Interview with Dr. David Richardson on Public Healh
By Elin Slavick

Doctor David Richardson is an epidemiologist working at the World Health Organization’s International Agency for Research on Cancer in Lyon, France. He will return to the University of North Carolina at Chapel Hill as a Research Associate in the School of Public Health (an institution sloughing off its decades-old commitment to public health to begin bio-chemical military research). He has published his research in many leading public health and scientific journals. He recently traveled to Lithuania and Moscow to visit their nuclear facilities and to collect data, and to Australia with the Medical Association for the Prevention of War.

As an art professor, active socialist, and David’s comrade of six years, I have worked with him to bring artists Sue Coe and Cornelia Hesse-Honegger to the University of North Carolina's Chapel Hill campus to show and speak about some of their work, which reveals the horrors of the American meat processing industry and the effects of radiation on insects near nuclear facilities. We have worked with Students for Economic Justice to undo the multimillion dollar contracts with NIKE and other corporations on campus, and are active participants in the Carolina Socialist Forum. We are currently enjoying our last months in Lyon, where police in full-riot gear hit protestors behind the knees and stole their banners at a Mumia Abu Jamal rally staged at the City Hall for the US Ambassador, who was in town to inaugurate the direct flight from NYC to Lyon. While we are in a relatively socialist country, the powers that be are as interested in protecting private wealth as they are in the US. I spoke with David about his work, ideas, projects, and the current state of public health.

eos: When I first met you and you told me you were an epidemiologist, I thought you studied skin. So, what is Epidemiology?
Dr. David: It’s the study of who gets diseases; when, where, and why diseases occur.

eos: Does an epidemic have to occur before you do an epidemiological study?
Dr. David: At minimum, someone has to raise the concern that there is a problem. Often these are little epidemics rather than plagues of biblical proportion. An epidemic might just mean that more people in a group are sick than might be expected. In some cases, such as diseases related to low-level environmental contamination, an epidemiologist might be looking for evidence of relatively small increases in disease.

eos: How is Public Health different from the Medical Establishment?
Dr. David: Medicine is focused on treating diseases of individuals. Public Health is, or should be, focused on collectives. Public Health includes people working in nutrition, maternal and child health, sexual health, and the prevention of occupational and environmental diseases.

eos: Has Public Health been successful?
Dr. David: Public Health efforts have been responsible for most of the major reductions in diseases. It has been more successful than modern medicine’s efforts to treat individual patients. Things like public sanitation and water services, worker safety programs, and efforts to provide basic nutrition and decent places to live have been the best things we have done to improve health.

Recently, in the US, a substantial amount of effort at schools of Public Health has moved away from collective changes towards projects that require expensive technologies and that focus on things that individuals should do—like take hormone replacements pills or quit smoking. In many cases, this reflects decisions to focus on promoting even better health for the wealthiest while ignoring systemic problems for the uninsured and underserved.

eos: Why this shift?
Dr. David: Part of the answer is that there is research money available for approaches that are profit-making. If there is a pill that can be sold or a blood test that can be marketed, it will be funded by a corporation. An enormous effort by epidemiologists is now directed at identifying a gene that can be screened for, or a substance that can be ingested, which will change your risk of heart disease or cancer. This leaves aside non-market-driven study questions like, can heart disease be reduced by changing peoples’ access to foods through legislation on pricing? (Currently we provide huge subsidies for products like refined sugar). There is also a focus on diseases that plague the affluent and the insured. Government research agendas are responsive to the lobbying efforts of the politically powerful and adept. This includes breast and prostate cancer, which are certainly real health problems. But it is illustrative of what is studied and what is left aside; there are numerous diseases that are well understood, preventable, and yet there appears to be little political will to intervene in their eradication. You have cases of silicosis (dust related lung disease) in the US among sandblasters, farm laborers dying of heat exhaustion, and poultry workers suffering from crippling repetitive stress injuries. One type of disease is not more important than another. It’s a question of whose health problems are receiving attention and whose aren't. Unfortunately, the people with the least access to basic medical care are also being neglected by public health officials and workers. The professional class of researchers study the health problems of the professional class.

eos: What is one of the projects that you've been working on?
Dr. David: I am still involved in an ongoing project with the residents around Three Mile Island (TMI) and their class action suit. These are residents who have been waiting since the 1979 accident for a fair hearing and some sense of justice. The nuclear industry has formed what they call the "Pools," which includes many of the US nuclear utilities, to fight a legal battle against the residents around TMI. Consequently the industry has more money than God and has been able to drag the court case out for years. Meanwhile, the residents are still waiting for a trial in which they can talk publicly about their experiences and health problems as a result of the accident.
eos : The research you did found large increases in cancer after TMI, right?
Dr. David: Yes. The radiation traveled in plumes of radioactive gas so that there were some downwind areas that received higher exposures than others. Cancer rates were higher in the downwind areas and the rates changed over time. They were higher after the accident than before the accident. The official government estimate is that radiation doses from the accident were only a fraction of what a person receives from natural sources each year. The fact that we observed substantial increases in cancer downwind of TMI, only after the accident, suggests that those estimates are way off base. This is not surprising to the residents around TMI, who describe the painful deaths of pets and farm animals, people losing hair, spontaneous bleeding, and nausea during the accident.

eos : So, how were your findings used?
Dr. David: The research was presented as evidence in the class action suit. The judge made the surprising decision not to allow the residents to present evidence from their chosen experts. She excluded evidence from environmental engineers and meteorologists. She allowed us to include our evidence, but only for certain types of cancers. In the end, after excluding a long list of expert testimony, she decided there was inadequate evidence to have a trial.

eos: That’s unbelievable.
Dr. David: A recent court decision has reopened the possibility of a jury trial, but this is now more than 20 years since the accident. Many people, including myself, are skeptical of seeing justice through the courts.

eos: Does the story which they based the recent Hollywood movie Erin Brokovitch on give you any hope that justice is possible?
Dr. David: There are cases in which people may be successful at winning a legal battle against a powerful criminal organization. In large part, it may depend upon factors like luck and chance. In most cases, the form of justice is a financial settlement, and perhaps an admission of guilt. In that narrow sense, there may be cases of legal justice, but it’s often of little consolation to parents who have lost a child, or to a person who has lost her partner. In the TMI case, a large number of the litigants are seeking some form of an admission of guilt by the utility company. Some members of the class action suit have been offered large cash payments on the condition of silence. They have refused because they want to see the company go to court.

eos: What else have you been working on?
Dr. David: I've been studying cancer among nuclear workers in the US and other countries. These people were not studied for decades. In recent years they began to fear that their diseases were caused by exposures on the job. After decades of officials asserting that nobody was harmed by exposures at these facilities, the government has begun to acknowledge that there were problems. This has important implications for the hundreds of thousands of people exposed to on-the-job radiation today, and the even larger number of people living in areas with radiation contamination. Studying former nuclear workers is one way to better understand the risks that come from repeated low-level exposures to radiation.

eos : You don’t mean "background radiation," do you?
Dr. David: The term "background radiation" is interesting for the very reason that some people’s background radiation is higher than other people’s background radiation. In part, that’s a result of natural exposures to radiation from rocks or space, but it’s also a result of political and economic decisions about who is most exposed to radiation from nuclear weapons tests and nuclear facilities. We need to redefine "background" to include these exposures. Our background has become contaminated. This raises a more general point about environmental diseases. The people who often bear the heaviest burden from environmental exposure are excluded from political decisions. For example, hazardous waste incinerators tend to be in black and poor neighborhoods. The problems of environmental contamination are problems of social justice.

eos: Would you give a brief history of radiation exposures and their proved link to cancer?
Dr. David: There are more than a million people in the US who are exposed to ionizing radiation on the job. There are large numbers of soldiers and civilians exposed to radiation. In addition, the vast majority of Americans will be exposed to radiation from medical and dental procedures. All of us have been exposed to increasing levels of environmental sources of radiation—from nuclear weapons tests to routine releases from nuclear power and waste facilities, and commercial uses of radiation. So, everyone should be concerned about the health effects of being exposed to radiation. This isn’t really a question about whether radiation causes cancer. Any increase in radiation exposure increases the risk for cancer.

Currently, the US government sets limits on occupational and environmental exposure to radiation that are based on studies they’ve done on the survivors of Hiroshima and Nagasaki (A-bomb Studies). Beginning in 1950, while Japan was under the control of US occupying forces, a study of the long-term health effects from the bombings was undertaken. Early findings provided reassuring results to the government researchers. There seemed to be little evidence of long term effects, like cancer. The only health problems were from the immediate destructive effects of the bombs, like burns and physical injuries.

eos: You seem to be implying that there are problems with the A-bomb Studies?
Dr. David: Only the healthiest people in Hiroshima and Nagasaki lived through the devastation—the epidemic diseases, the burns, fires, lack of sanitation and food. It has to be stressed that studies of the A-bomb survivors began in 1950, five years after the attack. Tens of thousands of people died prior to the start of these studies. The old, the very young, and the feeble were more likely to die. So, you’re studying the fittest members of the Japanese population.

Further, nobody in the A-bomb Study was individually monitored for radiation exposure. Instead, beginning in 1950 scientists began to ask survivors where they were when the bomb exploded. Using information about their position and estimates of shielding, like from buildings, they calculated doses. Any questionnaire has problems with inaccurate responses, made worse by the fact that in Japan there are reasons for people to be ashamed about exposures. Women found it difficult to marry as A-bomb survivors. The inaccuracy of the study can be seen when you look at people who suffered acute effects from high doses of radiation—like burns, hair loss, spontaneous bleeding—but were estimated to have received only low doses based on the questionnaire.

eos: And are the A-bomb Studies still used?
Dr. David: They are the basis for current radiation protection standards. They are using a study of survivors of a nuclear attack in which people were exposed to a sudden flash and unmeasured high doses of radiation, as the basis for worker and public protection in situations where people are normally exposed to repeated low-level radiation. It just doesn’t make sense.

eos: Some people think that bias in the media is different than bias in scientific publications. Do you?
Dr. David: Until the late 1970s, there were no published studies of radiation workers. This is surprising because the nuclear industry had been operating for more than 30 years and was possibly the largest US government project in history. Government documents indicate some of the reasons why studies weren’t done and why information was kept secret. The government believed that health studies of workers in the nuclear industry would only create problems of legal liability and problems with unions. By the 1960s they determined the best course of action was to not study occupational and environmental health problems at all. When a workers’ health study was finally undertaken at the end of the 1960s, it was described as a study NOT intended to find any problems. It was to provide the Department of Energy (DOE) with a study that showed that workers were not being hurt on the job. However, when the study was completed in 1976, it did indeed find excess cancers among workers at the Hanford Nuclear Plant in Washington State. The researcher in charge of The project was attacked publicly, the study was criticized, and his contract was terminated. Similarly, at Rocky Flats in Colorado, a health study found evidence of excess cancer. Again, the researcher was confronted by his superior and was told that he was not doing studies for research journals, but to please his employer, the DOE. At Oak Ridge National Lab, in Tennessee, a similar story was played out. When a study of workers found an increase in cancer death rates related to radiation exposure on the job (increases that were ten-fold higher than expected from the A-bomb Study) the researcher was told to go back to his university and come up with the "right" answer. This has been the institutional pressure exerted by the DOE on scientists. The US Government has conceded that the DOE no longer has the public’s confidence and can not conduct credible health research.
Many journals have also practiced forms of self-censorship. They have chosen not to publish findings that challenge orthodox opinions about effects of radiation because in their words, "this will prompt controversy and letters to the editor." Or that these topics should be left to specialized journals dealing with nuclear issues, rather than be treated as public or medical health problems.

eos: We can’t talk about all this and not mention Dr. Alice Stewart. Unfortunately, most readers of this interview probably don’t even know who she is because of the internal and external censorship that occurs in medical journals, but even more so because the nuclear industry and first world governments don’t want you to know who she is.
Dr. David: I agree. Alice Stewart is the woman who showed that prenatal exposure to a single diagnostic x-ray could lead to a doubling of a child’s risk of cancer. In the 1950s, Dr. Stewart started a study of childhood cancers. For any child in England, Scotland, and Wales who died of cancer, she interviewed the mother, as well as a mother of a living child of the same age and sex in the region. It quickly became apparent that the children who had died of cancer were substantially more likely to have been exposed to radiation when they were a fetus. In England, it was common for doctors to take x-rays of pregnant women as a form of what they called "pelvimetry," that is, measuring the size of the mother’s pelvis before delivery. Her findings enraged the medical establishment for several decades because of their investment in x-ray procedures and their resentment of the implication that they were harming their patients. However, it’s now accepted that very low doses of radiation are dangerous to the fetus. Dr. Stewart is largely responsible for changing medical practice.

She continues to be deliberately overlooked and goes unmentioned even in articles about her research. In her 90s, she continues to do research, publish, and to challenge the orthodoxy. She is an inspiration. There is a recent biography on her called The Woman Who Knew Too Much, by Gayle Greene.

eos: What do you think is the main cause of cancer?
Dr. David: There is probably no single cause of cancer. I view cancer as a process of interaction between people and the environment they are living in. That’s a dialectic operating on a full range of scales, so that you might think of molecules like DNA in their watery cellular environment, cells and organs in our bodies that we feed and expose to sun and chemicals, or individuals in their built environments. When you read that a gene for cancer has been found, or that a particular chemical is a cause of cancer, that’s only less than half the picture.

Causes of cancer are only meaningful within a specific historical context as well. For example, for the contemporary Ethiopian, low-level exposure to radiation will not lead to a measurable increase in cancer. This is because they’re unlikely to live long enough to die of cancer. So, causes of cancer are meaningful only in the context of competing causes of death, access to medical care, your entire social environment.

eos: Do you think that we can cure cancer?
Dr. David: Some people’s cancers are treated and cured. Given the amount of funding, probably more types of cancer will be treatable. But, this leaves open the question of who gets treated and who doesn’t. Equally important, whose cancers are diagnosed early enough to be treatable, who gets quality care necessary for treatment. These are the types of problems that come from a consumerist approach to cancer treatment and health care in general. It’s extremely expensive. It involves waiting until people are diseased before taking any action. There are inequities in who lives and who dies. The alternative is to think about cancer as an often-preventable disease and focus on issues of health rather than disease treatment.

eos: What would be your recommendation for the amount of radiation one could be exposed to without risk?
Dr. David: There is no safe dose of radiation. When any amount of ionizing radiation passes through your body it can change molecules, disrupt your cells, cause problems for your DNA. Down the line, that can lead to cancer. For people who are setting rules about what level of radiation is acceptable for workers and the public to receive, they are making some decision about the number of extra cancers that is acceptable to them. Regulators of occupational exposures to radiation say that the number of acceptable cancer deaths is supposed to be roughly equivalent to the number of deaths on the job in other trades. The trades used in comparison aren’t things like secretaries, scientists or government regulators, but the most dangerous job, which is coal mining.

eos: What is a person to do?
Dr. David: People need to act to protect themselves and to protect each other. Examples of self-protection include confronting your doctors and dentists (if and when you see them) about their use of diagnostic x-rays. Before being exposed, find out if the results of the x-ray will change the course of treatment. Both at the local and global level, there are anti-nuclear campaigns.

There are communities affected by the nuclear age who are struggling for openness about histories of exposures they’ve received, better information about the consequences of those exposures, and compensation for wrongs done in the past. Some groups to work with are: Physicians for Social Responsibility, Greenpeace, and if you’re working with nuclear technologies you can organize with PACE, a union that struggles to protect workers from radiation hazards. Wherever there is a nuclear facility, there is usually an anti-nuclear community group. These campaigns and groups are important because the decisions we make today have consequences for thousands of years.

We’re currently using nuclear technologies for electricity, weapons, and products like medical isotopes. All of this creates a legacy of nuclear waste, which limits our options for how we organize a democratic society. This sounds like a grand statement, but it’s essentially true and a frightening prospect. The huge amount of plutonium and high-level nuclear waste that we’ve already produced means that we have a legacy of incredibly dangerous stockpiled material that has to be monitored and guarded for tens of thousands of years. This is longer than the existence of any written language. In order to take care of this legacy we’re required to have at least some form of centralized government to oversee it. The bigger this problem gets, the more we cut ourselves off from possibilities of decentralized, smaller, democratic forms of self-government. These are huge choices. While this seems like a battle against a monolithic power, the anti-nuclear movement has been amazingly successful.

In the US, it is now politically impossible for the industry to build any new power stations. At least for now, the nuclear weapons complex is scaling back. A few years ago, in Munster, Germany (I was there for a radiation conference), they practically had to declare Marshall law to transport nuclear waste through the city because of the number of protestors. You probably didn’t hear about it on the evening news or see it in the papers, but it happened and continues to happen every day, sometimes on a smaller scale, sometimes on a much larger scale. The point is there are people who are organized and who are fighting back.