How Does Radiation Affect Humans?Radiation may come from either an external source, such as an x-ray machine, or an internal source, such as an injected radioisotope. The impact of radiation on living tissue is complicated by the type of radiation and the variety of tissues. In addition, the effects of radiation are not always easy to separate from other factors, making it a challenge at times for scientists to isolate them. An overview may help explain not only the effects of radiation but also the motivation for studying them, which led to much of the research examined by the Advisory Committee.
What effect can ionizing radiation have on chemical bonds?The functions of living tissue are carried out by molecules, that is, combinations of different types of atoms united by chemical bonds. Some of these molecules can be quite large. The proper functioning of these molecules depends upon their composition and also their structure (shape). Altering chemical bonds may change composition or structure. Ionizing radiation is powerful enough to do this. For example, a typical ionization releases six to seven times the energy needed to break the chemical bond between two carbon atoms.[91]This ability to disrupt chemical bonds means that ionizing radiation focuses its impact in a very small but crucial area, a bit like a karate master focusing energy to break a brick. The same amount of raw energy, distributed more broadly in nonionizing form, would have much less effect. For example, the amount of energy in a lethal dose of ionizing radiation is roughly equal to the amount of thermal energy in a single sip of hot coffee.[92] The crucial difference is that the coffee's energy is broadly distributed in the form of nonionizing heat, while the radiation's energy is concentrated in a form that can ionize.
What is DNA?Of all the molecules in the body, the most crucial is DNA(deoxyribose nucleic acid), the fundamental blueprint for all of the body's structures. The DNA blueprint is encoded in each cell as a long sequence of small molecules, linked together into a chain, much like the letters in a telegram. DNA molecules are enormously long chains of atoms wound around proteins and packed into structures called chromosomes within the cell nucleus. When unwound, the DNA in a single human cell would be more than 2 meters long. It normally exists as twenty-three pairs of chromosomes packed within the cell nucleus, which itself has a diameter of only 10 micrometers (0.00001 meter).[93] Only a small part of this DNA needs to be read at any one time to build a specific molecule. Each cell is continually reading various parts of its own DNA as it constructs fresh molecules to perform a variety of tasks. It is worth remembering that the structure of DNA was not solved until 1953, nine years after the beginning of the period studied by the Advisory Committee. We now have a much clearer picture of what happens within a cell than did the scientists of 1944.
What effect can ionizing radiation have on DNA?Ionizing radiation, by definition, "ionizes," that is, it pushes an electron out of its orbit around an atomic nucleus, causing the formation of electrical charges on atoms or molecules. If this electron comes from the DNA itself or from a neighboring molecule and directly strikes and disrupts the DNA molecule, the effect is called direct action. This initial ionization takes place very quickly, in about 0.000000000000001 of a second. However, today it is estimated that about two-thirds of the damage caused by x rays is due to indirect action. This occurs when the liberated electron does not directly strike the DNA, but instead strikes an ordinary water molecule. This ionizes the water molecule, eventually producing what is known as a free radical. A free radical reacts very strongly with other molecules as it seeks to restore a stable configuration of electrons. A free radical may drift about up to 10,000,000,000 times longer than the time needed for the initial ionization (this is still a very short time, about 0.00001 of a second), increasing the chance of it disrupting the crucial DNA molecule. This also increases the possibility that other substances could be introduced that would neutralize free radicals before they do damage.[94]Neutrons act quite differently. A fast neutron will bypass orbiting electrons and occasionally crash directly into an atomic nucleus, knocking out large particles such as alpha particles, protons, or larger fragments of the nucleus. The most common collisions are with carbon or oxygen nuclei. The particles created will themselves then set about ionizing nearby electrons. A slow neutron will not have the energy to knock out large particles when it strikes a nucleus. Instead, the neutron and the nucleus will bounce off each other, like billiard balls. In so doing, the neutron will slow down, and the nucleus will gain speed. The most common collision is with a hydrogen nucleus, a proton that can excite or ionize electrons in nearby atoms.[95]
What immediate effects can ionizing radiation have on living cells?All of these collisions and ionizations take place very quickly, in less than a second. It takes much longer for the biological effects to become apparent. If the damage is sufficient to kill the cell, the effect may become noticeable in hours or days. Cell "death" can be of two types. First, the cell may no longer perform its function due to internal ionization; this requires a dose to the cell of about 100 gray (10,000 rad). (For a definition of gray and rad, see the section below titled "How Do We Measure the Biological Effects of Radiation?") Second, "reproductive death" (mitotic inhibition) may occur when a cell can no longer reproduce, but still performs its other functions. This requires a dose of 2 gray (200 rad), which will cause reproductive death in half the cells irradiated (hence such a quantity is called a "mean lethal dose.")[96] Today we still lack enough information to choose among the various models proposed to explain cell death in terms of what happens at the level of atoms and molecules inside a cell.[97] If enough crucial cells within the body totally cease to function, the effect is fatal. Death may also result if cell reproduction ceases in parts of the body where cells are continuously being replaced at a high rate (such as the blood cell-forming tissues and the lining of the intestinal tract). A very high dose of 100 gray (10,000 rad) to the entire body causes death within twenty-four to forty-eight hours; a whole-body dose of 2.5 to 5 gray (250 to 500 rad) may produce death within several weeks.[98] At lower or more localized doses, the effect will not be death, but specific symptoms due to the loss of a large number of cells. These effects were once called nonstochastic; they are now called deterministic.[99] A beta burn is an example of a deterministic effect.
What long-term effects can radiation have?The effect of the radiation may not be to kill the cell, but to alter its DNA code in a way that leaves the cell alive but with an error in the DNA blueprint. The effect of this mutation will depend on the nature of the error and when it is read. Since this is a random process, such effects are now called stochastic.[100] Two important stochastic effects of radiation are cancer, which results from mutations in nongerm cells (termed somatic cells), and heritable changes, which result from mutations in germ cells (eggs and sperm).
How can ionizing radiation cause cancer?Cancer is produced if radiation does not kill the cell but creates an error in the DNA blueprint that contributes to eventual loss of control of cell division, and the cell begins dividing uncontrollably. This effect might not appear for many years. Cancers induced by radiation do not differ from cancers due to other causes, so there is no simple way to measure the rate of cancer due to radiation. During the period studied by the Advisory Committee, great effort was devoted to studies of irradiated animals and exposed groups of people to develop better estimates of the risk of cancer due to radiation. This type of research is complicated by the variety of cancers, which vary in radiosensitivity. For example, bone marrow is more sensitive than skin cells to radiation-induced cancer.[101]Large doses of radiation to large numbers of people are needed in order to cause measurable increases in the number of cancers and thus determine the differences in the sensitivity of different organs to radiation. Because the cancers can occur anytime in the exposed person's lifetime, these studies can take seventy years or more to complete. For example, the largest and scientifically most valuable epidemiologic study of radiation effects has been the ongoing study of the Japanese atomic bomb survivors. Other important studies include studies of large groups exposed to radiation as a consequence of their occupation (such as uranium miners) or as a consequence of medical treatment. These types of studies are discussed in greater detail in the section titled "How Do Scientists Determine the Long-Term Risks from Radiation?"
How can ionizing radiation produce genetic mutations?Radiation may alter the DNA within any cell. Cell damage and death that result from mutations in somatic cells occur only in the organism in which the mutation occurred and are therefore termed somatic or nonheritable effects. Cancer is the most notable long-term somatic effect. In contrast, mutations that occur in germ cells (sperm and ova) can be transmitted to future generations and are therefore called genetic or heritable effects. Genetic effects may not appear until many generations later. The genetic effects of radiation were first demonstrated in fruit flies in the 1920s. Genetic mutation due to radiation does not produce the visible monstrosities of science fiction; it simply produces a greater frequency of the same mutations that occur continuously and spontaneously in nature.Like cancers, the genetic effects of radiation are impossible to distinguish from mutations due to other causes. Today at least 1,300 diseases are known to be caused by a mutation.[102] Some mutations may be beneficial; random mutation is the driving force in evolution. During the period studied by the Advisory Committee, there was considerable debate among the scientific community over both the extent and the consequences of radiation-induced mutations. In contrast to estimates of cancer risk, which are based in part on studies of human populations, estimates of heritable risk are based for the most part upon animal studies plus studies of Japanese survivors of the atomic bombs.
The risk of genetic mutation is expressed in terms of the doubling dose: the amount of radiation that would cause additional mutations equal in number to those that already occur naturally from all causes, thereby doubling the naturally occurring rate of mutation.
It is generally believed that mutation rates depend linearly on dose and that there is no threshold below which mutation rates would not be increased. Spontaneous mutation (unrelated to radiation) occurs naturally at a rate of approximately 1/10,000 to 1/1,000,000 cell divisions per gene, with wide variation from one gene to another.
Attempts have been made to estimate the contribution of ionizing radiation to human mutation rates by studying offspring of both exposed and nonexposed Japanese atomic bomb survivors. These estimates are based on comparisons of the rate of various congenital defects and cancer between exposed and nonexposed survivors, as well as on direct counting of mutations at a small number of genes. For all these endpoints, no excess has been observed among descendants of the exposed survivors.
Given this lack of direct evidence of any increase in human heritable (genetic) effects resulting from radiation exposure, the estimates of genetic risks in humans have been compared with experimental data obtained with laboratory animals. However, estimates of human genetic risks vary greatly from animal data. For example, fruit flies have very large chromosomes that appear to be uniquely susceptible to radiation. Humans may be less vulnerable than previously thought. Statistical lower limits on the doubling dose have been calculated that are compatible with the observed human data. Based on our inability to demonstrate an effect in humans, the lower limit for the genetic doubling dose is thought to be less than 100 rem.[104]
The President's ChargeThe Advisory Committee was created under the Federal Advisory Committee Act of 1972, which provides that committee meetings and basic decision making be conducted in the open. The Committee's charter[4] defined human radiation experiments to include
- experiments on individuals involving intentional exposure to ionizing radiation. This category does not include common and routine clinical practices.
- experiments involving intentional environmental releases of radiation that (A) were designed to test human health effects of ionizing radiation; or (B) were designed to test the extent of human exposure to ionizing radiation.
In essence, we were to answer several fundamental questions: (l) What was the federal government's role in human radiation experiments conducted from 1944 to 1974? (2) By what standards should the ethics of these experiments be evaluated? and (3) What lessons learned from studying past and present research standards and practices should be applied to the future?
In addition, while the Committee was not expressly charged with considering issues relating to remedies, including financial compensation, we have felt obliged to address the type of remedies that we believe the government, as an ethical matter, should provide to subjects of experiments where the circumstances warranted such a response.
______
The Manhattan Project: A New and Secret World of Human ExperimentationIn August 1942, the Manhattan Engineer District was created by the government to meet the goal of producing an atomic weapon under the pressure of ongoing global war. Its central mission became known as the Manhattan Project. Under the direction of Brigadier General Leslie Groves of the Army Corps of Engineers, who recently had supervised the construction of the Pentagon, secret atomic energy communities were created almost overnight in Oak Ridge, Tennessee, at Los Alamos, New Mexico, and in Hanford, Washington, to house the workers and gigantic new machinery needed to produce the bomb. The weapon itself would be built at the Los Alamos laboratory, under the direction of physicist J. Robert Oppenheimer.Plucked from campuses around the country, medical researchers came face to face with the need to understand and control the effect upon the thousands of people, doctors included, of radioactive materials being produced in previously unimaginable quantities.
In November 1942 General Groves, through the intermediation of an Eastman Kodak official, paid a call on University of Rochester radiologist Stafford Warren. Rochester, like MIT and Berkeley, was another locale where radiation research had brought together physicists and physicians. "They wanted to know what I was doing in radiation. So I discussed the cancer work and some of the other things," Warren told an interviewer in the 1960s. Then "[w]e got upstairs and they looked in the closet and they closed the transom and they looked out the window. . . . Then they closed and locked the door and said, 'Sit down.'"[22]
Soon thereafter, Dr. Warren was made a colonel in the U.S. Army and the medical director of the Manhattan Project. As his deputy, Warren called on Dr. Hymer Friedell, a radiologist who had worked with Dr. Stone in California. Dr. Stone himself had meanwhile moved to the University of Chicago, where he would play a key role in Manhattan Project-related medical research.
Initially, researchers knew little or nothing about the health effects of the basic bomb components, uranium, plutonium, and polonium. [23] But, as a secret history written in 1946 stated, they knew the tale of the radium dial painters:
The memory of this tragedy was very vivid in the minds of people, and the thoughts of potential dangers of working in areas where radiation hazards existed were intensified because the deleterious effects of radiation could not be seen or felt and the results of over-exposure might not become apparent for long periods after such exposure. [24]The need for secrecy, Stafford Warren later recalled, compounded the urgency of understanding and controlling risk. Word of death or toxic hazard could leak out to the surrounding community and blow the project's cover. [25]
The need to protect the Manhattan Project workers soon gave rise to a new discipline, called health physics, which sought to understand radiation effects and monitor and protect nuclear worker health and safety. The Project was soon inundated with data from radiation-detection instruments, blood and urine samples, and physical exams. The "clinical study of the personnel," Robert Stone wrote in 1943, "is one vast experiment. Never before has so large a collection of individuals been exposed to so much radiation." [26] Along with these data-gathering efforts came ethical issues.
Would disclosure of potential or actual harm to the workers, much less the public, impair the program? For example, a July 1945 Manhattan Project memo discussed whether to inform a worker that her case of nephritis (a kidney disease) may have been due to her work on the Project. The issue was of special import because, the memo indicated, the illness might well be a precursor of more cases. The worker, the memo explained, "is unaware of her condition which now shows up on routine physical check and urinalysis." [27]
As this memo showed, there was an urgent need for decisions on how to protect the workers, while at the same time safeguard the security of the project: "The employees must necessarily be rotated out, and not permitted to resume further exposure. In frequent instances no other type of employment is available. Claims and litigation will necessarily flow from the circumstances outlined." There were also, the memo concluded, "Ethical considerations":
The feelings of the medical officers are keenly appreciated. Are they in accordance with their canons of ethics to be permitted to advise the patient of his true condition, its cause, effect, and probable prognosis? If not on ethical grounds, are they to be permitted to fulfill their moral obligations to the individual employees in so advising him? If not on moral grounds, are those civilian medical doctors employed here bound to make full disclosure to patients under penalty of liability for malpractice or proceeding for revocation of license for their failure to do so? [28]It is not clear what was decided in this case. However, the potential conflict between the government doctors' duty to those working on government projects and the same doctors' obligations to the government would not disappear. Following the war, as we see in chapter 12, this conflict would be sharply posed as medical researchers studied miners at work producing uranium for the nation's nuclear weapons.
Another basic question was the extent to which human beings could or should be studied to obtain the data needed to protect them. The radium dial painter data served as a baseline to determine how the effects of exposures in the body could be measured. But this left the question of whether plutonium, uranium, and polonium behaved more or less like radium. Research was needed to understand how these elements worked in the body and to establish safety levels. A large number of animal studies were conducted at laboratories in Chicago, Berkeley, Rochester, and elsewhere; but the relevance of the data to humans remained in doubt.
The Manhattan Project contracted with the University of Rochester to receive the data on physical exams and other tests from Project sites and to prepare statistical analyses. While boxes of these raw data have been retrieved, it is not clear what use was made of them.[29] Accidents, while remarkably few and far between, became a key source of the data used in constructing an understanding of radiation risk. But accidents were not predictable, and their occurrence only enhanced the immediacy of the need to gain better data.
In 1944, the Manhattan Project medical team, under Stafford Warren and with the evident concurrence of Robert Oppenheimer, made plans to inject polonium, plutonium, uranium, and possibly other radioactive elements into human beings. As discussed in chapter 5, the researchers turned to patients, not workers, as the source of experimental data needed to protect workers. By the time the program was abandoned by the government, experimentation with plutonium had taken place in hospitals at the Universities of California, Chicago, and Rochester, and at the Army hospital in Oak Ridge, and further experimentation with polonium and uranium had taken place at Rochester.
The surviving documentation provides little indication that the medical officials and researchers who planned this program considered the ethical implications of using patients for a purpose that no one claimed would benefit them, under circumstances where the existence of the substances injected was a wartime secret. Following the war, however, the ethical questions raised by these experiments would be revisited in debates that themselves were long kept secret.
In addition to experimentation with internally administered radioisotopes, external radiation was administered in human experiments directed by Dr. Stone at Chicago and San Francisco and by others at Memorial Hospital in New York City. Once again, the primary subjects were patients, although some healthy subjects were also involved. In these cases, the researchers may have felt that the treatment was of therapeutic value to the patients. But, in addition to the question of whether the patients were informed of the government's interest, this research raised the question of whether the government's interest affected the patients' treatment. As discussed in chapter 8, these questions would recur when, beginning in 1951, and for two decades thereafter, the Defense Department would fund the collection of data from irradiated patients.
Ensuring safety required more, however, than simply studying how radioactive substances moved through and affected the human body. It also involved studying how these substances moved through the environment. While undetectable to the human senses, radiation in the environment is easily measurable by instruments. When General Groves chose Hanford, on the Columbia River in Washington state, as a site for the plutonium production facility, a secret research program was mounted to understand the fate of radioactive pollution in the water, the air, and wildlife.[30]
Outdoor research was at times improvisational. Years after the fact, Stafford Warren would recall how Manhattan Project researchers had deliberately "contaminated the alfalfa field" next to the University of Rochester medical school with radiosodium, to determine the shielding requirements for radiation-measuring equipment. Warren's associate Dr. Harold Hodge recalled that a shipment of radiosodium was received by plane from Robley Evans at MIT, mixed with water in a barrel, and poured into garden sprinklers:
We walked along and sprinkled the driveway. This was after dark. . . . The next thing, we went out and sprayed a considerable part of the field. . . . It was sprayed and then after a while sprayed again, so there was a second and third application. We were all in rubber, so we didn't get wet with the stuff . . . then Staff [Warren] said that one of the things we needed was to see what would be the effect on the inside of a wooden building. So we took the end of the parking garage, and we sprinkled that up about as high as our shoulders, and somebody went inside and made measurements, and we sprinkled it again. Then we wanted to know about the inside of a brick building, and so we sprinkled the side of the animal house. . . . I had no idea what the readings were. . . I hadn't the foggiest idea of what we were doing, except that obviously it was something radioactive.[31]Outdoor releases would put at risk unsuspecting citizens, even communities, as well as workers. There were no clear policies and no history of practice to guide how these releases should be conducted. As we explore in chapter 11, this would be worked out by experts and officials in secret, on behalf of the workers and citizens who might be affected.
The Atomic Energy Commission and Postwar Biomedical Radiation ResearchOn August 6, 1945, when the atomic bomb was dropped on Hiroshima, the most sensitive of secrets became a symbol for the ages. A week later, the bomb was the subject of a government report that revealed to the public the uses of plutonium and uranium.[32]Immediately, debate began over the future of atomic energy. Could it be controlled at the international level? Should it remain entirely under control of the military? What role would industry have in developing its potential? Although American policymakers failed to establish international control of the bomb, they succeeded in creating a national agency with responsibility for the domestic control of atomic energy.The most divisive question in the creation of the new agency that would hold sway over the atom was the role of the military. Following congressional hearings, the Atomic Energy Commission was established by the 1946 McMahon Act, to be headed by five civilian commissioners. President Truman appointed David Lilienthal, former head of the Tennessee Valley Authority, as the first chairman of the AEC, which took over responsibilities of the Manhattan Engineer District in January 1947.
Also in 1947, under the National Security Act, the armed services were put under the authority of the newly created National Military Establishment (NME), to be headed by the secretary of defense. In 1949 the National Security Act was amended, and the NME was transformed into an executive department--the Department of Defense.[33] The Armed Forces Special Weapons Project, which would coordinate the Defense Department's responsibilities in the area of nuclear weapons, became the military heir to the Manhattan Engineer District. The Military Liaison Committee was also established as an intermediary between the Atomic Energy Commission and the Defense Department; it was also to help set military requirements for the number and type of nuclear weapons needed by the armed services.
Even before the AEC officially assumed responsibility for the bomb from the Manhattan Project, the Interim Medical Advisory Committee, chaired by former Manhattan Project medical director Stafford Warren, began meeting to map out an ambitious postwar biomedical research program. Former Manhattan Project contractors proposed to resume the research that had been interrupted by the war and to continue wartime radiation effects studies upon human subjects.[34]
In May 1947, Lilienthal commissioned a blue-ribbon panel, the Medical Board of Review, that reported the following month on the agency's biomedical program. In strongly recommending a broad research and training program, the board found the need for research "both urgent and extensive." The need was "urgent because of the extraordinary danger of exposing living creatures to radioactivity. It is urgent because effective defensive measures (in the military sense) against radiant energy are not yet known." The board, pointing to the AEC's "absolute monopoly of new and important tools for research and important knowledge," noted the commensurate responsibilities--both to employees and others who could suffer from "its negligence or ignorance" and to the scientific world, with which it was obliged to "share its acquisitions . . . whenever security considerations permit."[35] In the fall of 1947, as recommended by the Medical Board of Review, the AEC created a Division of Biology and Medicine (DBM) to coordinate biomedical research involving atomic energy and an Advisory Committee for Biology and Medicine (ACBM), which reported directly to the AEC's chairman.[36]
Not surprisingly, the DBM and ACBM became gathering places for the luminaries of radiation science. The ACBM was headed by a Rockefeller Foundation official, Dr. Alan Gregg. It settled on Dr. Shields Warren, a Harvard-trained pathologist, to serve as the first chief of the DBM. Warren, as we shall see, would play a central role in developments related to radiation research and human experimentation. In the 1930s, focusing on cancer research, and influenced by the work of Hevesy and the pioneering radioisotope work being done in Berkeley and Boston, Warren turned to the question of the effects of radiation on animals and the treatment of acute leukemia, the "most hopeless . . . of tumors at that time." As the war neared, Warren enlisted in the Naval Reserve. He continued medical work for the Navy, turning down an invitation to join Stafford Warren (no relation) on "a project . . . that he couldn't tell me anything about [the Manhattan Project]."[37]
While most of the AEC's budget would be devoted to highly secret weapons development and related activities, the biomedical research program represented the commission's proud public face. Even before the AEC opened its doors, Manhattan Project officials and experts had laid the groundwork for a bold program to encourage the use of radioisotopes for scientific research, especially in medicine. This program was first presented to the broad public in a September 1946 article in the New York Times Magazine. The article began dramatically by describing the use of "radioactive salt" to measure circulation in a crushed leg, so that a decision on whether to amputate below or above the knee could be made.[38]
By November 1946, the isotope distribution program was well under way, with more than 200 requests approved, about half of which were designated for "human uses." From the beginning, the AEC's Isotope Division at Oak Ridge had in its program director, Paul Aebersold, a veritable Johnny Appleseed for radioelements.[39] In presentations before the public and to researchers, Aebersold, dubbed "Mr. Isotope," touted the simplicity and low cost with which scientists would be provided with radioisotopes: "The materials and services are made available . . . with a minimum of red tape and under conditions which encourage their use."[40] At an international cancer conference in St. Louis in 1947, the AEC announced that it would make radioisotopes available without cost for cancer research and experimental cancer treatment. This, Shields Warren later recalled, had a "tremendous effect" and "led to a revolution in the type of work done in this field."[41]
To AEC administrators, Aebersold emphasized the benefits to the AEC's public image: "Much of the Commission's success is judged by the public and scientists . . . on its willingness to carry out a wide and liberal policy on the distribution of materials, information, and services," he wrote in a memo to the AEC's general manager.[42]
The AEC biomedical program as a whole also provided for funding of cancer research centers, research equipment, and numerous other research projects. Here, too, were advances that would save many lives. Before the war, radiotherapy had reached a plateau, limited by the cost of radium and the inability of the machines of the time to focus radiation precisely on tumors to the exclusion of surrounding healthy tissue. AEC facilities inherited from the Manhattan Project could produce radioactive cobalt, a cheaper substitute for radium. As well, the AEC's "teletherapy" program funded the development of new equipment capable of producing precisely focused high-energy beams.[43]
The AEC's highly publicized peacetime medical program was not immune to the pressures of the Cold War political climate. Even the lives of young researchers in the AEC Fellowship Program conducting nonclassified research were subject to Federal Bureau of Investigation review despite protests from commission members. Congressionally mandated Cold War requirements such as loyalty oaths and noncommunist affidavits, Chairman Lilienthal declared, would have a chilling effect on scientific discussion and could damage the AEC's ability to recruit a new generation of scientists.[44] The reach of the law, the Advisory Committee for Biology and Medicine agreed, was like a "blighting hand; for thoughtful men now know how political domination can distort free inquiry into a malignant servant of expediency and authoritarian abstraction."[45]Nonetheless, the AEC accepted the congressional conditions for its fellowship program and determined to seek the program's expansion.[46]
The AEC's direct promotional efforts were multiplied by the success of Aebersold and his colleagues in carrying the message to other government agencies, as well as to industry and private researchers. This success led, in turn, to new programs.
In August 1947, General Groves urged Major General Paul Hawley, the director of the medical programs of the Veterans Administration, to address medical problems related to the military's use of atomic energy. Soon thereafter, Hawley appointed an advisory committee, manned by Stafford Warren and other medical researchers. The advisers recommended that the VA create both a "publicized" program to promote the use of radioisotopes in research and a "confidential" program to deal with potential liability claims from veterans exposed to radiation hazards.[47] The "publicized" program soon mushroomed, with Stafford Warren, Shields Warren, and Hymer Friedell among the key advisers. By 1974, according to VA reports, more than 2,000 human radiation experiments would be performed at VA facilities,[48] many of which would work in tandem with neighboring medical schools, such as the relationship between the UCLA medical school, where Stafford Warren was now dean, and the Wadsworth (West Los Angeles) VA Hospital.
While the AEC's weapons-related work would continue to be cloaked in secrecy, the isotope program was used by researchers in all corners of the land to achieve new scientific understanding and help create new diagnostic and therapeutic tools. It was, however, only a small part of an enormous institution. By 1951 the AEC would employ 60,000 people, all but 5,000 through contractors. Its land would encompass 2,800 square miles, an area equal to Rhode Island and Delaware combined. In addition to research centers throughout the United States, its operations "extend[ed] from the ore fields of the Belgian Congo and the Arctic region of Canada to the weapons proving ground at Enewetak Atoll in the Pacific and the medical projects studying the after-effects of atomic bombing in . . . Japan."[49] The Isotope Division, however, would employ only about fifty people and, when reactor production time was accounted for, occupy only a fraction of its budget and resources.[50]
The Aftermath of Hiroshima and Nagasaki: The Emergence of the Cold War Radiation Research BureaucracyWhile promoting the beneficial uses of radiation, the government also wished to continue and expand research on its harmful effects. Three days after the destruction of Hiroshima, Robert Stone wrote two letters to Stafford Warren's deputy, and Stone's former student, Hymer Friedell. The first expressed hope that the contribution of medical researchers could now be made public, so that people would know what they had done during the war.[57] The second letter described Stone's "mixed feelings" at the success that had been achieved and his fear that the lingering effects of radiation from the bomb had been underestimated: "I could hardly believe my eyes," Stone wrote, "when I saw a series of news releases said to be quoting Oppenheimer, and giving the impression that there is no radioactive hazard. Apparently all things are relative."[58]Friedell and other researchers, including Stafford Warren and Shields Warren, soon traveled to Hiroshima and Nagasaki to begin what became an extensive research program on survivors. The data from that project quickly became and still remain the essential source of information on the long-term effects of radiation on populations of human beings. It was not long, however, before there were additional real-life data on the bomb, from postwar atomic tests. In 1946, the United States undertook the first peacetime nuclear weapons tests at Bikini Atoll in the Marshall Islands. Operation Crossroads, conducted before journalists and VIPs from around the world, was intended to test the ability of a flotilla of unmanned ships to withstand the blast. Since most of the ships remained afloat, the Navy declared Crossroads a triumph.[59]
Behind the scenes, however, Crossroads medical director Stafford Warren expressed horror at the level of contamination on the ships due to the underwater atomic blast.[60] When the ships returned to the West Coast from the Pacific, they were extensively studied to assess the damage and contamination from the atomic bombs. The government created the Naval Radiological Defense Laboratory (NRDL) to study the effects of atomic bombs on ships and to design ways to protect them. "Crossroads," according to an NRDL history, "left no doubt that man was faced with the necessity for coping with strange and unprecedented problems for which no solutions were available."[61]
Hiroshima and Nagasaki, it now seemed, were only the beginning, not the end, of human exposure to bomb-produced radiation. As Crossroads confirmed with the lingering problem of contaminated ships, what the bomb did not obliterate it might still damage by radiation over the course of days or years. It was no longer enough to know about the effects of radioactive materials on American nuclear weapons workers; now there was the urgent need to understand the effects on American soldiers, sailors, and even citizens as well.
Largely invisible to the public, an ad hoc bureaucracy sprang up to address the medical and radiation research problems of atomic warfare. This bureaucracy brought together former wartime radiation researchers, who were joined by junior colleagues, to advise, and participate in, the government's growing radiation research program. Other, already established groups--such as the AEC's Division of Biology and Medicine and its advisory committee--also had important places in the new network.
Beyond considering fallout from the testing of atomic bombs, these groups also looked at how radiation itself might be used as a weapon. During the war, scientists like J. Robert Oppenheimer had speculated on the possibility that fission products (radioactive materials produced by the bomb or by reactors) could be dispersed in the air and on the ground to kill or incapacitate the enemy. In 1946, the widespread contamination of ships at Crossroads by radioactive mist gave dramatic evidence of the potential of so-called radiological warfare, or RW. In 1947, the military created a committee of experts to study the problem. The following year, a blue-ribbon panel of physicians and physicists looked at the prospects, both offensive and defensive, of what the Pentagon termed "Rad War." The work of these panels would lead to dozens of intentional releases of radiation into the environment at the Army's Dugway, Utah, testing grounds from the late 1940s to the early 1950s. The very fact that the government was engaged in RW tests was a secret. Indeed, the records of the RW program--including, as we shall see in chapter 11, the debate on what the public should be told about the program--would remain largely secret for almost fifty years.
In 1949, a military program to build a nuclear-powered airplane led to a set of proposed human radiation experiments. The NEPA (Nuclear Energy for the Propulsion of Aircraft) program had its origins in 1946 as a venture that included the Manhattan Project's Oak Ridge site, the military, and private aircraft manufacturers. Robert Stone, as we shall see in chapter 8, was a leading proponent of experiments involving healthy volunteers, as a key to answering questions about the radiation hazard faced by the crew of the proposed airplane.
The NEPA and RW groups considered important, but still discrete, projects. Where did the "big picture" discussions take place? The Advisory Committee has pieced together the records of the Armed Forces Medical Policy Council, the Committee on Medical Sciences, and the Joint Panel on the Medical Aspects of Atomic Warfare.[62] These three Defense Department groups, all chaired by civilian doctors, guided the government on both the broad subject of military-related biomedical research and the new and special problems posed by atomic warfare.
If the surviving records are an indication, from its creation in 1949 to its evident demise with the reorganization of the Defense Department in 1953, the Joint Panel quickly became the hub of atomic warfare-related biomedical research. The Joint Panel gathered information about relevant research from all corners of the government, provided guidance for Defense Department programs, and reviewed and coordinated policy in the matter of human experimentation using atomic energy.
By charter, the group was to be headed by a civilian. Harvard's Dr. Joseph Aub, a long-standing member of the Boston-based medical research community who had worked with Robley Evans on the study of the radium dial painters and had also studied lead toxicity, served as chair. Those who served with Aub included Evans, Hymer Friedell, and Louis Hempelmann, Oppenheimer's Manhattan Project medical aide. Other government participants came from the AEC, the Public Health Service, the National Institutes of Health, the Veterans Administration, and the CIA. (The charter provided that the Joint Panel should collect information on relevant research conducted abroad, which the CIA evidently provided.)[63]
This bureaucracy provided the venue for secret discussions that linked the arts of healing and war in ways that had little precedent. At one and the same time, for example, doctors counseled the military about the radiation risk to troops at the site of atomic bomb tests, advised on the need for research on the "psychology of panic" at such bomb tests, and debated the need for rules to govern atomic warfare-related experimentation. (See chapter 10.)
The records of the Joint Panel show that, during the height of the Cold War, the resources of civilian agencies were part of the mobilization of resources to serve national security interests. For example, Dr. Howard Andrews, trained as a physicist, was the National Institutes of Health's representative to the Joint Panel, and in the 1950s he worked with the DOD and the AEC in monitoring safety measures and measuring fallout from nuclear tests.[64]
In 1950 President Truman ordered federal agencies, including the Public Health Service and NIH, to focus their resources on activities that would benefit national security needs. On paper, at least, PHS and NIH policymakers sought to direct resources to questions of radiation injury, civil defense, and worker health and safety.[65] For example, a 1952 internal planning memo explained that NIH "will not wait for formal requests by the armed forces . . . to undertake research which NIH staff knows to be of urgent military and civilian defense significance. Limited selective conversion of research to work directly related to biological warfare, shock, radiation injury and thermal burns will begin immediately. . . ."[66] The fragmentary surviving documentation, however, does not show the extent to which PHS- and NIH-funded researchers actually redirected their investigations or merely recast the purpose of ongoing work.
Whether to Experiment with Humans: The Debate Is JoinedSpurred by proposals for human radiation experiments connected with the nuclear-powered airplane (NEPA) project, AEC and DOD medical experts in 1949 and 1950 engaged in debate on the need for human experimentation. The transcript of a 1950 meeting among AEC biomedical officials and advisers and military representatives provides unique insight into the mix of moral principles and practical concerns.[67]The participants in the debate included many of the key medical figures in the Manhattan Project and the postwar radiation research bureaucracy. For the Navy, for example, Captain Behrens, the editor of Atomic Medicine, made the point that an atomic bomb might contaminate, but not sink, ships. The Navy would need to know the risk of sending rescue or salvage parties into the contaminated area. There were questions of "calculated risk which all of the services are interested in, and not only the services but probably the civilians as well."[68] Brigadier General William H. Powell, Jr., of the Office of the Air Force Surgeon General, added further questions: How does radiation injure tissue? Can equipment protect against the bomb's effects? Is there a way to treat radiation injury? How should mass casualties be handled?[69]
These questions were hardly abstract. Operation Crossroads had demonstrated that postblast contamination of Navy ships was a serious hazard. The use of the atomic bomb as a tactical weapon, declared Brigadier General James Cooney of the AEC's Division of Military Applications, "has now gone beyond the realm of possibility and into the realm of probability."[70] This meant that "we have a responsibility that is tremendous," Cooney added. "If this weapon is used tactically on a corps or division, and we have, say, 5,000 troops who have received 100 R[oentgens] radiation, the Commander is going to want from me, 'Is it all right for me to reassemble these men and take them into combat?' I don't know the answer to that question."[71] Commanders needed to know "How much radiation can a man take?"[72]
Cooney argued that human experimentation was necessary. He invoked the military's tradition of experimentation with healthy volunteers, dating back to Walter Reed's famous work on yellow fever at the turn of the century. Cooney urged that the military seek volunteers within its ranks--"both officer and enlisted"--to be exposed to as much as 150 R of whole-body radiation.[73]
The AEC's Shields Warren took the other side in this debate. Warren raised two basic points in response to Cooney. First, human experimentation was not essential because animal research would be adequate to find the answers. Second, data from human experimentation would likely be scientifically useless. "We have," Warren declared, "learned enough from animals and from humans at Hiroshima and Nagasaki to be quite certain that there are extraordinary variables in this picture. There are species variables, genetics variables within species, variations in condition of the individual within that species." The danger of failing to provide data had to be weighed against the danger of providing misleading data: "It might be almost more dangerous or misleading to give an artificial accuracy to an answer that is of necessity an answer that spreads over a broad range in light of these variables."[74]
There were, moreover, political obstacles to the program Cooney had proposed. Satisfactory answers, Warren concluded, would require "going to tens of thousands of individuals." But America was not the Soviet Union: "If we were considering things in the Kremlin, undoubtedly it would be practicable. I doubt that it is practicable here."[75]
At the heart of Warren's objections to Cooney's proposal was a concern about employing "human experimentation when it isn't for the good of the individual concerned and when there is no way of solving the problem."[76] To Cooney's invocation of Walter Reed, Warren responded that, in the case of yellow fever, humans were needed as subjects because there was no nonhuman host to the disease.
Cooney did not disagree with Warren "that statistically we will prove nothing." But, he pointed out, "[G]enerals are hard people to deal with. . . . If we had 200 cases whereby we could say that these men did or did not get sick up to 150 R, it would certainly be a great help to us."[77]
Even then, Warren rejoined, the data might not be of great use: "I can think in terms of times when even if everybody on a ship was sea-sick, you would still have to keep the ship operating."[78]
The 1950 debate over NEPA provides clear evidence that midcentury medical experts gave thought before engaging in human experimentation that involved significant risk and was not intended to benefit the subject. On paper, the debate was decided in Shields Warren's favor. Following Warren's and DBM's opposition, Cooney and the military agreed that "human experimentation" on healthy volunteers would not be approved. However, even as this policy was declared, the Defense Department, with Warren's apparent acquiescence, proceeded to contract with private hospitals to gather data on sick patients who were being treated with radiation. The government's use of sick patients for research, as we shall see in chapter 8, raised difficult ethical questions of its own.
Whether to Put Populations at Risk: The Debate ContinuesAs the medical experts debated the issue of whether to put individual human subjects at risk in radiation experiments on behalf of NEPA, they were also engaged in secret discussions about whether to proceed with the testing of nuclear weapons, which might put whole populations at risk.It was also in 1950 that the decision was made to carry out atomic bomb testing at a site in the continental United States. President Truman chose the Nevada desert as the location for the test site. Shields Warren's Division of Biology and Medicine was assigned the job of considering the safety of early tests. Like the earlier transcript, an account of a May 1951 meeting at Los Alamos, convened by Warren, provides a window onto the balancing of risks and benefits by medical researchers.
The meeting focused on the radiological hazards to populations downwind from underground testing planned at the Nevada Test Site. Those in attendance realized that the testing could be risky. "I would almost say from the discussion this far," Warren summarized, "that in light of the size and activity of some of these particles, their unpredictability of fallout, the possibility of external beta burns is quite real."[79] Committee members considered the testing a "calculated risk" for populations downwind, but they thought that the information they could gain made the risk worthwhile. According to the record of the meeting, Warren summarized the view of Dr. Gioacchino Failla, a Columbia University radiological physicist: "[T]he time has come when we should take some risk and get some information . . . we are faced with a war in which atomic weapons will undoubtedly be used, and we have to have some information about these things . . . if we look for perfect safety we will never make these tests."[80] Worried about the potential consequences of miscalculation, the AEC's Carrol Tyler observed, "We have lost a continental site no matter where we put it." Still, Tyler argued, "If we are going to gamble it might as well be done where it is operationally convenient."[81] A proposed deep underground test did not take place, and a test evidently considered less risky was substituted. Ultimately, in a summary prepared at the end of the 1951 test series, the Health Division leader of the AEC's Los Alamos Laboratory recorded that perhaps only good fortune had averted significant contamination: "Thanks to the kindness of the winds, no significant activity was deposited in any populated localities. It was certainly shown however," he wrote, "that significant exposures at considerable distances could be acquired by individuals who actually were in the fallout while it was in progress."[82]
The NEPA debate and the advent of nuclear testing confronted biomedical experts with a set of conflicting, and even contradictory, objectives. First, they were called upon to offer advice on decisions that might inevitably put people at some risk. The risk had to be balanced against the benefit, which in most instances was defined as connected with the nation's security. In many cases, the experts agreed, it was better to bear the lesser risk now, in order to avoid a greater risk later. Second, these experts were also called upon, as in the 1951 Nevada test, to provide advice on minimizing risk. Third, as in the Nevada test, these same experts saw the tests as opportunities to gather data that might ultimately be used to reduce risk for all.
Whether and What the Public Should Be Told About Government-Created Radiation RiskScientific research had a long and celebrated tradition of open publication in the scientific literature. But several factors caused Cold War researchers to limit their public disclosures. These included, preeminently, concern with national security, which necessarily required secrecy. But they also included the concern that the release of research information would undermine needed programs because the public could not understand radiation or because the information would embarrass the government.The tension between the publicizing of information and the limits on disclosure was a constant theme in Cold War research. When, in June 1947, the Medical Board of Review appointed by David Lilienthal reported on the AEC's biomedical program, it declared that secrecy in scientific research is "distasteful and in the long run contrary to the best interests of scientific progress."[83] As shown by its organization of the medical isotope program, the AEC acted quickly to make sure that the great preponderance of biomedical research done under its auspices would be published in the open literature.
However, recently retrieved documents show that the need for secrecy was also invoked where national security was not endangered. At the same time that biomedical officials, such as those on the Medical Board of Review, spoke openly of the need to limit national security restrictions, internally they sometimes sided with those who would restrict information from the public even where release admittedly would not directly endanger national security. Thus, as we shall see in chapter 13, Shields Warren and other AEC medical officials agreed to withhold data on human experiments from the public on the grounds that disclosure would embarrass the government or could be a source of legal liability.
A further important qualification to what the public could know related to research connected with the atomic bomb--including the creation of a worldwide network to gather data on the effects of fallout from nuclear tests. In 1949, the AEC undertook Project Gabriel, a secret effort to study the question of whether the tests could threaten the viability of life on earth. In 1953, Gabriel led to Project Sunshine, a loose confederation of fallout research projects whose human data-gathering efforts, as we see in chapter 13, operated in the twilight between openness and secrecy.
Finally, while documents show that medical experts and officials shared an acute awareness of the importance of public support to the success of Cold War programs, this awareness was coupled with concern about the American public's ability to understand the risks that had to be borne to win the Cold War. The concern that citizens could not understand radiation risk is illustrated by a recently recovered NEPA transcript. In July 1949, the nuclear airplane project gathered radiation experts and psychologists to consider psychological problems connected to radiation hazard. To the assembled experts the greatest unknown was not radiation itself, but the basis for public fear and misunderstanding of radiation.
"I believe," General Cooney proposed, "that the general public is under the opinion that we don't know very much about this condition [radiation]. . . . We know," he ventured, "just about as much about it as we do about many other diseases that people take for granted . . . even tuberculosis."[84]
Yet, said the Navy's Captain Behrens, "there are some peculiar ideas relative to radiation that are related to primitive concepts of hysteria and things in that category. . . . There is such a unique element in it; for some it begins to border on the mystical."[85] A good deal of the public's fear of radiation, declared Berkeley's Dr. Karl M. Bowman, a NEPA medical adviser, "is essentially the fear of the unknown. The dangers have been enormously magnified." As Dr. Bowman and others noted, the public's perception was not without reason, for "we have emphasized for purposes of getting funds for research how little we know."[86]
The perspective expressed in the NEPA transcript would lead, as shown in chapter 10, to the use of atomic bomb tests to perform human research on the psychology of panic and, as shown in other case studies, to decisions to hold information closely out of concern that its release could create public misunderstanding that would imperil important government programs.
In view of all these uncertainties, what risk estimates did the Committee choose?Despite all these uncertainties, it must be pointed out that more is known about the effects of ionizing radiation than any other carcinogen.The BEIR V Committee of the National Academy of Sciences estimated in 1990 that the lifetime risk from a single exposure to 10 rem of whole-body external radiation was about 8 excess cancers (of any type) per 1,000 people. (This number is actually an average over all possible ages at which an individual might be exposed, weighted by population and age distribution.) For continuous exposure to 0.1 rem per year throughout a lifetime, the corresponding estimate was 5.6 excess cancers (that is, over and above the rate expected in a similar, but nonexposed population) per 1,000 people. It is widely agreed that for x rays and gamma rays, this latter figure should be reduced by some factor to allow for a cell's ability to repair DNA, but there is considerable uncertainty as to what figure to use; a figure of about 2 or 3 is often suggested.[112]
The estimates of lifetime risk from the BEIR V report have a range of uncertainty due to random variation of about 1.4- fold. The additional uncertainties, due to the factors discussed earlier, are likely to be larger than the random variation.
In comparison, for most chemical carcinogens, the uncertainties are often a factor of 10 or more. This agreement among studies of radiation effects is quite remarkable and reflects the enormous amount of scientific research that has been devoted to the subject, as well as the large number of people who have been exposed to doses large enough to show effects.
Hunters Point-Treasure Island historyAccording to Da Costa, 95 percent of what we know as the Hunters Point Naval Shipyard, like Treasure Island, is landfill. In the late ‘40s, early ‘50s, the Navy demolished two huge hills. That dirt expanded the shipyard.
Navy policymaking was conducted at Treasure Island, the Navy’s official headquarters. Command staff enjoyed magnificent views of the City and the Bay from their homes on Yerba Buena Island, high above.
Engineers and scientists worked at Hunters Point, known for shipbuilding and experiments. During World War II, depleted uranium was first tested there. Prior to moving to Lawrence Livermore, the National Defense Lab was located at the shipyard, where Little Boy, the bomb dropped on Hiroshima, was assembled.
Ships present at Bikini Island bomb tests returned to Hunters Point and Treasure Island. Sandblasting at Hunters Point sprayed much of the radioactive residue into the Bay and scattered it through shipyard soil.
Da Costa describes “intense” and “serious” lab experiments and scientific tests. In close proximity to the seven-story National Defense Lab was the UCSF lab at Palou and Navy Road. The National Defense Laboratory, the UCSF Lab and Lawrence Livermore Labs collaborated on experiments.
During World War II, the 10-story above-ground, four-story below-ground Naval Radiological Laboratory was used for testing and building bombs, missiles and other weapons.
Canisters containing cesium and radium were transported through half- and quarter-mile underground tunnels.
Large animals – horses, cows – were brought to the shipyard, experimented upon and tested, then their radioactive carcasses buried all over the shipyard.
Da Costa reports that, in distinction to the Hunters Point Naval Shipyard, most of Treasure Island’s radioactive contamination came from spills. For example, aircraft carriers would jettison a spent capsule contaminated with nuclear fuel residue from the vessel onto the ground and into the water.
Navy policymaking was conducted at Treasure Island, the Navy’s official headquarters. Command staff enjoyed magnificent views of the City and the Bay from their homes on Yerba Buena Island, high above.
Engineers and scientists worked at Hunters Point, known for shipbuilding and experiments. During World War II, depleted uranium was first tested there. Prior to moving to Lawrence Livermore, the National Defense Lab was located at the shipyard, where Little Boy, the bomb dropped on Hiroshima, was assembled.
Ships present at Bikini Island bomb tests returned to Hunters Point and Treasure Island. Sandblasting at Hunters Point sprayed much of the radioactive residue into the Bay and scattered it through shipyard soil.
Da Costa describes “intense” and “serious” lab experiments and scientific tests. In close proximity to the seven-story National Defense Lab was the UCSF lab at Palou and Navy Road. The National Defense Laboratory, the UCSF Lab and Lawrence Livermore Labs collaborated on experiments.
During World War II, the 10-story above-ground, four-story below-ground Naval Radiological Laboratory was used for testing and building bombs, missiles and other weapons.
Canisters containing cesium and radium were transported through half- and quarter-mile underground tunnels.
Large animals – horses, cows – were brought to the shipyard, experimented upon and tested, then their radioactive carcasses buried all over the shipyard.
Da Costa reports that, in distinction to the Hunters Point Naval Shipyard, most of Treasure Island’s radioactive contamination came from spills. For example, aircraft carriers would jettison a spent capsule contaminated with nuclear fuel residue from the vessel onto the ground and into the water.
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Details of first production of HAIR
This is a rare program (playbill) from the Original San Francisco engagement of the groundbreaking GEROME RAGNI, JAMES RADO and GALT MacDERMOT American Tribal Love-Rock Musical "HAIR" at the Orpheum Theatre in San Francisco, California. (The production originally opened October 29th, 1967 at New York's Joseph Papp Public Theatre and ran for 49 performances. An overwhelming demand for tickets resulted in a move December 22nd, 1967 to the Cheetah Theatre, a former discotheque on Broadway at 53rd Street, where it ran for an additional 45 performances. The production later opened April 29th, 1968 at the Biltmore Theatre in New York City and ran for 1750 performances. The San Francisco engagement began August 29th, 1969 and ran for over two years.) ..... "HAIR" is a rock musical which was the product of the hippie counter-culture and sexual revolution of the 1960's. Several of its songs became anthems of the anti-Vietnam War peace movement. The musical's profanity, its depiction of the use of illegal drugs, its treatment of sexuality, its irreverence for the American flag, and its nude scene caused much controversy and as a result initially made it difficult to find a home in a Broadway theatre. The show broke new ground in musical theatre by defining the genre of the "rock musical" and utilizing a racially-integrated cast. Hair was conceived by actors JAMES RADO and GEROME RAGNI (both members of the Original Broadway and Aquarius Theater Casts). The two actors met in 1964, when they acted together in the Off-Broadway play Hang Down Your Head and Die, and they began writing Hair together in early 1965. The main characters of Claude and Berger were autobiographical, Rado's Claude being the pensive romantic and Ragni's Berger the extrovert. Their close relationship, sometimes volatile, is symbolized in the show by the well known ballad "Easy to be Hard". In addition to the two authors, the Original Broadway Cast included a young DIANE KEATON and MELBA MOORE. Other prominen |
Philip Michael Thomas "HAIR" Orpheum Theatre 1969 San Francisco Program
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