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Home , Aomori Prefecture, Chernobyl disaster

Hiroshima, Nagasaki, & Fukushima: A Medical Radiologist's Advice on Exposure, Risks, and Other Threats to Public Health

by Keiichi Nakagawa, MD, Ph.D

( 放射線医が語る被ばくと発がんの真実・中川恵一 )

translated by Alexander Isao Holmes Table of Contents

Introduction 5 Valuable Records, a Legacy to Posterity 43 Decisive Factors in Radiation Dose 43 Chapter 1 The Truth About Radiation 8 The Health Status of Atom Bomb Survivors 44 (1) The True Nature and Risks of Radioactive Substances 8 Overview of the Atomic Bomb Damage 44 Has Been Detected in Yokohama 8 (2) Another Chapter in the True Story of the Atom-Bombed Cities 48 The Threat of Radiation 11 The Health Status of Post-Blast Radioactivity Survivors 48 (2) The Truth About Internal Exposure 25 What Is “Internal Exposure”? 25 Chapter 4 The Truth About the Chernobyl Nuclear Accident 51 But What, Then, Exactly Is “Internal Exposure to Radiation”? 25 The Worst Nuclear Accident in History 51 The Dangers of Internal Exposure 26 The Actual Number of Victims 51 Radioactive Material in Food 26 The Increase in Cancer in Children 52 The Truth About Exposure to Cesium 27 Was There a Sudden Increase in Bladder Cancer? 53 The Reason in Children Could Not Be Prevented 53 Chapter 2 Cancer Risk Facts 29 The Complete Food Chain Leading to Cancer 54 (1) What Causes Cancer? 29 Why Collects in the Thyroid Gland 55 , World Cancer Record Holder 29 Thyroid Cancer’s Real Danger to Children 55 Why Do People Get Cancer? 30 Radioactive Iodine Is Also Sometimes Used to Treat Cancer 56 The Longer the Average Life Expectancy, the Higher the Cancer Rates 31 The Differences Between Chernobyl and Fukushima 57 Our Growing Population of “Youthful” Seniors 32 Restrictions on Food Products Came Too Late in Chernoby 58 Your Chances of Getting Cancer Are 50-50 33 Japanese Food Regulations Are Safe 59 Magic Bullets For Cancer? (Only Lifestyle Improvement and Early Detection Work) 33 Problems With Defining the Evacuation Zone in Fukushima 59 Total Cancer Rates Would Be Cut by 20% if Nobody Smoked 33 Average Life Expectancy Fell After Chernobyl 60 The Younger the Smoker Is, the Greater Tobacco’s Effect on the Human Body 35 What Unnecessary Evacuation Really Does 61 Alcohol + Tobacco = Double the Rate of Cancer 35 Taking the Lessons of Chernobyl to Heart 63 Drinking Can Give You Cancer! 36 (2) How to Prevent Cancer 38 Conclusion 65 The Seven Pillars of Cancer Prevention 38 Early Detection: Finding the Disease Before Symptoms Appear 38 Chapter 5 Radiation’s International Standards 73 Comparing Exposure to Radiation vs Lifestyle Choices 39 (1) International Organizations Active on Radiation Exposure-Related Problems 73 International Rules Regarding Exposures 73 Chapter 3 The Truth About and Nagasaki 43 United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 73 (1) What the Data From Hiroshima and Nagasaki Tell Us 43 The International Commission on Radiological Protection (ICRP) 74

2 3 Introduction

The Most Reliable Framework Based on International Agreements 75 Ten months have passed since the Great East Japan Earthquake and European Committee on Radiation Risk (ECRR) 75 of March 11, 2011, and the ensuing nuclear accidents. As we begin to move towards reconstruction, the problem of exposure to radiation has become a (2) International Rules to Protect People From Exposure to Radiation 76 major hurdle to recovery. The Normal Standard: 1 mSv Annual Exposure 76 Overreactions Have Harmful Side Effects 77 Since late April, beginning about one month after the accident, I have been ICRP’s Message Regarding Fukushima 78 periodically visiting Iitate-mura in together with a team from the University Hospital Department of Radiology. We listened The Dilemmas Confronting Us 82 directly to what residents had to say and we have been providing advice and recommendations on a variety of health-related issues to authorities. Chapter 6 Fukushima Now and in the Future 84 My strongest impression at these meetings in the affected area was a sense of Fukushima’s Current Situation (2011) 84 people’s vague but intense anxiety. People had many questions: What exactly The Problems Are Piling Up 84 is going on in the current situation? How much radiation is there, and what Future Risks From Radioactive Substances 84 kind of effect does this have on one’s health? What about the safety of our The Ill-Timed Order to Evacuate to Iitate-Mura 85 food and ? Should we relocate? And what kind of care do the children The Truth About External Exposures 86 need? What is going to happen next? External Exposures in Fukushima 87 In addition to questions, we heard rumors that somewhere in Japan a show Internal Exposure in Fukushima 87 using fireworks made in Fukushima had been cancelled, that pinewood from (2) My Visits to Iitate-mura 88 trees in the disaster-stricken areas would not be allowed to be burned in My Visits to Iitate-mura and What I Saw 88 religious rituals, and things like that. I also heard that school children from the Intensive-Care Nursing Homes: Evacuate or Stay Put? 89 areas affected by the disaster were victims of unjustifiable discrimination in Residents Speak for Themselves 90 the schools they had been transferred to.

Verification of Official Published Data 91 We cannot simply shrug off these behaviors as symptoms of a lack of morals Keys to Decontamination 92 in the Japanese. The main problem here is the lack of accurate information. High Exposure Risks for Accident Site Workers 93 Ever since the accident at the Fukushima plant, newspaper Cancer Rates in Fukushima Will Not Increase 93 and magazine articles, TV shows, and the Internet have been deluging us Balancing Risks While Making Urgent Decisions 94 with factoids and statements that ignite and fuel fears. People who are not experts are making irresponsible statements all the time, and it is fair to say that these statements have awakened the public’s anxieties and prejudices Chapter 7 Responses to Radiation Exposure in Times of Emergency 96 and distorted their understanding of radiation.

“Escape westward!” “You shouldn’t eat vegetables from Fukushima!” “There Chapter 8 Addressing Anxieties About Radiation Exposure and Cancer 103 will be more cancer, more birth defects, strange new diseases, and increasing mental retardation in Japan 20 years from now...” I heard of a family who 112 In Conclusion quit their jobs and relocated to another area. Another person, they said, only

4 5 eats imported food products. One mother (probably just one of many...) will Company (TEPCO) and at the Fukushima who let this not allow her children to play outside at all, because she wants to protect immense problem happen. I also believe that residents should be fully them from radiation. These actions were probably deemed best by parents compensated for their losses. However, unfortunately, we will have to deal who had to make painful choices to protect the health of their families, small for a long time to come with the problems of radiation released from the children in particular. Fukushima nuclear power plant. I doubt that anybody ever imagined we would live in a world like Japan today, where people go out and buy their However, as I stated above, the most serious issue is the lack of accurate own to measure radiation levels in the parks that they grew up information. The Fukushima nuclear accident has been repeatedly compared playing in and in the streets of the towns that they live in. to the Chernobyl nuclear accident. People say, for instance, “It is the same level 7 as Chernobyl,” “There have been hot spots identified in the center We must do something to prevent factoids and malicious rumors from doing of Tokyo that are on a par with Chernobyl levels,” “Restrictions on food are more harm. And in order to relieve the anxiety that people are feeling, not stricter than for Chernobyl,” and “Compared to the forced relocation area in only in the areas affected by the disaster but all over Japan, what is most Chernobyl, the standards are laxer in Fukushima,” and so on. needed now is accurate information about radiation.

On the other hand, I wonder just how well the public knows the facts I have treated cancer patients as a radiologist for 27 years at the Department below. In 2011, 25 years after the Chernobyl nuclear accident (April 1986), of Radiology of the University of Tokyo Hospital. I believe that the anxiety the Russian Government published an enormous 150-page comprehensive inspired by radiation comes from fears that cancer risks will rise. Using my report titled “25 Years After the Chernobyl Accident: Summary and Overview many years of experience as a radiologist, I would like to explain to readers of its Impact and Overcoming its Aftereffects, 1986-2011.” In its Conclusions, the relationship between exposure to radiation and how cancer forms, in there is one sentence that I think we should pay very close attention to: detail but in a way that is as easy to understand as possible. Japan is the only nation that has suffered atomic bombings, and has the world’s highest Analysis of the situation 25 years after the Chernobyl accident reveals that, cancer rates. It is tragic that atomic bombs were dropped on Hiroshima and compared to the radioactivity released, other factors, namely the economic Nagasaki and that so many people lost their lives there. In this book, I hope and social impacts of the accident, caused much more serious damage: to communicate a correct understanding of how radiation affects the human psychological stress, disruption of familiar lifestyles, limitations on economic body; I will cite information gained in the 60-plus years since the atomic activities, and material losses. bombing of Japan as well as the comprehensive Russian study published to Amidst the welter of confusing factoids flying around, I am very concerned mark the 25th anniversary of the Chernobyl nuclear accident. that the same mistakes could be made in Japan. The danger is that other, I believe that this information will limit the damage done by rumors and more serious, harm may result from actions based on fears and anxieties misinformation, and that actions based on accurate information are what is based on misinformation. Even non-experts are boldly professing their views needed so that, as soon as possible, each and every one of us can go back to on the “menace” of radiation. I wonder if those people have ever considered living with a sense of security. the possibility that what they are saying does more harm than good. I sincerely hope that this book will help readers to become secure in their All this misinformation makes me almost angry, but at the same time, as a knowledge of radiation’s real effects. clinician who specializes in , I realize that at this precise moment I have a special role to fulfill.

At the root of it all is the nuclear accident. Of course we must bring responsibility to bear on the people in charge at Tokyo Electric Power

6 7 Chapter 1 Currently, cesium is the radioactive substance most likely to pose a problem, The Truth About Radiation and wherever cesium is detected, small amounts of strontium are also being (1) The True Nature and Risks of Radioactive Substances detected. The amounts are very small, and I think it is safe to say that this strontium has no effect on the human body. Strontium Has Been Detected in Yokohama However, there is more to the story of this strontium found in Yokohama. As Since the nuclear accident at the Fukushima Daiichi nuclear power plant a result of a detailed analysis of sediments collected by the city of Yokohama, on March 11, 2011, not a single day has gone by without television and the Ministry of Education, Culture, Sports, and Technology newspaper reports about radiation. The names of radioactive substances announced that neither of the substances found there were newly deposited such as iodine and cesium, once rarely mentioned outside of academia, now due to the accident at the Fukushima Daiichi Nuclear Power Plant. So where seem like they are part of our everyday lives. (I will explain more about iodine did they come from? and cesium in greater depth later.) and strontium have also been released from nuclear reactors. Strontium Was Already Present in the Environment

In October of 2011, strontium was detected on the rooftop of an apartment This strontium has actually been present in the environment for a long time. complex in Yokohama, 250 kilometers away from the nuclear power plant. In the 1960s, the United States and other Western nations, (formerly This was taken up by newspapers, television, and other media. Presumably the USSR), and China, as well as other nations were vying with each other many people felt that some very scary substances were headed their way. to test nuclear weapons -- in the atmosphere. As a result, large amounts of plutonium and strontium were released and have spread all over the earth. Strontium: a Substance Stored in the Bones That Causes Leukemia The plutonium spewed into the stratosphere because of this testing spree Exactly what kind of substance is strontium? Chemically, strontium has has gradually fallen to the ground. The amounts 50 years ago were 5000 properties similar to calcium and, once inside the human body, is stored in times the current amount, which is enormous when compared to the amount bone tissues. If the amount taken in is large, the risk of leukemia and of bone released due to the accident in Fukushima. in this cancer increases; it is thought to especially affect children, whose bones are way is simply unforgivable. still in the process of formation and therefore more susceptible to this risk. The Ministry of Education, Culture, Sports, Science and Technology has Since strontium is assumed to be less likely to be scattered and spread by adopted the position that this strontium recently detected in Yokohama is the wind, many specialists do not believe that this strontium was blown from probably fallout: a residue of nuclear weapons testing in the environment Fukushima to a location as far away as Yokohama. whose byproducts later descended to the ground. Strontium is thought to enter the human body via the food we eat, since it is If this is true, this problem is not limited to the city of Yokohama. In the wake stored mainly in the bones and internal organs of fish, and once it is absorbed of the accident in Fukushima, the presence of radioactive substances in into human bones, it is said to take from three to seven years to be eliminated familiar places was brought rudely to our attention for the first time. It is not from the body. widely known, but the Ministry of Education, Culture, Sports, Science and Is Yokohama Eligible to Become an “Evacuation Zone”? Technology has been publishing data regarding these radioactive substances

The strontium found in Yokohama is called strontium-90 and has a half life detected in Japan since before the Fukushima accident occurred. of thirty years. The amount of radiation is 195 per kilogram. (The Highly Toxic Plutonium is a unit of radioactivity.) This is significantly higher than the 77 Plutonium is used to make nuclear weapons. Its high radioactivity and toxicity becquerels found in Fukushima city’s between April and May.

8 9 give it word associations with the Devil. Once inside the human body, it can be certain that this plutonium is really from the and not accumulates in the lungs. Plutonium is also known to have an extremely long from past atmospheric nuclear weapons tests. half life. I will explain in greater detail later what a “half life” is, but the main However, compared to cesium, which is considered the biggest problem problems are plutonium 238 to 244. The physical half life, a time right now, it certainly doesn’t scatter long distances as easily, and I think it’s period that cuts their radioactivity in half, is 87.7 years for 238, 24,100 years safe to say that, in these amounts, it won’t present health hazards. for 239, and 6570 years for 240. These are very, very long periods of time. The Threat of Radiation Plutonium was used in the atom bomb dropped on Nagasaki. The bomb that exploded in the sky above Nagasaki released enormous heat and radiation, Now let me explain a little about the effects that radiation has on the human snuffing out thousands of precious lives in a flash. body. I am not trying to scare anybody by saying this, but if a person is instantaneously exposed all over the body to very, very large amounts of Photographs of the bomb victims shows “keloid” (fibrous) scars on their skin. radiation, that person will die. Out of a given number of people who have This symptom may be what leaves the most vivid and cruel impression of their whole body exposed to 4,000 millisieverts (mSv) of radiation, half will atom bomb radiation in people’s hearts. Yet however much these keloid scars die. look like the result of intense radiation, this is not in fact the case. I will write about this in greater detail in Chapter 3, but for the majority of atom bomb Of course, this kind of exposure to large amounts of a radioactive substance victims who lost their lives, what killed them was not radiation, but their is exceptional to say the least, but in 1999 this did occur in the Tokaimura severe burns. That this fact is so little known illustrates how poorly people, nuclear accident (called the “JCO rinkai-jiko” () in Japanese) even in Japan -- the only country in the world that has been the victim of in , Japan. The two people who died due to full-body nuclear bombings -- understand the reality of the damage done by nuclear exposure are thought to have been exposed to between 8,000 and 18,000 bombs or what kind of effects radiation has on the human body. mSv.

Current Levels of Plutonium Pose Only a Small Risk A criticality occurs when nuclear substances ( in the case of JCO) undergo a fission . This is not a problem when it happens in a Plutonium was also released in the course of the nuclear accident at confined environment such as inside a reactor, but in the JCO case there was Fukushima, and like strontium, plutonium is thought not to scatter easily. an “uncovered” criticality in a corner of the plant. Inside the bodies of those However, according to a study of the soil conducted by the Ministry of exposed, the stem cells (which produce blood cells and intestinal mucosa) Education, Culture, Sports, Science and Technology in 100 locations within underwent “apoptosis” (programmed cell death) induced by large amounts 80 kilometers of the power plant between June and July 2011, plutonium of radiation, resulting in a decrease in the number of blood cells, severe 238 (a substance which is thought to be related to this accident) was found diarrhea, and bloody stool. in six locations in Fukushima Prefecture (including Iitate-mura, Soma-cho and This is the same mechanism that causes side effects in people who undergo Namie-machi, which I visited; more on that later). anti-cancer chemotherapy and radiation therapy. Cells throughout the The radiation readings 45 km away from the nuclear power plant in Iitate- victims’ body stopped reproducing, and this killed them. mura are 0.82 becquerels (per square meter), 4 becquerels in Namie-machi, On the other hand, while there are no external symptoms for whole-body and 0.57 becquerels in Futaba-machi. Similarly in Minami-Soma-shi, a total of exposures of less than 1000 mSv, tests show there is a noticeable decrease in 15 becquerels of plutonium 239 and 240 was detected. white blood cells at levels greater than 250 mSv. For workers on-site where Because plutonium was also found in Yokohama, I am unsure whether we the nuclear accident took place, the exposure limit has been raised from 100

10 11 mSv to 250 mSv; this means that the limit was brought up to the borderline level for which tests show no abnormalities.

How to Interpret the Much-Debated “Exposures Under 100 mSv”

So is it that exposure to less than 250 mSv, a level at which no outward symptoms or test abnormalities are seen, is not a problem?

No, one cannot say it is not a problem, because there is an effect: once exposure exceeds a certain amount, the risk of cancer in the future increases. The risk that someone will get cancer later in life becomes higher. One can say, however, that no health hazards other than cancer are involved.

So for an ordinary citizen, the problem with exposure is the problem of getting cancer later. This is the biggest reason why I, being a clinician involved in cancer treatment, can speak about the nuclear accident at the Fukushima Daiichi power plant.

The real issue in this discussion is whether exposures of less than 100 mSv should be seen as dangerous or not. I say that exposure of less than 100 mSv presents a very, very low risk of causing cancer. The data from Hiroshima and Nagasaki provide evidence corroborating my view. The data from studies conducted over long periods of time on victims at Hiroshima and Nagasaki do not give any evidence that the risk of cancer is increased by exposures below 100 mSv.

Not everyone agrees with me, however: even among experts, there are sharply contrasting views on exposures below 100 mSv. International experts whose job is to protect the public from radiation have adopted the premise that radiation levels lower than 100 mSv do have health effects.

They support what is called the “linear no-threshold hypothesis” or model, which assumes that cancer risk increases proportionately in response to exposures rising from zero to 100 mSv. In the graph at the end of this section, a dotted line slopes down leftward from 100 mSv all the way to zero to signify the chance that cancer risk will increase from the baseline value even when exposure is less than 100 mSv. This is taking a more safety- conscious approach than other experts do. However, this assumption is not a scientifically based hypothesis: it is merely a policy aiming to decrease exposure as much as possible.

13 There is no scientific proof that exposure to less than 100 mSv of radiation The Truth About Low-Level Radiation increases cancer risk. Scientific data are, however, available on the risk of This is the other experts’ argument: Radiation, even when it is lower than exposures over 100 mSv. Below that threshold, there are no data; even if 100 mSv, whether it be 50 mSv or 10 mSv, is dangerous. The risk of exposure there is a risk, therefore, it’s so small that it can’t be measured. diminishes in a linear fashion but continues to exist for low level radiation. Think of it this way: there is no scientific proof that cancer risks do not Even the smallest exposure might pose a threat to us. increase as a result of the sugar and butter we consume at the dinner table. The people who stress this point of view base their assertions on the linear On the other hand, if we consumed kilos of sugar and butter daily, it is almost no-threshold model, which as I mentioned before is merely a hypothesis, certain that the risk of cancer would go up. However, just because there’s no a theory, not a scientifically demonstrated fact. The only way to get to the scientific evidence regarding moderate amounts of exposure, can one bottom of this issue is to gather a very large amount of data on a very large conclude that the risk of cancer from moderate amounts will increase just number of people who have been exposed to low-level radiation, but this because exposure to large amounts increases risks? is not possible right now. For example, one would need data from 5 million I think it is permissible to say that the risks are extremely small, although people to prove that development of cancer will not increase at a level of 10 one might also say that the risks appear small simply because scientific data mSv, and this is simply impossible with people as subjects. However, a similar are unobtainable. The problem with the linear no-threshold hypothesis is experiment has been conducted using animals at the Japanese Institute for that by presenting both scientific data and policies (ways of thinking) about Environmental Sciences in Prefecture. protection against radiation at the same time, the two tend to be confused. For 400 days, 4,000 mice (half were males, half females) lived in the same Graph representing the very slight increase in cancer mortality environment and ate the same food; 3,000 of them were exposed to at annual radiation exposures from 100 to 300 mSv radiation, 1,000 were not. Of the 3,000 that were irradiated, 1,000 were (from 100 mSv to 300 mSv, cancer mortality due solely exposed to a total of 20 mSv of radiation, 1,000 others were exposed to 400 to radiation increases from approximately 30.5% to 31.5%.) mSv, and the remaining 1,000 were exposed to 8,000 mSv of radiation -- all for 400 days.

0.5% 1% 1.5% In the mice that were exposed to radiation compared to the mice that were not, life span was shorter only in the entire group that was exposed to the maximum of 8,000 mSv, and the males of the group that were exposed to

No clear increase in Out of 1000 people in the 400 mSv had almost the same life span as those that weren’t exposed. In the cancer mortality is Japanese population, 305 will die observable as annual of cancer; 5 of them are estimated females exposed to 400 mSv, a slightly shorter life span was observed. At 20 radiation exposure to have contracted cancer as a mSv, there was no shortening of life span seen for either males or females. increases from 0 mSv result of exposure to no greater to 100 msv. than 100 mSv of radiation. In these experiments using mice, therefore, it seems that there is a threshold (borderline) between whether or not radiation exposure will have an effect 30% of the Japanese population die from cancer No clear increase in cancer mortality is observable as annual radiation somewhere between 400 mSv and 8,000 mSv (this is admittedly a rather wide exposure increases from 0 mSv to 100 msv. range). In humans, exposure to 100 mSv or more of radiation causes the risk of cancer to rise. In this range of 100 mSv or higher, higher radiation doses 30% of the Japanese population die from cancer 0 100 200 300 clearly increase the risk of cancer; 100 mSv is therefore usually considered the Cumulative radiation dose in millisieverts threshold, because exposure to 100 mSv of radiation increases one’s risk of

14 15 cancer by 0.5%. our lives have become increasingly affluent and convenient. Today, we eat a lot of meat and chronically lack exercise, thanks in part to the automobile. However, we do not know whether exposure to 80 or 90 mSv causes any People and drink more and their lives are full of work-related and effects. Low-level exposure to under 100 mSv cannot necessarily be called interpersonal stress, among other changes in our lifestyles that may induce safe. I believe that there is a threshold somewhere under 100 mSv that cancer. determines whether the exposure is either safe or harmful. By the way, tobacco smoking increases the risk of cancer twofold in males There is usually an effect on the human organism whenever some amount and 1.6 times in females. If one consumes 3 servings of sake everyday (180 of a harmful chemical substance in excess of a certain amount is taken into ml x 3) or more, one’s risk of cancer rises additionally by roughly 1.6 times. If the body. Whether this is salt or alcohol, the principle is the same: excess people really want to reduce cancer rates, they should stop smoking, drink amounts are harmful. Radiation is no exception, and that is why I believe that moderately, eat plenty of vegetables, and limit their intake of meats and there may be a threshold. sodium. It is also important to prevent obesity through moderate exercise. On the other hand, I cannot prove using humans that there really is a What I want to say here is that in this range of exposure of under 100 mSv, threshold. In other words, it will never be possible clearly to establish for which there is no scientific data or proof of risk, the risk of cancer can scientifically whether or not low-level radiation causes cancer rates to be increased far more by the stress and worsened lifestyle that comes from increase. However, there is no doubt that even exposure at 100 mSv does not emphasizing the supposed “dangers” of this level of radiation. present a large risk for developing cancer. I think it should be regarded as an effect so small it cannot even be detected. This is why I say, “the possibility I understand the concerns of parents of small children. They want to keep of developing cancer due to exposure to under 100 mSv of radiation is very their children as far away as possible from any kind of radiation. Of course, small”. nothing would be better than if this could be achieved easily. But consider that lack of exercise increases cancer risk more than exposure to 100 mSv of Merely the Fear of Exposures Under 100 mSv Can Be Harmful radiation does. I will now tell you about the adverse effects of emphasizing that “exposure I visited a facility for the elderly in Iitate-mura, Fukushima. The average age under 100 mSv is dangerous as well” in an emergency situation, such as the of the people living there was 80, and there was even one person who was one we are currently in. 100 years old. From my talks with the people who worked there, I came to This is something that struck me when, a month after the accident at the the conclusion that the disadvantages of evacuation outweighed the merits. nuclear power plant, together with a team of radiologists from the University What are the (non-monetary) costs of moving to an unfamiliar location and of Tokyo Hospital, I visited and came into contact with local people in Iitate- coping with the stress of a new environment? (Note that the annual radiation mura in Fukushima. Cancer is not the only thing that endangers our lives and level in this area is now under 10 mSv.) If the elderly residents of retirement makes our lives more difficult. The stress caused by a great shift in lifestyle homes in Fukushima were to evacuate, they would die at three times the (when children can’t play outside, parents are anxious and insecure about usual rate. Consider also that it takes a 100-year-old person 20 years to their jobs and future, etc.) and irregular living habits (smoking, drinking develop cancer, even when exposed to 100 mSv or more of radiation. alcohol, sleep deprivation, etc.) also have very serious consequences. I cannot avoid thinking of the downsides to the constant scaremongering As I wrote before, the problem with exposure to radiation is cancer. In this day that “even exposure to less than 100 mSv is harmful” -- said while the critics and age, one out of each three Japanese dies of cancer. Compared to before are sitting comfortably at home in Tokyo, so far away from Fukushima, where and during WWII, when tuberculosis was the number one cause of death, I saw many people and their families who cannot so easily change their

16 17 lifestyles. This scaremongering is not protecting anyone from anything. radiation emitted from the earth (rocks) and minerals, radiation from in the atmosphere, and radiation in radioactive substances included in our food. The International Commission on Radiological Protection (ICRP), itself People are exposed to this kind of radiation every day. an advocate of the linear no-threshold hypothesis, clearly states in fact in its report that the risk of cancer does not increase at 10 mSv (the level People in Japan are exposed to an average of 1.5 mSv of natural radiation. currently in the villages I visited). In other words, when the level is below 10 This 1.5 mSv is a low figure by international standards. This is because Japan mSv, it is even regarded as “scientifically” acceptable -- regardless of policy has few natural resources and few minerals that emit radiation. However, considerations and other alternative ways of thinking and approaches to there are differences between regions. “below 100 mSv” levels. Geologically, Western Japan is rich in granite containing large amounts of Increases in Cancer Rates Above 100 mSv radioactive materials, making the average exposure 1.5 times higher than in Eastern Japan. If we limit our discussion now to natural radiation, it turns out Let us look now at cases in which exposure exceeds 100 mSv. The risk of that those who fled to Western Japan evacuated to a region where they are cancer is known to increase when radiation exposure exceeds 100 mSv. exposed to higher levels of radiation. When people are exposed to over 100 mSv of radiation, the rate of death by cancer is 0.5% higher than usual, and this rate is thought to be 1.0% higher Since volcanic ash from Mount Fuji’s eruption (loam) covers the ground when the exposure is 200 mSv. Currently, the number one cause of death in surface in the Kanto Plain, this has the effect of blocking radiation emitted Japan is cancer, and it has been so for quite a while, because of Japan’s aging from rocks deep underground. The Kanto’s loamy soil is why Kanagawa and population (cancer is a type of aging phenomenon). One out of two people in Tokyo have the lowest exposure to natural radiation in Japan. Japan get cancer in their lives, and a third of all deaths are caused by cancer. Mount Fuji is so high that the atmosphere becomes thinner at the summit. Under these circumstances, the death rate by cancer goes up 0.5% with Everywhere on Earth, the atmosphere serves as a protective film against exposure to 100 mSv. This does not mean, however, that if you had one-tenth cosmic rays falling on us; its protective effects become weaker at the summit the exposure (10 mSv), your risk would only increase by one-tenth (0.05%). As of tall mountains, where the atmosphere is thinner -- and the radiation level I wrote above, this is because the increase in the range under 100 mSv cannot is as much as five times that on the surrounding plain. be scientifically determined or calculated. Out in outer space, beyond the Earth’s atmosphere, there is even more Fact: We Are Exposed to 1.5 mSv of Radiation Annually radiation flying around. A person who spends one day in space is exposed to 2/3 of the amount of natural radiation they would be exposed to on Earth in People are scared when they hear about “radiation” or “exposure.” This one year (in Japan). is understandable. After the nuclear accident, there were families that evacuated to Western Japan. Many foreigners returned to their home The reason why astronauts return to Earth after about six months is that, by countries. Perhaps a feeling came into play that anywhere that is farther away then, their exposure to radiation has passed what is considered the limit and from the Fukushima nuclear power plant would be safer. there will be negative effects on their health if they stay.

However, there is already, practically everywhere on our planet, radiation Living on the ocean’s surface is the best way to avoid being exposed to other than the radioactivity caused by the nuclear accident or the fallout natural radiation. It is the farthest from outer space, with no earth underfoot. from atmospheric nuclear weapons testing that I mentioned earlier. Did you This does not mean, however, that there is less cancer among sailors. know that we are exposed to radiation on a daily basis? Cosmic rays (radiation) The average annual exposure to natural radiation in Japan is 1.5 mSv, but from outer space have been falling on the earth since its formation. There is at the global level, the figure is a bit higher, 2.4 mSv. In Guarapari in Brazil,

18 19 annual natural radiation exposure is as high as 10 mSv. In the state of Kerala (the kind we are talking about here) is stronger and can penetrate deeper: it in southern India, annual exposure is 4 mSv, but at high altitudes it exceeds has the frightening power to break the DNA of cells of organs deep inside the 70 mSv. The reason for this is the relative abundance there of the mineral human body. monazite, which contains radioactive thorium -- but a study conducted by How the Human Body Repairs Itself Kagoshima University found no increase in cancer rates in this region. In Iran’s Ramsar region, famous for its hot springs and the Ramsar Convention Life cannot continue if our DNA continues to be destroyed. Fortunately, on Wetlands, there are places where annual exposure to natural radiation cells have the ability to repair their DNA. For 3.8 billion years, DNA has been exceeds 200 mSv, but there are no reports that the incidence of cancer is destroyed and repaired over and over again by living cells. Life has adapted higher there. Incidentally, regions with hot springs generally have higher to the damage that radiation causes, and has found a good way to cope with exposures to natural radiation. The famous Arima hot springs resort, one of it. (Or to be more exact, only the that were able to overcome the Japan’s oldest, is also a “fountain of radioactivity”. effects of natural radiation have survived natural selection.)

The average annual exposure to natural radiation in the US, at roughly 3 mSv, Even if people are exposed to amounts of radiation slightly above natural is about twice that in Japan. Note also that a round-trip airline flight between levels, the body can respond by repairing the broken DNA. However, when Narita and New York exposes people to 0.2 mSv of radiation (because of the the level of exposure is too high, DNA is broken simultaneously in many high altitude and exposure to cosmic rays). For example, if frequent flyers places, and the body cannot repair these in time to prevent the cells from like trading company representatives go back and forth between the US and dying. It is something like what happens when many accidents occur at the Japan seven times, they are exposed to 3 times the annual natural radiation same time and there are not enough ambulances to respond to all the calls. levels of Japan. However, there are no data showing that employees of In other words, the effect of radiation exposure on the human body does trading companies or pilots have increased risks of developing cancer. not depend on whether the person was exposed to radiation or not, but rather on the amount of radiation that the person was exposed to at one Of course it is not just humans: all living creatures on Earth are exposed time. Therefore, if somebody is exposed to 1.5 mSv annually for 80 years, the to radiation. From the time 3.8 billion years ago when life began on Earth, total amount of exposure will be 120 mSv. The workers in the nuclear power organisms have been continually exposed to radiation. But radioactive plant where the accident occurred were exposed to 120 mSv of radiation in substances constantly lose some of their radioactivity as time passes; thus the space of a few days. The same 120 mSv of radiation has a much different the level of natural radiation in the past was presumably higher than it is effect on the human body in this case. This is why the situation of workers in now. To undo the damage to cells caused by radiation, living organisms have nuclear power plants worries me very much. developed repair mechanisms. Radioactivity Decreases Over Time Radiation Destroys DNA It is easier to understand the relationship between radiation, radioactive Let me explain a bit about radiation and how living organisms work. The key materials, and radioactivity by analogy to a candle. to the effect that radiation has on life is in organisms’ genes, or DNA. DNA, which controls life, is composed of two very thin threads that are twisted Let us say that the candle represents a radioactive substance and its state around each other. Radiation breaks these threads. Skin disorders such as when it is burning represents its having radioactivity. Radiation is the light sunburn occur when people are exposed to rays. The rays break emitted from the flame. As time passes, the candle becomes shorter. When the DNA of cells in the surface layer of a person’s skin. When a person is the candle eventually dwindles to nothing, the fire goes out as well. This is exposed to ultraviolet rays, they stop at the skin surface; when its radioactivity ends, or when radiation from it becomes zero. The time

20 21 it takes the candle to become half of the length that it was is the half-life. To imagine what is happening, it may help to compare this to taking a bath. If someone is in an empty bathtub, and a big bucketful of hot water at 45 Just as different candles burn for different durations until they are halfway degrees Celsius (113 degrees Fahrenheit) is poured into the tub suddenly, the consumed, half-lives vary as well. One of the characteristics of radioactive occupant will be startled, to say the least. But if the same amount of water at Iodine-131 is that its half-life (the time it takes for the candle to burn down 45 degree Celsius flows gradually from the faucet into the tub, our bather can to the halfway point) is eight days -- very short. After eight days, the amount enjoy his bath. is halved, and after an additional eight days, the amount becomes one fourth. Eight days after that, it will become one sixteenth. After roughly three If a person is suddenly exposed to large amounts of radiation, the body months, the amount of radiation becomes less than 1/1000 of what it was cannot repair the damaged DNA in its cells quickly enough. On the other initially. hand, if the radiation is gradual and in small amounts over a long period of time, even if the total amount of exposure is the same, the body will be able Cesium-137, on the other hand, has a half-life of roughly 30 years; to repair the damaged DNA. Strontium-90 has a half-life of about 28 years; and Plutonium-239 has a half- life of 24,000 years. These half-lives have a very important meaning for how The risk of cancer increases with exposure to more than 100 mSv of radiation. we interpret the effects of radioactive substances on the human body. This means that the risk increases when people are exposed daily, little by little, and the total amount is 100 mSv over a year’s time. As a result of the Candles with short half-lives burn like short, fat candles. They emit a lot of nuclear accident, the Tokyo metropolitan area, over 200 kilometers away, had energy quickly, for a short time, but on the other hand, they do not last long. readings of radiation in the air of 1 microSv/hour. If people continued to live When these kinds of radioactive materials are released into the environment, where radiation continued at this level into the future, it would take 11 years the initial response is crucial. After the Chernobyl accident, the initial or so for the total exposure to reach 100 mSv. But as I have explained already, response to the need to impose food restrictions was late; thyroid cancer in when people are exposed to small amounts of radiation over a long period of children increased as a result. time, there is less effect on the human body. On the other hand, radioactive materials that have long half-lives are like thin Radioactive Substances Spread Like Pollen candles that burn for a long time. They emit radiation a little bit at a time, so the response must be long-term: it’s a lasting relationship. Now, let me write about the how radioactive materials spread over great distances. Just like pollen, radioactive materials are carried to other places by When DNA Can and Cannot Be Repaired the wind. In the case of radioactive materials, this “pollen” emits a special kind Perhaps you have read newspaper accounts of what is going on at the site of of ray called radiation. the nuclear accident that read like this: A good example would be to liken a nuclear reactor to a large cryptomeria “If a person works in this location for one hour, the exposure will amount tree (known as sugi in Japanese). Cryptomerias release huge amounts of to the limit set for one year.” In other words, workers get a one-year pollen, and most of this pollen is carried off by the wind. So much pollen maximum allowable dose in one hour. is released that you cannot approach the tree when it is showering pollen, even if you try: there is just too much. Similarly, workers at a nuclear power I mentioned this a little bit earlier, but the effects on the human body differ plant cannot get as close to the reactor as they would like in order to work on depending on whether the person was exposed to a certain amount of it while it is highly reactive. Even if someone is far away from the giant sugi radiation for a short time, or if the person is gradually exposed to the same trees, pollen (which we are likening to radioactive substances) is carried by amount of radiation over a long period. the wind, sticks to a person’s body, and enters the body when that person

22 23 eats or breathes it in. (2) The Truth About Internal Exposure We can say that now there are no longer any radioactive substances from the What Is “Internal Exposure”? Fukushima Daiichi accident in the air, but while radioactive substances are still in the air, the proper thing to do is to wear a mask, close all windows, and There is a famous academic personality who appears often on Japanese take other protective measures. This has some effect, but the effect is limited. TV and writes in magazines who announced publicly that he “won’t buy Being inside a concrete building rather than being outside is better: it can vegetables grown in the area from to ” decrease your exposure to radiation to less than 20% of that outside. (quite a vast range). He probably means to say that he is afraid of internal exposure to radioactivity caused by eating contaminated vegetables. Radiation Levels Depend on Wind, Rain, and Terrain In October, 2011, the Food Safety Commission drew up a report stating Kashiwa-shi in , located roughly 200 km away from the that the total cumulative level of exposure capable of exerting an effect on Fukushima nuclear power plant, is referred to as a “hot spot.” There are also health due to ingestion of food over a person’s lifetime is a figure in excess locations within Fukushima with high radiation readings and other locations of approximately 100 mSv. As long as people eat food that is sold in ordinary with low readings. This occurs because radioactive substances spread in a supermarkets, the amount of exposure falls within this range, so there is characteristic way. nothing to worry about. As we said, radioactive substances are carried away from their source by the But What, Then, Exactly Is “Internal Exposure to Radiation”? wind, just like pollen. Furthermore, they do not spread evenly or all at once, but characteristically move in clusters, called “plumes.” Generally, the farther There are two types of exposure to radiation. One occurs when people are away from the nuclear power plant a person is, the less effect its radiation will exposed to radiation externally (outside their bodies, in other words). Internal have. However, this may change with conditions such as the direction and exposure occurs when radioactive substances enter someone’s body and strength of the wind and the shape of the terrain. their body is exposed to radiation from the inside. External exposure to radiation occurs when radiation from a radioactive substance gets attached Rainfall is another factor just as important as wind. There are locations such to clothing or skin. Internal exposure occurs when radioactive materials in the as Katsushika-ku and Adachi-ku in the Tokyo metropolitan area and Kashiwa- air are inhaled or a radioactive substance is taken in with food. shi in Chiba Prefecture (also in the north-east Kanto region) located a long distance away from Fukushima that recorded high levels of radiation after When asked which they are more afraid of, many people tend to be more the accident. This is because the radioactive substances that were carried afraid of internal exposure. Perhaps people get the idea that once the harmful westward by the wind from Fukushima were absorbed by the rain and fell to materials enter the body, they will be deposited there and continue to have the ground there. Winds that carry plumes blew into the Tokyo metropolitan harmful effects for the rest of their lives. area on March 15th and March 21st of 2011; it is thought that Kashiwa-shi in I think there is a historical precedent for this that influences people’s Chiba Prefecture is where the wind met the rain on those two days. Since the attitudes. The first case of environmental that drew the general cesium included in the radioactive plumes heading westward gradually fell public’s attention in Japan was Minamata disease. Fish in Minamata Bay to the ground with the rain, the external exposure to radiation in Setagaya-ku had ingested (taken in) harmful levels of mercury from their environment, and other parts of western Tokyo was less than the exposure in the eastern and these levels built up; when people further up the food chain ate fish parts of the city. containing these high concentrations of mercury, tragedy resulted. Perhaps internal exposure reminds people of the tragedy of Minamata disease. However, radioactive substances, unlike heavy metals such as mercury, are

24 25 metabolized and excreted if they enter the body. This difference with respect decrease the risk of cancer. From this we can say there is no reason to worry to heavy metals is crucial. about internal exposure to radiation from Potassium-40.

The Dangers of Internal Exposure The Truth About Exposure to Cesium

I understand why people respond with fear to internal exposure, but 1 mSv As I mentioned before, very small amounts of strontium and other radioactive of internal exposure is not more dangerous than 1 mSv of external exposure. substances were released from the nuclear power plant after the accident. The effects are exactly the same. However, the amounts of these substances are not sufficient to affect a First of all this is because the “” unit indicates the effect of radiation person’s health, so we can say that in reality it is the radioactive iodine and on the human body; for the general public, however, it is represented as an cesium that are threats to health. Keep in mind that the radioactive index of the increased risk of cancer. Iodine-131 has a half-life of eight days; currently, ten months after the nuclear accident, it is undetectable, so the only problem material remaining is cesium. The effects of internal radiation manifest themselves inside the human body; This cesium has been detected in levels above regulatory limits in beef and therefore they cannot be seen, but there is something called a “committed in tea from Shizuoka, causing increased concern about food. The wind is dose” that quantifies their effects. When radioactive substances are taken responsible for carrying this radioactive cesium over and across the Tokyo into the body, they do not necessarily remain there intact. Metabolism and metropolitan region to Shizuoka, on the far side of Tokyo from Fukushima. excretion rid the body of these materials over time, and their radioactivity lessens in proportion to their half-lives. The indicates the The radioactive Cesium-137 that was released after the nuclear accident has a overall amount of internal radiation to which a person will be exposed over half-life of 30 years. Once inside a human body, almost 100% of it is absorbed a lifetime from the moment of ingestion, based on the assumption that the in the gastrointestinal tract. However, the cells in the human body are effect weakens over time. It clearly expresses one aspect of the threat of constantly being replaced, so it takes the body about two or three months to internal radiation: one never knows when the exposure will end. excrete half of the amount ingested. In the case of infants, half of the amount Radioactive Material in Food is excreted much faster: in ten days.

There is radioactive material in the food that we eat every day. A radioactive To recall what we know from Chernobyl, radioactive iodine and cesium were substance called Potassium-40 is contained in such vegetables as spinach, scattered across a wide area by the blast when the nuclear reactor exploded. for example. Potassium-40 is a substance that is essential for the growth of Ultimately, the result was a confirmed increase in the rate of thyroid cancer in organisms, and people take it in on a daily basis when they ingest vegetables. children due to the ingestion of milk contaminated with Iodine-131, because Even when ingested, this will eventually leave the body via metabolism and no restrictions were imposed on food intake in Chernobyl. Thus there was excretion, but more will enter the body when the person eats vegetables also internal exposure to radiation from cesium for the same reason. When again, so there is always about 4,000 becquerels of Potassium-40 in the body scientists conducted a local study at Chernobyl of cesium in the bodies of of an adult male weighing 60 kg. Roughly 0.2 mSv of internal radiation occurs roughly 200,000 people, mostly children, they found amounts of Cesium-137 annually due to Potassium-40. If a person lives 100 years, this will add up to had risen from a few hundred becquerels to tens of thousands of becquerels 20 mSv. after the accident. However, to this day, cesium has not been confirmed to have caused any cancer in these people. This means that the more vegetables a person eats, the more internal exposure increases. However, consuming vegetables is known to greatly We learned, in other words, that thyroid cancer was caused in children due to

26 27 Chapter 2 Iodine-131, but adverse effects of cesium have not been observed. Cancer Risk Facts Note that cesium is chemically similar to potassium; both are both alkali metals. There is far more radioactive potassium detected in our bodies than (1) What Causes Cancer? radioactive cesium from Fukushima. Consequently, I do not think there is any Japan, World Cancer Record Holder reason to be excessively concerned about internal exposure to radiation from Japan has the highest rates of cancer in the world, and the number of people cesium. who get cancer is still increasing. Every year, roughly 650,000 people are newly diagnosed with cancer and 1.5 million people are receiving treatment for it. And every year, 350,000 people die of cancer in Japan.

It is estimated that roughly one out of every two Japanese people gets cancer. The rate is 60% for males, and 40% for females. What many people worry about in connection with the nuclear accident at Fukushima is the possibility of cancer rates rising due to radiation. So will there be more thyroid cancer? How about leukemia? What kind of effect will it have on the health of children? I’m sure that parents, especially those who have small children, are worried sick when thinking about this.

What causes cancer in the first place? Roughly speaking, one third of the overall causes for cancer can be attributed to cigarettes, another third to alcohol, diet, and so called lifestyle. The remaining third can be attributed to (bad) luck; no matter how ideal a lifestyle one lives, there is no way to completely avoid cancer.

Those are the facts. Two-thirds of the causes of cancer are lifestyle-related.

Ten months have now passed since the nuclear accident; the amount of radiation in Fukushima has now settled to levels that will not affect a person’s health.

I will write in more detail in Chapter 6 about the situation in Fukushima, but even if a person lives exposed to current levels of radiation, there will be no increase in cancer. However, I must emphasize one thing: two-thirds of the causes of cancer are lifestyle-related. Therefore the possibility that cancer risk will actually increase in the wake of the accident cannot be excluded because more people are feeling more stress about their impaired lifestyle as they evacuate for an extended time period in an unfamiliar place, even if the amount of radiation decreases.

I believe that if people sacrifice their lifestyle in fear of low-level radiation

28 29 (which causes almost no increase in cancer risk), the cancer risk is sure to or “pseudo-Nakagawa cells”. It is hard for immune cells, whose mission is increase due to this worsening of their lifestyle. Of course, all this was caused to eliminate foreign cells, to see these cancer cells as foreign, because they by the nuclear accident, so I blame the nuclear power industry for the harm it are so similar to my own cells. There is always a risk that immune cells will has done. overlook them.

In this chapter, I would like to give a detailed explanation of the mechanisms The Longer the Average Life Expectancy, the Higher the Cancer involved in cancer formation so that you can have a proper understanding of Rates cancer and, as much as possible, avoid the risks. Sooner or later, a cancer cell that has slipped through the dragnet laid by the immune system will quietly begin reproducing and proliferate (increase Why Do People Get Cancer? in number). That is how cancer starts. It will take from 10 to 20 years for it to The human body consists of roughly 60 trillion cells. Roughly 1% of these die grow to a detectable size (roughly 1 cm). every day. The reason that hair falls out and old skin peels off is because the As people get older, the damage to their DNA caused by lifestyle builds up cells are dying. It is said that 600 billion cells die every day. and it becomes easier for cancer to occur. Since their immune functions also If all of our cells died, life would not be unsustainable, so living cells divide deteriorate, elderly people become more susceptible to cancer. and multiply to make up for the dead cells. There is a need to copy DNA, On the other hand, let’s say (although it’s horrible to imagine) that my cancer which is the genetic blueprint of the cell, in its entirety in order to divide a cells were injected into another person. In that case, the cancer cells from my living cell. This is something that humans do, so errors sometimes occur. body inside that person’s body will all be killed. That is because, that from For instance, sometimes a cell is born that is different from the original cell it that person’s immune cells’ point of view, my cancer cells are clearly foreign came from. This is the phenomenon known as . These copying errors and therefore every one of them will be killed. Therefore, cancer does not in in cell DNA during cell division can be attributed to tobacco and alcohol use, general get transmitted to other people. chemicals and stress, aging, and exposure to radiation. One out of every two Japanese gets cancer, and one out of three dies from Of the cells that are born from a mutation, on rare occasions there are “cells cancer. Japan has the world’s highest cancer rates. The reason for this is that that do not die”. These will endlessly continue to divide and grow. These cells Japan is the country with the world’s longest life expectancy. Cancer is an that do not die are cancer cells. If the environment is just right, bacteria will aging phenomenon. continue to live and divide forever. Cancer is the same in this aspect. Before and during WWII, tuberculosis was the leading cause of death. According to one theory, some 5000 cancer cells are produced daily in Takuboku Ishikawa died at age 26, and Ichiyou Higuchi at 24, both from the normal human body, once it reaches a certain age. Under normal tuberculosis (both were great Japanese writers of the early 20th century). circumstances, our immune cells would win 5000 battles every day without They did not reach the age at which cancer commonly occurs. During the losing a single time in their fight to kill off cancer cells. Meiji and Taisho periods (from the mid-1800s to the 1920s), when the

There is a catch, however: because immune cells are there to detect, attack, average Japanese life span was short, many people died of tuberculosis and and kill foreign objects, it is hard for them to recognize cancer cells as being infectious diseases before they developed cancer. (The life expectancy of foreign objects, because they are replicas of our normal cells. many countries in Africa today is in the 40s, so I doubt there are many cases of cancer there.) For instance, let’s say I have cancer. My cancer cells will be zombie-versions of “Nakagawa cells”, so they could also be called “former Nakagawa cells” The reason that cancer kills is because ageless, indestructible cells are created

30 31 in our bodies. When we realize that these cells reproduce indefinitely, it is Your Chances of Getting Cancer Are 50-50 ironic to think that eternal youth and immortality, which humans have been Even when people hear that one out of two people will get cancer, they dreaming about throughout the ages, can kill them. think it is someone else’s problem. Many people may think wishfully that Our Growing Population of “Youthful” Seniors they will be OK, and will end up among the lucky 50% that do not get cancer. However, even if that person has an “ideal” lifestyle, there is still a 20% to Cancer rates start to increase in people in their 40s, and continue to increase 30% risk of developing cancer. This is because there is also an element of as people get older. I sometimes hear people say that it’s hard for elderly luck involved. Some people are heavy smokers and also drink heavily. The people to get cancer, but that is not true. Cancer continues to increase, even people around them may think that they will no doubt be diagnosed with when people are 80 years old, even when they are 90. lung or liver cancer, but those people refuse to even consider changing The fact is that much of the cancer in elderly people has been with them their lifestyle. And some people like this will even live until they are 90 years since middle age. This is because the cancer cell that slipped through the old. Conversely, there are people who don’t smoke cigarettes, eat mostly immune cells’ dragnet took 20 years to become 1 cm in diameter. vegetables, and exercise regularly. Even people who live ascetic lives like this

It is only natural that cancer, a symptom of aging, is increasing in a country have a chance of developing cancer. such as Japan, where life expectancy is the longest in the world. That does Magic Bullets For Cancer? (Only Lifestyle Improvement and not mean, however, that nothing should be done about the increase in Early Detection Work) cancer in the elderly population. However, if you compare 1000 heavy smokers with 1000 ascetic quasi-saints, Our elderly population is, in a sense, getting “younger”. Instead of retiring, the heavy smokers’ rates of cancer will probably be overwhelmingly higher. they want to continue being active and working hard, contributing to society It is believed that the risks of developing cancer are decreased by from 20% -- and that is also what society wants. to 30% by making judicious lifestyle choices. There are cases, on the other hand, where luck is not on the side of the person concerned, however ascetic. For example, Namihei, the father in “Sazae-san”, a manga that was started 60 Therefore, it is not enough to be cautious about one’s lifestyle choices: it is years ago, is supposed to be 54 years old. Singer Go Hiromi is now almost the also important to undergo proper cancer and work toward early same age as Namihei. Born in 1955, Go Hiromi will be 56 years old this year detection. (2011), but does not look the same age as Namihei, no matter how you look at this difference. In other words, the wonder drug for not dying from cancer, the only one, is an improvement in lifestyle and early detection of the disease. At the time the Sazae-san manga series was written, people in their 50s were one step away from retirement, but these days many Japanese in the same Many different things cause cancer. Tobacco is top on the list of causes, but age group are still active. Namihei’s wife, Fune, is 48, and popular singer Seiko drinking too much, not eating enough vegetables, and consuming too much Matsuda is 49. I cannot believe these two individuals are supposed to be meat (especially processed meats such as ham and sausage), high salt intake, almost the same age. and lack of exercise also cause cancer. Cervical and liver cancer are caused by viral infections, and stomach cancer is mainly caused by infection by I have been invited many times to the same lectures as journalist Shuntaro Helicobacter pylori. Torigoe. One day he said to me, “There’s no way I’ll ever get cancer”. Later, he did get cancer, though, and he wondered, “How could I, of all people, get Total Cancer Rates Would Be Cut by 20% if Nobody Smoked cancer?” Mr. Torigoe has now undergone four surgeries for rectal cancer -- The biggest cause of cancer is tobacco smoking, and second to that is alcohol. and is still currently very active as a journalist.

32 33 Tobacco is the largest man-made disaster of the 20th century, and claims tobacco at once. By quitting smoking, you will reduce the risk of developing the lives of five million people every year. It is also the top-ranking cause of lung cancer. The longer someone resists the urge to smoke and refrains from cancer. smoking, the lower that person’s risk of lung cancer becomes. Ten years after one quits smoking, the risk becomes one-third to one-half of what it was. But If no one in Japan smoked tobacco, it is estimated that roughly 20% of it takes longer to reduce the risk of lung cancer than to reduce the risks of Japanese cancer cases would not occur. (The reduction would be 30% for other diseases: the risk of heart disease, for example, decreases almost to the males, 3% or 4% for females.) level of non-smokers more quickly, in 5 to 10 years after quitting smoking. As for the types of cancer, Japanese men generally get laryngeal, lung, and esophageal cancer. Other things being equal, the risks of these The Younger the Smoker Is, the Greater Tobacco’s Effect on the Human Body occurring are increased by 33 times, 4.4 times and 2.3 times respectively, by smoking tobacco. In addition, tobacco use increases pancreatic cancer, liver All this does not mean, however, that one will be cancer-free for the rest cancer, stomach cancer, and most other cancers as well. There are roughly of one’s life just because one has quit smoking. And there are also heavy 4,000 types of chemicals in tobacco smoke. Among these are roughly 60 smokers who do not get cancer. That is why some people claim that tobacco types of known carcinogens, such as nitroso compounds, aromatic amines, smoking and cancer are unrelated. acetaldehyde, and . Yet the risks of cancer are undoubtedly much higher for smokers than for It is not only one’s throat, windpipe, and lungs, which come into direct non-smokers. We can liken cancer to an invisible spear that falls unexpectedly contact with tobacco smoke, that are affected: carcinogens are carried from the sky, totally “out of the blue”. As one’s age increases, the frequency through the bloodstream and affect almost all your organs. Many with which these spears fall increases -- and so does the incidence (occurrence carcinogenic substances cause when they are activated by rate) of cancer. If a person , the frequency of those sudden and enzymes in the body and bind to genes in the process of cell duplication. It is invisible spear attacks is even greater. If on the other hand the person thought that the damage to damaged genes created in this way accumulates exercises and has a diet of mostly vegetables, the frequency of these spear with continued exposure to carcinogens, and that this changes healthy cells attacks can be decreased. The important thing is to realize that, no matter into cancer cells. how careful somebody is about their health, they may eventually be hit, and conversely, heavy smokers may escape unscathed throughout their lives. I don’t smoke. The reason why I chose not to smoke is that even second-hand tobacco smoke has carcinogenic effects. Tobacco is not something whose What we know with certainty is that smoking tobacco increases the risk of consequences affect just the smokers themselves. If a woman’s husband getting cancer. The best defense against cancer is to refrain from smoking. smokes more than one pack of cigarettes a day, her risk of developing cancer Alcohol + Tobacco = Double the Rate of Cancer doubles, even if she herself does not smoke. Filters on cigarettes function to remove carcinogenic substances from the smoke that the smoker is inhaling. After tobacco, alcohol is the leading cause of cancer. In addition to directly However, they do not filter the smoke breathed by those around the smoker. affecting membranes in the mouth, throat, and esophagus, it puts a To make matters worse, tobacco smoke becomes more carcinogenic as its burden on one’s liver, and as a result may cause oral, pharyngeal, laryngeal, temperature decreases. esophageal, hepatic (liver) and other types of cancer. These cancers can be called alcohol-related cancers. In other words, the smoke that people around the smoker are inhaling is more dangerous than the smoke that the actual smoker is inhaling. If you do According to a study conducted by the Ministry of Health, Labour, and not want to lose your family to cancer, I recommend that you quit smoking Welfare that tracked over 70,000 people across Japan for ten years, the risk

34 35 of cancer for males who drink on average between two and three servings acetaldehyde in our livers. Ethanol is not toxic: it is even used as a disinfectant; of sake per day was 1.4 times greater, and this risk was 1.6 times greater for but acetaldehyde can cause cancer. Aldehyde dehydrogenase-2 (ALDH2) is those who on average drink three or more servings of sake per day. an enzyme that breaks down acetaldehyde to acetic acid and detoxifies it. The type of ALDH2 you have is determined genetically. There are both normal One serving of sake is equivalent to one large bottle of beer or two of genes for ALDH2 that have a strong ability to break down acetaldehyde, and wine (240 ml) or one whiskey double. According to these figures, 13% of all defective deleted genes that cannot do this well. cancer occurs in people who drink two or more servings of sake per day. The risk is especially high for those who both drink alcohol and smoke tobacco. You inherit one of the two gene types that your parents pass down to you. Roughly 5% of Japanese have inherited the deleted gene type from both In males, the group that drinks on average two or three or more servings of parents. These people can’t drink any alcohol; they are tee-totalers, non- sake per day has a 1.9 times greater risk of getting cancer, and the group of drinkers. Non-drinkers, being unable to drink alcohol, do not increase their males who drink on average three or more servings of sake per day has a 2.3 risk for cancer by drinking because they do not drink. They are safe. times greater risk of getting cancer. At the very least, I recommend that you absoutely avoid one of the two. Acetaldehyde does not accumulate easily in people who inherit normal genes from both parents, so the good news is they have a decreased risk of cancer; Let us look now at the figures for colorectal cancer: males who drink two the bad news is that they can become alcoholics if they drink too much. or more servings of sake on average per day and who also smoke tobacco Most westerners fit in this genetic category, so people who cannot drink any have a 3-times-greater risk of cancer than someone who neither smokes nor alcohol at all are rare in Europe and the US. drinks. This means that if alcohol and tobacco disappeared from the face of the planet, roughly half of the colorectal cancer in males would disappear. The problem occurs when either of the genes inherited from one’s parents is the “deleted” type. Those who get red-faced when they drink are people By the way, I don’t smoke, but I do like to drink alcohol. Getting cancer who can drink, moderately. Between 30% and 40% of Asian people fit in this because one smokes is one’s own fault, but the blame for smoking does not category. If these people drink a lot of alcohol, their risk of cancer increases. stop there, since it increases cancer risk for other people as well. With alcohol, calling the risk incurred one’s own fault, taking responsibility for it, and being It happens this way. There are no carcinogens in alcohol in itself. However, able to say the buck stops there is the good thing about drinking. (This may the acetaldehyde produced when alcohol is broken down is carcinogenic. sound like a self-serving excuse for myself, being a drinker...) Someone might inherit one type of ALDH2 gene for the enzyme that detoxifies this from one parent and the other defective type from the other I regard being able to enjoy both sake and wine as among the privileges of parent. This “heterozygous” person has a reduced ability to break down being born in Japan. However, it is not good to drink too much. Limit yourself acetaldehyde but will be able to drink moderately. to two servings a day, and set yourself some alcohol-free days to give your liver a rest. I try to do that myself (but I have to admit it may be merely a goal Even so, the heterozygous people with a combination of functioning and that I’ll never achieve). defective genes cannot completely break down acetaldehyde. It is the acetaldehyde that is not broken down and remains in the body that causes a Drinking Can Give You Cancer! person’s face to turn red. There are people whose faces turn red when they drink alcohol. Though they This may not be something that drinkers would like to hear, but when their are not tee-totalers, they ought to be. They have to be careful. They are at a faces turn red, it means that the carcinogen acetaldehyde in their bodies is very high risk of getting cancer. not being broken down and remains in their bodies. Some people say “When The ethanol contained in alcoholic beverages is broken down into I was younger my face turned red, but now I’m okay.” Unfortunately, this does

36 37 not mean that the person’s ability to break down carcinogens has increased. Early detection of cancer is practically synonymous with cancer screening. Let It just means that their bodies got used to acetaldehyde: it is no reason to feel us talk about breast cancer. Physicians call tumors smaller than 2 cm “early- at ease. stage” cancer. Cancer smaller than this can be treated.

(2) How to Prevent Cancer It takes a cancer cell roughly 20 years to grow to 1 cm as it escapes attacks from immune cells. But once cancer cells start growing, their growth The Seven Pillars of Cancer Prevention accelerates. A cancer cell takes only a year and a half to grow from that 1 I have mentioned the two main causes of cancer, but a variety of other causes cm to 2 cm. Cancer cells can be 2 cm, 1 cm, or even 1 mm. Whatever the exists, such as insufficient intake of vegetables in one’s diet, obesity, viruses, size, they are cancer cells. However, a cancer cell that measures only 1 mm etc. Here I would like to sum up for you the lifestyle choices that are most across cannot be diagnosed as cancer. Roughly speaking, cancer cannot be likely (but not guaranteed) to help you avoid cancer. diagnosed until the cancer cell is 1 cm in diameter.

1. Don’t smoke. In other words, early detection has a time limit, and that time limit is the year 2. Drink no more than one serving of alcohol per day. and a half that it takes cancer cells to grow from 1 cm to 2 cm, when it still 3. Add lots of vegetables to your diet and avoid eating always the same can be cured. This is the reason for the need to have periodic screenings once things. every one or two years. 4. Decrease your salt intake. In the long lifetime of a cancer cell, the window of opportunity for early 5. Exercise regularly. detection through screening is only a year and a half. If a person undergoes 6. Stay as fit and trim as you were when you were younger. cancer screening once every one to two years, even if they do get cancer, in 7. Avoid catching viral and bacterial infections. theory it will be caught in time, while it is still “early-stage cancer”. It is not always easy for people today to put these seven principles into practice. We should try nevertheless to decrease our risk of cancer as much as Comparing Exposure to Radiation vs Lifestyle Choices possible by keeping these things in mind. Let us get back to our topic: the relationship between exposure to radiation and cancer. Two-thirds of the causes of cancer are attributable to lifestyle Early Detection: Finding the Disease Before Symptoms Appear choices ranging from tobacco and alcohol use to vegetable-deficient diets The important thing here is early detection. However, in the case of cancer, and failure to exercise, as I have stated earlier. early detection does not mean going to the hospital to have tests conducted There is also exposure to radiation, which does cause cancer. Unlike the as soon as one is not feeling well or after symptoms appear. You must go lifestyle choices that people make on their own, the exposure to radiation before you feel unwell. from the Fukushima nuclear power plant accident has put people from The most typical symptom of cancer is pain. This is usually due to bone infants to the elderly at risk for cancer, regardless of whether they are aware metastasis (spreading of cancer to bones from some other organ). Since a of or responsible for it. This cause of cancer is the most insidious. complete cure is unlikely if you already have metastatic cancer, pain caused To what degree are the dangers from each of these two types of causes of by cancer means it is already very difficult or impossible to treat. cancer comparable? A study was conducted by the National Cancer Center of Furthermore, cancer that is detected early has not yet produced symptoms in Japan. any organs. It is necessary to get periodically screened while one thinks one is healthy and free of cancer. Take a look at the table on the next page.

38 39 You’ll see, for instance, that it examines the risk of developing cancer due to exposure to 100 mSv of radiation. At this level, radiation does increase the risk of cancer, but so do second-hand smoke and a vegetable-poor diet, which carry comparable risks. Similarly, excessive drinking carries a very high risk of developing cancer.

The study compared findings of papers published by the Radiation Effects Research Foundation and other research organizations that examined rates at which cancer developed over extended periods of time in roughly 44,000 people who were exposed to radiation from the atomic bombings of Hiroshima and Nagasaki with epidemiological studies conducted by the National Cancer Center to measure cancer risks due to people’s lifestyle choices.

According to this study, a group that was exposed to 100 to 200 mSv of radiation due to the atom bombs had a 1.08 times greater risk of developing cancer than those people who were not exposed. Compared to the cancer risks involved in lifestyle choices, this figure is slightly higher than for a woman who is married to a man who by smoking a pack of cigarettes a day exposes her to his second-hand smoke, or than somebody who doesn’t like vegetables (whose cancer risk is 1.061 times higher than people who eat vegetables).

The range 100 to 200 mSv is a high dose of radiation; it is what people working at the Fukushima Daiichi Nuclear Power Plant are exposed to. But eating too much salty food or becoming too fat carries the same kind of risk of cancer. Smoking increases cancer risk by more than 10 times that, and second-hand smoke has a similar effect to being exposed to 100 mSv of radiation. (I conclude from these figures that we need to take measures against second-hand smoke as soon as possible.)

Seen in the light of these comparisons, exposure to radiation from the nuclear accident is an insidious cancer risk indeed, but there are many things in our everyday lives that, though we tend not to notice them, nonetheless appreciably increase our risks of cancer. These things should not be overlooked, either.

With the nuclear accident and exposure to radiation leaks caused by this accident, we are faced with threats that we have never experienced before,

40 41 Chapter 3 and we are likely to blame radiation for all our worries and insecurity. It is The Truth About Hiroshima and Nagasaki natural to do this. However, as a cancer specialist I feel it is my duty to warn you that making bad lifestyle choices -- drinking and smoking more and (1) What the Data From Hiroshima and Nagasaki Tell Us eating fewer vegetables -- out of one’s fear of radiation exposure may in Valuable Records, a Legacy to Posterity the end increase your risk of cancer. Unfortunately, the Chernobyl nuclear accident has proven that this can happen. I will explain this in detail in Myriad lives were lost irreplaceably in the atomic bombings of Hiroshima and Chapter 4. Nagasaki, events which have marked people’s hearts around the world as the most ghastly massacre in the history of mankind.

As ghastly as it was, the atomic bombing victims’ unprecedented ordeal has provided a huge wealth of data for research on the effects of radiation on the human body. The experiences of Hiroshima and Nagasaki have undoubtedly laid the foundations of current radiology and radiation therapy research. The dropping of the atom bombs on Hiroshima and Nagasaki has also provided themes for such great works of literature as Masuji Ibuse’s Black Rain and Tamiki Hara’s Summer Flowers, a literary legacy for future generations. While the war experience itself seems increasingly to have been forgotten, we Japanese must never allow ourselves to forget the atomic bombings of Hiroshima and Nagasaki.

Decisive Factors in Radiation Dose

The radiation dose one would receive from an atomic bombing is decided almost entirely by how far away the person is from the hypocenter or ground zero. In the case of Hiroshima, large amounts of gamma rays and radiation were released from the atomic bomb that exploded 600 meters above the ground, instantaneously killing nearly 100,000 people due to external exposure to radiation. These deaths were caused by acute . Since radiation spreads much more quickly than conventional blast waves and infrared (heat) rays, many people were exposed to large amounts of radiation in about one millionth of a second. There was absolutely no time for them to run away.

The amount of exposure for those who were at ground zero is estimated to have been roughly 100 (Sv), equivalent to 100,000 mSv, of gamma rays and 140 Sv of neutron radiation. However, the greater the distance from ground zero, the smaller the amount of radiation: at 500 meters from ground zero, the amount of exposure was 28 Sv for gamma rays and 31.5 Sv of neutron radiation. People 3.25 km away were exposed to 1.0 mSv. With each

42 43 further increase of 200 meters in the distance from ground zero, the amount the 340,000 to 350,000 people living in the city of Hiroshima, between 90,000 of exposure is halved. and 166,000 people died within four months of the bombing due to the destruction of nuclear blast winds, heat rays, and radiation. In Nagasaki, of the The Health Status of Atom Bomb Survivors 250,000 to 270,000 population, 60,000 to 80,000 people died. In 1972, Hiroshima University’s Research Institute for Radiation Biology and However, these numbers of deaths are just estimates, since records of deaths Medicine began a study on 78 people who found themselves within 500 m of military personnel were destroyed by fire and some entire families were of ground zero but miraculously survived. It is thought that these people killed, leaving nobody to report the deaths. A number of U.S. prisoners of war were exposed to lesser doses because they were in concrete buildings, also died in the atomic bombings. underground, or in packed streetcars and that these obstacles blocked the radiation. Their survival was presumably due to the sheltering effect of We think that a breakdown of the total energy from an atomic bomb is 50% buildings and to their distance from ground zero. blast winds, 35% heat rays, and 15% radiation. Of the total number (100%) of those killed by the blasts within 2 km of ground zero, 88.7% died within In other words, at Hiroshima and Nagasaki, the amount of exposure was the first two weeks and 11.3% died from the third to the eighth week. The decided by where that person was at that instant. Through interviews breakdown of causes of death for those within 1.2 km of ground zero is and medical examinations of survivors, the detailed relationship between roughly 20% external wounds from blast winds, 20% damage from radiation, amounts of exposure and cancer has been documented; survivors’ and 60% due to heat rays, secondary fires, and burns. experiences have provided us with valuable scientific data. Cancer and leukemia (like trauma and burns) occurred later, and more Contrastingly, an accident at a nuclear power plant is different in this regard: frequently, the closer to ground zero the victims were at the time of the blast. radioactive substances are carried by wind, are dissolved in the rain, and seep It is believed that roughly half of the deaths caused by leukemia and roughly into the soil, and the amount of radiation differs significantly depending on 10% of solid tumor cancer cases were caused by exposure to radiation. The the location. For this reason, the amount of residents’ exposure cannot be total number of cancer cases that resulted from exposure to radiation is accurately determined without a portable . estimated to be roughly 1,900 cases as of the year 2000. Given these limitations, the data from the atomic bomb survivors are the most reliable we have. Data from Hiroshima and Nagasaki prove that Keloids Are Not Caused by Radiation exposure to over 100 mSv of radiation causes a linear (directly proportional) Most of the people who died in the atomic bombings were killed directly increase in cancer. after the by the blast winds and heat rays. The temperature at ground zero was over 3,000 degrees Celsius; many people died from whole- It should be pointed out that in addition to the initial burst of radiation, body burns. there were radioactive substances that fell from the sky later (“fallout”) and additionally exposed some people in Hiroshima and Nagasaki after the atom Half of any group of people whose whole body is exposed to 4 Sv (4,000 bombs were dropped. People exposed to radiation days after the mSv) of radiation die. However, even in this kind of massive exposure, the are called post-blast radioactivity survivors; compared to survivors of the temperature of that person’s skin rises by only 1/1000. The burns and keloids initial radiation, these people were exposed only to very small amounts of caused by the atomic bombings have nothing to do with radiation, though radiation. they are the main cause of many of the victims’ deaths. This fact may not be as widely known as one would expect. Overview of the Atomic Bomb Damage

Let me give you an overview of the damage caused by the atomic bombs. Of

44 45 The Story Told by the Hiroshima and Nagasaki Data large amounts of energy called radiation. The remaining 90% is believed to have risen into the stratosphere along with the fireball. The following effects of radiation on the human body have been Some part of these radioactive substances (uranium in Hiroshima and documented. plutonium in Nagasaki) fell on the cities of Hiroshima and Nagasaki as black Ten years after exposure, there was an increase in breast cancer, gastric rain. Radioactive substances are carried considerable distances by the wind. cancer, colorectal cancer, lung cancer, and other types of cancer. It was In Hiroshima the winds drifted north-westward, and the rain containing established from these and other data that the risk of cancer increases with radioactive substances fell on north-western regions of Koi and Takasu; in exposure to more than 100 mSv of radiation. Nagasaki they rode the winds eastward in the direction of the Nishiyama

Leukemia began to increase about two years after exposure, and its incidence district. in children increased several-fold. We found out from this that children are Ground contamination due to falling radioactive substances (fallout) was affected more easily than adults are by radiation. After six to eight years, the actually higher in distant regions. However, it has been confirmed that the number of patients with leukemia started to decrease, and after twenty years, residents in these far away areas have been exposed only to small doses of leukemia rates were back to the Japanese average. radiation. The level of exposure due to ground contamination at ground

It should be noted that no genetic effect of radiation exposure has been zero was roughly one-tenth that of those distant locations with the highest found to be passed down from survivor parents to their children (so-called levels of contamination. This is similar to how there are locations with low “second-generation survivors”). Though genetic effects have been observed levels of contamination close to the Fukushima nuclear reactor, while hot in studies conducted on animals, no genetic effect of exposure to radiation spots recording high levels of radiation are found far away from any nuclear has been confirmed in humans. reactors.

There are, however, things that we do not yet understand. For example, we Some part of the radioactive substances made its way into rainwater and fell do not know whether or not cancer rates increase after exposures of less than to earth; it is believed that the greater part of the uranium and plutonium 100 mSv -- an issue currently in dispute in the wake of the nuclear accident. from the blasts was dispersed widely in the atmosphere. The half-life of I wrote about this in Chapter 1, but there is no scientifically confirmed Uranium-235, for example, is 700 million years. If there were much of this left increase in cancer at exposures to radiation under 100 mSv. In other words, in the city of Hiroshima currently, the risk of exposure to radiation would still there is scientific data for exposures over 100 mSv, but no data for exposures be high. In neither Hiroshima nor Nagasaki is this the case, however. under that level. This means that even if there is a risk, it is too small to detect. In sum, the effect of radioactive fallout from the two first atomic bombs has become so small it cannot be distinguished from the nuclear testing that The Black Rain That Fell on Hiroshima and Nagasaki took place in the atmosphere in many parts of the world during the 1950s Masuji Ibuse’s novel Black Rain tells the tragic tale of a woman who, although and 1960s. she escaped the radiation and heat rays that were emitted after the atomic bomb’s flash and explosion, was exposed to radioactive substances in the rain that fell far from ground zero. The atomic bombs dropped on Hiroshima and Nagasaki exploded in the air, 600 m and 503 m above ground level respectively. The explosions became huge balls of fire that were pushed upwards into the sky by ascending air currents. It is believed that roughly 10% of the nuclear material in the bombs caused fission reactions emitting

46 47 (2) Another Chapter in the True Story of the Atom-Bombed directly exposed to radiation at Hiroshima or Nagasaki or in adjacent areas Cities when these cities were atom bombed, to those who entered within a 2 km radius of ground zero within two weeks after the bombs were dropped (post- The Health Status of Post-Blast Radioactivity Survivors blast radioactivity survivors), and to those who were still in the womb of their People who entered the cities of Hiroshima and Nagasaki the day after these mother when she was exposed to radiation at the time of the bombings. cities were bombed were also exposed to radiation. These are “post-blast Holders of a survivor’s handbook can, in principle, receive treatment at any radioactivity survivors” who entered a 2 km radius of ground zero within two hospital, free of charge, not only for cancer, but also for diseases ranging from weeks after the atomic bombings. They entered the city looking for relatives diabetes to the common cold. Currently around 220,000 people have these and acquaintances, or happened to be outside the city the day it was handbooks. Their number peaked in 1980 at 372,264. This is a number larger bombed but less than two weeks later returned or entered the city for relief than the combined populations of the cities of Hiroshima and Nagasaki at the efforts. These people were exposed to fallout and “induced radiation” from time the war ended. the atomic bombs. (Neutron radiation emitted by atomic bombs hits other materials and makes them radioactive; the radiation from those materials is Free medical treatment had tremendous effects. In particular, in the case of called induced radiation.) post-blast radioactivity survivors who were exposed to lower amounts of radiation than the blast survivors (i.e. survivors who entered the cities after However, very surprisingly, the average life expectancy of post-blast the cities were atom bombed), the positive effects of enhanced access to radioactivity survivors is higher than that of the average Japanese. In addition, medical care were greater than the negative effects of exposure to radiation, the average life expectancy for women in Hiroshima is the highest in Japan and these survivors ended up living longer than the national average. (and the longest life expectancy in Japan’s cities of over 500,000 population). How can this be? We can say that Hiroshima demonstrates vividly to us what good healthcare can do for a population. Since the Japanese have the highest life expectancy in the world, that would mean that women in Hiroshima have the world’s highest life expectancy. Not There is one additional factor in their longevity that I want to mention: the only that, but the birth rate is number two, and the rate of stillbirths is second fact that residents didn’t evacuate after the atomic bombings, but continued from the lowest in Japan. The city of Hiroshima underwent a miraculous post- to live where they had been, played a part. war recovery, and has become the number one industrial city in western I do not even want to think about, but I have to ask myself: what would Japan, with a population of currently 1.2 million people. What can explain happen if Tokyo were to be atom bombed? I fear that many of the survivors this? would “evacuate” immediately, fearing black rain and residual exposure, and this would have dire consequences. However, at the end of World War II, only Why is Hiroshima Women’s Life Expectancy the World’s Highest? a small number of experts had any knowledge of radiation, so the people of Hiroshima and Nagasaki did not realize that radiation was dangerous or fear What brought about Hiroshima women’s unexpectedly high life expectancy? it in the aftermath of the bombings. It seems the atomic bombings and tragedy of the people of Hiroshima had an ironic outcome. This, then, is another reason why there were so many unknowing post-blast radioactivity survivors: those who survived stayed where they were and This owes much, firstly, to the “Survivor’s Handbook” (officially called the did not evacuate. No one lived in uncomfortable refugee housing because Atomic Bombing Survivor’s Health Handbook). These official certifications they were afraid of radiation -- presumably because they were ignorant of entitling their bearers to free health care were delivered to those who were radiation’s dangers.

48 49 Chapter 4 In Chernobyl, on the other hand, the average life expectancy dropped significantly. I will write about this in the next chapter. The Truth About the Chernobyl Nuclear Accident The Worst Nuclear Accident in History

In the long history of the development of nuclear power, the nuclear accident that occurred in Chernobyl (in the former , now the Russian Federation) on April 26, 1986, is considered to be the worst ever.

When workers tried to shut down Unit 4, considered to be state-of-the-art equipment at the time, for periodic maintenance, the reactor went out of control and blew up.

Radioactive substances such as cesium and iodine spread across a wide area, contaminating Russia, , and . The radioactive substances it generated wound up causing serious problems in and as well. The radioactive substances released were equivalent to 400 bombs of the type dropped on Hiroshima.

The government of the USSR at the time made the damage caused by the accident worse by initially refusing to admit that an accident had taken place and failing even to take the barest minimum of precautions, such as restricting the supply and intake of contaminated food and milk. I will explain this later, but the frequent occurrence of thyroid cancer in children was in part caused by the careless response of the government. In addition, unnecessarily stringent evacuation measures, taken after the USSR collapsed, were an additional major aggravating factor that shortened former residents’ lives.

The Actual Number of Victims

Those killed by the accident were workers at the plant and firefighters who came in to extinguish the fires immediately after the explosion. Of these 134 people who threw themselves into this suicide mission, exposing themselves to 1,000 to 8,000 mSv of radiation, 28 died within three months of the accident due to acute radiation. Roughly 20 more of the remaining workers and firemen died within 25 years of the accident. Cancer seemed to be the cause in some, others died of heart disease, and some died in other accidents. There were various causes, but the specific cause of death has been identified for each of them.

50 51 Apart from the 48 I have mentioned, all the rest are still alive as of this the accident (as of 2011), roughly 6,000 people have been operated for printing. Therefore, out of 134 people exposed to intense radiation, the cancer, and 15 of these people have died. The survival rate at five years after deaths of 48 were directly caused by the nuclear accident. receiving treatment for thyroid cancer is 95% or better: this is an example of a “curable” cancer. According to Russian scientists specializing in nuclear energy, records are being kept even now on 500,000 people, including both workers involved in Was There a Sudden Increase in Bladder Cancer? post-accident management and cleanup (who worked within a 30 km radius There are often claims that bladder cancer increased suddenly after of the nuclear power plant but not including the above-mentioned 134 Chernobyl, since radioactive substances were detected in the urine of those who took part in the suicide mission) and civilians; of this large monitored exposed, but these claims have no basis from a scientific point of view. group, 198 died due to leukemia within 25 years of the accident. If you are There are also claims that there were infants born with hydrocephalus and wondering if all of these 198 leukemia cases were due to the effects of the abnormally large heads. Though some scientists claim that some form of accident, they are not. Leukemia, also known as cancer of the white blood inherited symptoms occur in children born to parents who were exposed to cells, also occurs in people leading ordinary normal lives. Of these 198 deaths radiation, there is no evidence that exposure to radiation has an effect on due to leukemia, 80 deaths are thought to be due to exposure to radiation future generations, and the studies conducted at Hiroshima and Nagasaki from the accident. These do not include the civilians, only the workers whose concur. In fact, reports from credible international organizations such as work within a 30 km radius of the nuclear power plant was connected with the United Nations Scientific Committee on the Effects of Atomic Radiation the accident. (UNSCEAR), the International Atomic Energy Agency (IAEA), and the The Increase in Thyroid Cancer in Children International Commission on Radiological Protection (ICRP) state that genetic effects are not seen. So what exactly was the effect on the general public? Scary and dangerous mental images are associated with radiation and There were fears that there would be an increase in various other kinds of radioactivity in Russia and elsewhere. The same is true in Europe. There cancer, but the only increase reported was in thyroid cancer in children. The are some people in Europe who claim that 100,000 people died due to the cause of thyroid cancer is radioactive iodine. Because the nuclear reactors accident at Chernobyl and the government has covered this up. However, it in Chernobyl were made of , much of this graphite caught fire due is internationally agreed that the only health effects on civilians due to the to the explosion. The pillar of smoke containing graphite rose 1.5 km in the Chernobyl accident were an increase in thyroid cancer for children. sky. That smoke contained radioactive substances such as iodine, and high concentrations of iodine were even detected in locations 250 km away from The Reason Thyroid Cancer in Children Could Not Be Prevented the nuclear power plant. Cesium and a variety of other radioactive substances are certain to have Iodine is a volatile substance, and can be carried in the wind to far away been scattered in the environment in Chernobyl when the nuclear reactor locations once it is released into the atmosphere. If it drifts into parts of the exploded, but why did only the iodine induce thyroid cancer? sky where it is raining, it will dissolve in the water and fall to the ground. This Even scientists and experts who conducted on-site health surveys did not is the reason iodine was detected in metropolitan areas far away from the initially know the reason for this, because there was no hint in the data Fukushima nuclear power plant after its accident. collected in Hiroshima and Nagasaki that iodine was the culprit. Scientists There were 5,000 children (as of 2006) who were diagnosed with thyroid then studied the frequency of thyroid cancer in those who were children at cancer due to exposure to iodine scattered across a vast geographical area the time of the accident and those born after the accident. They found that by the Chernobyl accident; 9 of these children died. In the 25 years since thyroid cancer was concentrated in children who were 0 to 5 years of age at

52 53 the time of the accident, and no increase was detected in children who were such as hypothyroidism when they cannot take in enough iodine from then still in their mothers’ wombs. sources such as seaweed. In the US, they add iodine to table salt (“iodized salt”) in order to prevent this. Let us use the process of elimination to find the culprit. Cesium also was released along with iodine due to the explosion. Since cesium has a long half- In short, becoming iodine deficient is always possible unless you do life of 30 years, there should have been an effect on children born after the something about it. In the area around Chernobyl, the local food contains accident. However, there is no increase in cancer in children born after the very little iodine. If iodine suddenly appears in this kind of environment, even accident. Thus cesium is crossed off our list of suspects. when it is due to a nuclear accident, our bodies will thirstily absorb the iodine in the way a thirsty person drinks water. Dairy cows ate grass contaminated On the other hand, iodine has a short half-life: eight days. It will affect those with radioactive iodine, and people drank milk from these cows that had who take in iodine immediately after the accident, but it will not affect accumulated high concentrations of iodine. This is the food chain that led to children born some time after the accident. cancer. To start with, iodine is a substance that is easily taken up by the thyroid gland. It gets absorbed in the thyroid gland and becomes the raw material Why Iodine Collects in the Thyroid Gland for creating thyroid hormones. Whether or not it is radioactive, the substance How does the iodine absorbed by the thyroid gland cause cancer? iodine has the same properties, so the thyroid gland will absorb radioactive Before answering this question, let us think of why the thyroid gland takes in iodine as well. iodine. Why instead of circulating throughout the body does it accumulate Having marked iodine as a suspect, scientists found out when they studied in just one organ? Most cells in the human body do not need iodine. Only iodine’s pathways into a child’s body that thyroid cancer occurred at cells in the thyroid gland need iodine, because it uses iodine to make thyroid higher rates in children who drank lots of milk. As a result, the mechanism hormones. These hormones promote cell metabolism and can be likened to responsible for causing thyroid cancer was identified as the drinking of milk the accelerator in a car. contaminated with high levels of iodine. There were no restrictions on milk It is indispensable to life in vertebrates from fish upwards on the evolutionary and food consumption in Chernobyl of the kind that were put in place for trail to mankind and would be easier to vaguely understand when likened to Fukushima, so there was no way to prevent exposure to radiation through the driving force behind a tadpole’s transformation into a frog. food. (It was impossible to expect countermeasures to be taken when the accident itself was being concealed.) Cells in the thyroid gland need three or four iodine atoms to create one molecule of hormone. It is for this reason that cells in the thyroid gland Thus children drank their contaminated milk, suspecting nothing. Children take in iodine and have the ability to store it. Cells in the thyroid gland do drink more milk than adults, and are at a higher risk of developing cancer not, however, have the ability to determine whether or not that iodine is than adults when exposed to the same amount of radiation. radioactive. Radioactive iodine taken in by the thyroid gland emits beta The Complete Food Chain Leading to Cancer rays, which have a range of just a few millimeters. This is why radiation only damages cells in the thyroid gland; other organs are out of its range. This is Chernobyl being inland was another factor. Iodine is an element that is why iodine only causes thyroid cancer. essential to the human body. Japan is surrounded by the ocean, so seaweed, which is rich in iodine, is in the diet. The Japanese take in iodine everyday, but Thyroid Cancer’s Real Danger to Children this is not the case for people living in the central regions of a vast continent. This is important, so I will state it once again: the only health hazard that has It is not uncommon for people to develop chronic iodine deficiency diseases been confirmed to affect residents of Chernobyl is thyroid cancer in children.

54 55 Children were affected because rain that had radioactive iodine (Iodine-131) even if it gets into the body, and eventually it will make its way out of the in it fell on grass, which was eaten by cows, which produced milk with high body. This is called thyroid blocking, and is the reason why (non-radioactive) levels of radioactive iodine. The former Soviet government did not announce is distributed to nearby residents in case an accident occurs the Chernobyl accident for several days and was slow to place restrictions on at a nuclear power plant. food products. The children of Chernobyl, located inland, were chronically But be careful: you need to know more. Recently in Fukushima, this became iodine deficient. Radioactive iodine released from the nuclear reactor an issue because it is dangerous to drink tincture of iodine just because it has suddenly became abundantly available to their thyroid glands. The substance iodine in it. This may actually cause worse health effects than radiation. itself is the same, whether or not it is radioactive, so these children’s thyroid glands took in enormous amounts of radioactive iodine. As a result, in this In emergencies, iodine is distributed to people by local governments. It is not region almost 1% of children under the age of four had their thyroid gland something sold at drugstores. If you were given this in an emergency, you exposed to more than 10 Sv (10,000 mSv) of radiation. Growing children’s cells would be told to take 100 milligrams per dose for adults, 50 mg for children. divide very actively, making their genes more easily affected by radiation, But it may cause side effects, so please always follow the instructions of your creating the conditions for cancer to get a start more easily in them. This is healthcare provider. why thyroid cancer in children increased. Supplements and quack remedies are advertised “to cleanse the body and rid Radioactive Iodine Is Also Sometimes Used to Treat Cancer it of radiation”; these products sell well whenever people feel anxious in the event of emergencies. From a doctor’s standpoint, I think it would be wise to On the other hand, iodine, even radioactive iodine, is not a substance that stay away from them. does only bad things. Radioisotope therapy uses the unique property of cells in the thyroid gland to induce the gland to take in iodine (if you remember, And finally, given what we know about the levels of thyroid exposure to other cells do not...) in order to treat cancer. radiation from the Fukushima accident, there is simply no need to take iodine.

Although it seems like this treatment would be difficult, it is actually very The Differences Between Chernobyl and Fukushima simple. Radioactive iodine is placed in small capsules, which the patient The nuclear accident at Fukushima and Chernobyl were both rated Level 7 in swallows. Let us say that there are cancer cells in the thyroid gland for some severity on the International Nuclear Event Scale. reason. Since cancer cells originally are created through a mistake in copying Though Chernobyl and Fukushima are often compared to each other, there is ordinary cells, they inherit the characteristics of the organ they were born in. one major difference: at Chernobyl, a nuclear reactor blew up while it was in As a result, the administered iodine accumulates inside thyroid cancer cells. operation, releasing all sorts of radioactive substances. At Fukushima Daiichi, This is a mechanism that kills even tough cancer cells, since just like normal the nuclear reactor and the containment vessel surrounding it remained; it cells they have little ability to mend the damage caused by radiation. was the reactor building housing the containment vessel that was damaged However, the patients -- in Japan -- are asked to refrain from taking in by a gas (not a nuclear) explosion. seaweed and other foods rich in iodine before they take the radioactive Here the explanation becomes a bit technical, but nuclear power plants in iodine capsules. This is to “starve” the thyroid cancer cells of iodine. Japan are designed to trap the fuel that produces energy through nuclear Conversely, in other cases, leaving the thyroid gland “sated” or filled with fission in the reactor, surround that with a containment vessel, and cover as much iodine as it can absorb is a method of preventing damage from that further with a reactor building. There was no containment vessel around environmental radioactive iodine. If the thyroid gland is sated with iodine the Chernobyl reactor, and one safeguard designed to confine the nuclear that is not radioactive, there is no place for new radioactive iodine to settle reactor that blew up did not function. At Chernobyl, restrictions on milk and

56 57 other food items were put in place too late, exposing many children’s thyroid were placed on the intake of food and milk in which radioactive substances gland to enormous amounts of radiation (10 Sv, or 10,000 mSv). had been detected in amounts in excess of Japan’s regulatory limits. I believe that the problem of contaminated milk that occurred in Chernobyl could In Fukushima however, evacuation measures and restrictions on milk and have been avoided in this way. food were put in place right away. Therefore, the risk of damage and injury from iodine with its short eight-day half-life, where an immediate response is Japanese Food Regulations Are Safe required, was kept to a minimum. Measurements of thyroid exposure in over Japanese regulations on food are very strict. There is normally no need to eat 1,000 children in Fukushima show that the maximum level of exposure was food that exceeds regulatory limits, but the exposure would not be enough 35 mSv. to affect a person’s health, even if some were ingested.

The level of exposure at Chernobyl was three levels of magnitude (a thousand For example, at the Kanamachi water treatment plant in Tokyo, the water’s times) higher, and thyroid exposures under 50 mSv do not increase cancer radioactivity at one time measured 210 becquerels per kg, which exceeded rates. Therefore, we can say with some certainty that thyroid cancer rates will the limit set for water given to infants (100 becquerels per kg). not increase in Fukushima. Exposure to radioactive iodine almost exclusively There is no need to go out of your way to drink this, but even if infants drank affects the thyroid gland, but the amount of whole-body exposure to a little, or if milk was reconstituted with this water, there would be no effect. cesium in Chernobyl was more than 50 mSv for the 270,000 people in highly A person would have to drink one metric ton of this water for there to be any contaminated areas, and from 10 mSv to 20 mSv for the 5,000,000 people in effect. Realistically speaking, there is no way that a person can continuously low-contamination areas. However, even now, 25 years later, cancer due to drink one metric ton of water whose level exceeds the restrictions. cesium has not been confirmed. Not only that, but the safety standards for radioactivity in food that would As I will report in the next chapter, there is far less exposure to cesium in cause internal exposure to cesium are even stricter. Yoko Komiyama, Minister Fukushima, so it is safe to say that there will be no increase in any kind of of Health, Labour and Welfare, announced on October 28, 2011, that she cancer. would lower temporarily the upper limit for radioactive cesium from 5 mSv Restrictions on Food Products Came Too Late in Chernobyl. per year to 1 mSv per year. She did this because the Food Products Safety

In Chernobyl, initially the very occurrence of the accident was concealed; no Commission of the Cabinet Office released a report stating that effects planned evacuation took place, nor were restrictions placed on the supply of radiation on people’s health had been found in people exposed to a or intake of food products and milk that were contaminated with radioactive cumulative amount of more than 100 mSv in their lifetime. substances. Residents went on with their daily lives as if nothing had I participated in the Food Safety Commission’s discussion as an expert happened, even in places that should have been evacuated. The accident witness. The thinking is like this: if we assume people may live until they are occurred on April 26th, but on May 1st (May Day, or International Workers’ 100 years old, the upper limit to exposure from food would be 1 mSv per Day, a public holiday in the Soviet Union) many people were marching in year. For example, the temporary regulatory limit for vegetables is 500 mSv parades while radioactive materials were being released into the atmosphere per kg, but if this were simply divided by five, the upper limit would be 100 not far away. The government had announced that food was safe to eat, and mSv. This is only 1/12 that of the limit in the United States, and an extremely people in villages continued to eat their accustomed food and to live their tough target for producers to achieve. However, this revised, more stringent, usual lives. standard should lessen fears of internal exposure and bring peace of mind to

In Fukushima on the other hand, immediately after the accident, restrictions a larger proportion of the population.

58 59 Problems With Defining the Evacuation Zone in Fukushima Other than thyroid cancer, there are no confirmed pathological changes in the general population of civilians that are thought to be caused by I can say good things about the restrictions placed on food, but problems radiation exposure. These death tolls are not enough to affect the average life remain with the evacuation measures taken. The orthodox approach to expectancy of a country. protecting the public from radiation is by establishing evacuation areas within 20 km or say 30 km of a nuclear power plant. I believe that the real reason why life expectancy was shortened was many people’s grief at the accident and their weakened will to live. The people Until the Fukushima accident, related organizations’ training for emergencies in Chernobyl must have known how scary radiation is, having heard about in nuclear power plants defined the evacuation area as within a 10 km radius Hiroshima and Nagasaki, so presumably they have been tormented by of the accident site. It would appear that following the accident, authorities anxiety and fear. Even experts and doctors who flew in from the United States have assumed that doubling the radius of the perimeter to 20 km would be and Europe brought their own food and water and did not touch the local better. food products. People had to live away from home and in fear of developing However, there are locations beyond the evacuation zone perimeter where cancer, and many had lost their jobs. No one would buy the farmers’ crops, high levels of radiation were recorded. Like pollen, radioactive substances can job opportunities disappeared, and a steady exodus of people began. reach locations far away from the nuclear power plant, wherever the wind The Soviet government, on which people ought to have relied, was destined carries them, and high levels of radiation will be detected there. In fact, it was to collapse five years later: it was not a situation in which one could expect learned from the Chernobyl experience that wind direction and other factors generous support. People lost their pride and reason to remain alive and were are crucial. This point appears to have been overlooked in the confusion economically stymied as well. There were people who became dependent caused by a nuclear accident following on the heels of the unprecedented on alcohol out of desperation, others who suffered severe and lasting major earthquake and tsunami catastrophe affecting a vast geographical depression, and some who went as far as to commit suicide. The death rate area. This is a situation that we must all think seriously about and attempt to for elderly males was high in Ukraine, and this is probably because males are learn from. especially vulnerable to this kind of psychological damage. Average Life Expectancy Fell After Chernobyl What Unnecessary Evacuation Really Does I stated in the previous chapter that women in Hiroshima have the highest life As I stated in the previous chapter, after the atomic bombs were dropped, expectancy in Japan. Average life expectancy in Russia and Belarus, however, the people of Hiroshima lived long lives; after Chernobyl, the average life significantly decreased after Chernobyl. The average life expectancy in Russia expectancy dropped significantly. in 1986 when the accident happened was 65 years; this fell seven years, to 58, in the year 1994. The same very significant decrease was seen in Ukraine In the case of Hiroshima, good medical care and the issuance of atomic bomb and Belarus as well. The National Academy of Sciences of Ukraine has offered survivor handbooks had good effects that were strong enough to overcome an analysis revealing that the death rate of elderly people rose particularly the adverse effects of exposure to radiation, but in Chernobyl, evacuation steeply. (which did not happen in Hiroshima) did more harm than good.

Roughly 50 of the firemen and workers who entered the nuclear power In the case of Chernobyl, all residents of areas where annual exposure would plant on their heroic mission to bring the accident under control, 80 people amount to or exceed 5 mSv were forced to evacuate. This figure 5 mSv is a who took part in accident control and cleanup efforts who later developed low level, four times as strict as the 20 mSv per year limitations placed on the leukemia, and 15 out of 6,000 in the general population who developed planned evacuation zone in Fukushima. thyroid cancer are thought to have died as a result of exposure to radiation.

60 61 The official report issued in 2011 by the Russian government, “25 Years with high incomes. The average life expectancy in Nishinari, Osaka, where After the Chernobyl Accident: Summary and Overview of its Impact and there are many homeless people, is the lowest in Japan, for example. Overcoming the After-Effects 1986-2011”, expresses the following regrets over “excessive evacuations”: On the other hand, let us think about how much a lifespan can be cut short due to exposure to radiation. The 6.4 million residents in the contaminated “What aggravated severalfold the social, economic, and psychological area in Chernobyl were exposed to roughly 10 mSv of radiation. consequences of the Chernobyl accident was to a large degree the legislation that defined ‘contaminated areas’ more strictly than As I mentioned in Chapter 1, there are no data to suggest that less than necessary.” 100 mSv of exposure to radiation increases cancer rates. The linear no- threshold model, which assumes merely on a precautionary basis that The same report also addresses the negative impacts that evacuation has on cancer can increase with even a slight increase in exposure, has become people: the basic concept for protection against radiation. When calculating the “It was revealed that the side-effects of the accident such as psychological effect on the average life expectancy of today’s Japanese citizens based stress, the destruction of the way of life people had become accustomed on this model, we find that 10 mSv of exposure would shorten average life to, and restrictions on economic activities were far more damaging than expectancy by roughly 4 or 5 days. We see that the effect is far less than the the exposure to radiation.” negative consequences of evacuation. Even the International Commission on Radiological Protection (ICRP) -- which advocates the linear no-threshold There was an increase in thyroid cancer in children because no restrictions model -- has clearly stated in reports that “there is no increase in cancer with had been put on milk and food, but there has been no confirmed increase in exposure of less than 10 mSv”. any other type of cancer. And yet the average life expectancy in Ukraine and Taking additionally into consideration the fact that residents of countries Belarus fell by roughly seven years after the accident at the nuclear power formerly part of the Soviet Union don’t have as long a life expectancy as plant. people in Japan, I conclude that exposure to radiation has little to do with the The report concludes: “There is one main lesson from the nuclear accident at observed shortening of Chernobyl residents’ lifespans. Chernobyl, which is that the importance of social and psychological factors was not fully appreciated”. Taking the Lessons of Chernobyl to Heart We must not repeat the same mistakes in Fukushima. It is for this reason that Depending on the kind of evacuation, evacuation itself may shorten a medical care for exposure to radiation must be provided together with a person’s life, even if it reduces the evacuee’s exposure to radiation. The wide range of care in other areas such as attention to people’s psychological loneliness of living in an unfamiliar place, economic stress due to joblessness, needs. and living in fear of developing cancer due to radiation -- there is simply no way that this kind of life is good for one’s health. Nothing can be better than, from the start, having never been exposed to radiation because of an accident at a nuclear power plant. Let us not forget, In fact, it has been scientifically proven that lifespan can change greatly however, that many other risks exist in the world besides radiation. And due to the social and psychological factors referred to in the Russian what’s worse, people sometimes incur a different and much more serious government’s report. For example, lifespan varies depending on occupation. risk when they focus too narrowly on only one particular risk. For example, In data from British males, unskilled workers live an average of seven years people who are afraid of airplane accidents may actually increase their risk shorter lives than those who work in a profession. Japanese data show that of dying in an accident. According to a study conducted by the US National males with low incomes have twice the risk of dying from cancer than those

62 63 Transportation Safety Board, the probability world-wide of dying from an (The following is excerpted from the Conclusion section of the Russian airplane accident is 0.0009%. If this is limited to only domestic US airlines, the government’s report, “25 Years After the Chernobyl Accident: Summary and probability is much small lower, at 0.000034%. The probability of dying in an Overview of its Impact and Overcoming the After-Effects 1986-2011”.) automobile accident in the United States is 0.03%, so the probability of dying Conclusion in an airplane is 1/33 the probability of dying in a car in the US. Currently, 25 years after the Chernobyl nuclear accident, the situation And yet, since the synchronized terrorist attacks on September 11, 2011, of radiation hygiene in areas of radioactive contamination has returned many Americans have avoided airplanes and are traveling more by car. For to normal. The amount of additional radiation to which the majority of this reason, the deaths due to automobile accidents in the US between residents of areas surrounding Chernobyl are exposed is well within the October and December of that year increased by roughly 1,000 people range of natural radiation variability in the Russian Federation and many compared to the previous year. European countries.

The second meeting of a Japanese government working group regarding We were able to implement large-scale and complex protective measures response measures following exposure to low-level radiation was held on in the contaminated areas in a shortened period of time thanks to Russia’s November 15, 2011, and there was an intense debate between experts scientific capability and expertise in field applications. and Diet members about the effects of the Chernobyl nuclear accident on This significantly decreased the radiation dose for residents and solved the people’s health. following unprecedented and highly complex challenges:

From a scientific point of view, experts stated that no confirmable direct - Trying not to exceed the maximum allowable annual radiation dose for health hazards had been observed in the wake of the Chernobyl accident residents of European countries and the Soviet Union at the time; other than the increase in thyroid cancer in children. Diet members objected - Avoiding significant losses in agriculture and forestry. that the absence of scientific proof is no justification for certainty that no It is also important to emphasize that the radiation dose to evacuated hazards exist. Some went as far to state that science should show more residents is significantly lower than the current reference values for humility. evacuation. There were also recommendations that the evacuation standards be made Although the situation of the nuclear accident was complex, the outcome stricter and that exposure limits be set at 5 mSv per year. This annual was made possible due to the government commission to investigate the exposure of 5 mSv is the standard actually used in the areas around Chernobyl nuclear accident making speedy and clear decisions, the heroism Chernobyl, and as I mentioned before, the Russian government has stated and self-sacrifice of those who were involved in bringing the accident under in their report that the introduction of these strict standards was politically control, and because the workers at reactors number one, two, and three motivated -- and that they regret that this resulted in the significant decrease were able to ensure the security and continuity of operations. in average life expectancy of the residents. We can say that there is a need to think about risks to health and lifespan from a broader perspective. The miscalculations in the first few years of managing the disaster are as follows: It is impossible to condone the nuclear accident, but we have no choice but to go on living in Japan after 3.11. Disparities in informedness also lead to That prevention of exposure by distributing and administering iodine disparities in health and lifespan. The responsibility of government and media was too limited in scale, that no restrictions were placed on agricultural to inform the public is crucial. products and milk which included highly radioactive iodine while it was still

64 65 highly radioactive, that the accident response measures put in place at the suffered acute radiation sickness. Of these, 28 died within a few months site of the nuclear power plant and within a 30 km radius were not always after the accident, and an additional 22 died before the end of 2010 due based on solid evidence, and that in and after 1988 large-scale migration to various causes; programs were implemented. - Less than 40% of the 748 cases of thyroid cancer in children identified Furthermore, the long-term social, economic, and psychological effects were in Oblast, , Orlov District, and Tula Oblast between multiplied many-fold by the adoption of legislation in the designating 1991 and 2008 were caused by radiation; areas where measured Cesium-137 levels exceeded the reference value of 1 Ci/km2 (37 kBq/m2) as Chernobyl contaminated areas. - Of the 115 cases of thyroid cancer identified in 84,772 people, there

This led, however, to the inclusion in the evacuation zone stipulated by law were roughly 20 cases among the “Liquidators” (the teams, numbering of areas where the additional radiation impact on residents was lower than in the thousands, who worked to bring the Chernobyl nuclear accident the natural radiation level. under control). The Liquidator group was affected by radiation between April and July of 1986 while working in the radioactively contaminated In the social and economic situation at the time, the problem of Chernobyl area. was transformed from one of for residents into a Of the 198 cases registered in the national registry between 1986 and political issue. 2007, fewer than 80 people died of leukemia in the Russian Liquidator

The social and economic situation in the contaminated area became group among those who were exposed to more than 150 mSv of extremely difficult due to the psychologically complex situation caused by radiation. the perceptions characteristic of residents with regard to radiation exposure Over this 25-year period, 40,000 of the Liquidators (more than 190,000 and its effects on health and the inadequacy of legislative and information people) died of various causes. measures. Chronic ischemic heart disease (1,763 cases) was the most important cause It is clear now that to ease social tensions in radiation-contaminated areas, of death, and malignant tumors (485 cases) in the lungs and bronchi were comprehensive information campaigns ought to have been organized to the biggest cause of death in patients affected by severe cancer. overcome the effects and after-effects of the radiation accident, to form a culture of safety in residents’ lives, to secure unrestricted access to The total death rate among the Liquidators does not, however, exceed that information, and to raise the level of residents’ understanding of radiation. of male residents of Russia.

The documents published in this national report convincingly show above Furthermore, the mortality rate for residents of (province), all that, of the harm to society endured due to the Chernobyl accident, the Kaluga Oblast, Orlov District, and Tula Oblast, which suffered the worst effects on health caused by radiation were much smaller than the accident’s levels of radioactive contamination after the nuclear accident, is close to the other negative impacts. national index level.

From the national registry data on radioactive contamination, we can The good news is that the infant mortality indices in each of these provinces confirm that the effects of radiation on people are as follows: has improved greatly in the past several years. This is largely due to the implementation of a national assistance program for the residents of areas - Of the firemen on the site and the workers at the Chernobyl nuclear affected by the Chernobyl nuclear accident. power plant who were there for a full day after the explosion, 134 Analysis of the situation 25 years after the accident and comparison of the

66 67 effects of radiation with the effects of psychological stress, destruction of society as a whole is the basis of this strategy. people’s familiar way of life, and restrictions on economic activity makes it clear that the other factors, namely material losses associated with the When planning and implementing national policies in this area, we must Chernobyl accident, had a far larger detrimental impact on people than consider both provisions of the current legal standards and the following radiation itself. basic principles and standards which have been validated by actual experience in the past: One of the main lessons learned from the Chernobyl nuclear accident, and one that can now be asserted openly, is that the importance of social and 1. To protect the health of citizens who were victims of the disaster and psychological factors was not sufficiently appreciated. to secure environmental conditions desirable to live and work in for residents of the disaster-stricken community are priority areas in the No matter what scale at which one examines the data, if an area is national government policy for overcoming the adverse health effects and contaminated with radiation, these effects are the most important, and after-effects of the Chernobyl accident (in the event a state of emergency people’s everyday experiences demonstrate this clearly. has arisen, the protection of residents is of paramount concern, as stated The decisions of authorities must be made based on a comprehensive in Articles 7, 41, and 42 of the Constitution of the Russian Federation). assessment of the long-term social and economic outcome of these 2. The activities purposefully conducted in coordination with national decisions, including an analysis of the effects on the psyche of society as a government agencies, local government offices, various organizations, whole. and citizens based on their respective rights, authority, and duties in this Even when the effects of radiation are being lessened in a speedy and field, objective manner, a critical worsening of the social and political situation 3. Consideration of what social and economic effects they will have, what may occur. resources are needed and sufficient for the purpose, and how they can be Responses to radiation accidents that are effective and backed by solid used most effectively in the planning and implementation of policies to scientific evidence can only be implemented under conditions where the overcome the effects of the Chernobyl accident and in the determination authorities are trusted and where consistent and fair information policies of the scale and the measures included in these policies. are in place. 4. Protection and rehabilitation through medical care for citizens listed in This means that today’s social responsibility toward people who were the national registry. It is the people in this category who need to undergo affected by the accident is to compensate the majority of victims for medical examinations in the framework of appropriately scheduled mistakes made in the past. medical services for early disease detection, prevention, treatment, and rehabilitation. This is why social protection needs to continue to be a priority area for the 5. The main criteria when making decisions about the need for measures Chernobyl National Program. to overcome the effects of the Chernobyl accident are the residents’ Furthermore, on the national level, a strategic plan backed by scientific average annual effective dose and, in cases where the residents of the evidence is needed to ensure the social protection of people in each of area were exposed to doses lower than the predetermined reference different categories who are called on by the state to perform duties value, the amount of residents’ accumulated exposure. involving health risks. 6. The standards for planning and implementation of measures in the Consideration of the long-term interests not only of individuals but of agro-industry complex and for testing the radioactivity of food and food

68 69 ingredients are the health requirements for food and food ingredient undesirable environmental conditions. quality and safety. Upon consideration of the approach detailed above to overcome future 7. Measures are planned and implemented for social and psychological effects of the Chernobyl nuclear accident, the basic direction of the rehabilitation in areas where the average annual effective doses of national policy in this area must be in accordance with Overcoming the radiation are lower than the predetermined reference values, and tests Consequences of Radiation Accidents for the Period until 2015, a Russian for radioactive contamination in food and food ingredients are done federal target program, as follows: only when necessary. - Creating the infrastructure necessary to ensure safe living conditions It is extremely evident that the implementation of national policies for people in the affected areas; regarding coping with the nuclear disaster in Chernobyl henceforth must be - Development and implementation of integrated measures for the health conducted within the framework of the Russian Federation’s new objectives of citizens exposed to radiation; program, “Overcoming Effects of the Accident by 2015”. The items that are the main objectives for these programs are as follows: - Creating the conditions for safe use of agricultural land and forestry “fund” resources (translator’s note: land made available for forestry, - To achieve levels needed for safe living and economic activities in excluding that set aside for defense and similar purposes but including communities contaminated with radiation due to the Chernobyl nuclear non-forested land adjacent to forests) in radioactively contaminated accident. areas; - To strengthen development of response systems that are planned - Improving radiation monitoring systems and their components, as well and technically organized to make it possible to ensure that residents as predicting the evolution of the situation in affected areas; are protected from all but the fewest possible radiation accidents and accident effects, based on the experiences of those in charge of - Increasing the readiness of authorities and the armed forces to take overcoming the effects of the nuclear accident. action to minimize the consequences of radiation accidents by improving their technical, technological, normative planning, and organizational The material documented above is consistent with the following: base; - The UN action plan regarding recovery efforts in areas around - Information support and socio-psychological rehabilitation of citizens Chernobyl until 2016 are based on the social and economic development exposed to radiation; priorities and resolution, “UN Action Plan on Chernobyl to 2016”, adopted by the UN General Assembly on November 20, 2007, based on - International cooperation in overcoming the consequences of the the Secretary-General’s report on optimizing the international effort to Chernobyl accident and other radiation accidents.

study, mitigate and minimize the consequences of the Chernobyl disaster Implementation of state policy in the aftermath of the Chernobyl nuclear (document A/62/467). accident under the federal target program “Overcoming the Consequences - The Concept of long-term socio-economic development of the Russian of Radiation Accidents in the Period up to 2015” will make the following Federation until 2020, approved in Government Decree No. 1662-p of possible:

the Russian Federation on November 17, 2008, includes improving the - Improvement of environmental conditions; quality of the environment and human living environment standards - Restoration of territories affected by radioactive contamination and as well as significantly decreasing the proportion of people living in restarting of economic activity;

70 71 Chapter 5 - Ensuring that the most affected populations can lead their daily lives Radiation’s International Standards under safe radiological conditions and protecting their healthcare and social benefits. (1) International Organizations Active on Radiation Exposure- - Providing medical care to persons at greatest risk of negative Related Problems consequences of radiation exposure (risk groups); International Rules Regarding Exposures

- Promoting improvement in people’s living standards and quality of life There are international rules that protect people from radiation exposure. through the creation of conditions for dynamic and sustainable economic These rules are decided by the International Commission on Radiological growth in radioactively contaminated communities; and Protection (ICRP), a British non-profit organization. Governments of every country follow them. - Increasing the willingness of administrative authorities of the Russian Federation and of the public to meet the challenges of overcoming the Perhaps you may have been worried about the effects of radiation from consequences of radiation accidents and incidents. the Fukushima Daiichi nuclear accident, searched online, and seen the ICRP recommendations. Many people are alarmed, not only by the Lessons learned from the experience of overcoming the consequences and ICRP recommendations, but also by sensational remarks made by other after-effects of the Chernobyl accident are highly relevant today in light of international organizations regarding radiation and exposure levels and their the accident that occurred in March 2011 at the Fukushima Daiichi nuclear risks after accidents at nuclear power plants. power plant in Japan. In this chapter I will give a simple introduction to the organizations that make (Published by The Ministry of the Russian Federation for Affairs for Civil these recommendations, why Japan and other countries in the world place Defence, Emergencies and Elimination of Consequences of Natural Disasters, importance on and follow the IRCP recommendations, and describe what is Moscow, 2011. Source: web site of the Nuclear Safety Institute, Russian behind the setting of international standards. Academy of Sciences . Translated from the Russian into Japanese by Fusae Haraguchi. The United Nations Scientific Committee on the Effects of Atomic underlining is by the authors. Translated from Japanese into English by Radiation (UNSCEAR) Alexander Isao Holmes.) There is a public organization called UNSCEAR, a scientific committee in the United Nations (UN) that evaluates and reports on the effects of atomic radiation. Its independence and objectivity are protected, and it is not swayed by any particular country’s influence or ideology. It reports the effects of ionizing radiation on the human body from a purely scientific standpoint.

The highly independent UNSCEAR was established by the UN in 1955. During the in the 1950s, nuclear tests were repeatedly conducted as the development of nuclear weapons intensified. The committee was established out of concern that increasing amounts of radioactive fallout and other effects of testing would affect the general public. They also make proposals seeking an end to nuclear tests.

UNSCEAR officially reports that from an epidemiological perspective,

72 73 radiation doses of less than 100 mSv are too small to allow detection of their to the committee along with radiologists and radiation genetics experts, effects. and started drafting standards for the general public, separate from those for radiation workers. In this way, we can assume that there was a tug-of- The International Commission on Radiological Protection war over protection and exposure dose limits between those in the nuclear (ICRP) power industry, who tried to justify a certain level of exposure to radiation, UNSCEAR is a UN organization whose aim is to scientifically evaluate the and radiologists, who are actually on the receiving end of radiation exposure. effects of radiation on the human body, while the International Commission It is extremely important to note that, in these efforts spanning many on Radiological Protection (ICRP) is a private sector international academic years, we have been heading in the direction of ever stricter regulations for organization that gives recommendations regarding radiation protection radiation doses. from the point of view of radiology experts. In the first ICRP recommendation in 1958, the limits for annual exposures The basis of the recommendations made by ICRP is UNSCEAR’s scientific data. for nuclear power plant workers and for the general public were set at 50 In other words, ICRP recommends policies regarding the risks of exposure to mSv and 5 mSv, respectively. After 1977, the limit for the general public was radiation based on the scientifically proven effects of radiation observed by lowered to 1 mSv. However, ICRP has different staged level recommendations UNSCEAR -- which reports, for example, that exposures over 100 mSv increase for “normal”, “emergency”, and “recovery” situations, which I will write about risks linearly in proportion to the increase in exposure, while exposures under in detail later. 100 mSv are not observed epidemiologically to increase such risks. The Most Reliable Framework Based on International For example, the ICRP recommendation that the limit for exposure in the Agreements general public should be 1 mSv/year is not based on scientific data. Instead, What ICRP places the most importance on when issuing recommendations it would be more correct to call it a policy approach that takes safety into regarding protection against radiation is the above-mentioned UNSCEAR’s consideration. scientific reports. The IAEA cooperates with the World Health Organization Let us go back a bit in history. The International X-ray and Radium Protection (WHO) and other international organizations to present international Committee (IXRPC), ICRP’s international organizational predecessor, was standards for protection against radiation to member countries based on the founded in 1928. This organization’s origins go back to the discovery of X-rays content of the ICRP recommendations. by Wilhelm Konrad Röntgen in 1895, and in response to growing concern Japan, like other countries, follows these frameworks for limits to radiation. about radiation’s effects on the human body with the increase of leukemia The recommendations and reports that each organization sends out share in radiologists and skin disorders in patients that followed rapid advances in the same basic data and the positions they take are almost entirely the medical radiology after the discovery of radium by Marie and Pierre in same. They also critically examine each work of scientific literature (out 1898. of a vast total number that are published), and many times they publish Events took a huge turn after World War II. Exposures to radiation diversified criticisms, even of scholarly papers published in academic journals. Their with nuclear power plants and nuclear bomb testing in the atmosphere. uncompromising stance on basing recommendations on scientific evidence In particular, the problem of exposure of the general public in unspecified has improved the reliability of the agreements among these organizations, numbers arose, something that was never considered to be a problem and this is why countries follow their recommendations. before. European Committee on Radiation Risk (ECRR) This is how, in 1950, ICRP (formerly IXRPC) added nuclear power experts The organization called ECRR, or the European Committee on Radiation Risk,

74 75 is separate from ICRP. It is a non-profit organization that does not have any temporarily is based, as I wrote in the previous chapter, on reflections on how, relation to the UN or to national governments. Many of the participants are at Chernobyl, a strict evacuation standard of 5 mSv per year was adopted and scientists and experts who advocate anti-nuclear positions, and they conduct ended up shortening evacuated residents’ average lives (and was found to activities that seem to counter those of ICRP. have caused the most serious health hazard).

For example, ECRR reports contain some extreme statements, such as that Based on ICRP’s thinking, the Japanese government announced a policy to the effects of internal exposure to radiation are 600 times that of external set the maximum annual limit of exposure to radiation at 20 mSv when they exposure, and if people do not evacuate but keep on living where they are, determined that the situation was headed toward recovery. However, this more than 416,000 people living within a 200 km radius will develop cancer sparked a controversy. within the next 50 years due to the Fukushima nuclear accident. These claims There was opposition to this policy because the public did not understand are widely contested for their lack of scientific evidence and are mostly the rationale for applying standards flexibly depending on changes in the ignored by international organizations. situation (normal → accident → rehabilitation). They reasoned, “If the usual I will add that the central figure in their activities, Chris Busby, makes fervent limit is 1 mSv, how do they expect us to tolerate 20 mSv?” They thought that claims about the threat of internal exposure to radiation, while on the other the government was changing the standards as a makeshift to make it look hand he sells expensive “supplements” that he claims are effective against like standards were being met. exposure to radiation. This impression was made worse by experts who had joined the government (2) International rules to protect people from exposure to as cabinet advisors and who gave a press conference in April at which, radiation claiming that it offended their conscience as scientists to allow annual radiation exposures of 20 mSv, they quit their posts in tears. This undeniably The Normal Standard: 1 mSv Annual Exposure gave many people the impression that 20 mSv is dangerous -- although it is ICRP recommends that exposure to radiation that is caused artificially true that some misunderstandings are attributable to media reports on this (excluding medicine) should normally not exceed an annual level of 1 mSv. event as well. This figure is raised in emergencies, such as immediately after a nuclear accident, to permit an annual radiation exposure range of 20 mSv to 100 The government followed the ICRP recommendations and chose the mSv for residents (ICRP’s 2007 recommendation). Once the accident is in maximum 20 mSv based on the 1 mSv to 20 mSv standard range of allowable the recovery phase, the limit returns to a stricter level, a recommended levels for the recovery period. The most pertinent point here is that an annual radiation exposure level ranging from 1 mSv to 20 mSv (ICRP’s 2008 international standard states that up to 20 mSv is acceptable, and this was a recommendation). major premise for the government’s decision.

In other words, they are set in stages as follows: It is important to emphasize that this was within the range of established standards, not merely a convenient makeshift. The lack of adequate In normal times: 1 mSv explanation on the part of the government, which made people distrustful, is ↓ ↓ regrettable. In emergencies/in the immediate post-accident phase: 20-100 mSv ↓ ↓ Overreactions Have Harmful Side Effects In the rehabilitation (recovery) phase: 1-20 mSv Some people feel that the level should be brought back to the normal level of 1 mSv once the emergency is over. However, establishing planned evacuation The idea that the standard for permissible doses of radiation can be eased

76 77 zones where annual radiation doses would exceed 20 mSv had already or a Radiation Emergency, is a recommendation that was specially re-issued turned thousands of people into refugees. To reduce the tolerance further by ICRP as a message to the people of Fukushima. It was originally issued to 1 mSv would undoubtedly condemn even more people to uncomfortable by ICRP in 2008, but was re-issued on April 4, 2011, after the emergency in lives at evacuation centers and make progress towards reconstruction even Fukushima. I will tell you more about this later, because it contains helpful harder. advice for people living with the effects of radiation.

I repeat: the less radiation one is exposed to, the better. However, realistically The nuclear power plant site is presently moving towards “putting out speaking, choosing an attainable limit within the “safety zone” and moving the fire”: the reactor is being cooled stably, and the amount of radioactive towards a future goal of reducing radiation to as close to zero as possible is substances being released has lessened. However, the people who lived the approach most likely to protect people’s health and livelihoods. I have around that area continue to be forced to live far from the place they love. stated already that, in the current state of medical science, cancer risk is They have to live in constant awareness of the steps they need to take to known to rise only when exposure goes over 100 mSv. No effect of less than protect themselves from radiation. This is really tough to do. Without the 100 mSv of radiation has been proved. So if we are thinking in terms of the support of the national and local governments and relevant authorities, these scientific evidence we have, the upper limit to radiation exposure -- whether people’s future is shrouded in darkness. it is in normal times, in emergencies, or during the subsequent recovery It is probable that most of the people forced to leave their land hope to period -- should always be 100 mSv. return and to live there again if they can. However, in order to do this they However, physicians, other scientists, and experts on radiation protection must overcome hurdles, and this will require major efforts on their part. ICRP’s have different ways of thinking. The massive amounts of scientific data report serves as a guide in this process. I think by using this guide well, people from Hiroshima and Nagasaki point to 100 mSv as a critical point or “cliff’s can avoid not only direct adverse effects due to radiation, but also other edge” between what is safe and what is dangerous, but running through the inconveniences such as limitations on what they eat caused by excessive thinking of radiation protection experts is the notion that the public should concern about contamination in the food and lack of exercise caused by fear not be made to suffer any consequences of unnecessary exposure. of going outside.

In other words, the standards adopted to ensure the public’s protection from Note also that there is a gap between how people living near the nuclear radiation are much more cautious and, shall we say, prefer to err on the side power plants and how people living in the Tokyo metropolitan area think of safety, compared to the scientific critical point of what is known to be safe about the problem of radiation. Because the situation undermines our and what is not. Another way of saying this is that, even if actual exposure confidence in our country’s future, it is important for as many citizens as to radiation exceeds the standard for protection by a little bit, it is at a level possible to share an awareness of the problems of radiation. I will go through that will not affect one’s health. Rather than pursue a debate over which one the points the report makes in a way which is easy to understand. is correct, the scientific evidence-based standard or the radiation-protection Point 1: “Emergency exposure situations” are followed by policy standard, we should try to understand the differences. “existing exposure situations”.

ICRP’s Message Regarding Fukushima The “emergency exposure situations” they are talking about here are the high Several documents have been published that are very useful in thinking levels of exposure to radiation immediately after a nuclear accident, in which about how to tackle the problems of radiation in Fukushima. ICRP Publication governments order emergency evacuations and standby operations. It is the 111, Application of the Commission’s Recommendations to the Protection same situation that the area around the Fukushima nuclear power plant was of People Living in Long-term Contaminated Areas after a Nuclear Accident placed in from March to April, 2011.

78 79 The term “existing exposure situations” refers to situations, after emergencies, Point 4: Define the reference level. heading towards rehabilitation or recovery. The nuclear power plant is in a The reference level is the dose above which evacuation and other measures situation where it cannot yet be controlled, but the release of radioactive should be taken. This number is only a guideline, however. ICRP states substances into the atmosphere has been reduced, changing this emergency that the reference level in existing exposure situations (during recovery/ situation to a situation of exposure to existing radiation. That is point number rehabilitation) should be set to between 1 to 20 mSv annually (this is why one. This is the situation that people in Fukushima and all Japanese are facing the Japanese government adopted the limit of 20 mSv). After that, they set right now, an exposure to existing radiation. the long-term limit at 1 mSv. They also state that even if the exposure is less Point 2: Management of exposure proceeds by individual dose. than the reference value, protective measures should be taken if there is any chance of reducing exposure. Since the amount of exposure to radiation in a nuclear accident differs greatly based on the individual’s behavior (lifestyle, diet, evacuation, etc.), it is not Point 5: Participation of residents (protection through self- appropriate to put in place measures that hypothesize an average level of help) is needed. exposure. It is necessary to put in place detailed measures that study the It goes without saying that residents are worried about the effects of exposure of individuals or evaluate groups based on their level of exposure. radiation. In addition, they probably expect the prefectural and national This presumably includes distribution of personal dosimeters. governments to respond and may mistrust those responses at times. Point 3: It is important to optimize and to justify protection However, there is a need for residents to act on their own behalf as well. measures. It is important for residents to adapt their behavior to the post-accident Optimization of protection measures means avoiding the adverse effects rehabilitation environment to decrease their exposure; they can do this by of exposure (through evacuation, etc.), but the balance of socio-economic taking note of locations where radiation levels are high and not entering elements (the losses in income, pride, and purpose in life that come with those areas, by avoiding foods that are easily contaminated by radioactive evacuation) must also be considered, and that means that the optimal substances such as and wild greens, and by monitoring their method of protection should be chosen taking these elements into own exposure and helping to support children and the elderly. In addition, consideration. Because all exposure protection measures impose some residents should actively participate in regional council meetings that debate greater or lesser degree of inconvenience on surrounding populations, rehabilitation and how to decrease exposures. depending on how extensive they are, they must be justified by showing Point 6: The authorities (prefectural and national) have the that these measures are necessary and take into consideration the balance responsibility for this. between the risks of exposure and the inconveniences imposed on residents. The authorities should not only protect the people who have been most For example, to evacuate people from areas where the exposure level is one exposed to radiation, but also draft radiation protection policies and that has absolutely no effect on the human body would harm, not protect, measures to decrease each individual’s exposure as much as possible, and the population. show proof of this. There is a need to define clearly and make public the assumed conditions In addition, it is their responsibility to determine what areas are inhabitable and data that serve as the evidence for deciding protection measures. The and guarantee the general convenience of habitation in those areas. premises are that (1) all important information is being provided to the parties in question and that (2) third parties can confirm the validity of the Besides these responsibilities, the authorities should also measure and entire decision-making process leading to the measure’s adoption. monitor individual exposures, decontaminate buildings, improve the

80 81 condition of soil and vegetation, review how livestock should be raised, younger people. The decision whether or not to leave one’s home and land monitor the environment (air, soil, etc.) and agricultural products, provide depends, therefore, to a certain extent on one’s age. safe food, process waste, inform the public, provide guidance to residents, In this way, individuals each make their own decisions -- but do not doctors and educate children. and other scientists and experts have the most important responsibility to The Dilemmas Confronting Us provide accurate and detailed information about radiation so that people can make appropriate decisions? The government should not take measures to These six points that were cited in the ICRP report clearly show what roles forcefully evict residents, but respect their wishes; instead, the government the national government, local governments, and residents themselves play should ensure first that they have the residents’ understanding, then draft in reducing damage caused by exposure to radiation and in moving towards flexible rules. rehabilitation. However, as I read this report, I could not help but think of the dilemmas we are facing. ICRP Publication 111 points to a basic way of thinking for moving toward overcoming the problems of exposure to radiation in the wake of a nuclear For instance, it is extremely hard to determine what is the best protection accident, but it does not give detailed instructions. That was left to the measure (cited in Point 3). Let us take agricultural products. discretion of the people of Japan. That is our decision. If the regulations for radioactive substances on agricultural products are excessively strict, restrictions imposed on the shipment of vegetables will become so stringent that local producers will not longer be able to do business. Attempts to protect consumers will adversely affect producers.

In this case, it is very important that local residents and other citizens reach a consensus, and at times it is important also to leave things up to the discretion of individual citizens, on the basis of national regulatory standards. In addition, there are problems with setting the “reference level” described in Point 4. This is a matter of the balance between the risk of exposure to radiation and the wishes of local residents (i.e. whether or not they want to remain where they are and keep living in their homes). The government has set the limit for annual public exposure to radiation at 20 mSv in the post- accident phase while things are returning to normal. If the exposure exceeds this level, the area will be evacuated.

So in other words, people can stay and live as usual in areas that are exposed to less than 20 mSv annually. There are many people who feel a sense of purpose and even advantages in staying where they are to till their fields and raise their cattle even if they know they incur a small risk by exposing themselves to radiation. Of course, some, unlike the others, will want to start a new life in a new home. For example, sensitivity to radiation varies depending on age. If exposed to the same amount of radiation, middle- aged people and the elderly will not be affected as much as are children and

82 83 Chapter 6 doses of radiation. In Fukushima-shi, 60 km away from the nuclear power Fukushima Now and in the Future plant, the radiation dose detected in the air remains at 1 micro-sievert per hour. If one stays in this environment for a whole year, the annual exposure Fukushima’s Current Situation (2011) would amount to roughly 9 mSv. However, this is a value that does not The Problems Are Piling Up require concern.

As I write this book, not yet ten months have passed since the accident at What’s more, when people in Fukushima-shi actually go out and measure Fukushima Daiichi Nuclear Power Plant. The work of repairing damage to external exposure with their personal dosimeters, their readings are the nuclear power plant has proceeded in fits and starts, a series of trial and significantly lower than 9 mSv. error attempts, but TEPCO has announced that they will bring the reactor Within a few days of the accident until the end of March, the cesium released to a “cold shutdown” by the end of 2011. The highest levels of radiation at from the nuclear power plant was carried by the wind and dissolved into the the perimeter of the nuclear power plant site have reached an annual level rain, which in turn fell down to the ground. The gamma rays emitted by this of 0.2 mSv (as of October 2011). This means they have dropped to roughly cesium are a cause of external exposure. As I stated in Chapter 1, the half-life 1/8,000,000 of the level of exposure after the accident. of cesium-137 is long, 30 years, so it will still be around for quite a while. In However, the problems are still accumulating. There are still challenges that other words, unless the area is decontamined, gamma rays will continue to remain and will require time, money, and wisdom to overcome, such as the be emitted. decontamination of 23 times the surface area of Tokyo Dome (Japan’s “Yankee On the other hand, the half-life of iodine is eight days. We can assume that all Stadium”, 112,456 square meters/27.8 acres), processing of nuclear power of this radioactive iodine has disappeared. plant-related waste, and establishing lifetime medical care for all of the 2 million people in Fukushima prefecture. Now is the time when Japan’s true The Ill-Timed Order to Evacuate to Iitate-Mura national potential is being tested. Iitate-mura, roughly 40 km northwest of the nuclear power plant, was not In this chapter, I will write about the current situation in Fukushima ten designated as an evacuation zone immediately after the accident. It was months after the disaster, and my experiences in periodically visiting Iitate- actually a destination for residents around the nuclear power plant to mura after the earthquake. I hope it will provide some guide to the making of evacuate to. However, because the wind had blown northwest from the decisions when faced with the future challenges of dealing with exposure to nuclear power plant, high doses of radiation were recorded there and the radiation. town was re-designated a “planned evacuation zone”. This caused great confusion among the town’s residents, who thought they were safe because Future Risks From Radioactive Substances they were located at such a great distance from Fukushima Daiichi. The nuclear power plant itself has not yet returned to normal or been I actually went into Fukushima on the bullet train and measured the level repaired, but it now releases hardly any radioactive substances into the of open-air exposure in Fukushima-shi, Iitate-mura, and Minami-Soma-shi; atmosphere. Currently, there are hardly any radioactive substances in the my readings showed that the radiation was highest in Iitate-mura, then in atmosphere or water supply. There is no need to wear a mask to prevent Fukushima City (seat of the prefectural government), and lowest in Minami- yourself from inhaling these substances, nor is there a reason to wear long- Soma-shi. The reason why Minami-Soma-shi, the closest to the nuclear sleeve clothing to avoid exposing your skin. It goes without saying that I, too, power plant, had the lowest reading is that winds carrying the radioactive am drinking tap water as usual. substances did not blow in that direction. However, the cesium that fell on the ground in March is still a cause of high

84 85 The result is that people who fled localities close to Fukushima Daiichi might they have been carrying around a dosimeter. be exposed to higher levels of radioactivity at their presumably “safer” External Exposures in Fukushima destinations than they would have if they had not evacuated. It is extremely regrettable that correct evacuation instructions were not given, because the So-called “ badges” are handy ways to measure individuals’ doses from authorities did not know basic facts regarding how radioactive substances external exposure. These dosimeters are used in hospitals; when radiation are spread. However, I should add and confirm that the level of exposure to hits a special kind of glass, a chemical reaction occurs, and the properties of radiation at that time was very low, not enough to increase the risk of cancer. this glass are used to “remember” the amount accumulated. The amount of exposure is measured by having people carry a small case with this The Truth About External Exposures glass inside at all times. The measurements from these glass badges are Some people have calculated that somebody will be exposed to 9 mSv yielding useful findings. It has been reported that the amount of radiation annually if they are in a park that has an exposure level of 1 microsievert/ accumulated between July and September by the roughly 2,500 people in hour for a year, but this assumption is nonsense. For one thing, the amount Kawamata-cho was at most roughly 1 mSv over three months. Similarly, it was of external exposure changes a great deal if you just move a few meters away found from the measurements of roughly 8,400 people in Date-shi during the from a given spot. month of August that annual exposure levels did not exceed roughly 5 mSv at most. Cesium carried by the wind gets dissolved in the rain that in turn gets absorbed by the soil it falls upon. Therefore, radiation in the open air changes Such an annual exposure to 5 mSv is indeed greater than the exposure limit greatly depending on the direction the wind is blowing in, precipitation of 1 mSv for normal times, but it is still below the level at which cancer rates and other weather conditions, the terrain, and the nature of the surface would increase, so this should not worry anyone. it falls upon. The radioactive substances released from Fukushima Daiichi Internal Exposure in Fukushima were carried by the wind between March 15 and 21, and even went as far as the Tokyo metropolitan area. The amount of cesium carried on the 15th At Chernobyl, restrictions on the consumption of milk, etc. were not imposed was greater, but fortunately no rain fell on that day and it just passed right until too late, and nearly 1% of children under four years old had their thyroid through. However, with the rainfall on the 22nd, cesium was deposited on glands exposed to over 10 Sv (10,000 mSv) of radiation -- an immense dose. surface soil. In Fukushima, restrictions were put on milk and food items and people were evacuated immediately after the accident occurred. As a result of actually When dissolved in water, cesium forms positive ions. Because soil is measuring the amount of exposure in the thyroid glands of over 1000 negatively charged, positively charged cesium is absorbed into the soil. The children in Fukushima, it was found that the maximum exposure was 35 mSv. place where the winds brought cesium on both March 15th and March 22nd The figure in Chernobyl was three digits (roughly a thousand times) greater, was around Kashiwa-shi. This area thus became a “hot spot”. and no increases in cancer rates come from thyroid exposures less than 50 Hot spots are found particularly in places where there was heavy rainfall mSv. and through which winds carrying cesium passed, and in parks and other We can therefore predict that there will be no increase in thyroid cancer in places where there is a lot of exposed soil. Exposures inside buildings, on the children in Fukushima. other hand, are much less than exposures outdoors. Even in wooden houses, exposure is about 40% of the level outside, and less than 20% in apartment In addition, studies on Fukushima residents are making it increasingly buildings and other reinforced concrete buildings. So in the final analysis, the clear that the observed levels of internal radiation due to cesium are level of an individual’s exposure to external radiation can only be known if not preoccupying. A study of amounts of internal exposure measured

86 87 continuously until the end of September by 4,463 people from Fukushima people there brought home to me how different residents felt very differently prefecture found that two people showed readings of 3 mSv -- and this was about the very same term, “evacuation”. Even among farmers, the way people the highest value detected. In addition to these two, eight people were feel about evacuation depends a lot on whether or not they raise livestock. exposed to 2 mSv, six people were exposed to 1 mSv, and the remaining 4,447 Livestock farmers give a compelling argument. They say, “our livestock are people were exposed to less than 1 mSv of radiation. There are probably family. Even if we evacuate, the livestock will need to be cared for every day,” many people who feel insecure because even a minute amount was and “People have trouble adjusting to unfamiliar land; cows have trouble, detected. This is not, however, a level at which cancer rates increase. I repeat: too: the amount of milk we get from them falls to half.” Pregnant women and there is no scientific proof that cancer rates increase at exposure levels of less parents with infant children are haunted by terrible anxieties. Such being the than 100 mSv. case, we presented the results of our team’s radiation dose measurements in On the other hand, from a radiation protection point of view and to be safe, the village in the following way. ICRP (International Commission on Radiological Protection) advocates the We told them: “Judging from our cumulative radiation estimates, the levels linear no-threshold model, which assumes that cancer will increase at even we found are not enough to justify extreme fears of increased cancer risk very small exposures, less than 100 mSv of radiation. Their policy is that the in adults. The risk is lower than the risk of eating too much salty food or too less exposure to radiation, the better. And yet even ICRP states clearly in a little vegetables. One alternative for you is to decide to evacuate only the report (ICRP Pub 96, Table 3.1) that cancer does not increase at 10 mSv. pregnant women and infants. But all things considered, the stresses of living There are, it seems, two sets of standards, one for 100 mSv and the other for in an evacuation center would be cause for more concern than the radiation.” 10 mSv, so there may be people who are confused about this. While no data We then had a talk with the mayor, Mr. Kanno, and we reached an agreement point to an increase in cancer at exposures under 100 mSv of radiation, 10 about what we would do. Our team would hold a lecture at which we would mSv is regarded as a level at which one can say definitively that no increase in explain to the village the effects of radiation exposure on health. We did this cancer occurs. because not knowing things and not having enough information are the According to studies conducted this September, hardly anyone’s exposure biggest causes for anxiety. Family situation, age, health status, etc. naturally has reached 10 mSv due to the accident at Fukushima. I repeat again: cancer differ from one person to the next. Given that it is so difficult to decide, will not increase in Fukushima. we offered to provide materials so that residents could consider their own situation and decide themselves what is best for them. I considered that this (2) My Visits to Iitate-mura was the best way to relieve their anxiety. My Visits to Iitate-mura and What I Saw Intensive-Care Nursing Homes: Evacuate or Stay Put? In my radiation therapy work at the University of Tokyo Hospital, I team up There is an intensive-care nursing home in Iitate-mura. I talked to Mayor with doctors, nuclear industry engineers, theoretical physicists, and medical Kanno regarding the evacuation of people in this facility. physicists. Beginning in late April 2011, together with this team, I periodically visited Fukushima. The mayor asked me, “Wouldn’t it be better for the residents to stay in the facility, rather than to be separated from each other, placed in gymnasiums We went into Iitate-mura, spoke with residents, and also interviewed the and evacuation sites like that all over the place?” mayor, Mr. Norio Kanno. I came across so many things there that I had not noticed or seen when I was in Tokyo that I was ashamed of my lack of insight, The average age of the nursing home’s residents is roughly 80; some are but in addition to my lesson in humility, I got a feel for the problems that over 100 years old. In contrast to the way fetuses and children are sensitive people in these areas were facing. For example, meeting and talking to to radiation, the risk that the elderly will develop cancer does not increase,

88 89 even when exposed to the same amounts of radiation. In most cases, it takes “If I believed everything I’m told I’d go crazy!” 10 to 20 years for cancer to develop from exposure to radiation. In addition, “I cannot sleep because of the stress. I wake up in the middle of the night.” drastically changing their living environments can subject elderly people to major stresses. “These children used to run around in the mountains. I feel so sorry for them now that they can’t play outside anymore.” As I wrote in the chapter about Chernobyl, a large-scale migration program was put in place in Chernobyl, implementing an extremely strict set of criteria “I was drinking local well water after March 11, even though I’m for the evacuation of all residents, and this evacuation significantly shortened pregnant...” people’s lives. Taking these things in consideration from a physician’s “Won’t I bring radioactive substances back, stuck to my clothes and bags, standpoint, I consider that it’s inappropriate to forcefully evacuate the elderly. if I go in to the village and back?” Residents Speak for Themselves “Young people say they don’t want to go back. Even if we go back ten Whether or not to evacuate is a very difficult question. All people have their years from now, we too will all be old folks.” own circumstances and ways of thinking, and family makeup and age groups differ as well. To ignore this diversity and apply one uniform set of guidelines “Wouldn’t it be better to spend the hundreds of millions on moving to all and sundry is not always the best bet. That is how I feel and my feelings somewhere else, rather than spend it on decontamination?” on the subject only grew stronger as I took part in the Q&A session after These are just some of the concerns they mentioned, but they vividly a village health affairs counseling meeting and listened to the evacuees’ portray the grim situation these residents are placed in and the uncertainty complaints. that lies ahead of them. I will cite some of them in the following pages: Some said about evacuation, “Even if we could come back someday, we want “My role in this world is to grow vegetables, so it hurts not to be able to to live somewhere else for now”, or “We just want to move somewhere else farm. I was supporting myself and self-sustained before.” with our whole community, all together”. Others, especially the elderly, want with all their heart simply to return to the place where they’ve been living “Assuming I go back, what am I supposed to do in a place where there and which they know so well. are no young people?” Flexibility is necessary in adapting to the circumstances and thoughts of each “Iitate is mostly mountains. You can’t decontaminate that.” person, not just evacuating all villagers regardless of their wishes. I realized this, not when I was in Tokyo, located so far away, but when I entered “Will my grandson and his wife come? What about their children?” Fukushima and heard firsthand the voices of residents and began to gain an “My children are saying they can’t get married, and even if they do get understanding of the situation. married, they can’t have children!” Verification of Official Published Data “Why didn’t they at least evacuate the children sooner?” There was another major reason why we visited Fukushima: to measure “For information, I trust word-of-mouth first and foremost, and then radiation levels. Our objective was to study why, within such small areas comes the Internet.” as schoolyards, there were different readings depending on the location. Moreover, many people had let our team know that they didn’t trust the “I am skeptical about all the information I hear.” measured radiation levels announced by the national and local governments,

90 91 and so we were there to verify the validity of these official data. get covered in dust and mud. The possibility of their inhaling earth dust is higher in schoolyards than in other places. Since it is especially important to To jump quickly to the conclusion, we found no reason to doubt the national care for our children in school, decontamination in schoolyards and similar government’s officially released information. We chose three locations areas should be given the highest priority from the standpoint of radiation (No. 32, No. 33, and No. 36) from the monitoring points established by the protection, that is, protecting the public from radiation. Ministry of Education, Culture, Sports, Science and Technology and made independent measurements of radiation using instruments of the same make The soil requiring decontamination from the nuclear accident is an estimated and model as the ministry’s. The values announced by the ministry and the 23 times the volume of Tokyo Dome (the world’s largest roofed baseball results of our measurements were as follows: stadium, a 55,000-seat structure in Tokyo measuring 1.24 million cubic meters), an overwhelming amount. It is impossible to process this all at once. No. 32; Ministry: 19.5 mSv, Nakagawa Team: 18.3 mSv We must establish priorities for the different tasks to be done and proceed as No. 33; Ministry: 13.8 mSv, Nakagawa Team: 13.6 mSv thoroughly and reliably as possible. No. 36; Ministry: 2.6 mSv, Nakagawa Team: 2.5 mSv

In all three locations, we found barely any difference between our High Exposure Risks for Accident Site Workers measurements and the government’s published figures. The people who Undoubtedly the radiation to which workers who have been working to collect these data are serious, hard-working researchers, and these figures are handle the accident day and night since it occurred will have effects on made widely available to everyone, to people and organizations all over the their health. Because cancer risks increase with annual exposures over 100 world, so under the circumstances, a cover-up is inconceivable. mSv, these workers, who are allowed exposures of up to 250 mSv, must be especially careful in the future. Keys to Decontamination

Decontamination work is now going on in Fukushima and other parts of the People who work on the front lines are assumed to be aware of the risks, Tohoku region and in Northern Kanto. What is needed, though, is a more and yet they must be urged to undergo regular checkups and screening and effective decontamination process that takes the radiological characteristics receive other medical care relevant to radiation exposure, and to continue of the contamination into account. As I mentioned before, of the various vigilantly to protect their health for the rest of their lives. Early detection radioactive substances released in the accident, a particularly difficult increases the chances of curing cancer. problem is posed by cesium, which has a long half-life and was dispersed in large amounts. Cancer Rates in Fukushima Will Not Increase. In the Chernobyl accident, 28 of the firefighters and workers who went into According to a study conducted in and Scandinavia after the site of the accident on a suicide mission died within three months due to the Chernobyl accident, the speed at which cesium sinks into the ground acute radiation damage caused by exposure to massive amounts of radiation. is usually 1 cm a year. Seven years after the accident, most of the cesium At the Fukushima nuclear power plant, workers were at least able to avoid a remained within 10 cm of the surface. A lot of rain falls in Japan; cesium from situation in which they absorbed a large amount of radiation instantaneously. atmospheric nuclear testing (during the 1950s and 1960s) has been seeping Although two workers were hospitalized due to acute exposure to radiation, into the soil since then, but none is found deeper than 30 cm from the no one is presently hospitalized, and no one has died. This is a big difference surface. Consequently, intensive decontamination by stripping off the surface soil between Chernobyl and Fukushima. is still possible and would effectively remove the risk of radiation exposure The increase in thyroid cancer in children that occurred in the general due to cesium. Children playing in schoolyards exercise vigorously and population in Chernobyl will not happen in Fukushima, either. It has been

92 93 confirmed that the internal exposure of the thyroid gland to iodine, and understanding of the risks of exposure to radiation. First and foremost, the amounts of external and internal exposure to cesium, are much lower what the government and authorities must do is to fully inform community than at Chernobyl. This is because, as I explained in Chapter 4, restrictions residents and citizens, produce a long-term radiation protection strategy, and were placed on the intake of contaminated foods and milk in Fukushima make everything as easy as possible for those concerned to understand. promptly after the accident. This was a very important lesson learned from the Chernobyl accident, and it was put to good use.

Balancing Risks While Making Urgent Decisions

On April 22, the area within a 20 km radius of the nuclear power plant in Fukushima was defined as a security zone based on the Basic Act on Disaster Control Measures. It was the first time that people have been barred (in principle) from entry into such a large inhabited area.

Outside of the 20 km radius, areas for which annual cumulative radiation doses were predicted to exceed 20 mSv were designated as planned evacuation zones.

Additionally, some areas in a 20 km to 30 km radius of the security zone were designated as emergency evacuation preparation zones; orders were given to prepare in these areas to take refuge indoors and to evacuate in the event of an emergency.

The number of people living as refugees away from their homes due to the accident is said to be 70,000 people. It is natural that many of those living now as refugees want to return to the land they love as soon as possible. Of course, if they return to their homes while radiation levels are high, the risk of exposure will increase. On the other hand, the stresses and psychological damage that come with living hemmed in and miserable in refugee centers increase day by day. This is also a risk. We need to think about balancing these risks to choose the best path for each individual.

We must move quickly to provide realistic answers to complexly interwoven challenges involving health, environment, economics, psychology, and ethics (in other words, the challenges of life itself amidst a multitude of risks). This, seemingly a philosophical proposition, poses real challenges in people’s daily lives. Living from one day to the next requires that deep and difficult decisions be made.

The elements needed to help us decide are accurate data and a correct

94 95 Chapter 7 a perpendicular direction (at right angles) to the way the winds are blowing, Responses to Radiation Exposure in Times of Emergency so in this case that would be either west or east. This is the speediest way for you to escape from the path the wind takes when carrying radioactive Ten months have passed since the nuclear accident occurred in Fukushima. substances. Initially, many people evacuated after the accident to Iitate-mura to avoid exposure to radiation. They didn’t know that radioactive substances from 2. Do not leave laundry outside to dry. the nuclear accident in Fukushima would be carried far away by winds. For In areas around volcanoes such as Sakurajima and Asamayama, volcanic example, there were strong winds blowing north-westwards from the nuclear ashes spewed out in eruptions sometimes pile up on roads, fields, rooftops power plant, and as raindrops fell, those radioactive substances fell to the of houses, and windshields of cars. Radioactive substances behave in a very ground. Compared to other locations equally distant from the nuclear power similar way to volcanic ashes. If laundry and bedding is left outside to dry, plant, the amounts detected in the area north-west of the plant, where Iitate- radioactive substances will stick to them. mura is located, ended up being clearly higher than elsewhere. Whenever and wherever the amount of radioactivity detected is high, I Initially, this was overlooked and an evacuation zone was established after recommend that you do not leave laundry outside to dry; presently, however, the accident based simply on the radial distance from the nuclear power there are barely any radioactive substances in the atmosphere, including in plant. Even in locations equally distant from the nuclear power plant, there Fukushima Prefecture, so it is safe to leave laundry outside. Sunlight has the are locations with both heavy and light contamination depending on the ability to disinfect (kill germs), so usually, in terms of hygiene, drying laundry wind direction; detailed evacuation plans should have considered these outside is better than drying it inside. For those of you who still worry, you points. can put covers on your bedding when you air it outside. The radioactive substances sticking to the covers can be brushed off easily before bringing The nuclear power plant is currently moving into the recovery phase. them inside. However, basic knowledge is the ingredients you need to make decisions and act in a calm manner, no matter what happens in the future. What is more, 3. Refrain from going outdoors. radioactive substances, even if the amounts are extremely small, are being Compared to being outdoors, the risk of being exposed to radioactive detected here and there nearly everywhere. There are some facts that we substances lessens when you stay indoors. For instance, exposure to radiation need to know in order to avoid further exposures. inside a concrete building is less than 20% of exposure outdoors. Concrete In this chapter, I will write about what we can do to prevent exposure to buildings provide shielding from radiation, and also prevent radioactive radiation. Take note that there may not even be any need to take these things substances from coming inside. Exposure inside wooden houses is roughly into consideration in the future, given the current radiation doses. I still hope 40% of the outdoor level. that you will stock and keep this information in the back of your mind, to be There are some people who claim that retreating indoors does not have used in times of emergency. much of an effect, but they are wrong. The effect of retreating indoors comes 1. Escape in a direction perpendicular to the direction the from the fact that the building shields people from radioactive substances winds are blowing. in the atmosphere and radioactive substances that adhere to the ground As I explained in Chapter 1, radioactive substances spread like pollen. If the and outsides of buildings. You should avoid going outside when you don’t winds are blowing northwards from the nuclear power plant, radioactive need to, but there is no need to worry if you wear a gauze mask and clothing substances will be carried by this wind and travel north. Evacuation is quite that does not expose your skin. Commercially available masks are effective simple. You should pay close attention to the weather forecast, and escape in in preventing dust in the atmosphere with radioactive substances stuck to

96 97 it from getting into your body. To be even more thorough and for greater and things like that. When I went to visit in April, roughly a month after the protective effect, you can hold a wet towel or handkerchief to your nose and accident, I conducted quick radiation measurements on spinach and wild mouth. vegetables that were provided with the cooperation of residents of Iitate- mura. The results showed that extremely high doses of radiation were When coming back from outside, make it a point always to brush off your detected, as follows: clothing to rid yourself of the radioactive substances that have stuck to them, and to gargle. By doing this regularly, not only will you be removing Type: Cs-134 Cs-137 radioactive substances, but this will also be effective for hygiene. However, Fatsia sprouts (Iitate-mura) 2874 becquerels/kg 3528 becquerels/kg there is no need to change clothes every time you come back home from Flowering fern (Iitate-mura) 10240 becquerels/kg 13242 becquerels/kg outside. Fukinoto (Namie-machi, point 32) 9681 becquerels/kg 12061 becquerels/kg (Note: The becquerel is another unit of radioactivity. Food products are not Radioactive substances reach the ground via rain, so you should try to stay allowed to be shipped if the level exceeds 100 becquerels.) out of the rain as much as you can. The team I was a part of advised residents not to eat the wild vegetables they 4. Be suspicious of wild vegetables and edible mushrooms had picked themselves. harvested outdoors.

To avoid taking in radioactive substances through food intake, you can 5. Small children are more susceptible to the effects of remove radioactive substances that may have adhered to your food by radiation. peeling off the outer layer of cabbages and Chinese cabbage, and carefully There are ditches and rain gutters around us all, and there are some points peeling the skin from potatoes, carrots, etc. You should thoroughly rinse leafy in which rain water containing cesium easily accumulates. There are times vegetables such as spinach and komatsuna. when radiation doses are higher and radioactive substances are more highly

Commercially distributed food products have passed inspections to get to concentrated in these places than in other locations. It is important to be storefronts, so there basically is no problem. (However, spot checks of certain careful that children do not stick their hands inside the pools of water that shipped food products have detected radioactive substances that exceed the accumulate under rain gutters, or drink this water. It is also wise to prevent national provisional limits.) them from breathing in clouds of dust in these areas. This is because, even when exposed to the same amount of radiation, children can develop cancer The national and prefectural governments will send out information if the more easily than adults. By the way, the effect on the thyroid gland when amount of radioactive substances in drinking water and food products are radioactive iodine is taken in (what they call the ) is 10 times found to exceed the regulatory limits. If this kind of information is not being that of an adult. However, the amount of food intake for children is less than reported, it is safe to think that levels are within the regulatory limits. adults, so they take in smaller amounts of radioactive substances. It would be wise not to eat foods that individuals gathered in the mountains, If you are worried about the radioactive substances in the atmosphere, you since those foods have not been inspected pre-shipment. In particular, can try to avoid ventilating rooms in which infants stay, or when ventilating, mushrooms and wild vegetables have a tendency to build up concentrated use ventilation equipment with very fine filters to prevent radioactive levels of cesium, so you need to be careful. substances from entering the room. If you are worried that radioactive For example, Iitate-mura is a treasure house of wild vegetables. I hear that substances enter the room and stick to your bedding, couches, or rugs even many people were looking forward to picking wild vegetables. However, it is while you are quickly opening or shutting your windows, you can vacuum known that cesium is easily concentrated in flowering ferns and mushrooms frequently to remove them.

98 99 6. Be especially cautious about what your children put in their warrant concern about the effects of internal radiation in children who have mouths. put mud into their mouths like this just once or twice. However, parents do

We cannot with any certainty deny the possibility that exposure to radiation need to be careful that children do not repeatedly do this. (This is not solely can come from such sources as cesium contained in food and drinks such as because of the effects of radioactive substances: it is also because eating mud milk that children take in. In general, there are no problems with commercially in itself may have adverse effects on the child’s health.) available milk and dairy products, but you should check the information that 7. To move away or not to move away should not be decided is sent out by the national and prefectural governments. Furthermore, as I hastily. wrote in Chapter 4, the safety regulations regarding radiation which might I hear people say they are wondering whether or not to move away because cause internal exposure will become even stricter in the future. they live in a place with high radiation doses. I think that asking for an The Ministry of Health, Labour and Welfare has announced a policy to lower expert’s advice about how much radiation you would be exposed to by the provisional limit for radioactive cesium from 5 mSv a year to 1 mSv a year. living there for one year is a good way to get an estimate to base your This is because the Food Safety Commission of Japan, which reports to the decision on. Evacuations are semi-compulsory, but moving is something you Cabinet Office, has published a report evaluating the effects of radiation on have a choice about. Relocating entails economic burdens and greatly alters health due to internal exposure from food; it reports that effects are seen your living environment. It is a very hard decision to make on your own. when lifetime accumulated exposure exceeds 100 mSv. For example, the Before making this important decision to relocate, it would be wise to provisional regulatory limit for vegetables is 500 mSv/kg, but if we simply decontaminate the roof, walls, window frames, crevices in which water is divide that by 5, then 100 mSv will become the new limit. This is 1/12 of the easily collected, and soil of areas surrounding your home. There are cases in regulatory value set in the United States, so for producers it is an extremely which people carefully vacuum up the dust inside their houses but still have stringent standard. With this revision of the limit, fears of internal exposure continually high radiation doses detected, for example, only in the rooms to radiation should be even further reduced, and this should bring peace of facing south. This may be the effect of radiation from radioactive substances mind to people in Japan. in the garden or yard. Removing a few centimeters of surface soil and weeds Furthermore, the current provisional regulatory limits for radioactive cesium in your garden or yard will probably decrease the radiation doses in those are set in five categories: drinking water, milk/dairy products, vegetables, rooms. grains, and meat/eggs/fish/other. In the future, these five categories will Fukushima Prefecture has published a Guide to Measures for the Reduction be reorganized to meet international standards, and there will only be four of Radiation Doses. I recommend that you use this as a reference when categories: a new category, baby foods, which will include powered milk, etc., decontaminating your property because it is a detailed and very user- plus the three remaining categories: general foods, drinking water, and milk. friendly manual. It also writes about how you should go about disposing of With this change, new regulations will be imposed on foods for children, who the surface soil that you removed. If you are equipped to measure radiation are more susceptible to the effects of radiation, and this should put the minds doses, it would be good to compare your measurements before and after you of parents of small children at ease. decontaminate. Remember that in many regions of the world, annual doses In addition, sometimes I hear stories of children in so-called hot spots where of natural radiation reach 10 mSv, but residents there suffer no increase in high levels of radiation have been detected who accidentally put their muddy cancer rates. hands in their mouths while they are playing in mud. Small children will put ICRP has clearly stated that there is no increase in cancer caused by exposure anything in their mouths, so there is a need to be careful. In general, the to less than 10 mSv of radiation. I think it is safe to live anywhere where amounts of radioactive substances detected thus far are not high enough to

100 101 Chapter 8 radiation is less than 10 mSv. Addressing Anxieties About Radiation Exposure and Cancer 8. Unnecessary exposure to iodine and cesium is strictly unnecessary. All kinds of information and statements about radiation have been pouring

There has been no confirmed increase in cancer risks from exposures to less from the TV, newspapers, magazines, books, and the Internet since the than 100 mSv of radiation. However, just because it has not been confirmed nuclear accident at Fukushima. As a physician and a radiation specialist, I am is no reason to expose oneself to unnecessary radiation. Based on the ICRP angry that many imposing statements have been made by people with no recommendations, Japan has set the limit for annual radiation exposure to expert knowledge about radiation, fomenting people’s anxieties and fears. 20 mSv for residents in the post-accident recovery stage. The limit is 1 mSv in Of course, nothing would be better than never having been exposed to normal times, so we should try to get back to 1 mSv as soon as possible. radiation needlessly. If I could, I would like to get into a time machine and go back before March 11th. Unnecessary exposure to radiation is strictly unnecessary: all reasonable efforts to decrease exposure to radiation are absolutely necessary. I have written in this book that there will be no increase in cancer in Fukushima due to exposure to radiation -- but there may well be adverse effects on people’s health and happiness due to evacuation and stress. I personally know a couple that got divorced over the question whether they should let their child play outside or not. I believe nuclear accidents are a sin with terrible consequences.

Even so, as a clinician, I cannot stand by idly as people who call themselves experts feed people’s anxieties by repeatedly claiming that the situation is dangerous, although they don’t even know the facts about Hiroshima, Nagasaki, and Chernobyl.

I feel strongly about this because there will be negative health effects if we fear exposure to radiation too much, at the same time that there will be negative effects if we fear it too little. In other words, worrying too much about exposure to radiation does not stop at just being needless concern: it has negative impacts. This is clear from the fact that people in Hiroshima enjoy long life expectancies, and from the fact that the average life expectancy in Chernobyl dropped after the accident.

Cancer will increase if one fears exposure to radiation and lets one’s lifestyle deteriorate, and life expectancy will be shortened if people who do not need to evacuate are forced to. In particular, exposure to low levels of radiation causes hardly any increase in the risk of cancer, but if anxiety is fueled, this will have negative repercussions on people’s lives, and this worries me as a clinical oncologist.

In the following pages I would like to describe my personal reaction to some

102 103 of the untrue things that some elements of the mass media tell people and UNSCEAR, IAEA, and ICRP (all reliable international organizations) have whose truthfulness people have good reason to wonder about. reported that such genetic effects have not been seen. There is no cause to Question: Seven mothers in Fukushima were found to have 2-13 becquerels/ worry in the case of Fukushima, either. liter of radiation in their breast milk. Is this dangerous? Question: Does it get harder for a person to get pregnant if Answer: A study group from the Ministry of Health, Labour, and Welfare they are exposed to radiation? announced these test findings in June 2011. The radiation is most likely Answer: At even moderate doses (e.g. exposing testes to 100 mSv of due to cesium. The level cited, 2-13 becquerels/liter of breast milk, is so low radiation), there are rare cases in which males become temporarily infertile; that it is hard to even tell whether or not that breast milk actually had any they recover spontaneously, however, and this has no effects on radioactive substances in it. his mate’s future pregnancies or children. Massive exposures to radiation For example, if a sample of 10 cc of breast milk was taken and tested for at levels that can result in death (thousands of mSv) do cause irreversible radiation, and this measured level of radiation was multiplied by 100 (to make infertility. Low levels of exposure to radiation (under 20 mSv), however, do it a per-liter figure), its accuracy would be in doubt: the margin of error is too not make it harder to achieve pregnancy. large in proportion to the sample size. I doubt that a reading at this level has any meaning at all. Assertion: “We must keep the annual limit to exposure at 1 mSv” Furthermore, I do not think that there would be any effect, on either the mother or the child. The amounts of cesium found in the body tissues and the Fact: I hear these kinds of statements made on the Internet and on TV. Of urine of many children exposed to radiation at Chernobyl is known to have course, the lower the radiation dose is, the better. However, there is no surpassed 500 becquerels/liter (1 liter of fluid = 1 kg of solid). Even at those evidence that there will be adverse health effects due to low exposures over much higher levels, there were no confirmed cases in Chernobyl in which 1 mSv. There is no scientific evidence for these values. cesium caused cancer. Furthermore, there is roughly 5,000 becquerels of There is a law in Japan stipulating that the annual level of exposure to radioactive potassium in an adult human body in normal times to start with, radiation under normal circumstances should be kept under 1 mSv (it does and this does not cause any health problems. Given these considerations, not take into account natural radiation and the man-made radiation used in radiation levels of 10 becquerels fall within the margin of error. medicine). This is a policy that takes safety into consideration, with a margin

That is not all: relatively large amounts of radioactive potassium are found of extra safety. This margin is scientifically based on the level above which the normally in fruits and vegetables, so if a person takes in a lot of fruits and risk of cancer is known to increase due to exposure to radiation, which is 100 vegetables, there will necessarily be an increase in internal exposure to mSv (assuming people live to be 100 years old). radiation. And yet we know for a fact that eating vegetables decreases, not I have explained this in other chapters, but data collected from the studies increases, the risk of developing cancer. conducted in Hiroshima and Nagasaki and data on workers’ exposures at nuclear power plants and on exposures of medical radiologists and radiation Question: Will congenital anomalies occur more frequently in newborns? technicians do not show any verifiable increase in cancer risk due to doses of radiation lower than 100 mSv. Answer: Some scientists claim that some sort of genetic symptoms will be caused in children by their parents’ having been exposed to radiation. I am worried about the adverse effects of hastily taking such actions as However, the studies of Hiroshima and Nagasaki reveal no case where the evacuation out of one’s fear of exposures to low doses of radiation. As I have effects of exposure to radiation were passed on genetically to children. said repeatedly, there is nothing better than not to be exposed to radiation.

104 105 But we must realize that forcible evacuation in situations where very little or atomic bomb was dropped, the radioactive substances that did not undergo no health risk is caused by radiation may cause harmful and unnecessary side rose up into the stratosphere, and after that, some of these effects. This is a lesson that the Chernobyl nuclear accident has taught us. We radioactive substances fell to the ground when it rained. This is what people must not forget this lesson. call “black rain”. The radioactive substances that fell with the “black rain” were later detected in the north-western regions of Hiroshima, and the eastern Assertion: “The ‘deathly ashes’ () that were parts of Nagasaki, blown there by the prevailing winds. The dispersion of generated by the nuclear accident are equivalent to 800,000 times the amount in the nuclear bomb dropped on Hiroshima. radioactive substances was, in other words, almost identical to how they The total heat generated is 29.6 times that of the Hiroshima moved in Fukushima. bomb.” However, in the atom bomb explosions, much of the radioactive substances Fact: These comparisons cite specific numbers, which make them all the that were pushed up into the stratosphere did not come back down to the more sensational and excite terrible fears. However, I don’t think that the ground, and were dispersed into the atmosphere. Uranium-235, which was comparison of nuclear accidents with nuclear bombings is fair, and it is used in the atomic bombing of Hiroshima, has a half-life of 700 million years. meaningless in the bargain. For its radioactivity to lessen will take an unimaginably long time. If a lot of this had fallen onto Hiroshima, there would still be effects on the health of In an atomic bomb explosion, large amounts of radiation (gamma rays, people who currently live there, but this is not the case. , etc.) are released, killing many people by acute radiation injuries undergone when they are exposed to the flash. In a nuclear accident, rays Question: Would it be better to consider moving to Western (radiation) are not emitted all at once; the radioactive substances released Japan? from the plant site spread like pollen, and the problem of radiation comes Answer: I think this is utterly pointless. Why? Because the amount of natural from that. radiation that people are exposed to is higher in Western Japan. There is a big difference in the effects on the human body between being I can understand why someone would move to western Japan to get away exposed to a large amount of radiation at once (atomic bombings) and from the trouble of insufficient supplies of groceries and daily necessities and slowly being exposed to radioactive substances (as happens after accidents an inconvenient lifestyle, but I believe that moving west to escape the effects at nuclear power plants), and they should not be treated in the same way. of radiation is just nonsense. The levels in Tokyo (also in eastern Japan) have Let us momentarily overlook our objections to this comparison and calculate almost returned to normal. the amounts of radioactive cesium, a component of the “deathly ashes”: Regions in which there are silver and copper mines and other mineral ores we can say that 168.5 times the amount of cesium that was produced at have higher levels of natural radiation. has the highest levels Hiroshima was produced as a result of the accident at the Fukushima nuclear of natural radiation in Japan, and the lowest levels are found in Kanagawa. power plant. These numbers by themselves are very surprising. Of course, this There is a difference of about 0.4 mSv between the two places. Now, if is a very serious situation. I must add, however, that atomic bombs mainly you are thinking that there might be fewer cancer patients in Kanagawa release gamma rays and neutrons, and the amount of cesium is small: that is Prefecture, that is actually not the case at all. As I wrote in Chapter 1, the another (perhaps the main) reason why the figure for cesium released after amounts of natural radiation that we are exposed to on a daily basis are very the Fukushima nuclear power plant accident is 168.5 times what it was at small, so they do not have an effect on human health. Hiroshima. Question: I live in a place that is called a “hot spot”, but how However, let us look also at the similarities between the situations. After the many mSv is dangerous?

106 107 Answer: There are hot spots in locations toward which winds blew from the even stricter. The current limit for annual exposure to radiation in food is 5 nuclear power plant after the accident. Kashiwa-shi in Chiba Prefecture is mSv, but there is strong pressure to lower this even further to 1 mSv, one-fifth one of these locations. According to data presented by a research group at of the current limit. The Food Safety Commission, upon deliberating on the Nagasaki University, even if the hourly exposure to airborne radiation is 5 effects on the human body of radioactive substances in food, has officially mSv, the individual radiation dose is actually just one-tenth of that. Levels of declared that cumulative lifetime exposure to radiation that people receive airborne radiation do not equal the amount of individual exposure. from food should be kept under 100 mSv. If we assume that a life lasts 100 years, a simple calculation gives us a limit of 1 mSv per year. Although this is just a reference figure, the level at which radiation becomes dangerous is when hourly exposures exceed 1 microsievert. That is when we For example, the current maximum in vegetables is 500 becquerels/kg, but should pay attention to our exposure to radiation. Japan has currently set the this will be lowered to 100 becquerels/kg. The regulatory limit for vegetables annual exposure limit at 20 mSv, and is designating for mandatory evacuation in the US is 1200 becquerels, so this is 1/12 of the US regulatory maximum. It all areas with exposure levels higher than 20 mSv. may seem unreasonably strict to impose such demanding restrictions, but I believe the government has set the limit this low because they expect this to As I wrote previously, after the Chernobyl accident, people were forced to be achievable. evacuate from areas that had annual exposure levels of as little as 5 mSv -- even stricter than Japan’s regulations. Russian experts themselves now admit Of 3,373 people who were studied in a survey of internal exposure to that this was a mistake and failed to protect the people. Many residents radiation in Fukushima Prefecture, seven people had exposure levels above 1 who had no need to evacuate were forced to evacuate, and as a result, they mSv -- not even 1% of the total sample. All others were exposed to less than 1 suffered harmful adverse effects in addition to their exposure to radiation, mSv. resulting in a seven-year decrease in the population’s average life expectancy. Question: Where are we going to put the rubble and soil from People lost their will to live and their pride when sudden changes in their lives Fukushima? brought on unemployment and austerity. Alcoholism rose, many became Answer: Where to put the contaminated soil is a tough problem for depressed, and some even committed suicide because of this. Psychological Fukushima. This is a problem when decontaminating individual people’s anguish and stress increased the risk of mortality. residences as well. If the radioactive substances accumulated in the gutters I understand that people may feel anxious about living every day in an area in front of peoples’ houses is simply flushed away, it may end up in front of that is called a hot spot. However, the levels that are being detected right the next person’s house. This kind of thing is happening every day. Whether now will cause no problems. It is wiser to think that evacuation would pose a the decontamination is done individually or on a large scale, we must hurry greater risk. to create a system that does not merely shift the burden onto someone else’s Question: They say that 3200 becquerels/kg, six times the shoulders. Considering this, I think it was a great thing for Tokyo Prefecture to national regulatory standard of 500 becquerels/kg, was accept rubble from Fukushima. detected in beef from cows that ate contaminated rice straw. What would happen if I ate that? Complaint: Malicious rumors are hurting us. Reply: For harmful rumors to be eliminated, the majority of people need to Answer: If you are served and eat a 200 g steak made from this beef, the share a correct understanding of radiation. It is because people do not know exposure would be 0.01 mSv; this is not a dose at which you should worry the facts that some make statements on TV and in the press such as “Don’t about the effects on your health. eat vegetables from Fukushima.” I believe that this is the kind of malicious act Starting in April 2012, Japan’s national regulatory restrictions will become that foments harmful rumors.

108 109 People in rural areas and people in the metropolis, survivors of the disaster, harmful things into their bodies. Minamata disease, the starting point of producers, and consumers all have differing points of view, but the most Japanese environmental pollution awareness, was caused by accumulation of important thing is that they share a correct understanding and knowledge. I a heavy metal in the human body in high doses, because people are high in want people to know that Japanese food safety standards are already strict as the food chain. More recently, pathogenic 0-157 and BSE (mad they are, and they will become even stricter. cow disease) have been in the news. Both were caused by putting harmful things into the body. These problems in the past have heightened people’s I understand that the people of Fukushima are in a terrible predicament now. present awareness regarding food safety. Furthermore, Fukushima’s most important industry, agriculture, is facing a major crisis because, beginning in April, the regulatory limits for radiation I think that the almost excessive anxiety in response to internal exposure in food will become 1/5 what they were. In other words, annual exposure to radiation has this as a backdrop. However, radioactive substances are limits are going to be lowered from 5 mSv to 1 mSv. This will certainly hit the different from heavy metals and are discharged eventually from the body producers hardest. through excretion and one’s metabolism. I should also add that radiation weakens over time. It takes a certain period of time for radiation that has been emitted to disappear. I hope that there will be generous compensation for producers. Let me add finally that when people make sensational remarks, various From the consumers’ standpoint, however, the fact that food regulations will motives can be at work behind the scenes. The claimants may have a conflict become even stricter means that no one should have any worries when they of interest when, for example, they warn you about internal radiation eat agricultural products that are available on the market. exposure and also coincidentally sell supplements that, they claim, protect you against this exposure. The best protection is to have access to the most I cannot help but feel that someone who, safe and secure in Tokyo, makes reliable possible information. a commotion about dangers where the risks are low is causing needless suffering for the people of Fukushima.

Assertion: “Internal exposure to radiation is 600 times more dangerous than external exposure.”

Response: I have no idea where the scientific proof for this statement is. Cesium, an , is similar to potassium, and like potassium, when it is taken into the body it is distributed almost evenly throughout the body. This has been confirmed by analysis of cows in Fukushima Prefecture that ran wild and were put down. Because cesium is distributed very evenly throughout the body, internal exposure to radiation emitted by cesium does not collect in or affect any particular organ; it is almost the same as exposure to external radiation, which affects every part of the body equally.

I therefore do not think there is a difference between internal and external exposures to radiation. 1 mSv of exposure has the same effect on the human body, whether the exposure is internal or external. I have seen the claims made by some ECRR scholars, but I think that they do this just to scare people. However, psychologically speaking, people do feel anxious about putting

110 111 In Conclusion Tokyo consumed and consumes especially large amounts of electric power, Ever since the nuclear accident caused by the Great East Japan Earthquake so now is the time to support Fukushima in return. I touched on the subject on March 11, 2011, we have had to face serious problems, one after another, of accepting Fukushima’s debris in this book. This is one of the few things problems we have never faced before. that we who live far away from Fukushima can do, in however modest a

The first was the risk of cancer from exposure to radioactive substances fashion, to share the hurt of the people of Fukushima. leaking from the nuclear power plant. This probably is what most people This great metropolis with its dazzlingly bright lights, lit up throughout were most worried about. Here I have tried to explain from my standpoint as the night and consuming vast quantities of electricity, is a symbol of the a radiologist in a way that is as easy to understand as possible the connection modernization that mankind has achieved. Yet even with the world’s highest between exposure to radiation and the mechanism of cancer’s occurrence. technology, we cannot reduce the half-lives of Cesium-137 (30 years) and

This nuclear accident created other problems as well. They include the Uranium-238 -- a mind-boggling 4.5 billion years. Even worse, because men psychological and economic damage resulting from living for months have created substances such as plutonium and strontium that never existed and years in evacuation centers and from malicious rumors, as well as in nature, we are polluting the natural environment with elements beyond the aftereffects of being bombarded with conflicting reports and more our control, and as a result, we, too, must now lead insecure lives. information than anyone can normally deal with, situations which cause the I see so much palpable arrogance in this destructive behavior, because we affected populations immense anxiety and severe mental anguish. human beings are but one species among multitudes inhabiting planet Earth.

When I saw this situation arising, I felt strongly, more strongly than I had ever May this accident be a chance for us to reexamine our own mode of existence before, how immoral it is that nuclear accidents are allowed to occur and with humility and to rethink our approaches to how things (including energy how I must now assume fully my duty and role as a radiologist. I needed to problems) ought to be dealt with in modern society. Japan is a country communicate the facts properly in the light of the current situation, as an surrounded by the sea on all four sides; it has four enjoyable seasons of the expert and as fully as possible. This was how this book came to be published. year and plentiful forests and water all year round. The Japanese have lived I will never say to people: “You have nothing to fear: don’t run away.” I for thousands of years blessed by the seas and mountains that surround it. understand very well parents’ feelings when they worry about their very Fukushima, with its abundant harvests of vegetables, fruit, and seafood, was young children: they will obviously choose to do what is best for their a prefecture that typified the generosity of Japan’s natural endowments. For families. Ever since the nuclear accident, we have been faced with unusually many, many years to come, the national government and TEPCO must make hard decisions affecting our everyday lives. This will probably continue for amends for their horrible crime of polluting such beautiful lands and , some while. My hope is that this book will help readers understand their forcing tens of thousands of residents to move far away from their homes. options if they are placed in a situation where they must make such difficult The path ahead of us is long and will be filled with hardships. However, choices. eventually, in one way or another, we will recover. My reasoning behind this When looking back once again at that nuclear accident, I am assailed by a certainty, as I have repeatedly stated in this book, is that, after Hiroshima and welter of thoughts. Tokyo Electric Power Company (TEPCO)’s Fukushima Nagasaki, Japan rose up and became the prosperous nation it is today. Even Daiichi Nuclear Power Plant provided electricity mostly to the Tokyo more surprising, Hiroshima is now the city with the longest life expectancy metropolitan area. In other words, the nuclear power plant in Fukushima in Japan (which has the highest life expectancy in the world). Fukushima provided us here in Tokyo with the electricity we needed to live in comfort for Prefecture, by coming to terms with the facts of radiation and taking decades. We must never forget this. appropriate actions, will someday have the highest life expectancy in Japan. I

112 113 firmly believe this.

December 2011 Keiichi Nakagawa

114