Why Is Cuba’s Health Care System the Best Model for Poor Countries?
By Don Fitz – Black Agenda Report – 12/12/2012
Furious though it may be, the current debate over health care in the US is largely irrelevant to charting a path for poor countries of Africa, Latin America, Asia and the Pacific Islands. That is because the US squanders perhaps 10 to 20 times what is needed for a good, affordable medical system. The waste is far more than 30% overhead by private insurance companies. It includes an enormous amount of over-treatment, making the poor sicker by refusing them treatment, creation of illnesses, exposure to contagion through over-hospitalization, and disease-focused instead of prevention-focused research. [1]
Poor countries simply cannot afford such a health system. Well over 100 countries are looking to the example of Cuba, which has the same 78-year life expectancy of the US while spending 4% per person annually of what the US does. [2]
The most revolutionary idea of the Cuban system is doctors living in the neighborhoods they serve. A doctor-nurse team is part of the community and know their patients well because they live at (or near) the consultorio (doctors’ office) where they work. Consultorios are backed up by policlínicos which provide services during off-hours and offer a wide variety of specialists. Policlínicos coordinate community health delivery and link nationally designed health initiatives with their local implementation.
Cubans call their system medicina general integral (MGI, comprehensive general medicine). Its programs focus on preventing people from getting diseases rather than curing them after they are sick
This has made Cuba extremely effective in control of everyday health issues. Having doctors’ offices in every neighborhood has brought the Cuban infant mortality rate below that of the US and less than half that of US Blacks. [3] Cuba has a record unmatched in dealing with chronic and infectious diseases with amazingly limited resources. These include (with date eradicated): polio (1962), malaria (1967), neonatal tetanus (1972), diphtheria (1979), congenital rubella syndrome (1989), post-mumps meningitis (1989), measles (1993), rubella (1995), and TB meningitis (1997). [4]
The MGI integration of neighborhood doctors’ offices with area clinics and a national hospital system also means the country responds well to emergencies. It has the ability to evacuate entire cities during a hurricane largely because consultorio staff know everyone in their neighborhood and who to call for help getting disabled residents out of harms way. At the same time New York City (roughly the same population as Cuba) had 43,000 cases of AIDS, Cuba had 200 AIDS patients. [5] More recent emergencies such as outbreaks of dengue fever are quickly followed by national mobilizations. [6]
Perhaps the most amazing aspect of Cuban medicine is that, despite its being a poor country itself, Cuba has sent over 124,000 health care professionals to provide care to 154 countries. [7] In addition to providing preventive medicine Cuba sends response teams following emergencies (such as earthquakes and hurricanes) and has over 20,000 students from other countries studying to be doctors at its Latin American School of Medicine in Havana (ELAM, Escuela Latinoamericana de Medicina). [8]
In a recent Monthly Review article, I gave in-depth descriptions of ELAM students participating in Cuban medical efforts in Haiti, Ghana and Peru. [9] What follows are 10 generalizations from Cuba’s extensive experience in developing medical science and sharing its approach with poor countries throughout the world. The concepts form the basis of the New Global Medicine and summarize what many authors have observed in dozens of articles and books.
First, it is not necessary to focus on expensive technology as the initial approach to medical care. Cuban doctors use machines that are available, but they have an amazing ability to treat disaster victims with field surgery. They are very aware that most lives are saved through preventive medicine such as nutrition and hygiene and that traditional cultures have their own healing wisdom. This is in direct contrast to Western medicine, especially as is dominant in the US, which uses costly diagnostic and treatment techniques as the first approach and is contemptuous of natural and alternative approaches.
Second, doctors must be part of the communities where they are working. This could mean living in the same neighborhood as a Peruvian consultorio. It could mean living in a Venezuelan community that is much more violent than a Cuban one. Or it could mean living in emergency tents adjacent to where victims are housed as Cuban medical brigades did after the 2010 earthquake in Haiti. Or staying in a village guesthouse in Ghana. Cuban-trained doctors know their patients by knowing their patients’ communities. This differs sharply from US doctors, who receive zero training on how to assess homes of their patients.
Third, the MGI model outlines relationships between people that go beyond a set of facts. Instead of memorizing mountains of information unlikely to be used in community health, which US students must do to pass medical board exams, Cuban students learn what is necessary to relate to people in consultorios, polyclínicos, field hospitals and remote villages. Far from being nuisance courses, studies in how people are bio-psycho-social beings are critical for the everyday practice of Cuban medicine.
Fourth, the MGI model is not static but is evolving and unique for each community. Western medicine searches for the correct pill for a given disease. In its rigid approach, a major reason for research is to discover a new pill after “side effects” of the first pill surface. Since traditional medicine is based on the culture where it has existed for centuries, the MGI model avoids the futility of seeking to impose a Western mindset on other societies.
Fifth, it is necessary to adapt medical aid to the political climate of the host country. This means using whatever resources the host government is able and willing to offer and living with restrictions. Those hosting a Cuban medical brigade may be friendly as in Venezuela and Ghana, hostile as is the Brazilian Medical Association, become increasingly hostile as occurred after the 2009 coup in Honduras, or change from hostile to friendly as occurred in Peru with the 2011 election of Ollanta Humala. This is quite different from US medical aide which, like its food aide, is part of an overall effort to dominate the receiving country and push it into adopting a Western model.
Sixth, the MGI model creates the basis for dramatic health effects. Preventive community health training, a desire to understand traditional healers, the ability to respond quickly to emergencies, and an appreciation of political limitations give Cuban medical teams astounding success. During the first 18 months of Cuba’s work in Honduras following Hurricane Mitch, infant mortality dropped from 80.3 to 30.9 per 1000 live births. When Cuban health professionals intervened in Gambia, malaria decreased from 600,000 cases in 2002 to 200,000 two years later. And Cuban/Venezuelan collaboration resulted in 1.5 million vision corrections by 2009. Kirk and Erisman conclude that “almost 2 million people throughout the world … owe their very lives to the availability of Cuban medical services.” [7]
Seventh, the New Global Medicine can become reality only if medical staff put healing above personal wealth. In Cuba, being a doctor, nurse or support staff and going on a mission to another country is one of the most fulfilling activities a person can do. The program continues to find an increasing number of volunteers despite the low salaries that Cuban health professionals earn. There is definitely a minority of US doctors who focus their practice in low income communities which have the greatest need. But there is no political leadership which makes a concerted effort to get physicians to do anything other than follow the money.
Eighth, dedication to the New Global Medicine is now being transferred to the next generation. When students at Cuban schools learn to be doctors, dentists or nurses their instructors tell them of their own participation in health brigades in Angola, Peru, Haiti, Honduras and dozens of other countries. Venezuela has already developed its own approach of MIC (medicina integral communitaria, comprehensive community medicine) which builds upon but is distinct from Cuban MGI. [10] Many ELAM students who work in Ghana as the Yaa Asantewaa Brigade are from the US. They learn approaches of traditional healers so they can compliment Ghanaian techniques with Cuban medical knowledge.
Ninth, the Cuban model is remaking medicine across the globe. Though best-known for its successes in Latin America, Africa and the Caribbean, Cuba has also provided assistance in Asia and the Pacific Islands. Cuba provided relief to the Ukraine after the 1986 Chernobyl meltdown, Sri Lanka following the 2004 tsunami, and Pakistan after its 2005 earthquake. Many of the countries hosting Cuban medical brigades are eager for them to help redesign their own health care systems. Rather than attempting to make expensive Western techniques available to everyone, the Cuban MGI model helps re-conceptualize how healing systems can meet the needs of a country’s poor.
Tenth, the new global medicine is a microcosm of how a few thousand revolutionaries can change the world. They do not need vast riches, expensive technology, or a massive increase in personal possessions to improve the quality of people’s lives. If dedicated to helping people while learning from those they help, they can prefigure a new world by carefully utilizing the resources in front of them. […]
Discussions of global health in the West typically bemoan the indisputable fact that poor countries still suffer from chronic and infectious diseases that rich countries have controlled for decades. International health organizations wring their hands over the high infant mortality rates and lack of resources to cope with natural disasters in much of the world. [3]
But they ignore the one health system that actually functions in a poor country, providing health care to all of its citizens as well as millions of others around the world. The conspiracy of silence surrounding the resounding success of Cuba’s health system proves the absolute unconcern by those who piously claim to be the most concerned.
How should progressives respond to this feigned ignorance of a meaningful solution to global health problems? A rational response must begin with spreading the word of Cuba’s New Global Medicine through every source of alternative media available. The message needs to be: Good health care is not more expensive — revolutionary medicine is far more cost effective than corporate controlled medicine.
Notes
1. Fitz, D. (December 9, 2010). Eight reasons US healthcare costs 96% more
than Cuba’s—With the same results.
http://www.alternet.org/health/149090/eight_reasons_us_healthcare_costs_96%25_more_than_cuba%27s–with_the_same_results
2. Dresang, L.T., Brebick, L., Murray, D., Shallue, A. & Sullivan-Vedder, L. (July-August, 2005). Family medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine, Journal of the American Board of Family Medicine 18 no. 4: 297-303.
3. Cooper, R.S., Kennelly, J.F. & Orduñez-Garcia, P. (2006). Health in Cuba, International Journal of Epidemiology, 35: 817–824.
4. Pérez, J. (May 15, 2012). Gender and HIV Prevention. Slide presentation at the Pedro Kouri Institute of Topical Medicine, Havana, Cuba.
5. Whiteford, L.M. & Branch, L.G. (2008). Primary Health Care in Cuba: The Other Revolution. Lanham: Rowman & Littlefield Publishers, Inc.
6. Fitz, D. (February 14, 2012). Med School Classes Cancelled in Havana.
http://blackagendareport.com/content/med-school-classes-cancelled-havana
7. Kirk, J.M. & Erisman, M.H. (2009). Cuban Medical Internationalism: Origins, Evolution and Goals. New York: Palgrave Macmillan.
8. Fitz, D. (March, 2011). The Latin American School of Medicine Today: ELAM. Monthly Review 62 no. 10: 50–62.
9. Fitz, D. (September, 2012). Cuba: The New Global Medicine. Monthly Review 64 no. 4: 37–46.
10. Brouwer, S. (2011). Revolutionary Doctors: How Venezuela and Cuba are Changing the World’s Conceptualization of Health Care. New York, Monthly Review Press.
Don Fitz can be contacted via fitzdon@aol.com
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A Radioactive Conflict of Interest
Having the Energy Department manage radiation health research makes as much sense as giving tobacco companies the authority to see if smoking is safe
By Robert Alvarez | Other Words | June 25, 2012
The U.S. government is going out of its way to downplay radiation hazards in the aftermath of one of the world’s worst nuclear accidents.
Last month, the Massachusetts Institute of Technology (MIT) heralded an Energy Department-funded study indicating that evacuation zones around nuclear power stations might not be needed after a major nuclear accident. The study, which exposed mice to radiation levels comparable to those near the Fukushima nuclear disaster, found no evidence of genetic harm. “There are no data that say that’s a dangerous level,” says Jacquelyn Yanch, a leader of the study.
“Current U.S. regulations require that residents of any area that reaches radiation levels eight times higher than background should be evacuated,” according to MIT’s press release. “However, the financial and emotional cost of such relocation may not be worthwhile, the researchers say.”
It’s quite a leap to claim that evacuation zones around nuclear power plants might not be needed based on the chromosomes of 112 irradiated mice.
In a devastating critique, blogger Ian Goddard points out that the MIT study excluded extensive evidence of genetic damage to humans living in a radiation-contaminated environment. Although doses in a peer-reviewed study of 19 groups of children living near Chernobyl were consistently lower than the MIT mouse study, most showed lasting genetic damage. “MIT’s presentation of its study as the first scientific examination of the genetic risks of living in a nuclear disaster zone is pure science fiction, not fact,” Goddard concludes.
Even more troubling, the Obama administration reduced emergency preparedness in case of a major nuclear accident in a quiet announcement made six months ago, right before Christmas — virtually guaranteeing minimal media attention. Given that the number of people living near nuclear stations has grown four-and-a-half times larger since 1980, a move in the opposite direction would make more sense.
What’s going on? The United States remains a major pillar of nuclear support here and around the world. About 70 percent of the Energy Department’s $26.3-billion budget covers nuclear activities — and that’s not including $18.5 billion in loan guarantees for new reactors that are slated for construction in South Carolina and Georgia. Japan’s failing nuclear industry is supposed to build them.
The Energy Department is also the main source of funding for radiation health research. That’s like having the tobacco industry determine if smoking is bad for your health. And this conflict of interest is nothing new. Several prominent scientists on the nuclear payroll in the 1950s and 60s vigorously claimed that radioactive fallout from atmospheric nuclear weapons tests was harmless. Some went so far as to claim that fallout might be beneficial because increased radiation-induced genetic mutations could weed out the weak.
This problem was not lost on congressional investigators over the past 35 years. They revealed the government’s suppression of incriminating data, blacklisting of uncooperative researchers, unethical human experiments, and submission of fraudulent research in federal court. By the late 1980s, the agency was forced to move funding for radiation research to public health agencies. This all changed a decade later, when the Republican-controlled Congress restored the Energy Department’s monopoly over radiation health research.
Things have gotten so bad that the agency gave MIT a $1.7-million grant last month to research, among other things, the “difficulties in gaining the broad social acceptance” of nuclear power. MIT also receives millions of dollars from Tokyo Electric Power Co., the company responsible for the Fukushima nuclear disaster.
This conflict of interest has tragic dimensions. The government and nuclear industry still have yet to deal with the costly disposal of enormous amounts of radioactive waste and profoundly contaminated “sacrifice zones” at the Energy Department’s nuclear sites. Or to resolve the issue of the tens of thousands of sick nuclear workers, uranium miners, military veterans, experiment victims, and nuclear test “down-winders,” who are receiving billions of dollars in compensation after being put in harm’s way on behalf of splitting the atom.
~
Robert Alvarez, an Institute for Policy Studies senior scholar, served as a Senior Policy Advisor to the Secretary of Energy during the Clinton Administration. He authored the report Spent Nuclear Fuel Pools in the U.S.: Reducing the Deadly Risks of Storage.
Why Are These Fraudulent Papers Unretracted?
Big Pharma’s Ghostwriters
By MARTHA ROSENBERG | CounterPunch | April 27, 2012
According to Science Times [1], the Tuesday science section in the New York Times, scientific retractions are on the rise because of a “dysfunctional scientific climate” that has created a “winner-take-all game with perverse incentives that lead scientists to cut corners and, in some cases, commit acts of misconduct.”
But elsewhere, audacious, falsified research stands unretracted–including the work of authors who actually went to prison for fraud!
Richard Borison, MD, former psychiatry chief at the Augusta Veterans Affairs medical center and Medical College of Georgia, was sentenced to 15 years in prison for a $10 million clinical trial fraud [2] but his 1996 US Seroquel® Study Group research is unretracted. [3] In fact, it is cited in 173 works and medical textbooks, misleading future medical professionals. [4]
Scott Reuben, MD, the “Bernie Madoff” of medicine who published research on clinical trials that never existed, was sentenced to six months in prison in 2010.[5] But his “research” on popular pain killers like Celebrex and Lyrica is unretracted. [6] If going to prison for research fraud is not enough reason for retraction, what is?
Wayne MacFadden, MD, resigned as US medical director for Seroquel in 2006, after sexual affairs with two coworker women researchers surfaced[7], but the related work is unretracted and was even part of Seroquel’s FDA approval package for bipolar disorder. [8]
More than 50 ghostwritten papers about hormone therapy (HT) written by Pfizer’s marketing firm, Designwrite, ran in medical journals, according to unsealed court documents on the University of California–San Francisco’s Drug Industry Document Archive. [9] Though the papers claimed no link between HT and breast cancer and false cardiac and cognitive benefits and were ghostwritten by marketing professionals not doctors, none has been retracted.
Pfizer/Parke-Davis placed 13 ghostwritten articles[10] in medical journals promoting Neurontin for off label uses, including a supplement to the Cleveland Clinic [11] but only Cochrane Database Systematic Reviews and Protocols has retracted the specious articles. [12]
Nor is the phony science just a product of “Big Pharma.” In 2008, JAMA was forced to print a correction stating that authors of an article arguing for a higher recommended dietary allowance of protein were, in fact, industry operatives. [13] Sharon L. Miller was “formerly employed by the National Cattlemen’s Beef Association,” and author Robert R. Wolfe, PhD, received money from the Egg Nutrition Center, the National Dairy Council, the National Pork Board, and the Beef Checkoff through the National Cattlemen’s Beef Association, said the clarification. Miller’s email address, in fact was smiller@beef.org, which should might have been the JAMA editors’ first tip-off.[14] The article has also not been retracted.
Martha Rosenberg’s is an investigative health reporter. Her first book, Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health, has just been released by Prometheus books.
Notes.
[2] Steve Stecklow and Laura Johannes, “Test Case: Drug Makers Relied on Two Researchers Who Now Await Trial,” Wall Street Journal, August 8, 1997
[3] Richard Borison et al., “ICI 204,636, an Atypical Antipsychotic: Efficacy and Safety in a Multicenter, Placebo-Controlled Trial in Patients with Schizophrenia,” Journal of Clinical Psychopharmacology 16, no. 2 (April 1996): 158–69
[4] Alan F. Schatzberg and Charles B. Nemeroff, Textbook of Psychopharmacology (New York: American Psychiatric Publishing, 2009) p. 609
[5] http://www.scientificamerican.com/article.cfm?id=a-medical-madoff-anesthestesiologist-faked-data
[6] Scott Reuben et al., “The Analgesic Efficacy of Celecoxib, Pregabalin, and Their Combination for Spinal Fusion Surgery,” Anesthesia & Analgesia 103, no. 5 (November 2006): 1271–77.
[8] http://www.lifesciencesworld.com/news/view/12152 (BOLDER study)
[9] Martha Rosenberg, “Flash Back. The Troubling Revival of Hormone Therapy. Consumers Digest, November 2010
[10] Kristina Fiore, “Journals Aided in Marketing of Gabapentin,” MedPage Today, September 11, 2009
[11] United States District Court, District of Massachusetts, Report on the Use of Neurontin for Bipolar and Other Mood Disorders,http://i.bnet.com/blogs/neurontin-09513078512.pdf
[12] P. J. Wiffen et al., “WITHDRAWN: Gabapentin for Acute and Chronic Pain,” Cochrane Database Systematic Reviews and Protocols 16, no. 3 (March 16, 2011); P. J. Wiffen et al., “WITHDRAWN: Anticonvulsant Drugs for Acute and Chronic Pain,” Cochrane Database Systematic Reviews and Protocols no. 1 (January 20, 2010);
As “Blockbuster Drug” Bubble Bursts, Big Pharma Takes Jobs Overseas
By Martha Rosenberg | Dissident Voice | March 12th, 2012
It is no consolation to the roughly one out of 600 families who lost their homes in the U.S. but Wall Street made a lot of money slicing and dicing mortgages it knew would implode, while hiding risks. Financial giants, like AIG, are still buzzing along and neither penalties or new laws will prevent a future crash, say financial analysts, because the risky business models have not really changed.
A similar Big Pharma bubble, leavened with risky blockbuster drugs that also blew up, is now bursting. Like Wall Street’s bundled high risk loans, the “tide” created by Big Pharma’s high risk drugs raised many ships during the 2000s from advertising, public relations and medical communication agencies to TV and radio stations, medical journals and doctor/pitchmen who shoveled in its marketing budgets. But now the joy ride is over and Pharma is shedding jobs and settling billions in claims without changing its risky business model, like Wall Street.
In Europe, governments are no longer willing to pay the high prices for drugs that they once did say published reports and some countries are drafting laws making drug makers “prove their drugs are effective or risk having them dropped from the coverage list, or covered at a lower rate.” Imagine!
Germany has already saved 1.9 billion euros in 2011 by refusing to pay higher prices for drugs unless they are clearly superior to existing medicines, and Pharma worries that other countries will also get tough and want scientific proof for drug effectiveness instead of marketing and spin. In the U.S. and elsewhere, a drug only needs to be superior to no drug (placebo) to be approved by regulators — yet “new” is conveyed as “better than any drug to date” in advertising. Some clinicians say Haldol, an inexpensive antipsychotic, and lithium, a similar affordable bipolar drug are better than blockbuster antipyschotics and bipolar drugs that created Pharma’s 2000 bubble.
Before the Vioxx scandal and major settlements over blockbuster drugs like Zyprexa, Bextra, Celebrex, Geodon and Seroquel, being a Pharma rep was probably the next best thing to working on Wall Street. Direct-to-consumer advertising did your pre-sell for you, and all you had to do was show up with your snappy Vytorin tote bag and samples case. Some Pharma reps had their own reception room with ice water, swivel chairs, and laptop ports at medical offices, and most waltzed in to see the doctor right in front of waiting and sick patients. (It didn’t hurt that reps were usually “hotties,” both men or women).
But, by 2011, the bloom had fallen off Pharma reps’ roses. The number of prescribers willing to see most reps fell almost 20 percent, the number refusing to see all reps increased by half, and eight million sales calls were “nearly impossible to complete,” reported ZS Associates. Blockbuster drugs that were found to be unsafe after their big sales push or even withdrawn altogether, did not help the reps’ credibility with doctors. After the aggressively marketed hormone therapy was linked to high incidences of cancer, stroke and heart attack, Wyeth (now Pfizer) announced it was eliminating 1,200 jobs and closing its Rouses Point, New York plant where Prempro products were manufactured.
As government and private insurers increasingly say, “You want us to cover what?” about expensive, dangerous drugs that are not even proven effective, Pharma bubble jobs are evaporating. Almost 20,000 jobs have vanished at AstraZeneca, Novartis and Pfizer in the last 12 months alone. (AstraZeneca scrapped 21,600 more since 2007). Meanwhile, Pharma is outsourcing more of its operations to poor countries.
Workers and people willing to be trial subjects are both a bargain in poor countries where many can’t understand drug risks or refuse them if they did (and most can’t afford the very drugs they help sell). In January the Argentinian Federation of Health Professionals accused drug maker GlaxoSmithKline of misleading participants and pressuring poor families into joining a trial for the Synflorix vaccine, which the company says protects against bacterial pneumonia and meningitis, reported CNN. In 2010, 10 deaths occurred during Pfizer and AstraZeneca drug trials at the Bhopal Memorial Hospital and Research Centre which was ironically built for survivors of the 1984 Bhopal gas disaster, reports MSNBC. 3,878 workers perished in Bhopal when chemicals leaked at a Union Carbide pesticide plant.
Outsourcing drug manufacturing to cheap venues also contributes to Pharma’s cascade of “quality control” problems in which drugs are mislabeled, contaminated or otherwise made dangerous. It is speculated that Johnson & Johnson’s CEO William Weldon “was pushed to retire because of all of the quality issues at McNeil as well as with the company’s hip implant products, which have resulted in a raft of litigation,” reports FiercePharma.
Like the Wall Street bubble, the Pharma bubble was built on products that industry, but not the public, knew were risky, sold for quick profits. Now regulators are examining some of these “assets” more closely and with disturbing findings. The FDA now warns that bestselling statin drugs like Lipitor and Crestor, even approved for children, are linked to memory loss and diabetes associated with. The equally well selling proton pump inhibitors like Nexium and Prilosec for acid reflux disease (GERD) are now believed to increase the risk of bone fractures by 30 percent.
In March, the FDA even rejected a Merck drug that combines the active drug in Lipitor with the active drug in Zetia and Vytorin, a drug that Forbes calls Son of Vytorin. Vytorin (the father) was advertised to treat both food and family “sources of cholesterol” until results from a study that Merck and Schering-Plough appeared to withhold from regulators showed the drug had no effect on the buildup of plaque in the arteries (believed to correlate with heart attack and stroke). There was such a gap between marketing and science, Sen. Chuck Grassley (R-Iowa) asked the General Accounting Office to investigate why the FDA was approving “drugs that appear to have little to no effect in protecting lives and increasing health.”
Yet even as clouds develop over Pharma’s top-selling drugs, some say the FDA is too hard on new drugs, not too easy. “The FDA is impeding useful innovations in the U.S.,” says former FDA deputy commissioner Scott Gottlieb in the a Wall Street Journal oped and lagging behind other countries. Former FDA commissioner Andrew Von Eschenbach, also writing in the WSJ, agrees. The FDA should improve U.S. drug competitiveness by allowing drugs “to be approved based on safety, with efficacy to be proven in later trials,” while the public is already taking the drugs. Isn’t that what’s happening now?
~
Martha Rosenberg is a columnist/cartoonist who writes about public health. Her first book, titled Born with a Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp the Public Health, will be published in April 2012 by Amherst, New York-based Prometheus Books. She can be reached at: martharosenberg@sbcglobal.net.
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Media, Academia Join Forces to Downplay Dangers of Nuclear Power
By Titus North | Dissident Voice | March 10th, 2012
Last April 20 the New England Journal of Medicine (NEJM) published an on-line article entitled “Short-term and Long-term Health Risks of Nuclear-Power-Plant Accidents” by Dr. Eli Glatstein and five other authors. The article was riddled with distortions and misinformation, and overall was very poor research. As the NEJM is a peer reviewed journal and has a significant letters section, I wrote a letter pointing out some of the errors committed by the authors, and a longer piece containing a comprehensive critique.
The NEJM demands that letters to the journal contain material that has not been submitted or published elsewhere, so I had to refrain from submitting my longer piece anywhere until the NEMJ made a decision on my letter. When my letter did not appear after a couple of weeks I inquired, and was told that the article would soon appear in the printed version of the Journal, and that no letters about the article could be published until after the print version came out. The printed version finally appeared on June 16.
However, on July 1,1 was notified by the NEMJ that they would not publish my letter due to “space constraints.” The four letters that they did publish in response to the article were at most only mildly critical and missed the glaring short-comings of the report. In other words, NEMJ sat on my letter and effectively stifled my critique of what can only be described as industry propaganda for almost three months until public attention had moved on to other matters. However, with attention once again focused on the still-out of control Fukushima reactors on the first anniversary of the accident, my expose on how the media and academia have joined together to downplay the dangers of nuclear power is a poignant as ever.
*****
Since the nuclear disaster in Fukushima started in March, the media has been full of misinformation about the dangers posed by the nuclear accidents and the damage caused by past accidents such as those at Chernobyl and Three Mile Island. Whether it is Jay Lehr on Fox News1 or George Monbiot on Democracy Now,2 the story line is the same: there were only dozens of deaths from the Chernobyl and none from TMI, the health consequences for the general population are negligible, and all things considered nuclear power is among the safest forms of energy. In some cases the lines are spoken by industry hacks whose true motive is to protect profits, while other times the spokesperson is a global warming tunnel visionist who has lost sight of the fact that we as humans have ingeniously devised a multitude of ways to mess up our planet, including nuclear wars and disasters.
Lehr and Monbiot both made reference to a 2005 report commissioned by the United Nations that included the participation of the International Atomic Energy Agency (IAEA), the World Health Organization (WHO) and several other UN-linked agencies. Oddly enough, the official press release by the UN announcing publication of the report starts off with the following sentence: “A total of up to four thousand people could eventually die of radiation exposure from the Chernobyl nuclear power plant (NPP) accident nearly 20 years ago, an international team of more than 100 scientists has concluded.”
The reference to 50 deaths pertained to those “directly attributed” to radiation from the disaster. Moreover, this report represents the most conservative of studies from credible sources, with other estimates reaching as high as almost one million Chernobyl deaths.
Lehr works for a public policy think-tank and Monbiot is a journalist. Perhaps we should expect writers from those professions to misleadingly cite sources in order to promote a preset agenda in the hope that no one will check their sources. However, it comes as a shock that medical doctors writing in a prestigious medical journal like the New England Journal of Medicine (NEJM) would resort to the same practice. On April 20 the NEJM published an article by six doctors entitled: “Short-term and Long-term Health Risks of Nuclear-Power-Plant Accidents.” I will not presume to know what the motives of the authors were or what led them to their erroneous conclusions, but I do feel the need to point out the errors that somehow the NEJM’s peer review process failed to notice.
The authors prominently cite two International Atomic Energy Agency (IAEA) studies in downplaying the deaths from Chernobyl. The authors state that “[a]lthough the Three Mile Island accident has not yet led to identifiable health effects, the Chernobyl accident resulted in 28 deaths related to radiation exposure in the year after the accident. The long-term effects of the Chernobyl accident are still being characterized, as we discuss in more detail below.” What is the reader intended to take from this statement? First of all, that the TMI accident in its totality did not cause any health effects that have been identified, which is itself a problematic statement. Secondly, that the total deaths from Chernobyl were the 28 in the first year plus whatever would be discussed later in the paper. As it turns out, the rest of the paper only mentions fatalities one other time, and that is that 11 of 13 plant and emergency workers that underwent bone marrow transplants died, and it is not clear whether or not these eleven are included in the above mentioned 28 fatalities. So the reader is left with the impression that the studies that the NEJM authors are citing conclude that the Chernobyl accident in its totality produced only a few dozen fatalities.
However, just as with Lehr and Monbiot, the NEJM authors start with the most conservative studies and then are misleading in their citations. They ignore the existence of high-profile studies that draw very different conclusions, omit the more damning parts of the studies they do cite, and then quote statements that were not intended to portray the totality of the accidents as if they were bottom line conclusions.
For instance, in making the assertion that Chernobyl caused 28 deaths in the first year, the NEJM authors cited an IAEA report that actually said: “The accident caused the deaths within a few days or weeks of 30 ChNPP employees and firemen (including 28 deaths that were due to radiation exposure).”
Notice that the IAEA statement is limited to power plant employees and fireman, whereas the authors imply the entire population. In fact, that IAEA study focused on the “600 emergency workers who were on the site of the Chernobyl power plant during the night of the accident,” and not the exposed population at large or the hundreds of thousands of “liquidators” who worked to contain the plant over the next couple years. Moreover, the IAEA study did not preclude the possibility that some of the liquidators or general public could have been killed due to radiation exposure in the first year, not to mention subsequent years. While the authors only mention a handful of cancer deaths in subsequent years, the second IAEA study acknowledges that among the one million or so most exposed, several thousand Chernobyl-caused cancer deaths would be “very difficult to detect.” The study states the following:
The projections indicate that, among the most exposed populations (liquidators, evacuees and residents of the so-called ‘strict control zones’) total cancer mortality might increase by up to a few per cent owing to Chernobyl related radiation exposure. Such an increase could mean eventually up to several thousand fatal cancers in addition to perhaps one hundred thousand cancer deaths expected in these populations from all other causes. An increase of this magnitude would be very difficult to detect, even with very careful long term epidemiological studies.
Clearly, the content of these two IAEA studies was not accurately reflected in the NEJM article. Moreover, the IAEA is not necessarily the best source of information. It was never intended to protect the public from the dangers of nuclear power plants. That is not part of its mission. The statute of the IAEA states that:
[t]he Agency shall seek to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world. It shall ensure, so far as it is able, that assistance provided by it or at its request or under its supervision or control is not used in such a way as to further any military purpose.
Thus, the IAEA was created to PROMOTE nuclear power (while checking the proliferation of nuclear weapons). It therefore cannot be assumed to be an unbiased or authoritative source of information on the health risks of nuclear power.
The NEJM article is misleading or inaccurate in other instances. For instance, its discussion is weighted too much towards whole body radiation, which is really only relevant to the emergency workers. The article acknowledges that it is not whole body radiation, but rather internal contamination that is “the primary mechanism through which large populations around a reactor accident can be exposed to radiation.” So why emphasize whole body radiation if it is not the mechanism through which populations are endangered?
They then launched into a long discussion about acute radiation sickness, which is largely a red herring since the threat to the general public is mainly from cancer. The NEJM article further obfuscates the issue with a table that compares the effective doses of radiation that a resident near a nuclear accident is exposed to with what someone is exposed to from something mundane like an airplane ride or a chest x-ray. This is like comparing the force of a cool breeze to the force of a knife slicing the jugular. The knife is lethal because it allows a very small amount of force to be concentrated on a vulnerable target. Similarly, the risk to Fukushima residents is not radiation spread out over their entire body, but rather radioisotopes like iodine 131 being concentrated by biological processes into a vulnerable target like the thyroid.
The NEJM authors mislead in other ways. They write “After Chernobyl, approximately 5 million people in the region may have had excess radiation exposure, primarily through internal contamination.” They cite the second IAEA study. The reader is likely to assume that up to 5 million people in the countries in Europe and Asia where the fallout from Chernobyl may have reached could have been exposed to excess radiation (i.e. radiation in excess of normal), and that this is the limit of exposure to internal radiation.
However, the IAEA study is only referring to the contamination region designated by the former USSR (a small area in the corners of Ukraine, Belarus, and Russia) and does not imply that excess radiation exposure (internal or otherwise) was limited to this area. In fact, they do not use the word “excess,” but rather specify a particular level of radioactive cesium. The actual wording of the IAEA report was as follows:
More than five million people live in areas of Belarus, Russia, and Ukraine that are classified as ‘contaminated’ with radionuclides due to the Chernobyl accident (above 37 kBq m-2 of 137Cs).
On the same page, the report also states that “The cloud from the burning reactor spread numerous types of radioactive materials, especially iodine and caesium (sic) radionuclides, over much of Europe.” It added that radioactive cesium-137 “is still measurable in soils and some foods in many parts of Europe.” Thus, there certainly were people outside of this narrow region of 5 million inhabitants who also were exposed to Chernobyl radiation through their environment and food. Indeed, the authors discuss the move by Polish authorities to administer potassium iodide to 10 million Polish children. Obviously Polish officials feared radiation exposure to these people.
Furthermore, there is major omission in the authors’ discussion of radiation. They discuss beta and gamma radiation, but do not mention alpha radiation. They then go on to dismiss the danger of plutonium contamination, which is dangerous precisely because it is an alpha emitter. They state that “Radioisotopes with a … very long half-life (e.g., 24,400 years for plutonium-239) … do not cause substantial internal or external contamination in reactor accidents.” The authors are either lying or ignorant. The danger from plutonium-239 has nothing to do with its half-life (long half-lives indicate slower radioactive decay). Plutonium, if ingested internally, is dangerous because the large and heavy alpha particles it emits are the most damaging to DNA and the most likely to cause cancer. In fact, Plutonium is the most lethal substance known to mankind.
As mentioned above, the IAEA cannot be thought of as an authoritative, unbiased source of health information given its explicit mission of promoting nuclear power. The same can be said for other sources cited by the authors, including the U.S. Nuclear Regulatory Agency and the Nuclear Energy Agency of the Organization for Economic Cooperation and Development. At the same time, the authors ignored prominent studies produced independently of the nuclear industry and affiliated governmental bodies that indicate that there were indeed serious public health consequences from the Chernobyl and Three Mile Island accident.
Significantly, the authors failed to mention the seminal work on the consequences of radiation exposure from Chernobyl done by Yablokov, Nesterenko and Nesterenko of the Russian National Academy of Sciences.3 This team of scientists from Russia and Belarus studied health data, radiological surveys and 5,000 scientific reports from 1986 to 2004, mostly in Slavic languages, and estimated that the Chernobyl accident caused the deaths of 985,000 people worldwide. Given the prominence of this report and the fact that its findings are completely at odds with the conclusions reached by the IAEA and other sources cited by the authors, it was intellectually dishonest not to mention the report if only to dismiss it.
Indeed, the Yablokov et al report is hardly the only major study to contrast starkly with the minimalist portrayal of the health consequences from nuclear accidents. Regarding Three Mile Island, there is the June 1991 Columbia University Health Study (Susser-Hatch) of the health impacts from the TMI accident published its findings in the American Journal of Public Health and subsequent work by Dr. Steven Wing of the University of North Carolina. These studies point to increased incidences of cancer in areas close to the reactor or downwind from it.
Another example of minimizing potential health impacts of a nuclear plant accident is this statement in connection with the accident at Fukushima:
Although the radioactivity in seawater close to the plant may be transiently higher than usual by several orders of magnitude, it diffuses rapidly with distance and decays over time, according to half-life, both before and after ingestion by marine life.
Japan has a massive fishing industry because, along with rice, fish is the staple of the Japanese diet. Any release of radiation into coastal fishing grounds will wind up being concentrated through biological processes as it works its way up the food chain and eventually to the Japanese dinner table. The narrow restrictions on commercial fishing near the Fukushima coast may be obeyed by fisherman, but many of the fish they seek are migratory, and there is no way of preventing these fish or their food sources from passing through contaminated water. Moreover, the claim that the radioactivity “decays over time” glosses over exactly how much time. While some of the radioisotopes being spilled into the ocean have half-lives of days, others have half-lives of years and even millennia. The impact on health from releases into the ocean cannot be so lightly dismissed.
Although it will take some time for the dust (or fallout) to settle, it may well turn out that the Fukushima disaster is the worst nuclear accident of all-time, surpassing Chernobyl. The contamination from the Chernobyl accident led to the establishment of a 30-kilometer wide “zone of alienation” to which people are not allowed to return. The current evacuation zone around the Fukushima plant is of comparable size, and with the Fukushima reactors continuing to release contamination for the foreseeable future, the only question is how large will be Japan’s “zone of alienation.” And while greater Tokyo has so far been largely spared due to the prevailing winds blowing so much of the contamination into the Pacific, winds will be changing with the upcoming monsoon season and the summer typhoons. [Note: countless radioactive “hot spots” have since been detected all over greater Tokyo, particularly in places where rain water accumulates.]
It is this proximity to Tokyo, one of the world’s most densely populated metropolises, that could make Fukushima the worst industrial calamity in history. An increase in cancer mortality even of the “difficult to detect” scale referred to by the IAEA study described above could condemn several tens of thousands of people. And that is far from being the worst case. The NEJM authors and others who propagate myths about the minimal casualties from Chernobyl and other accidents feed into a mindset that is leading to disastrous policy decisions. The only way to correct course is to identify the myths and the mythmakers.
- Jay Lehr said that at Chernobyl “the bottom line was that 50 people died in the explosion from radiation from fire…”
- George Monbiot stated that “so far the death toll from Chernobyl amongst both workers and local people is 43.”
- Alexey V. Yablokov, Vassily B. Nesterenko, Alexey V. Nesterenko, “Chernobyl: Consequences of the Catastrophe for People and the Environment“, 2010, Nature – 400. Also available at: Annals of the New York Academy of Sciences, Vol. 1181
Titus North is an adjunct professor in the University of Pittsburgh’s Political Science department.
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The Genetic Deception — now in paperback (Second Edition)
Lies are Unbekoming | October 2, 2026
The genes the field promised were never there.
The genetic story of disease is a cover story.
The twenty-first century runs on it. Paediatric clinics. Cancer centres. Forensic laboratories. Family-planning counsel. It is used to explain illness, to assign blame, to foreclose questions. It protects the industries whose products and practices are what actually caused the harm.
It isn’t true.
In 2010, Jonathan Latham and Allison Wilson looked at over seven hundred genome-wide association studies covering some eighty common diseases. The genes the field had promised were not there. The field invented a term, “missing heritability”, to explain the absence, and has quietly worked to bury the finding ever since.
The Genetic Deception is a book about what Latham and Wilson found. What the field did with it. And what the public was told instead. … continue
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