Kate Brown. Culture, Theory, and Critique. Voume 58, Issue 4, 2017.
In the past thirty years, more than one scientist has called Chernobyl a ‘living laboratory’, a kind of natural experiment to learn more about radiation and health. And, indeed, there was a lot to learn. In the decades preceding the 1986 disaster, scientists had carried out very few studies on chronic low doses of radioactive isotopes to civilian populations, especially among children and pregnant women, who were among the four million exposed to such doses in the aftermath of the 26 April explosion of Chernobyl Reactor Number Four. After the accident, political leaders and scientists repeatedly asserted that Chernobyl was an event of global significance and required a long-term study of its biological consequences to answer once and for all the debate about the health effects of low-dose exposures to ionising radiation. But that study never occurred. Despite the fact that millions of dollars have been spent on Chernobyl-related health research, there is today no Chernobyl textbook, nothing akin to a gold-standard, lifespan study of the Japanese Atomic Bomb Casualty Commission, a project begun in 1950 and lovingly elaborated for sixty years.
The absence of large-scale epidemiological studies does not mean there are no opinions about Chernobyl health impacts. A compendium of research by Russian, Ukrainian and Belarusian scientists presents evidence of a wide range of debilitating health effects in the zones of contamination. They report expected fatalities numbering in the hundreds of thousands (Yablokov, Nesterenko and Nesterenko 2009). In contrast, the United Nations agencies maintain that the health consequences of the Chernobyl accident are limited from 33 to 44 fatalities and 6,000 cases of children’s thyroid cancer. Journalists often cite the UN numbers as scientific consensus. How did this opinion come about?
The majority of Chernobyl studies have telescoped onto children’s thyroid cancer, one health problem among a host of possible radiation-related effects. Why so many studies of thyroid cancer and why so few about other possible health problems? Adrianna Petryna (2013: xxvi) points out that science research tends to ‘focus on the known at the expense of the unknown’. While that statement is true, thyroid cancer was for decades not ‘known’ to be associated with exposure to radioactive iodine. In fact, for seven years after Soviet doctors presented evidence of an alarming growth in thyroid cancer in children exposed to Chernobyl radiation, foreign scientists and international scientific agencies disputed the finding, denying and delaying recognition of it. The super-abundance of studies on childhood thyroid cancer is an important feature of blinkered Chernobyl science, not an exception to it. International and national regulatory agencies and research institutes expended a great deal of effort not to know about the effects of the Chernobyl accident, to limit research and to contain judgements. This article explores how we came to know so little about Chernobyl health effects. By focusing on controversies over low dose exposures and thyroid cancer, I seek to show what the science of political containment looks like and how it came about. The Chernobyl case reveals how scientists engaged in a broad continuum of ignorance-producing activities (Funtowicz and Ravetz 1995; Oreskes and Conway 2010; Proctor 1995; Proctor and Schiebinger 2008; Gross and McGoey 2015). The obfuscation of possible health outcomes also grew out of an intense human desire for clarity, for a science that supplies answers, ones that are unequivocal and precise, even when mythical.
In the decades between Hiroshima and Chernobyl, international nuclear regulatory agencies located in Western Europe, Japan and North America worked up elaborate risk estimate formulas that started with estimated doses to whole bodies and organs and then calculated the probability of additional cancers from the doses. The concept of risk assessment emerged in the United States when policymakers first tried to demonstrate the safety of nuclear testing and the first nuclear power plants. At this juncture, analysts resolved that ‘risk’ could be measured and defined. Risk, they elaborated, was the ‘produced magnitude of a loss or damage multiplied by the probability of its occurring’ (Liberatore 1999: 3). The generalised concept of risk to entire populations, as opposed to individuals directly in harm’s way, had a palliative, soothing function (Boudia and Jas 2007; Hamblin 2006). As data came in from the large Atomic Bomb Lifespan Study, a programme begun in 1950 and financed by the United States Atomic Energy Commission, health physicists drew up a list of diseases that the study confirmed were caused by exposure to atomic bomb blasts. In computing risk estimates, the doses drove the science. With a dose, a health physicist could predict the probability of additional disease, which, as derived from the Lifespan Study included an excess of a handful of cancers. Risk estimates were useful for regulating nuclear industries by providing thresholds. With doses lower, for example, than a threshold of 100 rads (1 gray) radiologists predicted that there would be no non-cancerous health effects. They estimated that the vast majority of people in the Chernobyl territories had received doses far lower than 100 rads, and so predicted that Chernobyl would cause no detectable health impacts. Scott Frickel and Michelle Edwards argue that within risk standards are a host of assumptions relating to health effects, exposures and a toxin’s bioavailability. As scientists representing the International Atomic Energy Agency (IAEA) computed risk estimates for the Chernobyl accident they made guesses about a range of questions: what people ate, time spent outdoors, work patterns, weather, ground water, soil composition, wind patterns, etc. They admitted that these assumptions were uncertain, but the uncertainties were lost in the final numbers produced (Frickel and Edwards 2014).
Even when scientists did not have much information on doses, they proceeded to make predictions. In 1987, the IAEA charged Lynn Anspaugh with the job of calculating doses for Romania. The only problem was that he had no numbers. IAEA inspectors, he claimed, did not like to go to Romania, because ‘It was closed, secretive and the hotels were cold’. Anspaugh found someone who supplied over the phone two measurements, one for caesium 137 on the ground and another for caesium 137 in milk. With those two numbers, Anspaugh calculated the increased probability of health impacts for all Romanians. Buried in his final risk estimate were large gaps in knowledge about radiation levels in Romania.
During the Cold War, some scientists in the field of health physics questioned the standard risk estimate models. Alice Stewart, Steve Wing, Joseph Gofman, Arthur Templan, Karl Morgan and Ernst Sternglass, among others, asserted that low doses of radiation could be harmful. In response, they were censored, had funding pulled and lost their jobs (Boudia and Jas 2013: 84; Johnston 2007: 6).
In 1990, the question of Chernobyl’s health impacts went public and got entangled with arguments about national independence and international aid. Chernobyl became a cause célèbre for all who wanted to denounce Soviet rule. Suddenly, people seeking political office, national independence or big grants from foreign agencies began to trumpet what they claimed was a health disaster resulting from the Chernobyl accident, a disaster not predicted by the risk estimates (Petryna 2013; Kuchinskaya 2014). Detractors accused the activists of using a supposed health crisis to rattle the cup to secure international aid. They also claimed that Soviet doctors were poorly trained, had few diagnostic tools and would generally hand over a Chernobyl diagnosis for a bribe. And, it is true, doctors were taking bribes and public health officials did start Chernobyl children’s organisations in order to personally enrich themselves.
What can a historian do when faced with this controversy? Historians work in archives reading file after file until the past begins to replay in real time. Sometimes, as in the scientific debates over tobacco, lead and climate change, historians can help resolve impasses by showing how science was managed, mismanaged or even deliberately falsified (Orestes and Conway 2010; Proctor and Schiebinger 2008). In these cases of ‘deviant science’, histories pivot around questions of what scientists knew and when they knew it. Before February 1989, there was a ban in the Soviet media on Chernobyl health problems. Doctors could not share information with one another or with their patients. That makes the question of timing interesting. Doctors’ and scientists’ assessments of the consequences of the disaster between 1986 and 1990 might offer a glimpse of the issue before Chernobyl was politicised and monetised.
When I arrived at the archives in Kiev to ask for the Ministry of Health records from 1986 to 1991, the archivists were discouraging: ‘Chernobyl was censored during Soviet rule. You won’t find anything.’ I took a look at the search aids anyway, and quickly located dozens of files named ‘medical effects of the Chernobyl disaster’. The first set of documents dealt with people evacuated from a 30-kilometre belt around the smoking power plant and the second category concerned communities that remained on territory contaminated at various levels.
In the summer of 1986, doctors in specially devised clinics for children and pregnant women resettled from the Chernobyl zone wrote to the Ukrainian Republic Ministry of Health to say that most of the children were in good condition, but a quarter of them showed strange symptoms—nervous tremors, flushed faces and throats, the slowing of motor skills and weight gain. Some kids were weak and listless. Two-thirds had enlarged thyroids and 60 per cent had thyroids functioning on overdrive. The physicians held Geiger counters to children’s thyroids to measure gamma rays emitting from them. Most children (89 per cent) recorded absorbed doses in the thyroid of 30 to 200 rads. Several hundred had doses between 200 and 500 and over, up to an alarming 1,500 rads (15 gray). As the summer wore on, they noticed that 20 per cent of the exposed children had anaemia, chronic tonsillitis and gastritis. Increasingly the children suffered from respiratory illnesses, gastro-intestinal problems and severe infections. Pregnant women, too, had health problems. Many were anaemic and half had enlarged thyroids. Many exposed women chose to have prophylactic abortions. Yet despite the increase in abortions, the number of miscarriages, haemorrhages, complications at birth and premature babies rose alarmingly. The newborns were sicker, smaller and weighed less than the average.
Most of the doctors in the emergency clinics were not specialists in radiation medicine. They received a crash course after the Chernobyl disaster. Their knowledge of radiation medicine came in the form of a manual issued in June 1986 specially for the emergency. This text emerged from the military wing of the Soviet nuclear programme. Unlike the vast body of literature in the West, the manual did not dwell on probable doses, risk estimates or long-term health problems, such as cancers. Rather, it focused on descriptions of acute radiation syndrome (weakness nausea, vomiting, infections, haemorrhaging, fatigue, sleepiness, euphoric mood swings) and physical descriptions of the accompanying changes in the body. Rather than imagining 100 rads, as did literature in the West, as a threshold between severe radiation poisoning and no non-cancerous health effects, Soviet specialists were able to perceive damage to the nervous system at 0.01 rems, a measure 50,000 times more sensitive. The authors of the emergency manual envisioned a continuum of health problems along a scale from severe to mild. The authors called the lower level of exposure ‘chronic radiation syndrome’, defined as a complex of unspecific symptoms that could include malaise, headaches, lower work capacity, loss of appetite, sleepiness during the day, insomnia at night, bleeding gums, disorders of the liver, kidneys, thyroid, menstruation cycles, tonsillitis and chronic gastritis.
Soviet public health officials had no radiation maps. Those were classified. Rather than scanning for environmental measurements and calculating probabilities, Soviet doctors turned to bodies for evidence. In the months following the accident, they hospitalised tens of thousands of people and studied patients’ bodies. To determine the extent of exposure, Soviet doctors counted leucocytes and thrombocytes in blood. They looked for changes in the functioning of the heart, palpated and measured the thyroid, checked temperature, weight, muscle tone, skin and the functioning of sensory organs. They held Geiger counters to thyroids to measure rads emanating from the organs of adults and children. Thyroids especially became a biological barometer of exposure.
This research effort was tremendous and led to what became in subsequent years a renaissance in knowledge of radiation medicine, a field that elsewhere was by 1986 attracting few new graduate students. The health monitoring programme demanded a great deal of manpower. Nine thousand medical personnel were mobilised in Ukraine alone to examine people in contaminated areas. Ukrainian health officials reported having looked at 86,000 children exposed to Chernobyl radiation. In the West, scientists, doctors and lab technicians were paid high wages. Their valuable time was rationed, making the kind of body-intensive work Soviet researchers did prohibitively expensive. In the USSR, where medical personnel and scientists received the same wages as factory workers, employing personnel for lab work did not present notable problems. Given the differing political economies of socialism and capitalism, the emphasis on computational work in the form of risk estimates in capitalist countries makes sense (Ravetz 2011). Perhaps this is one reason why after the Three Mile Island accident, there were no mass screenings of potentially exposed people, though communities asked for them (Mangano 2004).
Due in part to the close study of exposed bodies, the Soviet diagnosis of chronic radiation syndrome is unique in the world. No Western scientists adhered to it when they first heard of it via classified diplomatic channels. Maybe the Soviet doctors were projecting the diagnosis of chronic radiation syndrome onto their patients after reading the manual issued for the emergency? The manual categorised what they would find, and so they found it. Certainly, no radiologists in the Western tradition would have expected to see these unspecific symptoms at the doses that most of the children received. There was no category in Western literature on health physics for non-cancerous symptoms at doses below a whole body count (as opposed to a dose to one organ) of 100 rads. In this literature, either a person had acute radiation syndrome, or they had nothing at all (Jorgensen 2016: 230-1).
The diagnosis of health problems at low doses symbolised the chasm between the ways Soviet and Western scientists understood radiation medicine. In the USSR, the scientists making judgements on Chernobyl health effects were usually medical doctors. In the West, in contrast, ‘health physicists’ were rarely physicians, but physicists who worked largely with environmental data. The first group focused on bodies. The second group zeroed in on isotopes as measured in the environment. Geo-spatial considerations also created a divide as the Chernobyl disaster played out. Doctors on the ground in Ukraine and Belarus saw a clear pattern of health problems, while radiologists and health physicists farther away, in Moscow and abroad, asserted repeatedly that computations showed there could be no health problems.
After a few months, the children were checked out of the clinics and returned to live with their parents. Several hundred communities remained in Ukraine within the pale of Chernobyl fallout. Soviet radiation monitors in Ukraine categorised areas with soil concentrations of more than 15 curies of caesium 137 per kilometre as ‘zones of severe control’. From 1 to 15 curies constituted a ‘control zone’. Mobile brigades, often made up of young doctors and medical students, travelled the countryside to help rural doctors carry out these examinations. In them, about 10,000 children had doses to the thyroid of more than 75 rads. Several thousand children had doses over 500 rads. The classified doses sounded high, but the prognoses were good. In 1988, Soviet officials announced that, thanks to good medical care and supplies of clean food, of the 106,000 exposed children in Ukraine, 80 per cent were deemed ‘healthy’. Soviet officials pronounced that they saw no increase in birth defects and that the child mortality rate in Ukraine went down between 1985 and 1988. Scientists in the West came to similar conclusions.
Statistics have a way of taking shape depending on who is using them. When officials sought to placate a nervous public, they turned to numbers that described large populations on the republic or national scale. And the numbers looked good. The aggregate numbers, however, look less promising on the local level. When local public health officials telescoped onto the heavily contaminated regions just south and west of the Chernobyl plant, the picture radically altered.
In the archives, there is a wash of documents filled with reams of statistics and data, but, to put it most simply, the majority of adults and especially children in the contaminated control regions were sick. They had chronic illnesses, many suffering from a number of different diseases at once. Like the children evacuated from the 30-kilometre zone, people remaining in contaminated regions had chronic tonsillitis, chronic upper respiratory illnesses, digestive tract disorders and generally compromised immune systems that left them vulnerable to infectious disease. The incidence of endocrine system disorders and anaemia doubled and tripled, respectively, from 1985 to 1988. Nervous system disorders surged; so too did diseases of the circulatory system. In 1988, in the heavily contaminated Ovruch region, half the children had upper respiratory diseases, and 14 per cent had endocrine system problems. In Polessia, those numbers were 80 per cent and 28 per cent, respectively. In Ivankovki, where clean-up workers lived, 92 per cent of all children had a respiratory disease.
Numbers pass by quickly. Sometimes it helps to linger over them. In Ivankovki 9,222 kids out of 10,000 had chronic bronchitis or pneumonia. In the town of Polesskoe, of 1,550 kids, 1,132 had at least one serious illness. Soviet officials were in the midst of a successful campaign to reduce child mortality rates, and the numbers showed they had indeed succeeded in most regions of Ukraine, except for in a number of highly contaminated regions where twice as many children died in 1987-8 than in 1986. In most of these rural regions, with little industry, the cancer rates before the accident were well below the national averages (Marei, Barkhudarov and Ia Novikova 1974: 141). But in these areas they rose, from two cases per 10,000 a year in 1986 to six, 20, 38 and 40. People suffered from rare cancers of the lips, oral cavities, oesophagus and stomach, as well as from the more radio-sensitive leukaemia and cancers of the thyroid and lungs. As Soviet researchers looked at these trends, they began to discern a pattern of diseases that tracked with the pathways of radioactive isotopes as they were ingested into the body, paths that began in either the mouth and throat and headed towards the gastro-intestinal tract or started in the lungs and followed the blood into the circulatory system. Radioactive iodine sped to the thyroid, causing endocrine and hormonal damage. Another category of concern was reproductive health. Women haemorrhaged more often and had more complications while giving birth, and the number of perinatal deaths grew. The rates of birth defects for many of the most contaminated regions doubled or tripled from 1985 to 1988.
The Chernobyl accident occurred in Ukraine and so authorities there may have been especially sensitive to health issues. What about Belarus? Seventy per cent of Chernobyl radiation landed on Belarusian territory. I headed to Minsk and Gomel to see what the public health landscape looked like there in the five years after the accident. I found a picture that was eerily similar to that reported in Ukraine.
In internal documents, public health officials in Moscow and Kiev explained these alarming statistics by pointing out that improvements in detection and recording of illness after the accident led to better accounting and so increased detection. Indirect causes, such as stress, anxiety, limited diets and restrictions on spent time outdoors also caused a statistical increase in illness. They borrowed a phrase, ‘radiophobia’, to explain away the rise in post-accident illness as stress related.
There are some problems with these arguments. From 1986 to 1988, local public health officials did not know about contamination or health problems outside their immediate community. There was no discussion of the public health calamity in the media, and maps tracking caesium in soils were classified. Doctors, in other words, only learned to be ‘radiophobic’ by assessing the bodies they investigated. Increased screening was also not much of a factor. Despite the effort to examine all children exposed, doctors were not able to carry out this herculean task in the economically challenged, rural USSR. The Soviet countryside did not have enough permanent doctors, or specialists in endocrinology, pathology, oncology or haematology, and that dearth got worse, not better, after the accident. Young doctors refused to be assigned to contaminated territories, and many established doctors left, so the number of medical personal fell every year, decreasing the chances of detection and diagnosis. Staffing got so bad in Belarus that officials in Minsk begged Kiev to send doctors and medical equipment. Kiev replied they had none to spare. Children who had been resettled, sometimes from one contaminated region to another, got lost in the system and fell off the registries. Families moved away or emigrated. Blood drawn for examinations did not make it to the lab in time because of poor roads, bad weather or a shortage of vehicles. The daunting job of trying to monitor and track hundreds of thousands of exposed persons led to an under-reporting rather than excess of reporting of illness.
Yet, despite the secrecy and lack of maps, people knew they were in contaminated regions, as the designations ‘control zone’ and ‘severe control zone’ cued people to understand the possibility of exposure. Any illness that residents contracted in a contaminated zone they and their doctors would attribute to radiation. But what about a place where no one knew they were exposed? Such a community would serve as a good control for the thesis that increased screening was finding more illness than usual. There was such a territory, 200 miles to the west of the Chernobyl Zone in the Rivni Province of Ukraine, which had been declared clean in 1986, but three years later local sanitation officials reversed this judgement. They discovered that two regions, Dubrovitskii and Rokitnovskii, had levels of radiation over 15 curies per square kilometre, a threshold that, when verified, placed them in the ‘strict control zone’. Some villages ranged as high as 40 to 60 curies per square kilometre, a figure that should have spelled immediate evacuation in 1986. In these regions, all the milk tested contained caesium 137 over permissible doses.
Because the radioactive contamination had gone undetected, these communities had received no special post-accident attention that might cause either stress-related illness or increased detection of existing illnesses. In fact, the regional medical service was in terrible shape. The paediatric hospital consisted of two rooms in a peasant cabin, heated by a wood stove. The per capita number of doctors was one of the lowest in Ukraine (1.2 paediatricians per 10,000 children). Dubrovitskii and Rokitnovskii regions had for three years limped along suffering the usual Soviet neglect of poor rural territories, but, despite these limited resources for diagnoses, children and adults in the two regions had the same growing list of medical problems as in areas known to be contaminated. Most alarmingly, the number of tumours among children was 20 times higher in 1988 than in other contaminated regions. I had to pause to imagine the moment of detection of a rare childhood cancer in the crumbling, two-room wattle-and-daub cottage that housed the paediatric unit in the northern region of the Rivni oblast, a territory where roads dwindle into rutted paths then disappear as the land gives way to the swamps and bog of the great Pripet Marshes. Eighty-two per cent of country-dwellers died at home. Rural hospitals rarely had oncologists or pathologists on staff, and so ambulance drivers wrote most death certificates. It is difficult to have confidence that many cancer deaths from 1986 to 1991 in the contaminated areas of Rivni Province were ever considered for inclusion in the official accounting of Chernobyl statistics.
Dying is a song the body plays. A song it eventually masters. The question is at what tempo and volume. Radiation damage is hard to isolate and detect because it causes no new, previously unknown illnesses. From their study of exposed children and adults, Soviet doctors saw radioactive decay as a force that intensified the drumbeat of diseases that make up the natural background rhythm of morbidity and mortality. In other words, they saw that radioactive isotopes clapping about inside bodies accelerated the process of aging and amplified the spontaneous generation of tumours and organ damage that cause disease.
I am saying that, once I looked (and I was the first researcher who signed out the files), the evidence of something like chronic radiation syndrome was overwhelming, and it came from almost every possible quarter. The accounts of unspecific, widespread and chronic illness, reproductive problems and acute increases in cancer resound like a lament from the contaminated regions between 1986 and 1990. Despite the official silence on the topic, doctors and sanitation inspectors in hard-to-reach rural areas of Ukraine wrote in from clinics, each individually describing a portrait of medical problems similar to those which researchers found in specialised radiation medicine clinics serving clean-up workers (called ‘liquidators.’) Doctors wrote of sick kids from paediatric clinics in Kharkiv, far outside the contamination zone, where evacuees had been settled. They reported from Donetsk, where miners who had burrowed under the blown reactor in the weeks after the accident were being treated for a host of illnesses. They listed medical workers, commandeered to serve in the contaminated areas in 1986, whose ‘illnesses are identical to those of the liquidators’. The entire Union of Soviet Radiologists wrote a collective petition about Chernobyl health problems. Even a KGB general sounded the alarm. Mikhailo Zakharazh conducted a study of 2,000 people in a specially equipped, well-subsidised KGB clinic in Kiev. His staff discovered that patients’ bodies were not only host to radioactive iodine and caesium, but had incorporated up to a dozen different radioactive elements. He reported that caesium 137, used in dose estimates, made up only 40-50 per cent of the ingested dose, meaning that dose estimates that took into account only caesium had under-estimated by half. Summing up four years of medical investigation, Zakharazh wrote in 1990, ‘We have shown that long term, internal exposures to low doses on a practically healthy individual leads to a decline of his immune system, a lowering of defensive strength, and a whole series of pathological changes and illnesses.’ The KGB’s traditional role in the USSR was to solve problems, silence detractors and generally shore up a patriotic appreciation of the Soviet polity. General Zakharazh proceeded in the other direction. He estimated that not a million but 4.5 million people had been contaminated above the permissible norm, and he demanded that the 30-kilometre zone of alienation be extended to 120 kilometres and a zone of danger be declared up to a distance of 450 kilometres, a zone that would include the ancient and beautiful city of Kiev, where he lived.
In 1989, in the lead-up to the first perestroika-era elections, teachers, parents, union officials and local activists began to openly voice the news of the public health catastrophe that until 1989 had sounded only in official, classified correspondence. They contacted public officials, journalists, regional and republic health departments—anyone who would listen—to report the sad sight of children, lethargic and unable to concentrate, passing out in classrooms, with noise bleeds, infections, complaints of pain, chronic bronchitis, gastritis and/or tonsillitis. When their pleas went unanswered, they protested in public squares, formed groups, contacted foreign journalists and scientists and announced hunger strikes.
Swamped by these voices and unnerved by the growing body of research, the Soviet leadership turned for help in 1989 to the World Health Organization and the IAEA, both United Nations organisations. A few months later, in 1990, the newly elected Ukrainian leaders radically changed course and, instead of publicly minimising health consequences, they began to trumpet them. They petitioned the United Nations to appeal on their behalf for a major international disaster relief programme. And so emerged the first rifts in the ‘indivisible’ USSR as the republics, like giant icebergs noisily cracking, rafted away from one another. On one side, stood the long-standing Moscow-driven assertion, backed up by international nuclear scientists, that health problems were limited to a few hundred liquidators and some undetectable few thousand cancers in the future. On the other side, physicians in Ukraine and Belorussia presented evidence of widespread medical problems of a malignant and non-malignant nature that amounted to a public health disaster so devastating as to change the course of history.
Panicking, the Soviet Ministry of Atomic Energy turned to the IAEA and requested an ‘independent’ assessment. With the Soviets footing the bill, the IAEA assembled four teams of scientists to look at dosimetry and health problems. Soviet officials asked Fred Mettler, an American radiologist and US delegate to the United Nations Scientific Committee on Effects of Atomic Radiation (UNSCEAR), to head up the health effects section. Mettler raised a team of scientists and in 1990 they made a half-dozen ten-day trips to the contaminated regions surrounding Chernobyl. Mettler’s teams randomly selected 1,726 people in six contaminated and six control communities, and Mettler said, they looked for everything—cancers, reproduction problems, psychological effects and non-malignant diseases. Mettler reported that they found a lot of illness owing, he said, to poverty, poor medical care, limited diets, use of tobacco and alcohol, but nothing they could attribute to radiation. ‘The doses were too low,’ Mettler told me over the phone. ‘The evidence was not there.’
It is worthwhile to take a closer look at the study’s research protocol to see how UN scientists reached this conclusion. What does it mean to examine 1,726 people of a possible 4.5 million exposed? What could this study as designed possibly find? According to the UNSCEAR’s understandings of low-dose radiation, the probability of detecting risk would require hundreds of thousands of subjects. A random examination of 600 people among 4.5 million exposed would turn up statistically significant effects only if people were dying on the streets, tragic effects so great that they would be difficult to miss. Nor was it likely that people in the control regions were really control cases. People are not mice, living and feeding on a small territory. Humans forage widely for their food. Belarusian researchers found (and they supplied this information to IAEA teams) that people outside contamination zones recorded nearly as high levels of radioactivity as people inside the zones of contamination because of the exchange of food across regions. For the International Chernobyl Project to conclude that they found no effects with a tiny examined population without stating they were looking for catastrophic health effects was a ruse. Abel Gonzalez admitted in 2016 interview that the study design had indeed been erroneous.
A closer look at the data IAEA scientists used to come up with dose estimates is illuminating. IAEA scientists assumed in their calculations, as Soviet officials told them, that people were eating clean food from store shelves, but regional inspectors confirmed that rural stores were empty and people were eating contaminated home-grown produce. IAEA scientists calculated a diet including a half-kilogram each of mushrooms and berries a year, a strangely low number for populations that traditionally relied on forest produce for a large portion of their diet. They did not take into account the smoke from the family stove burning radioactive wood and peat. Nor did they consider that villagers used radioactive ashes and manure to fertilise kitchen gardens. IAEA scientists visiting contaminated towns and villages would have noticed the empty store shelves, the vibrant kitchen gardens, the people walking along forest roads with baskets of berries and mushrooms, the thick smoke coming from most households where a large masonry stove fired up every day for heating and cooking, but they did not alter their estimates. Nor did the foreign experts take into account local ecological factors: that cows pastured on flood plains that were seasonally refreshed with radioactive flood water; or the special qualities of the sandy, acidic Polesian soils. Soviet scientists had a sophisticated understanding of soil interaction with radioactive isotopes, knowledge that they communicated to IAEA missions. They understood that the peat bogs channelled fatty acids into water streams and that the water-insoluble fatty acids coagulated with radioactive isotopes to keep them afloat (Medvedev 1991: 30). They calculated an extremely high transfer coefficient of 40 per cent of caesium from local soils into plants. They recorded that even in places with permissible levels of caesium 137 (below 15 ci/km2) in the soil, 89 to 100 per cent of the milk samples came in above permissible levels for consumption. The streamlined data selected by the IAEA teams under-estimated the doses people were getting in the contaminated zones, sometimes radically. The uncertainties, assumptions and guesses in the IAEA’s risk estimates entered the record as a form of ‘embedded ignorance’ (Frickel and Edwards 2014).
In short, the design of the IAEA assessment and the selection of data affirmed established assumptions in the sphere of health physics about permissible doses. The IAEA assessment served as a confirmation of the field of health physics and the risks estimates so important for radiation protection internationally. But the study did not answer questions that people in the contaminated zones were desperately asking. They wanted to know what happens to a body that slowly ingests day by day nano-quantities of radioactive isotopes? The IAEA study brought humanity no closer to answering that question.
The much-awaited IAEA assessment issued in the spring of 1991 concluded that no health disorders could be contributed directly to radiation exposure. Fred Mettler authored the medical effects section of the 600-page Technical Report. Buried in the report, Mettler noted 20 ‘verified’ cases of childhood thyroid cancer, an extremely rare disease in children, but then strangely a few sentences later he contradicted that evidence, stating they found ‘no clear pathologically documented evidence of an increase in thyroid cancer’. The report concluded that there were no detectable Chernobyl health impacts, except for psychological stress, and predicted a probable chance of childhood thyroid cancers in the future. Mettler told me that when he had first placed that prediction in the technical report the editors in Vienna had taken it out. ‘I had to fight very hard to get it put back in,’ he told me.
The IAEA assessment was followed by a conference at the agency’s Vienna headquarters. The conference proceedings make for dramatic reading. Scientists backed by the IAEA calmly re-asserted their long-standing assessment that doses were too low to predict any but a tiny percentage of future cancers. Scientists especially from Ukraine and Belarus noisily rejected the assessment’s dose estimates, which were averages that did not take into effect localised hot spots, nor did the UN scientists consider the ingestion of hot particles born on dust that lodged in vulnerable soft tissue. They spoke of the rise in non-malignant health problems discussed above. They showed slides with charts. They asked why the report had not included the children who had thyroid cancer. Thyroid cancer in children is extremely rare. Before the accident, one child in a million in Belarus and Ukraine suffered from thyroid cancer. In 1990, five cases appeared in one village of the Gomel Province, 30 in Belarus as a whole and 20 in northern Ukraine. These increases, if verified, would be telling. Mettler spoke up at the meeting and again reported he had taken home from Ukraine slides for 20 cases of thyroid cancer and ‘they checked out’. He did not add that, of the 20 children, 11 lived in contaminated territories and were registered as having doses to the thyroid above the permissible norm. Yet again, as in the original IAEA assessment, Western scientists refuted the evidence, replying that ‘Most of the reports of thyroid cancer were anecdotal in nature’.
I asked Mettler over the phone whether he had noticed thyroid cancer when he was carrying out his study in the contaminated zones. ‘Thyroid cancer is very difficult to diagnose,’ he told me, ‘and it’s easy to get wrong.’ I questioned him about the 20 slides from Ukraine. He sounded surprised. He didn’t remember them. ‘I was never given any samples. I first heard of those thyroid cases at the meeting in Vienna.’
In the midst of the IAEA study, in April 1990, the World Health Organization (WHO) signed an agreement with the Soviet Ministry of Health to begin a large-scale study of health impacts from Chernobyl exposures. Publicly, WHO officials sold the International Programme on Health Effects of the Chernobyl Accident (IPHECA) as an opportunity to discover the hazards of low doses of radiation. Privately, WHO officials noted that ‘exposures were extremely low’, that they did not expect to find health impacts from radiation, but that the best way to placate an anxious public was to show them studies with negative results. By 1991, the rise in thyroid cancers among children in Belarus and Ukraine was becoming common knowledge. Belarusian scientists officially informed researchers at WHO, the American National Cancer Institute and the Radiation and Research Foundation in Japan of the growing cancer rate, 80 new cases in 1991. No one followed this up. WHO officials flew (first class) to meetings throughout Europe to promote the IPHECA project, but accomplished little in the way of concrete steps to initiate studies or help ailing children.
WHO had two offices working on Chernobyl: the Headquarters in Geneva (WHO HQ) and the WHO regional European office in Copenhagen (WHO EURO). Growing impatient, several doctors from Minsk contacted WHO EURO in late 1991 and told them again of the troubling spike in children’s thyroid cancer. Scientist Keith Baverstock, newly hired to WHO EURO, organised a meeting in January 1992 near Munich for the Belarusian doctors to present their evidence. Larisa Astakhova and Valentina Drozd gave a presentation showing the rise in childhood thyroid cancer. They reported the alarming increase each year, from a baseline of two annually in Belarus to 80 cases in 1991. From the most highly contaminated areas, in the Gomel Province, the most cancers were appearing. Fifty per cent of the cancers were aggressive and invasive. To confirm the diagnoses, Belarusian scientists brought slides that lab workers had made from window glass and household chemicals for lack of medical supplies. A WHO official noted, ‘the slides were of poor quality’, which made agreement among the foreign experts on the diagnosis hard to reach.
Although WHO HQ officials had known about the cancers for two years, at the meeting they pretended they were news to them. They expressed scepticism about the existence of a total of 80 thyroid cancers among 2.25 million Belarusian children. Radiologists were used to thinking of radioactive iodine as a diagnostic tool and a beneficial medicine to treat Grave’s disease. A small Swedish study of adults treated with iodine 131 had shown no rise in cancers. Latency periods for solid cancers are usually a minimum of ten years, while the Belarusian and Ukrainian cancers had emerged after only four years. And the evidence was patchy. WHO officials noted that Belarus had reported a large increase in cancers, while Ukraine had registered only a moderate rise, and Russia none at all. If the same exposures were in play, they asked, why would the rates differ across a republic border?
The Belarusian home-made slides, taken as incompetence by WHO HQ officials, did not dissuade Baverstock. He was impressed with Valentina Drozd’s precise, well-documented data on doses of radioactive thyroid based on 250,000 measurements and 19,000 individual dose reconstructions of exposed children. Mettler’s IAEA study, in contrast, had looked at only 600 children. The studies showed that children in Belarus, as in Ukraine, had received extremely high, incorporated doses of radioactive iodine, three to ten times more than adults. Soil analysis showed that the poor, sandy soils of the forested terrain surrounding the Chernobyl plant were naturally low in iodine. Children’s thyroids would have hungrily soaked up radioactive iodine as a replacement for the mineral in a benign form. Baverstock also knew of the studies of children in the Marshall Islands who were exposed to US bomb tests, who also exhibited an excess in thyroid cancers. The only question was whether the 80 reported Belarusian cases were really thyroid cancer. European and American scientists tended to have little confidence in Soviet medicine, and they were sceptical of Drozd’s evidence. Baverstock suggested that scientists from WHO EURO and the Council of European Communities (CEC) (also at the meeting) form a fact-finding mission to Belarus to look at the cases on site. The mission was set for July 1992. Scientists from WHO, CEC and the National Cancer Institute all agreed to join the task force.
Just as preparations were underway, however, the task force dissolved. Baverstock received a letter saying that the CEC no longer supported the mission. The Americans withdrew as well. Baverstock reported that he asked Abel Gonzalez at IAEA if his agency wanted to send a scientist. Gonzalez replied that the mission was a waste of time, that they wouldn’t find anything. Baverstock next turned to Wilfred Kreisel, Director of WHO HQ’s Division of Environmental Health, asking if WHO HQ wanted to participate. Baverstock had to wait, he said, while Kreisel had a long consultation with his supervisor, Nikolai Napalkov, a Russian appointee, who ruled that the mission should not occur. Kreisel relayed to Baverstock that he should pull out or risk losing his job. Not to be daunted, Baverstock, supported by his boss at WHO EURO, carried on. He recruited two world specialists in thyroid cancer and went to hungry, crisis-ridden Minsk. At a Minsk clinic, they saw 11 children with surgical dressings on their necks. They looked at tumour samples, X-rays and echograms of the child patients. They studied the histological slides of a 104 cases and agreed that 102 of them were cancer. The case was clear. There was no way a country the size of Belarus could produce so many cancers in one place at one time without an external factor.
In early September 1992, Baverstock with Dillwyn Williams of Oxford published an article in Nature, accompanied by articles from the Belarusian Minister of Health Vasili Kazakov and Larisa Astakhova. The scientists announced the unexpectedly early and large spike in cancers in children from the most contaminated regions, and underlined that these cases were aggressive and so would have been detected with or without screening.
In the next several issues, scientists wrote letters to Nature refuting the link between the Belarusian cancers and Chernobyl radiation. In a barrage of articles, Valerie Beral from Oxford who frequently worked with WHO, Elaine Ron, a cancer epidemiologist from the US National Cancer Institute, Itsuzo Shigematsu from the Radiation Effects Research Foundation in Hiroshima and J. W. Thiessen from the US Department of Energy argued the cancers were probably ‘occult’, meaning they would not have been found if there had not been intensified screening. They asserted that, without precise dose estimates and background cancer information, the reports could not sustain a connection with radioactive iodine. The authors called for a suspension of judgement and further study. Repetitive and dismissive, the letters read like an orchestrated attack.
The Nature article caused a storm between WHO HQ and WHO EURO. From WHO HQ, Kreisel wrote to Baverstock’s supervisor reprimanding him for the mission to Minsk and for the publication in Nature: ‘While the increase in thyroid cancer, as established by the mission, is consistent with data that have been available to WHO for some time, the publication of the findings without prior consultation with HQ causes concern.’ UN agencies involved in nuclear issues had a practice, Kreisel maintained, of ‘inform[ing] the other members of major developments with respect to Chernobyl’. It appears Kreisel was motivated by angry phone calls from another UN agency: ‘The IAEA, has been questioning, at the highest level, WHO’s attitude in this instance.’
Kreisel, working jointly with officials at IAEA, drafted a press release, which he presented to Baverstock in Kiev in November, and insisted he sign it and withdraw his name and WHO’s association from the Nature article. He told Baverstock he would be sacked if he did not sign. But Baverstock had secured a letter from his supervisor specifically authorising the mission, and he refused to sign or to cease to pursue the thyroid cancer case. For the next several years, IAEA officials wrote to WHO HQ about Baverstock and his meddlesome pursuit of Chernobyl issues. Meanwhile, Baverstock initiated a thyroid project in Belarus with a cancer research institute in France which paralleled and duplicated WHO HQ’s slow-moving thyroid study. IAEA pursued its own investigation of thyroid cancer, violating a prior agreement that WHO would handle Chernobyl medical issues while IAEA studied technical problems. The US Joint Committee developed yet another thyroid study with Ukraine which advanced far more slowly than tumours in children’s glands. The Japanese Sasakawa Foundation launched in 1990 a major initiative for children’s health in the contaminated territories and reported screening 50,000 children, but somehow missed the major increases in thyroid cancer (Satow et al 1995). French, British and German scientists all developed independent investigations as well.
Overcome by this confusing mashup of thyroid studies, officials from WHO HQ travelled from meeting to meeting insisting that the WHO should have a monopoly on the topic for the sake of efficiency and to ‘avoid duplication’. At the same time Abel Gonzalez, IAEA Deputy Director of the Division of Nuclear Safety, asserted that his agency’s International Chernobyl Project (the 1991 IAEA assessment) should take precedent over all others. Referring to the 1991 Technical Report that found no Chernobyl-induced health problems, Gonzalez wrote angrily to WHO in 1993, ‘The IAEA has … the one documented study on Chernobyl which has been peer reviewed internationally and it should therefore be the major reference base for any international Chernobyl related initiative.’ WHO, Gonzalez stated, ‘should tailor its activities’ to IAEA’s ‘recommendations and conclusions’. The IAEA’s conclusions, which were not peer reviewed, stated there would be no detectable effects and the agency recommended no further study. He pointed to the duelling projects of WHO HQ and WHO EURO and called the agency ‘adrift’ and its projects ‘scientifically unsound’. In short, the international politics of Chernobyl medical investigations were angry, competitive and jealously guarded, and the children in poorly lit and haphazardly supplied clinics were lost in the scrum.
Of course, the bulk of the ‘foreign experts’, global leaders in international radiology and health physics, were wrong. In 1996, WHO, UNSCEAR and IAEA had to admit, six years after Ukrainian and Belarusian officials announced the problem, that the still skyrocketing increases in thyroid cancer in children were due to Chernobyl exposures.
So they were late with the recognition of thyroid cancer and made some mistakes that over-estimated the power of the 1991 IAEA assessment. What difference do a few years make? It turns out, a great deal. The delay and the inflated assurances of no detectable illnesses meant that programmes aimed at treatment and screening were slow to start. Aggressive cancers were caught later and caused more damage and pain. The influential 1991 IAEA Summary Report on Chernobyl included a recommendation to cease resettlements from the most contaminated regions. With that, the planned depopulation of contaminated territories slowed tremendously. Meanwhile, the rash of competing thyroid studies that the Nature articles triggered dominated the field of Chernobyl health impacts, blocking funding or interest in other topics. On a grand scale, the IAEA’s and WHO’s suppression of knowledge of children’s thyroid cancer translated into a dismissal of the problem in the 1991 IAEA Summary Report. The UN General Assembly had been waiting for the IAEA report before holding a pledge drive to raise US$646 million (1.1 billion in 2016 dollars) for a large-scale epidemiological study of Chernobyl health impacts and for resettlements out of the contaminated zone. Coming on the heels of the report, the response was ‘disappointing’. A few small countries gave small sums totalling US$970,000. The big potential donors—the US, Japan and the European Community—begged off, citing the IAEA report as a ‘factor in their reluctance to pledge’.
In 1996, when the IAEA finally recognised thyroid cancers as a Chernobyl health impact, Angela Merkel, then German Minister of the Environment, again called for a long-term epidemiological study of Chernobyl effects on a mass scale, equivalent to the A-bomb studies. No study ensued, again, for lack of funds and a shortfall of leadership. The WHO, overtaken by infighting, had proven a disappointing leader in the crowded Chernobyl field, from which the IAEA gradually emerged triumphant. In 2003, the IAEA created the Chernobyl Forum, an umbrella organisation representing seven UN agencies, with the IAEA at the helm. Instead of a large-scale epidemiological study on Chernobyl health impacts the Chernobyl Forum reviewed existing studies and issued a ‘comprehensive report’ in 2006 which echoed the earlier IAEA reports of 1987, 1988, 1991 and the UNSCEAR review of 1996 (which included the addition of childhood thyroid cancer).
Denial and delay had a lasting impact upon the field of radiation medicine. Susan Lindee documents a similar pattern of jurisdictional infighting and resistance to admitting possible medical problems which held up the commencement of the Atomic Bomb Casualty Commission Study for the first critical years after the bombing (Lindee 1994: 57). As a result, science today has a vacuum of knowledge about radiation’s health effects in the immediate five years after exposure. Short-term medical problems that were documented in abundance in the Ministries of Health in the USSR were possibly missed in Nagasaki and Hiroshima because no one was recording them. Soviet doctors did, however, monitor and regularly examine hundreds of thousands of exposed people in the first five years after Chernobyl. Their work is unique in the realm of civilian nuclear medicine. Meanwhile, a growing body of contemporary medical studies supports the early work of Soviet researchers. Because there was no long-scale Chernobyl study, however, these studies remain fragments of a larger picture that has yet to be placed in one frame.
But what about Fred Mettler, one of the first radiologists from the West to lead a team of foreign experts into the contaminated areas? He wasn’t involved in UN politics, infighting or the larger skirmishes between nuclear lobbyists and anti-nuclear lobbyists. He was a university scientist doing his job. He could have played the role Baverstock did, breaking the news of the unexpected spike in thyroid cancers to a surprised scientific community. But on three separate occasions he failed to draw conclusions on evidence about childhood thyroid cancer which his lab had verified. When I asked him about the 20 slides from Ukraine in 2016, he didn’t remember them at all.
Oral history is a notoriously difficult practice. Subjects asked about events 30 years in the past rarely have a precise grasp on events. The Lifespan Studies which are so important to Mettler’s health risk estimates were based on data that were collected by asking bomb survivors where they were several years after the detonation of the first nuclear weapons in Nagasaki and Hiroshima. Pollsters asked women to give second-hand information on the location of their husband’s exposures. All this made for a very ‘messy’ situation, as James Neel, a leading geneticist on the project, recognised (Lindee 1994: 183).
Mettler’s eclipse of memory shows how we bend our minds to fit templates of stories told by others. Mettler’s memory lapse is an acute, personal version of the omissions practised throughout the minor international drama I have laid out in this essay chronicling how scientific consensus came reluctantly to recognise the powerful carcinogenic effects of radioactive iodine on children’s thyroids, while ignoring other short-term symptoms reported by local doctors. Mettler excised thyroid cancers from his memory just as officials at WHO and IAEA tried to delete them from scientific journals and international assessments. Perhaps Mettler engaged in deviant science, wilfully disappearing evidence. Rather than deviant science, however, his repeated amnesia points to the power of the mathematical models health physicists constructed. The Belarusian and Ukrainian cases of childhood thyroid cancer emerged too soon, sooner than the established risk estimates indicated, and there were too many of them. Instead of an expected ten per cent increase in disease, there was by 1992 a 100 per cent increase. According to the risk estimates, the doses were too low for such a consequence. To recognise the thyroid cancer epidemic would mean to recalibrate risk estimates, to ask whether there might be other effects, to fund studies and expand the kinds of questions health physics asked. Very little of these recalibrations occurred in the decades following Chernobyl.
In sum, the Chernobyl thyroid study shows a broad continuum of ignorance-producing activities that have had a lasting effect. Soviet officials requested an ‘independent’ assessment from the IAEA, an agency created to promote nuclear energy and on record as stating there would be no Chernobyl health impacts. Producing rival studies that call into doubt evidence of harm is a familiar political tactic in science wars (Proctor 1995). Gonzalez’s pressure on WHO officials to halt investigations into Chernobyl health effects is reminiscent of controversies over radium, lead and tobacco where pro-industry groups promote ‘undone science’ (Oreskes and Conway 2010). The creation of dose estimates and the assumptions and uncertainties contained within them demonstrate an embedded ignorance. The sheer impossibility of tracking systematically a wide range of radioactive isotopes across a dynamic landscape indicates an ‘undoable science’ that was veiled in assurances of a regulatory regime set up to sooth and assure (Frickel, et al. 2010). The reliance on simplified computational formulas over the labour-intensive work of looking for biological indicators points to the failures of big science (Ravetz 2011).
The sociologist Barbara Allen examines the context of scientific enquiry as a lens to show how official science can be weak or incomplete at its foundations (Allen 2003). She calls for citizen-scientist alliances, of the kind that Ukrainian and Belarusian researchers forged with local doctors, radiation monitors and public health officials such as Keith Baverstock. The thyroid cancer story might easily have remained permanently slipped from memory, lost in dismissals of Soviet science, references to screening bias, and explanations about poor diets and ‘psycho-social’ trauma, had it not been for Baverstock, a rare UN insider who went rogue. The question remains, however, are the effects of chronic low doses of radiation which Soviet researchers reported from 1986 to 1990 as real as the children’s thyroid cancers proved to be?
When I asked Mettler what else might have been overlooked in the Chernobyl medical story—what about the Soviet understanding of chronic radiation syndrome?—he replied that wasn’t possible. The doses were too low. He referred me to a host of UNSCEAR documents on the topic. I pulled them out.
They are wonderful to look at. After wading through, as Mettler must have, thick volumes of tables and charts of health statistics generated by Soviet agencies, with confusing, sometimes conflicting data in various calibrations and measurements, the UNSCEAR charts felt like meditation. They were simplicity itself, soothing and lulling. The only thing better than the sunny lucidity of the charts’ risk estimates is the promise of mathematical certainty amidst the vast confusion and overload of conflicting data that Chernobyl presents. Feed the charts an estimated dose, which itself is a gross generalisation based on shadowy personal memories and second-hand accounts, and the charts tell the reader the increased probability per dose of cancer in a given organ. Like Mettler, I wanted to believe them too, to dissolve into them and make those sick kids in the contaminated regions go away. Lost in the risk estimate’s fantastical magical trick of making dozens of insensible and harmful radioactive isotopes appear and be counted are the bodies that ingested them and an accounting of how they have fared.