Post-disaster Fukushima: Up to 30 mile Impact

It’s been more than two years since the Fukushima nuclear power plant experienced a meltdown after the earthquake and tsunami.  The environmental disaster resulting from the meltdown has received some publicity of late when solutions were being sought to contain the contaminated water leaking (or flowing) from the site.  We have heard very little about the impact of this on local residents.  Wednesday’s New York Times provided a glimpse at the effect of this disaster on residents more than 5 miles away.

Unfortunately residents up to 20 miles away from the plant were relocated and are unable to return to their homes – even now.  I think I imagined that people within a few miles of the plant were certainly affected – but I have to admit I had my head in the sand in terms of how many people were affected.  A total of 11 towns were evacuated.  Nearly 83,000 refugees evacuated from these areas are still not able to go home. We can see an uninhabitable area surrounding the plant for miles – I assume the shape of the area relates to weather and geographic features.  These residents are in ‘limbo’ regarding whether it will ever be safe to return.   Here is a link to the article with the zone affected surrounding the plant identified - (http://www.nytimes.com/2013/10/02/world/asia/japans-nuclear-refugees-still-stuck-in-limbo.html?smid=pl-share ) as you can see people up to 30 miles away have contamination levels in the ‘yellow’(20 to 50 millisieverts/yr) or ‘red’ zone (more than 50 millisieverts/yr). 

What does this mean? Public exposure is suggested by the International Commission on Radiological Protection (ICRP) of no more than 0.3mSv/year exposure from waste management and no more than 0.1mSv/yr for prolonged exposure.  For comparison - in homes with radon exposure, the remediation level is 3-10 mSv/yr and for occupational exposure the dose is 20mSv/yr.  Doses from 20mSv/yr to 100mSv/yr are considered ‘emergency exposure situations’.  (information on exposure rates can be found in  ICRP Publication 103, Annals of the ICRP, 37(2-4), 2007. Or try this link: http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103  )

As we see here – disasters do happen – fortunately for most of us they are rare events and typically they affect us only a short amount of time – but unfortunately for a small few the impact is catastrophic. I have written previously that we don’t seem to expect that things like this could happen to us – but this example tells us – that yes, they do happen.  We expect that the power company and public officials have assured that regardless of natural or other type of disaster scenario the plants will be safe – yet we see failures and the devastating consequences.  While we learn much from disasters and apply it to preventing the next catastrophe, I do not believe we can ever imagine all the possibilities.  This of course leaves us open to being the next group with an unexpected or unprecedented disaster.

Recently we experienced an era where the business side of most operations (including health care, and utilities I am sure) decided that having ‘just in time’ inventory was enough – one replacement for parts or equipment would be enough – we decided not to stock up for the rainy day – but to better use that investment elsewhere to balance the books.  As we see with the massive power outages or transportation problems lately – not having needed supplies available to perform operations affects us regularly.  Luckily these problems are few and far between – but we are no less stunned and outraged when they occur.  

I imagine with the nuclear power plants you and I live near to – we tend to think a disaster of this sort couldn’t happen here – we have safety standards and safety or disaster planning that would limit the impact.  Unfortunately this may not be true – sometimes we really don’t have control over things – sometimes it is impossible to control things (like with the events in Fukushima or hurricanes or… ). 

We do have nuclear power here in CT.  I wonder how many of us could be impacted in a major disaster such as this?  If we drew a 20 or 30 mile circle around our plant (or our storage facility from our closed reactor), who would be impacted?  If I bought a home close to the plant I would knowingly be taking that risk – but how close? I did not choose to live within a few miles of a nuclear plant – but as we see many things can affect the plume of such a disaster.  Were we all aware that this could affect our ability to live freely in our own homes?  What do I or anyone else know of risks like this! 

Our closed reactor, CT Yankee was disassembled and its contaminated fuel rods and irradiated enclosures are stored right here in CT.  The federal government was supposed to open a used fuel storage facility in 1998 (part of the Nuclear Waste Policy Act) – but still has not done so.  So we have one containment facility in CT.  I imagine this is a low risk for disaster site – but I really do not know.  We also have a working facility, Millstone in CT.  Over 100,000 people live within 10 miles of that facility (http://en.wikipedia.org/wiki/Millstone_Nuclear_Power_Plant) .  (The Nuclear Regulatory Commission identifies a 10 mile radius plume exposure zone within which breathing airborne contaminants would be dangerous and a 50 mile zone for ingestion of food or drink contaminated by radioactivity - that may be most of CT Wikipedia indicated nearly 3 million in this zone) (Here is a link to their info: http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/emerg-plan-prep-nuc-power-bg.html).  That is a lot of exposure and a lot of people to relocate.  Imagining the evacuation required boggles my mind…  those who are still in the process of recovery from our recent natural disasters can probably still relate to what is involved when your home is destroyed or declared uninhabitable.

My hearts go out to the residents of these 11 towns in Japan – I imagine that like me – they never expected that their homes would be devastated in this way. 

Food Fraud: Counterfeit food products

The New York Times included an article about counterfeit food this week – similar to counterfeit designer bags – except consumable – and maybe even dangerous to your health.  Disturbing.

It seems any part of the food chain might be involved – from the oil in the baked product – whether bought pre-packaged at the store or fresh in a local bakery! 

The article was focused on fraud found in the UK and Europe, but the US is not immune.  Some examples:

• Counterfeit chocolate, olive oil, champagne – which may have water, vegetable oil, or other substitutes to increase profits.
• Shellfish that may be contaminated and we have heard about fish that is mislabeled as a more expensive type. 
• Vodka with perfect counterfeit labels and duty stamps (Glen’s Vodka in this case) – but the vodka was spiked with BLEACH to correct the color – and it had high methanol levels – which of course risks blindness if enough is consumed.  All of course sold at a bargain price – we do love a bargain don’t we?

My question is – how can we be sure we are getting the real thing – and that our food is really safe?

The FDA of course is the primary regulator in the US, and they do monitor and regulate food products for safety and truthfulness.  ABC News reported on these issues back in January, 2013 and identify several groups that provide some monitoring of these issues – 

• The US Pharmacopeial Convention (USP), 
• the Anit-Counterfeit and Product Protection Program (A-CAPPP), 
• the Grocery Manufacturers of America, 
• the National Consumers League.  

It appears the USP and the National Consumers league actually test products.  The USP  maintains a Food Fraud Database (here is the link: http://www.foodfraud.org/ )– which identifies a variety of risks associated with foods with references to studies that have been completed on various foods – however does not list direct information that would help you avoid certain brands on your shopping list.

My question remains – how can we be sure we are getting the real thing – and that food and drink are really safe?

References: 

Here is the link to the NY Times story by STEPHEN CASTLE and DOREEN CARVAJAL (Published: June 26, 2013)  http://www.nytimes.com/2013/06/27/business/food-fraud-more-widespread-than-suspected.html?smid=pl-share

And to ABC News Coverage by Jim Avila and Serena Marshall (Jan 22, 2013): http://abcnews.go.com/US/exclusive-group-finds-fake-ingredients-popular-foods/story?id=18281941&singlePage=true#.Uc2sdNi0SrM

Michael Douglas: Raising awareness about HPV and Oropharyngeal Cancer

Michael Douglas recently raised our awareness about the risk of Human Papillomavirus (HPV) infection leading to oropharyngeal cancer.  HPV is a common Sexually Transmitted Disease (STD) – here is a link to some information about HPV: http://www.cdc.gov/hpv/whatishpv.html.  HPV can lead to both minor and major health problems, including warts on the hands or feet, genital warts, and cancers.  There are more than 160 types of HPV – over 40 of which are transferred by mucosal or genital transmission, of these 40, two are responsible for most of the cancer risk, HPV 16 and HPV 18, including cervical, anogenital and oropharyngeal cancers (Saraiya,2013).  Information on HPV-associated cancers can be found here: http://www.cancer.org/ and on oropharyngeal cancer here: http://wwwnc.cdc.gov/eid/article/16/11/10-0452_article.htm.  

It is laudable that Douglas would disclose this, particularly given the stigma related to STD’s.  He raises awareness of the risk of this STD to individuals (like middle aged and older adults) who may not consider themselves at risk from exposure to HPV decades earlier.  Unfortunately little can be done to detect this form of cancer early.  Here is a useful guide from the American Cancer Society related to oropharyngeal cancer: http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/index

Michael Douglas at the Vanity Fair party for the 2012 Tribeca Film Festival; by David Shankbone, 4/17/2012. (Use of this photograph does not imply endorsement of the author or the ideas shared)   Image from: http://en.wikipedia.org/wiki/File:Michael_Douglas_VF_2012_Shankbone.JPG

Douglas’ acknowledgement of the possibility of his cancer being linked to sexual activity and HPV transmission has naturally raised the question of what should be done about this risk? Men are at much higher risk of developing oropharyngeal cancer from HPV than women.  Should we screen all men for HPV like women are screened with pap smears to reduce cervical cancer risk?  Unfortunately there are difficulties to screening for this type of cancer.  Here is a video by the New York Times discussing some of these concerns: http://www.nytimes.com/video/2013/06/10/health/100000002273386/a-collective-gulp.html?smid=pl-share

While screening programs are common and they are usually viewed as only good – there are actually down-sides to screening – for example what happens when it is very difficult to detect the presence of the HPV virus (HPV-16 or HPV-18) that leads to throat cancer?  What if attempting to detect the presence of a virus to prevent its eventual turn to cancer actually has dangers to the individual?  Particularly in a situation where the rate of cancer development from this virus is low?  For example, although nearly everyone who is sexually active will acquire HPV, most virus types are not cancerous – and cancers are rare even in those infected with high risk HPV types (HPV 16 and 18), requiring persistent infection (Saraiya, 2013).  There were an average of approximately 32,000 new HPV-associated cancers identified between 2005 and 2009 in the US, of which 20,000 were identified in women (89% genital cancers), while 12,000 were identified in men (78% were oropharyngeal ) (Saraiya, 2013).

Similar to other screening programs, we should be judicious in use of societal resources to identify disease – it is difficult to weigh the risks and benefits of screening because not all diseases are simple to detect, and often our methods of detection are less than perfect – leading to many individuals who test positive for a disease by a not-so-good screening method to initially believe they have cancer only to find out later it was a false-positive result.  This of course is true in mammography where women often have lumps that require follow up ultrasound or biopsy – which then pushes the woman into a limbo of fear of actually having breast cancer – only to find out later it was an innocuous lump.  Depending on the type of lump found, some women undergo lengthy periods of heightened screening– leading to anxiety and greater exposure to ionizing radiation – however this screening is of great benefit when the risk of disease is high. 

While early identification and treatment of disease are important goals for our health care system, the actual ability of providers and detection methods to deliver this result is often limited by the lack of research and technology to accurately detect the disease.   In the case of HPV there are immunizations that prevent infection, however evidence is not yet available that these vaccines are effective in those who are already infected – this is one reason why the immunization focus is on youth who are not yet sexually active- it is hoped that most infections with HPV 16 will be prevented in the future, thus eliminating risk of cancer from this infection.  With continued research we will accumulate efficacy data from immunization.  Hopefully someday we will also better understand how to prevent cancer in those with acquired HPV infection  and also have better methods for early identification of the infection before the cancer occurs.

References & Links used to prepare this summary:

Saraiya, M. (2013). Public health importance of human papillomavirus infection and disease. CDC: Division of Cancer Prevention and Control. Accessed on 6/11/2013: http://www.cdc.gov/about/grand-rounds/archives/2013/pdfs/GR_HPV_Feb19.pdf

http://www.cdc.gov/hpv/whatishpv.html

http://www.cancer.org/

http://wwwnc.cdc.gov/eid/article/16/11/10-0452_article.htm

http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/index

http://www.nytimes.com/video/2013/06/10/health/100000002273386/a-collective-gulp.html?smid=pl-share