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H E A L T H,   S A F E T Y,   &   S O C I A L   I S S U E S

Explosion of a 32-kiloton thermonuclear device
fired from a tower at the Nevada test site in
1953; U.S. Department of Defense photo

Radiation & Atomic Vets

For decades many U.S. veterans who took part in atmospheric nuclear tests have wondered whether their exposure to radiation might ultimately cost them their lives. Their private fears became a public issue in 1976 after a veteran claimed his leukemia was caused by radiation from a 1957 test series. His claim triggered a government study, which produced the first scientific evidence supporting the veterans’ theories.

But the “atomic veterans” and their families, as well as researchers and policy-makers, continue to struggle for definitive answers.

These have been elusive, at least in part, because a crucial piece of information has been difficult to get — the radiation dose that each individual received. Without knowing that, epidemiologists cannot accurately weigh the evidence on whether the blasts were responsible for some veterans’ deaths.

In the largest study to date, researchers from the Institute of Medicine (IOM) have come up with some partial answers. But they too were limited in their ability to draw conclusions by the lack of usable information on radiation exposure. A panel of experts advised the IOM researchers that exposure records from the 1950s were too incomplete or unreliable to use in this kind of study.

This latest report, which supersedes a National Research Council report published in 1985, was undertaken when substantial inaccuracies in were discovered in the government data provided to the researchers.

The new study focused on participants in five series of nuclear tests, all of which took place either in the Nevada desert or the South Pacific. Nearly 70,000 soldiers, sailors, airmen, and marines were involved in at least one of these, and about 30 percent of them have now died. For comparison, researchers selected a group of 65,000 military people serving at the same time under similar conditions, except that they did not take part in nuclear tests.

After an intensive review of service and death records, researchers found no difference between the two groups in overall death rates or in total deaths from cancer. Had there been a dramatic radiation effect, it would have shown up in this comparison.

The researchers also analyzed specific causes of death, including diseases linked in other studies to radiation. Here there were some differences. Among the nuclear test veterans, 14 percent more died from leukemia than those in the comparison group, although the difference lacked statistical significance and could have resulted from chance.

When comparisons were made based on whether the veterans participated in nuclear tests in Nevada or in the Pacific Ocean, the differences were sharper: a 50 percent higher leukemia death rate among Nevada atomic vets than among the comparison group. This was not true among Pacific test participants, who actually had a slightly lower — though not statistically significant — leukemia death rate than those in their comparison group.

As the researchers looked at a broader range of specific causes of death, they also found a higher death rate among the test participants for prostate cancer and nasal cancer. But since neither of these cancers have been linked in previous studies with radiation exposure, these results were difficult to interpret.

The next logical step would have been to determine whether there was a correlation between the development of cancer and the individual’s radiation exposure. The lack of usable data made that impractical. So although no dramatic effects were observed, the researchers could not rule out that some distinct subgroups of the atomic veterans had died from radiation-related diseases. — Neil Tickner

The Five Series Study: Mortality of Military Participants in U.S. Nuclear Weapons Tests. Medical Follow-up Agency, Institute of Medicine (1999, 240 pp.; ISBN 0-309-06781-2; available from National Academy Press, tel. 1-800-624-6242; $48.50 plus $4.50 shipping for single copies).

The project was funded by the Defense Threat Reduction Agency, U.S. Department of Defense.

Rethinking AIDS

When a new class of drugs became available in late 1995, doctors began to hope they could tame the AIDS epidemic — at least in the United States. These protease inhibitors helped suppress the virus, raising hopes that AIDS might one day become a manageable disease. At the same time, vaccines long in development inched toward human trials. With so much emphasis on new treatments, high-risk behaviors surged — possibly because prevention messages seemed less urgent.

But some of that optimism has now faded. The virus has proved hardy and elusive. New infections are on the rise, heightening the risk of transmission and the need for prevention. Over the past several years, the rate of infection has increased dramatically among women, African Americans, and young people — largely through heterosexual sex and intravenous drug use. This changing face of the epidemic calls for a fresh look at the nation’s prevention strategy.

To help accomplish that, a committee of the Institute of Medicine will review federal AIDS prevention programs to see whether they reflect the shifting nature of the epidemic. The study will focus primarily on the work of the U.S. Centers for Disease Control and Prevention. Based on this assessment, the committee will develop a five-year national approach for preventing the spread of the AIDS virus. The study report is expected to be completed next summer. — N.T. (See listing under New Projects.)

Space Station Risks

To build and maintain the International Space Station, U.S. astronauts and Russian cosmonauts will be working outside their spacecraft, typically in six-hour shifts. During the construction phase — which began in 1998 and is expected to be completed by 2004 — these “extra-vehicular activities” are estimated to exceed a total of 1,500 hours and are likely to occur during periods of intense solar storm activity. Such storms emit streams of radioactive particles which may cross the space station’s path.

While the most severe levels of radiation from solar storms are not considered immediately life threatening, astronauts could be exposed to single doses that are the equivalent of several hundred chest X-rays. These levels would put them in danger of exceeding lifetime limits for exposure and increase their chances of developing cancer. In addition, dangerous levels of radiation could interrupt a shuttle mission and impact future flight schedules.

Given these concerns, a new report by a National Research Council committee urges NASA to take action to reduce the astronauts’ risk of exposure. For example, agency regulations say that changes in flight plans must be based on current data that reflect the weather immediately around the space station. Forecast data, such as models that estimate the size and shape of a solar storm, could help in avoiding the radiation threat, but are not used in these decisions.

NASA should use existing equipment and mathematical models that can produce real-time data on solar storms, the committee recommended. And an electron dosimeter, which can warn astronauts working outside the spacecraft of dangerous radiation conditions, should be installed on the station as soon as possible.

Space weather data generated from government satellites and collected by the National Oceanic and Atmospheric Administration’s (NOAA) Space Environment Center is made available to radiation risk managers. The safety of astronauts would be improved if these observations were to be used in models that accurately predict the weather around the space station, the report says. Of more significance is the agency’s policy of not providing “tailored” support to any other government units. NOAA should change its policy to allow NASA to receive specific data that are not available from other sources. — B.L.

Radiation and the International Space Station: Recommendations to Reduce Risk. Committee on Solar and Space Physics, Space Studies Board, and Committee on Solar-Terrestrial Research, Board on Atmospheric Sciences and Climate; Commission on Physical Sciences, Mathematics, and Applications (1999; ISBN 0-309-06885-1; available in January from National Academy Press, tel. 1-800-624-6242; $25.25 plus $4.50 shipping for single copies).

The committee was chaired by George Siscoe, research professor of astronomy and space physics, Boston University, Mass. The study was funded by the National Aeronautics and Space Administration.

Safer Smoking?

For smokers who can’t quit, perhaps one solution would be to make smoking less harmful. The idea interests manufacturers and researchers, but provokes debate in public health circles.

Jim Emery/Folio Inc.

One suggested approach involves the use of nicotine replacements such as the patch and gum. Researchers believe that long-term use of these products could help smokers cut down, even if they didn’t quit. But so far, federal regulators have approved nicotine replacements only for short-term use to help wean smokers from their addiction. Some tobacco manufacturers are working along similar lines, developing products that they could market as being “safer.”

These efforts to reduce the health risks of smoking create a whole set of issues regulators may one day have to face. In preparation, the U.S. Food and Drug Administration has asked the Institute of Medicine (IOM) for advice on the specific evidence needed to determine if a product truly reduces the harm of smoking. An IOM study committee will look at how to measure whether there is less exposure to the toxic substances in cigarettes, whether that translates into less physical harm, and whether there are appropriate clinical indicators that can answer those questions quickly — without following a group of patients for decades.

The committee also will examine several behavioral questions. For example, some public health advocates worry that the very idea of a safer cigarette, regardless of physical effects, may give smokers an excuse not to quit. If so, a less-harmful tobacco product could turn into a more deadly one. Such products, they say, also might help lure nonsmokers into addiction, creating a new generation of tobacco-related health risks. The project is expected to be completed by early 2001. — N.T. (See listing under New Projects.)

Science & Diplomacy

When the government of Kazakhstan asked the United States for help in disposing of weapons-grade uranium left over from the Soviet era, both countries were fortunate that the U.S. ambassador in Kazakhstan had experience in nuclear issues and knew what technologies would be needed to remove the uranium. He worked with the State Department and other U.S. agencies to develop a plan for transferring the uranium to a site in Tennessee. The operation, known as Project Sapphire, was carried out successfully, meeting little resistance from Russia, the U.S. Congress, or environmental groups.

The American envoy in this case used the technical knowledge he had about nuclear weapons — as well as diplomacy — to eliminate a potential proliferation problem. Whether dealing with radioactive material in the former Soviet Union, infectious disease in India, pollution in Mexico, or genetically modified foods in Europe, diplomatic dilemmas that involve science, technology, and health have become an everyday consideration in foreign affairs.

To confront issues like these successfully, the secretary of state needs to articulate and implement a course of action to make science, technology, and health considerations an integral part of U.S. foreign policy, says a new report from the Research Council. The report was requested by Secretary of State Madeleine Albright amid growing concern in the U.S. scientific community and among foreign policy experts that the State Department had reduced its technical capabilities despite the growing impact of scientific and medical advances around the world.

All foreign service officers and other State Department officials should achieve a basic level of familiarity with scientific, technological, and health issues, the report says, and specially trained science counselors should be assigned to at least 25 embassies where such issues are of critical interest. Technical experience and competence should be considered an advantage — not a hindrance — to career advancement within the diplomatic corps.

To make certain that expert advice is readily available to the secretary of state and other officials, a highly qualified senior adviser should be appointed, the report says. In addition, an undersecretary should be given responsibility for ensuring that technical know-how is considered during policy discussions, with the phrase “for scientific affairs” being added to his or her title. A science and technology advisory committee of outside experts should be established and, when appropriate, the department should transfer responsibilities for international science, technology, and health matters to other agencies that have expertise in these areas.

Following public release of the report, the State Department announced Albright’s intent to meet with Bruce Alberts, president of the National Academy of Sciences and chair of the Research Council, to discuss the report’s findings. Jack Gibbons, a former presidential science adviser, has been hired by the department to guide it through the report’s recommendations including defining the role of a department science adviser. — B.K.

The Pervasive Role of Science, Technology, and Health in Foreign Policy: Imperatives for the Department of State. Committee on Science, Technology, and Health Aspects of the Foreign Policy Agenda of the United States, Office of International Affairs (1999, 126 pp.; ISBN 0-309-06785-5; available from National Academy Press, tel. 1-800-624-6242; $29.00 plus $4.50 shipping for single copies).

Robert Frosch, from the John F. Kennedy School of Government at Harvard University, chaired the committee that wrote the report. The study was funded by the Golden Family Foundation and the Carnegie Corporation of New York.

Beyond Welfare

In the wake of welfare reform, the number of Americans receiving government assistance has dropped substantially, and many former recipients have found work. But a comprehensive national picture of the effects of the legislation will not emerge until policy analysts can track a broader cross section of the nation’s poor, according to a recent report from a panel of the Research Council. To make this happen, the U.S. Department of Health and Human Services (HHS) needs to play a leading role in guiding welfare reform research and data collection so that policy-makers have the information they need for assessments.

Many researchers and policy-makers have focused attention on the status of families who have left the welfare rolls since the law was passed in 1996. But while such families’ experiences provide useful information, they are only part of the story. For a comprehensive picture of how new welfare programs have shaped the lives and decisions of low-income people in general, HHS should sponsor studies of families who choose not to apply for benefits, the report says. Studying these families would help determine whether they have not sought benefits because they have found work or because they are able to support themselves through other means — through marriage, for example, or by sharing resources with a partner, friend, or relative.

Given that some states and counties have formal “diversion programs” to discourage individuals from applying for public aid, the panel believes it is a welcome step that HHS has awarded grants to monitor the status of families who have been steered away from cash assistance benefits. HHS also should learn more about families who continue to receive welfare and those who depend heavily on the welfare system for long-term support.

In addition to playing a leading role in steering overall research, HHS should take steps to make data, analyses, and definitions as comparable as possible across and within states, the report says. And it should identify key policy questions and data-collection priorities that federal and state officials should focus on over the next three to five years. In some instances, HHS has already begun work on making data collection more uniform across states and pinpointing key policy issues. Such projects should be expanded. — Vanee Vines & Cheryl Greenhouse

Evaluating Welfare Reform: A Framework and Review of Current Work – Interim Report. Panel on Data and Methods for Measuring the Effects of Changes in Social Welfare Programs, Committee on National Statistics, Commission on Behavioral and Social Sciences and Education (1999, 140 pp.; ISBN 0-309-06649-2; available from National Academy Press, tel. 1-800-624-6242; $31.50 plus $4.50 shipping for single copies).

The study panel was chaired by Robert A. Moffitt, professor, department of economics, Johns Hopkins University, Baltimore. The project is funded by the U.S. Department of Health and Human Services.

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