What Is Really Going On in Fukushima, by Keiichi Nakagawa
English translation by Christopher Holmes of What Is Really Going On in Fukushima, by Keiichi Nakagawa,
Chapter 1, pages 15-40 of the original
Chapter 1 Radiation Quiz: True or False? Know the facts, don't panic!
Why it's OK to dump contaminated water into the ocean
For the past three years since the earthquake, a lot of attention has been paid in the mass media and
elsewhere to the release of radioactively contaminated water from Tokyo Electric Power Company
(TEPCO)'s Fukushima Daiichi nuclear power plant; the public regards this as a serious problem.
Amounts of this contaminated waste water increase constantly as natural underground water from the
mountains flows into the coolant water which contains radioactive substances inside the power plant itself,
and ways have been under study to siphon off this water and dump it into the sea before it gets into the plant
building. The consent of fishermen and fishery businesses was not obtained until May 2014, when water
discharge began, subject to strict criteria.
It was decided to undertake a large-scale construction project to prevent groundwater from leaking in by
freezing the soil around the building; it is expected that this would take more than a year to complete.
Amounts of this contaminated water are increasing at the rate of 400 tons a day; the plant site already houses
some 1000 tanks for this water. A look at the tanks packed side by side suffices to convince you that there's
nothing to do about it except to dump it.
When you hear that this is "contaminated" water, instinctively (and understandably) you feel that this is
unsafe. Let's take a moment to see whether this is really so. Currently, purifying equipment is removing
almost all radioactive substances from contaminated waste water; all that remains in it is tritium, the
radioactive isotope of hydrogen. Tritium emits only very, very low-energy beta rays. Unlike gamma rays,
which are emitted by radioactive cesium (and other high-energy particles), these beta rays don't enter our
bodies. Beta rays can't penetrate the skin, so a layer of skin is enough to keep them out. There is therefore no
danger of external irradiation (from outside the body).
What about internal exposure? Well, if you were to drink, every day, two liters of water each liter of which
was contaminated at the level of 60,000 becquerels (the maximum allowed in water discharged into the sea),
after a year your total exposure would be 0.8 millisieverts. Incidentally, what "becquerels" measure is the
number of rays emitted in one second; it has nothing to do with the effect on the human body. The unit you
should be concerned about is not becquerels (units of radioactivity) but sieverts (a measure of the effect on
health).
To explain this with an analogy to rain, becquerels describe how the rain falls, sieverts describe how wet you
get.
This is why discharging water containing tritium not exceeding 60,000 becquerels per liter into the ocean is
authorized. One hundred becquerels per liter of cesium in drinking water would be a completely different
matter.
So as I was saying, even if you drank two liters a day of water radioactively contaminated at the discharge
limit of 60,000 becquerels per liter (which is not possible in reality), your exposure in one year would be
about 0.8 millisieverts. Currently tritium levels in seawater off the coast of Fukushima are below detectable
limits.
The Japanese undergo "natural" internal exposure to about 1 millisievert per year, mostly due to their intake
of fish and shellfish containing polonium, a naturally occurring radioactive substance. Excessive anxiety
over contaminated water is therefore mostly unwarranted.
The worst-case scenario is one in which another earthquake should strike the huge park of giant tanks on the
nuclear plant site and cause spillage of large amounts of contaminated water that has not yet been purified of
its radioactive substances. TEPCO and Japan's government bear of course a heavy responsibility for this
situation, but given the urgent need to deal with the contaminated water as quickly as possible, I feel that
once they've removed all the radioactive substances whose removal from the water is technically possible,
the water should be diluted so the levels of remaining tritium meet the standard criteria and then discharged
into the sea. We need to look at what is really going on, judge cool-headedly what is really dangerous and
what is not, based on objective data.
Excessive decontamination is unnecessary
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Now let's look at decontamination. To begin with, the natural or "background" level of exposure to radiation
in Japan is lower than in other countries, about 2 millisieverts per year on average. But there's another fact
you should consider: during medical procedures, the Japanese expose themselves voluntarily to radiation at
the world's highest level: 3.87 millisieverts per year on average! But the reason for this behavior is a good
one: Japan is a place where people can receive the most medical care anytime, anywhere. For example, the
Japanese visit a hospital or a doctor's office on average 13 times a year. The corresponding figure for the
United States of America is four times and for Sweden is three times a year. The kind of universal health
care that the Japanese can get anytime, anywhere, is the envy of the world; many countries see Japan as a
model to aspire to.
I studied in Switzerland and in Sweden and learned how difficult it is to get medical treatment at a hospital in
Europe. Every single hospital seems to be ensconced in a bureaucratic shell. If you call up the town office, a
public health nurse will most likely tell you to go to bed and rest. No resident of Switzerland goes to see a
doctor when she catches a cold. If you want to have a head CT done, they'll just tell you you can't. They
won't do a head CT just because you have a headache.
On the other hand, one-third of the world's CT scanners are found here in Japan. That's precisely why
medical exposure to radiation is so high in Japan: there are CT scanners available in every clinic. A single
CT scan exposes the patient, on average, to about 7 millisieverts (although of course the level of exposure
differs depending on the scanner). And yet CT scans are an extremely effective way to detect pathological
conditions and they contribute to the Japanese people's longevity. The point is that there's a balance between
the merits and the demerits of the technology.
You must not forget that the Japanese have the world's greatest longevity and the world's highest medical
radiation exposure. Taking all this into account, instead of spending trillions of yen on decontamination for
the purpose of reducing exposure to 1 millisievert or less, I believe it would be better to spend some money
on citizens' risk communication.
By "risk communication" I mean programs to facilitate a dialogue, two-way exchange of information,
between accident and disease victims and experts. After the nuclear accident, what was most immediately
needed was a correct understanding of what radiation really does; what is important now is to address the
anxieties and suspicions of individual victims by providing them with clear answers. This boils down to
assisting residents who have taken it upon themselves to solve their own problems, which means building
networks of people from different backgrounds with different skills and needs, and I think it calls also for an
approach to organization that makes the most of specialists' knowledge and the particular individual skills of
each person at each stage in each situation. Residents form the core of this kind of network, and it's not so
much a matter of their getting other people to do something for them, but of their finding ways to work
together with other people.
Radiation is what kicked off the whole adjustment process in Fukushima now, but it's not what defines the
true nature of the problem. And if that's the case, what radiation experts can do is limited. As integral
members of the network, doing what's necessary when it's necessary, isn't that enough? I think so.
I set up a Fukushima supporting research team and sent a member of my team to live at Matsukawa Daiichi
Kasetsu, a temporary housing facility for residents of Iitate, a village whose entire population was evacuated
after the nuclear accident; a junior colleague of mine is also working at the health and welfare services
section of the Iitate Village Offices, now located in Fukushima City. Despite these "boots on the ground,"
however, I have not been able to get any funds allocated for risk communication. It seems wasteful to see
immense sums spent on decontamination, which from our point of view is an extremely disproportionate
response in view of the real needs.
Radioactive rays damage your DNA
Let's now think about the effects of radioactive particles, or rays, on the human body. In the nucleus of every
cell are strands of deoxyribonucleic acid (DNA), the genetic blueprint of the cell; the paired strands are
curled around each other in the so-called "double helix" configuration. Radioactive rays are particles that
sometimes bump into and break these DNA strands. These particles are able to penetrate physical objects and
strike the DNA of cells of organs inside the body.
Natural ("background") radiation is found in nature, that is, before any man-made isotopes or man-made
elements were created in laboratories; strands of DNA are being cut, constantly and in every part of our
body. Radioactive substances decay, that is, become less radioactive over time, becoming half as radioactive
at the point known as their "half-life."
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Our natural environment in the past was more radioactive the farther back in time you go. For example,
there's a radioactive substance found in nature called potassium 40. Its half-life is 1.2 billion years, so one
billion two hundred million years ago, there was twice as much radioactive potassium 40 in the natural
environment as there is now. Three billion eight hundred million years ago, when life was born on our
planet, there was eight times as much potassium 40 as now. This is the setting in which life evolved.
You might even say that evolution might not have occurred if radioactivity had not existed. Unless mutations
(changes in the genetic blueprint leading to variant forms of life) occur, species would not change at all.
Three billion eight hundred million years ago, a primitive form of life similar to our colon bacterium
Escherichia coli was born; if its DNA had never changed at some later point in time, the primitive organism
would not have changed either. Radioactive rays can in fact be called the motor of evolution. They're not
popular, considered a kind of "killer ray," but they're not totally bad.
If DNA strands were cut and left that way, life would end. Life has responded to the situations brought about
repeatedly by radioactive rays by finding a way to repair itself when DNA is damaged. Though this happens
very rarely, there are times when an accumulation of breaks in the strands go beyond the point where they
can be repaired and the DNA becomes permanently damaged. The mis-repaired DNA becomes a flawed
blueprint, and sometimes the change is such that the cell becomes immortal, that is, it doesn't die of and by
itself. Thus is born a cancer cell. We'll learn more about how this happens in Chapter 2, but in this way, new
(and under ideal conditions, potentially immortal) cancer cells are being born in us every day. (I am not
saying, however, that cancer cells would never arise if there was no radiation and no exposure to it. And
technically speaking it is not the radioactive particles themselves, but electrons dislodged by them, which are
at the root of DNA breakage.)
DNA strands are broken under the effect of radioactive rays. The breaks are repaired. However, when the
repair doesn't go well and damage remains, and as a result the cell doesn't die but becomes a cancer cell, it's
not actually the radioactive rays themselves (for example, gamma rays emitted by cesium) that cut the DNA
strands.
"Radioactive rays" that do damage are more properly called "ionizing radiation." Ionization refers to the
action of releasing electrons. So when gamma rays or other forms of ionizing radiation enter the body,
electrons are produced in large quantities. The electrons are the starting point in DNA breakage. But there
are two ways this happens: cases where the electron itself breaks the DNA, and cases where active oxygen
produced by electrons breaks the DNA. The first is called the direct effect and the second the indirect effect
of electrons in DNA damage. It is said that in the case of human beings the indirect effect (where electrons
make active oxygen that cuts DNA strands) is responsible for 70% to 80% of the damage. In either case,
however, electrons are the prime mover in DNA breaks.
Whether radioactive rays are natural or man-made makes no difference
When a radioactive substance enters the body, regardless of the type of radioactive substance, the first thing
that happens is many electrons are released internally. Electrons are liberated, whether the rays are found in
nature or whether they are artificially produced. Let's take the case, by way of example, of the most
problematic contamination in Fukushima now, the artificial radioactive substance known as cesium.
Cesium belongs to the same alkali metal group as potassium; both potassium 40 and cesium are distributed
fairly evenly throughout the cells of the body. They both have the same whole-body distribution and emit
gamma rays. Potassium 40 is found in nature. The cesium we are talking about is artificial, man-made
(although cesium is found naturally as a trace element, meaning in very minute quantities). You might think
that this makes a difference, but whichever type it is, once cesium gets into the body it remains dispersed (i.e.
not concentrated in one organ or region) and emits radioactive rays from every part of the body.
The important point is that both exposures liberate electrons in vast quantities throughout the body; what's
happening is absolutely identical. The natural radioactive substance potassium 40 is safe; there is no reason
to say radioactive cesium is any more dangerous.
Amount and speeds make a big difference
Life has always been exposed to radioactive rays, and broken DNA is usually fixed, as I said above.
However, as occurred at Hiroshima and Nagasaki when the atom bomb was dropped, it can happen that a
very large simultaneous dose of radiation causes a very large number of simultaneous breaks in cells' DNA.
When this happens, the body's repair apparatus can't keep up and the damage goes unrepaired. It is therefore
important to consider not only the number but the speed of occurrence of the phenomena.
What Is Really Going On in Fukushima, by Keiichi Nakagawa
For example, say that we require 6 grams a day of salt. Over the course of a year, that comes to about 2
kilograms. But if you ingested two kilograms of salt in one day (instead of spread out over 365 days), it
would kill you. That is just common sense. Whether something is harmful to us depends on the amount and
how quickly the exposure takes place.
Merely at hearing that something is "so many millisieverts", many people get anxious about the amount
alone, but whether the amount (of exposure) is instantaneous or spread out over a year makes a big
difference. For example, exposure to 1,000 millisieverts (one sievert) in an instant, such as occurs in the flash
of an atomic explosion, critically reduces the number of leukocytes (white cells) in the blood -- but the same
total amount, 1,000 millisieverts, spread out over 100 years (10 millisieverts per year) probably has no effect
at all.
Why cancer incidence does not increase, even when background radiation exposure is
260 millisieverts per year
People do not pay much attention to amounts and rates, particularly rates, and it's a pity. We have scientific
data from the Hiroshima and Nagasaki atom bombings indicating that cancer incidence (the rate of
occurrence of new cases) increases when exposure exceeds 100 millisieverts. The town of Ramsar in Iran (a
hot spring resort where the Ramsar Convention on Wetlands, a wildlife protection treaty, was concluded in
1971) has, due to radioactive elements in its soil, an extremely high level of natural background radiation:
260 millisieverts per year. Cancer was found in Hiroshima and Nagasaki to increase in proportion to
exposures over 100 millisieverts, so people living in Ramsar would be expected to have high cancer rates.
That is not the case, however. Why not? Because the 260 millisieverts they are exposed to are spread out
over a year, whereas at Hiroshima and Nagasaki, victims were exposed to 100 millisieverts in a flash.
It is true that after the bombs were dropped, there followed a period when "black rain" with radioactive ashes
fell and there was some residual radioactivity, but almost all the radiation exposure was due to the flash of
the explosion. In Ramsar, the 260 millisieverts are spread out over an entire year, and that difference is
critical. It's the same principle as in salt intake, as I explained above.
We are not just talking about 100 millisieverts versus 260 millisieverts, it's the very important distinction
between a short concentrated exposure and an extended diffuse exposure to the same amount of
radioactivity. Exposure following a nuclear accident is basically long and slow, closer to natural background
radiation.
Incidentally, hot springs always have high levels of radioactivity. The famous spa called Arima Onsen in
Japan is a radioactively "hot" spring. All of my patients are cancer patients and when they reach the stage
where their cancer is untreatable, many go to the Tamagawa Onsen. That thermal spa in Akita Prefecture has
naturally high radiation levels that are widely known to be due to radium and radon.
In other words, my patients who go there are deliberately exposing themselves to radiation.
They go back because of their pleasant memories. They feel that the pleasurable effect of soaking in very hot
water is far more therapeutic and relaxing than the possible effects of low-level radiation.
Internal and external exposure: the same difference
There are two kinds of exposure to radioactive rays. One comes from outside the body, the other comes from
radioactive rays emitted by radioactive substances that find their way into the body through ingestion or
inhalation.
External exposure occurs when someone is in the path of radioactive rays emitted from soil or the roofs of
buildings or from radioactive substances attached to clothing or skin. Internal exposure occurs when
someone inhales a radioactive substance in the air or ingests a radioactive substance in something they eat or
drink.
I often ask people attending conferences and meetings the question: "Which of the two exposures are you
most afraid of?" Invariably, the hands go up at "Internal exposure is the scariest."
I understand the psychology of the feeling that something bad inside you is scary. The Japanese remember
the Minamata Disease mercury poisoning tragedy, and for this reason they tend to believe that radioactive
substances remain in the body and could have the same kind of effect.
Radioactive substances are completely different from organic mercury, however. Organic mercury is not
water-soluble: it dissolves only in oil and finds its way into the brain and nervous system, where it settles and
stays permanently. Cesium, on the other hand, like potassium, is excreted from the body fairly rapidly in the
What Is Really Going On in Fukushima, by Keiichi Nakagawa
urine. In an adult, half of it is gone in two or three months, and in infants, it's half gone in ten days. Cesium
is not stored and does not accumulate in the body.
Which is more dangerous, internal or external exposure?
Let's compare two situations over the period of a year: 5 millisieverts internal exposure and 5 millisieverts
external exposure. The sievert unit measures the biological effect of radiation, which is the same, whether the
radiation comes from outside or from inside the body.
Low radiation doses in particular have no effect apart from possibly causing or increasing the risk of cancer;
accordingly a sievert can be thought of as a unit expressing the degree of increased risk of cancer. Whether
it's internal or external, a 5 is a 5. Or look at it this way: if a person has simultaneously an internal exposure
of 5 millisieverts and an external exposure of 5 millisieverts, his total is 10 millisieverts. The calculation of
internal exposure is a bit more difficult, however, so we try always to err on the safe side in our estimates for
that.
At the beginning of this chapter I talked about drinking contaminated water; there's a considerable margin of
safety included in the calculation used when I said that drinking two liters of water containing tritium
contaminated at the level of 60,000 becquerels per liter every day for a year would lead to an annual
exposure of 0.8 millisievert. In other words, it is very probable that the true figure is lower than 0.8
millisievert. Knowing this, we radiologists tend to think that, between the two, internal and external
exposures of 5 millisieverts, the internal exposure said to be 5 millisievert is actually likely in reality to be
less than 5 millisieverts, therefore slightly less risky.
Half of the Japanese natural background exposure is internal
Japan's natural background exposure is approximately 2.1 millisieverts per year. The world average is 2.4
millisieverts, in the USA, it is 3 millisieverts, Sweden's is 6 millisieverts, and Finland's is over 7
millisieverts. In other words, Japan's is very low.
This is because Japan has few mineral resources and its natural background radiation results from cosmic
radiation (mostly from the sun), radioactivity from underground, and a natural radioactive gas called radon,
inhaled with the air we breathe. For Japan, the breakdown of the levels is (a) cosmic rays 0.3 millisieverts,
(b) geological radioactivity 0.33 millisieverts, and (c) radon 0.48 millisieverts (all per year).
But greater than the sum of these three is the (natural) internal exposure from what we eat in Japan: it
amounts to about 1 millisievert per year. In other words, half of our exposure to natural radiation in Japan
comes from internal exposure.
Why is there so much internal exposure from what the Japanese eat? The answer is polonium, a radioactive
substance naturally present at fairly high levels in fish. You may have heard that polonium was used to
assassinate by poisoning the KGB former agent Alexander Litvinenko and Palestine Liberation Organization
Chairman Yasser Arafat. The alpha rays emitted by polonium can be stopped by a single sheet of paper.
Polonium can therefore be put in a bottle and carried around and remain totally undetectable. If it is mixed
with a drink, it is undetectable from outside. Alpha rays in the body cannot be detected, and that's why
polonium is used in assassinations.
Of the radioactive substances found in food, polonium is the most common, followed by potassium 40.
Potassium 40 is present mainly in vegetables and fruit. Consumption of vegetables and fish is known to
greatly reduce, not increase, the risk of cancer. The vegetables and fish that the Japanese eat are responsible
for their longevity, although they bring with them internal exposure to radioactivity.
All this is not to say that radiation exposure is good, but there are merits to fish and vegetable consumption
(like the relaxing effect of bathing in hot springs) that clearly outweigh the demerits of radiation exposure.
Moreover, the Japanese diet is changing: we eat less and less fish, vegetables, and fruit, and more and more
meat (which causes little internal radiation exposure), but cancer rates continue to climb. This should warn
us that instead of trying at all costs to avoid radiation exposures, we should be weighing the relative merits
and demerits of the risks we take in an all-inclusive way.
What it means to say "You can't say with certainty that cancer increases at exposures
below 100 millisieverts"
The higher the exposure to radiation at levels exceeding 100 millisieverts, the greater the chances that the
person exposed instantaneously (as happened at Hiroshima and Nagasaki) will sooner or later get cancer.
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Deaths from cancer increase very slightly (0.5%) in people who were exposed (instantaneously) to 100
millisieverts. Since your chances of dying of cancer are 20% to start with, that means a very slight increase.
As for exposures under 100 millisieverts, whether cancer risks increase or not is unknown. The effect, if any,
is so slight that it can't be detected.
There are many factors that increase the risk of cancer, and I'll explain them in greater detail in Chapter 2,
but the biggest risk factor is smoking (tobacco), followed by drinking (alcohol) and contracting infectious
diseases; after that come other risk factors including lack of exercise, emaciation (excessive leanness),
insufficient consumption of vegetables, excessive salt intake, and passive (second-hand) smoking.
In descending order of factors contributing to cancer risk, radiation exposure from 100 to 200 millisieverts -at that high a level -- is a factor on the same level as insufficient consumption of vegetables and second-hand
smoke. In Hiroshima and Nagasaki, scientists monitor cancer rates over time in residents with a variety of
dietary habits and lifestyles; when the risk of getting cancer increases no more after exposure to 100 or 200
millisieverts than it does when people don't eat enough vegetables or breathe smoke from other people's
cigarettes, the greater margin of error in the case of much lower exposures (below 100 millisieverts) makes
any effect imperceptible, and this makes it impossible to say whether under those circumstances cancer risk
increases at all.
You need large numbers of subjects to detect a small difference: if you wanted to prove that exposure to 20
millisieverts increased cancer risk, you would need data from several million subjects exposed to that level
of radiation. Since that kind of data doesn't exist, it cannot be proved that cancer increases at low exposure
levels below 100 millisieverts.
Some people say, "Prove to us that exposure to low levels of radiation doesn't cause cancer!" but it simply
can't be done. This kind of dilemma has been known since the days of the Romans as "the devil's proof" (i.e.
requiring someone to achieve an impossible proof, called probatio diabolica in Latin).
The linear no-threshold model and misunderstandings it engenders
What we do know, in short, is that 100 millisieverts does increase the risk of cancer. Below 100 millisieverts,
no one knows what effect exposure has. In order to prove that cancer does not increase at rates of exposure
below 20 millisieverts, in other words, to prove that there's a threshold below which cancer risk due to
exposure to radiation does not increase, scientists would have to have enormous quantities of data that are
simply unrealistic to gather. The scientific data we do have start with exposures above 100 millisieverts. We
would like to know what happens after people are exposed to less than 100 millisieverts of radiation, but we
simply don't know.
Let's assume for the sake of argument that no threshold indeed exists and any additional exposure, increasing
from as little as 1 millisievert to 2 millisieverts, for example, increases the risk of getting cancer. This
approach is an all-out attempt to ensure safety. This then is a focus on "safety first" and is represented by the
part below 100 millisieverts in the lower-left corner of the figure titled "Linear Non-Threshold Hypothesis".
In a nutshell, the Linear Non-Threshold Hypothesis is a blend of physics and metaphysics. Ultimately... a
person's personal beliefs get entangled in what happens in the area below 100 millisieverts. After the March
11, 2011, earthquake a well-known Cabinet Councilor said, weeping, "I can't allow a 20-millisievert lower
limit!" This man hates (or fears) radioactivity to an irrational degree, perhaps because Hiroshima is his
hometown. People's feelings skew what they see in this gray zone below 100 millisieverts. The linear nothreshold model means literally that there is no threshold, which supposedly means that cancer risk should
increase even at exposures as low as 1 millisievert. If the increase in the risk of getting cancer is 0.5% at 100
millisieverts, the increase in risk might theoretically be 0.05% at 10 millisieverts. So out of one hundred
million people, an additional fifty thousand people will die of cancer if they are exposed to 10 millisieverts
of radiation. That's how some people do the math, but math and moods don't mix. Even the International
Commission on Radiological Protection (ICRP, the organization that proposed the linear no-threshold
model) says it is not permissible to do calculations (extrapolating into the unknown gray zone) that way.
Cancer risk is not increased by exposures under 10 millisieverts
The ICRP states that no increase in (cancer) deaths is observed even in very large groups of subjects exposed
to radiation under the 10-millisievert level. In effect, they are contradicting themselves when they say this,
because their own policy is the no-threshold model: aren't they saying that 10 millisieverts is the threshold?
In the final analysis, the linear no-threshold model is just an admonition, a warning to be careful and stay
What Is Really Going On in Fukushima, by Keiichi Nakagawa
safe. The fact is that even the international agency in charge of radiological protection cannot say that
radiation exposures below 10 millisieverts increase cancer risk.
Here in Japan, annual average radiation exposures vary by as much as 1 millisievert depending on where you
live. In the world as a whole, depending on where you live, annual radiation exposures vary by 10
millisieverts. There are no data anywhere in the world that show cancer risk increases with a difference in
exposure of less than 10 millisieverts. Ten percent of the Finnish population live in areas where the natural
background radiation is 5 millisieverts or higher. In Hungary, the equivalent figure is 14%. And yet their
cancer rates are not especially high.
Taking all these facts into consideration, you can understand why the people of Fukushima had to flee their
homes, even though they were told they're safe as long as exposure remains under 100 millisieverts.
Evacuation seemed prudent as a precaution, for safety's sake, in light of the very, very cautious linear nothreshold model.
END OF CHAPTER 1, PAGE 40 IN THE ORIGINAL BOOK
###
English translation by Christopher Holmes of What Is Really Going On in Fukushima, by Keiichi Nakagawa,
Chapter 2, pages 41-59 of the book
Chapter 2 Cancer Quiz: True or False? Lifestyle choices with worse effects
than radiation
New cancer cells are born every day
Most people think that their body is like a perfectly blank slate, where there's not even a trace of cancer until
radiation comes along and contaminates it with cancer. It seems that even people at the International
Commission on Radiological Protection (ICRP) think so. They are obviously not clinical oncologists (cancer
specialists).
In reality, many, many cancer cells are born every day in you, the person reading this. From the age of 65 up,
cancer cells are formed by the thousands daily. According to one theory, the rate is some 5,000 per day. Two
hundred or more new cancer cells are created every hour.
But that's actually a small number. The human body is composed of about 60 trillion cells, of which 1%,
about 600 billion, die every day. The remaining living cells divide and make new cells to replace the dead
cells. During cell division, copies identical to the original are made according to the cells' DNA (genetic)
blueprint; the trouble is, sometimes they miscopy data. That is how cells arise that differ from their mother
cells. Causes of copy errors include the effects of tobacco smoking and of alcohol, other chemical
substances, stress, aging, and so on. Exposure to ionizing radiation is among those causes. The "miscopied"
cells (more properly referred to as mutations) sometimes (though very rarely) produce cells that don't die as
normal cells eventually would. Almost all of these diehard or quasi-immortal cells are identified as abnormal
and destroyed by the body's immune system; however, if for any reason they escape detection, they go on
dividing and multiplying and the clusters of these cells get bigger and bigger. This is the mechanism of
carcinogenesis, or cancer formation.
Cancer starts from one single immortal cell. Later, as the cancer develops from a colony initially no bigger
than a grain of sand, millions of cancerous cells clump together. To reach the size of your fingertip, about a
centimeter in diameter, about a billion undying cells are needed.
Cancer increases as DNA is damaged by aging
As we all know, all things deteriorate as time passes. It's a little like the paper of a dress pattern getting dogeared and torn as it's used over and over and wear and tear accumulates. The DNA blueprint of cells is
similarly damaged as it undergoes the wear and tear of life. This is why cancer rates increase with increasing
age.
Japan is the country with the world's highest rates of cancer. Half of the Japanese population (60% of its
men) will get cancer at some time during their lives. The 2010 data show that 60% of men and 45% of
women had or have cancer. This rate was and is still increasing. Two out of three Japanese males get cancer
these days; those who don't are the minority. And the underlying reason why cancer's incidence (number of
new cases in a given period) is on the rise is the longevity of the Japanese.
Cancer, you could say, is one of the processes of aging. The number (per day) of new cells that don't die
increases with increasing age. Mere living subjects the blueprint to wear and tear. At the same time, the
ability of the immune system to kill cancer cells as soon as they arise diminishes with age; in other words,
the immune system, too, becomes weaker with advancing age. Influenza strikes the elderly especially
frequently because their immune system is weaker. The daily number of attackers increases as the strength of
the defenders decreases: that's another way of explaining why cancer becomes more common as people age.
Immunity finds cancer to be a tough nut to crack
Lymphocytes are the immune cells that kill cancer cells as they arise. They gang up to fight and overwhelm
the intruders (cancer cells). Cancer cells arise daily here and there in the body, but the lymphocytes slaughter
every single one of them. Except in the rare cases when they don't: there is a catch.
Lymphocytes are designed to detect and destroy not anything harmful they find, but anything that is "not
self" -- i.e. identified as something other than the host organism. The cancer cells that are born of one's own
cells from faulty cell division are virtually indistinguishable from the self; for this reason, some cancer cells
escape detection and destruction.
Looked at in another way, cancer doesn't infect others. Cancer cells from me would be immediately detected
as non-self in you. If, say, they had been injected in you, cancer cells from me couldn't survive in your body.
Cancer is something that can only survive in the body of the patient in whom it arose.
Cancer isn't painful
Cancer is a disease that tends to have few symptoms. Many people think it causes great discomfort and pain,
but that only happens at the terminal (end) stage.
Kanzaburo Nakamura was only 57 when he died of esophageal cancer. He was five years older than me and
went to the same school, Gyousei Gakuen in Kudan, in Chiyoda Ward in Tokyo. I was a first-grader when he
was in sixth grade, but I knew that he was unbelievably popular, even at that age. Later in life he was a
drinker and would turn bright red when he imbibed alcohol, but that didn't stop him from drinking like a fish
-- and on top of that he smoked. As a doctor, I worried that he might get cancer of the esophagus, and my
fears turned out to be well founded.
People who, like him, turn beet red when they drink -- and who smoke -- have a thirty-times higher-thannormal risk of getting esophageal cancer. A more detailed risk breakdown is this: heavy drinkers whose face
turns red when they drink have a ten-times normal risk of getting cancer; when on top of that they smoke, the
risk multiplies to 30 times, and this is proved by solid data.
When Kanzaburo Nakamura finished his long run performance at the Nakamuraza Theater in Asakusa a few
years ago, it was his birthday and he whooped it up spectacularly. To tell you that he dived into his huge
birthday cake is to say that obviously he had no symptoms of his disease at that time. He underwent a
checkup the next day, and that's when his cancer was detected. Worse, it had already metastasized (spread to
other organs). And yet, he still had no symptoms. In other words, (early-stage) cancer is asymptomatic
(symptom-less).
Cancer patients die from malnutrition
So what is it that kills cancer patients? The direct cause is malnutrition. You've never seen a fat terminalstage cancer patient, have you? As I said earlier, about 1% of our cells die every day and through cell
division they are replaced. For each cell that dies, a new one is produced because a living cell splits in two,
and thus a balance is maintained between dying and newborn cells.
This equilibrium is upset by cancer cells, however, which pay no attention to the normal rules of cell division
and keep on dividing and producing new cells limitlessly. For cells to go on proliferating this way, they need
nutrients; that's the food that nourishes the patient's organs.
Cancer cells continue multiplying until they use up the body's nutrients; the patient eventually dies of
malnutrition. If I have lung cancer, for example, it is my cancerous lung cells that refuse to die and have
upset the dead cell-newborn cell equilibrium. These are cells that slip past the immune system network
undetected and continue reproducing until finally they make their way into the bloodstream and spread to
other organs. My cancer cells steal resources from other parts of me and keep on growing and growing,
selfishly. They starve the rest of me.
But in the end, when I die, my cancer cells will die with me. My cancer cells can only grow inside me. My
body is "Mother Earth" to them, but they kill her. That's the stupid thing about cancer.
I'll write more about this in Chapter 5, where I write about human civilization, but what our species is doing
to the Earth is very similar to what cancer does to the body in which it arises. The world population is
increasing explosively and at the same time using up the earth's resources and destroying the environment.
Apart from cases where a brain tumor grows and crushes a region of the brain or a cancer metastasizes to the
liver and interferes seriously with liver function, "to die of cancer" means basically that the patient dies when
her organs are deprived of nutrients: that is, ultimately, she dies of malnutrition.
To grow to one centimeter, cancer takes twenty years
Cancer starts with a single cell that snuck past the immune system and kept on growing; most people think
that cancer, once established, gets bigger quickly. In reality it usually takes twenty years for a cancer to grow
from a single cell to a lump measuring one centimeter in diameter.
One cancerous cell measures 10 microns (one one-hundredth of one millimeter) across. Through cell division
one cell becomes two, two become four, four become eight, and so on. In other words, the number of cells is
increasing at an increasing rate and for a tumor to occupy a cubic centimeter requires 2 to the 30th power
cells (one billion cells).
Reaching this one-centimeter size is the result of the cancer cells' successive division 30 times. That takes
about 20 years. Once it reaches one-centimeter size, however, the process speeds up. In the case of breast
cancer, it only takes 18 months for a lump to grow from 1 to 2 centimeters; in five years, it will grow to 10
centimeters.
Radioactive rays cut the cells' DNA. This is part of the process of the birth of a single cancer cell's mutation.
So in order to find cancer caused by radiation, you have to wait at least 10 years. You need to know this,
because if you don't, you make the mistake explained in the following section.
Mr Yoshida's death
In June 2010, Mr Masao Yoshida was appointed head of the Fukushima Daiichi nuclear power plant; he was
in charge of the plant and on the site when the nuclear accident occurred (in March 2011) and he was giving
orders to everyone in the plant. On July 9, 2013, Mr Yoshida died of cancer of the esophagus at the untimely
age of 58 years.
He was a take-charge boss, who continued to pour seawater to cool the reactor even after the Prime
Minister's office and TEPCO headquarters had told him to stop. For eight months after the accident Mr
Yoshida remained in the control center of Fukushima Daiichi struggling to bring the situation under control;
during that time he received 70 millisieverts of irradiation -- more than anyone in the general population of
Fukushima could possibly have received. We the Japanese people must never forget to thank the workers
like him who remained at the site of the accident and who saved Fukushima: they deserve our respect. And
yet Mr Yoshida's esophageal cancer had nothing to do with his 70-millisievert irradiation.
As I said above, it takes close to 20 years for a single cancer cell overlooked by the body's immune system to
multiply and grow to one-centimeter size. In other words, Mr Yoshida's cancer of the esophagus arose from a
single cancer cell that was formed over 20 years earlier, long before the nuclear accident. Unrelated to his
work at Fukushima Daiichi, a single cancer cell grew into a cancer through repeated divisions and became
manifest; it is a sheer coincidence that this happened three years after the nuclear accident. And although Mr
Yoshida's 70-millisievert exposure and his esophageal cancer in reality had nothing to do with each other, it
is easy to associate mentally his exposure to radiation and the cancer that killed him, and the association lives
in the popular mind.
Mr Yoshida was a heavy smoker and he is reported to have continued smoking heavily even after the
accident; this long history of tobacco use is very likely to have been the real cause of his esophageal cancer.
The folly of evacuating the retirement home in Iitate Village
My team first went to the village called Iitate on April 29, 2011. That is when we first met the village
headman, Norio Kanno, and began our Iitate support activities. On that first day we also visited the
intensive-care old people's home located next door to the village offices; the home had been told to evacuate,
together with all other inhabitants. The Democratic Party of Japan government then in power had given the
entire village instructions to evacuate. The average age of the residents was about 80; one woman there was
102 years old. Of the total of about 100 residents, 60 were wheel-chair bound and 30 were bedridden.
I was astonished: "You're really going to move these people?" The 102-year-old woman probably had tens of
thousands of cancer cells forming in her every day, she might even have had detectable tumors in her
already. Exposure to radiation might indeed conceivably increase the number of cancer cells born in her
daily. And it is also possible that her immune system would fail to detect them. But even so, for each of
those new cancer cells to grow to a lump one centimeter in diameter would take twenty years; at the age of
102, it seems to me that she could not possibly be harmed by radiation.
On the other hand, however, evacuation would seriously harm her. Back in those immediate post-accident
days, you would hear some people say that the elderly were vulnerable to radiation. However, the reverse is
true: the elderly are little affected by radiation. The risks are high for children, because they still have a long
life ahead of them. Radiation increases children's chances of getting cancer.
That is why I told government officials, every time I met one, that evacuating the elderly was stupid. Data
show, and are showing again, that the chances of the elderly dying increase when they are moved to a new
location.
The continually growing number of disaster-related deaths
Evacuation (the term still being used) is actually incorrect: you should call it "relocation". The distinction is
an important one: evacuation is something that lasts at most a few weeks. But because the mass media have
called it "evacuation" all along, I'll continue to use the term below, interchangeably with relocation.
There's a category, "disaster-related" casualties, whose number is still growing: deaths from overwork and
suicide caused not directly by the earthquake or the tsunami but indirectly by evacuation (or more properly
by relocation, as I have just explained). By the end of March 2014, three years after the earthquake, the
number of indirect disaster-related deaths in Fukushima, 3,089, had risen above the total caused directly by
the disaster.
The deaths are especially numerous among the elderly. And yet the number of deaths caused by the so
passionately feared exposure to radiation is zero. Liberal Democratic Party parliamentarian Sanae Takaichi
stirred up a controversy when she said the post-nuclear accident situation is not such that anyone will die as a
result of it, and ultimately she had to retract her statement, but she was right: not a single death has been
caused by radiation.
In the case of Fukushima Prefecture, about 30% of the disaster-related deaths were caused by the physical
and mental stress of evacuation and the burden of relocating. For example, of the residents of a facility for
the elderly in Futaba Town, 36 (over 40% of the 88 who were relocated) died of pneumonia or "old age"
within 18 months of the accident. Of the total of 1,766 residents in Fukushima at the time of the accident
living in 34 facilities for the aged (ranging in type from intensive-care facility for the elderly to simple old
people's home) who were forced to relocate, 520 or about 30% had died by January 1, 2014. The resident
mortality is now 2.4 times the pre-disaster figure at these 34 institutions. This is atrocious.
Radiation levels were high on March 15, 2011, and patients were hurriedly transported from several hospitals
to other locations by bus. One after the other, patients died in the buses. It must have been a hellish
experience. It's obvious, but when you move bedridden people without a good reason, they die.
Iitate village headman Norio Kanno's mother-in-law died in this way after being relocated twice from a
facility in Fukushima to first one then another institution in Tochigi Prefecture. She "fled" with the rest and
two weeks later, after cremation, her bones returned to Fukushima for burial.
The government had given orders to remove everyone from Iitate, which had been designated a "planned
evacuation zone"; the headman's personal experience was among the reasons why he felt it would be too
cruel to move residents from the Iitate Home for the elderly and wanted to let them stay in the village. The
home was preserved, in part at my suggestion, and even now 75 senior citizens are living there in the home,
unburdened by relocation stress. The home's employees, though, are forced to live far away from the village
and commute to the home, checking their dosimeters inside and outside the home regularly. It's a heavy
burden for them to bear and their devotion deserves our admiration.
Damage that comes from inactivity: disuse syndrome
Seniors 66 years of age or older account for 90% of the disaster-related deaths and the burden of evacuation
affects the elderly most directly, but evacuation is harsh on younger people, too. Iitate is blessed by such
natural beauty that it had sometimes been called "a Japanese Switzerland". Villagers who used to live there
in big, comfortable houses and eat delicious fresh food that they grew themselves now have to live in
cramped temporary dwellings or leased housing, which puts immense stress on everyone, whatever their age.
Being cooped up indoors in cramped quarters with few opportunities for genuinely active pastimes, they
suffer from what doctors call "disuse syndrome", or impairment of physical functions caused by inactivity
over a prolonged period.
Many villagers learned only after being relocated about "convenience" stores and how easy being a customer
is; quite a number now rely on convenience store box lunches for their meals (just like most MDs do at the
University of Tokyo Hospital).
A marked number of responses to two questionnaires conducted by village authorities since the evacuation
indicate that relocated villagers' tobacco use and alcohol consumption have increased, as have insomnia,
frustration, and their weight and blood pressure. Cancer is imputable in two out of three cases to smoking,
drinking, lack of exercise, excess salt intake, and insufficient consumption of fruit and vegetables: in short,
lifestyle. Decontamination work has been going on in Fukushima Prefecture with the aim of reducing
average annual radiation exposure to 1 millisievert, but smoking increases the risk of cancer as much as
2,000 millisieverts (2 sieverts) does, and drinking as much as 1,000 millisieverts (or one sievert).
Increased incidences of cancer were confirmed in atom bombing victims who were exposed at Hiroshima
and Nagasaki to more than 100 millisieverts. Presently 60% of the inhabitants of Fukushima are exposed to
less than 1 millisievert and 99.9% to less than 10 millisieverts per year; both these levels are far below 100
millisieverts, but cancer risk is increased as much in people who get little exercise or are obese as it is
increased by exposure to 100 millisieverts.
Obesity is increasing in Fukushima in both adults and children. Diabetes, which is caused by obesity and
related causes, increases all cancer risks by 20%, and doubles the risk of getting cancer of the pancreas or
liver.
The people of Fukushima were relocated to avoid getting cancer. Ironically, the relocation and their new
lifestyle increase their cancer risks. And this worst-case scenario is playing itself out right before our eyes.
Seven ways to avoid cancer
When you compare the risks of tobacco smoke and radiation exposure, to be perfectly frank, I don't think
there's any point in smokers' being relocated. I've witnessed scenes like the following: in a family restaurant
in Tokyo, I saw a mother accompanied by her child smoking a cigarette while she nervously checked the
radiation reading on her dosimeter! While exposing herself and her child to the risks of tobacco smoke (even
passive exposure to cigarette smoke is dangerous), she was afraid of radiation, which exposes her to far
lower risks. All I can say is her priorities are mixed up.
I'll summarize seven steps that you can take in your everyday life to avoid cancer:
1. Don't smoke.
2. Drink no more than one standard serving of alcohol (0.18 liter, in the case of Japanese sake) per day.
3. Vary your diet and eat mostly vegetables.
4. Reduce your salt intake.
5. Exercise regularly (if possible, by taking a walk every day).
6. Maintain your weight where it was when you were young.
7. Avoid contracting viral and bacterial diseases.
Don't smoke, and that's not all: even passive smoking (other people's tobacco smoke) increases your cancer
risks, so stay away from smokers!
Alcohol? One standard serving (a glass of wine, a pint of beer), maximum. When they say proverbially that
alcohol is the master of all medicines, they're not saying you should overdose. If you want to avoid cancer,
drink only very moderately.
Remember also that the risks of alcohol depend on your genetics. The Japanese don't have the same genes as
Caucasians (white people). The so-called "Asian flush" reaction to alcohol (associated with Asian ancestry)
doesn't occur in people of European ancestry. In individuals whose face turns red when they drink, the
consumption of alcohol leads to a buildup of acetaldehyde, a carcinogen (substance that causes cancer), due
to a lack of an enzyme needed to break down acetaldehyde. This causes their skin to flush. This increases
their risk of cancer. (In Europeans, there is little association between alcohol and cancer.)
Add to this that because most reports on cancer and its risks come from the United States and Europe, the
risks to Japanese of alcohol consumption are understated: we Japanese should be more careful. In the case of
the strongly alcohol-associated types of cancer like cancer of the colon, the liver, the esophagus, and the
pharynx, even as little as one standard serving of an alcoholic beverage increases one's risk. So as a cancer
specialist, I have to tell you: "Don't ask for another glass."
Some people drink a little every day; some drink a lot, but only on weekends. What affects your health most,
however, is not the type of drink or pattern of drinking but how much ethanol you consume per week. That
said, people who give their livers a rest one or two days a week have a lower risk of dying from cancer than
those who drink daily (or nightly). Note also that giving your liver a weekly day off still has no effect if you
drink a total of over 21 standard servings of alcohol per week.
There's another factor involved, however: apart from the above-mentioned alcohol-related cancers, drinking
has relatively little effect on overall cancer risk -- unless you smoke. The alcohol-related cancers are
relatively infrequent; if you limit the discussion to drinkers who don't smoke, drinking three or more
standard servings of alcohol doesn't add that much to your overall cancer risk. One out of four Japanese men
(myself included) routinely drinks two or more standard servings. We and many nonsmokers are relieved to
hear that drinking isn't as dangerous as smoking. But what's worst of all is to smoke while drinking, and
what's especially frightening is the second-hand smoke you're exposed to while you're in drinking and eating
establishments. It's deplorable that passive smoke prevention measures are lagging behind in Japan, where
the risks of cancer from alcohol are higher than in Western countries. Red-faced hard-drinking salaried
workers packed into smoky bars and nightclubs are headed straight for the cancer ward, if you ask me.
Now let's talk about salt: consume less than 5 grams a day (low salt helps to prevent stomach cancer).
Eat fruits and vegetables.
Eat fish.
It's important to eat a balanced diet, including some dairy products.
And what's best of all is to get plenty of exercise.
As for fruits and vegetables, it's enough to eat enough: becoming a vegetarian will not reduce your risk of
getting cancer. But the more exercise you get, the more you lower your chances of getting cancer. Seven
times a week is better than once a week. An hour or more a day is better than fifteen minutes a day. At fancy
hotels, you often see foreigners using the gym. In the West, most people take their health, and therefore
exercise, seriously; in Japan, unfortunately, not much is done in schools to teach students what they need to
know about health maintenance.
If we had "ideal" lifestyles, how many of us would never get cancer? The answer: one out of three men and
one out of two women would still get cancer. The cumulative cancer incidence risk -- in other words, the
statistical probability of getting cancer at some time during one's life -- is 60% for men and 45% for women.
Many men smoke, and by reducing or quitting smoking, their risks of cancer would be greatly diminished.
Women have more sensible lifestyles; that's why they get cancer less frequently than men. Still, even if
people were wiser and led ideal lives, one out of three men and one out of two women would still be at risk
for cancer.
In other words, better lifestyles and behaviors are not sufficient to prevent someone from dying of cancer;
periodic screening and early detection are very important. The people living in Fukushima would do well to
undergo cancer screening for these reasons. Get your cancer checkup done properly or you'll be sorry.
In Chapter 3, I'm going to tell you what you need to know about thyroid cancer.
END OF CHAPTER 2
###
What Is Really Going On in Fukushima, by Keiichi Nakagawa
English translation by Christopher Holmes of What Is Really Going On in Fukushima, by Keiichi Nakagawa,
Chapter 3, pages 61-97 of the book
Chapter 3 How ironic! Fukushima's number-one cancer-inducing risk factor is
not radiation but relocation
The battle with cesium
The types of radioactive substances emitted by the Fukushima nuclear accident of 2011 are almost the same
as those emitted by the Chernobyl accident of 1986. The three most worrisome substances are Iodine-137,
Cesium-134, and Cesium-137. Cesium-134 and Cesium-137 are emitted in roughly one-to-one proportions.
The half-life of Iodine-131 is eight days, of Cesium-134 is two years, and of Cesium-137 is 30 years.
Radiation leakage was throttled at a relatively early stage; no major discharge of radioactive substances has
occurred since the immediate aftermath of the accident more than three years ago; now the enemy is the
cesium isotopes. The cesium isotopes released in March 2011 settled on roofs and sank into soil, and from
this contaminatation radiation is still being emitted. This cesium in the soil is taken up by grass, (edible) wild
plants, and mushrooms, which wild boars eat. As this happens, the concentrations of radioactive substances
in mushrooms and boars increase and people who eat mushrooms and boar meat are exposed to the radiation.
Almost 100% of the cesium that makes its way into the body is absorbed by the stomach and intestines.
Unlike mercury and other heavy metals, however, the cesium is excreted (expelled from the body) almost
completely, in two or three months in the case of adults and in about 10 days in the case of infants. Whatever
the case, the cesium released in March 2011 is still around us even now, over three years later.
External exposure is what we call it when radiation strikes us from soil and other materials, and internal
exposure comes from things we eat that contain radioactive substances. As I explained in Chapter 1, if you
undergo both types of exposures that are "the same" measured in sieverts, it is the external exposure that is
quantitatively far greater than the "same" internal exposure.
Internal exposure is now practically zero
It is possible to determine how much internal exposure is occurring by measuring radiation in foods eaten by
the people of Fukushima, and it is possible accurately to measure individuals' internal exposures using
whole-body counters. Measurements by these methods indicate that Fukushima residents are receiving
almost no internal exposure. This is a totally different outcome compared to Chernobyl, and this fact is
stunning.
In Fukushima, 60% of the people's measured external exposures are 1 millisievert or less; 99.9% of
measured external exposures are 10 millisieverts or less; a very small percentage of people in Fukushima
have received 5 millisievert or 7 millisievert external exposures. None of these levels should cause anxiety.
How Chernobyl was different
Cancer increased only in children in Chernobyl, where Iodine-131 caused thyroid cancer. About 6,800
children got thyroid cancer and fifteen died. As these figures show, thyroid cancer is actually extremely easy
to treat, even to cure. But it's caused by radioactive iodine, not by cesium. As for cesium, it has not been
observed to cause any increase in cancer in adults either.
The fact that thyroid cancer increased after Chernobyl is known and a matter of great concern to the people
of Fukushima, but the level of radiation to which Chernobyl's children were exposed was incomparably
greater. At Chernobyl, increases in thyroid cancer were reported in preschool children, ranging in age from
newborn infants to five-year-olds; of children in this age range, 4.8% were exposed to over 5,000
millisieverts of radiation. At Fukushima, the maximum exposure was 35 millisieverts. The United Nations
Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) cites a 82 millisievert level, but that
is a presumptive value allowing for safety, based on very few data, and Japan's own domestic radiation
studies report no higher than 35 millisieverts. Even at 50 millisieverts, cancer does not increase, and in
Japan, no increase in thyroid cancer has been observed in children.
So why is there such a discrepancy between the two nuclear accidents, both of which were classified as
Level 7? For one thing, at Chernobyl, the reactor itself exploded; at Fukushima Daiichi, the reactor and its
containment vessel remained, though the building housing the containment vessel was destroyed by a
hydrogen gas explosion. That's a big difference. Another difference is the speed at which restrictions were
placed on food products, and one relevant factor affecting the difference is that Chernobyl is located in
Ukraine, inland, far from the sea, while Fukushima has a sea coast. Compared to Chernobyl, the Fukushima
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Daiichi nuclear power plant accident released only 1/10th as much radioactive material, and most of the
radioactive substances that were released ended up going out toward the sea. (Luck was on the side of
Fukushima, you could say.)
That Fukushima Daiichi was located by the sea had other advantages. Iodine, which is found in seaweeds
that are a normal part of the Japanese diet, is one of the elements required by living organisms. In the United
States of the America, iodine is added to table salt to ensure that people get enough iodine in their food.
Chernobyl is located inland in a place where seafood and marine products are hard to come by and the
people suffer from chronic iodine insufficiency; on top of that, measures to regulate the distribution and
consumption of milk and other products contaminated with radioactive Iodine-131 were put in place far too
late at Chernobyl. As a result, children there ate products (especially milk) that were contaminated with
radioactive Iodine-131 from the nuclear accident. By so doing, about 5% of preschool children were exposed
to 5,000 millisieverts of radiation -- over two orders of magnitude greater than the maximum recorded
exposure at Fukushima.
There is another crucial difference: children in Fukushima (as in other parts of Japan) eat a lot of seaweed
and other seafood on a daily basis and their thyroid glands are well stocked with non-radioactive iodine. So
their thyroids do not crave iodine: they are satiated. Moreover, after the accident, restrictions on the
distribution and consumption of foods were quickly put in place in Fukushima. It is thanks to these
differences that internal exposure to radiation was practically zero -- a huge difference with respect to
Chernobyl.
Is thyroid cancer increasing?
A Japanese television program aired on March 11, 2014 (three years after the earthquake and tsunami),
reported that about 270,000 children in Fukushima had undergone thyroid examinations and that 33 had been
found to have thyroid cancer and had been operated. It reported that normally thyroid cancer is found in one
or two children per million, so the observed incidence at Fukushima was far in excess of this level.
Why is this so? The discovery is surprising, given that the above-mentioned UNSCEAR experts had reported
that the thyroid exposure dose at Fukushima was less than 1/60th that of Chernobyl, and that "Fukushima
was no Chernobyl".
The answer is that the 33 thyroid cancer surgeries do not mean that cancer is increasing in Fukushima. The
thyroid cancer being found in Fukushima now is unrelated to any exposure to radiation; it is a naturally
occurring type, and it was there before the accident. These cases came to light because in the aftermath of the
accident, all young people 18 years of age or younger were examined for thyroid cancer using ultrasound.
Thyroid cancer is a type that often occurs in young people; the noted Japanese politician Ichiro Ozawa (now
in his 70s) underwent surgery for thyroid cancer when he was 27, immediately after he won his first election
to parliament. For a while after his operation, he was unable to speak, and it seemed his political career was
in jeopardy, but that was then: since then, he has been reelected 15 times.
The same Ozawa on the above-cited television program criticized Prime Minister Abe's energy policy, citing
the (untrue) "fact" that thyroid cancer has increased because of the nuclear power plant accident. Actually,
almost all of the "children" diagnosed with thyroid cancer were of high school age. Lung cancer and colon
cancer are virtually never found in high schoolers, but as I explained above it is not rare for the naturally
occurring form of thyroid cancer to be found in adolescents. The TV program and Ozawa's criticism were
both wide of the mark.
Cancer is basically an aging phenomenon, but in thyroid cancer other factors are involved. It is still not fully
understood why, but thyroid cancer is most frequently found in women in their early twenties. In fact, an
acquaintance of mine, someone of that age, had thyroid cancer. So thyroid cancer can be and certainly is
found even in high schoolers, but as people age, almost everyone is practically certain to have a cancer of the
thyroid, if you look hard enough and if you include very, very small cancers.
In the United States, they compile data obtained from autopsied organs of victims of automobile accidents
examined under the microscope. If you include cancer that is only visible by microscopy, you find everyone
60 years of age or older has thyroid cancer. This kind of cancer is called "latent" or "silent": it is there,
unnoticed, causing no symptoms, until the patient dies of another cause.
In the last section of this book I've included a conversation I had with the writer and Buddhist priest known
as Sôkyû Genyû. In it we talk about the many cases of thyroid cancer that are discovered at autopsy but were
What Is Really Going On in Fukushima, by Keiichi Nakagawa
never noticed by the people who had the cancer in them. Contrary to people's usual mental image of cancer,
it does not always get bigger and bigger until it eventually kills the bearer.
Almost all Japanese live to be at least 60 years old. And each year, 1.26 million Japanese die, yet fewer than
2,000 of them die of thyroid cancer. The rest -- almost everyone in other words -- carries their silent thyroid
cancer with them to the grave.
Thyroid cancer is the most common kind found in Korean women
The most common kind of cancer found in Korean women is thyroid cancer. (In Japanese women, it is breast
cancer.) The reason for this high incidence is the recent rapid spread of thyroid gland examinations at most
healthcare institutions since about the year 2000, when it was decided in South Korea to examine women's
thyroid glands after ultrasound screening for breast cancer. This is not because thyroid cancer is on the rise,
it's because more of it is being discovered.
And in South Korea, while the number of cases of thyroid cancer being discovered is soaring, the number of
deaths from thyroid cancer has not at all decreased. It's simply that due to overdiagnosis, they are discovering
cases that don't need to be discovered.
On a trip to South Korea I made together with a delegation of officials from the Japanese Ministry of Health,
Labour, and Welfare to observe cancer screening there, I learned that this problem is a big headache for the
South Korean government. If someone is told they have cancer, they worry, and so they undergo surgery.
But due to the steep rise in cases discovered, the patients have to wait a year before they are operated. For a
whole year, they worry about their cancer before their turn for surgery comes. And because the surgery
means total resection (removal) of the thyroid, after surgery they have to take supplemental hormones for the
rest of their lives to do the job of the thyroid gland they lost.
For this reason, the South Korean government later decided to exclude thyroid cancer from the list of types
of cancer whose diagnosis entitles patients to insurance benefits. This is a case where ignorance of the facts
leads to trouble.
High schoolers who undergo thyroid surgery are victims of overdiagnosis
In Fukushima, almost all residents of the prefecture under 19 years of age as of March 11, 2011, undergo
ultrasound examinations of their thyroid as part of the prefecture's health survey program. If this were not
limited to children but extended to adults (especially those over 60), in Fukushima as in South Korea, this
would lead to a rapid increase in diagnoses of thyroid cancer.
At Chernobyl, cases of thyroid cancer began to increase in frequency four or five years after the accident and
those affected were infants and children under six years of age at the time of the accident; this is totally
different from the situation at Fukushima, where all the thyroid cancer cases discovered were high schoolers.
The kind of naturally occurring thyroid cancer found during adolescence is more common in females (the
ratio is 7:3); the thyroid cancer in infants and children caused by radiation exposure at Chernobyl is equally
common in males and females (5:5). Clearly, the two types differ. The thyroid cancer found in young people
in Fukushima is found most often in young women (again, the ratio is 7:3); this also proves that this is the
naturally occurring type of thyroid cancer and is unrelated to radiation exposure.
The television program I cited accusingly pointed the finger at radiation in Fukushima as the cause of thyroid
cancer since the incidence is higher in children now than it was known to be in the past. Until recently the
only cases of thyroid cancer we knew about were the children diagnosed with thyroid cancer because they
had symptoms and went to a hospital for treatment of those symptoms; we didn't and don't have a valid
baseline value for comparison because we don't know in what proportion of all children thyroid cancer
would have been found by examining asymptomatic children in the past, because those data were not
collected.
If you did the same kind of tests on children in Tokyo, or in New York, or in Paris, you'd find the same
percentages of children with thyroid cancer as you do in Fukushima; likewise, if you do tests on children
born in Fukushima since 2012, you will find thyroid cancer in the same percentage of children examined.
Thyroid examinations done on -- admittedly a small sample of -- people in Aomori, Yamanashi, and
Nagasaki found no difference between the incidences of thyroid abnormalities in these three prefectures and
the incidence in Fukushima.
Cancer is not always something that progresses rapidly and kills patients. The slowly progressing type
accounts for almost all cases of thyroid cancer, and even for thyroid cancer to disappear by itself is not rare,
so early detection is not always much of a help. The high school students who underwent surgery for thyroid
What Is Really Going On in Fukushima, by Keiichi Nakagawa
cancer that had never done them any harm and would almost certainly never harm them were victims of
overdiagnosis. Their thyroid would never have been examined had the accident never occurred and it is very
likely that they would have lived their whole lives without noticing anything unusual about their thyroid
gland. They, too, are victims of the nuclear power plant accident.
Thyroid cancer screening should be stopped immediately
Thyroid cancer itself has not increased in South Korea, it's the rate of detection of thyroid cancer that has
increased. At the University of Tokyo Hospital there is a department of mammary gland endocrinological
surgery in which there are surgeons who are both mammary gland (breast) experts and thyroid gland experts
who will examine your mammary and thyroid glands. All over the world, breast cancer is found using a kind
of x-ray examination called mammography; in South Korea, the examinations are done using ultrasound.
Since ultrasound is also used to detect thyroid cancer, in Korea, both tests came to be done together (as a set,
as it were) to examine women for breast cancer and thyroid cancer at the same time. That is the reason why,
as reported above, thyroid cancer was said to be increasing rapidly in South Korea.
Of all the doctors, patients, and life insurance companies involved in this massive unnecessary screening, the
only beneficiary might be said to be the doctors. Doctors (more specifically, surgeons) are compensated for
each surgery they perform, so they examined thyroids en masse and did more surgeries.
I believe that, in Korea as in Fukushima, routine examinations of children's thyroids should be stopped
immediately. I am not alone in feeling this way: quite a number of medical experts agree. From the
prefectural government's standpoint, however, it's not easy to stop a healthcare program once it has been
launched, so I think that, at the very least, they should publicize as widely as possible that one of the options,
should a small cancer less than one centimeter in diameter be discovered, is to wait and see.
Over 100,000 people are still radiation refugees
In Fukushima more than 100,000 people are still "evacuees" in other parts of Fukushima or outside the
prefecture. (They are referred to as "evacuees" but that term normally refers to displacements for periods of a
few weeks; more correctly, they should be called "relocatees" or refugees.)
I've already mentioned in Chapter 2 that the number of deaths in Fukushima is increasing, not deaths of
victims of the earthquake or tsunami or another direct cause, but deaths due to ill health and overwork and
suicide and other "disaster-related" deaths caused by being forced to live as refugees. The stress of months
and years of living far from one's home is taking its toll on the people of Fukushima.
Since August 2013 one of my subordinates has been living in the same sort of temporary housing in Iitate as
the refugees, assisting the village in its administrative duties; over this time, the way of life and the health
conditions of the displaced residents has worsened radically. Because about 60% of cancer's causes are
related to lifestyle, such as smoking, drinking, obesity, and lack of exercise, the present situation of refugees
is preoccupying from the standpoint of cancer prevention, with lack of exercise leading to overweight and
obesity and stress leading to excessive smoking and drinking. (Let me add, for the sake of completeness, that
genetic factors account for only 5% of cancer causes.)
What the health data on one thousand people at Iitate show
Fear of radiation, the psychological shock of the earthquake and the nuclear power plant accident, and the
stress of months and years of living in temporary housing as a refugee are causing a rise in depression. Add
to this the physical damage done to many of these patients with depression by high blood pressure or
diabetes and the sadness and inactivity of their lives. Data from health checkups on over a thousand residents
of Iitate show that their state of health has unquestionably been worsening since the earthquake and that
hypertension, obesity, diabetes, and other lifestyle diseases are clearly on the rise (and the rise is statistically
significant).
What increases when one lives the life of a refugee is not only the frequency of lifestyle diseases. In patients
with diabetes, the risk of cancer of the pancreas and of the liver roughly doubles; the risks of all types of
cancer combined increase by about 20%; it is therefore feared that cancer will increase among the displaced
residents of Fukushima.
Temporary housing and leased housing
In addition to specially built temporary housing, ordinary apartments are being leased to house Fukushima's
many refugees. The ratio of temporary to leased dwellings is approximately 3:7. Leased housing is solidly
built; temporary housing is prefab construction, drafty and with poor soundproofing and insulation. At first,
What Is Really Going On in Fukushima, by Keiichi Nakagawa
therefore, you would think that people in temporary housing are worse off. In fact, though, the people living
in the prefab dwellings are getting on pretty well. The reason is that the villagers in the temporary housing
are living together: they still have a community.
Those in leased housing, however, are dispersed to empty apartments here and there, without a community
they can belong to. Feeling their solitude, they become depressed and don't want to go out. They don't go
outside, they stumble and injure themselves in falls, they stop calling friends and family on the phone -- and
this pattern is verifiable by the data collected so far.
The next time a disaster strikes, the leased housing approach should be abandoned. This is a reminder that
man is a social animal: no one can live alone.
Cancer will increase in Fukushima -- but not due to radiation
The ostensible purpose of the Fukushima relocations was cancer prevention. However, because there are no
risks to health from radiation apart from an increased risk of cancer and because the very low-level radiation
levels that people would be exposed to do not in fact increase cancer risks, the relocations intended to
prevent cancer will ironically have the opposite effect: the result of Fukushima's prolonged relocations will
be higher cancer rates due to the emotional and physical damage done by the relocations and the lifestyle
changes they bring with them.
Because Fukushima residents' radiation exposures were kept far below levels at Chernobyl, the UN and other
international organizations have declared that increases in the incidence of cancer due to radiation exposure
at Fukushima are inconceivable. It is not possible, however, to distinguish cancer caused by relocation and
cancer caused by radiation. Though the moment when cancer rates will begin to rise due to relocations at
Fukushima is more than a decade ahead of us now, when it eventually happens, most mass media will blame
it on exposure to radioactivity. The true cause, however, will be the media's fearmongering, which causes the
displacements to go on longer than necessary.
One hundred million yen just to relocate a family of four?!?
The zones from which inhabitants were removed are classified into three types in descending order of
danger: "zones to which return is almost impossible," followed by "zones in which residence is restricted"
and "zones where the lifting of instructions to evacuate are in preparation."
Former inhabitants of zones to which they may never return receive, on average, compensation of 100
million yen for a family of four. Even the displaced who are most likely to return receive about 60 million
yen. This is exempt from taxes and is paid in a lump sum. It's not hard to understand why you see a lot of
new cars in the parking lots outside temporary dwellings.
Wherever money is involved, things get complicated
For a nuclear accident to drive people from their homes and force them to live as displaced persons for years
and years is awful, and the entire responsibility for this lies with Tokyo Electric Power Company (TEPCO)
and the Japanese government. There are people known as "goyôgakusha" in Japanese: sycophantic
academics and pseudoacademics who will say and write whatever government officials and politicians ask
them to say. Some of these self-styled nuclear power "experts" have received grants of tens of billions of yen
(unlike me: I've received absolutely no grants or money) to fund research, but that money was never spent to
enhance nuclear power's safety. In fact you could even say that they have always spent those research funds
in a way that has nothing at all to do with nuclear power.
To start with, the Fukushima accident wouldn't have occurred if the decision-makers had put the nuclear
power plant's emergency batteries at a higher elevation. As you might suspect, much of the tragedy is manmade, due to negligence.
The inhabitants who were ordered to leave their homes are entitled to receive compensation for
psychological trauma, regardless of age or sex (whether a baby in a cradle or a bedridden senior) amounting
to 100,000 yen a month, in addition to compensation for irretrievable household goods and loss of
employment. The total compensation to a family of four ranges, as I said, from 60 million to 100 million yen,
unheard of and exorbitant sums on which they will pay no taxes.
Because it was TEPCO's fault, some will say it's not surprising that continuing to live as displaced persons is
more lavish, therefore easier, than before and that "these people have it made!" They don't take into account
that people in this uprooted community are smoking and drinking ever more. Many are depressed and don't
What Is Really Going On in Fukushima, by Keiichi Nakagawa
want to work anymore and are becoming addicted to gambling: pachinko parlors are doing a booming
business in Fukushima.
The displaced people of Fukushima are in anything but an enviable situation because being kept away from
their homes for years and years will increase the risks of cancer and their susceptibility to other diseases. I,
for one, want to make sure they are better informed about the facts: that it is not radiation but relocation that
will increase their cancer risks.
TEPCO's to blame, but not for Fukushima's present situation
For three and a half years, this internal exile has damaged the inhabitants of Fukushima physically and
emotionally, but can it be true that relocation entitles them to such massive compensation? Perhaps we
shouldn't criticize relocations that were precautionary measures and, though they were unnecessary, they
were intended to be temporary and were well meant.
But the fact is that relocations do entail major risks, and at the root of it all is the question "How much
radiation exposure was prevented preemptively in Fukushima by evacuating inhabitants and installing them
in temporary housing?" In other words, what were the actual radiation exposures?
Although immediately after the nuclear power plant accident, the Fukushima Daiichi disaster was classified
as "Level 7" -- the same as Chernobyl -- it turns out that in reality there were vast differences. The amounts
of radioactive substances released from Fukushima Daiichi were only 9% of the Iodine-131 and 18% of the
Cesium-137 released from Chernobyl. Amounts of strontium were 2% and of plutonium were 0.01% of the
Chernobyl figures. The wind direction was also in our favor at Fukushima, so that only one-tenth of the
material released fell on Fukushima soil, and inland soil was contaminated by only about one percent of the
radioactive substances released. The total area contaminated was also only 6% of the Chernobyl total.
I told you already at the beginning of this chapter that the inhabitants' exposures were much, much lower at
Fukushima than at Chernobyl. Of course that does not excuse those who caused the accident.
The disaster-related deaths (3,089 as of March 2014), which already outnumber the deaths caused directly by
the earthquake and tsunami in Fukushima, would not have occurred were it not for the accident, for which
TEPCO and the national government bear a heavy responsibility.
I have been unjustly accused of being one of the "goyôgakusha", although I am neither part of the nuclear
power industry lobby (known as "Genshiryoku Mura" in Japanese), nor do I advocate for nuclear power. I do
think, however, that the opponents of nuclear power tend to exaggerate the effects of the accident. And I
think that assessments of accidents and damage to health ought to be made objectively, free of ideological
slant and ideas about energy policy.
Oishimbo's bloody nose
The popular gourmet manga magazine called Oishimbo, of which I am a fan, stirred up a big controversy
when it took up the topic of the Fukushima nuclear power plant accident less than a year ago. The manga's
main character, a (fictional) newspaper reporter named Shiro Yamaoka, visited the Fukushima Daiichi
Nuclear power plant, which was being decommissioned after the accident. After his visit he didn't feel well:
he complained of fatigue and nosebleeds but he didn't know what caused them.
Here in the fictional manga story appears a real person identified by his real name, Katsutaka Idogawa,
formerly mayor of Futabamachi Town in Fukushima Prefecture, a real place. "Yeah, nosebleeds are
common," he declares. "Lots of people in Fukushima have the same symptoms. They just don't talk about it."
In the manga magazine, Mr Idogawa declares the nosebleeds "are caused by the radiation," and on his own
Facebook page he shows a photo to "prove" it. He even warns townspeople, "As the former mayor of
Futabamachi, I warn you: don't stay in Fukushima Prefecture!"
Whereupon Fukushima's Prefectural Government officially complained, saying that it was "very alarmed by
the expressions used in the manga, which cannot fail to give its readers the impression that the views of a
certain individual appearing in the issue describe the situation in Fukushima as it really is, causing anxiety
and embarrassment to many people both in Fukushima and elsewhere." Governor Yûhei Satô declared at a
press conference, "It's regrettable that this creates an impression that promotes harmful rumors."
As I wrote above, one of my subordinates has been living with refugees from Iitate since the summer of
2013, moving from one to another of all the temporary housing units (except the nursing home, etc.) in
Fukushima City to assist the village in its administrative services for displaced Iitate villagers. I also visit
Fukushima once a month, but I have never heard of nosebleeds being frequent among the displaced. An
acquaintance of mine who is an ear-nose-throat doctor in Fukushima says the same thing.
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Let's now change the subject and think a bit about another topic: the reasons why more people have died
from disaster-related causes such as deteriorating health and overwork, suicide, etc., than from direct causes
such as the earthquake or the tsunami.
The health status of Fukushima's disaster refugees is worsening seriously. According to a survey conducted
by the prefectural government among refugees and published in April 2014, 67.5% of households have
members who describe themselves as physically or mentally unwell. More than half complain that they find
no pleasure in anything (anhedonia) and that they can't sleep at night (insomnia); over 40% complain of
being in a gloomy mood (depression), that they tire easily (fatigue), and that they feel lonely (isolation). The
survey found that 34.8% report that their previous medical conditions have worsened and 22.6% report
drinking and smoking more.
The health checkups among the Iitate villagers clearly indicate worsening of diabetes and hypertension (high
blood pressure); people in Fukushima who are being kept for a long time from returning to their real homes
might well complain of chronic fatigue and in some cases hypertension might indeed cause nosebleeds. But
nosebleeds do not occur due to the low-level radiation following the accident, nor do they occur in workers
at the Fukushima Daiichi nuclear power plant, who are exposed to higher levels of radiation. For 29 years I
have worked in hospitals as a therapeutic radiologist treating cancer patients with radioactive rays. One of
the diseases I treat is cancer of the upper pharynx (in the back of the throat), which is difficult to treat
surgically and it is treated mainly with radiotherapy. The cancer tends to metastasize (spread) to the lymph
nodes, so we irradiate a wide area, from the nose to the neck, exposing the nasal mucosa to a cumulative (not
instantaneous) total of nearly 70,000 millisieverts. And yet the number of patients whose nose bled after
irradiation is practically zero.
A practicing radiologist like me receives occupational exposures; the Japanese astronaut Koichi Wakata who
spent six months in outer space and returned safely after completing his mission was exposed while in space
to almost 1 millisievert every day, because out there in the vacuum of outer space the atmosphere that
normally protects us from cosmic rays is not there to shelter astronauts the way it does us. Even by a
conservative estimate, a six-month stay in outer space produces an exposure of over 100 millisieverts, but no
one has ever reported that nosebleeds are frequent among astronauts. In conclusion: nosebleeds supposedly
caused by low-level radiation are complete nonsense.
Calling this harmful and false rumor "extremely disappointing and regrettable," Takumi Nemoto, born and
bred in Fukushima and elected from a Fukushima district and Minister for Reconstruction from 2013 to
September 2014, has called for better radiation risk communication. Chief Cabinet Secretary Yoshihide Suga
also has commented on the need properly to tell people the facts based on a correct scientific understanding.
So-called "experts" who claim "You can't prove there's no causal relationship"
People bleed more easily when their blood has an unusually small number of platelets (blood cells that help
the body stop bleeding from a wound, for example); this kind of bleeding is a symptom of leukemia and
occurs after exposure to radiation, but only if the whole body is exposed to nearly 1,000 millisieverts. Over
99.8% of the measured external radiation exposure of Fukushima residents is less than 5 millisieverts; more
than 99.9% is less than 10 millisieverts; almost no one has been exposed to internal radiation.
As reported by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR),
cancer due to radiation will not increase in Fukushima (although, as I point out here, it will increase as a
result of the relocations and unnecessary medical tests) and what's more, such definable effects as nosebleeds
(symptoms occurring as large numbers of cells die, as seen for example several weeks after a brief exposure
to high levels of radiation) will "absolutely" not occur.
This notwithstanding, former Futabamachi mayor Katsutaka Idogawa stated in Oishimbo that the nosebleeds
"are caused by the radiation" and warns, "Don't stay in Fukushima Prefecture!" Unfortunately, he's not alone:
other so-called "experts" step forward and propound their crazy theories without even disguising their
identities. In the same manga, Dr Eisuke Matsui, formerly assistant professor at Gifu University, reports that
800 people living near incinerators at disaster detritus disposal sites in Osaka have complained of health
problems. Fukushima University associate professor Takeru Arakida has declared that he thinks Fukushima
is now uninhabitable, that people can't live there safely, and that to decontaminate vast areas of Fukushima
so that people can ever live there again is impossible.
Oishimbo's publisher has announced they will suspend publication for a time, but the manga's editorial
department, while acknowledging their "deep sense of responsibility as editors," say they "will reconsider the
wording" but will continue to present the opinions of well-informed people "on both sides, in parallel".
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Embroiling himself in this controversy, Okayama University professor of immunology Toshihide Tsuda has
declared that "You can't prove there is no causal relationship" -- i.e. that low-level radiation exposure might
cause nosebleeds -- another example of what presenting the opinions of "both sides" means: presenting most
prominently views that accord with Oishimbo's slant.
It is true that it is virtually impossible to prove the absence of a relationship between radiation exposure and
nosebleeds. This has always been the case: from Roman times, the proof that something is not a fact has been
called "the devil's proof" (probatio diabolica in Latin: demanding an impossible proof). It's easy to prove, for
example, that pandas are found in Tokyo: all you have to do is go to Ueno Park Zoo and take a picture of
one; but if you wanted to prove that pandas don't exist in Fukushima, how would you do it? You can't. But in
fact, there are no pandas in Fukushima and there is no relationship between nosebleeds and radiation.
Oishimbo's author Tetsu Kariya is an ecologist who hates food additives. As a young man he did research on
elementary particles at the University of Tokyo and aspired to become a physician; he is not someone
without any scientific training. I would say he has let his antinuclear ideological bias cross over into his
manga. Let's try to be more coolheaded. I'm sick and tired of seeing people confuse arguments about whether
nuclear power is good or bad with the effects of radiation.
The stupidity of linking one's political beliefs to an antinuclear stance
Among the well-informed people cited in the issue of Oishimbo that led to the manga's suspension is a writer
who lives in Fukushima and who thinks the same way as I do, Sôkyû Genyû. Specifically, we both think that
talking about where the responsibility lies is not the same thing as judging objectively what's going on now.
To be more specific, to say that TEPCO is to blame for the accident is not to say that radiation causes
nosebleeds. Making that kind of sloppy connection is an error.
We must not associate unrelated things, we must keep them separate in our minds. I think it's strange for
engineers, for example, to publicly voice opinions on subjects that have nothing whatever to do with their
field of expertise. Obviously I, too, have political convictions, like anyone else. I have opinions on energy
policy and nuclear reactors, but because I am not an expert in these matters I think they should be left to the
experts in those fields. I think this non-interference is a matter of showing respect for other branches of
science. All that I, as a specialist in medical radiology, am qualified to talk about is how much radiation is
actually present and what its effects on the human body are.
I've been called a "goyôgakusha" (an unprincipled academic lackey in the service of the State) and a member
of the lobby known as "Genshiryoku Mura" -- even though I've never received a penny from the nuclear
power industry. Not a penny. I'm always short of research funds and once thought that all you had to do was
ask for money and they'd give it to you. But it never happened that way for me. But as it happens, when
people hear that you are a radiation specialist from the University of Tokyo they assume you're a denizen of
"Genshiryoku Mura".
It's truly a shame that opposition to nuclear power is associated with certain political beliefs. I get the feeling
that ever since the latest nuclear accident Marxist-Leninist academics have come out of the woodwork to say
that radiation is very dangerous. People are free to have their own ideologies and political beliefs, but for
politics to confuse people so much that they believe that radiation causes nosebleeds is just plain silly.
Bias spoils everything
In September 2011 I was invited to a lecture and when I arrived I saw many policemen on duty. Five were in
civilian clothes, about five were in uniform, and I wondered what had happened, but no one would tell me.
As soon as I began to speak, though, a chorus of angry roars rose from the crowd. They were shouting,
"Come on, everybody: do you think you can trust a government lackey like him? He gets paid to say this
stuff!" And others in the audience stood up and howled their agreement. These were the first antinuclear
agitators I had met face to face.
On another occasion, I've been surrounded by a crowd of people acting nasty, although no one actually laid
their hands on me. I've even been called up at home by people I don't know. At first, I was afraid, but
gradually I got used to it.
Every winter until 2011, a Japan Air Self-Defense Forces helicopter used to bring snow down from Aomori
in the north to kids in Okinawa in the south who had never touched snow before. This was an annual event.
After the nuclear accident, however, a meeting was held in Naha (in Okinawa) to protest that it was
dangerous to bring snow from the "radioactive" Tohoku region (of which Fukushima is a part). So the annual
Aomori snow event was canceled. Who was it who made such a fuss at those meetings? It seems it was a
What Is Really Going On in Fukushima, by Keiichi Nakagawa
bunch of semiprofessional agitators who had "evacuated" from Tokyo to Okinawa for relative safety and
economic advantage. They certainly weren't ordinary children's mothers in Naha (the capital city of
Okinawa).
In elections, it's the silent majority who wins in the end, but when you have a majority of a small number of
people who make decisions, it's a minority with a political axe to grind that makes the rules. It took the form
of a majority vote, but it was undemocratic. In this case, the losers were the children of Okinawa. In fact, the
snow of Aomori is less radioactive than the rain in Okinawa. That's how stupid this kind of agitation is.
Here's another example: a few months ago, on a trial basis, the city of Kita-Kyushu (in southern Japan)
incinerated some debris brought south from Ishimaki (in Miyagi Prefecture, north of Fukushima).
Newspapers at the time reported that "Citizens physically blocked access to prevent incinerator operation,
and two people were arrested." In fact, however, extremists had announced they were responsible for the
action. Newspapers shouldn't have called them "citizens" but "promoters of a protest movement".
Just as it's unacceptable for children in Okinawa to have their fun in the snow spoiled by people with an axe
to grind, no set of beliefs should cloud people's scientific judgment. If playing in the snow in Okinawa is
really such a big issue, then it's the people of Okinawa who should vote on the issue in a referendum. In this
case, it was a majority of about ten who made the decision. Those who attended the meeting where this was
decided were not residents but opponents of nuclear power from outside prefectures.
Even if you think that it's unavoidable and there's nothing you can do about the fact that political beliefs
bring about a biased point of view, it's actions like this that end up spoiling everything. That, I think, is a
major threat to the foundations of democracy.
Takaaki Yoshimoto's legacy
The political and social thinker Takaaki Yoshimoto, who passed away in March 2012 at the age of 87, was
born and bred, like me, in Chuo City in Tokyo. After graduating from Tokyo Institute of Technology (from
which former Prime Minister Naoto Kan also graduated), Yoshimoto was active in the labor movement and
continued studies on his own, studying everything from literature to politics, society, religion, and even
subcultures, and in his writings and lectures he dealt with almost everything under the sun. He's regarded as
one of the giants of postwar Japanese thought.
Yoshimoto wrote many, many books and one of the best known is "Kyôdô gensô ron" (On Collective
Illusions). His writing style is very hard to understand, but the younger generation counts among his wildest
fans.
These are examples of his style:
"If you're really in trouble, of course it's OK to steal so you don't starve." (in "Akuninshôki")
"Those who get married and have children, whose children turn their backs on them and
disobey them, and who grow old and decrepit and die [...] -- those who live and end their lives in this
way have had the most valuable existence." (in "Jiko to ha nanika" (What is the Self?))
"Born as commoners, growing up, having children, living, growing old and dying -- the
multitudes who have lived through this kind of life over and over again have exactly the same value
as people who are seen in this world only once in a thousand years" (in "Karl Marx")
As you see from these quotes from three of his books, Yoshimoto was a writer with an attitude, a tough and
loyal inner-city working-class ethos that does a lot to explain his popularity.
Yet for years he made repeated statements on nuclear weapons and nuclear power issues that could not fail to
be interpreted as pro-nuclear power industry lobby. In the 1980s in particular he stirred up a controversy
when Japanese writers started an antinuclear weapons movement, which he lambasted as "pseudopacifism."
"To conflate opposition to nuclear weapons with opposition to nuclear power and then to ecology is the
sheerest ignorance," he wrote harshly in "Jôkyô he no Hatsugen" (Statement on the Situation).
What sparked this was a statement against nuclear weapons released in 1981 and signed by dozens of
Japanese writers, including Kôji Nakano (known for "honest poverty thought"), Masuji Ibuse, Yasushi Inoue,
Hisashi Inoue, Makoto Oda, Shôtarô Yasuoka, Junnosuke Yoshiyuki, Kensaburô Ôe, and other well known
Japanese writers, in total 36. Ultimately, their declaration was signed by over 500 other novelists and
essayists and developed into a petition campaign with 20 million signatures culminating in an antinuclear
demonstration in May of the following year.
What Is Really Going On in Fukushima, by Keiichi Nakagawa
Yoshimoto nevertheless lambasted the movement. In "Taishû to shite no genzai" (Now as the Masses) he
writes: "Is the purpose to object? Then when an antinuclear movement of the sort that means discontinuing
the profession of writing begins to heat up over a cause that seems like no one can object to -- then it's in
pretty bad trouble, I think." Yoshimoto was brought up in Japan's militaristic period; perhaps he thought
there was some overlap in the mass appeal of the anti-nuclear movement with Japan's rush into the Pacific
war.
Japan's literary and intellectual establishment unleashed a barrage of countercriticism; Yoshimoto was left
isolated and alone. In like fashion, after the Fukushima Daiichi accident, the consensus view was that the
post-accident radiation levels were dangerous. Most experts held their tongue, fearful that unless they joined
the chorus lamenting the dangers of radiation they would be accused, like me, of having sold out and being
beholden to the government and nuclear power industry. This is reminiscent of the prewar climate of opinion
where many Japanese intellectuals who had been saying "There's no way Japan can win a war against the
United States" eventually set aside all their reservations and joined the association of writers and scholars
who put their literary talents to use for war propaganda.
Yoshimoto had been a science major at Tokyo Institute of Technology and had his own take on science and
technology. After the Fukushima nuclear accident, in the New Year's issue of Shûkan Shinchô 2012, he
asked "Is it OK to discard the results of humanity's accumulated science and technology because of one
accident?" He went on, "Lots of people are killed in automobile accidents, but nobody is proposing that
automobiles be banned. To abolish a certain technology just because it has caused harm is to negate
modernity, which through humanity's progress has built up civilization."
In this book, I have not discussed the wisdom or folly of nuclear power generation. That's because I'm not an
expert in nuclear reactors or energy issues. And unless someone is actually a physician, I think that frankly
it's odd for someone who has never studied radiation biology to set himself up as a self-styled "expert" and
go about pronouncing on the health effects of radiation exposure. As a specialist in radiation medicine and as
a clinician and radiotherapist who treats cancer patients using radiation I can assert with confidence that
cancer will not increase at Fukushima due to radiation. For this I'm often told I've got guts, but I'm simply
emulating my senior from Tsukishima, Takaaki Yoshimoto.
The mass media's irresponsible scaremongering
The biggest risk we can ever run is to lose our life. The top-ranking cause of death in Japan is cancer. Every
year, 360,000 Japanese die of cancer (about 30% of all deaths). Broken down further, that's 130,000 deaths
due to cancer and heart disease caused by smoking, plus 30,000 suicides, from 30,000 to 50,000 deaths due
to air pollution, and 4,600 killed in automobile accidents. (In the last category, in addition to the deaths, there
are 60,000 injured and maimed -- but not killed -- by traffic accidents.)
So where does radiation fit into all this? The number of people who have lost their lives due to exposure to
radiation in the Fukushima accident, including nuclear power plant workers, is zero. So you can't say that the
risk of dying from radiation is great.
That smoking kills 130,000 people a year is not news, not considered newsworthy. The risks of smoking are
so great that they're taken for granted and not reported. But when it comes to BSE (bovine spongiform
encephalopathy, or mad cow disease), or dioxin, or PM2.5 particulates in the air -- those are all new, novel -and even if their risks are extremely small, the mass media feel obliged to cover them. That's how news is
made.
So we live constantly exposed to risks, but the yardstick we used to gauge risks breaks to pieces when
something unusual happens.
One of Japan's weeklies published a report immediately after the nuclear power plant accident declaring that
"Twenty years from now, there will be more cancer, birth defects, previously unknown diseases, mental
retardation -- children and grandchildren will be "damaged." However, there is actually no reason to think
that the sort of things alluded to in that report will ever happen: Genetic effects on children and
grandchildren have not been observed, even in Hiroshima and Nagasaki where the exposure was thousands
of sieverts. Even more intriguing is the repeated claim that health effects appear frequently at the 1
millisievert level; the Tokyo metropolitan area is at greater risk than Fukushima, supposedly. Tokyo's
radiation is more dangerous than Fukushima's? If you're talking about amounts of radioactivity, that's
impossible.
Why do the mass media publish such things? The reason is quite simple: Tokyo has a bigger population than
Fukushima. In other words, the magazine has more potential buyers in the metropolitan area. Write a scary
What Is Really Going On in Fukushima, by Keiichi Nakagawa
article and they'll buy it. Magazines and newspapers are commercial products; periodicals have to be sold or
the publishers won't make money; the mission of the mass media is to sell.
The same principle is at work in a movie called "Chernobyl Heart." The plot goes like this: the number of
children with heart disease has increased at Chernobyl, so doctors are recruited from Ukraine and Belorussia
to treat them. The problem is that no data show that pediatric heart disease has actually increased at
Chernobyl. The data show only that pediatric thyroid cancer has increased. Whether you're talking about
Chernobyl, Tokyo, or Fukushima, birth defects occur at a certain rate. Because the nuclear accident made a
deep impression on people, birth defects end up being linked to the accident, even though the accident had
nothing to do with the birth defects.
I'll cite another case where the public imagination races ahead of the facts: at Hiroshima and Nagasaki,
where the victims of the atomic bombings lost their lives, we know that victims' skin temperatures rose only
1/1000th of a degree due to the radiation. The burns and keloid injuries they sustained were caused not by
radiation but by blasts of hot air. Yet in the hearts of the Japanese, there is a tendency to associate
everything, including keloid scars, to the radiation of the atomic bombings, because our country is the only
country to have been atom bombed. I think it's important to understand that bias of this sort unavoidably
causes misapprehensions.
The urgency of teaching the younger generation the facts
In September 2012, I gave a one-day crash course on radiation and cancer at a public middle school in
Iitatemura in Fukushima Prefecture. Before I said anything, I had the students answer a questionnaire. When
I asked them what they thought of when they heard the word radiation, 28% answered "Fear" and 57%
answered "Increased risk of cancer."
Even though no influence on genetic inheritance has been confirmed in atom bomb victims at Hiroshima and
Nagasaki, 36% of all students and 56% of the girls thought that "Radiation has an effect on children born in
the future." This impression is attributable to misinformation circulated in all kinds of forms, partly due to
irresponsible reporting by certain elements of the mass media. This is how almost 60% of the girls in Iitate
Middle School had come to feel insecure about their prospects for marriage and childbirth.
The greatest loss of human life after the Chernobyl accident was in fact caused by the wave of abortions it
triggered, according to one report I remember reading. To be perfectly frank, thinking about the students'
anxieties put me in a black mood.
Luckily, however, after the lessons, the answers to the follow-up questionnaire were much more sanguine:
18% said they still associated radiation with "Fear" and only 4% overall (and 0% among the girls!) still had
anxieties about the effect on children. The percentage of students who said they understood well the effects
of radiation on the body was 8% before and 58% after the course. The one-day course considerably relieved
anxieties about radiation: the percentage of students who were not worried went from 29% before to 56%
after attending the classes -- and yet, nearly half of the students continued to worry...
As for knowledge and concerns about cancer, there were also big changes: 37% originally thought cancer
was incurable, but this percentage plummeted to 4%; 44% had thought cancer was a scary disease, but this
was better than halved to 17%; the percentage of students who thought having cancer was painful fell from
17% to 3%; and the 51% who thought all cancers had to be treated by surgery decreased to 16%. There were
corresponding increases in other attitudes and beliefs: the percentage of students who thought cancer could
be prevented better than quadrupled from 13% to 54%, those who understood it was a disease that occurred
more often as you got older better than doubled from 22% to 46%, and those who realized that lifestyles are
among the causes of cancer better than trebled from 16% to 53%.
Their knowledge of the facts of cancer prevalence certainly improved: before the course, close to 40%
thought that one out of five Japanese would get cancer at some time during their lifetime; afterward, 96%
answered correctly that one out of two Japanese develop cancer. Almost 90% reported that their father
smoked, probably because smoking is common among the farmers who grow tobacco. And in effect, when I
visited the Matsukawa temporary housing facility after giving the course, I observed that almost every man
had a cigarette between his lips. The risk of second-hand smoke is equivalent to the cancer risk of a 100
millisievert exposure to radiation. The effect of other people's smoking on the health of children living in
cramped temporary dwellings is a matter of great concern.
Fortunately, over 90% of the children said they would talk to their parents about radiation exposure when
they got home. In this way, parents' education by their children can be effective in bringing parents to
understand the facts of radiation correctly as well as in leading them to a reexamination of their lifestyles.
What Is Really Going On in Fukushima, by Keiichi Nakagawa
After his "Radiology 101" lessons on the elementary facts of radiation and its risks, fourteen-year-old Daiki
Sugano, representing his classmates, assured me that he would talk to his parents when he got home and
share what he had learned with them. In a way, I was even more reassured by these lessons than my students
were.
THE END of chapter 3, page 97
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