RJH V1N4, 1986.pdf
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Volume I
March 1987
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NUCLEAR TECHNOLOGY AND HEALTH
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Editorial Perspective
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Working Editors:
Amar Jesani, Manisha Gupte,
Padma Prakash, Ravi Duggal
Editorial Collective:
Ramana Dhera, Vimal Balasubrahmanyan (A P), lrnrana Quadeer,Sathyamala C (Delhi), Dhruv Mankad
(Karnataka), Binayak Sen, ¥ira ~adgopal (MP), Anant
Phadke, Anjum Rajabal!'. Bl)arat Patankar, Srilatha
Batliwala (Maharashtra) Amar Singh Azad (Punjab),
Smaraiit Jana and Sujit Das (West Bengal)
·~II Correspondence:
Radical Journal of Health
C/o 19 June Blossom Society,
60 A, ·Pan Road, Bandra (West)
Bombay-400 050 India.
· Printed and Published by
Armer Jesani .for
Socialist Health Review Trust Regjstered
Address: C-6 Bala~a, Swastik Park, Chembur,
Bombay 400 071.
Printed at:
· : Bharat Printers, Shiv Shakti,
Worli, Bombay.
'
Annual Subscription Rates.
Rs. 301:- .for individuals
Rs.. 45/- for institutions
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US dollars 20 for the US, Europe and Japan US
dollars 15 for other countries.
We have special rates for developing countries.
109
NIGHTMARE OF DREAM
116
HEALTH HAZARDS OF NUCLEAR CYCLE
Manan Ganguli
119
DON'T JUST REDUCE RISK, TRANSFORM IT!
Dave Rosenthal
124
THE 'NUMBERS GAME
V T Padmanabhan
130
UPDATE: News and Notes
133
COMMUNITY PARTICIPATION IN INTEGRATED CHILD
DEVELOPMENT PROGRAMMES
V Raman Kutty
Book Reviews
136
MILK MONITORS
138
HUNGER AND MYTH OF PLENTY
Bernard D'MeUow
Dialogue
140
VACCINE PRODUCTION IN PRIVATE SECTOR
RS Dahiya and Peeyush Sharma
(AII remittance to be made out in favour of Radical
Journal of Health. Add Rs 5/- on outstation cheques).
MYTH OF ALTERNATIVE MEDICINE
Thomas George
·-. - ..-:--=------ ~
"-
ANATOMY OF NUCLEAR WAR
Achin Vanaik
SINGLE COPY: Rs. 8/-
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113
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No4
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Editorial Perspective
Nightmare of a Dll."eam
ON DECEMBER 2, 1942 the first nuclear reactor went political lever for other kinds of gains in international
critical, releasing for the first time the enormous diplomacy; it was-only logical therefore todevise ways
energies of. atomic fission and ushering in the nuclear and means of continuing and expanding research and
dream. But the reality was to be different; the dream · development efforts in nuclear sciences which while
rapidly turned into a:nightmare. By the end of that being ostensibly 'civilian' could easily be harnessed to
decade not only had energy from the atom claimed war efforts when needed.
'war victims' but it had also shown its potential in killThus the technical linkages between peaceful and .
military nuclear reactors-i e, the fact that it is dur__-;r-- , ing, maiming.and scarring for life anyone who worked
with it. Pi.s early as August 19 a young worker at the ing the process of controlled fission that the bomb
Los Alamos 'atom bomb laboratory' working on . material is produced or that the enrichment plants used
fission studies diedan agonising death after accidental to produce· fuel for the 'peaceful' nuclear reactor-can
&-:osure to radiation even as his numerous colleagues also, with. sufficient modifications, be used to
",.cffansporting fission material or experimenting with it manufacture bomb material.....:.have been politically
wer~ becoming permanently affected. By the fifties reinforced. To argue that the two, the peaceful atom :
while several countries had built commercial reactors. and the military atom are differentis neither politically
producing electricity, well-developed weapons pro- nor technically tenable.
grammes were also under way; And that was when the
It is in this context that the Indian nuclear· promyth of the· peaceful atom took shape and gained gramme got under way. It would be incredibly naive·
substance.
today to believe that the Indian bourgeoisie at the time·
The nuclear debate, in addition to being a human of independence were not aware of the weapons potenrights issue directly impinges on all aspects. of health tial of the peaceful nuclear programme. The fact that
care; A nuclear war, even: a limited one, would be com- the programme has from the beginning been .accord-.-.
pletely unmanageable by even the, most efficient and ed high priority in terms of funding, that it has always
most sophisticated health care system. (See p' 112) been under the prime minister's direct control, the creaMoreover no, weapons system, even.if meant as a deter- tion of tpe Atomic Energy Act with its unbelievable
ranee, and however rudirnentary/skelatal can be built powers to suppress information, and the fact that the
up without some kind of testing of the-devices. -This department's-accounts have never been open to public
has a direct consequence for the burden of ill-heakh or parliamentary scrutiny o~ .audit by the ·Auditor;
among people not only of the affected region, but General of India are obvious indications that the
globally. And then there is the expenditure on ar- weapons angle has always been kept in perspective j~.
maments which is eating into the already meagre health developing the programme, Events in subsequent years
and welfare budgets. While this is true of a1'1 countries, especially in the last decade have given further evidence
it has a more disastrous impact on poor nations. The of this.
•
• .
'peaceful atom' too is a h.ealth. hazard. Three Mile
The nuclear debate is not new. While the dissent of
Islands and Chernobyls can with the increasing pro- the 50s was generally focussed on nuclear armament,
liferation of nuc)ear reactors, happen more frequently. the first ever protest against a nuclear power reactor
With the secrecy which is an integral feature of the in- was organised in 1957 in the US. But it is -in the-seventernational nuclear industry, we may not even know ties that the nuclear debate came into its own.
when and if such disasters have taken' place, Besides, Throughout the 60s even as more and more 'peaceful' .
evidence is accumulating on the long-term effects of nuclear reactors were being built, data was also acculow-level' radiation, once thought to be 'harmless; (See melating about radiation-related deaths among victims
p 113).
· exposed to nuclear test fallouts, about the numerous
things that could go wrong in a nuclear reactor, and
'Atoms For Peace'
about the potential' Iong-term effects of low-level
It is not an accident
of history 'that the Atoms for radiation.
I
Peace programme was proposed by Eisenhower in.
Throughout the fifties. the US continued to test
'1953. By then ,the military expenditure. on nuclear in- nuclear weapons in a variety of geographical
stallations had overshot anything that the country had locations-66 of the 200, were in the Pacific ocean.
spent even during times of war; the anti-bomb lobby While radiation damage from the-fallout had been acwhile certainly not influential enough to change the cumulating slowly over the years throughout the area,
course ot development, at least had nuisance value; it was the Rongelap or the Bikini test which ~rought
nuclear reactors whether for peaceful uses or for war home to the world not only the horrors of thenuclear
weapons development were essentially the same; under armaments programme even during peace time, but
US legislations weapons technology could not be also the horrendous coverup used by the US and every
shared with non-weapons countries-an important other state which has had anything to do with the
March 1987
1'09
atoms--the denials, the coverups and the secrecy, another manifestation of these considrations, proChiildren of Rongelap played in the 'snow' from the viding a motive force: The growth, of the peace move"
massive fallout from the test which entirely covered the ment cannot be measured only in terms of nbmbers"
ground for 78 hours before the US decided to.inform but In terms ofits political effcctivity. One consequence'
the islanders of the deadly radiation and evacuated of this has been the incorponatiorr of mamy of the antithem. The first five years saw a sharp rise in miscar- nuke movements, demands into the progrnmmes and'
riages and stiHb~rths; but it was only after 9 years that· manifestos of opposition parties in Europe. Whi1le the
the US medical experts acknowledged that the children Green party has gained ground in West Germany ,in
were particularly prone to thyroid problems and the- the last election, in Australia and Leeland too parties
seriousness was highlighted when a 19-;year-.old boy wi~h a maior.focuson anti-nuke and peace issues have
who had been the youngest to plav in the 'snow' died contested elections and won ,parJ.iamentary represerrof leukaemia. Women from Rongelap continue to give ration. The communists in France are ac_tively parbirth to what they describe as "a bunch of grapcs'!._a tici,phating i1: antdi-nuke ddeFQon.strations; f?r thhepco~1f,~- ,.__,___ _ _
#"- -~
consequence of radiation exposure because of whie"h trr. as continue to con. UCt nuc 1 ear tests in l · e · aCI IC
despite
worldwide
protest.
At
Greenham
Common,
UK
cystic grape like structures occur in the uterus or
women have been camping outside the defence area
sometimes a ~ingle hydatiform mole is formed from
in protest aganst the deployment of Cruise missil~
· a fertilised ovum which has lost its nucleus.
In the Pacific too, several nations have come together - _ _:
The peaceful atom too was beginning 10 show its
to
declare the zone a nuclear free one with ma11y counbelligerence-the increasing health problems of nuclear
workers-the uranium miners, the transporters, reactor tries, including the USSR and excluding the US ratioperators and; the whole army of workers-was forcing fying the declaration. Not the least of these new
several nations to pass legislations: But this also led developments has been the spectacular ,impact of the
to successful efforts to formulate so-called safety stan- International Physicians for the prevention ofnuclear
dards which only obliterated the real effects of radia- war (IPPNW) (See p 111) ·
But closer home a vocal nuclear lobby is ,pressurising
tion damage;
the Indian state into giving the final signal to produce
It is interesting here to point out that the internathe bomb which is supposedly all but ready. Moreover
tional bodies which are supposed to set the limits of
the nuclear industry is planning ,the biggest expansion
exposure and monitor it are themselves open to
programmes, with· a target of 10,000 MW of power
·-<1
criticism of bia:s. Moreover, even as evidence acfrom nuclear sources. Capitalist development in India
cumulates about the extensive and long-term damage
poised to shift gears. to a more rapid grow.th which will
due· to nuclear operations, the levels of exposure etc
inevitably make demands for changes in'the economy.
have been revised and concepts modified to accomThe atoms-for-progress-and-peace theme is acquiring
modate them. For instance, it is now accepted that there
11ew mea11ing. Acquiring nuclear ·weapons capabHity
is no safe dose of radiation; therefore the 'permissible
not only ·becomes necessary as deterrance 'to keep
dose' was evolyed. And.ironically enough it is not the
peace' in the region, but also to reassert hegemonic
health establishment which has tradkionaliy been inaspirations. At the same time nuclear power with its
volved with monitoring these aspects; the- discipline
called health physics which evolved at around the time long-term advantage of low labour inputs, ceRtralised
of the first nuclear reactor has been dominated by cont11ol etc is seen as the only means of providing for
physicists and engineers and its ftindamental concern the power requirements of indastrial growth.
This t~e n~clear debate has both"a global aRd-a nahas been to giv.e the nuclear industry a dean chit. (See
tionaI
dimension and within this broad perspective are
page 119 for discussions on the biases in concepts of
several issues. There is on the ;one hand the issue. of
'risk' and safety'.)
how we view war, nuclear armameRt and disarma,.neRt
Anti Nuke Debate
at the global level' as wel'l as the nati,onal. ReceRt
marxist
analyses of war see it mainly as a condition
It is-pertinent to ask why a debate which has been
goi11g.on for over three decades needs to be given space of capitalist .production. 'Fhey argue that highly inand' attention here. There have been .:Several dustrialised capitalist economies generate surplus value
developments in the past few years about which we can at such a rate that .:apital begins to accu(ltulate i:apidly
neither remain unaware· nor unconcerned. For one and this inevitably leads to faUing ,returns of investthing after four decades· of the arms race the US and ment thus leading to crisis. The creation of d'efence
the USSR are on the verge of reaching a historic agree.- establishments which must be kept ready to strike at
ment on dfsmantling nuclear weapons in Europe. If all times in terms of training, competence aRd technical
the agreem~nt ·on dismantling intermediate raHge superiority provides for vast capitali expenditures in a
missiles in Europe whatever its limited scope comes justifiably non-productive fashion-ie without ,creating
through it will be the first ever of its }fad. Undoubted- new value. Seen in this light the theory of deterrance,
ly, national and giobal .econ<?mic and .political con- whether.it fa. in terms of ke\;!ping huge conventioRaI
siderations have had a lot to do with the ·move, with military establishments or buitding up nucl'ear
the growi11g European peace movement, which is itself armaments and deploying them becomes a cpnditions
0
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Radical Journal of Health
\
of capitalist production.
nuclear accidents are not specific
.,, and rare instancesIn the context of international capitalist development they can occur at any point ,in the nuclear cycle, no
itis absurd to take one view of war and armament on matter how fail-safe the process. The secrecy which is
the global level, i e, support disarmament efforts, while part 0f any nuclear establishment anywhere in t:he
at the same time take a completely different view at world makes it impossible to ensure the safety of
the national level, i e,. support the bomb lobby populations around. Only in the last decade has the
encouraging nuclear arms production.
issue of what to do with old nuclear plants received
,Equally, it would be utterly naive and blind to try attention: The dilemma is that firstly,. the expenses
to delink the.nuclear arms· issue from that of nuclear
involved in shutting down are enormous, secondly c,l •
power. Setting up a nuclear capability for producing nuclear plant unlike other establishments cannot
10,000 MW JJOWer is equivalent to establishing the base simply be abandoned it is in the nature of a time bomb
for producing a full complement of nuclear weaponry. because it will be radioactively 'hot' for a long-time ·
. __,But for the moment let us assume that it is possible and has therefore to be safeguarded' and thirdly in the
-?"- for us to seperate the two. Would nuclear power be a bright dawn of thenuclear era nobody had thought
, feasible and safe proposition then?
to make provisions, costwise or otherwise about
It is important here to point out that India has been dismantling these monsters,"
~ eon the peaceful nudear front at every level of
But notwithstanding alt this there is yet another facet
~
fie"'nuclear cycle. Uranium is mined in the country;
of the picture which demands attention. Atomic energy
t~is ore 11s well as other fission materials can be pro- has not only produced. electricty but a variety of
cessed and enriched, albeit to _a limited extent accor- nuclear products used in a range of applications, parding to official sources; we have several reactors which
ticularly in medicine. There can be no denying the fact
even if they have never been working efficiently to pro- that the use of radioisotopes have enormously benefitduce power for which they were ostensibly set up they
ted biomedical and engineering sciences and there is
have been producing fission products in large quanno. substitute for radiation · therapy with aM its
tities and huge quantities of radioactive waste; India
drawbacks and.problems. While it is true that the
has had a sophisticated reprocessing facility for almost
technology to produce them may be different, can it
as long as •it has had its first power-reactor and it has
not be argued that this is in many senses a matter of
had to store the long and short ·half Ii fe wastes in many , scale? Can we seperate this from the rest of the issue
dumps.
and would it be possible to confine all future applicaThere is today enough information worldwide to
tions, research etc only to these areas. Can scientific
showhow workers and "non-workers in and around
developments no matter what their impetus and. the
these various ~uclear establishments are being perpredetermined boundaries of growth, be entirely
manently affected by radiation damage. Indian studies
contained?
(see.p 124) have shownjust how incapable the departThe Indian anti-nuke movement has been of fairly
ment has been in monitoring the health of workers in
recent origin-but it has already made considerable imthe Rare Earths plant at Alwaye _in Kerala one. of the
pact on an establishment, which for the first time has
oldest such plants in the country. Since the 70s ·several
been forced to give serious consideration to'. sensitive
stories of how workers are exposed to high radiation
questions. But the medical establishment, has in
doses during cleanups have •reapetedly surfaced from
keeping with its class interest kept out of the picture .
.\_
Tarapur and Rajasthan. The department' has kept on
However, if heaith is our everyday concern and if
record ofpeople around any nuclear installations; but
\ye bdieve that health care in more than medicare an_d
recent studies in UK have shown a definite possibility
is a political issue, we have .to confront the nuclear
of chiid9ood lel!lkaemia.ch1sters around power plants
issue~For, in doing so, we confront in quintessence,
and no significant contraditions have as yet come forth
the contradictions and consequences of world
despite close scrutiny of the studues, A;d nobody is
capi,talism.
_ J'adma P'.:-,kash
aware,ofwhere the nuclear waste dumps are which is
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March 1987
111
Medical Response to Nuclear Threat
IN 1961, a group of young physicians ·from Boston founded dn
organisation called Physicians for Social ResponsibHity'('PSR).
· Among them were Bernard Lown, Jack Gelger, Victor Si deli and
Sidney Alexander. Beginning with an historic article in'the New
England Journal of Medicine, they calculated and publicised
the medical consequences of a nuclear weapon detonated over
a major city:
After a period of dormancy, PSR was revived in "1'978 by
another group of- young Boston doctors, including Helen
Caldicott, Eric Chivian and Ira Helfand. The organisation was
concerned with both nuclear Weapons and nuclear power, and
developed a national constituency in the wake of the accident
at the Three MHe Island nuclear reactor in Pennsylvania. fa the
following year, PSR decided to focus its attention on the nuclear
arsenals. Dr. Chivan, a psychiatrist at the Massachusetts Institute
of Technology and Harvard Medical School, agreed to design
and organise die first major American conference on the medical
consequences "of nuclear war.
At the same time, Dr. Lown and several other American physicians, including Harvard Medical School professors Dr. James
Muller and Dr. Herbert Abrams, began discussing the possibility
of a Soviet-American medical dialogue on nuclear war. Dr.
Muller had studied cardiology in the Soviet ·union and later
visited there on official delegations. He and Dr. Lown agreed
there should be some kind of joint effort by Soviet and American
physicians to address the nuclear arms race. Together with Dr.
Abrams, chairman of the radiolegydepartment at Harvardl.they
formulated a strategy for approaching Soviet colleagues.
One· key element of that strategy was the personal' and professional relationship between Dr. Lown, !l. professor of cardiology at the Harvard School of Public Health, and Dr. Evgueni
Chazov, director of the USSR Cardiological Institute. The two
had first met in 1966. ·
colleagues in calling upon Presidents Reagan and Brezhnev to
preclude the use of nuclear weapons "in any form or on .any
scale", the Congress achieved a major goali of the IPPNW
founders=-demonstratiag to the world that American and Soviet _,.
physicians could co-operate on the gravest public health ques- ;t
tion of the time. This fact was under-scored by the widespread. J-'-,~
coverage .given the ·Congress :by Soviet press . .andi television.
Soon after the First Congress, the American Medical Association, after -reviewing material, submitted by IPPNW arid its lJS
affiliate, Physicians for Social Responsibility, passed a resolution which recognised the professional obligation of doctors~io----e'tlucate their patients on the medical. effects of nuclear war. The
basic message of IPPNW's founders had' entered th~aiAstream.
.
~!I~-=~
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[Central Office: IPPNW, 225 Longwood Avenue, Boston, N!}l~~l15,
~~
.
We Apologise
For Irregularity and.Delays in Bringing out ;RJH
The reasons have been mainly technical and financial.
But we are generally out of the woods and would be much
' : mo Fe confident If we are assured of your continued sup' port! So please do renew your subscriptions.
We wiU be bringing out ,the next issue, the first of the
new volume in the next 45 days, at the latest. The focus
of the number is 'Medical 'Iechnology and Health' and
we're sure i,1 wiill raise a number of issues for debate. Do
make sure you get your copies.After that we hope to be·
back on schedule with: Drugs and Pharmaceuticals:
Health in People's Movements; Health and Agricultural
I-ate in° 1979 and ~arly in.1980, Dr. Lown wrote to Dr. Chazov
Development.
with a proposal.to create a Soviet-American physicians' moveFinancially, the Socialist Health Review Trust is collecment to prevent nuclear war. The proposal reasoned that docting a corpus fond so that RJH can be supported; This
tors owe a professional' duty to address the greatest tlireat to
fund is being collected through individus] and institutionat
human life, andthat an East-West medical organisation would
donations and donors.may avail' of tax henefits'"under the
be particularly effective in alerting the public and persuading
ATG scheme. Apart from this RJH is seeking life subscripgovernments .•
tions of Rs 500 from individua ls and Rs 750 from institu-tions. This wiH form a corpus fund which wiH Sl!lppcrrt
In Apfit 1980, Dr. Lown travelled .to Moscow to ask Dr.
the pubijcation from the interest earned. We airn r.e col'Chazovt~ urge his Soviet colleagues tojoin such.an ~ffort. Dr.
Chazov was encouraging, an.d ·in the spring of 1980, Dr. Lown, , Iect a minimum of 100 Hfe subscriptioAs by -the end of
Dr. Abrams, Dr. Muller and Dr. Chivian incorporated IPPNW
the year and we have quite away to.go as ye.t. We would
as a non-profit, educational organisatiph .. ·
really appreciate y0l!lr suppon/help in reaching the target.
· - ·The efforts of the Bostbh .physician.s led to a -meetin.g in
One 9f the major objectives -of-the Journal was to bring I:
December 1980 in Geneva between three American doctors and , to ,r~aders material, opinion, debate aAd analyses, Aot easithree to lay the intemationaMoundatioBs of iIPPNW.
ly accessible to activists aAd whkh wou,Jd ,enrich and
Soon after, a small group of US phy~icians assumed the task
enlarge t-he marxist understanding -of health. We believe
of traBsforming the concept of :IPPNW into an organisatioal
the RJH has made significant contribution ,in the area ,and
i:eality. Their initial' assignmeBt was ,to organise the 'First World
wi-lil ,continue to do so. We coHec.tively recognise thle
Congress of IPPNW. The Congress, held near Washington D:C. i political, necessity of Sl!lch an eAdeavour. No mauer what ~
in MaFch ,1981, attracted 70 doctors from twelve countries.
the odds, RJH wiill continue .to be pt1blished. We appeal
to you to help us im whaie\·er way you <.:aA.
fa the eyes of the western ,press, the dramatic news from the
HJH Colll•cHw
First Congress was the presence Qfthe Soviet delegation·. When
Soviet doctors joined their American, European, and Japanese
1
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112
Radical Journal of Health
Anatomy ·of Nuclear War
a_chin vanaik
The date August, 6, 1945. The Place - Hiroshima, Japan
=-, _,.. 1
practioners are aware of what a nuclear war means? And
how many are actively opposed :to such ·a War breaking out
and to the nuclear weapons. powers or potential' nuclear
weapons powers army themselves with such weapons?
Today, with the "live" experience of Hiroshima and
Nagasaki a great deal is known about the medical' consequences of a nuclear attack. A nuclear bomb explosion
involves blast effects, heat effects, and the effects of ironis-·
ing radiation. The proportions . of these effects can vary
1".depertding on the size and nature of the bomb. For example,' in the neutron bomb (the 'capitalist' bomb which kills
people but d'oes not damage property) the blast and heat effects are greatly minimised while the radiation/effect is greatly
enhanced. But in the 'normal' nuclear explosion, some 50
per cent of the energy goes. as shock wavesor other blast
"NO one could understand what had happened. Thousands
began to flee the city. Most of them seemed' to be hurt or
-mained. Eyebrows were burned off, skin was hanging from
faces and hands. were vomiting. Almost all had their heads
bowed, looking straight ahead, were silent and shared no
expression whatsoever. In general, survivors that day assisted
O}l-ly-fueir relatives or immediate neighbours, for they could.
-~ot comprehend or tolerate a wider-circle of misery,
Towards evening the streets became quieter; "Now not
many ~pie walked in the streets but a great number sat
and.
.the pavement, vomited, waited for death and
died!' Even now there was no organised help masses were
dead, masses were dying. "They all felt terribly thirsty and
they drank from.the river. At once they were nauseated and
began vomiting and they notched the whole day.' There were. effects, 35 per cent as heat and 15 per cent as radiation. The
a few people who were capable of helping others. Survivors range of these effects "will be· different if the bomb bursts
.that evening noted that the asphalt on the streets was still' in the air blast and heat range will be greater) :than.tf ,it bursts
on the ground (radioactive 'deaths, fall out etc, will' be greater)
too hot to walk.on with comfort. Two men noticed "a pum- or whether it explodes underground or underwater. ·
pkin was roasted on the vine", which was eaten. Potatoes
under the ground were found.to bebaked and were gathered
A sufficiently high overpressure (blast- effect) on the
for food. Many desperately ill survivors found their way to human body will lead to rupture and haemorrhages in the
~ ;:..._.;:.
the sand pits on the river deltas. The tide was coming in. lungs, air embolism and rupture of the gut and ear drums.
"=-· Many were too weak ,to move themselves but were helped In addition blast effects on buildings etc, will indirectly create
by exhausted survivors. "He reached down and took a many more human easualities through flying projectiles. and
woman by the hands, but her skin slipped off in huge glov- falling debris etc.
.
,
.
like pieces!' Others were moved up the sand pit but the follow· I'he fireball of nuclear explosion (small one) wiill look
ing morning they had gone as the tide had came-higher than brighter than the sun at noon to anyone within a 50°~He
expected.
radius of the explosion. To anyone looking at the firebaf!
During the first day, Father Kleinsorge was askedto help there is great likelihood of retinal burns leading to perrnasome soldiers. "When he had penetrated the bushes, he was nent blindness. 'fhe intense heat of such a ,fireball wiiU raise
there were. about 70 men and they were all in exactly the same flash burns of the ski,µ . A partial thickness burn leads to
,..,__ nightmarish state; their faces were wholly burned, their eye blistering which can :became infected.. A full ,thickiless burn
). sockets were hollow, the fluid from their melted eyes and nm is where the skio is completely destroyed, in ootn.eases loss
. }down their cheeks .. 'vhis was the result of having their faces of cn.ipial body fluids through ,the surface.of the bum can
· upturned when the bomb exploded!' (Based on the book 'lead to death. In addition, the explosion will create fires on
Hiroshima by fohn Hersey).
.
the ground leaaing ,to flame burns which wHl cause hmg
Not long afterwards during the Koi:ean War, the American damage throl!gh inhalation of smoke from a variety ,of burPentagon devised wp.at it called the 'Hiroshima-Death Fune- ning materials especially plastic.
.·
tion' (HDF} ,to calculate what would be the effect of using
After a nuclec!,r explosion comes the radioactive fallout as
nuclear weapons in. a selective manner. This HDF was an radioactive isotopes condense on debris and du-st to, prodl!ice
algorithm to calculate mortality as a function of distan.ce ,the radioactive dustcloud. In the first 24 hours some 60 per
· from ground zero of an air burst nuclear explosion. The HDF cent of radioactive products fall to the ground. This is the
is
early fallout. T~e 40 per cent which remains can ,take much
D(r) = 0.93 Exp -{0:693' [(r - ·800)/850]2}
Ionger to faU and can be.dispersed ovei: a wide .area depen- where D = Deaths and r = slant distance in yaFds from point ding on weather, winds etc. This ·is the delayed fallout. This
·;.-of burst for·r greater than 800.
radiation causes damage to rapid)y dividing ceJils sucil as
Despite the evrl of nuclear weapons and the widespread . tilose_ of bone narrow and the lining of the gastz:ointestinal
L.
revulsion at what happened in Hiroshima and Nagasaki, the · tract. When tht; whole :body is exposed op.e can get radia~ontingent use of nuclear weapons has never been far away tion sickness which is often fatal. One unit of dose Le. eHergy
~--.......,:.; "from the minds of nuclear warmongers. Certainly, these war- absorbed per unit mass is called a rad and a dose of450rads
·
mongers have few doctors or medical practioners tri their wi:11 kin 50 per cent of young, fit adults. A dose 0f ,150 rads
ranks. Most of them are defence personnel, poHticians, wiTI ki1'1 50 ,oer cent of elder.Iv. afready ill a0.d children.
strategists, academics and so on. But how many nJ,edical
In the first form ·Of radiation sickness/the bone-marro 1,
_, ,;_.-.~
Jl
)
.L
1e~
I
a
March 1987
]13
....
,
form requires only an exposure of 150 rads. The first symp- if there was a "limited' or "small" nuclear war in a remote
'toms are lethargy and nausea, then nothing for 10 days. part of the world.
Towards the end of the second week there is maximum
In sum for purely medical reasons algne, nuclear war must
depression of the white blood cells and platelets which never be allow~£!' to occur. No government should conreduces the blood's capacity to clot and stop bleeding or pro- template it and it should never be allowed to happen no mat- tect against infection. Spontaneous haemorrhages often tel' what the circumstances.
develop. By the fourth week many of the victims will die.
Why Nuc:lear All'Senals?
-~~,\
'If the radiation exposure is high enough then there wiH
-~
be gastrointestinal damage where· the cells of the small inWhy then do countries go in tor building nuclear arsenals?' testine are damaged. This leads to massivediarrhoea with Why then the insane nuclear arms race between the superloss of body fluids, to greater risk of getting septicaemia from powers? Why then the attraction that going nuclear has for
bacteria emerging through the damaged living. If exposure bomb lobbies in countries like India and Pakistan, which
is higher still, then the central nervous system of the body have nuclear weapons capability but have not as yet ®ssjd
is damaged leading to convulsions, coma and death in a few the nuclear rubicon of openly deploying a nuclear weapon~
hours. If the victim survives, there will be gradual loss of " system?
, mental and physical faculties which then results in death in
Nuclear war is mind-boggling but precisely -b~ause it
a few days.
throws into the dustbin older preconceived notio~-~f war
· Where radiation sickness does not lead to death, it can and its possible purposes, so many governments revert back
destroy. or damage fetuses in pregnant women. Brain to older forms of thinking in -order to cope with the minddamage was found in m~y children whose mothers were less boggling character of nuclear weapons. That is to say, these
then 15 weeks pregnant in Japan when the bombs fell. Small governments or these nuclear politicians, OF nuclear strategic
skulls (microcephaly) occured in 44 per cent of surviving experts try to 'treat nuclear weapons in much the same way
children and 16 per cent were severely mentally retarded. The as they try to treat and cope with conventional' weaponsfregnancy of stillbirths and post-natal infant deaths rose they try to make nuclear' weapons into ~iable instruments
dramatically.
of a country's foreign policy. Since the uncontrollable dimenThe longer term effects of radiation through delayed fall- sion of nuclear weapons means that the use of nuclear
out affect those not directly affected by the explosion. In weapons for political purposes is not viable (what possible. _
these cases, radioactive isotopes are ingested through con- political purpose can be justified by the use of such
taminated foodstuffs and fluids, by inhalation and occa- weapons?) what has become viable is not the use but the 7 ·
sionally through the skin. Radiation-induced cancers apart .tnreat of its use. This is want is caMed deterrence. Having
from leukaemia (which occurs more quickly) can emerge nuclear weapons becomes a, way of assuring nuclear peace.
after a latent period of 20-25 years. Genetic abnormalities Despite the universal character of nuclear weapons-its
and defects can take a number of generations before emerg- universal effects and the universal honor at its use-this way
ing since gene nutations are recessive.
of assuring nuclear ·peace is not the least universal in
- Even a single bomb of the .kind used on Hiroshima and character or orientation but is strongly nationalist. DeterNagasaki would completely overwhelm medical resources. rence becomes a way in which a nation prevents nuclear war
Quite apart from the psychological.damage or the direct/in- breaking out between itself .and another nation having
· direct effects of the explosion, there would be a great nuclear weapons by intimidating it. Thus the foundation of"' _ ,
deterioration in public health standard with sanitation nuclear peace.is nationalist intimidation and distrust.
facilities wrecked and incapable of coping with sewage
The great importance given to deterrence is ultimately a- ;_c:',
clearance, providing clean drinkirig water and so on. Thus refleciion of the bankruptly of those who have power 1n our
diseases Iike dysentry, infectious hepatitis an salmonellosis societies. Nuclear weapons, as Einstein pointed out, should
would be promoted. There would be diseases of over- andmustleadtoanewwayofthinking,amonghumankiri.d.
crowding, meningococcal meningitis, diptheria and tuber- Instead, very little has changed in the thinking of power elites.
culosis, diseases associated with dirt and vermin such as The best way to have nuclear peace say our tough-minded
typhus and in Indian conditions, even plague; Common in- "realists!' is to· prepare· for a nuclear )Var. W~a,t is more, if
fections like pneumonia and septicaemia would become deterrence is.to be 'credible, the possibility of a nuclear war
killers.
_
at least a retaliation of nuclear attack must als.~be real. Thus;
AU' this would be the effecteof a feyv explosions. The ef- when governments say they do not believe that there can be
feet of a nuclear war issimply unimaginable. The indirect any circumstances which justify the launching a nuclear
effects would be far greater then the direct effects and im- weapons, they are either wilfuHy lying or caught in an in- ---:
possible to calculate. As far as the environmental damage soluble contradiction. If nuclear deterrence for a country's . r e.g to the earth's ozone· layer, leading to worldwide and government is to be meaninful and credible, its wiillingness devastating ecological' damage e.g, freezing of the temperate to launch nuclear weapons must be real in certain
regions, submergence of large land masses under water, circumstances. .
· ·:
ciesti;uction of a lar&e part of the world's agricultuFe, excessive
Dethrence, then; is a justification for the proliferation-6f -:,., .__
ultraviolet radiation as atmospheric protection is nuclear weapons. Thern is both horizontal proliferation ·
eliminated-these are aU pact ,of .)Vhat is now called the (more and more countries becoming nuclear weapons,
"nucl~ar winter" scenario which coul'd become a reality fven powers} and vertical proliferation (the .superpower aFms race
-A
{J
114
Radical Journal of Health
and "the other weapons powers adding to their nuclear
arsenals). Both kinds of-proliferation must be curbed. Such
has been the insane logic of deterrence that both superpowers
in the name of "national security" and "deterring the enemy"
have embarked upon such a fast moving escalator of arms
development and deployment, that both of them have
enoromous "overkill," capacities. The end result of this search
<1
for nuclear security "has been ever greater insecurity vis a
vis each other, and for the world". This is the historical
~'-;balance sheet of all these years of nuclearly arming in order
to keep the nuclear peace.
Finally, with the coming of Gorbachev in the USSR, there
_ seems to be a chance{after three and a half decades ofcom___:y-- plete barrenness) .of the possibility of the superpowers agreeing to a partial' and limited! disarmament in Europe. But if
there is to be an escalating momentum of disarmament then
pu~r:essure and mass mobilisation on issues of disarma-,
mlnt must be maintained. The dangers of a new and more
dangerous escalation of the arms race in space (star wars)
is very much there. There is a vicious circle between the two
superpowers that must be broken by external forces such' as
mass peace movements impinging themselves on the Kremlin
and the White House, The superpowers keep on nuclearly
arming themselves because they don't trust each other; they
- don't, trust each other because they keep on nu clearly arming themselves.
For various reasons, however, the biggest danger of a
nuclear war is not in Europe or the USA or Russia but in
the third world where-a nuclear war between the superpowers
might erupt as a result of an escalating conventional war between allies of both superpowers e.g, in the Korean peninsula between north and south. Incidentally in the demilitarised zone, there are'atornic mines and tactical nuclear
weapons are available to the American-backed forces of
South Korea.
Furthermore, rival: countries with a history of mutual antagonism, such as India and Pakistan could also develop
nuclear arsenals which would greatly add to the terrorism
that already exist. There is already an ever growing lobby
in this country demanding that India go in fer the bomb now
that there is growing evidence of Pakistan having a "bomb
1 in the basement" with the "last wires unconnected", What
this lobby wants other people to forget is that India exploded
its bomb in Pokharan in l974 and very likely has its own
"bombs in the basement" with the "last wires unconnected",
But having some bombs in the basement and openly deploying and progressively expanding one's nuclear weapons
system aretwo different things. It is still possible to step back
from the brink as far as avoiding a regional nuclear arms
race is concerned. There are thus two levels at which the
struggle for disarmament must condnue=the global and the
regional levels, One must endeavour to halt and reverse both
vertical and horizontal proliferation. 111 the case of India and
Pakistan the safest thing to do is not to get into an'arms race
in the first place i e to mutually abstain from going nuclear,
This is what the establishment of a Nuclear Weapons Free
Zone (NWFZ) in South Asia would' mean. Of course, such
a thing is feasible only if both countries want it, whether
for the same or for different reasons. Pakistan has expressed
-----
its willingness to consider such a zone ifJndia would', because
Pakistan equates itself with India and realises that ,the burden
of maintaining "balance" on a constantly escalating regional
nuclear arms race would be much the. greater fot it. Thus
it is in its self-interest and not because of altruistic or "peaceloving'.' reasons that Pakistan is willing to jointly foreclose
the nuclear option.
But India and its bomb Iobby ,is not willing to accept such
an "insulting" equation between itself arrd' Pa\dstan. Thus
it is opposed to such regional steps at denuclearisation preferring to argue that -unless there is a halt to decline in vert_ical
proliferation of nuclear weapons, there ·won't be a halt or
reversal of horizontal proliferation. This Is wrong. Both kinds
of ,disarmament efforts must be pursued and expanded.
Limited and partial efforts at disarmament at one level help
such efforts at the other level. Both India and Pakistan
should forego the nuclear option so that tensions between
the two will never threaten a holocaust ..
What about "nuclear blackmail" then by othersweapons
powers? This is a false question. There are three countries ·
that might practice such blackmail. In the case of VSSR and
USA, the disparity between them and India, even if the latter had a rudimentary weapon system deployed is so great
that there is no adequate nuclear riposte or counter threat
to nuclear "blackmail" by the superpowers. It is not enough
to have a few piddling bombs or missiles. India would have
to have a much more powerful and "credible nuclear deterrent" against th_e superpowers, which it can never have. 'Fhis
is not to say that either the USA or USSR can easily nuclearly
blackmail others. In fact one of the biggest problems with
nuclear weapons is that their unique nature makes it almost
impossible to use them effectively as political' weapons. For
example, how does the USA use its nuclear might to down
Nicaragua and Cuba?
So the only other country from which India might have
to fear "nuclear blackmail" is China, which has never been
tempted to try any such uncertain process. 'fo establish a
"credible deterrent" against China, India would have to embark on a crash programme of nuclear weapons devel'opment
to make up the 15/20 year technological and deployment gap
between the two countries as quickly as possible. Success in
such a,h endeavour is by no means assured. But what can
be assured is that such Indian efforts would greatly perturb
China and make it more willing t9 consider nuclear. action
or the threat of'it against India .. Sucha move-would also
read Pal,dstan to-try and nuclearly "ma'tch" India and thus
enhance the momentum of a regional arms race. There would
be greater interaction distrust and histility and above all,
greater nuclear insecurity for the countries in· the' regien-«
more· .and more insecutiry ,i,n the name of the search for
security. Nuclear security has to be a common security based
on the virtues and strengths of disarmament not armament.
It is the search for ways to disarm that hold the promise of
a safer worlrl not the search ,fOF how tQ use nllcleaF weapons
m the service of,nat1onal real politic. The greatest tragedy
of the, nuclear - era is the contradiction between the
regionalisation/internationalisation of -effects and dangers
of nuclear war and nllclear arms races and J;lie nationalised
1
(Continue<!- on p 134)
March 1987
115
manan ganguli
RAD IATION is dangerous. Exactly how dangerous even
experts are unsure. The more we learn about it, the more we
become aware how greatly the hazard has been underestimated in the gast. Kar l Morgan, a founder of the health
physics profession in the United States, stated, "... there is
no· safe level of exposure and there is no dose of radiation
so low that the risk of a malignancy is zero" in Bulletin of
· There can be emission of a chunk of nuclear matter called
particle which consists of. two neutrons and'two protons and
in so doing the nucleus loses two positive charges .. This. is
radiation.
, "'
. Alternatively, the neutron can spontaneously change into
a proton or vice-versa. In order to conserve electric charge,
a P-particle is.emitted which consists of an electron (if a
Atomic Scientists, September 1978 issue, He further admit- neutron becomes a proton) or its positive analogue, a
ted that earlier theories of radiation effects underestimated positron (if proton becomes a neutron). This is B-radiatfon. _
the dimage now being suffered in human populations,
There can also be r-radiationwhich is a high energy elec- .-;.__~.,_
Until 1934, the safe level of radiation exposures permit- tt'omagnetic radiation similar to x-rays, As we have seen, a
ted to workers in radiation-related occupations was assumed substance containing unstable atoms may emit, B or ~~aby the scientists to be 52 rems per year. With the growth in tion by which the radioactive atoms approach stability9and
understanding of the harmful effects, the level of permissi- the process is referred to as radioactive decay. This is indepinbleradiation dose has continually dropped. In 1934, the safe dent of all physical and chemical circumstances and is
dose forthe workers became 36 rem; and in i950,. a new measured by its physical 'half-life' i e, the time in which one
exposure level of 15 rem per year was recommended by the half of the atoms will decay. The ha.ff-life may be fraction
International Commission on Radiological Protection of a second or it may be millions of years: ·
(ICRP) which in·1957 reduced the exposure limit to the-curThis spontaneous transmutation from a less-stable to a rent level of 5 rein per year for a worker. However a double more stable state releases energy which is used in propelling
standard operates fornuclear workers and for the public- the x.or Bvparticles .. with considerable speed. Being electrically
a maximum of 05 rem per year for any individual member charged, these high speed particles interfere with the elecof the public. And contrary to so much new research that tron clouds of atoms through which they pass and change
has documented the harmful 'effects of current permissible the electrical charge of the atom within a cell by disrupting
exposure levels, ICRP in 1973 has recommended an increase its structure; This is ionisation.
in radiation exposure levels,
y./e cannot sense radiation, it is invisible to the naked eye,
· in this article; I shall explore the nature and effects of we cannot touch, smell or 'taste it. But a chaotic state can
radiation especially low levels of radiation and its relation be induced within a living cell when it is exposed to,fonising
to nuclear technology.
radiation. With the sudden influx of random energy and
ionisation, there may be cellular death or varying degrees
Radiation and Radiohiology·
of damage. This damage can be temporary or permanent:
The delicate but fantastically organised chemical subEverything in the universe is composed of elements-the stances in the biological cells can be subjected to a wide
smaflest particle of an element is an atom. Themajority of variety or types and degrees. of ·injury. Here I shalt oE!ly
these elements are stable, i e, they do not transform into their enumerate some major consequences. 'fhe most catastrophic
·elements. Some atoms are unstable and emit 'particles and result which the human body experiences.In one'generaiion
energy to transfrom into newer elements until they have is probably cancer. 'fl\e ,ceJil: nucleus {its, store of genetic
\.
changed to a stable form.
information) is damaged but the cell' survives and' multiplies
An atom consists of a central nucleus which contains in its -perturbed form over a number of years and forms, a
almost aH the mass of the atoin and which is positively group of cells that eventually appears. as cancer. What hapcharged; and a surrounding cloud 0f planetary electrons of pens between the ixµtial radiation injury and the ultimate apvery little mass which are negatively charged. Normally an pearance of a cancer.Is stiiH a mystery the identification of
atom is electrically neutral and there is an exact balance bet- which is contemporary ioiology's major challenge.
ween the central positive charge and the surrounding negative
Damage
Somatic Cells: Chromosomes of the ceH
charge. The central atomic nucleus consists of two kinds' of nucleus are the targets of ionising radiation. They are conparticles-protons and neutrons-both are very nearly of the sidered to carry all the information to control cellaiar actisame mass but protons have positive electrical charge whereas vities like growth, cell division and production of biologically
neutrons are electrically neutral.
_...
important chemicals like enzymes, hormones. Ceres are the
Between neutrons and protons in. close contact, there are units of infor•mation within the chromosome and are comvery strong forces which are 'capable of binding them together pos.ed of DNA. If ,the ionising radiation displaces one of the
into a stable nucleus. The stability however- depends upon electrons in the chemical bond of DNA or RNA, there will'
rather precise ratio of neutrons to protons. If there are too be alteration of infoimation-carrying chemicat structflre in t'
many or too few neutrons the nucleus wiill be unstable and a single geHe which in t1:1m misdirects the activities withm. ,---:-- ---,...
will. remedy the situation by spontaneously changing tfue a cell. 'There can be abnormal and unregl!lfate'd cell'-division
ratio. This can be done in the foHowing ways.
wfuich wHl prodl!lce cancer or leukaemia.
a
to
a
116
Radical Journal of Health
· Rapidly dividing cells are more vulnerable to radiation
damage. Thus an embryo or foetus suffers most. while
Medical X-rays and Radiotherapy: This diagnostic and
developing in the mother's womb and may be born with con- therapeutic procedure is one of the· artificial sources of
genital malformation. The cell may start producing a slightly garnma:radiation. X-rays emit low level radiation, yet .they
"ditferent hormone or enzyme than it was originally designed . are not any more considered safe. They have been several.
studies which have established the connection between
to produce which 'in turn may prodtce millions of such
, .
altered cells. This can have many adverse effects on the body X-rays and leukaemia, cancer and other health problems.
r•.
such as hastening the aging process, lowering -resistance to
Drs, Irwin Bross and Rosalie Berrell, analvsine X-ray data
~ .,.-, -disease and precipitating psychological stress.
·
of 1:3 million people in three states ID the -USA, have shown
,
Damage to Germ Cells: It has even more far reaching con- that (here is significant genetic damage; large increases in
sequences and may be transmitted to all future generations. · leukaemia and increased ·susceptibility to infectious diseases
as a· result of relatively-low doses of1-adiation.
·
We are probably fortunate if the damge .to the sex
ciiromosomes is such that they fail to fertilise or if fertilised
:Nuclear Weapons and 'Jesi Fa11:out:_ A 15 kiloton
--.J,-,- ·the unborn baby is miscarried. But with the low level ionis- uranium-235 bomb was dropped in Hiroshima in ~st
ing radiation, we are more unfortunate. The health effects
1945 lcilling between 80,000-200,000 people followed by a
upon new generations, carried through mutated genes of
plutonium bomb over :Nagasaki with similar .results, Within
c,,~....-- sex cells, are far more serious and pose a maddening
M~
five years there were increases in leukaemias, cancers and
tureat.
J
•
mutation-induced medical disorders from radio-ac;tive fallGenetic mutatiof!s occur due to natural sources of radiaout. These continued to appear even 22 years,,after the
tion and other known -and unknown causes. They form an
Hiroshima-Nagasaki bombing. Withou_t going into today's
equilibrium of.beneficial and detrimental genes in the human
picture of nuclear weapons, it is worth noting that fall-out ·
genetic pool. Indeed, some mutations may be beneficials,
from test explosions by USA, USSR, France and other counbut the prevailing genetic opinion indicates that any increase
tries has polluted the environment with radio-active materials
in the mutation rate wiU create a great deal of human sufto such an extent that it is comparable to several Hiroshimas
·
fering in new. generations with serious physical and mental ~1, round the globe.
diseases. The detrimental genes if dominant are removed
quickly through early death and if recessive will remain in- Nuclear Industry and Radiation
definitely in the genetic pool affecting generations after
generations untH they gradually disappear.
The nuclear industry is the major source of artificial radiaGeneticists and medical experts are today of the opinion
tion which will be polluting our environment for many
that major serious human diseases like diabetes mellitus,
thousands of years. It is not only the reactor out the whole
atherosclerosjs and associated heart diseases, rheumatoid archain beginning from mining to-fuel fabricationtoreprocessthritis, schizophrenia are genetically determined. They are
ing of spent fuel and· waste disposal that. is tremendol!sly
known now as rnultigene diseases which comprise over 50 . dangerous and there is no.way of keeping the workers and
per cent of all diseases compared"to earlier single-gene rare
the public out ofradiati~ ~P.o~ure.even with the normal
dis~ases like haemophilia; sickle-cell anaemia, cystic fibrosis,
running of the fuel cycle; It.is, worth noting here that there
etc.
is no safe level of raqiation exposure.
. . .
Mining and Milling: The fuel cycl~ begins witli the min'"Sources of Radiation Pollution
ing of uranium. where uranium ore'is extracted from the rock
strata by open cast-or underground method. in this process,
raclium-226 andradioactive·gas, radona222 which are alpha
'l'he,e are several sources of radiation artificial and natural
emitters lln, <elea>e<1. Rado~ ha, very sh0,i half-llve (3,8 days)
In this context, the anatomy ofthe nuelear fuel cycle will and i, e<t,emely iadioaEtive,and when inhaled causes lung
be dealt with to understand this greatest problem of en- cancer. American Indians in USA, bia~k Africans of South
viwnmentaJ pollution. Yet, other sources of ,adiation have Africa./Namlbia, abo,ginal Aust;iilfa ~s; f...;.m in France
to be ennside"'1 with equal seriousness, .
and.weake, Sections in oihei enuhltjes
been affected
Background Radiation: Genetic disorders, .diseases and. most bavfng not ~nly been drivenbff.therr l'a.nd but~;{jso
deaths ea",<ed by natural radiations me no different from • ·havh,g to live near thesedang e<0usiy polluted ffline, aiid by
those caused by artifical radili!tion. It is estimated that 5-10 · . working as miners.
:
.\-
ru,;;,
_
-=
per cent of diseases due to ge_l!etic mutations are by natural
Though the high piobapiljty of;fung'cancei deaths ani1:mg
radiation.
Cosmic rays from outer space and ultra-violet rays. from
',tho sun still penetrate through the p,esent thick owne Jaye, ·
of the atmosphere though it kmuch 1ess than whaf it used'
to be in the past. They are gamma radiation in natui:e. Then;
s9me rock Strata in the earth containiag uranium, radium,
\all'hon-'4, et~ release natu,al radiation and show high ind"denee of health problems hi those a,eas. ·'!'he oonnection between high natural radioactivity of coastal Kerala and higher
incideace of Down's Syndrome in that state is well known.
the tuanium mine,., wa., well
·,ror.:, i/m,g tiR>~. n~
studies ha·d been conducted until -recently. Sa.fen,· SUlntfatds,
and minCi-,·· heaiili have beeQ DegiecteJ;-.ooffl,,..\a tion; w;,.,, ·
denietl IUid el<pem 'im/n. UIS -~c !OSi'.sven iO,tifie;l ,thai
radon gas levels in the uraruµtil;•min~s·were .below a·threshold
level for hiunan health-darr1agef-According to us Public
Se<vire 1978, out .ir ·wo urarliuin 'mine>s bcln,g mooitored
from one-i,raniun>mine •in .NOW MexiUO,,;l; 'luwe
of cancer while stiii·i11 lheir forti~s. and a fu~ther;.20 are~ut:~
fering from ·~ancer. In tlte :report •<:>f the Australi~n Atomic
March 1987
J<noi.n
"""'ii§ ~-
Energy Commission, 1975, the incidence of leukaemia/ a microscope, can cause cancer ofthe lung ff inhaled. Apart
cancer among white Australian miners has been found ro be from causing cancer, it is concentrated by the testicles and
six times the expected norm.
ovaries where it will inevitably cause genetic mutations which
With the tragic consequences of radon gas and after many will be passed on to future generations. Yet each.operating
unnecessary miner deaths from Jung cancer, only in 1967 were nuclear reactor produces between 400 and 600, pounds of
safety standards and improved ventilation of the mines in- plutonium each year in its normal operations .. Strontium 90
traduced in US mines. Yet the uranium mining standards are chemically resembles calcium and is absorbed by bones and
not and cannot be sufficiently protective of the miner's causes bone cancer and leukaemia, Dodine-131 concentrates
health.
in the thyroid gland to cause thyroid cancer.
In the process of milling, i e, crushing the ore finely to
Tfiere have been several studies by the radiation research
extract uranium, radon gas is again released affecting the scientists and medical experts to evaluate the hazards of
,.
health 9f the workers. Milling results in vast quantities of radiation at the workplace. Perhaps the most extensive study
radioactive waste/products-tailings-dumped beside the yet undertaken was that of Thomas Mancuso .of the Univermills without sufficient care. Air, surface water and the sity of Pittsburg at the Hanford Atomic Works in USA. Thts:-, z:
groundwater are contaminated by the radon gas, radioactive stuqy was independently analysed and assessed by Alice (_.__..,...
particles and some highly poisonous heavy metals like mer- Stewart and her assistant George Nkeale, a-mathematician.
c_ury, lead, arsenic in the tailings. Ironically, in Colorado, they Stewart, a medical expert from Birmingham, had-first
-were once. used, as landfill or building materials for homes, documented the health effects of low level radiafioffe"Jr
schools, roads, hospitals and an airport .. We;have very little. medical X-rays on the human foetus. Mancuso-Stew~knowledge about the state ofour uranium mine at Jadugoda, Nkeale study evaluated astonishing results of cancer and
Bihar.. Proper. epidemiological study and health monitoring other radiation related hazards of Hanford workers; .and US
of the . Jninipg-community by a: team of medical experts, authorities terminated Mancuso's funding for follow-up·
biologists an geneticists is of utmost importance.
study and there were·even attempts to confiscate his Hanford
Enrichment and Fuel Fabrication: For the fuel of light ·data. Mancuso concluded that the dose required to double ·
water reactor (like Turapur plant), uranium ore has to be a person's risk of cancer is less thati half the internationally
enriched to increase the content of uranium-235 by approx- accepted limit .(33. 7 rad against nuclear industry's estimate
'imately 3 per cent. The process is complex, expensive and · of500 rdiJ.exposure). Unfortunately, all these studies are yet
uses enormous amounts of energy, There is routine releases to make an impact on the industrial' and military nuclear
of radioactivity to the environment; nonetheless, solid liquid world.
.•:
and gaseous wastes are· created in huge quantity. Increases
Reprocessing: in reprocessing, 'spent fuelrods ar.e broken
in Ieukaemia rates have been reported in the communities open and outer cladding is dissolved in nitric acid to separate
around the enrichment plants. We'll discuss the problem of plutonium and unspenfuranium. The plutonium is separated'
nuclear waste separately.
out for use in nuclear weapons or· for fuelin a breeder reacOnce uranium has been sufficiently enriched, it is sent to tor. The process is extremely hazardous and apart from the
a fabrication plant where enriched uranium is assembled into release of highly radioactive gaseous and liquid· effluents,
i fuel rods for reactor. During the fabrication, tltere is routine
releases routinely nitrous oxide to the air causing acid rain.
release of radioactivity affecting workers and to the at- There is severe occupational threat to health in reprocessing
mosphere permitted .as 'acceptabletlimit.
facilities and also serious environmental threat due to proNuclear Reactors: A tremendous amount of heat is duction of highly toxic radioactive waste.
. .'-~--.,JI,
generated from the fission of fuel 'rods and this in tum
Reprocessing has -more or less been abandoned in US'. -.. .:l
generates, electricity from a steam turbine as m a conventional Commercial reprocessing plants there have been shut down ;_~
power station. Nuclear reactors are thus a very complicated for years due to faulty technique and excessive contaminaand expensive means of boiling water. Apart from the serious tion. The large reprocessing plants in operation in UK (Win.de
radiation pollution, there is thermal pollution and damage scale) and France are no exception regarding radiation canto ecological-balance as two-thirds of the heat is discarded tamination and risk to the workers despite claims by the
into the environment. A range of radioactive elements is pro- authorities of safe running. Besides, the Irish Sea and the
duced of which only few· like -iodine-131, cesiumal37, surrounding environinenr have been heavily contaminated
strontium-90, plutonium-239, are considered iii"' the because of routine -dµmping of waste produced at these
discussions.
plants. The actual situation at the .reprocessing plant at
Reactors are constructed with mqltiple barriers in order Tarapur is·riot known; it is said that the.plant is inoperative
,to keep ,the radioactive release as low as possible and within due to contamination.
the containment building. ·Yet with the stress of heat and
Waste: As we have seen, nuclear fl:lel cycle generates vast
p~essure, . ·splits and holes ,occuF allowing radioactivity to quantities of radioactive waste at all' stages. They nave been
escape. 1n addition to occasional serious accidents, there is divided into three categories-high, intermediate and low
routine release -of vast quantity •of radioactive waste from levelj by the concerned international and national authorities.
the nuclear reactors. Of the radioactive elements produced Low· level wastes are :considered as a low hazard ·potential.,
in a nuclear reactor, plutonium·is the most toxic with a long Referring to earlier discussion, it appears that a 50 per cent~ ......
half-life of .24,000 years. ·Single particles. weighing one- increase in genetic disorder and diseases are considered by
.millionth ·of a gram, so smallthat.~hey can:6nly be seen under
(Continued on p 123)
0
,_
\
Radical Journal of Health
118
...... ~ ...
.,
i
)
,
dave rosenfeld
of harm from nuclear power, or from coal when applied to
coal. ·The calculatiorr of risk figures use disciplined methods
and are arguably worked through with ~ degree of scientific
rigor often lacking in safety analyses. Yet the actual notion
of risk, defined as 'probability of harm', has so far gone unchallenged. And it is precisely this notion, when it is analysed, that turns out to be the vehicle of prevailing prejudices
about technology.
·
Hidden meanings can be seen once we ask why 'risks!,_
seen frpm presentations of tables of deaths, in say coal,
nuclear" or other industries-always· seem s9 fixed. Tl}.ese
industry, or
THE.<i@uments for nuclear safety have become familiar: figures, we are told, represent the risk of
rather,
it
is
implied-and
this
is.
the
crucial
unspoken
step'The ~Qm a radiation does of 1 rem is the same as the
risk of being obliged to smoke 1120th of a cigarette every the hazards· due to the technology alone. Th\is the 'risk'-of
Sunday', claims Walter Marshall, chief of the Central Elec- nuclear power is l death in. a million people per year. When
tricity Generating Board (Atom October 1982). Independent risk analysts look at . average accident . rates over . decade
studies conclude that nuclear electricity in the whole fuel periods and claim that, on current improvements since 1940
cycle gives fewer deaths per unit of electricity than does coal in the coal industry, mining deaths will be down to 0:3 per·
(see Table in. Appendix). The argument appears absurdly 10,000 per year by 2000, it reinforces the inevitability and
risk, It is simply the 'risk of a technosimple, yet anti-nuclear objectors get locked into a debate asocial character
on the exact lever of risk from reactors, reprocessing plant, logy'. We can only wait.for the technology to b~ccime.safer.
· this kind offatalisirl is reinforced by ·a risk analysis·t1tit
transport bottles, dumped nuclear cargoes and nuclear
excludes
the social relations of haiards and so :makes }iftc
disposal sites. Hiring experts to challenge the well-funded
into
thing,
as an inherent, technical property of a particular
orthodoxyis expensive. Counter-experts are marginalised
technology.
'This
definition of the problem' serves to· relegate
from the 'scientific community' and are denied even minor
'decision-making'
to elites acting on behalf. of potential
funding. Some, like Professor Sternglass, have been crudely
victims.
In
particular
it uses 'risk reduction; to "justify· supattackedas 'fearmongers'. Some scientists find themselves
planting
older
skilled
teclinologies w.ith supposedly '•safed
moderating the objectors' 'overreaction' as they see the risk
as numerically low, even if it is really at double or treble the ones (coal VS nuclear), OF adding on extra 'safety devices to
industry's risk figures. For the anti-nuclear side the debate dubiousdesigns for nuclear-technologies (British-style PWR
for Sizewell).
.
is demoralising and endless,
The
prevalence
of
risk
analysis
(or
'risk
determination'
as.
But there is· more at stake than simply challenging the true
numbers bf deaths due to each technology. The yery idea they call it these days) in the Great Nuclear Debate raises
__ .
of quantitative 'risk' contains hidden assumptions that in- some important issues for the politics of science: Its use is
- ~ fluence not only the style and outcome of the debate, but based on the idea that risk is due to atechnology and
;-_~also. 'the -detailed choice or technology by industry's measurable ~s probable deaths per' year. Thi~ idea ·rests on
managers, This article will draw out some hidden assump- several definite assumptions, rarely spelled out: 'risks' are
. tions and challenge them. I end by showing that this is not in technology, asocial, randomly striking and quantifiable.
merely word-play, as the analysis gives useful perspectives Once having analysed these assumptions we will see the
for· a number of radical science issues, not least nuclear dangers of being led to-tilt at technology, and of acutally
inviting greater managerial control of work via-the-choice
safety.
·
of the 'least risky' technology.
.
What is This 'Risk'!?
The assumptions that lie behind risk as the 'probability ·
.
·
Risk determination is used by the nuclear industry in an of harm' are as follows:
(l)The calculated risk is due to the technology alone (in
its safety cases· to marshall safety information, from a
number .of disciplines, ,into figures of expected deaths, the sense of 'hardware'). Thus the risk figure is applicable
accidents or •disease· per .reactor, per disposal site, per -unit with,the same.technology to Britain and Brazil.jo 198Jand
·
-... of. electricity,, etc, For the initial breakdown of equipmeBt, 2003, to managers and workers.
(2) Jfe are 'exposed" to risks .that: strike from within the
.,,
elaborate engineering models: ('fault trees' aBd 'event trees')
are used in what's ca11e.d 'probabili:stic risk analysis'. FOF.the technology; the probability of harm is 'the probability of
'.:ipread of contamination, environmental modelling js used'.. being hit.
(3) The risk is randomly striking.; For the use. of
.,,.__-.:::, ?'..;.For the effects· <?f radiation on the exposed workers and
·
·
··
resiqents, to~ico\ogica:l models ,{of 'dose-response') are used. probabilitv:
aj rue specific hazardous encounter with technology is
It is not claimed that the -models yield causal predictions ..
identical every time. .
~ther they_give a figui:e of risk that is said to give the chance
In order to ensure a specially high degree of safety, the
job was·so highly compartmentalised. that those in different
. /''1 departments often· could not or were not allowed to com~.;,!:, municate with each other.
-- =-Robert Jungk, on the Cap de la Hague reprocessing plant,
in The Nuclear State
·
. It would be possible to write a history of the inventions
made.since 1830 for the sole purpose of supplying capital
~h the weapons against the revolt of the working class.
- Karl Marx, Capital, Vol 1.
an
of
I
l
a
March 1987
119
sound odd ,to the skilled craft worker. The ordinary risk of
a
cut finger is not random to ,the wood worker since it arises
with harm as the 'outcome' in · a few cases, entirely at
at
well-defined times when care can, be taken to avoid it. It
random.
c) This randomness gives rise to the fluctuations around is the term 'skilled' that we associate with remedial actions
an average number of .people struck per year, as a hand being on • a human scale, where the 'exposed/at risk'
might draw differing numbers of peas from a black bag, categories would misrepresent that control.
In the case of collective control, information on workplace
but always approximately a handful. It is the average
organisation can transform the nature of risk. For example,
number of deaths that is measured by probability.
(4) The quantifying of risks makes all activities come ask a worker at the Windscale nuclear fuel reprocessing plant
parable. The essential part of this 'risk' is its numerical level. to repair pipework in a high-radiation area unfamiliar to him.
Once that is known, the essence of the risk is grasped. Other- Even if there are only a couple of lethal 'hotspots' where
wise incomparable activities can then be compared by rank- doses are high, thewhole area appears hazardous. To him
(women are not employed in high-radiation zones) a-.wllJ.!c
ing them on a scale.
'
'
-The current use of risk analysis, then, leads us to a par- in a straight line is like crossing the road blindfold. As t.ne- ticular view of the structure of hazards-risks are asocial, nianagement gives him a chart of hotspots and· a pocket·
they are external, they strike randomly. If the construct of alarm meter, he feels sureto avoid deadly spots, confidently
the risk analysts is to be believed then we are surrounded and consistently-as long as experience tells him.;,.~ •.,,-.;;e
by randomly-hitting techno death-threats. Is it some kind of management or union safety committe have assuredthe~art
macabre prediction when we are given the retort, 'Well, meter are reliable.
In this example, ,if two areas had the same death rate, it
everything has a risk?, Is it a wonder that analystg speak of
would
be preferable to work in an area A (most _of which
people as being.risk-averse?
had lethal hotspots but where you're given accurate, trusted
Safety Science Is Dangerous
information) than in an area B (with very few lethal areas
How valid is this description of hazards given by risk- but no clue where they are), If some workers have died in
analysis? We shall look at its assumption. Some are easily areas A from carelessness, it seems less of a problem to
negotiate than if the same number died in area B from a
debunked. while others are more subtle.
(1) Is risk due to technology alone? For workers from a withering beam by bad luck. The randomness of the risk
workforce to die year in, year out, in similar numbers, they depends on workplace relations. So at one level there· are ~
.....
must be born, fed, clothed, transported to work, trained, indeed randomly striking hazards e g, cancer risks from ,.7~
ordered, paid, put in hazardous situations, kept healthy or radiation, viruses, chemicals. At another level hazards are
replaced. Inshort such statistics require that the whole system subject to detailed control, so that harm is due to bad design,
that gives rise to the hazard is reproduced. Mortality and bad procedures, poor training, poor information or
morbidity figures for industries, then, do not simply measure carelessness, e g, woodcrafting and Wbrk in 'hot' radiation
some 'technological risk'. .Rather, they measure the overall areas.
social reproduction of'industrialharm. That is, they measure
(4) Quantification adds n~ further assumption that is not
social. and economic forces that bring people into contact already made in the earlier points. However, the acceptance
with hazards as much as they indicate any intrinsic hazard of such numbers as 'inherently.comparable serves to hide the
of working with the hardware. Accepting the false assump- assumptions that we've identified,
tion leads to a false strategy. Attacking technology-as the
By assuming that all hazards are randomly probabillstic,
cause of the intolerable hazard will only solve hair the risk analysis treats people as passive objects of technological
problem=you must attack the forces bringing the technology hazards: individual and collective consciousness are ignored.
intc being, OF else a substitute fer the same purpose will be The immediate consequence is that, in general, . strategies to
reduce 'risk' evade the issue of control over safety instead
found.
(2) Is r:isk:a thing that 'exposes' andstrikesusfromwithin encouraging a 'lower risk' technology that isalienatedfrom
techn_ology? Do risksalways strike at random? These ques- worker and community control. The problem is not too little
tions.are linked by the idea of an alien threat hitting in an management attention to safety analysis, but too much. T~e.
unknowable way from outside our experience. Are hazards quantitative comparison of different risks encourages
in essence randomly striking alienated threats". The answer deference to the intrinsic 'risk of a technology' and ,thus to
is not straightforward: yes or no. At one level, some hazards management control over safety.
do strike randomly. For example pipe breaks in complex
Historical Origins of 'Acceptable Risks'
plants carrying toxic materials are due to metal fatigue or
How
does 'safety' get reduced tn a technical'choice among
mechanical failure that- is basically a random process.
different
technologies or different devices within . a
Likewise the effects of exposure to agents like radiation,
viruses, invisible asbestos fibres occur in individuals itr a way technology? This is done SQ compellingly by risk analysis
by quantifying risk as the probability of harm, yet' while .:.
which is governed -~y random biophysical events.
However, the assumption is false at another level-that hiding the assumptions involved-The !nuclear is saferthan ,
is, at the level of individual- or collective control over a coal' argument, then, involves more problems that the simple; · ' hazard. Take the case of detailed control by operators over hopeful predictions about nuclear accidents arid health' ·
a task. To speak of the 'exposure' to the risk of cutting your damage from radioactivity. More insidious than-that, the"
own finger with a chisel (assuming the blade is perfect) would whole framework treats the harm from each industry as
.b ) The risk exists in every encounter, but it only strikes
--
.
Radical Journal ofiHealtl:
120
....
. ~.
technical; fixed, whHe at the same time pretending not to
make value-judgements. Ironically, this type of risk-analysis namely a socio-psychological study of why people's reactions
arose from an historic admission of 'no safe level'. Let us do not correspond' to the objective reve] or risk.
This whole view, originating in the nuclear and' aerospace
see how.
1966 was a turning point for risk analysis. The Inter- industries, was seen as the proper way forscientlsrs to set
national Commission on Radiological Protection (a self- about dertying adjudicating on 'acceptable risk'. And', so it
appointing, non-governmental body) accepted that radiation appears, scientists could vqhmtarily abdicate the politicallymay have no safe level of exposure for cancers and genetic laden role of reassuring on safety (if ohly they would'!),.and
defects. Secondly, in that same year a fast-breeder reactor could instead retire to the rigorous and objective world of
near Detroit burst a fuel pin and partially melted down, toxicology and safety engineering methods in the new science
thereby exceeding its official 'Maximum Credible Accident'. of risk-analysis. Appealing though this scheme is, however,
The safety engineers quickly realised that automatic safety ·it has been openly admitted that risk analysis Is not entirely
' .sevkes can and do fail, so that there is no accident that could objective, And this admission has jeopardised the credibility
----1,e made strictly impossible by engineering safety features. of 'rational' decision-making and socio-psychological studies
ofl"people's. irrationality toward risk.
So by 1967, both in toxicology and in engineering, it could
For example, ~n developing measures of the risk of a~
no longer be assumed that risks had a 'safe level' that could
industry, risk analysis has used various ways of combining
be fa~,J scientifically.
S~e acknowledgement that some hazards have no the incidence of different accidents ;md diseases into index
safety level, new theories of how to predict risks from drugs, that would measure the total amount of harm. However the
rays, bugs, chemicals machines and industries have arisen conclusion became inescapable that, where these grand
together with social theories of how to resolve conflicts over indices were used, risk analysis was making moral judgesafety.. One model, popularised by W W Lowrence in 1976, ments. For example, if we simply add days. of worklost from
particU'larly captured the minds of researchers. It appeals to different diseases per year, we make judgement about the
the administrator role of professionals in the scientific/ relative amount of harm from physical versus mental suffering, suffering long versus dying early, frequent isolated
industrial/managerial world. In this view:
deaths versus infrequent mass-killings.
i) Everything has a risk-most agents, technologies,
To avoid making such ofwiously moral judgements, pracoccupations, leisure- The magnitude of this is a technical
titioners decided not to aggregate diferent forms of.harm,
judgement for scientists.
The disciplines of safety engineering and toxicology can
ii} Scientists should rightly avoid statements that
,
something is 'acceptably safe; which amounts to a political systematically analyse faiiure rates of machines and arrive
at does-response curves for toxins .. Mathematical formulae
r
judgement.
then
come out with: probabHity of harm per year for each
The view is articulated as follows. No, longer can scientists simply show that risks are non-existent and then reassure type of injury or disease separately. It is these welt-defined
· f~·.
the union, the patient, the plaintiff or the tenants associa- methods, usable by anyone, together with the experimental
. tion. As risks always exist on a ·numerical scale, a safety data and industrial accident data, that supposedly make risk
11
standard' represents some level of hazard. So someone analysis figures objective. f.t is only by a detailed look at the
(society, not the scientist) must either ban the technology or definitions of risk (as in the 'l!revious section) that we were
set an acceptable level of hazard, given the benefits of the able to get to grips with this last formulation and understand
"' ~- technology. in effect scientists purport to present simply the precisely how risk analysis is vanie-laden,
f..
~ facts and then allow others to set 'acceptable risks' within
Practical Consequences
,\hat rigged framework.
Risk analysis lies at the heart of the prevailing idea of•
Faced with a new technology, or afiewly contested one,
acceptably
risky technologies. Debunking it (j,) is usefur in
scientists must now find the objective ·level of risk from a
generai
-radical
science perspectives, (ii) informs some
· whole range of exposures. A new science, risk analysis, was
perplexlng
questions
for anti-nuclear campaigns, (iii) opens
painstakingly developed, supposedly to give a predicted
up
an,
approach
for
opposing
safety analyses that use probsliding scale of risks from different levels of technology. This
ability
and
(iv)
faciiiltates
intervention
in the 'risk debate;
scale was to be input to decision-making, where conflicts are
Firstly, we have-worked through an example of how science
resolved by choosing to expose people to a 'level of risk which
is outweighed by the benefits from the risky technology. The clearly acts as ideology. The scientific.content:-here the very
t
decision-making could operate 'rationallyt_that is, by using definition of 'risk!_is the vehicle of the manager's. right ,to
economic arithmetic to spend the limited safety and health dominate workers' activities. New questfons.·arise: Should
socialists abandon entirely the elaborate and' rigorous
.J . .:. resources in proportion to the level of risk.
methods
of ,engineering risk analysis? ls there a socialist
,
__ :- ·However, decision-making will ~e bedevilled by the need
science
of
risk? Will the simple expedient of stating the sociaf
to make expedient decisions because, so the model goes, the
level of risk people tolerate and the vigor of opponents to relations of (quantified) risk overcome the objection?
Secondly, we can see how the dominant manageriaf defini}i_sky projects is not in proportion the 'objective risk', as
tion
of nuclear safety fits well into the wider nuclear project.
.;r-____::p- ascertained by risk analysis. People (not the numbers) must
;
be wrong, ignorant, vindictive or irrational. Decision-makers Although nuclear energy will not deliver any net energy until
after the turn of the century-due to a net consumption
therefore need a second input, apart from risk analysis,
during the construction part of the programme-it could
an
J
~r.·:
l
March 1987
. dissecting a key scientific concept, quaudtative 'risk'.
Lastly, radical research on safety is given a new focus .by
nothing at times when transport workers or miners block the this analysis. Wf!ve discovered that the key debate is not
generate 300Jo of electricity by 2000. That is much more than
remainder.
... a nuclear programme would have the advantage of removing a
substantial proportion of electricity production from the dangers of
disruption by industrial action by coal miners or transport workers.
-leaked minutes of Thatcher's Cabinet Sub-Committee on Economic
Strategy, October 23, 1979 (originally published in Time ou·t)
Low-Level Radiat~on--;-Out of Control
Workers at Windscale experienci; by and large, a com- 1 :<..
prehensive programme for avoiding the 'hot-spots'.
~ •"::J:t:;:- !
Nuclear safety systems
This
programme
has
engendered
a
basic
confidence
..:....req1:1ire often intense workplace discipline, e g, the
that risks are under control. At the plant;-workers are
restrtcnocs on internal communication at Cap de' la
understandably quite defensive when 'outsiders' allege
Hague; ·
~hat :he~r wor_k is dan~erous, as they find memselves-c,
-reguire no~strike agreements to.achieve their assumed
1cfent1fymg with managemen_t on the safety issue.
,_· ' ··,
· performance; and
·
This
attitude
affects
relations
over
the
low-level
ex-rely on highly qualified scientists whose work and
posures. With low-level radiation, in contrast to the
attitude~ are highly integrated into management
h:igh-level situation, there is no alternative to.~hperspectives.
.
sically random. untouchable, unknowable hazar~u
Risk analysis, portraying risk as a neutral quantitative
do not even know whether you have been affected unmatter, paves the way for work organised under nuclear
til twenty or so years after the event. Routine, random
managers' discipline, even blackmail, all in the name of more
low-level exposure is tolerated in the knowledge that
safety. ls it not preferable to·back-coal, where a knowledge
the chance of harm per person is very remote.
and control of the system by workers· give ·higher chances
But this 'knowledgf! is chimerical and entirely different
~f winning a better safety deal than with the polutonium
from daily witnessing a competent hot-spot manage-.
state? What guarantee is there that current nuclear safety
ment operation. For low-level work, badges are issued
standards will not be eroded when the Tory government has
and exposures tallied, but the knowledge of the hazard
further cowed workers and other opponents with nukes?
is available only from scientific studies. BNFCs interAlready Reagan has been declaring the nuclear industry to
pretation of the studies is accepted- This acceptance
be 'over.:regulated', and promising side-steps to licencing
might he seen as a spin-off from the confidence won
hearings.'
from their track.record in hot areas, their vindication
As scientists are involved in designing and assessing
by 'independent' Government bodies and their success
technologies, they should be aware that "their work influences
in dealing with scientific challenges in the press and
the relations of control. When people reject 'dread hazards',
at inquiries. As BNFL win this confidence game, the
this is not simply a matter of their ignorance of 'the true
scale of low-level radiation risk remains uncontested
risks', but a sign also that no trust has been built between
as a workplace issue. (What has been contentious is
people facing hazards and those in control. Sometimes
the administrative practice of 'burning out', or expos"distrust comes from consistently negative experiences, as
ing unruly workers to the yearly maximum allowed
many shop stewards in industry will testify. But in other cases
radiation, thus disqualifying them from.further work
it is a sign that there is no consistent experience that people
in the year-but this is not directly linked to the 'ran..... ~. ·rl"'C;._
can· rely on. In short, there. is a gulf between people's
domness' issue.)
..'=-"-... j~ '
experience of techno_logical change and scientists mostly
This historical aquiescence by most workers, on the
aligned to managerial priorities, as defined especially by risk
lower-level
~posures, should not distract from the very ,
analysis. It is this class nature~f scientists role, and not some
different relations of. control. With high-level exfundamental irrationality of people, that generates hostility
posures, concern is highlighted when for example a
to new hazards.
.
direct injury qccurs, with visible effects within hours
· Thirdly, is it possible to challenge nuclear science as
o~ days. The response is obvious: press for. effective
science;;? ·The technical literature clearly paints the picture of
measures to prevnt any repetition, with whatever musa systeffiatic safety programme that's the envy of chemical
cle you have. With low-level exposures, your concern
safety campaigns. Time and again the literature asks whether
over getting a cancer or deformed kids is heightened
this effort is 'enough'. It seems a logical definition of the
only _by claims that the old risk-estimates are wrong,
problem. Yet once we are in the thick of the numbers game,
that it's more dangerous now. Workers don't control
it is hard to challenge the expensive and extensive studies that
science; the pronouncement could appear to come out
show nuclear power as 'relatively safe' or 'about as· safe as
of the blue unless you have reliable information from
coal'. Most critics stick to the general issues of the politics
scientific allies. And you have already been exposed;
of plutonium, rather than wade through the swamp of reyou cannot change that fact. Without those scientific
actor science, radioecology and radiotoxicology. There has
allies with a proven track record, the choice is between
been no an'alysis that criticises nuclear science as a starting
management's reassurance and abject worry. Thus the ""' · - point for identifyingthe,problem. Our analysis removes·this
class role of scientists is crucial. ·
quandary. By analysing the precise use of probabilistic risk,
we can argue specifically on the science of safety and win!
That is, we can expose the class base of the technology by
1
\
Radical Journal of Health
122
-~}
··
,-
about the level of risk from Sizewell B's proposed PWR. The
numbers used in risk analysis talk only about the hardware
failing. When operators are mentioned, the chance of
'operator error' is used.entirely ~s if operatorswere hardware, albeit defective. At nuclear plants we must expect that
the real failure rates will be dependent on the social system
that organises it:
· Real responses of thinking, waged operators
·
benefits.
In conclusion: Beware the 'low-risk' technology of safety
science, which serves to usurp control over hazards and thus
guarantee management's safety from workers. The important
safety question facing workers and communities is not some
precise, numerical level of safety. Rather ,it is how we can
gain detailed control over deciding which risks we take, so
that we are confident, at aH times, they're worth the benefit.
How do we transform alien hazards?
.
-Workers may be on strike in a minor accident
sequence.
-Management commitment to a training programme may
[Reprinted from Sd,·n<'t' Hadical' Journal 1989.]
lapse;
-Complex but. infrequent modes of failure may happen
___:y/_,. in too short a time for anyone to cope.
(Continued from p 118)
Smoothly running quality assurance programme
-Subcontractors may falsity quality inspections (and have th~ international atomic energy authorities as a small hazard.
· · Safe management of radioactive waste is an unanswerable
,Aane so). '
problem of the age because toxic products are not only highly
S~hly running maintenance programmes
~Non-unionised temporary maintenance workers may lethal but remain radioactive for several million years. The
more we go nuclear. the more we are adding to the problem
rebel against 'burning out' practices.
of survival of our future generations.
Effective inspection programmes ·
There·have been some romantic suggestions disposing of
-Inspectors close to the industry may be lax, believing
risks low. (Hendrie, chief US regulator, was sacked after toxic waste from the earth by rocket into space or deep burial
under the Antaractic ice but no adequate solution has yet
Harrisburg.)
been devised. Uptil now only high level radioactive wastes
':fhe techbology'
-Like each car, each reactor has its own unique history are stored in carbon or steel-concrete tanks whichlast 30-50
years; and low and intermediate level wastes are either
of construction and maintenance.
·
-When politicians like Reagan (or an 'over-regulated' dumped into the sea or buried underground in concrete silos.
_,
industry) change standards, the PWRs built and main- Proposals bave been made to solidify the highly toxic waste
in glass blocks to be stored in shafts driitled in the seabed
tained may be different.
·
in non-nuclear safety there is an increasing tendency to follow or under hard rock.
the assessment .methods developed in the nuclear energy · _AH the attempts and plans are far .from reaching any real
debate. In fire safety, asbestos control and chemical plant solution. There have been leaks from the storage sites consafety we see use· of 'cost-benefit analysis', 'reasonably prac- taminating the surface and ground water and the atmosphere
ticable reductions', 'engineering risk assessments'These all and causing serious health hazards. We know very little about
rest on the idea of balancing costs of reducing 'the risk' India's waste management programme,
. The operation of. a nuclear reactor generates astronomical
against supposed benefit of using the technology.
There are many obvious questions to raise about these quantities of radioactive waste of different types and of varyschemes: Who benefits from the product? How do you ing half-lifes ranging from a few seconds to a few thousand
--.. i;. measure the. cost of life? Our approach goes further by years. The amount of radioactivity produced from these
· -'\_ challenging the scientific definition of 'the risks'. that were elements is in direct proportion to the operation of the reac- measured in the first place and that were assumed to exist tors. Even. after Chernobyl which has put a big question mark
in the technology as a thing, not as an organising system. on the future of nuclear power, India's nuclear policy is unThrough our approach, the question of control over the risk changed. We have an optimistic plan of 10,000 MW eleccan be made central. to the debate even before monetary costs tricity from nuclear plants by 2000 AD! H ,is estimated that
are raised. Indeed, ··the particular social construction of one year's operation of a 1000 MW nuclear plant generates
nuclear risks turns out to be less a cost than itself a benefit fission products equal to that of a 23 megaton fission bomb;
that is more "than 1,000 bombs of. the Hiroshima size.
to nuclear management.
Safe, permanent and absolute isolation of these radioactive
The numbers game has often led environmentalists and ·
hazards campaigners into a blind alley of demanding 'zero poisons from the -environment is th~ only condition for
riskt=an idealistic and unrealistic fecus, This quandary nuclear power to be acceptable. An!± thi.s is simply not
points to the real difficulties with either rejecting or accep- realistic. There is no disagreement today about how much
ting a (supposedly apolitical) 'balance' between health 'costs' .radioactive poison is produced by the nuclear power plants.
versus industrial 'benefits'. That kind of choice usually con- There is little or no disagreement about how lethal these
fronts us as utterly compelling, universal rational. For ex- poisons are. '.Fhedisagreement lies in the quality and quan"; ample, could socialist societies delay reconstruction pro- tity of routine release of radioactive elements during all steps
~·-"':' grammes until alt industry is conclusively proven 'safe'? Our of the nuclear fuel cycle. WHl the nuclear advocates give a
approach offers a way out of the quandary: while defending satisfactory answer to this? No, they cannot and wilt not.
the primacy of health, we can assert the issue of control as The only answer is:
·STOP NUCLEA~ POWER
central to any 'acceptability'. of hazards in. the name of wider
March 1987
123
The Numbers Game
Occupational Health Hazards at Indian Rare Earths Plant.
v t padrnanabhan
The Department of Atomic Energy is currently pushing forward its ambitious plan involving a ten-fold expansion·
of nuclear power generation by the year 2000. This would involve the setting up of a number of nuclear establishments
and would expose a number of people, workers and neighbouring communities to varying degrees of excess radiation.
The Indian Rare Earths is the only DAE venture which has completed 30 years of operation, which incidentally is the
average latency for cancer which is just one of the health hazards of exposure to radiation.
This paper (condensed from the Economic and Political We!;!kly, March 8-15, 1986) reports a retrospective epidemiological
study of workers a1 the Rare. Earths Division of the Indian RareEarths Limited, Alwaye in Kerala. The studyexamines -.,,,_ -.
;the mortality profiles of workers for the last 15 years. Workers at 'the nearby Iravancore Cochin. Chemicals and those
_...,
insured with the Employees State Insurance Corporation are t~ken as the control populations, The study demonstrates
a, significant difference in the incidence of cancer .and mortality due to heart diseases and all causes between the I~
workers and the control populations. The incidence of sterility among the IRE workersand genetic disorders am~~their children also appear to be-high. However, a study of this sort canonly formulate a clinical hypothesis. There IS-·
an urgent need to institute a comprehensive, inter-disciplinary study ofthe plant and the workers. Such a study cannot
'unfortunately be conducted by independent workers or research centres because the Atomic Energy Act of 1962 pro-.
hibits any such inquiry into the affairs, including health and safety issues, of the DAE.
AN Occupational Health (OH) study involves the use of ground in the ball mill to 400 mesh size after which a suction
multidisciplinary techniques of medicine, environmental science, pump pulls oat' fine d!ust through a filter and deposits. it in a
social science and law. To be complete, the study should focus bin. Dust is then mixed with dilute caustic soda (lye). The soluon the health status of workers, quantify the poI!ution load in tion is then pumped into the attack tank where caustic soda
the work environment and study the health and safety apparatus . (flakesj.is added. The solution is then moved to arelay tank and
available including the internal safety organisation and compen- leached with water. The first product oftheprocess-:-"Trisodium
sation structure, etc.
Phosphate (TSP)-a .general purpose detergent-is decanted
In this paper, an attempt is made to study the health status here.
of workers of Rare Earths (RE) Division of the Indian Rare
The remaining slurry containng hydroxides of rare earths,
Earths Limited (IRE) Udyogamandal, Emakulam, Kerala, IRE, thorium, uranium, mesothorium and lead is pumped into a set
an undertaking of the Department of Atomic Energy (DAE), of 'More Filters' where it undergoes filtration and washing.
is engaged in the processing of monazite sand found in abun- Traces of phosphate are removed and slurry is p~ped into four
dance in Kerala and Tamil Nadu coasts. The plant under study extraction tanks where concentrated' hydrochloric acid is added.
has a processing capacity of 4,000tons of monazite a year. The At !his stage, the RE fraction of the compound becomes RE
main products of IRE are thorium, .rare earths {RE) chloride chloride which is drained out and pumped into a deactivation
and zirconium. Thorium is at present used in the production tank in which barium chloride and sodium sulphate are added.
of gas mantles. The metal, which derives its name from Thor- beactivation involves separation· of radioactive el'ements like
the Scandinavian war go_d-,.yQ_l\ld: be used as fuel in breeder uranium, .thorium and their 'daughters'. These as well as lead
reactor which is still in research stage,_ Z~rconium isused for clad- ?re then allowed to precipitate in the tank. The precipitate is
ding. of uranium fuel. pellets for atomic reactors, The other im- mechanically separated through press filters. The cleat·solution
portant product;-RE chloride-is used i~ the chinaware in- which is pure RE chloride, is decanted and: ,the precipitate is
dustry. .India commands a share of one third: of the world-market scrapped off the press filters manually. Thorium hydmxide is
for this product.
·
also sent to another set of press .. filters to remove traces of RE
The Health and Safety Division (HPD) of the BhabhaAtornic
c!llqride. Thorium hydroxide is scraped manually and pumped
Research Centre (BARC) unde~ bAE is entrusted with tlie sole into. a silo.
responsibllity .of'health and safety of workers in units under
. ·_ While no, .spot in..the IRE compound seems to be free of
DAE. The. Atomic Energy (AE) Act, 1~62 prohibits an indepen- .
l"!3-dioactivity, there are a few t>Fo.cesses which involves considerdent scholar or a research centre from making any inquiry into
able threats to the woFkers. "Let us consider a'.few examples:
the affairs .of the DAE, including ·the health· status of its
(a} Ball Mill: The µiill where monazite is ground is not air
workers." Even though the· DAE units employ more than 20,000
tiglit. There are numerous holes thFough whichd1:1st can escape.
. people, no data regarding workers' health status is available, ex·Moreover; mfH vents· ha.v~ to be opene.d fre,quently for sampl'e
cept, of course,' occasional briefings to the press made by the
collection. This _is done manually by the operator/helper. Thoagh
official spokespersons.!
respirators are given, the workers do not wear them-because:
In this section, the production process at the plant under.study
(i) it is uncomfortable; (ii} since a worker has to anend three
is described briefly and an attempt is made to identify some of
spots, it is inconvenie~t; and.(iii) since .the volume of air breathed
the more hazardous locations found on visits to the plant.
is reduced considerably,_ the worker· is not able to cope with the
The main raw material used is monazite which is an or- work-load.
t hosphate or 15 rare earth elements and thorium. The sand is
(b) Fitter Press('Cancer Ward'): Ai filters where thorium and
0
124
Radical Journal of Health
mesothorium are pressed into cakes, materials handled are richest
in radioactivity. Here work is done in pairs, each worker standing
on either side of a 10 ' x 2' rectangular press, with a series of
and this job is known as 'kulam vettal" which, in Malayalam,
means digging the pond. J'he approximate frequency of this event
is one a month. The tank contains hydroxides of rare earths,
thorium, mesothorium and uranium which have alpha, beta and·
gamma activity.
wooden frames. The. top o'f the press is at chest level. The sticky
concentrate has to be scraped from the frames using a metal
sheet as big as a Kitchen knife.
(b) Digging the Grave; Lead sulphide, the main solid waste,
Workers on this job are given gum boots and rubber gloves.
On the day of our visit, one of the two workers was not wearing which contains mesothorium and other radioactive materials,
gloves. He said that with gloves, the speed of work is redu~ed is stored inside an RCC barrel which can accommodate 200 kg,
considerably. The-plant superintendent who accompanied us did' the approximate output is more than normal, excess quantity
not ask him to use the 'protection gear' either, Mesothorium has bulges out of the polythene bag kept inside the barrel and is
gamma activity. Rubber, in any case is not a shield against this. removed manually with a shovel. This has to be done approximately once every month. The materials have beta and gamma
,.,__,(c) Lead sulphide disposal: Lead sulphide (which contains lead, activity.
___;r mesothorium, etc,) collected in the RCC barrels remains unsealed',
(c) Occasional Activities: Apart from these, occasional acfor a week. The barrel lis located by the side of a road leading
to the canteen/dispensary. They are sealed once in a week. After tivities like shifting of godowns are done by contract workers.
a y·~f9r so the barrels are buried in the factory compmmd itself During ~'983, dock workers of Cochin were employed to remove
bfa
'"'Qfsposal team consisting of a crane operator from the Fer- thorium concentrate stored in IRE godown near the port. Actilisers and Chemicals Travancore Ltd (FACT) and contract cording to an eyewitness, many of the MS drums in which the
workers. The fatter have to remain dose to the barrel for secur- concentrate was stored were corroded and broken. During
ing its hooks.
January/February 1985, casual workers were employed to shift
thorium
produced during he early fifties to the present silo. No
According to the International Labour Organisation (ILO)
guidelines, this class of .radioactie waste can only be handled prott,ction was giveri' in the above cases.
Among the permanent -employees, the exposure rate is not
in "sealed-in operations, with people working in plastic suit with
3
uniform
for all categories of workers. While helpers remain in
controllect ventHation". In IRE, workers ~ear only cotton
khakh] uniforms.
close proximity of'the production process, operators and supers
(d) Thorium Silo: Wet thorium hydroxide, kept in silos is visors who do not have to do much of a manual handling, reremoved occasionally for transportation to the Trombay facili- main a little away froni it. However, the management has made ty. (This is a Government of India-owned company which is it a point to evenly distribute hazards among all. the workers.
under the ma11agement of the IRE. Here, thorium hydroxide is This has been achieved in two ways: (i) In,:IRE, there is only
c;onverted into thorium nitrate for gas mantles and! thorium ox- one entry point for workers, they are recruited as helpers. The
ide for research' purposes.) Since silos contain-many hundred posts of operators and supecyisors are time-scale-promotion bastons of thorium stored for over three decades, there is the ed; (ii) Aft¢r a complete monitoring of the plant by HPD in
possibility o( a high concentration of thoron,
thorium 1966, pe1:manent postingof workers-to separate sections within
'daughter' in gaseous form. According to ILO, air in the silo the production line was discontinued. A rotation system was inhas to be evacuijted once in every 17 ·minutes.4 There is no troduced under which every worker moves olit.6f' one section
after a fixed interva:l.
facility for this in IRE. With radionuclides and thoron gas, work
.
The production technology was imported from France where
in the silo can be equated to both a radiation bath as well as
a radiation dust -bath.
• it was devel'oped in the forties and is outdated by nearly half
(e) Open Vessels: Almost all chemical treatment is carried out a century, During those days, the awareness of radiation hazards
in open vessels. ·spillover of con~iderable vintage 'has ac- was at a very low ebb, restristed as it was to a few radiologists.
~.cumulated all over the vessels. Because of the openness, ra- Between then and now, developments of a far-reaching nature
dionuclides and thoron gas float freely in the workpla.ce. In have taken place. In IRE, however, the ,increased awareness of
almost all processes, the external skin contamination is totally radiation hazards has not lead to any innovation to prevent it
unavoidable because of the bad housekeeping. According to the at source. Instead, cheap and totally inefficient measures like
plant superintendent the vessels as well as the floor, which ap- gloves and gum boots have been resorted to.
peared n? different from a paddy field during transplantation
· The Numbers Ganie
had not been cleaned for over a decade. While the above hazards
are of a day-to-day nature, there are riskier operations which
In a latter addressed to the Prime Minister April 15, 1985 Prohave to be performed periodically. Some examples are given fessor KV Thomas, member of the Lok Sabha from Ernakulam,
below:
alleged that 14 workers of IRE died ofcancer between i970'and
(a) Digging ihe Pond: After extraction of TSP, the remaining 1984, Jhe prime minister in his reply (April 23, 1985}promised
slurry is washed in three tanks. The slurry is moved from tank that he would have the-issue examined. Earlier, in a memoranto tank with an electrically-operated crane with a maximum dum addressed to prime minister, all the recognised trade unions
.T capacity of five tons. At times, when the slurry is beyond the
ofIRE had pointed out that the high incidence of cancer among
_~A carrying capacity of the crane, or due to some other faults, it workers can be attributed to radioactivity.
has to be removed manually. Workers, usually new recruits, enter
In our review of literature, we saw that the cause-effect relathe tank with a shoyel. They can wear their gum boots and rub- tionship between radiation and diseases Iike cancer, genetic
ber gloves, i.f they wish 10. 'fhe.sh.l_!rY is removed with the shovel disoi:ders, etc, has beep. well established. However, these diseases
can also be caused by agents other than radiation. There is no
March 1987
a
0
125
,.
Known as the latency period, this ranges from six to 30 years.
way to ascertain the initiating factor in carcinogenesis at present. In this study, we are examining cancer cases between 1970 and
Since occupational diseases do not carry a label indicating 1984. While the exact time of the crucial exposure cannot be
their origin, indirect methods have to be resorted to understand known, we can be reasonably sure that the first worker diagnosed
their aetology. Causative relationship between an agent and a as a cancer patient in 1970 must have had his exposure .at least
disease is established through epidemiological studies, in which six years before, i e, in 1964. As such, we would have to conthe incidence of disease in the exposed population is compared sider the worker strength of 1964 as the base line population.
In an industry, exposure to pollutants is not uniform among
with that of a non-exposed population. An epidemiological
study can be either retrospective or prospective. In the former, all categories of workers. An estimated 20 per cent of,employees
disease/deaths which have already occurred in the past are. who are on non-production jobs (like clerks, peons} can be
studied. In contrast, a prospective.study is futuristic, the stu- classified as the marginally exposed group. The remaining 80
dent waits for the event to occur. If a cle'arly identifiable trend per cent of employees, whom we classify as the seriously exposis discernible, it is ethically sound to study the past, so that ' ed group are taken as the·base-line exposed population. ""· ""'·-·
Tliese manipulations are not possible in the case of ESICdata ~speedy remedial action can be· initiated.
In this section, the incidence of cancer and mortality due to because we have no way to ascertain the year of enrolment or
heart disease and all causes during 1970-1984 among IRE the nature of the job of the workers who have been diagRo~d
workers is examined. In an epidemiological study, the two as cancer. As such, we would take the entire insured w~ers
population compared (the exposed and the control groups) of the respective years as the base-line population.
Since ours is a retrospective study, we are examining the morshould belong to similar socio-economic, age-sex groups.
Given the weakness of available estimates/data, use of a sam- tality profile of the past 15 years. Here, we are ,confronted wit\1.
ple of industrial workers sharing a common socio-economic the problem of assessing the exact cause of death. What are the
background would yield mroe reliable results. Adjacent to IRE, sources of information from which we can obtain reliable data?
there are three '.more,industries which form a cluster. There are Firstly, the hospitals. While some hospitals informed us that the
refused
the Hindustan Insecticides Limited {HIL), producing old documents are not preserved, two major hospitals
7
organochlorine pesticides like DIJf and BHC, the Fertiliser-s and to coaoperate for reasons known only to themselves. Then we
Chemicals Travancore Limited (FACT), manufacturing looked into the register of births and deaths maintained by the
nitrogenous and phosphatic fertilisers and the Travancore Cochin local self-governments. In many cases the cause of death has ....,,...
~,
Chemicals Limited (TCC) producing caustic soda, chlorine, etc. not been. recorded properly. This is an all-India phenomenon.
--,,,·
HIL and FACT have carcinogens in the work-places, like BHC It is only recently that the Indian Council ofMedicat Research
and DDT in the former and rock phosphate which contains (ICMR) has initiated a programme for maintaining the moruranium in the latter.5 None of the chemicals handled in TCC tality data in India according to the World Health Organisais known to be cancer causing. Moreover, since both IRE and tion (WHO) norms. 8 Another source could be the personal
TCC went on stream during the same year, the age cornposi- dossiers of workers maintained by the management. Ev~n this
source is not free of errors as can be seen in the ·ensuing
tion of workers is more or less similar.
In TCC, caustic soda is produced by electrolysing sodium discussion.
lnsted of depending on a single source, various sozµces as
chloride (common slat) using mercury as cathode; Mercury is
.. highly toxic; .chronic exposure can cause neurological and skeletal given below have been consulted so as to arrive at a near acdisorders. Workers are also exposed to heavy con_centration of curate conclusion. Lists of workeriwho died.alm1g with the cause
chlorine which is a by-product. Over and above the pollutants of death were obtained from the trade unions of IRE and TCC.
released by their respective industries, the workers of both IRE The cause of death was cross-checked from dossiers. Cases in
and TCC have. to live with invading pollutants from neighbour- which the union data did not tally with the .dossier, detailed ining factories-sulphur dioxide, ammonia and fertiliser dust from terviews of co-workers, trade unions activists, family members
9
and neighbours were conducted.
FACT and DDT from HIL.
To enable comparison of the data of all the three population
In terms of wages. and perks, both the population groups are
on a more or less equal footing-the only dnference being a groups (IRE,. TCC and ESIC), it has been converted into. rate ·
higher rate of bonus and a liberal housing loan in IRE. On the per 10,000. After conversion, the relative risk in ·IRE was
_ health care front, workers receiving less than Rs 1,000 a month estimated. 10 Statistical test (chi square) was used to see if the
are in~ured under ESIC. Those earning above Rs 1,000 have a difference between the study and control populations is
company medical scheme under which expenses incurred on significant.
treatment of workers and their famiiies in private nospitals
Cancer
recogni_sed by th.e management are reimbursed.
According to the unions, 14 workers of IRE and four workers
TCC has a residential colony in U9yogamandal itself, which
is nigh pollution zone.6 In contrast, workers of IRE have their of TCC died of cancer between 1970 and 1984. As per the IRE .
·residence scattered in the entire district. Hence, the pollution dossiers, only eight workers died of cancer.
Out of the six c·ontroversial cases, it is impossible to, accept
load in 'the living environment (beyond the factory).of TCC
the unions' claim of cancer as cause of death.in the first three
workers is higher than that of IRE.
1n this study, we have-used the workers of TCC as well as those cases. In the case of one, it is difficult to arrive at a definite
conclusion. The last two w0rkers, we are reasonably sure, died
insured under the ESIC as our control populations.
In the case of cancer, there is a time lag between the crucial of stomach cancer. This brings-the total number of cancer deaths
exposure to carcinogen. and the manifestation of the disease.
J-~
Radical Journal of Health
126
__-,,-~--·~l·
.---~~·...,.,
in IRE to ten. One worker is now under treatment fof lung Heart Diseases
· Let us now examine the incidence of heart diseases in IRE
cancer. In a(l, there have been U cancer _cases in IRE since 1970.
and .TCC. The method of data collection for this has,been the
I Our data have the following serious limitations:
(a) Workers who left service since 1964 have not been follow- same as that for cancer.
' eel up. Table 2 provides. the service particulars of the existing
A word of caution-as me~tioned ;earlier, workers ,of both
workforce in IRE. Out of 471 employees, 67 started working tlie factories a,re,exposed to i~vading pollutants fmm neighbourbefore 1960 and anothe~ 30 joined between 1%1-66. A'(erage an- ing factories.· Among such pollutants, sulphur dioxide released
nual enrolment during 1%ls66 being 5, there were 87 employees by ifACT is of more significance in terms of concentration as
on April 20, 1985,.who belong to the pre-1964 stock. Thirty- well as the associated health hazards. Chronic exposure to this
two workers of the pre-1964 stock are. now in the managerial gas leads to, thickening <;>f alveoli waHs of lungs, caesing
cadre, another 22 died while in service during 1970-1984.. In other respiratory diseases like hfonchitis, which at a 'later stage can
words, out of 328 base-year worker population of IRE,. 1_87 have graduate to heart disease$. This disease cycle is kwnon as ~h~onic
--either resigned or retired, Of these, 140 (80 per cent) belong to ObstFective Pulmonary Qiseases {COPD). The inc!dence of....,.....Y' the seriously exposed populaton. Since we do not know what respiratory and heart diseases is very high in the entire area.
AU the cases of heart diseases in IRE therefqFe cannot be at-·
happened to them, our result is likely to be a gross underestimatributed to the pollµtion caused by the marmfacturing p~ocess
tion of the exact risk in IRE.
:
~) The level-of accuracy with which cause of-death is record- in the plant.Likewise, the frequency obs~rved.,in TCC may-not
ed1ri the dossier is questionable. For instance, in one case, of be the expected freqµency in .an average. factory. Assuming that
death has been mentioned as "failure of heart'.' which is a the pollution foad by FACT is eqµal in bqth IRE and T~C, the
layman's term for cardiac arrest. More revealing ,is the entry difference in fr~quency between the two population groups can
be aitribut!!d to"the presence or.absence ·Of causative agents in
showirig costochondritis as cause of death.
In' IRE, there were four cases of stomach cancer. Thi; remain- their '.respective work en~iF0nments. .
.
ing cases are of different sites. While radia!ion ip.jury can proThe figures for IRE and TCC are fatal heart diseases. The
duce malignacy -of any organ, there is a strong association bet- ESIC data, .which also is presented below represents the incidence .
ween certain types ofcancer and occupational exposure; like lung only-not an .of them ,might be fatal.
cancer among uranium dial painters-Let us see, if we can offer
any explanatory hypothesis for the randomness of 'site of cancer' Mortality frofile
in IRE ..
IRE has all kinds of radiation hazards, viz, external from beta
So far, we have examined' the frequency oftworadiation caus.
·
ed diseases-cancer and heart diseases. "There is another group
and.gamma rays, internal from ingested nuclides and inhaled of diseases which is broadly classified as radiation-aided. We
radioactive gases like thoron and radon. The most serious threat saw that radiation can also cause cell death. An absorbed bone
in IRE seems to be from the internal emitters which are either marrow dose destroys white blood cells, which are essential for
ingested or inhaled. Now Iet us see the behaviour ofinterna11y fighting infection. If cell death is massive, the organism would
deposited·radioactive elements:
be rendred incapable.of fighting even a ve~y common infection..
-
.-.
..
It has alpha.
·
(.a)· .Thoror». is. a noble
. . . gas. (it does.. not. react at all).
.
. C.:eH death can also lead to ·premature
ageing. Measurement
activity a~d a half life of 54.5 sec~~ds. Polonium; ~he thoron of the ageing process involves high technology gadgets which •
daughter i_s a slid with alpha activity and a !ialf Iife of 0-16 ·. we have not been able to use. However since the end result of
sec?~~s. Next in the ~eries is Thorium. B '"'.ith beta and alpha ageining is death, consideration of -th; total mentality profile
activities and a_ half hfe of 1~.6 hours. 'Y~1le thoron do_es n~t might reveal certain basic trends, l:.et us compare the total morreact, her daughters get att:ache~ to the !issues nearby, m this tality (due to all causes other 'than suicide and accident} in IRE
case lungs. J\nd keep on, damaging the cells.
and TCC. {Mortality· data pertaining to workers ·insured under
'\
{b>:we have earlier observed that all heavy metals (including ESIC .is not available.)
the radioactive ones) follows the course of calcium. In other
In order to facilitate comparison between units, data presented
· words, as the:ageing process sets in, ingested' radioactive metals earlier has_ b~en converted into rates peli 10;000\ Relhth:e risk
.settle down at so£t tissues all over the body.
·
betweenIREand'fCC for.cancer and'heartdiseases is.4;62.and
(c) The ITRC study quoted abo'_'.e'~ev~als.thatth9rJ~m ll;lso 2.~~ resQectively, Coming to total mortality, [RE w?rkers had,
settles down in testicles. Albert RE reports that worlc~rs in plants 2. 72 times greater risk .of dying of alt causes. More pronounced
refining thorium have shown chronic deposition of-the metal in . is the relative risk between IRE and ESIC which is 6.77 .and 2.;2
1ungs,'·1ever, kidneys, spleen and bones.ll
for cancer and heart ,dise_ases ~espectively.
.
All this evidence proves tht once thorium enters the body, it
behaves very randomly. So does tumour: Clumps of cancerous
cells, often break away rrom the parent tumour, migrates to new
organs seed ·out and start growing as ·secondary cancers, which
are known as metastases (literally; "standing in •an abnormal
place"). Sometimes, .the primary cancers; remain undetected. We
,have therefore taken all types of cancer(including leukemia}into
a single group for the purpose of analysis.
March 1987
How significant are these dit:fereaces? 1n the case of cancer,
difference between IRE and' TCC/ESl!C is statistfc!,llly signi,ficant at 0.01 lever. For heart diseases, while the difference be.tween IRE and TCC is significant at0,2 level, the ·difference between lRE and ESIC is signific~nt at 0,01 levet Difference in
mortlity,due to aH causes 'between IRE and TCC ,is significant
at 0.01 !level. In short, we can conveniently reject ,t;he nuU
hypothesis.
1:27
··-
Genetic;! D.isordes and Infertility
During the course of the· study, we also stumbled upon a few
cases of sterility among workers and genetic disorders among
their offsprings. The data is not comprehensive, Major reasons
for limitation in data .ae as follows:
(a) Most diseases of autosomal dominant variety manifest
themselves at a later age. The parents do not perceive such cases
as. genetic.
(b) A welfare measure in IRE has not made any survey (with
limited resources) of families virtually impossible. IRE is om
of the few industries in India which has a unique housing scheme.
An employee can build a house with a liberal loan from the company at a place of his choice. Since every worker with a minimum
· of ten years of service can own a house under this scheme, the
· unions did' not press for a housing colbny. Some workers in IRE
feel that the liberal scheme was introduced for concealing the
increased incidence of genetic disorders among the employees'
offsprings. .Incidentally, the scheme was introduced a couple of
years after the health physicists' team took position in IRE.
Among the affected wbrkers, one in three alone presented the
children before a medical board, consisting of three doctors of
Lissie Hospital, Ernakulam. The board ruled that the cases can
be attributed' to inbreeding.
reported nuclear tacility in the world' to causerndiation-induced
sterility among workers.
Cases of sterility deserve a closer examination. In the survey
of literature, we saw that unlike cancer and' genetic disorders;"
sterility is a non-stochastic effect which has a safe threshold, •
Since there is no history of radiation-induoed sterility among
males, the exact sterilising dose is: not known. Sterilising dose
for females is 700 rems, administered during a short span of
time. Since· overies are more protected' than testicles, male sterilising dose should' be lesser than that of females. One estimate
places the dose at 60 rems, Assuming that the workers became
sterile during the first twelve':years of theirservice, the annual
average exposure works out to 50 rems, which incidentally· is ten= ,.._ ·
times higher than the maximum permissible limit.
-·- '1-
,. Health- and' Safety Apparatus
.'
.
' .
.
. '
.
.
~
. HPD of BARC is responsible for monitoring the heal~f
workers in all'-DAE undertakings. Health physicists.were posted
in IRE,. Alwaye, in 1962, teit years after the factory went into
stream. In 1966, the team recommended' a few safety steps, like
rotating workers from spot tospot after a fixed interval, provision of gumboots and rubber gloves, etc. HPD is supposed' to
monitor the dose absorbed by workers and take remedial action in critical cases. Monitoring is done by analysing the film
There are two types of inheritance of genetic disorders- badges worn by workers: :Film badge analysis alone is not adeautosomai dominant and autosomal recessive. in autosomal quate in an industry like IRE where the major .hazard comes
dominant Inheritance, only one of the parents supply a defec- from radionuclides and radioactive gases Iike redon and thoron,
tive gene, while in the recessive inheritance, both the parents A near accurate account of the dose absorbed can only be made
supply the defective gene at the same genetic locus. The 'book' through analysis of biological' samples which is not being done
has the following to say on the nature of inheritance:
in IRE. Even the results· of film badge analysis is not comfa as much ~s recessive diseases require the inheritane of.a mutation municated to the workers. Similarly, HPD had conducted a
at the same genetic focus from each parent, when the genes are r<!re,
the likelihood' of any two parents being the carriers for the same defect chromosome·analysis of Alwaye workers during ,the fate sevenbecomes sinall. However, if the parents have a common ancestor, .and ties, the result of which has also not been communicated sq far. •
if that ancestor was a carrier of the recessive gene, then the likelihood
In the past, three workers were ,transfei:red ,to ,Jess hazaFdous
that two of the descendants have inherited the gene becomes relatively jobs because of adverse medical findings. fin these cases, the
great.12
workers who had got medical advice from pfivate practioners
A person who has inheriteda.defectlve gene which lies dorhad to fight their way out for transfer. HPD, ratheF than assisting
mant would 'not be affected by the disease. He Of she is called'
in such cases, strongly opposed ;the transfi:rs. Even though all
a carrier. When two carriers. of the defective gene at the same
workers suffedng from occ;upational diseses are entitled for comlocus mate, th~ statistical probability of inheritance is:
penscJtion und'er the Workmen~s Compensation Act 1923, no one
twenty-five per cent of the children will be normal, 50 per cent would
in
IRE·has got',it s~ far. In short, theje is nothing much to corn'be heterozygous carriers and is per cent would-be homozygous and
affected with the disease ... Since with recessive mheritance, only one . ment on the health and safety apparatus in IRE.
Chromosome.aberratio.n, chemical1 change of DNA and cell
of the four children in a sibship ,is expected to be affected', multiple
cases in a family might not occur.13
death are the immediate cellular responses to•an absoFbed .a·ose
In the case another worker, all the four children have been . of radiation. iThe end result could' be any .of the stochastic or
affected. Moreover, according to the worken.he and' his wjfe are non-stochastic diseases menti~ned earlier. In this paper,. w~·have
sixth in a chain of consanguinity. This introduces an increased' oeen able to demonstrate statistically signifi9ant differences in
possibility of sortie other relatives also being affected .• No one incidence of cancer and'mortality due to heart diseases and' all
has been, so far. Secondly, as the provisionaf diagnosis shows, causes between IRE ~orkers and control pop~lations. :Fhe inall the children do not share the same symptom complex or cidence of sterility among workers and genetic disprders among
clinical history. This suggests the possibility of damages at dif- theif off-springs reported above is seemingly higher than their
ferent genetic loci. Hence, the probability of'both the husband spontaneous occurrence in general population.
and wife carrying several' damaged genes seems to be extremely
A retFospective epidemiologica:l studY. of this nature, cart onremote.
ly formulate clinical hypothesis. At best,. one can state that the
study populatio,p •.vas exposed' to the agent under ,consideration
Infertility
during the refeFence period-,-in this case till 1'964. Incidentally, ..
It is not possible to assess at this stage whether all these cases two years after this, the so-call~d' control' measures 'Vere h1troduc
are radiation-related. If they are, then the situation in IRE would ed in IRE an HPD: How ;effective are these measures? To :obhave historical significance. IRE! in that case wou Id be the first tain an answer .thm11g·h a0 epig_emio'logical study, ,one would' have
0
128
Radical Journal of Health
to Wait a few more years. Fortunately, we have a [ittle more concretdevidei:ice. In ,t!9'78;BARC conducted a chromosome study
..
)Yotes
l R ViR Krishna Iyer, fl985l: 'Nuclear Nationalism and the Law',
of IRE, Alwaye, workers. Though t~e results of this sutdy are
Philosophy and Social Action, Vol XI, No 2; pp 9'-19.
yet to be Published, there is a reference to this one of the DAE
2 For the' first time in the history, DAE released the annual average
annual reports:
radiation exposure to workers of Tarapur Atomic Power Station
(TAPS) on May '10, 1983(See Timesofindia, Bombay, May Il, 1983);
In continuationof the efforts to evaluate the biological effects of
high background radiation on Human population residing in the
This release was in response, to a detailed report by Praful Bidwai
in Times of India dated May 9;, 1983.
•
rnonazite belt (Chavara, Neendakara in Quilon district, Kerala),
chromosome analysis was carried out on 179 samples.
3 ILO (1983): Encyclopa~dia of Occupational Health and Safety, Vol
II, p 1882:
Under our chromosome analysis programme, broad sample in the
4 Ibid, p 1883.
normal background areas were analysed. Data on newborn and their
5 ILO, (1983) ibid; VoUI, p 1679,
mothers did not indicate any differences in the chromosome aberration frequency between samples from normal background radiation
6 Concentration of sulphur dioxide-and particulates in the area,
areas and those from high background radiation areas.
. measured by the National Environmental 'Engineering. Research In.
stitute (NEERI) is given in Table A.
--7,,:..-> In the samples taken from the IRE workers at Alwaye, a;h1gh abberration frequency was indicated, than that observed in-the high
7 Lissy Hospital and Medical Trust Hospital, Cochin are the Major
background' radiation, Chavara and Manavalankurichi samples.14
hospitals which-refused to co-operate without assigning any reason.
8 Gandharan P,. ibid.
.
·
.
•
In short, workers' health was, and still is in jeopardy.
Mohanan a tutorin 'Irichur Medical College was present in many
,-SDuring the course. of our study, we also found that there 9 EofPthese
interviews. Statements involving medical judgments are his.
~; gross irregularities in the fields of radioactive waste 10: "Relative. risk is the ratio between the incidence among exposed arid
management, as well as storageand transportationof radioacincidence among non-exposed".. See J E, Park and K Pa,rk (1981),
tive materials=-issues which are beyond the scope of this paper
Text-book-ofPreventive and Social Medicine"; Jabalpur, pp 279-280;
H Albert, R E (1966): 'Thorium: Its Industrial Hygiene Aspects·:
and hence being reported separately.
Academic Press, New York/London, pp ~8-64,, quoted in Tandon,
The situation is alarming. This calls for immediate action.
SK etal, (1977): 'Effects.of Monazite on Body Org~ns ofRats'-Ens
The management of IRE has. agreed· to· palliative measures
vironmental Research, Vol 13, pp 347-357:
like scanning of all workers for tumour by the Cancer Detec- 12 Robert G Petersdorf, et al, (ed) (i983): Harison's Principles of Internal Medicine 10th edition, McGraw-Hill, p 319.
tion Centre, Cochin, which is not enough in a hot spot like
B Ibid, p 318.
.
'IRE. The need of the hour is a comprehensive, inter14 Government.ofindia, Department,of Atomic Energy {DAE) Annual
disciplinary study of the plant and the workers. In order to
Report 1978-79; p. 38.
take effective remedial action, there should P.e a health survey '[EPW. March 8-15, 1985 in which the original article aope!lred is out
of the workers· which should include analysis, of urine, blood, of print. Copies ,ot the article are avai1a61e at Rs 10;:.copy from:
chromosome and tissues of critical organs like gonads. The The Circulation Manager, EP,Y, 284, Skylark, Shahid Bhagat Singh
Road,. Bombay 400 038.]
workers who have absorbed dose above the permissible levels
should be removed to safety. In the case·of work environment,
activity status of each spot would have ,to be measured and'
engineering measures adopted.
Such a study should have representation from the workers
as well as the people ·because what at stake is not only the
SCIENCE AS CUI.JURE
health of over 500 employees, but also the national gene pool
Edited
bytes Levld0w
which the present decision-makers have no right to tamper
with. We do not own the gene pool.
P0litical fafces shape science ~nd.
A clear understanding of the exact magnitude of hazards
techn0l0gy: the practitioners, .the
. .__
posed by IRE assumes national importance at this juncture
• research questl0ns, the c0nceptual
of our history, IRE is the only ,DAE venture which has comframeworks, the fundh:ig1.lnstitut1ons
pleted. 30 years of: operation, which incidentally is the average
that promote certain directions, and
latency for cancer. Today, DAE is pushing forward its am~he otficial hlstory ~f.thelr,progress.
bitious plan which involves a tenfold expansionof nuclear elecThe contributors ,to tlills collection
tricity generation by 2000 AD: Before allocating a massive Rs
take up several examples: 'Social
22,177 crore from the public exchequer (or the planned exDarwinism', the-Copernican
pansion, people have a legitimate right to look into the track
Revolution,
dialectical; biology, ,the
record of DAE during the past three decades of its .existence,
exportofhazards, nuclearpolitics.in
[fhis report is part of a book which is now at the design stage. This
Yugoslavia, the tunnel vision of the
study is a joint venture by,the.tradeunionactivists of ]RE and:Tcc,
Fu rum for Occupational Health and Environmental, Studies, Alwaye,
sociology of science,amf the ,U.ves'of
E P Mohanan and a group of students of MedicaiCollege, Calicut,
famous scientists,
and Krishnamohan, a scholar of environmental*science at hwaharlal
Nehru University (JNU), New Delhi. The team acknowledge.guidance
Radical Science Ser:ies no. 20
and help by Gyanesh Khudaisya, D Banerji and Im'rana Quadeer of
£5.95/$7.50 from
JNU. fraternal assistance from Nikolai lzmerow, Director, Institute
of Industrial Hygiene and Occupational Diseases of the Academy of
t•
.
F
', ree Association Books
Medical Sciences of the U SSR, Moscow, RalphNader and Joan
26 Freegrove Road , :
Claybrook of the Critical 'Mass Nergy Project, Washington, and AnLondon N7 9RQ
,
thony Mazzoechl, Director of Health and Safety, Oil, Chemical and
Atomic. Workers International Union is gratefully acknowledged.]
0
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v
.,·,
·.
-B
1
,
March. 1987,
129
rm
UPDATE
News and Notes
Bombay's Health Priorities
'
A LONG-STANDING criticism of health services,
·Even within curative health care, the services are so
curative-and preventive, private and public, has been that created as to provide the least access to the working
they are heavily urban-oriented and are skewed to offer masses. Hospital beds, for instance, show such a skewed
the least assistance to those who need it most, the rural distribution. In.1980,, 60, per cent of the hospital beds
.poor, What is often not as well documented is that the maintained by the corporation were in city wards in south
distorted priorities also influence urban health care. The Bom,bay .comprising 35 per cent of the largely better-off
annual budget estimates of the Boinbay MunicipalCor- population; the civic body did not maintain a single bed
poration {BMC) recently presented provide a glimpse of in the area which 'houses' a I~tge proportion of the work- ~
.. just how efficiently the civic body is discharging its obliga- ing class population of the city, To make matters worse ' -::
tions of providing health care.
67 per cent of the government beds are alsoin these south
The; corporation Spends 29 per cent of its revenue · Bombay wards. The rest -of the population (the lower niidbudget on public health ~d medical services. Expenditure die class and working class) is forced in the city to deon health care has been steadily increasing-there has been pend on private medicare. Although the number of
·a 69 per cent increase in the last three years. What is. im- hospital beds has gone up since then, the situation is hardportant, however, is that most of this 'increasing expen- ly better. As the municipal commissioner has pointed out,
diture has been on the curative side. The health budget "we have undertaken the construction of many skyscrapers
comprises three components-public health, medical relief for increasing the- number of beds in our major ·
and education, and measures to control environmental hospitals: . ·. while a large suburban population is denied
pollution. The proportion spent on public: health has immediate access to primary health centres".
consistently, even if marginally, .decreased=-from nearly
Quite obviously, whatever the increases in thehealth
15 per cent in 197.7-78 to 13.7°per cent. A grave result of budget, iris unlikely to benefitthe urban masses. In fact,
this is that neither th~ infant mortality
~01Jlle. pyeraU what With the commissioner's proposal to hike hospital
death rate 'has shown an improvement in ten years. Pollu-· registration charges, ·"resti:icting use of costly medical
tion control which includes such ·activities as ·airqualit'y equipment" by introducing "reasonable· charges" for their
monitoring, research laboratories for analysis of pollu- use and "avoiding waste of medicinesand_diet", users of
tion as well as an enforcement wing for ensuring the imple- municipal facilities will'find the services gradually movmentation-of control measures, accounts for less than one • Ing beyond their teach.
per cent of the expenditure. Admitte~ly,· the allocations
pp
in this area have increased many times in ten years, but
,considering that the BMC's own health survey has shown
a.deflhite link between the prevalence of a large number
Rums·.of War
of health problems.and air pollution, should this area not
have been considered a priority' area in health? LEBANON is constantly reported for ,internecine fights,
The corporation appears to be attacking the problem the shifting-loyalties of the groups involved in the fights
of health from the WFOng end-waiting f~r people to fall and above all Israel's repeated invasion-of that country,
m so that they may be taken care of, instead of eliminating the latest being in 1982. In the din of a!il this· gunfire and
the root causes.of ilJ health. The corporation is not atone. among the ruins of war, the condition of rnHlions of
in its apparently muddled understanding of these issues- Pald'tinian.refugees in'Lebanon and in Israeli occupied
every government, .state and central, has followed the same territories of West Bankand Gaza has almost been forgotprinciples of neglecting preventive health cam, The reasons ten. War itself has be::come an epidemic in the region, and
are, of course, ·obvious. The creation of imposing hospitals its.impact on people's health is of epidemic proportion,.
equipped with new equipment (even if they are ever put
The fighting between the Pa!lestiniaas .and! other armto use) adds to the prestige of the authority everras it of- e_d groups which are from time to time supported by Syria,
fers temporary 'repair facilities' for the masses, However, Israel or Iran, has alm~st destrciyedthe whole social fabriC:
expanding public health measures is quite another mat- and as a consequenc;e even the hell!lth care services,. }n the
ter. ifil doing so, the state wi:U necessarily have to confront Pidestinian ·refugee camps. Even ,the abysmal health serthe very classes which sustain, it-whether it is a matter vices which wer:e available to them before the t982 Israeli .:
of properly distributing clean water supplies or bringing invasion of that country _have almost ceased to be. For ·
defaulting indu_§tries to, book.
the. last two years the Syriancbacked Amal' Shite Muslim
. .
,
rafe
I,
0
li~Q
Radical Journal of Health
militia has resorted (o intermittent seizure of Palestinian
refugee camps and thereby cutting the residents of all civil
and medical supplies.
·
Chatila camp has been reduced to rubble and its
·'
population have fled south in search of food-and shelter.
In Bourj-al-Barajneh camp 35,000 people along with the
British charity, Medical Aid for Palestinians are trapped.
The electricity and water supplies to the camp are cutoff by the Amal militia. Food supply is not reaching the
camp people. Anybody coming out in the street to get
water and food or trying to leave the camp is shot dead.
.,,...- All relief supplies are turned back by the militia. Much
__y
of the medical- facilities established by the MAP at the
cost of£ 30,000, after destruction in the 1982 war, in the
__Gaza hospital, are destroyed including the hospital
:..~uilding itself. Another remaining hospital, the Haifa
~spital, has lost two of it's there floors and there even
medical worker's and patients have been hit by sharpnel,
Because of such attacks on all these camps, i~ is estimated
that almost 2000 camp inhabitants are killed, 1500 wounded and 80,000 made homeless.
AC J, from
The Lancet, February 21, 1987.
Double Standards: Some Improvements
In the past dozen years, major pharmaceutical firms
have made substantial improvements in the way theylabel
and promote their products in the Third World. They are
now less likely to puff up their claims to physicians and
are more willing to disclose possible serious or lethal
adverse reactions.
~ --;,~
These are the findings of three researchers at the University of California School of Medicine in San Francisco
(UCSF)-Milton Silverman, Philip R Lee and Mia
Lydecker. This group pioneered comparative marketing
studies, beginning in Latin America in the early 1970s.
Their latest findings were published in the October 1986
issde ~f the International Journal ofHealth Services. ·
I
Their original survey covered 147 products marketed
in the UnitedStates, Mexico, Central America and South
· America and the results were published in 1974. In their
second study, published in 1982, the UCSF group covered
515 ·products marketed in the United States. Latin
America, Central Africa and Southern and South East
Asia. Their present investigation includes I,069products
marketed by about 300 companies in-the United States,
the United Kingdom and 28 developing nations.
The present study reports striking changes. Many of
the firms wer~ 'found to be showing more restraint in
limiting their claims int he Third. World to those which
can be supported by scientific evidence and were far more
willing to. desclose serious hazards'.
•
March 1987
In the case of dipyrone, a widely-used but reputedly
dangerous remedy for fever and pain, itw as-noted that
119 of 155 products now carry warnings of possible fatal'
blood damage. This represents a marked improvement
over the situation in 1974 and in 1982. Most of the products still without such warnings were found to be
marketed in India, Mexico and Central America, mainly
by American and West German firms.
Of the 12 aminopyrine products, used for the treatment
of fever and pain, seven-maFketed by Polish, Spanish;
Swiss and German firms-carried no adequate warnings
of possible blood damage. Of the 15 phenacetin products.
which ate used to control fever ~d pain, eight carried
no warnings of possible kidney damage. They are
marketed by American and German companies. AU three
of theSfP,rnducts have long since been banned from the
United·""States·
and the United Kingdom.
r
· · In the case of chloramphenicol, a valuable but potentially 4wigerous antibiotic used especially In the treatment,
of typh<5id fever, 93 of 103 products now list warnings
against ii~~ i~ trivial infections, against preventive use and
against prolonged use. This too represents a remarkably
improved situation. Nevertheless, some firms were found
to be promoting chloramplienicol products in Indonesia,
the Philippines and Thailand for .sucb a minor illness as
tonsilitis.
·
,
Similar ·improvement was noted in the promotion of
tetracycline and other antibiotics, tranquilizers, antidepressive agents and anti-arthritis drugs,
Silverman, Lee and Lydecker also examined the promotion of numerous 'sex-tonics' in the Third World bY._
various American, European and Third World compaies.
These are widely recommended 'and sold for such indications as premature aging, sexual weakness, lack of physical
and mental capacity, failing memory, fatigue and 'general
wearing-out phenomena'. Evidence to support such use .
is questionable at best. None of the products. is allowed
on the market in the United States or Great Britain.
•
•
.
w
Drug companies cannot explainaway these differences
merely by claiming that the laws of specific developing
nation dictate what ma/or may not lie put on the label.
In the same country it was obvious that some brands of
a particular drug carry detailed warnings, while other
brands of the Identical-drug carry no warnings -0f any
kind. Among the companies whose products were-examined.jome were based in capitalist nations, some in MarxistSocialist countries and some in the Communist bloc. 'Our data show no significant differences between them inthe
reliability of their promotion', the USCF team said.
Among the profit-making companies, some were multinational while others were domestic or national. 'Our data
indicate that most cases of irrational promotion involve
domestic firms in the Third World'.
a
from HAI News, February, 1987.
l3l
I
Community Participation ,in Integrated
Chiid Development Programmes
·
The Kerala Experience
.
v raman kutty
-- This paper, attempts to enumerate the obstacles that stand in the way of community participation in Child Develop. ment Programmes, drawn from the experience of Kera/a state in India. There is also an attempt to provide a
conceptual and theoretical basis to the need for community participation in health programmes.
I
IN this article I shall attempt to discuss some of the issues separate the process and the goal in this: the CSDR is b"othJ
related to community mobilisation for action in child the objective of the programmes as well as .their m:ganisa-1
development programmes. The first part o{ the paper shall tional content. The CSDR be said to be charaeterisediby three
delineate the conceptual or theoretical basis for the need for principles in its organisation, each..of which underscores the
community participation in child development programmes; · importance of community participation for its sue~_;;
the second part shall be devoted to examining some of the
(1) The 'demand based approach' to child health
experiences in the light ofthese, '
,
(2). Lo'\V COSt interventions that Call be afforded by the I
The first major task in such aIJ. attempt is to define the poorest of communities; and
·
nature' of child development programmes. Child development
(3) Approaches with minimum technological complexity,
programmes grew out of two ideas:
so as to encourage selr'reliance. I shall examine each of these
1..The realisation that the development process has to be in detail.
seen not just in its economic perspective.
Rajni Kothari says: "I suggest that the unidimensional and
The. Demand Approach to Child Health
almost exclusively economic basis of the development
paradigm has undermined the prospects for not just 'developThe central idea behind the concept of the.CSDR is to
ment, but for the sheer survival of largestrata of the world's enable parents to protect their children from preventable
people; Mere transfer of-resources and technology does not death a11d-ilisablei:µent: and the thrust of.the strategy is to
necessarily bring us any closer to the realisation of a desired convert 'latent demand into effective demand' for child •
state''. (Kothari, 1985).
•
health.{Vittachi,. 1984). What is the concept of demand (or
Among these 'extra economic' goals of development, child health? For economists, the demand is the "ability and
survival should certainly demand high priority, ~'High rates willingness to pay". (Fuchs, 1968); Paying may not be always
of infant and child mortality are one of the heavier burdens in terms of money. In an under-developed community, even
borne by the nonulations of the less developed world". when services are supposedly free, mothers have to forego,
(Barnum and Barlow, 1!184). Hence even from an economic one day's work to avail of these services, because of so many
point of view, investment in child services-for .health, reasons that I need not go into. The value these sometimes
literacy, and in generalbetter quality of life for children- illiterate and mostly formally unemployed women place on .
have returns in terms of quality of personal in later.years their time, is the cost of the service. In terms of relative value I
to the family earnings, this should be certainly a high value, _
that justifiy, the investment.
2. The second idea-closely related to the first-is that The demand approach to chiid services 1n underdeveloped
of an integrated package of services for children. Most of communities should mean, i;f successful, that mothers, who I
the services offered have nothing now in their content: be are the key figures in caruing for. the children, are .prepar:ed
it immunisation, supplementary feeding, promotion of breast to incur this cost in order to avail this service. Thus we see
feeding, or informal education. What is new is the integrated successful demand oriented programmes have a built in
approach in supplying these services. But it should be realised element of community participation.
that "... true integration must mean something other than
But it is often not realised that .what is demanded is not
the simplistic invitation of everybody professionally con- what isneeded, The health or development needs ofa comcerned with a problem, to do what they are used to doing munity are th'ose defined by the expert as those required for
in their sector specialities, with the only difference that they them to reach a certain predetermined level of development.
do it simultaneously". (Kunttson, 1985). Thus integration in an ideal situation, health demands coincide with health
itself is to be seen· as a strategic move, a specific input into needs. But more often, health 'demands' are in excess of or
the defence against deprivation.
totally different from, health needs: There are two ,types of
. .J'he Child Survival and Development Revolution (CSDR) problems arising o~t of demand: demand failure arid in- I
as envisaged by the UNICEF could be described as the appropriate demand.. Demand failure in the context of childtfomalisation -of all these ideas. The CSDR is-or should be- survival strategiesmeans that mothers do not come forward
the ultimate goal of the integrated child development ser- to seek the protection of available services like immunisa-·
vices initiated by· many of the developing countries including .tion, oral rehydration, growth monitoring, and even curative ,
India. But it should be understood that it is difficult to services. This problem is common in developing f!Om- I
1
I
!
~
1
132
Radical Journal of Health
-~ -
munities, and is in tum due to two reasons: the illiteracy and point m the last part ~f this paper.
In this part there shall be an attempt at examining some
ignorance of mothers and their lack of self confidence in
decision making roles about children, which are themselves of Cilie· bottlenecks to community participation from exrelated problems. The second demand problem, that of in- perience of child development programmes in Kenda. We
1
appropriate demand, is more common in developing com- have witnessed.a series of programmes operating at various
munities like Kerala, where under the influence of high stages, fulfilling different needs in child survival and develop"
pressure advertising, educated but poor mothers reject cheap ment norms. The two programmes. which shall be discussed
j_
but effective alternatives and go in for child health inputs here are the {i) the Composite Programme for Women and
~
~ like .!Dilk foods, weaning foods, and tonics which they can Preschoolers, which was ,in operation through balwadis
j
ill afford. Both these problems, insufficient demand as well {children's' centres) in Kerala. Here the development departl'
as inappropriate demand, exclude community participation ment of the government of Kenda in conjunction with the
;,I
in child development programmes: the first because people · health department, provided an integrated package of
:
do-not come forward to take part in the programme, and services to preschoolers and pregnant and lactating mothers.
(Government of Kerala); (ii) 'iPhe Integrated Child Develop~the second because t,.ey seek solutions elsehwere.
rment Services Scheme .of the government of fadia. It was
launched in 3 3 community development blocks all over India
low Cost Intervention
\
in 1975, and consequently grew to 300 blocks by 1:981. fa
~
~
TntFs°econd point of stress in the CSDR, and also im- 1982 the IC:DS was included as "the principle vehicle for
portant in ensuring community participation, is that the meeting the needs of children and their mothers under the
interventions suggested are less costly, which can be afforded twenty point programme of the prime minister. (Sadka,
_!Wen by the poorest community, In fact, "voluntareeisni or 1984).
community contributions are a necessary element in the cost Demand need variation: One of the most important flaws
structure if the programme is to be maintained on a national cramping the execution of such programmes is the design
scale''. (Nyix, 1:984), We should define what we mean by 'cost'. which is· decided centrally.and is usually inflexible. lt is not
What is apparently 'low cost' in terms. of rupees and paise often remembered that child survival goals, and hence
may be high cost in terms of time spent to a rural mother demand as wellas need differ widely in India,among states
in a developing community. Here again, it is important to as varied as Kerala with i,ts low infant and toddler mortality
understand that iµ such a situation, community participa- to ,that of Uttar Pradesh, which would' approximate to the
all India picture in these indices. Unfortunately this factor
tion is one thing that can make costs less.
is not given due consideration in the pi:ogramme, and' the
goals and style of functioning are decided without taking
Inputs ~£ if.ow Technology Complexity
into. account the i:egionaill differences in child survival and
development priorities .. As a result, aspects of the programme
The third point of emphasis is that the suggested intervenwhich are very relevant to some areas are totaUy irrelevant
tions have very little technical 'density', in the sense of
in others, and consequently cannot attract people's participaneeding trained personnel and sophisticated equipment, in
Jion .. 'fhis is a price we have to pay for inflexibility. Kerala
spite of being the fruit of .modern thought. ln fact, among
being a state where the demand for foi:mal education is. very
the four key strategies currently emphasised intheCSDRhigh, the age of school entry ds five years, and pre-primary
--· ." growth monitoring, ,oral rehydration, breast feeding and
education is very much in vogue, it is not surprising to find
~~ immunisation-the only intervention with any technological
man}'. rural areas where even poor mothers are reluctant to,
i
~sophistication is immunisation. The central idea is that
send their children to the ICDS after four years. But in a
instead of beco~ing complex tools in the hands'O•f-experts
j.
state with a poor level of formal schooling, the non-formal
in respective fields, these ,techniques become effective
:1
education imparted in 'the [CDS centre till six years may be
weapons in the hands ·Ofthe ·Commucity to combat thi:eats
an important input which cannot be ignored.
to betterment of chiidren's conditions. Thus theoretically, this
should also have a strong component ·Of community Rigid-structure: 'Fhe second and very important aspect which
precludes community participation is the rigid' nature of the
participation.
· There are two reasons why I have gone into some detail programme implementation. 'I1he beneficiaries have no role
to show how the child survival and' .development revolution in deciding the site, or number of functionaries at the- local
is built around concepts which ·essentially entail ,community level. Here it is iateresting to contrast with the CPWP proparticipation, by their very nature. The first is to buitd a con- gramme which is now being eclipsed by the ICDS. The design
1
!.
.-.-ceptual backgi:ound against which r shall examine some ex- of the CPWP was. such that in each area, the people had
-~ periences with child development programmes. The second to form.and register a mahilasamajom {women's club) which
and the more important reason, is to make the point that had to provide the building, premises and local level funcwhile the three aspects discussed: demand orientation, low tionaries for supplementary feeding and other child develop' cost, and limited technology, are necessary conditions for ment programmes. There was also an attempt to provide the
~~--~~ community participation, they are not sufficient. If ·.com- focal type of foo4 and grow some of the vegetables ,in the
munity mobilisation is: to be truly effective, there shou_ld be premises, coupled with many employment generating
a rea11y participatory role for the beneficiaries at every stage activities for women, :li!ke goat rearing etc. This character of
from planning ,to ,implementation. l sba:M come back ,to this participation has been lost in 1he design of the ICDS. This,
-\,
f
,4
-;-
March 1987
133
·---· ---_c-~--~-=-..,,-~~~~---,------~=====~
'
is also a particular example of the point raised earlier, i e, programmes indeed have a large 'potential for community
whereas in other states of India one should not expect women participation in their design and' execution. In our experience,
to take the initiative to run their own community develop- a large part of this potential is fulfilled; In fact, it would
ment programmes, and hence a government administered not be wrong. to state that the ICDS is one programme in
programme might perhaps act as a focus for initiation of in the state with a large element ofcommunlty participation such activity, the opposite is the case in Kerala. In Kerala even as it stands now. I have only tried to point out areas
women do have the .confidence and initiative to run these of conflict, the resolution of which is a must if we are to
programmes, perhaps borne of their better literacy and go further.
exposure to media, and as such the programmes should be
Coming back to conceptual basics, communhy-participa- ·.
sufficiently flexible to allow their participation. This would tion in child development programmes fails if community
be expected of a demand-based approach, and would participation itself is not seen a~ a primary objective. Par-·
simultaneously ensure community participation.
ticipation should not be a means to facilitate reaching other
Goalsfor beneficieries and goalsforfunctionaries. The point goals, On the other h~d, maxim.isi~g comm.unity partieipl!;:,
is again related to the first two. When a programme becomes tio~ should ~e the prm~ary objective, s~bJect to the con=
centrally administered with a fixed pattern and permanent ,. s~nts. If this approach lS adopted, reaching the other goals
staff, it is· inevitable in the long run that the executives of will be much faster and automatic.
_
the programmes, on the whole, put their own personal goals
first. This is a folly to which it is particularly susceptible in
References
Kerala with its large number of educated unemployed, While Barnum H and Barlow R: Modelling resource .allocation for child surit should not be grudged thar such programmes have provival, Vol 4, p 364, 1984.vided jobs for a number of youth it should not also be forgot- Fuchs VR: 'Fhe growing demand for medical care New England lourten that furthering their career opportunities. is not the
nal of Medicine Vol 279, No 192, 1968.
of Kerala- CARE: Composite Programme for Women and
P rimary aim· of the programme. This point has been at the Government
Preschoolers Guidelines. .
·
back of many recent _incidents in Kerala. This is an area ,of Knuttson K-E: Immunising for development-the Child Survival and,
conflict, which, unless resolved, effectively blocks people's
Development .Revolution and development theory, Assignment
participation in the programme,'
Children 69/72, 1985 (Universal Child Immunisation by 1990)
V
~?
Not id,entifying priority needs: Sometimes a community may
be ba~lf in need ~f a ~~rvl~~ like protected water supply,
or irrigation facilities; which, while not directly linked to
child health needs, can act. as a rallying point from which
child development services can reach the people, Unfortunately, this aspect of community development has not
been given its true importance in the programme. This is
another obstacle on the way to better community
UNICEF, New York, 1985.
•
Kothari, R: Communications for alternative. development, towards a :o--.
paradigm Development .Q(alogue, Nos 1-2, Dag Hammarskjold
/
Foundation Uppsala 1984. P 22, as quoted in Knutsson K,E:. Immunising for development-the Child Survival, andDevelopment
Revolution and development theory, Assignment Children: 69/72.
(Universal Child Immunisation by 1990) UNICEF New York 1985.
Nyi Nyi: Going to scale: going national-eoperationalisarion ,process and
issues. Assignment Children65/68 UNICEF, New York,. 1984.
Sadka, Nancy: /CDS Integrated Child Development Services in India;
ed. Chawla N, NNICEF, New Delhi, 1984.
,
Vittachi V 1: The demand approach for child Survival and Development Assignment Children 65168 UNICEF, New York, 1984'.
~v Raman Kuttv
t
'Sake bam'
, .
Chelat Lane .ir
Trichur 680 004~-~ ·
participation.
Emphasis on technical aspects: There is·a tendency on the
part of the experts concerned with planning and implementation of the programme, especially 'medical personnel, to
see it as exclusively a technical programme. Doctors connected with the programme should be disabused of the idea
that it is a medical progr.:amme. On the other hand it should [Paper presented: at the conference ofSAARC_parliamentarians on Child
be seen as a non-medical programme with health returns. Survival, Development and Population, held at Colombo, Sri Lanka,
From the side of beneficiaries, there is a tendency, at least September-October 1986.]'
in Kerala, to, view the ICDS as a formal preschool education. This.isto be expected in a state where mothers put such (Continued from· p 115)
a high value on formal education even at the pre-primary
·nuclear mind-set of those who are in a position to take crucial
level. Here again, it is an instance of:demand conflicting with
need, and unless people are properly appraised of the decisions concerning nuciear' war and the arms races ..
While local and regional peace movements can play a vital1
objectives of the programme, there is a danger that they shall
role in promoting the process of disarmamentand sustain- _,
be disillusioned and this will effectively block their
ing its momentum, a world completely and'permnnentlysafe
participation.
from the fear of nuclear weapons cannot be created by
Using the programme for political leverage: It is inevitable movements against nuclear weapons atone, Such a world rein a highly politically-conscious state . like Kerala, with quires transcending nationalism and· national' elites in the
political fortunes see-sawing, that programmes like the iCDS name of the universal interestsrof human kind. In short the \
are used for political advantage. If this should happen, it struggle to create a truly and permanently nuclear free world J"'"- ,
alienates a large section of the community and this works is an intrinsic part of the. struggle for socialism. Without a
contrary to the spirit of community participation.
nuclear free world there wi:l:l be no socialism. Without
In summing up, I should pointout that child development socialism there will be no nuclear free world!
134
Radical Journal of Health
Book Reviews
Milk Monitors
pauline jackson
Methodologies for the Study of Low-Level Radiation in the Midwe st, Charles Huver et al, Millville, MN, Anvil
Press, 1979, $ 5.
THOSE who seek an easy introduction to the dangers of low- ceptualised as a deliberate attempt to conceal health hazards,
level radiation would do better to read the pamphlet-length chat is,as a political choice by state and corporate scientists
summary of this hook, Nuclear -Waste - The Time Bomb in to hide health risks from the population. If all 189 ra~ur Bones. Yet this extraordinary book is undoubtedly a land- dionucleides were monitored and the results rendered public;
mark contribution to the debate over nuclear health hazards. this would imply that the nuclear industry and its state supIt is a product of detailed investigation by a team working porters did care about health - an assumption that proved
-wiln Land Educational' Associates Foundation Inc. (LEAF), fatal for nuclear activist and trade unionist Karen Silkwood,
a~zens' research and resource network who publish books, who was assassinated while attempting to prove the hazards
newsletters, engage in lobbying and popularise research fin- generated by her own nuclear workplace.
dings for anti-nuclear activists.
The LEAF study provides some useful insights into milk
This book appears to be their most ambitious attempt yet monitoring techniques. Milk monitoring had been going on
to take on the state at its own game: the monitoring of low- for years in Wisconsin, where the research team was based,
level radiation releases and their impacts on human beings. so records of the results were available from various monitorTheir work is intended as a critique of the U.S. Environmen- ing stations over a period of years. Examining the records,
tal Protection Agency, the-U.S. Atomic Energy Commission they found evidence of radioactive substances which. could
and those private or public agencies who, in the opinion of only have come from atomic fallout during the 1950s.
the authors; downplay the hazards of low-level radiation. Matching the peaks and drops in measurements with inforTheir starting point, therefore, is an alternative method of mation in tests carried out in the atmosphere, they demonmonitoring the results of low-level radiation release, to com- strate the continuing impact of radiation on a population
bat the defects, errors, inadvertant omissions and mistakes who were perhaps only children at thetime ofthe test. They
of official monitoring.
.~
suggest a method of calculating the half-life of radioactivity
Their approach assumes that the problems surrounding still in the bones of adults who were exposed at the time,
monitoring can be reduced to precise errors, definite defects, and who would be vulnerable to cancer today.
certain omissions and accidental mistakes - an assumption
The authors were surprised to find that the records 'were
that is far from proven in the book. Certainly, the authors. blank for considerable spans of time. In some records, the
succeed in revealing an inadequacy of corporate and state same results from monitoring -appear on consecutive
monitoring. But they present the inadequacies more as a readings, from which they surmised that NO monitoring of·
series of random and accidental oversights than as a con- milk had been carried out during certain periods, while on
certed strategy by supporters of the nuclear industry to misin- others the results of the preceding tests were copied into the ,·
form the public.
records. In addition, monitoring results .. of no radioactivity
Huver et alia are critical of monitoring methods but not were to be found in the Wisconsin records. This provides the
of monitoring as such. They would not go ~o far to argue authors with an occasion to disect some arguments .around
· monitoring for low-level radiation (or low-level toxic chemical 'detectable levels' o'f radiation. In this regard they remark:
exposure) has become ~ fetish of the chemical and nuclear "... it is obvious that realistic dose estimate cannot be at-·
industry, used to lull the public into believing that a quan- tempted by assuming that concentrations below a "detectable
tifiable measurement is equivalent to quantifiable control level" must be interpreted as meaning that absolutely NO
over releases (as argued by Levidow and Pomata in J?.SJ 9). iodine-Bl is present" . .(pp. 61-62).
On the contrarythe authors accept monitoring and seek its
The statement reveals a weakness in their analysis of the·
extension and perfection by a more sensitive, all- purpose of monitoring in the first place. If the purpose of
encompassing methodology.
monitoring were to reveal the presence. of radioactive subTo illustrate their perspective: an exam ple cited in the study stances in.the milk, exact and precise measurements (however
is the frequent use by nuclear proponents of the idea of 'the miniscule) would.no doubt have been recorded .. ff the puraverage dose' of low-level radiation, which gives an 'average' pose of mon.itorfrig is to detect low-level radiation at and
population a once-off hit of radiation and then allegedly above the 'iiafe' threshold levels, then there is no need to
disappears. The authors expand at length on the inadequacy record tiny amounts of radiations, since such tiny amounts
of monitoring which fails to test for the consequences of all. are presumed by the monitoring agencies to be safe. The milk
189 radionucleides which can have an impact on health, with monitoringrecords which appear so defective ,in. the eyes of
tragic consequences in cancers of specific organs of the body the researchers are. undoubtedly very adequate from the
of individuals. The monitoring of selected radionucleides can standpoint -of the agencies doing the monitoring, since the
be attributed to an inadequate methodology, or it.can be con- test results· conform to their intention in monitoring: to prove
March 1987
. 135
that radioactivity in milk is not at harmful levels . . . levels on monitoring, research methods, source credibiility,,
being the crucial word!
statistical methods and so many other fundameneat issues,
Not content with combing the state's radiation monitoring One can draw some conclusions from their concern to enlarge
· records for faults, the authors compare nuclear reactor thenumbersofradionucleides andradiation pathways which
manager and state interpretation of the results with their own. are submitted to monitoring and their interest In t,he ,impacts
interpretations. They note that nuclear reactor utitity on individuals in specific. geographical, zones, districts with
managers and owners managed to underestimate the results distinct . living and eating patterns. Their work rejects
of the monitoring by half. The researchers attribute this hypothetical models of Hie impacts of low-level radiation on
underestimation to the use of formalin, which reduces the 'average' populations and' attempts to reconcile multiples,
detectability of the radionucleide Iodine-131. Being cynical, types .and volumes of radiation emissions with groups livone could also attribute the underestimation to dividng the ing in their path or liable to consume radioactive conoriginal results by 2 ...
taminated foods. along their pathways: Put another way, the
The study is extremely useful in its treatment of the food authors reject a robotic conceptions of human beings-e- , •
cycle and low level radiation exposure; this is perhaps the robotic in the ·sense of each person." being an exact replica ~~,.,.
best section of the book. The authors insist on the impor- of the next in history, culture, lifestyle, age and so on. Instead
tance of the food chain as a pathway for low-level radiation. they are attempting to humanise monitoring methodolqgies,
ingestion, The researchers examined the dietary patterns of to give them relevance to, Iocal communities, such as tf~~
the Wisconsin population, including the diet of so-called living in the various counties of the State or wisconsfii.
It is to the credit of LEAF that they responded quickly
minority groups. In an implicit critique of the 'average'
population perspective, they detail the differences in life-style to popular demand by publishing in pamphlet form a most
among the Wiscon.sin population and the accompanying readable summary of the book: Nuclear Waste - The Time
variations in eating and shopping habits. They calculate the Bomb in our Bones. Besides this [6-page 'cheap version of
predominance of dairy products in the eating patterns and· the book, LEAF have 3 informative brochures presenting the
then break down the dairy products according to whether salient aspects of selected' pieces of their research, aimed' at
or not they were extensively processed. They propose that Wisconsin's commune and health-food population. These
those who eat processed (as opposed to fresh}dairy products formats - pamphlets and! brochures - show that LE~F is
were less likely to get radiation exposure; since the half-life capable of citizen. research which unites grassroots activists
of the radioactivity in fresh milk, for example, had had more and researchers into dialogue. It is ail the more surprising,
therefore, that Methodologtes does not rise to the same stantime to decay during the processing.
If one hadn't been turned off dairy products by this stage, dard of accessibiiity as thier other publications.
It is aM the more important to have an accessible presenworse is to come in their assessment of other food products.
The consumption of wild berries, foods growing in. marshy tation of their philosophy of science when one reaiises the
areas and wild venison were extremely popular in Wisconsin. conclusion-that Huver et alia draw from their research, They
The topography of Wisconsin-with its snowfalls and ex- predict that Wisconsin ·14 year-olds have an increased risk
tensive marshy, lichen and.moss-maden.Iands-i-is apparently of cancer from Just 3 radionucleides in their food - a risk
conducive to the establishment of radiation. pathways. double or more than 'the normal' cancer risk. They predict
Animals and foods with their sources in these terrains are ,that 14 year-old Wisconsin .gi,r,ls have an increased risk from,
more likely to 'carry' radioactivity from previous fall-out than all cancers equivalent to 25 per cent above the normal cancer
' other foods. Poaching of venison is so popular as to make risk. The authors remind us:
venison a staple diet formany Wisconsin families; thedeer
Some of the Strontium-90 that found· its way into baby's milk bottle
in the early I:950s is still in the cells of that individual'. Every year
graze on the marshy lands close to the areas of the state with
it delivers an additional' 'annual' dose. Every year it increases that
the highest concentrations of Wisconsin residents who are
individual's risk of cancer (p, 168).
either vegetarian, fresh-food conscious or opposed to proThe risk of cancer and the suffering it implies for ,incessed food, the authors point out the radiation hazards of
dividuals
is all the more astounding when one considers
diet containing berries, unmilled grains and soyabean. Not
that, by the tim.e these M year-olds become middlesaged',
even sunflower seeds escape their scrutiny as concentrators
they may never have been near a n.uclear reactor, may live
of Strontium-Su! Combining·factors - of diet, age, proximity
on. another continent, may never have worked in, the
to nuclear reactors, waste facilities for reprocessing nuclear
n.uclear
industry an.d may irnagin.e thems¢lves safe from
materials, age when ,testing was being undertaken - the
exposure. LEAF is saying that the damage has already been
authors attempt to devise a methodology for examining the
done. Low-level' radiation is inside the environment of
radiation exposure already received by the population. of
Wiscon.sin
and cannot go away. In the words of the
Wisconsin and the amounts that are still decaying in their
authors:
bones from previous exposures as the ·half-life of radioIt has been 'lost on the way to the ban'k' - it is irretrievable - •it will
active substances continues to decay · over decades. Their
never be safely contained in some ultimate waste storage repository.
methodology resembles that used in sociology and
It willinevitably affectthe health.of,individuals inthe Wisconsin case
psychology ·for multi-variable factor analysis.
study and others yet unborn (p. 179}.
.
. In the absence of a chapter presenting the authors' scien·For authors of Methodologies there is no 'return to nortific assumptions or philosophy of science, the reader is mality' ·after a reactor doses down or after testing halts. 1..ow- •
obliged to deduce for her/himself where the authors stand level radiation stiU continues its assault on. the celils of in136
Radical Journal of Health
dividuaI humans. For ;.this protracted notion of war against LEAF, brochures on 'Radioactive Milli', 'Healtn Foods and Radiation',
radiation hazards, this book's contribution to the literature
'Deer Hunters Beware', Sierra Club Waste Paper Bulletin, Vol. HI,
no. L
•
on low-level radiation is a welcome addition. For those who
seek a critical analysis of monitoring as a tool for politically • 4s Levidow, 'Three Mile Island - The Ideology of Safe Level' as ai
Material Force'; RSJ 9 (1979), 82-92.
cooling-out agitated residents and citizens, this is__not the text
Gianna Pornata, 'Seveso - Safety in Numbers?', RSJ 9 (1979), 69,81.
to peruse. But it could' serve as a useful' reference source for Deborah Rogers (ed), Threats to Wisconsin Communities, Pure/Wager,
the wider debate about disinformation techniques employed
1981, 66pp. Available from 306 North Brooks Street, Madison, WI
53715.
.
by the nuclear industry and its supporters.
References
Ernest Sternglass, Secret Fallout - Low-Level Radiarionfrom Hiroshima
to Three Mile ls/and, NY. McGraw-Hill, ,J981.
LEAF, 3368 Oak Avenue, Stevens Point, WI 54481, USA.
LEAF, Nuclear Waste - The Time Bomb in our Bones, 1980, $ 1.25.
(Reprinted from Radial Science Journal, Issue on 'No Clear
Reason' 1984.)
Hunger and Myth of Plenty
~
.:¾.·
,hernanl' d'meHo
Empty Stomachs and Packed Godowns: Aspeets.of the Food System in India by Bharat Dogra; published
by Bharat Dogra, D-7 Raksha Kunj, Paschim Vihar, New Delhi lH) 063; 1987,. pp Vl'H + 126, Rs 50.
THE stock of foodgrains in India has.increased from 11.7
million tonnes in 1980 to 29.2 million tonnes in 1985.
However, this huge stock of foodgrains is not an indication
of plenty. Rather, it is one of the symptoms of lack of purchasing power of the poverty stricken millions who suffer
from hunger and malnutrition. Bharae Dogra, a free Iance
journalist, presentsa radical outline of ,the food problem in
available to a majority of the people. For instance, the loss
ofnutritious ingredients in the course of mHiling of rice and
hydrogenation of edible oils. .
A few regions produce a surplus of foodgrains.te g, Punjab
and Haryana) while others remain deficient {e g, Bihar,
Madhya Pradesh, Orissa and West Bengal~. Similarly some
crops have performed Feasonably well (e g, wheat) while proIndia,
duction o.f some others have i:efatively stagnated (millets and
Mme than 70 per cent of rural households lack the means pu'1ses), The peF capita availabHity of millets (jowar, bajrn,
to avait of even the least-cost balanced'diet as recommended ragi etc), the food ofthe.poor, has been declining. The proby the Indian Council of Medical Research (ICMRY, which duction of pulses (chana, urd, mung, kulthi, masur etc), the
is the bare minimum ration. According to the author, the poor persons protein, has stagnated. The biggest failure of
Iandless labourers andl peasants operating upto one hectare the green -Fevolution is the failurn of high yielding varieties
of land; who constitute 47 per cent of the i:urcd agricultural (HYVs) of rice. HYVs have failed to give the pi:omised and
population, experience hunger and malnutrition in the most much publisised higher yields despite the application, of high
acute form. In several viliages where land' is infertile and in amounts of ferti,Iiser and irrigation water. The main i:eason
highly drought-prone areas, peasants operating more than
foi: this faHure is the high pest and disease s11sceptibiHty.of
one hectare of land also suffer from acute hunger and the new HYVs relative to the resistance to disease and pests
malnutrition .. The single most important cause of hunger and of the older varieties.
·
·
malnutrition is inequality which deprives a majority of the
There is an interesting chapter on the long term adverse
. population of access to resources which can be employed to
envirnnmental effects of the green revolution development
produce food on yield an income for purchasing food.
strategy in.Punjab. The growth.of legume crops (e g, grams)
Is India self-reliant in food? Self-reliance in food is defined
in rotation with cereal crops and ,i,nter-cropping practices used'
as the ability toproduee adequate quantities of all the food
to be beneficial; for maintaining the fer.tiility of the land.
items which are part of the diet of our people and are an However, during·the green revolution period, the a,rea und'ei:
important source of nutrition for them. The iCMR has pulses went down from 1' 3.4 per cent of the total are?, under
worked out the per capita requirements of basic foods for crops. in 1966-67 to·J ,per cent ,in, 1'982-83 and the area unctei:
different age groups doing different types of work. 'iFhis is oiil .seed's has gone down from 6.2-per cent of the totat area
multiplied by the total, number of people in these age groups under crops In, l966-'67 to 2.6 pei: cent in 1982-'83. Thei:e :has
doing different types of work and summed up to get the
been a greater reliance on chemical fei:tHiseri for maintain. requirements of basic foods at the national, level in India. ing the fertility of the soil Felative to the use of crop-rotations,
Domestic production falls short of requirements in cereals, i:nter-crop,ping practices and dung. :Fhls tendency to i:ely moi:e
pulses, milk and' oiils and fats. Large quantities of edible oils , on chemical fer:tilisers for maintain,ing the fertHity of the soil
and dairy products are imported. Besides large quantities. of relative. to-·other better and' cheaper method's ·has been critiinputs used in the production of food Hke fertilisers and cised by ecologists and other specialists; Thus Francis Mom
pesticides are imported, Thus India is not self-reliant in food Lappe and Joseph CoHins wi:ite In their classic, Food First
which.is contrary to what is being claimed in official quarters. that "The more one relies on chemi~al fertilisers instead of
On the other hand, agribusiness promotes a massive manure,, compost, crop ,rotation and green manme, :the ,more .
wastage of food. In its--rnthless..sia1~h for profits, it ignores the organic matter declines, the ·less ab le plants are to absorb
and hinders ,the basic task of making nutritious food inorganic ni~rog_en in chemical fertilisers. 'Fhis helps to exMai-ch 1987
137
plain why US agriculture, according to biologist Barry Commoner, now 'uses about five times as much fertilisers it did
The export of rice, is dearly an undesirable trend. The
changed significantly in many areas. In earlier days when
marketing of milk was not so extensive, a lot of milk used
to be converted to· ghee at the village level. A nutritious byproduct called 'cliaach' obtained in the process was consumed
by the poor. Now, with extensive marketing facilities for fresh
milk, lesser ghee is produced within the village and consequently the poor are deprived of 'chaach', Thus, the poor
are deprived of a significant share of milk-related proteins
while chocolates and ice-creams are produced for the
metropolitan market.
special attention to- forest conservation, and a revaluatitn ·
of traditional farming practices, These measures will fac~
existence of a 'surplus' stock is no, reason for exporting
in 1947 to produce the .~ame amount of crop". In fact, the. especially when millions of hungry andmitlnourished;people·
Punjab State Planning Board in a perspective plan for _ ate deprived ofadequate amounts of this staple food. Instead
;griculture (1980-2000) notes that the heavy reliance on largescaie employment generating programmes like soil and
wheat-rice rotation has "upset the ecological balance ofthe water conservation and afforestation couldbe launched,
state and the agro-ecosystem has become fragile".
India is the fourth larg7,5t exporter of tobacco. Tobacco
In a country where purchasing power is concentrated in not only takes upland that can be used to grow food crops
the hands of a small proportion of the population while the but it also destroys. the fertility of the soil. Export of fish
masses lack purchasing power, the rich spend extravagently and fish preparations has increased from 33,000 tonnes in
on expensive food while the poor cannot even purchase essen-. 1970-71 to 90,000 tonnes in 1984-85. Capital and technology '
tial foodgrains. The consumption of barley, used by the poor · has been imported for deep sea fishing to step up exports,
either as flour for making 'chapatis' or as parched grains bypassing the protein needs of the poor local people.
-.:.. ,
to make 'sattu', has been declining. Instead barley is being
-;:. -~
diverted into the preparation of malt for producing beer,
The author outlines the elements of a solution, towards
safisfying the nutrition needs of the people which inwhisky, candy etc. The organisation of the milk trade has elude the implementation of radical land re-distributien;
formidable opposition from the ruling classes. Thus they can
succeed only ~s part of a wider struggle for social, economic
and political emancipation of the oppressed.
The book is a competent, radical overview of the food
system in India. The author. however focusses on the problems of hunger and malnutrition in rural India, but the
urban situation has not been dealt with adequately.
Are you looking for news and analyses
which rarely make it to the national
·· press?
Reports about people largely igno:red?
I:
If you are, read Adhikar RAKSHA - the
voice of the civil rights moveme.nt, the
only r,a1 Opposition today
Started in 1977 •after the Emergency, brought out from Bombay every •·
quarter, it carries reports by civil rights groups all over India: be it
excerpts from the banned Oppression In Pµnjabby VM Tarkunde, or.
, from the Mishra Commission Report; historical judgements or protest
poetry
:I
To discover
the true nature of the l1ndian State
the myriad violations of our rights
Subscribe to Adhi'kar RAKSHA
Bulletin of the Committee for the
Prctectton ofDemocratle Rights (CPDR),
cl o Super Book !House,
Sind Chambers,
Colaba Causeway,
Bombay 400 005.
F
IJ~
Radical Journal of Heatth
Dialogue
. Vaccine
.
.
.-Production in ·Private Sector
A Comment
r s dahiya and peeyush sharma
THE new drug policy was announced on December 18,
1986. The totai thrust of the drug policy is antipeople=the,
whereas. this was given free of cost in the government
hospitals.
,
prices of various drugs will increase substantially (50 per cent'
b) Moreover immunoglobulins are also recommended\
to 300 per cent) .. Also, the new drug policy has given undue along with Rabipur injections which entail further cost of
concessions to foreign multinational drug companies and Rs. -300-400 .
• monopoly houses of India. The small and medium manufacc) Even a lay person can understand how far economical
Murers along. with public sector will get a set back with this
new drug policy. Its above impact can be understood with it isl-Of course it can be said to be economical when the cost
is, compared with other brand names where cost is Rs. 2100
one example.
·
~er all the vaccines were being manufactured by the for one course.
publifs°ector in India. There may be multi-factorial reasons
Is it potent and safe?
for these vaccines being in short supply, but in whatever
The advertisement pamphlet reads as under:
limited quantity, these were being provided to the general
L Slight reactions at the site of injection such as pain,
public free of cost in government hospitals.
erythema and swelling. may occur in less than 5 · per cent
One example can be taken that of antirabic vaccine. There patients.
have been many reports in newspapers about the short-supply
2. Isolated instances of lymphadenopathy, headache,
of these vaccines in govemmental hospitals. The reasons of lethargy, slight elevations of temperature and allergic reless production and lacunae in regular supply have not been actions of skin have- be reported.
thoroughly evaluated. The new drug policy has given the
3. No experiences are yet available with regard to adminisoption to private companies to manufacture these vaccines.' tration during pregnancy,
One of the companies Behring Biologicals, a division of
4. This should not be used where there is a known allergy
~- Hoechst India Limited has come out with an antirabic toneomycin, chlortetracycline, amphotericin B, or chicken
vaccine with a brand name of 'Rabipur'.
protein. Prophylactic vaccination should not be undertaken.
The various ·advantage of this vaccine oyer the already proThe above statements made by the company themselves
duced vaccine by public sector. are documented as follow: raise many suspicions.
' - New generation tissue culture vaccine.
1. Is the vaccine really as safe as claimed?
- Potent.
2 . Will this be experimented o,_n pregnant woman in India
- Safe.
as many other drugs are being experimented. Does the com- Economical.
pany consider that Indian pregnant women are guinea pigs?
- It is to be given· intramuscular instead of intraperitoneal,
-3. The only thing which is an improvement is that the route
'tire dosage is one injection on each of days 0, 3, 7, 14, of · administration is intramuscular rather than intra_._
30 and 90 (hence less drop out).
peritioneal but as the number of abscess formation in S/C
~ - Rabipur should be stored protected from light at + 2 to or I/M immunisation is increasing who _knows. what will be
s-c.
the percentage of abscesses with this I/M injections. ·
- Cost of 1 ml: is Rs. 100 whereas total dose is 6 ml. Thereby
The new drug policy byopenlng vaccine manufacture to
cost is Rs. 600 for one patient.
private firms will only cater to the needs of those who can
New certain questions can be raised.
pay Rs. 600 to Rs. 2000 for simple antirabic vaccination.
How is it economical?
-RS Dahiya
707, Sant Nagar
Rohtak 124 001
a) Its cost is Rs: 600 for one course whereas the cost of
vaccines manufactured by public sector is R~. 40 per vial,
Haryana
· Myth of Alternative Medicine
thomas george
THE so-called 'radical perspective' of medicine has many
i.degrees, but all of them agree that modern medicine is more
_,,__,,,,./ or less bad, ineffective and expensive ";hile traditional medical
"
systems are projected as a sort of magical remedy to all health
problems. This view has gone into the folklore of self-proclaimed
'radical' writers and has been repeated ad nauseam, without
March 1987
discrimination· of scientific examination. A cl~se look at this
concept reveals several' fundamental flaws; to the extent of making it a reactionary rather than a radical view point.
In the. first place, the glorification of traditional systems is
utopean and unrealistic. To keep recalling bygone 'golden ages'
is fruitless. The fact fs that at the present time, all traditional
139
systems of medicine are prim_itive and ineffective in comparison
to modern medicine. To call for research in'these systems is one
thing, to project them as qell-developed, near-perfect systems
is quite another, In fact, the whole business of counterposing
modern medicine and traditional systems, of making them appear antagonistic and mutually exclusive has no basis in reason.
'Any scientific system will incorporate the results of research c1;nd
care. To provide really good medical care of the quality available
in the west woul'd be expensive.How much easier to give_ the
shadow-and go on a propaganda campaign to pass It off as
better than the substance! And it is this very ludicrous propaganda that the "radicals' have swallowed. They have now put
themselves in the ~illy position of saying that the best is too good
for the poor, that they should have only what they are accustomed to-quacks and ·magic remedies!
. ·· · • ·
any boundaries are artificial and foreign to scientists. These
boundaries definitely do not serve the cause_ of science and are
The talk of community health and the attemP.t.;t9 produce
of use only to vested interests who make a living out of such
divisions. When one comes down to, the nitty-girtty and asks non-existent antagonism between preventive and-curative serfor .a point-by-point delineation of the ways in which traditional vices, is all part of the attempt to cloud :the 11eal' issues by posmedicine is superior, one comes up, not against a wali, but -ing symptoms of the disease .as.rhe disease itself. To ·cov~.up
against a.rnass of fluff-9ague statements about being closer the lacunaein the health services and the woefully inadeqauate~-';;;_
,
to the people," arising out 9f their 'milieu etc. When one is sick; budget spent on it by the expedient of posing it all as a problem
of
priorities
is
nothing
short
of
criminal.
And
when
'radicals'
it may be reassuring to, see one's grandmother but far more effective to see one's doctor! AH this boils down to saying that accept ,this kind of solution, they in effect accept that tlreflie'alth
promising lines of enquiry in any system should be subjected budgetis adequate, its aH a matter of rhore'j udicious sp~ding,
to rigorous scientific research and the results integrated into the they accept that the best care is impossible; .attitudes that are
knowledge available in health care. To rigorously demarcate not only defeatist, but a grotesque travesty of the truth.
'systems' is ridiculous, wasteful and unnecessary.
.
The true radical viewpoint on health would be that the most
On the question of cost also, one finds that the idea that scientific and effective system should be available to all irrespecayurveda, siddha·or unani is. cheap, an idea that the 'radicals' tive ofcost, One can accept compromises.In the interim period
have been trying to ram into our minds, is far from true. These towards achieving the goal, but any attempt to pass off the comsystems as they now exist are expensive, often more so, than promises as better than the goal itself should be stoutly resisted.
modern medici'ne. In this context it is surprising how self- We cannot accept second class care as good enough, for the poon
proclaimed socialists make such a fetish about cost.
,. The ultimate 'It is the duty of every democracy tQ,pFovide thebesti» all fields
aim of a socialist system is to provide the best life for its citizens, for aH its citizens and this is the objective for which we should =---'
.
not the cheapest. In fact ,it is interesting that emphasis on tradi- fight.
tlonal systems finds so much favour with'foreigr, aid agencies,
. ·'F,homas. George
many of them wings of multinationalcompanies, doing business
Orthopaedic Surgeon,
by other forms. One possible reason for this favour is that givES! Hospital,
ing respectability to all the quacks.in the countryside is a cheap
Asramam, Quiio~ 691002,
way of preventing rural people from demanding better health
0
Kerala.
ADVERSE EFPEC'fS
Women and the Pharmaceutical Industry
Edited by Kathleen McDonnell
Medical remedies whic·h are
inappropriate, wasteful and sometimes.simply downright dangerous,
overload the world, ldany "are
targetted sj>eeifically a.t women.
ADVERSE EFFECTS sets o~t to
examine, in· a· .global ,context, how
women are frequently exploited
and' injured by drugs. Articles
from India,, the Philippines·,
Canada, the Netherlands. and USA
i'ilustra te how -women are, ,suc_cessfully organising themselves to
fight this ill-treatment· and'
manipule.tion.
'ADVERSE EFFECTS is essential reading for health activists everywhere. '
- BARBARA EHRENREICH
Author and women 'shealth advocate
:1====
ocu,
Jnternalional'Organiulion-of-Consumers Unions
Regional·Ofricc P~O. ·Box 1045, ·10830 Penang, Malaysia.
:::,.
~::::::
~=-"=-'- ,Ccnlral Office 259S EG The Hague, "Netberlands.
ADVERfaE EFFECTS: ISBN 967-?973-1:-4 -1916 0 IOCU 217'.pagcs 5½''
)I
~Y.i'' :USS7;95-pb.
.
ll
----- --------------------. ------- ---------------- ------------ - -X .
140
Radical Journal of Health.
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PHYSICIAN'S OATH
AND
STATEMENT OF MEDICAL ETHICS.I
tAdnptt•d for th« 11111·l<·ar
:i~. ,
Over the millenia
.physicians have evolved a long tradition of ethical affirmation,
represented originally by the Oath of Hippocrates, and later
by many other national and international codes and
statements of prof~al ethical obligations!
Recently in May 1983
the World Health Organisation General Assembly stated that,
'nuclear. weapons constitute the greatest immediate threat
'
to the health and welfare of mankind', and that physicians
'have both the right and the. duty to draw attention
in the strongest possible terms to the catastrophic results
that would follow from any use of nuclear weapons'.
To our long tradition of ethical statements
we· believe-thaf t'.Iiere-·snou'ltl 'now ·be-added:·
"As a physician of the 20th century, I recognise
that nuclear weapons have presented my profession
with a challenge of unprecedented proportions,
and that a nuclear war would. be
the final epidemic for humaking.
J will do all in my power
for work for the prevention of nuclear war'.'
Proposed at the Third Congrvs« ,11 I ntt•rnational Physicians for
the Prevention of :\uclcar War. The Hague, Junt• 17-21. 1983
-,-
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