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Aftermath of chernobyl
THE LANCET
EU health council meeting T h e European C o m m i s s i o n is to audit national blood collection, treatment, a n d control systems in the E u r o p e a n U n i o n (EU), Social Affairs Commissioner Padraig Flynn a n n o u n c e d at the E U Health Council on D e c 13. T h e m o v e w o n the full backing o f the E U governm e n t s . T h e audit could lead to legislative proposals for E U rules laying d o w n minim u m safety criteria, F l y n n said. H e also said that the c o m m i s s i o n is to draw u p blood collection a n d processing guidelines mainly for the commercial sector. Shortly before the health council, F l y n n m e t industry m e m b e r s to calm fears that the commission a n d m e m b e r states were about to enforce the 1989 directive's r e q u i r e m e n t that blood collections should be from voluntary, u n p a i d donations. T h e commercial sector supplies some 60% of the E U ' s annual plasma requirements, largely from paid sources in the US. While the council did n o t go this far, it did adopt a resolution confirming E u r o p e ' s c o m m i t m e n t to self-sufficiency based on voluntary, u n r e m u n e r a t e d d o n a tions. However, w h e n questioned, the current council president, Belgian health minister M a g d a de Galan, acknowledged that is was difficult to define " u n p a i d " , since the day's paid leave that B e l g i u m and s o m e other E U nations give donors is worth a lot more t h a n the $9 or $10 that
Aftermath of Chernobyl T h e world radiological c o m m u n i t y is in danger of losing its credibility over the Chernobyl follow-up, D r Keith Bayerstock warned. H e was addressing a m e e t ing o f the British group of the P u g w a s h m o v e m e n t - - a body o f scientists established after World W a r II to discuss a n d m o n i t o r the social a n d political implications o f scientific discoveries. T h e original i m p e t u s that led to t h e f o u n d i n g o f t h e group was the threat o f nuclear weapons. Over the years, however, it h a s addressed a wide range o f issues, a n d held its first m e e t i n g in the problems of C h e r n o b y l fall-out as early as September, 1986, only four m o n t h s after the accident. It was at that meetings in Budapest, that t h e presence o f heavy nuclide particles o n the clothes of tourists who h a d visited Kiev a n d M i n s k several weeks after those cities h a d been officially p r o n o u n c e d "clean" was first revealed. Baverstock, w h o is a m e m b e r of t h e W o r l d Health Organization International T h y r o i d Project in R o m e , was speaking, he emphasised, as a private i n d i v i d u a l - b u t as one who, for "20 years, h a s been interested in the epidemiology of ionising radiation effects.
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commercial firms pay contributors in the US. T h e c o m m i s s i o n is going to examine the question to try and c o m e up with a workable definition. Flynn underlined his support for the E U ' s self-sufficiency goal a n d wants to see m e m b e r states transferring surplus plasma or whole blood to neighbouring countries where there is a shortfall. He pointed out that s o m e m e m b e r states export surplus supplies outside Europe even w h e n there is a n e e d within the EU. However, talks at the D e c 13 health council failed to break a lengthy deadlock over proposed controls on tobacco advertising. M e m b e r states refused to b u d g e from entrenched national positions. T h e British government, for example, says an E U directive is u n n e c e s s a r y a n d too heavy h a n d e d , favouring the voluntary system o f controls operated in the U K . National g o v e r n m e n t s are also n o w stalling progress with claims that the c o m m i s s i o n has used the wrong E U treaty article for the draft directive's legal base. T h e c o m m i s s i o n has agreed to have its lawyers review the council's case. In a thinly veiled attack on m e m b e r states, Flynn said it was regrettable that the proposals were blocked particularly w h e n the health implications were considered a n d w h e n it was "recognised that s m o k i n g can seriously d a m a g e the health o f i n d i v i d u a l s . . . T h a t ' s n o t in d o u b t . " But the council did approve E U actions against smoking as part of a 55 million E C U "Europe Against C a n c e r " pro-
g r a m m e , which will start at the beginning of 1995 w h e n the existing p r o g r a m m e finishes. T h e new five-year p r o g r a m m e will "improve a n d s t r e n g t h e n " anti-cancer action to date, said Flynn, w h o a d d e d that "the key note will be partnership of approach". T h e p r o g r a m m e will focus on prevention first t h r o u g h information a n d health education, t h e n by helping the d e v e l o p m e n t and i m p r o v e m e n t o f national screening p r o g r a m m e s . A n o t h e r p r o g r a m m e that is to be extended When it finishes at t h e e n d of this m o n t h is the " E u r o p e A g a i n s t A I D S " p r o g r a m m e . T h e council p l e d g e d 9 million E C U s to keep the p r o g r a m m e going until the e n d of 1994, w h e n a n e w prog r a m m e is planned. T h e council also backed c o m m i s s i o n proposals t h a t efforts be concentrated on prevention of I--IIV transmission, especially in prisons a n d travel a n d tourism. T h e n e w p r o g r a m m e in 1995 will c o n t i n u e this work b u t will also look at other transmissible diseases. T o keep track of H I V infection a n d o t h e r diseases, the council w e n t on to approve plans to set up a n E U epidemiology database based on i n f o r m a t i o n from an epidemiology n e t w o r k that will link national public health authorities. T h e council also agreed that there should be a second E u r o p e a n d r u g prevention week in October, 1994, after the successful first event in N o v e m b e r , 1992.
M o r e than a year ago, he said, doctors in Belarus h a d b e g u n reporting a signifi' cant rise in the incidence o f thyroid cancer in children. Foreign specialists, however, h a d s h o w n a "high level o f scepticism", a n d h a d failed to couple this d o u b t with the appropriate scientific curiosity. Instead of discounting the Belarusian claim, he said, we should be asking s u c h questions as: is an increase in thyroid cancer to be expected in children u n d e r such circumstances? Is the increase d u e simply to better reporting? D o we k n o w the risk of thyroid cancer in a population exposed to low-level radiation, a n d if the cancers are radiation linked what is the expected timespan a n d geographical extent of the effect? Even those who dismiss the cancers as not statistically linked to Chernobyl should test their h y p o t h e s i s - - n o t dismiss the claims o u t of hand. Baverstock e m p h a s i s e d that there are i n d e p e n d e n t data supporting the proposal that exposure o f children to low-level radiation increases the risk of thyroid cancer. I n Belarus a n d Ukraine, he said, doctors a n d epidemiologists were trying, u n d e r conditions of virtual economic collapse, to m a p the epidemiology of radiation effects a n d reconstruct doses. " T h e s e people deserve our help, n o t our scepticism", he
said. W e s t e r n "expeditions" to t h e C h e r nobyl z o n e - - o f which there have recently been m a n y - - d i d n o t always coordinate their efforts or have access to each other's data. A n d s o m e scientific findings, from as early as 1986, h a d still n o t b e e n printed. T h e journal Nature, he said, h a d given s o m e scientists confirmation o f acceptance, a n d even proofs, b u t t h e i r papers have never appeared. " I ' d like to know what light those u n p u b l i s h e d data throw on the health effects", he said. " I ' d like to know what we m i s s e d . " W h e n contacted after the meeting, the editor o f Nature, J o h n M a d d o x , said that Nature h a d p u b lished m o r e t h a n 100 papers o n C h e r nobyl. " W e can n o t p u b l i s h everything"~ he said, a n d a d d e d that the setting up of an article and the issuing o f proofs is not, in itself, a guarantee o f publication. Baverstock called for the formation o f a n e w i n d e p e n d e n t w a t c h d o g b o d y to coordinate research work on the medical effects of Chemobyl~ work out a n appropriate code of conduct, act as a clearing h o u s e , a n d p r o m p t public debate a b o u t the events o f the past seven years.
Sara Lewis
Vera Rich
Vo1342 • December 18/25, 1993
EU health council meeting T h e European C o m m i s s i o n is to audit national blood collection, treatment, a n d control systems in the E u r o p e a n U n i o n (EU), Social Affairs Commissioner Padraig Flynn a n n o u n c e d at the E U Health Council on D e c 13. T h e m o v e w o n the full backing o f the E U governm e n t s . T h e audit could lead to legislative proposals for E U rules laying d o w n minim u m safety criteria, F l y n n said. H e also said that the c o m m i s s i o n is to draw u p blood collection a n d processing guidelines mainly for the commercial sector. Shortly before the health council, F l y n n m e t industry m e m b e r s to calm fears that the commission a n d m e m b e r states were about to enforce the 1989 directive's r e q u i r e m e n t that blood collections should be from voluntary, u n p a i d donations. T h e commercial sector supplies some 60% of the E U ' s annual plasma requirements, largely from paid sources in the US. While the council did n o t go this far, it did adopt a resolution confirming E u r o p e ' s c o m m i t m e n t to self-sufficiency based on voluntary, u n r e m u n e r a t e d d o n a tions. However, w h e n questioned, the current council president, Belgian health minister M a g d a de Galan, acknowledged that is was difficult to define " u n p a i d " , since the day's paid leave that B e l g i u m and s o m e other E U nations give donors is worth a lot more t h a n the $9 or $10 that
Aftermath of Chernobyl T h e world radiological c o m m u n i t y is in danger of losing its credibility over the Chernobyl follow-up, D r Keith Bayerstock warned. H e was addressing a m e e t ing o f the British group of the P u g w a s h m o v e m e n t - - a body o f scientists established after World W a r II to discuss a n d m o n i t o r the social a n d political implications o f scientific discoveries. T h e original i m p e t u s that led to t h e f o u n d i n g o f t h e group was the threat o f nuclear weapons. Over the years, however, it h a s addressed a wide range o f issues, a n d held its first m e e t i n g in the problems of C h e r n o b y l fall-out as early as September, 1986, only four m o n t h s after the accident. It was at that meetings in Budapest, that t h e presence o f heavy nuclide particles o n the clothes of tourists who h a d visited Kiev a n d M i n s k several weeks after those cities h a d been officially p r o n o u n c e d "clean" was first revealed. Baverstock, w h o is a m e m b e r of t h e W o r l d Health Organization International T h y r o i d Project in R o m e , was speaking, he emphasised, as a private i n d i v i d u a l - b u t as one who, for "20 years, h a s been interested in the epidemiology of ionising radiation effects.
1546
commercial firms pay contributors in the US. T h e c o m m i s s i o n is going to examine the question to try and c o m e up with a workable definition. Flynn underlined his support for the E U ' s self-sufficiency goal a n d wants to see m e m b e r states transferring surplus plasma or whole blood to neighbouring countries where there is a shortfall. He pointed out that s o m e m e m b e r states export surplus supplies outside Europe even w h e n there is a n e e d within the EU. However, talks at the D e c 13 health council failed to break a lengthy deadlock over proposed controls on tobacco advertising. M e m b e r states refused to b u d g e from entrenched national positions. T h e British government, for example, says an E U directive is u n n e c e s s a r y a n d too heavy h a n d e d , favouring the voluntary system o f controls operated in the U K . National g o v e r n m e n t s are also n o w stalling progress with claims that the c o m m i s s i o n has used the wrong E U treaty article for the draft directive's legal base. T h e c o m m i s s i o n has agreed to have its lawyers review the council's case. In a thinly veiled attack on m e m b e r states, Flynn said it was regrettable that the proposals were blocked particularly w h e n the health implications were considered a n d w h e n it was "recognised that s m o k i n g can seriously d a m a g e the health o f i n d i v i d u a l s . . . T h a t ' s n o t in d o u b t . " But the council did approve E U actions against smoking as part of a 55 million E C U "Europe Against C a n c e r " pro-
g r a m m e , which will start at the beginning of 1995 w h e n the existing p r o g r a m m e finishes. T h e new five-year p r o g r a m m e will "improve a n d s t r e n g t h e n " anti-cancer action to date, said Flynn, w h o a d d e d that "the key note will be partnership of approach". T h e p r o g r a m m e will focus on prevention first t h r o u g h information a n d health education, t h e n by helping the d e v e l o p m e n t and i m p r o v e m e n t o f national screening p r o g r a m m e s . A n o t h e r p r o g r a m m e that is to be extended When it finishes at t h e e n d of this m o n t h is the " E u r o p e A g a i n s t A I D S " p r o g r a m m e . T h e council p l e d g e d 9 million E C U s to keep the p r o g r a m m e going until the e n d of 1994, w h e n a n e w prog r a m m e is planned. T h e council also backed c o m m i s s i o n proposals t h a t efforts be concentrated on prevention of I--IIV transmission, especially in prisons a n d travel a n d tourism. T h e n e w p r o g r a m m e in 1995 will c o n t i n u e this work b u t will also look at other transmissible diseases. T o keep track of H I V infection a n d o t h e r diseases, the council w e n t on to approve plans to set up a n E U epidemiology database based on i n f o r m a t i o n from an epidemiology n e t w o r k that will link national public health authorities. T h e council also agreed that there should be a second E u r o p e a n d r u g prevention week in October, 1994, after the successful first event in N o v e m b e r , 1992.
M o r e than a year ago, he said, doctors in Belarus h a d b e g u n reporting a signifi' cant rise in the incidence o f thyroid cancer in children. Foreign specialists, however, h a d s h o w n a "high level o f scepticism", a n d h a d failed to couple this d o u b t with the appropriate scientific curiosity. Instead of discounting the Belarusian claim, he said, we should be asking s u c h questions as: is an increase in thyroid cancer to be expected in children u n d e r such circumstances? Is the increase d u e simply to better reporting? D o we k n o w the risk of thyroid cancer in a population exposed to low-level radiation, a n d if the cancers are radiation linked what is the expected timespan a n d geographical extent of the effect? Even those who dismiss the cancers as not statistically linked to Chernobyl should test their h y p o t h e s i s - - n o t dismiss the claims o u t of hand. Baverstock e m p h a s i s e d that there are i n d e p e n d e n t data supporting the proposal that exposure o f children to low-level radiation increases the risk of thyroid cancer. I n Belarus a n d Ukraine, he said, doctors a n d epidemiologists were trying, u n d e r conditions of virtual economic collapse, to m a p the epidemiology of radiation effects a n d reconstruct doses. " T h e s e people deserve our help, n o t our scepticism", he
said. W e s t e r n "expeditions" to t h e C h e r nobyl z o n e - - o f which there have recently been m a n y - - d i d n o t always coordinate their efforts or have access to each other's data. A n d s o m e scientific findings, from as early as 1986, h a d still n o t b e e n printed. T h e journal Nature, he said, h a d given s o m e scientists confirmation o f acceptance, a n d even proofs, b u t t h e i r papers have never appeared. " I ' d like to know what light those u n p u b l i s h e d data throw on the health effects", he said. " I ' d like to know what we m i s s e d . " W h e n contacted after the meeting, the editor o f Nature, J o h n M a d d o x , said that Nature h a d p u b lished m o r e t h a n 100 papers o n C h e r nobyl. " W e can n o t p u b l i s h everything"~ he said, a n d a d d e d that the setting up of an article and the issuing o f proofs is not, in itself, a guarantee o f publication. Baverstock called for the formation o f a n e w i n d e p e n d e n t w a t c h d o g b o d y to coordinate research work on the medical effects of Chemobyl~ work out a n appropriate code of conduct, act as a clearing h o u s e , a n d p r o m p t public debate a b o u t the events o f the past seven years.
Sara Lewis
Vera Rich
Vo1342 • December 18/25, 1993