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Sunday, August 3, 2014

Questioning the Very Status of the Ministry of the Environment Expert Meeting Regarding the Status of Disaster Victims' Health Management

Questioning the Very Status of the Ministry of the Environment
Expert Meeting Regarding
the Status of Disaster Victims' Health Management

It might have been a slip of a tongue, but Chairman Shigenobu Nagataki, an emeritus professor at Nagasaki University, a former chairman of Radiation Effects Research Foundation, and a mentor to infamous Shunichi Yamashita, appeared to be speaking earnestly when he said, "Committee members, please do not hesitate to ask questions. Given what was just stated, it will be disastrous for this committee to have to conclude that there is an actual increase in thyroid cancer [due to the Fukushima accident]." Toshihide Tsuda, a physician and an epidemiologist at Okayama University, has just emphatically stated that in certain Fukushima municipalities there was a clear evidence of a thyroid cancer epidemic in those who were 18 or younger at the time of the March 2011 accident. Calling this an “outbreak, occurring only 3.1 to 3.2 years after the accident,” Tsuda stressed that in the near future, thyroid cancer would begin to appear in those with relatively longer latency periods, which means a quick action is needed to secure adequate medical resources in order to be able to provide diagnosis and treatment in a timely manner.

This conversation happened during the eighth session of the Expert Meeting Regarding the Status of Health Management of Residents Following the Tokyo Electric Fukushima Daiichi Nuclear Power Plan Accident, held by the Ministry of the Environment on July 16, 2014. The Expert Meeting was originally established in order to discuss the health care and radiation exposure aspects of the Children and Disaster Victims Support Act, which was approved by the Diet in June 2012.

As a background, Fukushima Prefecture is already conducing health management survey for the residents utilizing a fund established by the national government. However, the national government is in need of discussing the current status of health management and its challenges in Fukushima Prefecture as well as the surrounding prefectures from a medical viewpoint. In addition, the Children and Disaster Victims Support Act requires the national government to take any necessary measures regarding surveys on radiation health effects. Based on these needs, the Expert Meeting was established within the Ministry of the Environment to discuss, from an expert perspective, the status of measures for grasping and assessing exposure doses, health management, and medical care.

Fundamentals of the Children and Disaster Victims Support Act are summarized as follows:

  • providing accurate information;
  • supporting the choice of residing, moving and returning based on the intention of disaster victims;
  • making efforts for prompt alleviation of health concerns from radiation exposure;
  • giving due consideration so that disaster victims do not face unwarranted discrimination;
  • giving special consideration for children (including fetuses) and pregnant women;
  • and continuing a long-term and reliable support for radiation effects as long as needed.

Issues discussed at the MOE Expert Meeting were in particular related to the Article 13 of the Children and Disaster Victims Support Act, in regards to the study on health effects of radiation exposure and the provision of medical care. The Article 13 reads as follows:

  1. In order to clarify the situation of radiation exposure caused by the Tokyo Electric nuclear accident, the national government shall take measures such as estimating radiation exposure doses and assessing exposure doses using tests effective for dose assessment, and any other necessary measures.
  2. The national government shall take necessary measures in regards to implementing regular medical checkups for the disaster victims and conducting other surveys of health effects from radiation exposure due to the Tokyo Electric nuclear accident. In this case, necessary measures should be taken so that those who have resided in areas with radiation levels measured above a certain threshold as children (including those who were in utero when their mothers resided in such areas), or those in equivalent circumstances, shall have lifelong medical checkups.
  3. In relation to the medical expenses to be borne by children or pregnant women who are disaster victims (excluding medical care relating to injuries or illnesses not caused by radiation exposure due to the Tokyo Electric nuclear accident), the national government shall take necessary measures to reduce the financial burden or any other measures relating to the provision of medical care to the disaster victims.

A point of contention at the MOE Expert Meeting, headed by Nagataki, has been the dose assessment, especially the direct measurements of thyroid glands of 1,080 children (age 0 to 15), conducted in late March 2011. Nagataki seemed determined to utilize the direct measurement data, which concluded that nobody exceeded 50 mSv, despite critical issues such as a small sample size and high background radiation levels. He has been trying to build an “expert consensus” regarding the validity of the direct measurement data. However, guest presentations by experts at the Expert Meeting have revealed that the contamination level of clothing, not the background air dose rate, was used as the background radiation level, which was subtracted from the actual count to obtain the exposure dose. This could have potentially resulted in underestimation.

In addition, Nagataki emphasized how the high kombu (a type of seaweed with especially high iodine content) consumption rate amongst the Japanese offered protective effects against radioactive iodine, given the fact the majority of children never received stable iodine tablets for thyroid blocking before exposure to the radioactive plume. However, the actual consumption amount of kombu in last 40 years has gone down, for reasons such as the introduction of western food in the 1970s. According to Nagataki's presentation at the 2007 American Thyroid Association meeting, the average dietary iodine intake from seaweeds was 1.2 mg/day in Japan1. However, kombu consumption appears to be decreasing each year, especially in younger families with children which consumed one-third of average amount of seaweed consumption, due to decreased consumption of traditional foods. Children's dietary intake from seaweeds might be a quarter to one-third of Nagataki's outdated claim.

As each session of the Expert Meeting progressed, Nagataki worked towards building a consensus to “scientifically” validate the 1,080 screening data for dose assessment and thus the basis for estimating health risks, despite its shortcomings. The exposure dose estimate from the 1,080 screening data, well below 100 mSv, which is widely regarded by regulators and radiation protection specialists as the level cancers might increase, would allow the government to claim that health risks is too low to necessitate expansion of medical checkups to wider areas and age groups. At the seventh session held on June 25, 2014, Nagataki pointed out2 that “Times are different between now and when the Children and Disaster Victims Support Act was approved. We now have more dose assessment data which allow us to talk about the health risks scientifically. This is a huge difference,” when Hiromi Ishikawa, the executive director of Japan Medical Association, pressed for consideration of introduction of medical checkups in hotspots outside Fukushima Prefecture, such as Matsudo and Kamagaya in Chiba Prefecture, based on the principle of the Children and Disaster Victims Support Act.

As a matter of fact, in his attempt to build an expert consensus, Nagataki appeared not to take into consideration opinions of outside experts if they differed from his. Even more, he appeared to be trying to disregard the very mission of the Expert Meeting: discussing radiation health effects and health management on the basis of the Children and Disaster Victims Support Act.

This became the most apparent at the July 16th session, as depicted in the July 22 Tokyo Shimbun article, translated into English here.

Tsuda, one of the five expert witnesses invited, claims that the current “outbreak” of thyroid cancers in Fukushima children cannot be explained by the “screening effect,” when the data is analyzed and compared with the national cancer statistics as well as within Fukushima Prefecture against municipalities with the lowest exposure dose.

Table 1 Comparison of thyroid cancer detection probabilities within Fukushima Prefecture
(Prevalence Odds Ratio determined against Aizu and Soma areas as the control).

Critical of the commonly accepted notion that health effects do not occur below 100 mSv, Tsuda presented numerous published studies that proved otherwise. In fact, he by far exceeded 10 minutes allotted for each of the five expert witnesses that day, and Nagataki had to nudge him to wrap up more than twice. Tsuda defiantly replied, “This Expert Meeting has not brought up these studies [as it should have], so I must do it [for you],” and went on until he was done.

Tsuda explained that in outbreak epidemiology, which was developed as an investigative tool in studying disease outbreaks where the cause isn't always apparent, the effect (disease) is what is studied and dealt with. He called the Expert Meeting's fixation on dose assessment “backwards” and “a mere laboratory method.” Tsuda said to Nagataki, “We must remember that this is an issue of humans.”

Tsuda also said that the Expert Meeting should consider the fact that all age groups including pregnant women were still being exposed to radiation in Fukushima Prefecture. This drew an applause from the audience of general public, which made Nagataki displeased. He said, “Um, this applause...haven't the audience been asked not to applause ahead of time?” This statement also appeared to startle Nagataki and other members, such as Otsura Niwa, a retired Kyoto University Professor who holds a position of Special Professor at Fukushima Medical University. Both Nagataki and Niwa, in disbelief, had to confirm with Tsuda what he meant. Tsuda said, “We are all being exposed to radiation in Japan, except the air dose rate is higher in Fukushima.”

During the debate following the presentations by the witnesses, there were some questions regarding Tsuda's presentation as described in this post. Tsuda insisted that the World Health Organization (WHO) report clearly stated thyroid cancer, leukemia, breast cancer and other solid cancers would increase. In response, Niwa talked3 about the dilemma he faced as a member of the WHO Health Risk Assessment Expert Group, which compiled Health risk assessment from the nuclear accident after the 2011 Great East Japan earthquake and tsunami, based on a preliminary dose estimation4 in February 2013.

Niwa felt that doses were overestimated due to various issues with assumptions utilized in dose estimation. He repeatedly asked the Expert Group to employ more realistic methods to estimate doses, but the Expert Group chose to stick to higher estimate doses, taking a conservative and cautious approach based on a radiation protection concept. Niwa says he disagreed with the Expert Group's decision and argued that the conservative approach certainly would be reasonable and indeed very important in a prospective estimation, but that it would not be appropriate to retrospectively estimate unnecessarily high doses in those who were already exposed. Niwa disclosed during the discussion that he suggested reducing the estimated doses by one-tenth, but that the Expert Group never incorporated his suggestion. (After the meeting was over, Tsuda and Niwa carried out further, informal discussion on whether the thyroid cancer cases in Fukushima were due to the screening effect or not. Tsuda asked Niwa if he has ever read a single published study regarding a screening effect. Niwa replied, “No, not myself.” Tsuda, speaking with a freelance journalist, Oshidori Mako, expressed his disappointment and frustration with the Expert Meeting, as the so-called experts were not even familiar with studies published on health effects of radiation below 100 mSv. Tsuda felt that it was impossible to carry out sufficient arguments as the grasp of the basic knowledge differed so much).

During the concluding statement, Nagataki acknowledged that the consensus of the Expert Meeting to accept United Nations Scientific Committee on the Effects of Atomic Radiation's (UNSCEAR's) approach to assessing health risks, based on dose estimation, appeared to differ vastly from the opinions of the witnesses. He stated that the Expert Meeting was taking a serious care to consider [the well-being of] the disaster victims and earnestly discussing the best way to carry out health management for them. This statement contradicts the statement he made at the June 25 session, dismissing the Children and Disaster Victims Support Act. Most of all, if the Expert Meeting were seriously considerate of the disaster victims whose true exposure doses are unknowable, due to the lack of sufficient early exposure data, why would it be disastrous for this Expert Meeting to have a conclusion that cases of thyroid cancers might be increasing? The Expert Meeting would be truly serving the disaster victims if it fully embraces its mission to expertly discuss radiation health effects and health management, adhering to the principles of the Article 13 of the Children and Disaster Victim Support Act, from the viewpoint of precautionary principle, rather than having prejudged conclusions.

Other important issues to be raised about this Expert Meeting have to do with the potential conflict of interest. For instance, Niwa, also a member of International Committee on Radiation Protection (ICRP) , is known to have received financial support from the Federation of Electric Power Companies of Japan for his travel expenses to the ICRP meetings5. Although the WHO Expert Group cleared his conflict of interests in this matter, citing his expertise in molecular biology and radiation biology, he certainly appears to have a conflict of interest for the MOE Expert Meeting.

Niwa is not the only one with the potential conflict of interest. Chairman Nagataki is currently a chairman of the board of Radiation Effects Foundation6, which arranged financial assistance from the Federation of Electric Power Companies of Japan to Niwa. Some of the members, Nobuhiko Ban and Toshimitsu Honma, were involved with the making of UNSCEAR Fukushima report. Yasuhito Sasaki is a former committee chairmann of UNSCEAR.

With the deviation from its original mission and the apparently predetermined conclusion to underestimate health risks, along with the potential conflicts of interest in multiple members, is it not time to question the very status of the Expert Meeting Regarding the Status of Health Management of Residents Following the Tokyo Electric Fukushima Daiichi Nuclear Power Plant Accident?


The Ministry of the Environment Expert Meeting: Witnesses Propose “A Drastic Overhaul of Medical Checkups and Dose Assessment”

(This is a translation of an article on the website of OurPlanet-TV, a Japanese independent media, which summarized the eighth session of the Ministry of the Environment Expert Meeting Regarding the Status of Health Management of Residents Following the Tokyo Electric Fukushima Daiichi Nuclear Power Plan Accident which was held on July 16, 2014. Tokyo Shimbun article regarding the same session is translated here).

The Ministry of the Environment Expert Meeting: Witnesses Propose "A Drastic Overhaul of Medical Checkups and Dose Assessment

Friday, July 25, 2014

Fukushima Thyroid Examination Fact Sheet: May/June 2014

Below is a synopsis of the thyroid ultrasound examination, being conducted in Fukushima Prefecture since October 2011. The synopsis is intended to organize and clarify available information regarding thyroid cancer cases discovered in Fukushima residents, who were under age 18 at the time of the March 2011 Fukushima nuclear accident. It also includes some information gathered from various committee meetings, conducted and streamed live online only in Japanese. 

Fukushima Thyroid Examination Fact Sheet: May/June 2014

In October 2011, seven months after the Fukushima Dai-ichi nuclear power plant meltdowns and explosions, Fukushima Prefecture began thyroid ultrasound examination, as part of Fukushima Health Management Survey1 (now called Fukushima Health Survey), in over 360,000 children. These children were younger than 18 at the time of the accident, and most of them did not receive adequate protection of stable iodine tablets for prevention of thyroid cancer. This was intended to be the baseline examination to assess the current condition of their thyroid glands. The thyroid gland is known to be affected, especially in children, by radioactive iodine 131 emitted from a nuclear accident.

The plan was to conduct the preliminary (first-round) thyroid ultrasound examination in all 360,000 plus children, beginning with municipalities with the highest radiation exposure doses. With Fukushima Medical University (FMU) being the sole conductor of the examination initially, as commissioned by Fukushima Prefecture, the first round of the examination was completed in late March 2014, at the end of Fiscal Year 2013. Cumulative results have been released every 2 to 4 months2, as the examination progressed on each year's cohort.

The final results of the first round of thyroid ultrasound examination from October 2011 to March 2014 are not yet known as of May 2014, since the secondary examination has not been completed. However, the results tallied up to March 31, 2014 were released on May 19, 2014, at the 15th Prefectural Oversight Committee Meeting for Fukushima Health Survey3.

Thyroid ultrasound examinations conducted on 295,511 Fukushima children (final results known for 287,056 children as of February 21, 2014) since October 2011, revealed that 136,804 children (47.7%) had an "A2" assessment, with either cysts 20.0 mm or smaller or nodules 5.0 mm or smaller. In addition, 2,069 children (0.7%) had a B assessment, indicating cysts 20.1 mm or larger or nodules 5.1 mm or larger, qualifying them for secondary examinations, including a more detailed ultrasound examination, blood and urine tests checking for thyroid function and iodine excretion, and fine-needle aspiration biopsy if necessary. Of these 2,069 children, 1,754 actually received the secondary examination.

So far, there are 49 papillary thyroid cancer cases, which were the most common form of thyroid cancer found in children after the 1986 Chernobyl accident, and 39 have suspect biopsies, meaning they need surgery to obtain a section of thyroid gland for tissue biopsy. Another cancer case is suspected to be of the poorly-differentiated subtype, with the final tissue diagnosis pending. The total number of confirmed thyroid cancer cases is 50, and the total number of confirmed and suspected cancer cases is 90 (this number is sometimes reported as 89, excluding one case that was confirmed to be benign). 32 were male and 58 were female, with an average age of 14.7 ± 2.7 (age range 6-18) at the time of the accident. The tumor size ranged from 5.1 mm to 40.5 mm. The youngest was a girl who was 6 at the time of the accident.

The incidence, or more accurately, prevalence, is thus 30.1 per 100,000 overall or 16.6 per 100,000 for confirmed cases so far. Although it is not possible at this time to determine if these cancers are radiation-induced or not, drawing on Japanese cancer incidence statistics, 3 or fewer cases of thyroid cancer would be expected in this population per year. (In 2010, normal incidence of thyroid cancer in Japan was 0.1 in 100,000 below age 15 and 1.1 in 100,000 in age 15-194,5). According to the National Cancer Institute, pediatric thyroid cancer incidence in the US, is 0.2 in 100,000 below age 15 and 1.76 per 100,000 in age 15-19 (12.2 in 100,000 in adults6).

So far, the official consensus of the Ministry of the Environment (MOE) of the Japanese government, FMU, and the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR) appears to be that the finding constitutes a “screening effect,” which means thyroid cancer is being discovered as all children in Fukushima Prefecture are screened7,8. MOE also conducted a study in distant prefectures, supposedly unaffected by radiation exposure, but the study population is not age- and sex-matched to the Fukushima cohort and the two datasets cannot be directly compared9.

It should be noted that about 20% of the 368,651 Fukushima children never underwent the first round of thyroid ultrasound examination for various reasons. In addition, about 15% of the 2,070 children are yet to undergo the required secondary examination, and 10% of the 1,754 who underwent the secondary examination are still awaiting their results.

In the full-scale examination beginning April 2014, those born between April 2, 2011 and April 1, 2012 will be included, some of who were exposed in utero, making the total to be examined 385,000 in a two-year period. Fukushima Prefecture is now offering more facilities to conduct the examination in Fukushima. Agreements have been signed with various medical facilities nationwide to conduct the thyroid examination, so that 17,634 children residing outside Fukushima Prefecture can have an easier access.

Additional information:

Shunichi Yamashita, in charge of the Fukushima Health Survey until March 2013, initially claimed any thyroid cancer discovered during the screening would be latent cancers which would not have been discovered until much later if the screening hadn't been conducted.

At the June 2013 meeting of the Thyroid Examination Assessment Subcommittee, Shinichi Suzuki, an FMU professor currently directing the thyroid examination, admitted that some of the 50 cancer cases had lymph node metastasis or symptoms such as hoarseness which validated thyroidectomy. Suzuki had also maintained these cancers represented latent cancers.

This revelation came when Suzuki was grilled about the possibility of overdiagnosis and overtreatment by one of the subcommittee members, Kenji Shibuya10, a public health specialist at the University of Tokyo Graduate School of Medicine. Shibuya co-authored an article raising the issue of thyroid cancer overdiagnosis and overtreatment, published in Lancet11 in May 2014.

Although Suzuki mentioned the existence of conditions which would justify surgery, he would not release any detailed data such as the actual number of such cases. However, his admittance of lymph node metastasis in some of the cases seems to contradict the initial claim that these cancers were latent cancers which would never have been found.

This is a controversial topic, and we are awaiting a release of some of the data by FMU. By the way, although no longer attending the Prefectural Oversight Committee Meeting for Fukushima Health Survey, Shunichi Yamashita remains as the senior director of thyroid ultrasound examination12.

5 Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H and The Japan Cancer Surveillance Research Group. Cancer Incidence and Incidence Rates in Japan in 2008: A Study of 25 Population-based Cancer Registries for the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Japanese Journal of Clinical Oncology, 44(4): 388-396, 2013

Tuesday, July 22, 2014

The July 22 Tokyo Shimbun article, "Running Backwards on Health Support After the Nuclear Accident: Ministry of Environment Expert Meeting"

On July 22, 2014, Tokyo Shimbun published an article titled, "Running Backwards on Health Support After the Nuclear Accident: Ministry of Environment Expert Meeting." The entire article is only available in the paper edition as in the image below, but it has been written out in this blog post.

Below is the complete English translation of this article.

Running Backwards on Health Support After the Nuclear Accident: Ministry of Environment Expert Meeting

The Ministry of the Environment (MOE) Expert Meeting Discussing Health Support After the Fukushima Nuclear Accident is taking an unthinkable twist. At the July 16th meeting, an outside researcher asked for the expansion of health checkups, but the committee chair looked the other way, stating “I don’t want to discuss the issue.” The expansion of health checkup is part of the Act Concerning Support for Children and Disaster Victims, but the committee chair himself voiced an opinion, “We now have different circumstances from when the Act was first approved.” There is no way disaster victims can accept such attitudes. (by T. Sakakibara)

◆ Hesitant on the Expansion of Health Checkups

“Radioactive materials [being disseminated due to the Fukushima nuclear accident] are not thought to remain within borders of Fukushima Prefecture. We need to urgently figure out if there are any cases in non-Fukushima residents. We should not be fixated only on dose assessments.”

It was the Ministry of the Environment Expert Meeting held on July 16th. An invited guest speaker Toshihide Tsuda, an epidemiologist and an Okayama University professor, challenged the current state of the meeting spending time on discussing what the exposure dose was for residents within and out of Fukushima Prefecture.

However, Shigenobu Nagataki, the committee chair and a former chairman of Radiation Effects Research Foundation, pushed aside what Professor Tsuda pointed out, stating, “You are extremely unique.”

Fukushima Prefecture began the Prefectural Resident Health Survey immediately after the accident, including thyroid examination for those who were under age 18 at the time of the accident. However, the central government currently pays for health examination only for Fukushima residents. Therefore, the Expert Meeting is presently discussing whether other areas might need health checkups.

Chairman Nagataki has set a policy to: 1) Assess the exposure dose for residents within and out of Fukushima Prefecture; 2) Analyze health effects based on the dose; and 3) Consider which health support might be necessary. At the last meeting (the seventh session) on June 26th, the rough outline of dose assessment was finally put together.

The outline, based on the dose estimates by an Independent Administrative Institution, National Institute of Radiological Sciences, as well as the behavior questionnaire of residents by Fukushima Prefecture, stated that the internal exposure dose from radioactive iodine that can cause thyroid cancer was “mostly under 50 mSv.” In regards to the external exposure dose, it noted that “The survey finding, ’99.8% was under 5 mSv in Fukushima Prefecture,’ could be reasonably applied to see the overall tendency.”

However, there are large uncertainties in this assessment result.

Only about 1,000 had direct measurements of exposure from radioactive iodine taken, which is 0.3% of residents eligible for thyroid examination by Fukushima Prefecture. Radioactive iodine has a short half-life of 8 days and cannot be measured now. Behavior questionnaires for external dose assessment had a low response rate of only 25.9%.

During the meeting, Professor Tsuda claimed, “When considering a causal relationship between an illness and a cause, data for the cause often tends to be scant. It is a principle of international epidemiological analysis to see it from the side of the illness. Considering the cause first is merely a laboratory method.”

In addition, he continued, “Fixating on dose assessments will delay countermeasures, worsening the damage.” He emphasized that health checkups should be immediately carried out within and out of Fukushima Prefecture, in order to identify cases of thyroid cancer and other illnesses and to analyze whether the number of cases increased after the accident or whether there are regional differences.

Despite inviting Professor Tsuda to the meeting, Chairman Nagataki practically ignored his opinion.

To this response [by Nagataki calling him unique], Professor Tsuda retorted, “My opinions are based on a textbook published by Oxford University Press. Chairman, you are the one that is unique.” However, Chairman Nagataki unilaterally cut off the conversation, stating, “I have no intention of arguing with you. We are going to carry on discussion based on exposure dose.”

◆ Not Meeting the Expectations by Residents

Passive assessments of radiation health effects by the Japanese government predate this meeting.

The Cabinet Office expert meeting, “Working Group (WG) on Risk Management of Low-dose Radiation Exposure,” put together a report in December 2011, concluding, “…increased risk of cancer from low-dose radiation exposures at 100 mSv or less is so small as to be concealed by carcinogenic effects from other factors, making verification of any clear cancer risk from radiation exceedingly challenging.” 

The Cabinet Office WG was also headed by Nagataki. It also included other members of the MOE expert meeting, such as Ostura Niwa, a special professor at Fukushima Medical University, and Keigo Endo, president of Kyoto College of Medical Science.

The expert meeting, at this point of time, is leaning in the direction of “Radiation health effects cannot be proven,” and “As the effects cannot be proven, even health checkups within Fukushima Prefecture are unnecessary,” since the exposure dose within and out of Fukushima Prefecture is expected to be significantly lower than 100 mSv.

In fact, the expert meeting already has some opinions hesitant on expanding health checkups.

The Act Concerning Support for Children and Disaster Victims [English translation here], approved in June 2012, asks for expansion of health checkups as well as reduction of medical expenses, but Chairman Nagataki cast doubt on the need for it at the seventh session, stating “Circumstances are quite different now compared to the time when the act was approved,” and, “As the dose assessment has progressed, we can now make scientific statements in regards to the risk.”

Likewise, during the same session, a member of the expert meeting and a professor at Osaka University, Tomotaka Sobue, explained disadvantages of health checkups using the term, “overdiagnosis.”

This means that since a slow-growing cancer, such as thyroid cancer, has a possibility of never becoming symptomatic in lifetime and causing damages to the body, discovery of cancer during health checkups could cause excessive anxiety and a psychological and physical burden due to surgery.

Another member and the clinic director at International University of Health and Welfare, Gen Suzuki, claimed “An adequate debate needs to be carried out as to whether the best answer is to conduct health checkups as a response to anxiety by residents regarding their health.”

However, requests for expansion of health checkups are swelling from the side of the parties involved, the residents.

On July 13th, there was an event in Metropolitan Tokyo for mothers from within and out of Fukushima Prefecture to talk about life after the nuclear accident.

One of the participants, Kaoru Inagaki (age 42), a member of citizen’s group, Kanto Children Health Survey Support Fund, which conducts thyroid examination in four prefectures including Tochigi, Ibaraki, Chiba and Saitama, said, “When we announce openings for the examination, they are immediately taken up.”

Another participant, Kumi Kanome (age 46), a mother who evacuated with a second-grade daughter to Kanagawa Prefecture from Otama Village, Fukushima Prefecture, appealed, “The nuclear accident increased our worries about children’s illnesses. It is natural for us to want to have them checked out. Regardless of whether living in or outside Fukushima Prefecture, any mother would feel that way.”

Emiko Ito (age 51), director of the event organizer, non-profit organization “National Parents Network to Protect Children from Radiation,” said, “The expert meeting is ignoring the Act Concerning Support for Children and Disaster Victims. That won’t be conducive to resolving residents’ anxiety. It only leads to mistrust.”

Some of the members of the expert meeting have different views. One of them, Hiromi Ishikawa, Executive Director of Japan Medical Association, criticizes, “The present expert meeting does not reflect opinions of the residents. I don’t know why anybody would just one-sidedly tell worried people, ‘It’s okay.’”

From a stand point of “nobody knows the effect of low-dose radiation exposure,” he says, “We need to quickly consider whether there are any illnesses due to radiation and how to deal with them if there are any. Worries can be only resolved when we are prepared that way.”

“Advantages and disadvantages of health checkups are not something that can be uniformly decided by those who are called experts. We need to establish the system for health checkups and let the residents, who are the parties involved, decide.”

Memo from the editing desk:
Mr. Nagataki is running the expert meeting. This fact alone makes it clear how the government has summed up the Fukushima nuclear accident. The predecessor of Radiation Effects Research Foundation was the United States Atomic Bomb Casualty Commission (ABCC), which “investigated the effects of atomic bombs without treatment.” A network originating there was involved in developing the “Myth of Infallible Safety.” Now they are working hard to spread the “Myth of Reassurance.”

Wednesday, May 28, 2014

Mako Oshidori in Düsseldorf "The Hidden Truth about Fukushima"

On March 8th, 2014, comedienne/journalist Mako Oshidori gave a lecture, "The Hidden Truth About Fukushima" in Düsseldorf, Germany, organized by a citizen's group, SAYONARA Genpatsu Düsseldorf. Translation of Mako Oshidori's March 6th, 2014 press conference at the German IPPNW (International Physicians for the Prevention of Nuclear War) Symposium in Frankfurt can be found here.

The lecture, given in Japanese with German interpretation, was transcribed and translated into English.

Moderator: Good evening everyone. My name is Mariko. Welcome to a lecture by Mako Oshidori. As we all know, the Japanese people experienced the Great East Japan earthquake and tsunami on March 11, 2011. A huge earthquake, followed by tsunami and the nuclear accident, has become an unprecedented disaster for the Japanese as well as the rest of the world. Moreover, this accident is not only out of control but continues to be in critical state.
As you may be aware, the issue of anti-nuclear power plant ranks third in the interest of Metropolitan Tokyo residents. This was revealed in the degree of interest survey of various public opinion polls during the recent Tokyo gubernatorial election. The number one issue was declining birthrate. It could be said that the interest in this type of issue is suppressed due to the media control. This is a situation where the voices from disaster-stricken Fukushima do not reach Tokyo residents.

However, today, we have invited Mako Oshidori to come and share with us her direct knowledge of what is happening in Fukushima. It is a rare opportunity that this type of information is directly disseminated in foreign countries, so this is going to be a valuable lecture. Mako Oshidori is a representative of Free Press Corporation in Japan. Is that right?

Mako: I am the director, not a representative.

This organization was originally created after the earthquake. The media is controlled as I just mentioned. This alliance was created for the purpose of conveying accurate, fresh information without media control.

Mako: Actually, it was created shortly before the earthquake. It was sort of coincidental.

Before the Fukushima accident, Mako Oshidori was performing Manzai, a two-person comedy act, as part of the pair, Oshidori Mako and Ken, for belonging to Yoshimoto Kogyo. However, after the nuclear accident, she began to voice her opinions about anti-nuclear power plant issues, which kept her from getting work. Instead, she became more known as a journalist, especially for her sharp questions which would drive TEPCO officials into a corner. Mako is of course a journalist, but she also visits Fukushima Prefecture to gather voices of local people and interview TEPCO workers to gather information. Now I will give the microphone to Mako Oshidori. I hope this evening will bring an informative and contemplative time together.

My name is Mako Oshidori.  I am sorry I speak in Japanese

I am very thankful I can meet you today and have an opportunity to talk here. I am glad to be here. I am very grateful to the Protestant church and the IPPNW or International Physicians for the Prevention of Nuclear War for inviting me to Germany. I would like to make a minor correction in the introduction given a moment ago. I was invited to talk to you, but I am actually not active in the anti-nuclear power plant movement. What I do is conduct investigations. There are numerous issues in Japan that I investigate, from the nuclear accident to other medical issues such as Minamata disease and Asbestosis.

However, doctors and scientists attending the IPPNW conference, which ended yesterday, shared how they end up being labeled as anti-nuclear activists even though they don’t consider themselves to be as such, when they research and publicize facts inconvenient for promotion of nuclear power. There is a tremendous amount of pressure exerted when researching and writing up facts the nuclear lobby doesn’t like. If you continue without giving in, despite such pressure, people eventually think you are an anti-nuclear power plant activist. Of course, it is my belief that we don’t need nuclear power plants on Planet Earth.

There is one thing that really surprised me here in Europe. It’s the fact that people here think Japan is a very democratic and free country. I am actually a journalist with the highest attendance rate at the TEPCO press conference. It seems inconvenient to them when I write various facts in articles, and a variety of pressure has been placed on me. There was a magazine I used to contribute an article to. An electric power company group would pressure the editor to place three pro-nuclear articles each time one of my articles was posted. As a result, my article ended up not being posted in the magazine. Also, there was a television show being planned where I would talk about the TEPCO accident, but sponsors gave an instruction not to have me use any words such as nuclear power and nuclear power plants. I ended up not going on the show.

In 2011 and 2012, pressure was placed on me by TEPCO. However, in 2013 when the Japanese central government decided to begin to restart nuclear power plants, the government placed a watch on me. In July 2013, a new House of Councilors was elected and both Upper and Lower House ended up with the Liberal Democratic Party as the ruling party. This administration then held a secret meeting by secretly gathering specialists and researchers in the field of nuclear power. The meeting was convened in order to collect ideas about how to decommission Fukushima Daiichi nuclear power plant, and a piece of paper was distributed with a list of names. The current Japanese government told the researchers not to approach anybody on the list. The list included people with power in the opposition parties, such as the former prime minister Naoto Kan and the politician Ishiro Ozawa, and I was told that my name, Mako Oshidori, was listed alongside these names. A researcher who was given the list and told not to approach anybody on it was friendly with me and told me the list included my name.

Soon after that a mysterious man began to follow me. This man appeared to be a member of Public Security Intelligence Agency in the Cabinet Office, which investigates various things. One of my hobbies is taking a candid shot, and I will show you the successful candid shot of this man. 

Just as you see here, there was a time period when someone would always be near me, trying to eavesdrop on my conversation with people. As I am a professional entertainer, whoever I am talking to would ask me if the person was my manager. I would say that the person must be one of my groupies, as I have never met the person. Sometimes I would go to Fukushima Prefecture to interview different mothers. We would have meals together and talk somewhere, and when the mothers are leaving the premise to go home, an agent from the Public Security Intelligence Agency would take a photo of each mother and make a note of the license plate number of each car. Afraid of having their photos taken or the license plate numbers recorded, some Fukushima mothers would refused to be interviewed, or they would even refuse to have their stories published. An ex-agent who is knowledgeable about the work of the Public Security Intelligence Agency said that when you are visibly followed, that was meant to intimidate you. If there was one person visible, then there would be ten more. I think that is analogous to cockroaches. So, when you do a little serious investigation about the nuclear accident, you are under various pressure and it makes it more difficult to interview people. There are actually other journalists from major newspapers and television stations, other than me, who have done a lot of investigation about the nuclear accident, but the information doesn’t readily come out. That’s because the pressure is placed on them not to release the information. What I am going to tell you now might surprise you, but the Japanese people are just as surprised when I tell them the same information as it’s something they have never heard of, read in the newspaper, or seen on TV.

Next, I would like to talk about the nuclear power plant workers. This man used to work for TEPCO as a nurse at a medical clinic inside FDNPP. I interviewed him when he quit his job at TEPCO in 2013. 

When NPP workers die, the only deaths publicly announced by TEPCO are deaths that occurred while at work. For instance, if workers die during a weekend, in sleep, or during time off after 3 months of work, their deaths won’t be announced. Such deaths are reported to someone like him at the medical team at TEPCO, but they are merely attributed to chronic illnesses they must have had. There is no way to tell if the deaths were due to radiation exposure, but he said he was certain the workers were working under extremely severe conditions. I really wanted to write about his interview in various magazines, but unfortunately I can only write about this on the Internet which doesn’t have any sponsors.

There was an NPP worker who died in January 2012. I did a fairly thorough investigation after I was able to obtain police report on him. We got an address for the guarantor for the deceased worker, so we went to that address. There was an apartment building at this address without a unit numbered 204 which was supposed to be where the guarantor lived. In Japan, number four could mean bad luck (Note: In Japanese, number 4 phonetically sounds just likea Japanese word for “death”). After room 203, there was room 205, skipping room 204. I asked the other occupants of the apartment building, but there was no resident there by the name of this guarantor, so it didn’t seem like I wrote down the number wrong. Even though the building could be located on a map, you have to go there to verify the room is actually there. This might have been an guarantor with an imaginary address. This is the dark side of the construction and nuclear industries, not just post-nuclear accident, that those without families, especially elderlies, are given harsh work.

Workers who were exposed to 100 mSv in 2011 are entitled to annual cancer screening and thorough medical care. However, most workers get exposure doses below 100 mSv, such as 90, 95, or 83 mSv, and they don’t qualify for thorough medical care. Workers who had been working at NPP since before the accident know what could happen to them a after reaching a certain exposure dose in one year, or what it means to get exposed to 35 mSv in 2 hours during a particular work. They talk about how they probably won’t live too long. They are determined not to have any children, and they often talk about how uncertain they are about their lives in 5 years.

In current Japan, even children are not being protected, but there are some who are determined to protect children’t health. However, there is hardly any group or individuals advocating for protecting the workers in the most dangerous environment at FDNPS. I believe that is our responsibility. My article about the deceased worker from the January 2012 investigation was actually published in a weekly magazine Shukan Bunshun. However, a singer Ayumi Hamazaki suddenly got divorced right then, and I was asked to cut 75% of the article. I think a big reason why information such as this is not publicized is because readers are not craving for such information. We are in essence not fulfilling our duty to be informed.

Next, i would like to talk about mothers in Fukushima. These mothers (and fathers) live in Iwaki City, Fukushima. They are active on school lunch issues. Currently, Fukushima produce isn’t selling well due to suspected contamination. So the prefectural policy is to encourage the use of Fukushima produce in school lunches, in an attempt to appeal its safety. As a large municipality, Iwaki City had been purchasing produce from distant prefectures instead of Fukushima produce, but after the accident, the policy changed to use Fukushima produce in school lunches in order to appeal safety of Fukushima produce by showing it’s safe enough to give to children. They are collecting signatures for a petition to oppose the use of Fukushima produce in school lunches. Some say stricter radiation testing (in food used in school lunches) could help, but the mothers claim that currently in Japan only cesium is measured and they have no idea if there is any strontium. They oppose the use of Fukushima produce in school lunches for fear of finding out, ten-plus years down the road, that there was actually plutonium in the food that children ate. Their concern is not so much if it’s safe or not, but it should not be a scientific issue but an ethical issue to use children as a way of appealing for safety. However, currently, about 70% of the municipalities within Fukushima Prefecture use Fukushima produce to children in school lunches as a way of appealing for safety. These mothers constitute a minority group, and therefore, they are pressured and harassed. They are told to leave Fukushima if they are worried about the contamination. I investigated details of these harassments, but I have been asked not to write about it and disseminate it. It’s because they are afraid the harassment might worsen once it becomes clear which specific harassments bother them.

This is a photo from the October 2012 Fukushima visit with Mr. Nesterenko, the director of BELRAD Institute in Belarus. The most surprising moment for him came when he took measurements in this area of Oguni Elementary School. 

It says 27.6 μSv/h. He asked me then if all the students had evacuated. I said they were in class as we spoke. He said the radiation level qualified for immediate mandatory evacuation in Belarus. He told me that he thought Japan was a wealthy country but that he was apparently wrong. At the time, some Date City government workers happened to come by, so I told them there was a spot with a very high radiation level. They told me they already knew about it. This spot has really a very high radiation level, but the inside of the elementary school has been decontaminated and deemed safe. However, Mr. Nesterenko kept asking what it was that they meant by saying it was safe inside as there is no air filter for school buildings and air from the high radiation spot still flows inside. I was shown by the mothers the radiation level for the spot was 179 μSv/h in September 2012, which was a month before our visit. The principle of the school sent a letter to families stating everything was okay because the radiation level came down to 3.9 μSv/h after decontamination.  

The mother who showed me the letter said she wanted the children evacuated immediately with the radiation level of 179 μSv/h. However, the evacuation never happened and the school remained in normal operation, so her family evacuated voluntarily at their own expense. During my 2012 visit there, out of 200 families at this school, only 2 families were concerned about radiation exposure. Now those 2 families moved away. Even after the move, they are constantly talking about they don’t know if they are just crazy, worried about nothing, or if it’s actually dangerous. 

By the way, the current measure to deal with areas contaminated with a high level of radioactive material is to remove the soil, put it in bags, and place them in an empty lot. It’s not just Fukushima Prefecture. Neighboring prefectures in eastern Japan, such as Ibaraki Prefecture, Gunma Prefecture, Miyagi Prefecture and Iwate Prefecture also have a lot of areas with contamination where people live. They decontaminate, put the soil in bags, and stack them in an empty lot. By the way, these bags look small, but each bag actually weighs 1 ton. It’s rather large. 

This photo is from Ibaraki Prefecture. Quite ironically, there is a sign at one end of the photo that says to “take any garbage home.” Currently, there is no plan on how to dispose these bags of contaminated material.

One difference I noticed between Fukushima and Chernobyl accidents is that in Fukushima the Internet is quite developed. This is an open house of a project called Matsumoto Boarding School Project for the Children of Fukushima. In Matsumoto City, Nagano Prefecture, the mayor started a project for Fukushima children to live in a dormitory and go to school. The first group will have 10 children. 

The mayor of Matsumoto City, Akira Sugenoya, is a physician who operated on thyroid glands of children in Belarus and Russia after the Chernobyl accident. Needless to say, he insisted on evacuating children immediately after the Fukushima accident. However, evacuation never happened. So he started this project with the Fukushima residents who evacuated to Matsumoto City.

In Fukushima, it has become a taboo to be afraid of contamination due to the nuclear accident or be concerned about radiation exposure. They are not supposed to be afraid as the country, the government and the researchers assure them it’s safe. Therefore, this project uses the word, boarding school, instead of evacuation, allowing for easier dissemination of information in Fukushima and less hesitant participation. 

As the new school year begins in April in Japan, Fukushima children will come to Nagano Prefecture to live beginning in April this year. This was a trial last December for the interested children and families. I had a chance to have private conversations with the children, who were interested in participating in this project, away from their parents. What they told me was quite shocking. Many of the children who are potential participants are junior high school can get on the Internet and collect information on their own. Even though teachers and fathers tell them that they are not affected by the nuclear accident, the Internet search says otherwise. Their health seems to be affected since the nuclear accident, and they seem to feel better if they go to uncontaminated areas for a visit. So, some children want to study in uncontaminated areas although their parents are against it. One junior high school girl said she would want to bear children when grown up, so she felt that she should leave Fukushima as soon as possible. One girl said she was going to leave Fukushima for high school or college, but she was interested in the project as she would be able to leave for junior high school. 

There are different opinions in regards to contamination, but children are actually gathering information on the Internet, thinking for themselves and being afraid. I was surprised at such a reality where children are unable to talk to parents or teachers about it despite their fear. There was one elementary school whose PTA discussed during a meeting that they should only rely on school information, as the Internet scares people. That scared some families enough that they actually decided to evacuate.

I was just told how much time I have left. I would like to talk about the current status of Fukushima Daiichi nuclear power plant.

This is a chimney called a “stack” behind Units 1 and 2. There are various issues all over Fukushima Daiichi NPP, but this is one of the places that I consider the most dangerous. It is 120 m tall. In December 2013, it was discovered the highest radiation level, 25 Sv/h, at the bottom of the stack. It’s not micro- or milli-sievert, but it’s 25 Sievert. and humans cannot go near it. The problem gets worse. TEPCO discovered deformities on 4 sides at 60 of the 120 meter height. That is shown in this photo.  

Some are totally severed.

Ordinarily, this should be immediately repaired, but the bottom of the stack is 25 Sv/h, and there is one spot that is 15 Sv/h. So, they can’t do anything about it. What TEPCO is doing about this is they have appointed workers to constantly watch it. This is very close to Units 1 and 2. We still get occasional earthquakes in Fukushima and eastern Japan. Workers on site are very worried about whether it would fall onto the reactor buildings. If it ever fell on Unit 1 or 2, all the workers would have to evacuate. There is no guarantee they would have enough time to evacuate, and it could lead to a severe accident necessitating evacuation of nearby residents once again.

One of the things not well known is the fact that in reality radioactive materials continue to be released into air and groundwater from the reactors at Fukushima Daiichi nuclear power plant. This is a quick drawing I made of a pressure vessel and a containment vessel. 

Currently, it is thought that fuel rods have melted, falling to and accumulating in the bottom of the pressure vessel. 

It is being cooled with water, but then a lot of hydrogen gas is being produced as part of the reaction between water and radioactive material.

This means there is a danger of another hydrogen explosion, so they inject nitrogen gas there, remove as much radioactive material as possible, and release the gas into outside air. Now we get to the real issue here: this is for Unit 1, but they inject 10 ton of nitrogen gas at 35 m3/h and release 21 m3/h after putting it through a filter. This means there is a leak continuing somewhere at 14 m3/h. The situation is the same for Units 1, 2 and 3, and a large amount of radioactive material continues to be released into the air. The total supposedly approaches 10,000,000 Bq/h.

Now we get to the real issue here: this is for Unit 1, but they inject 10 ton of nitrogen gas at 35 m3/h and release 21 m3/h after putting it through a filter. 

This means there is a leak continuing somewhere at 14 m3/h. 

The situation is the same for Units 1, 2 and 3, and a large amount of radioactive material continues to be released into the air. The total supposedly approaches 10,000,000 Bq/h.

Groundwater is of course contaminated. This is the area where PM Abe declared the contaminated water being completely blocked when trying to bring the Olympics to Tokyo. 

Groundwater is found to be highly contaminated in the area circled in red, and there is a large amount of contaminated water leak in this part, which has been acknowledged by TEPCO. Prime Minister Abe said contaminated water was totally blocked at the harbor, but journalists who attend the TEPCO press conference of course know that was not true. 

So, after the statement by PM Abe, one question after another came from many journalists at the press conference if the contaminated water was actually blocked by the harbor. Also, TEPCO said they asked the government of its intention after hearing PM Abe’s statement. In other words, TEPCO was quite surprised. TEPCO did not dare say it wasn’t blocked, but they always answer that they think the effect will be minimal.

In regards to this area with very highly contaminated groundwater, as described earlier, an announcement was made on February 6, 2014, that one of the wells had 5,000,000 Bq/L strontium detected. But it was actually last July when the well was dug and the groundwater sample was taken and measured. Why the measurement result wasn’t released until now? Measurement data for cesium and other radioactive material was released then, but not strontium 90. Why did they not announce the high strontium level back then? TEPCO explained that the level was so high that they were investigating to make sure there were no errors in the analytical method. This was the first measurement after the observation well for the groundwater was dug, so there is no way to know, at this point, how long and how much the groundwater had been contaminated. Currently, many wells are being dug to take measurements of the groundwater for assessment of contamination, but we are not sure what is leaking from where. All we know is that various things are leaking from many places, not just this one well. We don’t know how long and how much the groundwater has been contaminated. Also, there was an announcement in February that they had underestimated the measurements up to that point.

As described so far, radioactive materials continues to leak into air and water, and there are several places which need immediate attention even though they are not approachable by humans. However, very few Japanese people know about this type of information, as it’s not publicized on TV or in newspaper widely available. Also, the plan is underway to return evacuees to contaminated areas as the government and researchers say it’s safe. This is the reality of a “wealthy” country, Japan, which is considered a free, democratic and wonderful country. But it’s really our own responsibilities that we are in this situation. I am always thinking about how things can be changed. In Japan, many think they are participating in politics only by casting a vote at elections. That’s probably what I thought in the past. But then I realized we are constantly casting a vote when we decide what to buy, what to spend out time on, and where to go. So, I really appreciate you all decided to spend your time to come all the way here. Despite the current situation in Japan, I think things can change if we change our way of life by being mindful about what to buy and how to spend our time, while wanting to know, wishing the media to change, and wishing the politics to change.

I am often told, sometimes scolded, by my entertainer master, perhaps called maestro in German, that “It is no good kicking against the bricks.” On the other hand, another master who experienced WWII tells me not to talk for the country but talk for the happiness of the audience in front of me. Yet another master told me it would take 100 years for the world to change no matter how hard I tried by myself. I told this master, “Then, if there are 100 others like me, it would only take one year.” I think there are over 100 of you here today, so things will change in one more year. I think there are various issues in the world, other than the nuclear accident, but I would like to really think about how to spend my life and keep on living thoughtfully. Thank you so much for your attention.

Transcription by Takashi Mizuno
Translation by @YuriHiranuma