimating Chernobyl consequences (Jargin 2007; 2009a,b; 2010a,b).
Unreliability of other reports can be assumed by analogy: if earlier
papers on the same topic were unreliable, later ones might be unreliable
as well, because motivations and the attitude to the topic remained
unchanged. For an inside observer it is obvious that behind the avalanche
of predominantly Russian-language papers overestimating Chernobyl
consequences, some of them referenced in Yablokov (2010), was a directive,
which had been not uncommon for the Soviet science. In the former Soviet
Union, research themes were often assigned to the scientists, while
"expected results" were discussed at Scientific Councils (uchenyi soviet)
sometimes being, in fact, prescribed in advance. Desired research results
could be directly "recommended" by a superior, which was favored by the
ingrained authoritative management style. Manipulations with statistics
and other forms of scientific misconduct were known to occur in medical
research from of old (Jargin 2009c,d; 2010b-d). Motives for Chernobyl
consequences overestimation have been obvious: exaggeration of this theme
facilitated writing of dissertations, financing, international help, etc.
Chernobyl accident has been exploited to strangle worldwide development of
atomic energy (Jaworowski 2010) thus contributing to elevation of oil
prices.
Travelling to the areas, formerly contaminated due to the
Chernobyl accident, the author of this letter interviewed pathologists,
cytologists and other specialists, who participated in diagnostics of the
post-Chernobyl tumors. Most of them agreed that Chernobyl consequences had
been overestimated; and the role of vested interests was pointed out. It
was also stated that sets of histological specimens from a single patient
were sometimes subdivided into several ones, creating "dead souls" (Gogol
1842), which has influenced statistics. It can be verified by DNA
examination of the specimens accumulated in tissue banks. Radio- and
cancerophobia, sometimes amounting to panic, contributed to the
overdiagnosis of cancer, which can be illustrated by the following
passages from a Russian-language professional publication (verbatim
translation): "Practically all nodular thyroid lesions, independently of
their size, were regarded at that time in children as potentially
malignant tumors, requiring an urgent surgical operation" or
"Aggressiveness of surgeons contributed to the shortening of the minimal
latency period." (Parshkov 2006). Mechanisms of overdiagnosis were
discussed previously (Jargin 2009e; 2010a). Obviously, mass screening in
the areas, where pediatric thyroid cancer had been rarely diagnosed
before, on the background of poor equipment and shortage of modern
literature, in the atmosphere of radio- and cancerophobia, of vested
interests both in decision-making spheres and among researchers, must have
inevitably resulted in overestimation. The principal cause of Chernobyl
consequences overestimation remains to be pointed out: it is unreliability
of Chernobyl-related (and some other) research originating from the former
Soviet Union, a nonchalant attitude towards scientific misconduct in
general and manipulations with statistics in particular (Jargin 2009c,d;
2010b-d). The true state of affairs will be cleared sooner or later:
Chernobyl cancer specimens are preserved in tissue banks, and evaluation
of time-related markers of tumor dedifferentiation will allow one day to
estimate a true "age" of these tumors and to demonstrate, how many of them
had developed before the accident, being then misclassified as radiogenic
cancer. More difficult it would be to identify cases from non-contaminated
areas falsely registered as Chernobyl victims, because it would require
cooperation of the authorities, but this problem is technically solvable
as well. A concluding point is that overestimation of Chernobyl
consequences can create a wrong concept about carcinogenic action of
radioactive iodine, which can be harmful for research and practice.
References
Bay IA and Oughton DH. 2005. Social and economic effects. In: Smith
J, Beresford NA. Chernobyl - Catastrophe and Consequences, pp 239-266.
Springer, Chichester
Cardis E, Kesminiene A, Ivanov V, et al. 2005. Risk of thyroid cancer
after exposure to 131I in childhood. J Natl Cancer Inst 97:724-732
Chuchalin AG, Maracheva AV, Grobova OM, et al. 1997. Lungs exposed to
nuclear catastrophe: one-year therapeutic programme in Chernobyl
liquidators group. Swiss Med Wkly 127:165-169
Degtiarova LV. 2000. A Possibility of Gastric Cancer and Malt-
Lymphomas Appearance in Persons Affected because of Chernobyl Accident.
XXIII International Congress of the International Academy of Pathology and
14th World Congress of Academic and Environmental Pathology. 15-20 October
2000. Nagoya, Japan. Pathol Int. 50 Suppl. Abstract P-19-31.
Derizhanova IS. The Pulmonary-Renal Syndrome among Chernobyl Nuclear
Accident Liquidators. XXIII International Congress of the International
Academy of Pathology and 14th World Congress of Academic and Environmental
Pathology. 15-20 October 2000. Nagoya, Japan. Pathol Int. 50 Suppl.
Abstract P-19-34.
Grobova OM and Chernikov VP. 1996. The presence of cesium-137 in the
tissue of a lung tumor in someone who cleaned up the aftermath of the
accident at the Chernobyl Atomic Electric Power Station (in Russian with
English summary). Ter Arkh 68(3):26-30.
Davis S, Stepanenko V, Rivkind N, et al. 2004. Risk of thyroid cancer
in the Bryansk Oblast of the Russian Federation after the Chernobyl Power
Station accident. Radiat Res 162(3):241-248
Gogol NV. 1842. Dead Souls (in Russian). Possev, Moscow
Jargin SV. 2007. Over-estimation of radiation-induced malignancy after the
Chernobyl accident. Virchows Arch 451(1):105-106
Jargin SV. 2009a. Overestimation of Chernobyl consequences:
biophysical aspects. Radiat Environ Biophys 48(3):341-344
Jargin SV. 2009b. Overestimation of Chernobyl consequences:
calculation of a latent period for tumors with unproven radiation
etiology. Radiat Environ Biophys 48:433-434
Jargin SV. 2009c. Russian pathology and scientific misconduct. Indian
J Pathol Microbiol 52(3):443
Jargin SV. 2009d. Manipulation with statistics in medical research.
Dermatopathol: Pract & Conc 15(1):21. Available at
http://derm101.com/abstract/32761
Jargin SV. 2009e. Overestimation of thyroid cancer incidence after
Chernobyl. Health Phys 96(2):186
Jargin, SV. 2010a. Chernobyl-related Cancer: re-evaluation needed.
Turkish J Pathol 26(2):177-181. Available at
http://www.turkjpath.org/pdf/pdf_TPD_1440.pdf
Jargin SV. 2010b. Overestimation of Chernobyl consequences: poorly
substantiated information published. Radiat Environ Biophys 49(4):743-745
Jargin SV. 2010c. The heritage of Rudolf Virchow and the stem cell.
GMS Med Bibl Inf 2010;10(2):Doc14. Available at
http://www.egms.de/en/journals/mbi/2010-10/mbi000197.shtml
Jargin SV. 2010d Plagiarism in radiology: A substitute for
importation of foreign handbooks. J Med Imaging Radiat Oncol 54(1):50-52
Jaworowski Z. 2010. Observations on the Chernobyl Disaster and LNT.
Dose Response 8:148-171
Khmel'nitskii OK, Tret'iakova MS, Kiselev AV, et al. 2000. Morpho-
ecological characteristics of thyroid diseases in various regions of
Russia and Belorussia from surgical data (in Russian with English
summary). Arkh Patol 62(4):19-27.
Kogan EA, Cherniaev AL, Chuchalin AG, et al. 1999. Morphologic and
molecular-genetic characterization of lung cancer developing in people who
have worked at nuclear facilities and who have lived in Russian
territories polluted after the accident at the Chernobyl power plant. (in
Russian with English summary). Arkh Patol 61(1):22-26.
Lysenko AI, Kirpatovski? ID and Pisarenko SS. 2000. Morphological
changes in male sexual glands in Kaluga regions contaminated with
radionuclides (in Russian with English summary). Arkh Patol 62(4):27-31
Parshkov EM. 2006. Analysis of thyroid cancer morbidity. In:
Lushnikov EF Tsyb AF, Yamashita S. Thyroid cancer in Russia after the
Chernobyl. pp 36-59. Meditsina: Moscow (in Russian with English summary)
Ron E. 2009. Response to Jargin. Health Phys 96:186-187
Tronko MD, Howe GR, Bogdanova TI, et al. 2006. A cohort study of
thyroid cancer and other thyroid diseases after the Chornobyl accident:
thyroid cancer in Ukraine detected during first screening. J Natl Cancer
Inst 98:897-903
Watanabe T, Miyao M, Honda R and Yamada Y. 2008. Hiroshima survivors
exposed to very low doses of A-bomb primary radiation showed a high risk
for cancers. Environ Health Prev Med 13:264-270
Yablokov AV. 2010. Oncological diseases after the Chernobyl
catastrophe. Ann N Y Acad Sci 1181:161-191
Zablotska LB, Ron E, Rozhko AV, et al. 2010. Thyroid cancer risk in
Belarus among children and adolescents exposed to radioiodine after the
Chornobyl accident. Br J Cancer. Nov 23. [Epub ahead of print]
Competing interests: No competing interests
After the forest fires in the central part of European Russia in July
and August 2010, a concern was expressed that resuspended radionuclides
from the areas, formerly contaminated due to the Chernobyl accident, can
be transferred by winds to other regions and cause an increase of the
background radiation. This concern has been reinforced by articles in
scientific journals, where questionable statements were made with
references to non-professional publications (mass media, websites of
unclear affiliation, commercial editions) or without any references at
all, e.g. in the volume 1181 of The Annals of the New York Academy of
Sciences (2009) dedicated to the Chernobyl accident (commented in [1]).
For example, the following statement was made without references:
"Chernobyl radionuclides concentrate in sediments, water, plants, and
animals, sometimes 100,000 times more than the local background level."
[2] Another example from the same source: "In territories with a high
density of ground-level radioactive contamination (in soil, water,
vegetation) the hot air resulting from the fires caused radionuclides to
be carried up to a height of 3 km and transported over hundreds of
kilometers (Konoplia et al., 2006)." The referred source (Konoplia et al.,
2006) is not in the reference list of the [2] and was not found. The last
example: "On September 6, 1992, radioactive aerosols lifted by a strong
wind from the 30-km Chernobyl zone reached the vicinity of Vilnius,
Lithuania (about 300 km away) in 5-7 h, where the 137Cs concentration
increased 100-fold (Ogorodnykov, 2002)." The quoted source [3] is largely
a belletristic text. The quotation is correct, but the statement is made
in [3] without references; it is not commented, how the measurements were
made, whether they were reliable or not; there are no figures neither of
initial nor of maximal radioactivity in the affected area. Publications
such as [2], providing no reliable or verifiable information, only foster
radiophobia. It is known that "Chernobyl hysteria" impeded nuclear energy
production in many countries, thus contributing to higher prices for
fossil fuel. Cui prodest scelus, is fecit.
Here follows a brief overview of available information on this theme.
One year after the Chernobyl accident, only about 2 % of the total
radioactivity initally released was remaining in the environment. 10 years
after the accident, less than 1 % remained. A great part of 137Cs, the
main dose-forming Chernobyl radionuclide remaining after the decay of
short-lived isotopes, is adsorbed to the soil matrix [4], thus being
hardly available for resuspension during forest fires. The resuspension,
estimated by modelling of forest fires, involved only around 5 % of total
137Cs in the area of the fire. Radiocesium is relatively weakly
bioaccumulated in wood. Activity concentrations in trees are significantly
lower than in the soil, leaf litter and understorey vegetation. In the
forests around Chernobyl, around 5 % of radionuclides are accumulated in
trees; 20-85% are in the understorey vegetation, the rest being in the
soil [5]. Resuspension coefficients decrease with the time elapsing after
the initial radioactive fallout according to an exponential law [6].
Kasparov et al. [7] concluded on the basis of experimental forest fires
that radionuclide retransfer causes no considerable additional
contamination of an area even under the most unfavourable conditions [7].
All contamination indices diminish drastically with the increasing
distance from the centre of a forest fire. For example, radiocontamination
is 3-5 orders of magnitude lower at 1500 meters from the fire centre, as
compared to 250 meters (at a windspeed 5 m/s) [5]. A non-convection
spreading of an aerosol is accompanied by rapid decrease of airborne
radioactivity and of its fallout with increasing distance from the
resuspension focus. Depending on the weather conditions, the resuspended
radioactivity and its fallout decreases dozens of times at a distance of
100 meters and thousands of times at a distance of several kilometres from
the fire centre (at a windspeed 5 m/s) [7]. The part of radioactivity
involved into a non-convection transfer amounts only to several percents
from the total radioactivity resuspended by a forest fire [7].
Convectional spreading with lifting of the aerosol to a height can prevent
the radiocontamination of an immediately adjacent zone, with a possible
location of the contamination maximum at a distance of 1.5-2 km from the
centre of the forest fire [7]. Note that a transfer of radionuclides by
convection is accompanied by dispersion during vertical displacements of
the aerosol and turbulences. As a result, at a distance of 20 km from the
forest fire, sedimentation from a radioactive aerosol makes only a
negligible addition to the radioactive background [7]. The radionuclide
fallout along the plume axis is negligible in comparison to the existing
contamination [8]. Radiation doses because of forest fires on
radiocontaminated territories are discussed only for firemen exposed in
the affected area [5,8] and personnel within the Chernobyl zone [5].
Considering the above, forest fires in the Chernobyl area bear no risk of
significant radiocontamination today.
References
1. Jargin SV. Overestimation of Chernobyl consequences: Poorly
substantiated information published. Radiat Environ Biophys 2010; DOI:
10.1007/s00411-010-0313-1.
2. Yablokov AV, Nesterenko VB, Nesterenko AV. 8. Atmospheric, water,
and soil contamination after Chernobyl. Ann N Y Acad Sci. 2009;1181:223-
36.
3. Ogorodnykov BI. Chernobyl: Fifteen years later. In: Chernobyl:
duty and courage (in Russian) Moscow, 2002; Volume 1, Chapter 2. Available
at: http://www.iss.niiit.ru/book-4/glav-2-24.htm (accessed 19/09/2010).
4. Smith J, Beresford NA. Chernobyl - catastrophe and consequences.
Chichester: Springer, 2005.
5. Azarov SI. Atmospheric contamination by 137Cs during forest fires
in the Chernobyl area (in Russian with English summary). Radiats Biol
Radioecol. 1996;36(4):506-15.
6. Budyka AK, Ogorodnikov BI. Effect of some natural processes on the
formation and characteristics of aerosols in regions polluted with
radionuclides (in Russian with English summary). Radiats Biol Radioecol.
2001;41(6):695-9.
7. Kashparov VA, Lundin SM, Kadygrib AM, et al. Radio-ecological and
hygienic assessment of consequences of forest fires in the areas polluted
during the Chernobyl accident (in Russian with English summary). Gig
Sanit. 2001;(1):30-5.
8. Yoschenko VI, Kashparov VA, Protsak VP, et al. Resuspension and
redistribution of radionuclides during grassland and forest fires in the
Chernobyl exclusion zone: part I. Fire experiments. J Environ Radioact.
2006;86(2):143-63.
Competing interests: No competing interests
In a recently published letter1 it was noted that in volume 1181
of The Annals of the New York Academy of Sciences (2009), dedicated to the
Chernobyl accident, references to non-professional publications
(newspapers, websites of unclear affiliation, commercial editions, etc.)
are used to support scientific views. Besides, abstracts of conferences,
dissertations and articles in Russian are extensively quoted. Such data,
presented uncritically, can produce an exaggerated impression about
Chernobyl consequences.
A majority of articles are authored by Prof. A.V.
Yablokov. In the authors’ response2 it was acknowledged that “sometimes
references in the text do not correspond with those used in the list of
references”, 2 which is in fact a form of misquoting; but it was noted
that my criticism had been based only on 4 out of 18 sections of the
volume. Therefore, here is an additional comment.
Many articles about
Chernobyl, originating from the former Soviet Union, contained strained
interpretations or unfounded conclusions; some of them were discussed
previously.3-11 It is not only a matter of scientific argumentation, but
also of a tendency to overestimate Chernobyl consequences. For an inside
observer it is obvious, that behind this tendency was a directive, which
has been not unusual for the Soviet science. Research topics were often
assigned to the scientists, while “expected results” were discussed and
sometimes, in fact, prescribed in advance. Misquoting6 and plagiarism12
were found in some publications dedicated to Chernobyl.
Travelling to the
formerly contaminated areas of Belarus, Russia and Ukraine, I interviewed
pathologists and other specialists, who participated in diagnostics of the
post-Chernobyl thyroid carcinoma (TC). Most of them agreed that medical
consequences of the Chernobyl accident had been overestimated, while the
role of vested interests was pointed out: heated attention to the
Chernobyl topic facilitated writing of dissertations, financing,
international scientific cooperation, etc. A concluding point is that
overestimation of Chernobyl consequences can cause inadequate conception
about carcinogenicity of 131I and other radionuclides, which can have
negative consequences for research and practice.
1. Jargin SV. Overestimation of Chernobyl consequences: poorly
substantiated information published. Radiat Environ Biophys 2010 Jul 17.
DOI: 10.1007/s00411-010-0313-1.
2. Yablokov A, Nesterenko A. Reply to letter by Jargin on
"overestimation of Chernobyl consequences: poorly substantiated
information published" Radiat Environ Biophys 2010 Jul 17. DOI:
10.1007/s00411-010-0314-0.
3. Jargin SV. Over-estimation of radiation-induced malignancy after
the Chernobyl accident. Virchows Arch 2007; 451(1): 105-6.
4. Jargin SV. Overestimation of Chernobyl consequences: calculation
of a latent period for tumors with unproven radiation etiology. Radiat
Environ Biophys 2009; 48: 433-4.
5. Jargin SV. Overestimation of Chernobyl consequences: biophysical
aspects. Radiat Environ Biophys 2009; 48(3): 341-4.
6. Jargin SV. Publications exaggerating Chernobyl consequences: some
examples. BMJ Rapid Responses; published online 22 August 2009 Available
from: http://www.bmj.com/cgi/eletters/339/aug14_1/b3270#219071
7. Jargin SV. Dubious publications on radiation pathology:
significance for international cooperation. BMJ Rapid Responses; published
online 26 September 2009 Available from:
http://www.bmj.com/cgi/eletters/314/7073/82#220674
8. Chuchalin AG, Maracheva AV, Grobova OM, et al. Lungs exposed to
nuclear catastrophe: one-year therapeutic programme in Chernobyl
liquidators group. Swiss Med Wkly 1997; 127: 165-9.
9. Degtiarova LV. A possibility of gastric cancer and malt-lymphomas
appearance in persons affected because of Chernobyl accident. Abstracts of
the XXIII International Congress of the International Academy of
Pathology. 15-20 October 2000, Nagoya, Japan. Pathol Int 2000; 50(Suppl):
A74.
10. Derizhanova IS. The pulmonary-renal syndrome among Chernobyl
nuclear accident liquidators. Abstracts of the XXIII International
Congress of the International Academy of Pathology. 15-20 October 2000,
Nagoya, Japan. Pathol Int 2000; 50(Suppl): A73.
11. Kogan EA, Cherniaev AL, Chuchalin AG, et al. Morphologic and
molecular-genetic characterization of lung cancer developing in people who
have worked at nuclear facilities and who have lived in Russian
territories polluted after the accident at the Chernobyl power plant. Arkh
Patol 1999; 61(1): 22-6 (in Russian with English summary).
12. Jargin SV. Plagiarism in radiology: a substitute for importation
of foreign handbooks. J Med Imaging Radiat Oncol 2010; 54(1): 50-52.
Competing interests:
None declared
Competing interests: No competing interests
After the Chernobyl accident appeared many publications
overestimating its medical consequences. There follow several examples,
published in Swiss Medical Weekly. All articles are available online:
http://www.smw.ch/dfe/index.html
Twenty Chernobyl cleanup workers (the so-called liquidators) with
respiratory symptoms were studied [1]. No radiation doses were known;
cause-effect relationship between inhalation of radioactive dust and the
symptoms is not proven but presented as a self-evident fact, which is a
logical fallacy known as false premise. Smoking, the most significant
etiologic factor of bronchitis, is not mentioned at all. Moreover, it is
stated that macrophages from bronchoalveolar lavage fluid contained
phagolysosomes “with so-called elements of Chernobyl dust: Sr, Zr, I, Cs,
Np, Pu, Am, Cm” with reference to an experimental study [2] irrelevant to
the Chernobyl theme. The authors [6] measured neither the content of these
elements in the lavage fluid nor its radioactivity. Nonetheless it is
concluded that long-term persistence of the radionuclides in the lungs “is
likely to play a role in the origin of local anatomical and functional
disorders” [1].
Another example is provided by the article [3]. According to the
Patients and Methods section, 94 children in a sanatorium were subdivided
into 3 groups after the 137Cs activity concentration measured in their
bodies. The term “radio-contamination” was used but considering the units
(Bq/kg body weight) the activity concentration was probably meant. The
following figures are given in the article: 1st cohort (33 children) -
activity concentration was below 5 Bq/kg body weight; 2nd cohort (31
children) - 38,4 ± 2,4 Bq/kg; 3rd cohort (30 children) - 122 ± 18,5 Bq/kg.
It is not indicated, which value stands after the ± sign, a standard
deviation or a standard error of the mean, but in both cases these figures
could not have resulted from a subdivision of a single population: the
difference between the 2nd and the 3rd cohort is extremely significant
(P<0.001), whereas the difference between the 1st and the 2nd cohorts
(<5 vs. 38,4 ± 2,4) is almost absolute, which is unimaginable in an
arbitrarily subdivided population. Statistically significant differences
between the groups were found also in regard to cardio-vascular symptoms,
unusual in children, such as arterial hypertension and alterations of the
electrocardiogram (ECG). The treatment with the apple pectin significantly
reduced 137Cs contents in the children’s bodies and was associated with
ECG improvement. It should be commented that, according to the IAEA [4],
137Cs activity concentration in milk from contaminated areas (the main
alimentary exposure source especially for children), has been below the
permissible level since 1996 at the latest. The study was performed in
2003. Moreover, the 137Cs-lowering treatment with apple pectin appears
senseless in a sanatorium, where children are supposed to receive food
with no elevation of radionuclide content.
In the previous publication with participation of the same authors
[5], a teaspoon of diluted apple pectin given twice a day to the children
living in a sanatorium, was reported to reduce the “137Cs level in
children“ by 62 % , P-value being not only below 0.01, as it is indicated
in the article, but in fact below 0.0001 (paired t-test, calculated on the
basis of the figures from the article [5] using the software GraphPad
InStat, Copyright 1992-1998 GraphPad Software). The extremely significant
difference and, correspondingly, pronounced 137Cs-lowering effect of the
apple pectin appears doubtful because, to assure reliability of the data
by the low pectin doses given to the children, consumption of apples and
other pectin-containing fruit should have been strictly monitored, which
is not mentioned in the article. Characteristically, apart from one
Russian-language publication (the title of which is written in German for
unknown reason), no literature sources about the pectin methods are
quoted. Another reference (Korzum VN. Nutrition problems under wide-scale
nuclear accident conditions and its consequences. Internat J Radiation Med
1999;2:75–91; in the text of the article the author’s name is spelled
„Korsum“) was not found in spite of extensive search and represents
obviously a misquoting.
Finally, a mini-review [6] on the topic of radiation-induced
mutagenesis should be mentioned. No measured radiation doses and no number
of cases are given. Levels of significance are given only occasionally;
and figures with unknown levels of significance are used in argumentation.
For example, a negative correlation between the germline mutation rate and
paternal year of birth in inhabitants of Semipalatinsk area is stated
without giving the correlation coefficient value, its level of
significance and number of correlation pairs. According to the form of the
diagram depicted on the Fig. 2 in the article [6], this correlation is
probably insignificant. Nonetheless, extensive discussion is led on its
basis: “this correlation provides the first experimental evidence for
change in human germline mutation rate with declining exposure to ionizing
radiation and therefore shows that the Moscow treaty banning nuclear
weapon tests in the atmosphere (August 1963) has been effective in
reducing genetic risk to affected population” [6]. On the whole this
review, similarly to other analogous publications, does not provide
significant information but creates impression about high rate of
radiation-induced abnormalities in Chernobyl and Semipalatinsk areas. It
should be noted in conclusion that Chernobyl hysteria has impeded nuclear
power production in many countries and contributed to high energy prices.
References:
1. Chuchalin AG, Maracheva AV, Grobova OM, Cherniaev AL, Antonov NS,
Kalmanova EN, Dmitrov EV, Voisin C. Lungs exposed to nuclear catastrophe:
one-year therapeutic programme in Chernobyl liquidators group. Swiss Med
Wkly 1997;127:165-9.
2. Mueller HL, Drosselmeyer E, Hotz G, Seidel A, Thiele H, Pickering
S. Behaviour of spherical and irregular (U,Pu)O2 particles after
inhalation or intratracheal instillation in rat lung and during in vitro
culture with bovine alveolar macrophages. Int J Radiat Biol. 1989;55:829-
42.
3. Bandazhevskaya GS, Nesterenko VB, Babenko VI, Yerkovich TV,
Bandazhevsky YI. Relationship between caesium (137Cs) load, cardiovascular
symptoms, and source of food in 'Chernobyl' children - preliminary
observations after intake of oral apple pectin. Swiss Med Wkly
2004;134:725-9.
4. IAEA (2006) Chernobyl’s Legacy: Health, Environmental and Socio-
Economic Impacts and Recommendations to the Governments of Belarus, the
Russian Federation and Ukraine. IAEA, Vienna, p. 24-25
5. Nesterenko VB, Nesterenko AV, Babenko VI, Yerkovich TV, Babenko
IV. Reducing the 137Cs-load in the organism of "Chernobyl" children with
apple-pectin. Swiss Med Wkly 2004;134:24-7.
6. Dubrova YE. Monitoring of radiation-induced germline mutation in
humans. Swiss Med Wkly 2003; 133:474-8.
Competing interests:
None declared
Competing interests: No competing interests
Collecting things is a popular hobby that can provide inspiration, pleasure, and
profit. But sometimes collecting things is a sign of an obsessive-compulsive
disorder with deep-seated anxiety and loneliness, and requires professional
help. In my experience, such cases respond better to psychotherapy rather than
pharmacotherapy. The collectibles serve as a natural springboard for insightful
discussions of their symbolic and historical significance, while drugs tend to
suppress such discussions.
Competing interests:
None declared
Competing interests: No competing interests
Re: Rekindled passion: fire and fallout
Dear Sir, herewith I may kindly draw your attention to the following inexactitudes in the UNSCEAR Reports and other official publications on Chernobyl accident.
Thyroid cancer (TC) was relatively rarely diagnosed in children and adolescents in the former Soviet Union (SU) before the Chernobyl accident: in Belarus during 1981-85 the absolute number of TC diagnosed in children under 15 years reportedly was 3, and the annual rate per million children under 15 years was reported to be 0.3; for Ukraine - correspondingly 25 and 0.5 [1]. For the northern regions of Ukraine, where radioactive contamination later occurred, these values were correspondingly 1.0 and 0.1. So it was written in [1]; but adequately calculated incidence rates would be somewhat higher. According to the population pyramids for the year 1990 for Belarus and Ukraine [2], children under 15 years represented a little more than 12 % of the population of both countries. Therefore, the approximate annual incidence rate would be: 3 cases during 5 years per 1.2 million children result in the annual incidence rate of approximately 0.5 per 1 million children for Belarus, and 25 cases/5 years x 6 million children = 0.83 for Ukraine. For the northern Ukrainian regions the incidence rate would be correspondingly 0.17 per million per year. The above figures from [1] were reproduced in the Table 63 of the IARC publication [3] with a reference to [1]; but the rates were designated “Rate/Million” which can be understood as a rate for the whole period (1981-85) and for the entire population of a country (e.g. 3 cases/10 million inhabitants of Belarus = 0.3 per 1 million inhabitants per 5 years); which, however, would be at variance with the original meaning in [1]. In any case, the pre-accident incidence rates of TC in Belarus and Ukraine are relatively low in comparison with other developed countries [4]. In Russian Federation, TC was started to be registered as a separate entity only in 1989 [5], when the screening after the Chernobyl accident had been initiated and the registered TC incidence started to rise. Accordingly, there must have been a pool of undiagnosed TC in Belarus and Ukraine before the Chernobyl accident. The neglected cases have been diagnosed after the Chernobyl accident due to the screening and improved diagnostics, being partly misinterpreted as radiogenic cancers developing after a short latent period. Some TC cases were probably brought additionally from non-contaminated areas and falsely registered as Chernobyl-related ones. Percentage of older, more advanced cancers must have been higher among the ‘first wave’ cases after the accident, when the pool of neglected cancers had been untapped, equipment of histopathological laboratories outdated, post-Chernobyl radiophobia being at its apogee; more details are in [6,7]. Accordingly, the TCs detected earlier after the Chernobyl accident were averagely larger in size than the later ones [8].
The data on the TC incidence for 1986 (the year of the Chernobyl accident) and the subsequent years are given in the Tables 56 and 57 of the Annex J to the UNSCEAR 2000 Report with references to three "Communications to the UNSCEAR Secretariat" and one Symposium proceeding: in 1986 in Belarus were reportedly registered 3 pediatric TC cases and in Ukraine - 8 cases. The rates are given in the Table 57 per 100,000 children under 15 years at diagnosis: 0.2 both for Belarus and for Ukraine [9]. However, calculations according to the pattern from the preceding paragraph (using the population pyramids) result in the higher incidence rates for the year 1986: 2.5 and 1.3 per 1 million children per year for Belarus and Ukraine respectively. On my opinion, these data for the year 1986, when the attention to potentially radiogenic diseases had already increased, do not change the concept discussed above on the relatively low registered incidence of TC and a pool of neglected TC in the former SU before the Chernobyl accident.
The UNSCEAR 2008 Report [10] compares the enhanced TC incidence after the Chernobyl accident not with the pre-accident level but with the years 1986-90 (Annex D, pp. 60-61), when the incidence had already increased to around 5 cases per million per year. In particular, it is stated on the p. 60: 'The background rate of TC among children under the age 10 years is approximately 2 to 4 cases per million per year' [10], which is higher than the pre-accident rates reported in [1,3] and discussed above. Moreover, the number of the registered cases in Ukraine presented in the Table D11 in the Annex D to the UNSCEAR 2008 Report [10] is higher than the figures from [1,3]: 39 cases for the period 1982-85 vs. 25 cases for 1981-85. These higher figures were given in the UNSCEAR 2008 Report with references to a 'communication to the UNSCEAR Secretariat' and to [11]. However, the publication [11] was found neither in the PubMed database nor on the website of the International Journal of Radiation Medicine: http://www.physiciansofchernobyl.org.ua/magazine/eng/index.html (accessed 21 August 2013). I suspect this article has never existed or at least never been available to the international scientific community. All that looks like camouflage of the low incidence of pediatric TC before the accident, which could in fact have been even lower than that reported in [1].
1. Stsjazhko VA, Tsyb AF, Tronko ND, Souchkevitch G, Baverstock KF. Childhood thyroid cancer since accident at Chernobyl. BMJ 1995, 310: 801.
2. NationMaster. Belarus Population Pyramid for 1990. http://www.nationmaster.com/country/bo-belarus/Age-_distribution Ukraine Population Pyramid for 1990; http://www.nationmaster.com/country/up-ukraine/Age-_distribution (accessed on 14 August 2013)
3. Parkin DM, Kramárová E, Draper GJ, Masuyer E, Michaelis J, Qureshi S, Stiller CA. International incidence of childhood cancer. IARC Scientific Publication 144. IARC Press, Lyon, 1999.
4. Demidchik YE, Saenko VA, Yamashita S. Childhood thyroid cancer in Belarus, Russia, and Ukraine after Chernobyl and at present. Arq Bras Endocr Metab 2007, 51:748-762.
5. Abrosimov AYu, Lushnikov EF, Parshkov EM, Saenko VA, Tsyb AF, Yamashita S. Thyroid cancer in Russia after the Chernobyl. Meditsina, Moscow, 2006. (In Russian with English summary)
6. Jargin SV. Validity of thyroid cancer incidence data following the Chernobyl accident. Health Phys 2011, 101:754-757.
7. Jargin SV. On the RET Rearrangements in Chernobyl-Related Thyroid Cancer. J Thyroid Res 2012, article 373879.
8. Williams ED, Abrosimov A, Bogdanova T, Demidchik EP, Ito M, LiVolsi V, Lushnikov E, Rosai J, Sidorov Y, Tronko MD, Tsyb AF, Vowler SL, Thomas GA. Thyroid carcinoma after Chernobyl latent period, morphology and aggressiveness. Br J Cancer 2004;90:2219-2224.
9. UNSCEAR 2000 Report for the General Assembly. Sources and effects of ionizing radiation. Annex J. Exposures and effects of the Chernobyl accident. New York: United Nations.
10. UNSCEAR 2008 Report to the General Assembly. Sources and effects of ionizing radiation. Annex D. Health effects due to radiation from the Chernobyl accident. United Nations, New York.
11. Tronko, N. D., Bogdanova, T. I., Komissarenko, I., et al. Thyroid cancer in children and adolescents in Ukraine having been exposed as a result of the Chornobyl accident (15-year expertise of investigations). Int J Radiat Med 2002;4:222-232. (The reference was copied from the UNSCEAR 2008 Report).
Competing interests: No competing interests