Unconventional Wisdom 6

Policy Issues

“Hey, Curmudge, how did we get into this mess, anyway?”

“Actually Julie, I think there are two messes—the policies themselves and their unintended consequences.  Let’s start with Mess #1, the official recognition of the linear no-threshold (LNT) hypothesis in the U. S. and other countries (but not France).  This is discussed at length in several of the papers in Dose-Response Vol. 10, No. 2 and 4 (2012).  The big problem is that one can’t rigorously prove a small increase or small decrease in cancer deaths at very low doses of ionizing radiation when 20% of the human population die of cancer from any number of causes.  It’s the classical problem of trying to discern a small signal amid a lot of noise.  So the government takes the easy way out and assumes that the LNT hypothesis is valid.”

“Because of that policy, people have acquired an unshakable belief that ionizing radiation at all levels will cause cancer.  Gosh, Old Guy, just imagine the political power derived from that fear by anti-nuclear power activists and the promise of big payments to corporations that move ‘contaminated’ soil from one place to another.  It’s even the raison d’être for the town’s basement tester and radon exterminator.  And this happens because people choose to ignore, or (more likely) are totally unaware of the weight of evidence showing radiation hormesis or at least a threshold.”

“You’ve got it Julie, as usual.  Now let’s consider Mess #2, the consequences of the LNT.  The nuclear accidents at Chernobyl and Fukushima provide examples of decisions made by governments that were overly protective against radiation but that caused great harm to the populace emotionally, financially, and socially (1).  In the Chernobyl area 200,000 people were forcibly resettled where the natural background plus the Chernobyl contribution exceeded 500 mrem per year; recall that the natural background in Denver is 600 mrem per year. ‘Following the Chernobyl accident in 1986, an estimated 100,000- 200,000 Chernobyl-related induced abortions were performed in Western Europe.  Perceptions of radiation risks affected personal choices about continuing pregnancies.’ (2)”

“Curmudge, that’s horrible!  And then there was the Fukushima disaster in March 2011.  Ninety thousand people were evacuated from an area that had an estimated first-year dose of 2 rem to as high as 22 rem (3).  There are locations in Brazil and Iran with higher background than that.  Actual losses in the disaster were 15,000 deaths due to the tsunami and $55 billion spent on fossil fuel imports due to the shutdown of almost all of Japan’s nuclear power plants.  Could that happen here?”

“A tsunami on the Great Lakes is quite unlikely, but consider what would happen if a terrorist somehow constructed a rudimentary nuclear weapon—a so-called ‘dirty bomb’—and detonated it over Chicago.  Everyone’s fear of all radiation would cause panic in the streets, and government regulators would probably issue stupid evacuation orders.  Recall that President Obama requested that the Japanese evacuate all Americans from within 50 miles of Fukushima (4).”

“Oh, Curmudge, I’m not surprised.  But wouldn’t a lot of good things happen if the government abandoned the LNT hypothesis and taught people that low doses of radiation were not to be feared and could be good for them?”

“The list would be long Julie, but here are a few examples.  Our electricity would come from nuclear power plants, many of which would use breeder reactor technology that would reduce the problem of radioactive waste.  That would resolve the controversy over greenhouse emissions from fossil-fueled power generation.  Our cars could have small atomic engines that would be fueled once by the manufacturer.  And there would be lots of research on the medical uses of low doses of radiation.  Imagine getting a mammogram for cancer prevention instead of diagnosis.  And maybe old guys like me will live longer.”

“I would be concerned about that, Curmudge.  One old geezer that I know quite well is flakey enough already.  So how is this low-dose radiation controversy going to be resolved?”

“Slowly, I believe.  Consider the stakeholders, beginning with the people and their governments.  An expansive government will take advantage of the people’s fears by promulgating regulations, e.g., a carbon tax, and by practicing crony capitalism, such as investing in solar energy schemes.  Remember, this is the age of policy-based evidence—not evidence-based policies.  NGOs thrive on people’s fears and concerns, so they will fight the concepts of a threshold and hormesis tooth and nail.  Scientists who have not read the literature will view data that fit a ‘J’-shaped curve as counterintuitive.  Nevertheless, it will be up to the scientists to gain an understanding of low doses of ionizing radiation and teach what they have learned.  These findings are too significant to be kept under wraps indefinitely.”

“Hey, Cumudge, that’s what you and I are doing.  It’s a perfect job for a jaded nurse and an old inveterate teacher.  So what issue will we tackle next?”

“We may have more to say about low doses of ionizing radiation, but not right away.  It will soon be May and time to celebrate our sixth anniversary.  À plus tard (see you later), Julie.”

“Ciao (‘bye), Old Guy.”

Kaizen Curmudgeon    

(1)  Dobrzynski, L. (p. 467) and Wilson, R. (p. 480) in Dose-Response 10, No. 4 (2012).

(2)   Mossman, K. L. Dose-Response 10, No.2: 190 (2012).

(3)   Muller, Richard  The Panic Over Fukushima  Wall Street Journal, August 18, 2012.

(4)   Wilson, Richard  Dose-Response 10, No. 4: 480 (2012).

Acknowledgements:  Curmudge and Jaded Julie gratefully acknowledge the personal communications (face-to-face and email) between Doc Mack and the following distinguished scientists: Douglas R. Boreham, T. D. Luckey, Ron E. J. Mitchel, and Charles L. Sanders.    

Unconventional Wisdom 5

How much?  How does it work?

“Curmudge, I’ve been telling my friends about our recent discussions…about how large doses of radiation are dangerous but very small doses are not only not a hazard but might even be good for you.  After my friends get over being incredulous, those who are truly perceptive start asking questions.  ‘Okay, Julie.  So as the radiation dose gets lower and lower, where does it stop being hazardous and start being beneficial?’ “

“That’s a very important question, Julie, but we should include more recent literature in our discussion.  Remember that Hiserodt’s book was published in 2005.  A more up-to-date resource is Volume 10 (2012) of the peer-reviewed journal, Dose-Response.  I recommend issue No. 2, a special issue on The Role of Linear and Nonlinear Dose-Response Models in Public Decision-Making, and issue No.4 dedicated to the distinguished Polish scientist, Zbigniew Jaworowski.  Actually, issue No. 4 is a follow-up to No. 2 on low doses of ionizing radiation.” 

“I won’t ask how you found this, Curmudge.  You’ve probably already forgotten.  But since you made the discovery and spent the past week reading the papers, would you be so kind as to share with me some of the authors’ more profound findings and comments?  They ought to help me answer my inquisitive and not-fully-believing friends. My friends may need to be reminded that for beta, gamma, and x-radiation, values expressed in sieverts (Sv) or grays (Gy) are numerically the same.”

“I’d be delighted to help inform your friends, Julie.  Let’s start with higher doses and work down.  We’ve learned from Hiserodt’s book:

·      At 100 cSv (100,000 mrem) people experience radiation sickness.

·      Below an instantaneous 70 cGy (70,000 mrem) dose Japanese atomic bomb survivors outlived their unexposed countrymen.  The optimum dose was around 10 cGy (10,000 mrem).  

·      At 48 cGy/yr (48,000 mrem) background, people in Ramasari, Iran are presumably healthy but likely unhappy with their despotic government.

·      According to T.D. Luckey, the optimum annual exposure is 10 cG/yr (10,000 mrem).”

“Okay, Old Guy, now let’s look at more recent literature.  When we refer to the Dose-Response journal, recall that the page numbers are sequential through a whole volume.”   

“In response to a question about whether an 11-mSv CT scan would be cause for worry about future cancer, C. L. Sanders provided this reassurance:  ‘Feel blessed that you have received this dose from CT scans.  You could receive an annual cumulative dose of 100 mSv (10,000 mrem) and experience the benefit of reduced cancer and other disease risk.’ (Personal communication, 2011.)

‘The (protective) adaptive response in mammalian cells and mammals operates within a certain window that can be defined by upper and lower dose thresholds, typically between about 1 and 100 mGy (100 and 10,000 mrem) for a single low dose rate exposure.’ (Mitchel, R. E. J.  Dose-Response Vol. 8, p. 192 [2010])   

‘For doses ≤ 100 mGy (10,000 mrem) [the equivalent of several CT scans] the frequency of neoplastic transformations was reduced below the spontaneous level, presumably because of gamma-ray activated natural protection with selective removal of aberrant cells via apoptosis.’ (Scott, et al.  See reference in our 8/08/11 blog posting.)”

“How do I answer if my friend next asks, ‘Well, Julie, since you seem to know so much, how does this radiation hormesis stuff work in the human body?’ “

“I’d say, ‘Read the literature.  There are great articles that deal with this in depth, including those by Cohen (J. Am. Phys. Sur. 13, no. 3:70[2008]), by Scott and Di Palma (Dose-Response Vol. 5, p. 230 [2006]) and by Vaiserman and by Tubiana et al. (references in our 8/08/11 blog posting).’  A statement by Tubiana et al. that caught my attention was, ‘Life developed in a bath of ionizing radiation and solar ultraviolet radiation and created aerobic organisms requiring (a) defenses against the metabolically induced reactive oxygen species, (b) DNA repair, and (c) elimination of damaged cells.’ It seems as if life required radiation hormesis from the very beginning.“

“But suppose my friend wants me to describe radiation hormesis briefly—as in an ‘elevator speech’.”

“Here it comes, Julie, in the words of Scott and Di Palma: ‘Low doses and dose rates of low LET radiation activate a system of cooperative processes in the body.  (They) include (a) defenses such as scavenging reactive oxygen species, (b) presumably p53 related activated high-fidelity DNA repair/apoptosis, (c) a novel auxiliary protected apoptosis mediated process that selectively eliminates aberrant cells, and (d) induced immunity.’ “       

“Wow, Curmudge.  I believe the big words in those papers tell us that CT scans are good for us and how they do the good things that they do.  By the way, do you understand those big words?”

“Consider me biology-challenged, Julie, but the hyperlink at p53 was really helpful.  I already knew that apoptosis means programmed cell death, and if the dying cells are cancer cells, that’s good news for all of us.”

“So what’s next, Obsolete Academic?”

“Let’s talk about policy issues.  That might be our ‘last hurrah’ on low doses of ionizing radiation, at least for the moment.”

Kaizen  Curmudgeon   

Unconventional Wisdom 4

Radiation Background—All Around and Underground

“Curmudge, I sense your dogged determination to convince our readers that (a) the LNT hypothesis has been disproven, and (b) radiation hormesis occurs.  This is the fourth posting in the current series —so readers should already know what we are talking about—plus we introduced the topic way back on August 8, 2011.”

“Don’t give us too much credit, Julie.  You and I can’t change how people think.  If we could, we’d be employed or at least put to better use as volunteers.  The most we can do is make readers aware of the existing science.  That through 2005 is found—as noted previously—via complete citations in Hiserodt’s book.  It’s up to our readers to convince themselves.  And remember, it’s easy to scare people but hard to un-scare them.”

“Time for some cold, hard facts, Old Guy.  We mentioned that the average background in the U.S. is 300 mrem per year with radon as the largest contributor.  Other typical background values in the U.S. are 200 mrem/yr in Gulf Coast states and 600 mrem/yr in the Denver area.  More extreme backgrounds are found elsewhere, e.g., 1,300 mrem/yr in Kerala, India and 48,000 mrem/yr in Ramasari, Iran.”

“Here is a situation, Julie, where background radiation is more than an academic question.  It can become a major financial issue.  In the U.S. if one is selling his house, he may be asked to have the radon concentration in his basement air checked.  If the radon is found to be above the EPA’s action level of 4 picocuries per liter of air, the prospective buyers may require the seller to have equipment installed to reduce the radon concentration.  This is due to concern about lung cancer thought to be caused by radon.  (Note: A curie is 37 billion disintegrations per second; a picocurie [pCi] is one trillionth of a curie.)”

“Because you brought it up, Curmudge, please tell me how Cohen and others studied the ‘concern about lung cancer caused by radon’.”

“Bernard Cohen of the University of Pittsburg (1995) (chap. 20 in Hiserodt’s book) collected radon exposure and cancer mortality data from 1,729 counties in the U.S. (90% of the population).  Cohen’s results showed an inverse relationship between lung cancer mortality and radon concentration.  The LNT theory would have predicted ‘4.5 deaths per 10,000 men per year for each pCi/L increase in airborne radon.’  Cohen’s research showed ‘a minus 4.7 deaths per pCi/L.’  More specifically, Cohen (1994, chap 17) studied residential radon vs. lung cancer rates.  In the Rocky Mountain states the lung cancer rate was 47 per 100,000 persons, and the average residential radon was 2.6 pCi/L.  In the Gulf Coast states the lung cancer rate was 68 per 100,000 persons, and the average residential radon was 0.5 pCi/L.  ‘The low-LET* component from radon progeny was probably responsible for the strong hormetic effect described for lung cancer’ (1).”

 

“Wow, Curmudge!  That helps explain the popularity over the centuries of the Gasteiner Heilstollen (Healing Gallery) in Bad Gastein, Austria as well as a lot of other spas in Europe.  The radon content in the healing gallery is advertised at over 1,000 times the EPA action level.  Too bad you didn’t stop there when you were in Austria; it might have helped your late wife’s arthritis.”

“There are similar but much more rustic ‘radon mines’ in the western U.S., Julie.  The oldest is the Free Enterprise Radon Health Mine in Boulder, Montana.  Barbra Erickson has studied and reported on the radon spas in Europe and the radon mines in the U.S. (2).”

“As I recall, Curmudge, chap. 17 of Hiserodt’s book describes studies in Asia of radon in spring water as well as in air.  Mortality from stomach cancer and all cancers was lower in a Japanese town with higher radon in its spring water (Mifune et al. 1992).  A similar trend was noted for lung cancer in indoor air.”

“And in China, Zhai et al. (1982) compared cancer mortality from geographical areas with ‘low background,’ ~100 mrem/yr, and ‘high background,’ ~330 mrem/yr (near U.S. average).  Nearly all cancers were less in the ‘high background’ area as were spontaneous abortions, neonatal mortality, and infertility.”

“So I guess we can conclude, Curmudge, that at the levels studied it’s healthier to live in a higher radiation background, whether it is in the air we breathe, the water we drink, or our total surroundings.”

“It looks that way, Julie, but at my age it doesn’t matter much.  What really concerns me is the mistaken fear of low-level radiation among younger people and our whole society.  In a subsequent posting we’ll speculate how life might be different if that unjustified fear were absent.”

Kaizen Curmudgeon

*LET (linear energy transfer).  Betas and gammas are low-LET radiation.

(1)  Sanders, C. L.  Dose-Response 10:619 (2012).

    

(2)  Erickson, B. L.  The therapeutic use of radon; a biomedical treatment in Europe; an ‘alternative’ remedy in the United Stated. Dose-Response 5:48-62 (2007).

Unconventional Wisdom 3

Epidemiology

“If one is going to study the effect on human health of a phenomenon thought to be dangerous, it has to be done after the fact, right Curmudge?”

“It’s called epidemiology, Julie, and that’s what we will talk about today.  As in the two previous postings, information will come from Hiserodt’s book, which we may occasionally quote or paraphrase.  Original references are found in chapter 16.  An early study by Abbott (1983) of 4,000 nuclear workers, exposed in the workplace to an average of 7 cGy (about 20 years of additional annual background radiation), revealed that their cancer mortality was less than that of the population of Ontario.”

“But, Curmudge, those workers had to be healthier than the average citizen even to be hired.  No wonder their cancer mortality was less.”

“That’s called the healthy worker effect, Julie.  Abbott corrected for this by including a cohort of non-nuclear workers drawn from the same population as the nuclear workers.  The cancer mortality of the non-nuclear workers was right up there with the general population; for the nuclear workers it was much lower.  Another study in Canada, by Gribbin et al., compared leukemia mortality of unexposed Atomic Energy of Canada workers to their colleagues who were exposed to an average of 4.9 cSv.  The exposed workers had about half the leukemia mortality of the controls.”

“Curmudge, even a reckless old buzzard like you should be afraid of plutonium dust.  Plutonium emits alpha particles; they don’t go far, but I’ve always envisioned their making big holes—sort of like Swiss cheese—in one’s lungs.”

“Hiserodt described the fate of 26 males exposed to plutonium dust and fumes during atomic bomb development in 1944-45.  Their health was checked every five years starting in 1952.  By 1986-87, 22 of the subjects were still alive at an average age of 66.  Two had died of heart attacks, one in an auto accident, and one—a pack-a-day smoker—died of lung cancer at the age of 72.”

“Someone has calculated—Hiserodt didn’t say who—that eight of the atomic bomb workers (living at the end of 1987) had received a dose of more than 2 times 10 to the 15^th power alpha particles.  Curmudge, I think I’ll have to revise my mental picture of what alpha particles do inside lungs.”

“Don’t close the book yet, Julie.  In chapter 19 Hiserodt describes what might have been the definitive low-level radiation study.  In 1991 the U.S. Dept. of Energy contracted with Johns Hopkins University to study ‘Health Effects of Low-Level Radiation in Shipyard Workers.’  Workers were divided into three groups: (1) The Control group of 33,352 workers whose duties did not involve radiation.  (2) The Low group of 10,462 workers whose cumulative exposure was less than 500 mrem.  (3) The High group of 28,542 workers whose cumulative exposure was equal to or greater than 500 mrem.  Results were reported as standardized mortality ratio (SMR), which compares the death rate of a group in question with that of an age-adjusted population of peers.  The control group had an SMR of 1.00 for death by all causes, which corresponds with that of the general population.”

“That certainly sounds rigorous, Old Guy.  Tell me what those academic statisticians found.”

“With one exception, the SMRs for both exposed groups were lower (better) than those of the control group.  The exception was mesothelioma, which is known to be caused by amphibole asbestos.  For all causes of death, the difference between the exposed groups and the controls was statistically significant.  For cancers other than mesothelioma (leukemia, lymphoma and hematopoietic cancers, and lung cancer), the SMRs were lower than the controls but not significantly lower.  A reviewer (Prof. John Cameron of UW-Madison) has stated that, ‘This study is probably the best scientific evidence…to show that low levels of ionizing radiation are without health hazard.’ “

“Wow, Curmudge!  I certainly feel better after reading that last sentence.  It is especially interesting that this study was initiated to show the adverse effects of low-level gamma radiation and ended up showing no adverse effect.  It’s another nail in the LNT theory’s coffin.  But why, after so many years, hasn’t the Department of Energy issued a formal report on this work?”

“We can only speculate, Julie, and we will in a later posting.”

“I hope you haven’t forgotten, Senescent Senior, about the unintentional epidemiological event in Taiwan (1).  In 1982 several radioactive cobalt-60 orphan sources were inadvertently recycled into 20,000 tons of steel, some of which was used to construct apartment buildings housing 10,000 people.”

“It wasn’t forgotten, Julie; it was only a ‘senior moment.’  The average cumulative dose for the exposed residents was about 50 mSv.  Twenty years later, only seven fatal cancers were observed where 232 were expected.”

“Do you suppose, Curmudge, that the tenants’ rent was raised to reflect the benefits of radiation hormesis?”

“My guess is that the tenants were evicted and the buildings razed.  It was probably government policy to protect the residents from further exposure to radiation, whether it was good or bad for them.”

Kaizen Curmudgeon

(1)  Sanders, C.L.  Dose-Response 10, p.615 (2012).

Unconventional Wisdom 2

Mice in the Laboratory

“I’m not surprised that it’s hard to find humans to be the subjects of radiation research.  Although mice are ideal for this kind of work, I sometimes feel sorry for the little critters.”

“It’s not all that bad, Julie.  They get three squares a day, and they don’t have to worry about snakes in the grass, owls in the trees, and traps with cheese.  Sometimes they get to participate in reproduction studies, and they even have a 50-50 chance of being in an experiment’s control group.”

“Funny that you should say that, Curmudge, because we’re going to discuss chapter 14 of Ed Hiserodt’s book (see previous posting) in which the control mice usually got the short end of the stick.”

“Let’s look at some of the data:

Maisin, et al. (1988): 1,000 mice per data point were exposed to a single dose of gamma radiation from 20 to 600 cGy.  At 200 cGy, the LNT theory predicted a 60% increase in leukemia while the actual data showed a 35% decrease.

Ullrich, et al. (1979):  400 female mice per data point were exposed to 10, 25, 50, and 100 cGy.  At 25 cGy, cancer mortality was decreased by the following percentages: pituitary (20%), ovarian (20%), mammary (46%), and uterine (13%).

Sacher and Grahn  (1964):  About 100 mice per data point were exposed to cobalt-60 gamma radiation until they died.  Those exposed at about 0.5 and 5 cGy per day lived longer than the unexposed controls.”

“It would appear, Curmudge, that the little rodents died for a good cause, i.e., disproving the LNT theory and supporting radiation hormesis.”

“Here, Julie, is an interesting observation by Yonezawa (1990).  Mice were irradiated with a low dose of x-rays (50 cGy) two weeks before receiving a potentially lethal dose (740 cGy).  The survival rate 24 days after receiving the second dose was higher (80% survived) for the mice that had received the preliminary dose than for the controls that had received no preliminary radiation (11% survived).”

“That certainly resembles vaccination.  The authors called it ‘radioresistance’.  These findings have certainly changed my attitude toward mice, Curmudge.  The next time I see a mouse I won’t whack him with a broom; I’ll salute him.”

Kaizen Curmudgeon 

Unconventional Wisdom 1

A continuation of Conventional Wisdom posted August 8, 2011.

“Listen up, Julie.  I’m going to teach you that exposure to small amounts of radiation won’t hurt you.  In fact, it may even be good for you, even at the levels used for diagnostic purposes such as computed tomography (CT) scans.  Recent research has shown that living in a radiation-deficient environment stunted the growth of a protozoan.  And living in a radiation background that is several times our present level should improve our health and longevity. (Google Sir Samurai T. D. Luckey.)”

“Get off it, Curmudge!  I’ve been taught since I was a child that all radiation is dangerous.  Old men are supposed to dream dreams (Acts 2:17), but isn’t this one pushing the envelope?  And besides, blogs are too brief to teach anything.  The most they can do is inspire the reader to learn more.”

“Right as usual, Julie.  Our teaching—I mean exposure—to this topic began over a year ago (August 8, 2011) in our posting on Conventional Wisdom.  At that time we still had a sponsor and had to tread softly on controversial topics.”

“Hooray! Vive l’indépendence!  Now we can tackle controversial issues head-on.”

“Whoa, Ms. Enthusiasm.  As I said, we introduced today’s topic, the linear no-threshold (LNT) concept, in 2011. To avoid repeating everything, let’s all go back and read the Conventional Wisdom posting.”

[Blog delayed 10 minutes for Jaded Julie and readers to read old posting.]

“Now I remember, Curmudge.  According to the linear no-threshold theory a plot of cancer occurrence vs. exposure, based on high levels of exposure to radiation, could be extrapolated to the origin, i.e., there was no threshold below which there was no effect.”

“That’s it, all right.  But extensive research has shown the LNT theory to be invalid.  We cited some of it in our earlier posting, and we’ll list more books and papers today.  If our readers study the documents that we cite, most should agree that the LNT theory has become outmoded.  However, there will likely be some who will cling to the LNT dogma.”

“Also in our Conventional Wisdom posting there were references suggesting that exposure to low-level radiation imparted a protective effect against cancer.  Will we discuss that also?”

“We surely will, Julie, but it may require more than a single posting.  There’s so much information on these topics that we’ll only have room in the blog to mention authors and brief summaries.  Complete references are in Hiserodt’s book, discussed below.  And to examine these documents critically, a reader will need to become familiar with the units used to measure radiation, which we don’t have space to cover.”

“But Curmudge, we’ll need to use some numbers, and readers will require a few units to even gain a seat-of-the-pants understanding of our story.”

“Good observation, Julie.  Here are some common abbreviations and units:

Abbreviations: m = milli or 1/1000; c = centi or 1/100.

Rem is effective dose in U.S. units; sievert (Sv) [gray (Gy) is equivalent] is effective dose in international units.  1 Sv = 100 rem.  1 cSv =  1,000 mrem.”

“How about providing a frame of reference?”

“Here are some ballpark values:

Typical background radiation (cosmic, terrestrial, radon, medical) in the U.S. = 300 mrem (0.3 cSv) per year.  Background in Denver = 600 mrem (0.6 cSv).

Maximum permissible exposure for a nuclear worker = 5,000 mrem (5 cSv) per year.

Acute exposure (1-2 days) to cause radiation sickness = 100,000 mrem (100 cSv).”

A single computed tomography (CT) scan = 1,000-5,000 mrem (1-5 cSv).”

“Thanks, Old Guy.  Now we all should be on the same page.  Shall we begin our discussion by mentioning the books on this subject that are available?”

“To easily obtain the most information at a reasonable price ($5.91 from Amazon), I recommend Ed Hiserodt’s Underexposed (subtitled What if radiation is actually good for you?) (2005).  Despite its easy-reading appearance, the scientist or nonscientist will likely agree that much of the story is there, and that it is supported by a comprehensive Amazon review by Jay Lehr.  Books with more detail and a much higher price include Radiation Hormesis by T. D. Luckey (1991) and Radiation Hormesis and the Linear-No-Threshold Assumption by Charles L. Sanders (2009).  These books are well documented with peer-reviewed literature.  Luckey’s two books—an earlier one was published in 1981—contain over 2,00 citations.”

“Well Curmudge, I can guess which book a very familiar tightwad bought.  Prof. Luckey is revered in Japan, where they accorded him the honorary title of Samurai.  This can be confirmed by ‘googling’ Sir Samurai T. D. Luckey, where many of the teachings of this blog are also supported.  By the way, I noticed that the books by Luckey and Sanders have hormesis in their titles.  Perhaps you can tell us what hormesis means.”

“It’s the protective effect mentioned by Tubiana in Conventional Wisdom.  And more generally, it’s the phenomenon where something that is harmful at high doses is helpful at low doses.  Examples are many trace metals, vitamins, and even water.  So to proceed, in addition to the papers cited in our Conventional Wisdom posting (those by Vaiserman, Tubiana et al., and Scott et al.) the following tend to refute the LNT theory and support the radiation hormesis concept.  We’ll start with the early observations, made mostly by Japanese scientists, on survivors of the atomic bomb attacks on Hiroshima and Nagasaki.”

“Chapter 15 in Hiserodt shows plots of cancer deaths vs. exposure.  Because plots are hard to show in this blog, I trust, Old Guy, that you can describe them.” 

“A ‘hockey stick’ plot of effect vs. exposure (with blade to the left coinciding with data on unexposed controls) would have refuted the LNT theory.  These plots were shaped like field hockey sticks with blades drooping below controls, thus demonstrating radiation hormesis (fewer deaths than controls) below around 10 cGy.”

“Curmudge, with those exciting findings published in Health Physics and seemingly ignored since 1987, let’s take a few days to search the books further and find some more data.  Sayonara.”

Kaizen Curmudgeon                                               

The Ordeal 3--Summary

“Cancer patient, Jay, and his devoted wife, Ann, have begun six days of in-patient chemotherapy in a different hospital.  Hopefully, they will not be subjected to any hospital screw-ups that we’ll want to discuss.”

“So we’re done for the day?  I’m outta’ here.”

“Nicht so schnell, Julie!  We’ve still got work to do.”

“Based on the tone of your voice, Curmudge, I perceive that you just said ’Not so fast’ (in German).”

“Right as usual.  As we promised last week, we’ll summarize what we learned from Jay and Ann’s ordeal.  In addition, we’ll provide some unsolicited suggestions that the original hospital (which will remain anonymous) needs to consider.  Let’s start this way: Julie, if a hospital said that they were providing patient-centered care—and most of them say that—what would you, as a patient, expect?”

“First of all, if I were in severe pain, I would expect the hospital to do everything feasible to alleviate it.  Nothing else matters to one experiencing intractable pain.  If I had nausea or constipation or other physical discomforts, I’d expect help there too.  Also, I would consider a noisy environment to be a physical discomfort.  Finally (but definitely not least), the hospital should minimize the patient’s and family’s emotional stress.  Not knowing, waiting, or poor communication in general would be almost as bad as pain.  Things often not known would include one‘s diagnosis, when the next test will be and when its results will be available, and when one will be able to eat.  If a hospital can’t communicate with its patients, its supporting elements like clinics and pharmacies, and within itself, it might as well be a cottage industry in Kyrgyzstan.”

“Well put, Julie.  And at some point during Jay and Ann’s ordeal, they experienced each of the above.  The biggest issues at the first hospital were emotional stress and communication problems, which started with the computer hang-up in getting Jay admitted.  Then there were the almost non-existent communications between the hospital and pharmacy.”

“I was really concerned about Jay’s having to wait a day—in pain—for a CT scan and then overnight for the result.  CTs are run 24 hours a day in most hospitals, and there are services that read them overnight.  Of course, Jay, Ann, or nurses in the hospital should have stayed abreast of the constipation problem before it became serious.  Most everyone knows that narcotic painkillers cause constipation.”

“On the other side of the ledger, I was impressed by the on-call oncologists who answer the phone at 2:30 a.m.  It’s amazing that they can be alert and give sage advice to someone who might not even be their patient.”

“So, Curmudge, what’s the bottom line?  The original hospital seems to have a peck of systemic problems.”

“Julie, my one-word answer is the same as it has been for the past six years.  Lean! The hospital needs a Lean transformation.  Anyone who is not acquainted with Lean can start with the first Kaizen Curmudgeon posting in May of 2007 and read the next 240.  In a nutshell, the hospital needs to empower the employees to map their processes, find the root causes of problems, and then use plan, do, study, act cycles to implement continuous improvements.  They need to find the waste and inefficiencies in their systems and get rid of them.  And finally, the hospital must do this with the full support and leadership of management at every level.  If Jay and Ann’s first hospital has already started a Lean journey, it needs more attention.”

“That was a pretty concise rant, Curmudge.  If a hospital can get its systems in order, they should be well on their way to providing patient-centered care.  So what kind of problem will we illuminate—but not resolve—next?”

 

“We’ll take a break for a couple of weeks, read some books, and then present some stuff about a little-known issue that a few readers might not believe.”

“Sounds interesting.  I’m with you, Old Guy.”

Kaizen Curmudgeon