'7 1 8h :14 EXECUTIVE OFFICE OF THE r I .GIDENT 5 CQLOFFICEOF SCIENCE AND TECHNOLOGY REPOSITORY~Q~ik- WASHINGTON. D.C. 20506 COLLECTION cs%(- (-V-aR% 23 December 1969 BOX No. L-X? . , b'A% FOLDER bbM-b' wnz&,31st0

Dear Dr. Bruner:

I am writing to confirm our telephone conversation. The President's Science Advisory Committee (PSAC) has established a panel on Biological and Medical Science under the chairmanship of Dr. Ivan L. Bennett. The panel is devoting its initial efforts to a consideration of national health policy. On January 9 and 10 representatives of various Government agencies will meet with the panel to describe the relation between their agency's mission and health- related matters. The panel is particularly interested in learning the problems the agency faces with a view toward helping to solve these problems.

We hope to see you on Saturday, January 10, 10:30 - 11:30 a. m., in Room 208 of the Executive Office Building. If you would care to prepare a written summary (25 copies of ...... _ .._...... -.. .. background information) to supplement your presentation, I . would be happy to distribute it to the panel members in advance of the meeting. In order to do this, I would have to receive the summary by January 5.

I am looking forward to seeing you.

'Sincerely, , . , /

Leonard Laster, M.D. '

Dr. H. D. Bruner ** Assistant Director Division of Biology and Medicine U. S. Atomic Energy Commission Ge rmantown, Maryland 3 GL A" -

I

40035b0 < f SYNOPSIS OF GOlZLS OF TllE U. S. ATOMIC EKEEGY CO3PllSSlOY W11ICIl ARE RELATED TO IKALTH

1. PromoLe Xational Dcfcnse - To make the maximum contribution to the Con::#:oil deicnsc 2nd security of the United States through the devclopzcnc, use, and control of atomic energy for military and all other purposcs~whichare vital to the iiationnl security.

2. Contribute to General Welfare - To make tlic maximum 'contribution to the general welfare by conducting, assisting, and fostcring research and development, to encourage scientific and industrial progress in peaceful application, and to protect thc health and safety of the public.

I 3. Strengthen Competition - To direct the development, use, and control of atomic energy so as to strengthen free competition in private enterprise.

4. Promote International Cooperation - To make the benefits of peaceful applications of atomic energy available to cooperating nations as widely as expanding technology arid considerations of coinmon'defense and security permit.

Two Divisions of the Commission are charged with carrying out these Goals with reference to their health aspects.

1. The Division of Operational Safety develops and recommends safety policies, guides, and requirements followed by appraisal and evaluation of programs in the following areas for personnel of the , ...... 5 .L. _...... _ .._. , .. .. AEC and its contractors:

a. Standards and interpretations for radiological protection b. Occupational Medicine and industrial hygiene c. Fire protection and industrial safety d. Air, water, soil and environmental control e. Waste management f. Emergency planning vis-a-vis accidents g. Ten other areas related to reactors, power sources, waste management, and transportation

2. The Division of Biology and Medicine is charged with:

a. Bioxedical Research in Radiological Effects and Processes - To incrcasc basic knowledge of the biological effects of radiation on man and his cnviroiimenc and to provide scientific data to extend and rcfinc cxisting Guidance for the control of exposure to radiation. i i

h. Health and Safety Problems - To utilize basic knowledge of radiation effects to evaluate the consequences of radiation exposure to man and to solve the relatcd practical health and safety probleiiis of atoiiiic energy opei-ations.

c. Beneficial Applications - To discover beneficial uses of special nuclear and radioactive materials and accelerator radiations ior diagnosis and trent:ment of cancer and in other practical medical and biological applications.

d. To cooperate with other agencies and national programs in conducting programs in basic and applied biomedical research on ionizing radiations and related fields.

(Items 1 and 2 cover a very wide range of investigations which are directly related to resolving questions of the biologic hazards that might be associated with the rapid expansion of reactor programs and use of radiation in industry research and medicine. Radiation as a normal component of living things and the environ- ment cuts across conventional scientific disciplines and organizations so that problems and areas of investi- gation are correspondingly comprehensive. See Program . Booklet.)

, 3. Organization of the Division of Biology and Medicine:

a. Program development and control is administered by 40 . scientists of widely varied backgrounds supported by 41' administrative-secretarial personnel within the Headquarters at Germantown, Maryland.

b. The research program is carried by contract via operational offices with educational institutions, companies, foundations and other government agencies. . c. The current operating budget is essentially stacic at $89.5 M; about 75% is directed to the National Laboratories and large unit laboratories and 257, to individual investigators or small, groups in universities (average about $40,000 annually).

.-*e-- - 4. Problems and Issues:

a. The static budget is equivalent to a reduction in funding due to increasing salaries and other rising costs. The resulting

-7- Enclosure I'B"

I , dislocations and rcadjustmciits have been made morc acute hy the need to organize ncw programs, and to reorient and expand others to respond to organizations and members of Lhe piiblic who question the inLroduction of civilian nuclear power. Thus areas of equally important research, but of less urgency, are being deloycd or neglected. The effects of this deferral will bc felt within 5 to 10 year.

b. The immediate and short-tcrm effects of ionizing radiation are reasonably vel1 understood, whereas clear data concerning the long- term or chronic effcc ts of such exposures are only now beginning to be obtained. More is known about the effects of radiation on man, animals , and special laboratory materials than on the componcnts in the environment that make up the "ecological webs;" a special effect iiiust be made in the latter area.

Ecological studies above all require time; there is no reliable way of telescoping the procedures or the collection of the datz from such experiments. Second they are expensive and the publishable data appear disproportionately small. Third, only the mature investigator can affosd from a career standpoint to undertake such long-term possibly unrewarding studies regardless of the number of eventual publications. Fourth, there must be comqitincnts on both sic?es that the plan-led researches will be carried through and amply fuiided for the requisite number'of years--possibly 15 to 20. Fifth, the investigators must be ...... , allowed a substantial fraction of their time to devote to scientific researches not precisely a part of the research plan and be supported in every way in such researches.

The Division has pioneered in this type of investigation in man, animals , gcnctic models and several dif ferent environmc:irs. These reduce budgetary and program flexibility. Generally they tend to becmc progressively more expensive. . Problems arise in connection with their cost, finding and keeping high quality scientific personnel, and justifying their con- tinuance during the fallow years before the long- tern effects become detectible and enough data arc accuniulatcd for statistizal reliability. The restrictions and limitations inherent in the long-term cxperiiiient arc not fully appreciated by scientists, much less the public. And yet they arc one of tlic necessary lines of evidence for responding to questions about cnvironnicnral coil taniina t ion.

-8- Enclosure "B"

4003Sb3 c. Opposition LO the siting of reactors rakes the form of gencralizcd objections such as: Khat !;ill bc thc potential effects of its effluenLs on the "qualiLy of the ciivironment"? Responses based on Lhcory or analogy or on reference to recognized standards have not proved compelling. A full presentation of what in fact does happen whm actual reactor operations interact wiLh all components of thc environment seems to be the only response which will bct acceptable. Unfortunately the components of a circumscribed cnvironmcnt are complex and vary widely from location to location so that observations made on one site nay not be fully applicable to another. But if a combination of accepted scientfic principles and field observations cannot be synthesized into an acceptablc prediction (to be checked out later) an impasse develops that requires a solution based on judgments other than science.

A second line of objection is to call in question the validity of the radiation standards promulgated by the International Comaission on Radiological Protection, the National Comnittee on Radiation Protection and Pleasurements, and the Federal Radiation Council. The standards do contain an element,of judgment as to degree of effect relative to a given radiation exposure. Such judgnicn ts, howcvcr , are niade by radiological scientists of international reputation on the basis of sound data. Consequently when such standzrds are questioned the

...... problem becones part of a much broader issue. ... ._.i .... c. .._..._...... d. Studies of the long-term effects of nuclear explosions on human populations arc continuing at Hiroshima and Nagasaki, Japan under a contract with the National Academy of Sciences. Problems of carrying out successfully a pionccring epidemiological study involving 120,000 persons in an alien culture having unhappy memories have been solved. The effects observcd in the first two decades post-exposure have been published and form th: basis of most statements on the long-term effects of radiation on man. Now 24 years later, conditions with long latcnci-es, including accelerated aging, may begin to appcar. Costs for a given level of effort in Japan arc increasing at a rate of 10-12 percent pcr year and this has created fiscal problcrns which

with prcscnt budget trends will bccoinc restrictive. ' Every measure to reduce costs without endangering the systeins for collection of clinical and autopsy data has btcn put into effect. Without a rapid lcvcliu;: off of thG Japansse ,economy a doubling of costs in seven years will have to le met.

-9- Enclosure "B" i

The data to bc dcrivcd from this defined population over the next 20 years will bc absolutcly unique in defining long-term effects in riian; every review OF this program reaffirms the value of these data.

e. In the area of occupational health, activities are going forward which have al: times occasioned minor problems. These, horJevcr, are bcing worked out satisfactorily.

(1) A long-term cohor t epidemiologic study under the direction of Dr. T. Plancuso, University of Pittsburgh, is correlating the medical cxpcrienccs of contractor employees in AEC plants with work history in the industry. Single and cumulative radiation exposures and other identifiable occupational stresses are to he related ultimately to morbidity and, where possible, autopsy data. Collecting and codifying data beginning from 1943 proved more time- consuming and expensive than anticipated.

(2) Due to its remarkably high toxicity, particularly in the form of aerosols, plutonium has been.the subject of extensive work in animals. Nevertheless, knowledge of its behavior and toxicity in man is necessary for therapeutic, administriitivc, and other purposes. The Commission, recognizing its position in this matter , has authorized a Plutonium Registry, actually a Transuranic Element Regcs try, for the purpose of concentrating all ...... -. ...>’-...... its experience with human contamination by plutonium at

one center. The maximal perinitted lung burden (ICRP) of ~ 0.001 microgram for Pu-238 and 0.259 micrograms for Pu-239 is indicative of the biomedical problems encountered in working with this element. The Registry has now defined its protocols , including autopsy procedures and provision for long- term ei)idcmiological contact with persons considered to have been exposed. . This sketch of the Registry is not presented as a problem per se but is representative of a biomedical-epidemiologic prototype which could prove useful in studying other occupational and environmental hazards and problcms in man.

I . (3) Nost of the expertise for dealing with radiation accidents lias resided in the medical and pararncdical pcrsonnel of the AEC and its contractors. With tlic licensing of reactors and othcr plants to civilian co.mpanics it has become necessary to transfer this inforination to the

- 10 - Enclosure “B” 4003Sb5 i I

licensee’s physicians and to physicians in ncarby universities, hospitals, and medical center-s. Thc objective is to have clusters of mcdical pcrsonncl able to care For persons injured in L-adiati.cn accidents and to have hospitals prepared to accept such patients. Similarly, civil authorities, transport people, and the news mcdia bcncfitiiig from prior indoctrination assist greatly in Iceepiiig a radiation accident in its proper context,

This is a major problem that is being solved with the , collaboration and assistance of many civiliEn groups. It has been noted here largely for information purposes.

(4) There is need for increasing numbers of occupational physicians trained to deal with the special problems of nuclear energy. Occupational Medicine, however, is the only specialty where the physician must pay for the ‘ post-graduate training that leads to Board certification. There is a dearth of Board-certified occupational physicians and hence there is little incentive for a man who has passed his boards to take additional training in the special problems of nuclear and radiation medicine. It is important: that occupational physicians in civilian )nuclear plants be fully qualified to deal with the special radiation problenis in their plants. Thus fa:- the need has been met, but the future is uncertain......

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- 11 - Enclosure “B”

‘r0035bb ENCLOSURE "C" I

Dr. Bennett, Gentlemen:

We prepared the synopsis that was mailed to you largely as a.means

of consening your time. It previews those areas of our 'program in whiFh

there may be a problem or issue of interest to the panel. We, however,

would be happy to speak to any other areas which you may care to examine.

Since the goals of the Atomic Energy Commission are not generally

known, these were extracted from the Atomic Energy Act of 1954, as amended.

The Division of Biology and Medicine has been an operating or program

Division of the Commission since its formation in 1947. The Division

of Operational Safety was evolved from Biology and Medicine in 1959 as

a means of pulling together in one place all the health and safety

operations and controls that had previously been scattered across several

other Divisions. The Division of Biology and Medicine now is concerned

.;..:. solely with research, but we and Operational Safety work together as ...'....'-.....-...... :.. .._ .

G. two sides of the same coin.

Two additional explanatory items should be noted here. One is that

the Commission and the Division of Biology and Medicine support hospital beds'for research only at two national laboratories, Brookhaven . National Laboratory and the Lawrence Radiation Laboratory - Berkeley,

and two large medical research units engaged in cancer research, the

Oak Ridge Associated Universities and the Argonne Cancer Research Hospital.

c Our policy has been to support the more fundamental clinical work up to h h w the point that its usefulness has been demonstrated. We find that such 01 CT developments do not need advertisement. Examples are: crystal and 4 solid-state detectors; teletherapy machines; rectilinear scanners; the

Anger camera; isotopic labled macromolecules; the isotopic "cows" for

1-131, Tc-99m, etc; erythropoietin; and most rcccntly L-DOPA. - 12 - Enclosure :'c" -- -- 4'

The other is that except for an extremely small fraction of our

work, all investigations are completely unclassified and, in fact, we

become concerned when an investigator does not publish -- our feeling

has.been that if an investigator is willing to put his name on a paper

which has been referlted by his peers for publication in a reputable

scientific journal, we are satisfied.

The first item in our synopsis speaks to our budgetary problems

but we do not wish to emphasize this. No doubt the restrictive effects

have been presented by qthers. From our standpoint the Commission has -_ - given our Division every possible "break."

Dr. Goldstein and I will welcome your comments and questions.

...... -.. . . .

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- 13 - Enclosure "C" BIOLOGICAL AND MEDICAL SCIENCES PANEL, PRESIDENT'S SCIENCE ADVISORY COMMITTEE

Dr. Ivan Bennett, New York University Medical Center Dr . William Ross Adey, University of California, Los Angeles Dr . Peter Bing, Los Angeles Dr . Eugene Braunwald, University of California, Dept. of Medicine, San Diego Dr . Detlev Bronk, Rockefeller University Dr. James Ebert, Carnegie Institute, Baltimore Dr . Clifford Grobstein, University of California, San Diego Dr . Philip Handler, National Academy of Sciences Dr . Colin MacLeod, New York University Dr. George Pake, Washington University Dept. of Physics, St. Louis Dr. William R. Pritchard, University of California, Davis Dr . Lloyd Smith, University of California, San Francisco Dr . Harlan Wood, University of Georgia Dr . James Warren, Ohio State University Hospital Dr . Lewis Thomas, Yale University School of Medicine Dr . Leonard Laster

.

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Enclosure "D" 4fJ03SQB