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Saturday, 5 July 2014

There is an unacknowledged tragedy occurring for the children in Japan.

Author Rights aHEMagain
06/07/2014



It concerns the methodology being used for the tracking and treatment of thyroid problems caused by the Fukushima disaster.

Out of 287,056 children 99.3% of them have received ONE standard ultrasound examination in the three years since the disaster.  136,804 of them are at significant risk of slipping through the cracks and going on to develop thyroid cancer that metastasizes before their next exam in 2015-2016 if a significant change to methodology isn't implemented immediately.

Yet those trying to inform the public of these facts are being described as criminals by Forbes magazine in an article by James Conca titled "Scaring the Japanese People with Radiation is Criminal".

Before I get to far into this I have a question for Mr. Conca and anyone else who believes that there is a group of eco-freaks desperate to see dying children just so their rhetoric is proven right.

I think that you and your ilk are some of the most despicable human beings on the planet, willing to prostitute your intellectual abilities to mislead the public in support of an industry of death. Yet even I with such strident rhetoric don't actually think the intention behind your rhetoric is to see thousands of children struggling with the agony of trying to survive thyroid cancer.

Please recognize that those of us you paint as "fear mongers" are desperately trying to wake people up to the reality of this situation as we see it because we are trying to save lives, not because we are trying to prove a point.

[ed]

From the Forbes article, "A recent textbook case of this malfeasance is the Fukushima-induced thyroid scare in Japanese children. There is no increase in thyroid health problems in Japanese children living in and around the Prefectures of Fukushima and it is unlikely there ever will be (UN Report  ; Nuclear News ; J. of Am. Phys. and Surg. ; CBCnews ; Hiroshima Syndrome ; National Geographic ; Asahi Shimbun )."

This is factually wrong, and the sources Mr. Conca cites do not support such a statement. They do say whatever increase has already been seen occurring can't be blamed on radiation from Fukushima because at Chernobyl, it took four to five years for thyroid cancer to develop, so these cancers must be from another source. This four-to-five year figure seems to have become common kitchen table wisdom because no one cites a source for this figure.

Frequently it is just stated as fact by "an authority" such as this statement by Dr. Yamashita "Because the increase in thyroid cancer was reported to start 4 or 5 years after the Chernobyl accident, we expect no excess occurrence in the first 3 years in Japan. Therefore, assessment of current thyroid status will be completed within 3 years."

This is a misrepresentation of the fact that the first study done on Chernobyl's health effects began in 1991, five years after the accident and doesn't refer to the actual results of that study. 

It's interesting that Dr. Yamashita keeps repeating this "slow growth rate and long latency" in reference to Chernobyl, considering a paper he edited in 1998 described the exact opposite situation, "[Thyroid cancer] began developing with surprising rapidity and short latency.” (Childhood thyroid cancer: comparison of Japan and Belarus, Yamashita et al, First Department of Internal Medicine, Nagasaki University School of Medicine, Japan. Journal page 204, 1998 https://www.jstage.jst.go.jp/article/endocrj1993/45/2/45_2_203/_pdf ).

The likelihood that radiation-induced thyroid cancer has an aggressive development and short latency is also supported in the following study.

"Although some sporadic tumors unrelated to radiation may be included among our patients, the shortest latency period for both benign and malignant tumors was 1 year as occurred in 3 patients, whereas the longest time was 69 and 58 years, respectively (Fig. 1).” (Latency Period of Thyroid Neoplasia After Radiation Exposure
Shoichi Kikuchi, MD, PhD, et al. Department of Surgery, UCSF Affiliated Hospitals, San Francisco, CA. Journal List nAnn Surg v.239(4); Apr 2004 PMC1356259, full text at Link 

Again, from Mr. Conca's article, "However, many so-called researchers, activists and reporters claim thyroid cancers have exploded in Japan and Japanese children are dying by the thousands ( Business Insider ; Eco Childs Play).
They intentionally compared the wrong data sets, data sets that were not comparable, that used different methods, looked at different characteristics, even different ages. These news entities are not particularly known for their treatment of scientific issues and might be forgiven for not recognizing bad research, but just a phone call to a real scientist would have gone a long way to preventing this scare." 

It is perhaps a bit of projection on Mr. Conca's part to accuse Business Insider and Eco Child's Play of intentionally misrepresenting the results of studies they cited. I should note that I haven't read either article yet, so it will be interesting how our numbers compare.

Mr. Conca also tells us that the astoundingly large number of children having detectable nodules is simply because they were using very sophisticated ultrasound equipment. "According to Dr. Jane Orient in an article just published in the Journal of American Physicians and Surgeons 'Modern ultrasound equipment, such as that used in the TUE study, is able to detect thyroid carcinomas as small as a few millimeters, long before these may come to clinical attention.'"

Unfortunately this means neither Mr. Conca or Dr. Orient actually looked at the study protocol. Here is what the protocol actually calls for. Please note that the 10Mhz probe is a standard ultrasound examination, while the 18Mhz probe is the "new advanced" ultrasound investigation.

{{{ Study Protocol for the Fukushima Health Management Survey - Thyroid Ultrasound Examination (TUE) Program
by Shunichi Yamashita, released online August 25, 2012

ABSTRACT

Background: The accidents that occurred at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on 11 March 2011 have resulted in long-term, ongoing anxiety among the residents of Fukushima, Japan. Soon after the disaster, Fukushima Prefecture launched the Fukushima Health Management Survey to investigate long-term low-dose radiation exposure caused by the accident.
...

Detailed surveys
Thyroid Ultrasound Examination (TUE) Program

The Chernobyl accident revealed that thyroid cancer in children was increased by internal exposure to radioiodine. Thus, to ensure early identification and treatment of thyroid cancer in children, and their lifelong follow-up, we decided to perform thyroid ultrasound examinations on all children.
...
Due to the importance of long- term follow-up of all children in the prefecture and the considerable anxiety of their parents, all children aged 18 years or younger in the prefecture will undergo ultrasound examination.

Target: All prefectural inhabitants aged between 0 and 18 years on 11 March 2011, ie, those born from 2 April 1992 to 1 April 2011, including evacuees living in other prefectures. The total population is approximately 360,000.

Methods and criteria: Thyroid ultrasound, the primary examination, is done using a device that (a) has a 10-MHz or higher frequency probe,..
When the primary examination reveals a nodule or cyst, a confirmatory examination is to be carried out at Fukushima Medical University Hospital or another hospital (certified by our expert committee) for advanced ultrasound examination.

During the confirmatory examination, a detailed ultrasound, blood testing, urine analysis, and aspiration biopsy cytology are performed as necessary. Ultrasound devices used in the confirmatory examination must have a 18-MHz or higher frequency probe.
...
The following diagnostic criteria are used: 
A1, no nodule or cyst; 
A2, nodule less than 5.0mm and/or cyst less than 20.1 mm;
B, further examination necessary (nodule greater than 5.0 mm and/or cyst greater than 20.1mm); and
C, urgent need for further examination.

You might note that they ran into a bit of a problem with the orignial intention of the protocol of giving a confirmatory exam to every child having a detectable nodule or cyst.

They clearly weren't expecting to have to give 138,873 (testing results below) confirmatory examinations. So they added the A2 classification, eliminating the very group most in need of a more detailed examination. It also left the C classification as essentially meaningless.

I want to point out here that this is not a comprehensive public health policy guiding Japan's response to the immediate and serious health threats facing their people from the Fukushima disaster. Instead, it is a study. 

There also is no national tracking of physicians and hospitals to know how many children are being diagnosed and treated outside of the study. Given the secrecy laws recently passed in Japan, gathering and publishing such information is potentially illegal.

In any cases, here are the summarized results of the three-year "baseline-setting" period of TUE.

2011 Initial Cohort of 41,612 children
  (13 municipalities in the nationally designated evacuation zones).
2012 Cohort of 139,469 children
  (13 municipalities outside the nationally designated evacuation zones)
2013 Cohort of 105,975 children
  (34 municipalities outside the nationally designated evacuation zones)

FY 2011 Cohort  |  A1 = 26,321  /  A2 = 15,073  /  B = 218  /  C = 0
FY 2012 Cohort  |  A1 = 76,293  /  A2 = 62,185  /  B = 990  /  C = 1
FY 2013 Cohort  |  A1 = 45,568  /  A2 = 59,546  /  B = 861  /  C = 0

TOTALS  |  Total A1 = 148,182  /  Total A2 = 136,804  /  Total B = 2,069  /  Total C = 1

(A1 = no nodules or cysts;  A2 = nodules less than 5mm, and/or cysts less than 20mm; B = nodules greater than 5mm, and/or cysts greater than 20mm; C = urgent follow-up required)

Total primary examination = 287,056
Total who have nodules or cysts
  detected in the primary examination = 138,873 (48.4% of tested)
Total referred on to have
  confirmatory examination = 2,070 (1.5% of those with nodules/cysts detected)

Note: Testing of the FY 2011 Cohort was actually performed in late 2011 through 2013. So claims that it is impossible for the FY 2011 Cohort results to be related to Fukushima is a misrepresentation of the actual data.

So what were the results of these "confirmatory" examinations? These are the results as of March 31, 2014.

Cohort year  | # needing exams  /  # given exams  /  # deferred  /  # followup advised  /  # cytology

FY 2011  |  218  /  189  /  53  /  136  /  90
FY 2012  |  991  /  858  /  275  /  583  /  256
FY 2013  |  861  /  551  /  207  /  344  /  91

Total Examined = 1,598
Total deferred to next round
  of testing in 2015 = 535 (33.5% of confirmatory tests)
Total advised to have followup exams
  at 6 and 12 months = 1,063 (66.5% of confirmatory tests)
Total referred on to get Fine-Needle Aspiration Biopsy
  and Cytology = 437 (27.3% of confirmatory tests)

As you can see, only 1,598 children out of 287,056 were given the more advanced 18 Mhz ultrasound examination or 0.56%. So certainly that can't be an explanation for why 48.4% children tested had nodules/cysts when 4-7% would be expected from previous studies (http://www.doctorslounge.com/index.php/reference/diseases/120 )

What were the results of those biopsies?

Fine Needle Aspiration Biopsy and Cytology (FNAC) results as of 31 March 2014.

FY 2011 Cohort  |  15 suspicious or malignant, 13 surgical cases
FY 2012 Cohort  |  54 suspicious or malignant, 36 surgical cases
FY 2013 Cohort  |  21 suspicious or malignant, 2 surgical cases
Cohort Totals  |  90 suspicious or malignant, 51 surgical cases

90 suspicious or malignant or 20.6% out of 437 tested.

All of the figures I've given were drawn from the Thyroid Ultrasound Examination, FHMS http://www.fmu.ac.jp/radiationhealth/results/media/15-2_Thyroid_Ultrasound_Examination.pdf

So now we come to the crux of the matter.  Of 287,056 children 99.3% of them have received ONE standard ultrasound examination in the three years since the disaster.

Given the fact that Fukushima involves three, possibly four cores to Chernobyl's one, and that those cores continue to periodically release plumes of radioactive iodine to Chernobyl's single-release event, this is simply unconscionable.

Further, I don't know what the total number of children there were in Japan at the time of the disaster, but they certainly weren't all living in the municipalities tested.

While it is reasonable to expect the number of children to be impacted by the disaster to be highest in those locations receiving the highest levels of emissions, there are going to be children impacted throughout Japan.

This study isn't doing anything to decrease the chance that the first time those children come to the attention of the medical community is when they show symptoms of their unrecognized thyroid cancer metastasizing to their lymph nodes and upper respiratory system.

This study also isn't doing anything about the children born since the disaster who also stand to be impacted by the continuing releases from the plant.

Let's return for a moment to Mr. Conca's article. 

"So why are some unethical people declaring children are dying? Because they’re unethical. And they don’t care how many people they hurt as long as their political agenda is met. It’s nasty, cruel and wrong.

Of course, the same names keep popping up with these stories, like Joseph Mangano, Harvey Wasserman and Helen Caldicott. These articles all say the same thing and reference the same debunked scientific studies that skew data to indicate a non-existent problem." -- 

So I didn't want to skew my numbers by reading the offending articles cited by Mr. Conca, but with that out of the way I prepared to have to face the unethical horror-show of sensationalist reporting of children dying.

While it unfortunately wouldn't surprise me to find that children are already dying from thyroid cancer in Japan, I was curious what those articles were going to cite for evidence, since from my research I couldn't find anything other than heartbreaking anecdotal accounts. Official death and mortality statistics for me have proven elusive.

Not a single mention. Not one single word. Not one tear-jerking photo. In either article. No where was there ANY mention of children dying.

Now I'd like you to re-read the quote from the Forbes article. Hmm. I'd like to discuss the kind of person who would write an entire article condemning the unethical, nasty, cruel and wrong writing's of other author's, going so far as to describe them as criminal, all predicated on a lie? A fiction. A story made up out of whole cloth.

I would be inclined to give Mr. Conca the benefit of the doubt about not understanding the difference between warning children may and declaring children are, if he wasn't so damn clear about it.

What of these debunked scientific studies? Well the Business Insider article cites 4 studies, Radiology volume 237 issue 3, Management of Thyroid Nodules Detected at US: Society of Radiologists in Ultrasound Consensus Conference Statement; the New York Academy of Sciences book, "Chernobyl: Consequences of the Catastrophe for People and the Environment,"  ; the journal Nature's Scientific Report "Thyroid doses for evacuees from the Fukushima nuclear accident" ; and the Fukushima Health Management Survey . To my knowledge none of these have been "debunked".

The Eco Child's Play article cites no scientific studies.

"I understand the desire to reinforce a stereotype with data, but that is why being an actual scientist is important." says Mr. Conca.

Well Mr. Conca, one doesn't need to be an actual scientist to know what you are.

Bald.

Faced.

Liar.

aHEMagain

NOTE: All quoted material is less than 50% of cited sources. 

ps: while I also am not an actual scientist, I would be ecstatic to debate you any day of the week on your interpretation of the scientific literature in this matter, as well as your vague understanding of journalistic ethics.


pps: don't fuck with Helen Caldicott. Her ethics are beyond reproach, and it's clear her primary concern, fostered by genuine compassion, is the welfare of all the children in question.
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