This case report deserves wider publicity

A case report in the latest issue of  The British Medical Journal (THE BMJ) describing a serious injury to a 36 year old male patient deserves wider publicity as we can prevent such instances by imparting correct information.

Physicians from the Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, India authored the case report

The link:      http://casereports.bmj.com/content/2018/bcr-2018-226562.full.pdf

(The photographs which The BMJ carried may shock some readers).

Dr Jamie Well  wrote a news story based on it in one of the dispatches of the American Council on Science and Health (ACSH)

Here is the link:

https://www.acsh.org/news/2018/08/15/yes-you-can-%E2%80%98break%E2%80%99-your-penis-13314.

I feel that the case report must be published in popular dailies and other contemporary publications. I made this suggestion to the concerned physicians. Drugs such as Viagra are reportedly available on line. Patients may come to grief if they consume the drugs  without medical supervision

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Tributes to Dr K A Dishaw, an Eminent Specialist

Dr K A Dinshaw, an eminent radiation oncologist died on August 26, 2011 .She was 67. I  had  opportunity to work with her while we were together in an exploratory mission in the field of medical radiology to Italy organized by the Department of Science & Technology in November 1999.  There were other occasions when I interacted with her. I am referring to them in a PTI feature I wrote about her on September 3, 2011.

You may read it and if possible give me feedback at ksparth@gmail.com

PTI FEATURE   

  HEALTH

VOL NO XXVII(36)-2011              Sept 03 2011                 PF-143/2011

Tributes to an Eminent Cancer Specialist

Dr K S Parthasarathy*

 She was an institution builder.  She batted for indigenous equipment and pushed the agenda to develop an indigenous telecobalt unit and christened it Bhabhatron, which is now installed in 20 hospitals in India. Her admirers and peers may find it hard to list her contributions.

Dr (Ms) Ketayun Ardeshir Dinshaw DMRT (Lond), FRCR (Lond), eminent radiation oncologist and former Director of Tata Memorial Hospital (TMH), Mumbai died on August 26, 2011. She was 67.

She was born in a Parsi family in Kolkata; her father, an architect, motivated her to become a doctor. In an informative interview (Journal of Cancer Research and Therapeutics, August 26, 2011), Dr. Dinshaw, known to her close colleagues as Katy, vividly described her career in medicine.  After graduation from Christian Medical College, Vellore (1961-66), she had an inclination towards Surgery for her Master’s degree. She changed her mind and chose Radiotherapy, under Dr Padam Singh, who was then Head of Radiotherapy Department.

The interview, given to Dr. Meena Tiwari admirably covers Dr Dinshaw’s magnificent contributions.

Dinshaw completed her post-graduation in radiotherapy from Addenbrooke’s Hospital, Cambridge in November 1973. On her return to India in December 1973, Dr Jussawalla, Director, TMH appointed her as an Assistant Radiotherapist in 1974. Rest is history.

For the next 35 years, she served the hospital with distinction. She retired in November 2008 after remaining as Director for 13 years. Dr Dinshaw worked tirelessly to make TMH an outstanding centre for cancer treatment and research.

With the support of Dr. P B Desai, then Director TMH, she successfully set up a separate radiotherapy department as till then it co-existed with radiology. Among her achievements, she rated getting approval for the introduction of MD seats in radiotherapy as a major leap.

To Dr Tiwari’s query on what has been her biggest challenge as an administrator of Tata Memorial Centre, Dr Dinshaw noted that stepping in as Director of TMC was an uphill task in itself. During those times, the Directors of TMC were heads of the surgery department.

“No women have been at the helm of affairs at TMC. However, the selection committee endorsed my candidature and was very supportive”, she added. Physical renovation of the hospital building with the treatment of patients remaining unaffected was another big challenge.

Setting up  the Digital Library and Telemedicine project which gives unlimited access to professional information worldwide, particularly helping patients in remote areas such as North-East India  to gain easy access to medical expertise were notable achievements.

“She was responsible for TMH fraternity to accept that other than surgery, ‘Radiation’  as an important part of the management of cancer”, Dr K. R. Das who collaborated with her on some important projects noted. “Till then TMH was essentially a surgeon’s world” he added.

Dr Deepak Deshpande, Head, Medical Physics Department, TMH and Das highlighted her role in introducing Iridium 192 wires for interstitial implants in India in 1983. Later it found wide acceptance all over India.

Dr Das and Dr A.Shanta collaborated with her in introducing Iridium 192 wires for breast implants. “Dr Dinshaw was open to suggestions and never turned away from problems”, Das acknowledged.

Dr Dinshaw appreciated the role of medical physicists. “She was responsible for the introduction of counter checks in physics and clinical documentation. She devoted lot of time for medical physics even after becoming Director”, Shri P S Viswanathan, former Head, Medical Physics Department, TMH remembered.

“It is very important to work as a team with medical physicists and technologists. Equally important is to provide opportunity to every one to upgrade their expertise and genuinely make them fell as an important part of a team”, Dr Dinshaw told Dr Meena Tiwari when she sought from her a message to the young radiation oncologists.

Dr Dinshaw played a major role in setting up the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC). With pure research in the field of cancer and a clinical wing, ACTREC is achieving its objective as a centre of excellence.

In a touching tribute, Dr Rajiv Sarin, Director, ACTREC remembered that the internationally renowned cancer specialist lost her personal battle to the disease which she ironically fought as a disciplined soldier and a visionary leader for four decades.

“A staunch patriot and eternal optimist, in various international forums he pitched and batted in style and poise not just for India but for the cause of cancer in the entire developing world”, Dr Sarin noted.

“Her respect and admiration for the serving and retired men and women in the armed forces and their families who came to TMH for treatment or training and her sensitivity to women and children was so special and selfless” Sarin said…“she formed a personal relationship with each one of us which was much beyond her official role as director, head of department or colleague”, he added

“She treated equally all medical and nonmedical staff”, Viswanathan concurred.

“This great connoisseur of music and art was also an ardent admirer of the plant kingdom, ferrying lovely plants from all over the world…almost single-handedly she greened the spawling 60 acre ACTREC campus in Kharghar where there is a Dinshaw Baug full of her plants”, Dr Sarin revealed.

I had many occasions to interact with Dr. Dinshaw. Often I sought her views on patient safety related matters. An incident in Panama and another in Poland compromised the safety of patients.  She was very happy to note that I brought those incidents to the notice of Indian hospitals.

Occasionally, the Atomic Energy Regulatory Board took action against a few hospitals. Some physicians felt that the Board was a bit harsh. Dinshaw concurred with me after listening to my explanation.

We were members of an exploratory mission in the field of medical radiology to Italy organized by the Department of Science & Technology in November 1999. While visiting a hospital, a receptionist asked us to wait in the office of the Director. Shortly, the Director arrived. The first thing he did was to light a cigarette. Dr Dinshaw protested and asked him why he is hanging a “No Smoking” warning in his room. Without batting an eyelid, he told us that the rule does not apply to the Director!

“Cigarette-addicts are the same everywhere”, Dinshaw told him.

Dr Dinshaw received many awards  including Padmashri (2001). She was an institution builder.  She batted for indigenous equipment and pushed the agenda to develop an indigenous telecobalt unit and christened it Bhabhatron, which is now installed in 20 hospitals in India. Her admirers and peers may find it hard to list her contributions. —-PTI Feature

      * Dr K S Parthasarathy was a Raja Ramanna Fellow, Department of Atomic Energy when he wrote this article

                                                                  ——-xxx—–                 

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Pumpkins and Halloween

On December 31, 2018, I wrote an article titled “Pumpkins and Halloween” in  Eurasia Review. I am reproducing the link and the article below

https://www.eurasiareview.com/31102018-pumpkins-and-halloween-oped/

 

Pumpkins And Halloween – OpEd

 October 31, 2018 Dr. K S Parthasarathy  0 Comments

By Dr. K S Parthasarathy

Though I have been to the USA several times, I did not take any interest on Halloween. This year it is different. That is because of my granddaughters! Their infectious enthusiasm moves me. I abandoned my taciturn attitudes to celebrations, I had assiduously followed all these years! The little ones gladly ran around while their dad carved pumpkins of different sizes and shapes. The children helped their mom to paint them bright red, blue and green;; they painted themselves as their palms carry the colors they handled. They were glad that there were no noisy admonitions this time!

In an article titled “The Halloween Pumpkin: An American History“, Stephanie Butler writes that the association of pumpkins with Halloween is a very recent phenomenon. The author quotes a poem on “eating pumpkins at morning and pumpkins at noon”, a Massachusetts settler wrote in 1630s.

According to Ms. Butler,” Modern Halloween comes from the Irish festival Samhain, an occasion that marked the passage from the summer harvest season to the dark of winter. Tradition dictated huge bonfires be built in fields, and it was believed that fairy spirits lurked in the shadows. To distract these spirits from settling into houses and farms, people would carve rudimentary faces into large turnips, and set candles inside. The turnip lanterns would rest along roadways and next to gates, to both light the way for travelers and caution any passing fairies against invading.”

Ms. Butler says that the celebration of Halloween in America did not take off until waves of immigrants from Ireland and Scotland arrived in the mid-1800s. “Pumpkins are native to North America, so while it’s not known exactly when the first pumpkin was carved and lit, the first mention of pumpkins jack o’lanterns comes at around the same time. In 1866, the children’s magazine “Harper’s Young People” reported that “a great sacrifice of pumpkins” had been made that for that year’s Halloween celebrations. Pumpkin carving grew more and more popular as the years went on. By the 1920s, Halloween had been embraced throughout the United States. Parties and costumes became the norm, and “trick or treating” soon followed in the mid-1930s.”

Giant pumpkin carving is a skilled craft now. You may see some amazing pumpkin carvings here. These activities have another side: If you are careless, they may cause injuries. Ms Victoria Forster, postdoctoral research scientist at The Hospital for Sick Children, Toronto writes in Forbes (October 28, 2018) that hospitals recorded 4,500 Halloween related injuries last year.

The US Consumer Product Safety Commission published the following chilling facts:

  • October to November 2017, estimated 4500 Halloween related injuries were recorded
  • 41% were related to pumpkin carving
  • 32% were due to fall while putting up or taking down decorations, tripping on costumes or just walking while trick or treating
  • 22% of the injuries included lacerations or ingestions and other costume, pumpkin or decoration related injuries and
  • 5% due to allergic reactions or rashes.

“The most common Halloween injuries we see are severe hand injuries from pumpkin carving and leg and extremity injuries due to falls from long costumes and/or costumes that impair vision,” Ms Forster quoted orthopedic surgeon and American Academy of Orthopedic Surgeons spokesperson Kevin G. Shea, MD.

Ms Forster lucidly gave many instances of injuries and safety tips. After listing many safety tips, the CPSC concluded thus, “Now that your costumes and decorations have been created and placed with safety in mind, don’t forget to have fun! Have a safe and spooky Halloween with your family and friends”

At http://www.history.com you can find the following facts on pumpkins:

  • Pumpkins belong to the gourd family, which includes cucumbers, honeydew melons, cantaloupe, watermelons and zucchini. These plants are native to Central America and Mexico, but now grow on six continents.
  • The largest pumpkin pie ever baked was in 2005 and weighed 2,020 pounds.
  • People have grown pumpkins in North America for five thousand years.
  • They are indigenous to the western hemisphere.
  • In 1584, after French explorer Jacques Cartier explored the St. Lawrence region of North America, he reported finding “gros melons.” The name was translated into English as “pompions,” which has since evolved into the modern “pumpkin.”
  • Pumpkins are low in calories, fat, and sodium and high in fiber. They are good sources of Vitamin A, Vitamin B, potassium, protein, and iron.
  • Pumpkin seeds should be planted between the last week of May and the middle of June. They take between 90 and 120 days to grow and are picked in October when they are bright orange in color. Their seeds can be saved to grow new pumpkins the next year.

Americacomes alive website, while sharing the little known facts about America’s past, explained why carved pumpkins are a symbol of Halloween. Thus:

“The tradition of carving faces into vegetables dates to the Celts. As part of their autumnal celebration, they wanted to light the way to their homes for the good spirits, so they carved faces into vegetables such as turnips and squash. A light was placed within the hollowed out vegetable.

These carved vegetables were eventually called Jack O’Lanterns by the Irish who told a legend about a farmer named Jack who made a bargain with the devil that left him wandering the earth for all time.

When the immigrants arrived in America and found a bountiful supply of pumpkins, they soon adopted the pumpkin as the best fruit (and it is a fruit!) for carving Jack O’Lanterns.”

Pumpkin industry

According to the US Department of Agriculture, US harvested in 2016 about 15 million pounds of pumpkins from nearly 67,000 acres. It was worth $207.6 million. The Guardian reported that the UK would be wasting 8 million pumpkins after this Halloween, the equivalent of enough pumpkin pie to feed the entire nation.

“Almost three-fifths (58%) of consumers buy pumpkins to hollow out and carve, of whom only a third bother to cook the leftover but edible innards, according to the annual #PumpkinRescue campaign,” the daily reported

Shockingly, 51% of the buyers throw away the flesh. The daily noted that Halloween is a significant money-spinner for supermarkets and is now second to Christmas in terms of festive retail. The UK grows estimated 10m pumpkins annually, 95% of which will be hollowed out in lanterns for Halloween and the rest used in recipes.

“Some pumpkins are inedible and specified as “for ornamental use only” but the flesh of the majority is edible.” the paper added.

Mr. Alexandru Micu, the science blogger at ZMEscience.com wants everyone to fight the food waste during the Halloween. He directs us to the PumpkinRescue campaign page for some nifty suggestions and tips on how to cook our plump pumpkins.

Incidentally, Mathias Willemijns (Belgium) grew the heaviest pumpkin, 1,190.49 kg (2,624.6 lb) so far. Great Pumpkin Commonwealth (GPC) in Ludwigsburg, Germany authenticated it on 9 October 2016.

 

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Heavy metals in Ayurvedic medicines

On January 9, 2005, I wrote a PTI feature titled “Heavy metals in Ayurvedic Medicines.”  Some dailies reprinted it. Unfortunately I could not get a copy of my article on line. The topic is still alive. I did some follow up work on it over the next few years. This included writing letters to the Secretary, Department of Health and Family Welfare, Government of India. One of this letters contained the details on the pioneering work done by Dr K S V Nambi in this field.  Government of India banned exporting heavy metal containing Ayurvedic Medicines. All that can be a topic for a blog in due course I am reproducing the PTI feature article I wrote.

The Daily Excelsior January9, 2005

PTI Feature

Heavy metals in Ayurvedic medicines:
By K S Parthasarathy
Recently, Dr Robert B. Saper from the Boston University School of Medicine and his colleagues published a paper titled ‘Heavy metal content of certain Ayurvedic herbal medicine products’, which showed that 14 out of 70 unique Ayurvedic herbal medicine products (HMPs) manufactured by 27 companies (26 Indian and one Pakistani) and bought from 30 stores within 20 miles of Boston City Hall contained lead, mercury and /or arsenic.

They identified lead in 13 HMPs; mercury in six and arsenic in six. The drug manufacturers had recommended half of these medicines for children. If anyone consumes these medicines as per the manufacturer’s dosage recommendations, their intake will exceed regulatory standards. The researchers cautioned the users of Ayurvedic medicines about heavy metal toxicity and demanded that authorities must test these products for heavy metals mandatorily.

Scientists have detected heavy metals in Ayurvedic medicine in Australia, Croatia and the UK besides the USA and India. They have systematically documented their toxic effects. On July 9, 2004, the US Center for Disease Control and Prevention received reports of 12 cases of lead poisoning associated with the use of Ayurvedic medicines. Generally, these patients took the medicine for arthritis or diabetes and in one case for menstrual health. One woman aged 31 years and a man aged 34 years took the drug to increase fertility. In 2002, E Ernst, University of Exeter reviewed many case reports.
It is nothing new. For more than a decade, leading hospitals in Mumbai used to refer suspected metal poisoning cases to the Environmental Assessment Division (EAD), Bhabha Atomic Research Centre. During 1984-96, they identified Ayurvedic medicines as the source of lead in 29 out of the 95 suspected lead poisoning cases.

BARC doctors treated 56-year-old man for a long time for various diseases. His condition did not improve. They suspected that he was suffering from lead poisoning. BARC scientists confirmed it when they found high concentration of lead in his blood. Previously he ate about 8 milligramme of lead daily through Ayurvedic tablets, bhasma and solution. Intake of lead through normal food is forty times lower. He stopped the Ayurvedic medication; the level of lead in his blood lowered. His life was saved.
A 48-year-old female patient referred to BARC by a leading hospital had a lead concentration four times the normal in her blood. She was in coma. She was a diabetic and was taking an ayurvedic drug. A sample of this drug contained 37,770.4 microgramme gm of lead. She recovered fully after appropriate therapy.

Dr. K. S. V. Nambi and his colleagues from BARC listed the lead content ranging from 0.4 to 2, 61,200 microgramme gm in 14 Ayurvedic drugs in the Journal Energy Environment Monitor (13 :2, 1997).

Over the past several years, researchers at the Indian Institute of Environmental Medicine, Mumbai have been measuring routinely the lead content in blood samples of many patients referred to them. In many cases, they identified Ayurvedic medicine as the source of lead poisoning.

The issue is serious. It merits deft handling. Such formulations need close scientific study. Pharmaceutical companies may debunk Ayurveda. May be they are not transparent enough in their business practices. But our approach to the issue should not be shortsighted.

Newspaper headlines and editorials such as ‘Government rubbishes US report on dangers of Ayurveda’, ‘American Medical Association trains its guns on herbal medicines’. “This is a conspiracy by big pharma companies,” on this topic are worrisome. Some fear that the news will have an impact on tourism as substantial numbers of tourists come for Ayurvedic treatment; others have concerns on export earnings from drugs. These are important. So is the health of our own citizens.

Standardising Ayurvedic medicines is a daunting task. Specialists like Dr M. S. Kamath, Additional Professor and Head, Department of Ayurveda, Kasturba Medical College, Manipal argue that metals and minerals used in Ayurveda undergo certain purification process and are used in the form of bhasmas. In an interview published in a Johannesburg newspaper, Dr Rajen Coopan, an Ayurvedic physician from South Africa stated that the “bhasmas acted as catalysts by unlocking the healing properties of the herbal ingredients… All bhasmas were subjected to a stringent 18 step refinement and purification process that removed the toxicity from the metals.” Is it possible to verify such claims by animal studies?

The Union Health Ministry has promptly set up a high-level committee to study the JAMA report. The panel must also examine the case reports on the toxicity of Ayurvedic drugs sold in the Indian market to arrive at appropriate recommendations.

Recently I asked Ayurvedic firms whether they add heavy metals intentionally in some Ayurvedic medicines or they reach the final product inadvertently during manufacture. Do these metals have curative properties? I asked them how they will reassure a patient who asks them about the presence of toxic metals in quantities above acceptable limits in Ayurvedic medicines. Do the professional associations have a stand on these issues? Do they think that the fear of toxic metals in drugs will hurt their business especially export? I also wanted to know whether they believe that pharmaceutical companies and allopathic practioners deliberately project the issue as they have a vested interest in debunking Ayurvedic form of treatment. I did not receive any response from them so far.

I sent these questions to the US National Ayurvedic Medical Association (NAMA) and the Foundation for Indian System of Medicine in the Netherlands. J Rioux, Secretary, NAMA replied thus: “The issues you raise are complex and at this point NAMA is not taking an official stance on the presence of heavy metals in Ayurvedic drugs. I’m sorry that we cannot answer your questions in more detail, but as a professional association we can simply say that our constituency is broad and may have varied opinions on the subject. The discussion will be ongoing as Ayurveda continues to professionalise in the United States.”

I feel that the JAMA paper provided a much needed wake-up call. This awareness must goad us on to action. We must verify the claims of harmlessness of bhasmas etc scientifically. This is essential to preserve the traditional merits of Ayurveda. Unscrupulous vendors must not be allowed to play with the life of thousands of our compatriots.

PTI Feature

 

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Some controversies in radiological protection

The uses of radiation in industry, medicine, agriculture and research have increased many times over the past few decades. Radiation is also present in nuclear installations such as nuclear power plants.In 1960-1961, the radiation dose measuring programme in India covered over 3000 persons. In 2016, the workers covered were 1,43,149.

The science of radiation protection grew and formed the basis for various. recommendations. Most countries  enforce the recommendations of the International Commission on Radiological Protection (ICRP). There were a few controversies in the basic concepts. I had occasions to share , understand appreciate these controversies.

I covered some of them in an article I published in The Wire.

Here is the link: https://thewire.in/science/radiation-lnt-hypothesis-phobia

Another article I wrote in Eurasia Review may be also of interest.

https://www.eurasiareview.com/17052018-radiation-doses-their-limits-related-issues-of-public-perception-analysis/

I had an opportunity to be in the company of Prof Roger Clarke while attending the XIX Annual Conference of the Association of Medical Physicists of India at Delhi. He was then the  Chairman of the ICRP. Our discussions over a few days covered many of  the controversies in radiation protection. Please read the transcript of the interview given below:

EXTRACT OF THE INTERVIEW GIVEN BY Prof. Roger Clarke, chairman, International Commission on Radiological protection to Dr. K.S. Parthasarathy, Secretary, AERB during his visit to India to participate in the International Conference on Medical Physics and the XIXth annual Conference of Association of Medical Physicists of India

Dr. KSP : I remember that it is not your first visit to India

Prof. Roger Clarke : I cam to India a few years ago. But I am attending the Medical Physics Conference for the first time.

KSP : In your last visit you addressed the officers of the Atomic energy Regulatory Board (AERB).

RC : I know a few colleagues from India who worked with me in the Committees of the International Commission on Radiological protection.

KSP: How did you get into the field of radiological protection? What was the incentive to enter this field? The career of a radiation physicist may not have been lucrative. Is it not?

RC : I was a reactor physicist working for the Central Electricity Generating Board (CEGB). One day my head of Division came to me. He wanted an answer for the question, with how many failed fuel plus pins you can operate an Advanced Gas Cooled Reactor (AGCR). It was in the Sixties. AGCR fuel was more expensive. Primarily the emphasis was on the basis of those to the public. I collected relevant data. In the process, I calculated the inventory of the fission products. I got introduced to health physics. I did some environmental modeling, got interest in radiobiology. Later I joined the National Radiological Protection Board to establish close assessment capability after gathering inputs on the environmental concentration of radionuclide. There was a group working on the movement of radionuclide in the biosphere. This was 20 years ago. This group was primarily interested in the study of radiation doses due to releases of radionuclide.

KSP: Historically, the International Commission on Radiological Protection (ICRP) was setup to make recommendations on the safe use of ionizing  radiation in medicine. But it took a few decades for ICRP to bring out comprehensive recommendations on the protection of patients in diagnostic radiology. What was the reasons for this? Was it because  ICRP did not want any control on medical radiation proactive?

RC : In the early years, therapeutic treatment was given more emphasis. The forerunner of the ICRP originated from the recommendations of the British X-ray and Radium Protection Committee. Then the major concern was protection of the workers. This was because deterministic effects such as extensive skin damage was seen among the x-ray workers who handled x-ray units. After the Second World War more penetrating radiations came to be used in medicine. Artificial radioisotopes appeared on the scene. More and More public were exposed. The emphasis shifted to public exposure. It coincided with more developments in fifties the emphasis was on therapy. Later more and more diagnostic technologies were developed.

KSP: Is it true that after the Second World War, many technically qualified people entered the job market. Many of them were electrical engineers. Apparently, this gave a boost to the development of newer technologies, which included manufacture of x-ray generations of higher and higher voltages.

RC : That is true. Radiation generators emitting more penetrating radiation began to appear in medical practice. Leukemia was identified among medical practitioners. The work by an American Physician Mr. Shields Warren is notable. He reported that Leukemia among radiologists was higher than that among general medical practitioners. It was obvious that ICRP, in this background, started giving more emphasis to patient protection. I would like to mention one recent development. Deterministic effects are coming out into focus now. Some of the interventional procedure, if carried out without care, can give substantial does to patients.

KSP: So it is not true that ICRP was somewhat biased in favour of radiologists over the years. What was the type of representation radiologists had in the ICRP?

RC: That ICRP charter states that only one radiologist need be there in ICRP though it was set up by the International Congress of Radiology – a professional association of radiologist – It is often not known that there are two more organizations to be considered, the International Commission on Radiation Units (ICRUs) and the International Committee for Education in Radiation and Radiology. The latter organization was established a few years back, but was not very active. It was re-established around five years back.

KSP: What are the new concerns?

RC: The concern of the radiologists shifted to finding out what is a better image. Future is in imaging, in medical imaging. For instance, digital imaging in interventional radiology, electronic manipulation of images, fluoroscopy with computer software. These technologies are likely to appear. More and more computer will start controlling x-ray imaging. Surgeons will turn round and expect computers to control the imaging procedure. With the newer techniques being used a dose reduction of a factor of about 10 is possible to the patient. The workers are also benefited by the dose reduction.

KSP: Do you agree that the scholarly discussion on the Linear-Non Threshold (L-NT)hypothesis has contributed to the notion that there is no safe level of radiation. Has it not sensitized the large public to greater and unreasonable levels?.

RC : I agree. When experts disagree, the credibility of specialists suffers. If experts do not agree, how can people decide which side of the argument is believable? I cannot deny that the arguments on L-NT has created some difficulties. The situation could be bad because there is an increasing possibility that decisions in science may be made by judges and juries in court rooms and not by professional association or by Royal Societies. The judiciary system may not be able to convince itself about the increased possibilities of radiation effects.

KSP: Don’t you thing that it is futile to try to get a deterministic answer to a purely probabilistic question?

RC: Yes. But I do not understand why some people wanted to establish that there is a threshold does below which there will not be any radiation effect. One of the major difficulties is in tackling the problem of old contaminated sites. Small radiation doses due to residual radio activities left behind at certain sites an cause very tiny amount of radiation doses. But when these doses are integrated over several thousand years. One may end up with getting significant amount of doses. We ill be left with the estimates of a few hundreds of probable deaths due to these collective doses accumulated over a long period of time. But I believe that we must have started dialogue on acceptable risks.

KSP : I am sure we must exclude voluntary risks such as risk due to smoking while we consider acceptable risks.

RC : Yes, I agree. Only involuntary risks are to be considered. In general, I am worried that the philosophy of protection has become somewhat complex.

KSP :Even for the professional …….. 

RC : You said that and I agree. We must develop simpler concepts. ICRP must start consultations with other groups and collect ideas for reviewing and consolidating the system of protection. We have started to do that already. It explains why some of our recent documents are better than earlier ones. Consultation with others will help to improve the documents. The document on radon is an instance in point.

KSP: Everyone was keen on the on-going L-NT controversy. While the ICRP and the NRPB supported the argument that there is no threshold for the effects of ionizing radiation, the US Health Physics Society was unconvinced. The NRPB bulletin went to town with the suggestion that the attitude of the Health Physics Society is in tune with the liberalized attitude of US Administration to nuclear power. Can you comment on this development?

RC : Yes, certainly different professional groups looked at this issue very differently. American Health Physics Society has its own stated view. I have been to Health Physicists Society. Lots of people were interested in the controversy. The arguments put forth by the Health Physics Society are outdated with respect to the recent findings on the Japanese survivors of the atomic weapons. They did not then have  the occasion to see the data. The recent data indicated that there could be significant risk at doses as low as 50 mSv, of course with much uncertainty. I do not still understand why they are looking for a threshold. There are many unknown cellular phenomena to be understood. Genomic instability, for instance.

KSP: You have become an unquestionable proponent of the linear non threshold theory. Certainly you didn’t ask for such a position. Do you really think that this controversy when uncontrolled?

RC: Yes. In my view, there is no need to search for a threshold. Nobody denies that there is evidence for the repair of cellular damage. But we cannot ignore that the repair mechanisms are also statistical in nature.

KSP:  Biological effects of radiation has been studied for the past 100 years. The stochastic effects such as cancer world not have even been through about, but for the long an expensive epidemiological studies. Is it not unfair to spend too much of resources, in fact, vast sums of money to carry out studies about an agent which is now known to be much less hazardous than hundreds of toxic chemicals about which practically nothing is known.

RC:  I may say that physicists should take the blame for it. The study of nuclear physics progressed rapidly. Some of the best brains entered the profession. The study of physics was intellectually satisfying and scientifically stimulating. Unfortunately, the same was not true for chemicals. Of late, biologists are also stating to use more and more mathematical formulations. Probably natural sciences are getting ready to make quantitative estimate.

The biggest injustice done is to attach a speaker to a Geiger counter, You must remember that nobody attaches a speaker to a gas chromatograph. In case higher values of hazardous chemicals are detected, the speaker howling is more dramatic and will definitely arrest the attention and create a problem.

There are several aspects to the understanding of the risks from chemical compared to the risks from chemical radiation. Natural radiation is present everywhere. There is no such analogue in the case of hazardous chemicals. Releasing genetically modified plants without control is probably in my view a higher problem. No doubt of course, this area getting more attention now.

KSP When the French Academy if Sciences published a report critical of ICRP for lowering dose it as French Government policy. To many, it was not surprising as France has a stake in nuclear power. They feel that lower dose limit is probably not in this interest. What is the current position of the French Government?

RC: The French Government has signed the European Directive. The French Electric Power Industry is committed to ICRP recommendations.

KSP: Release form a nuclear facility can be controlled by appropriate methods. It may cause increase in the collective doses to workers. In some instances the collective doses to workers may be far more than those to public. Which option will be acceptable in your opinion?

RC: Both occupational and public exposures are being reduced by optimization procedures. Storage of waste on-site may actually cause a potential for accidental exposure of the public as well as exposing workers. As long as individual doses – workers and public – are acceptably low, the situation is optimized.

KSP: The recommendation of ICRP are universally respected. I remember that the National Radiological Protection Board recommended a dose limit of 15 mSv/year even before ICRP recommendation were issued. NRPB faced some amount of criticism. What is the status of implementation in the UK and USA?

RC: The European directive was issued in May1996. These directives are legally binding on all states and the directives were to be implemented by 2000. In UK, the Health and Safety Executive has to make appropriate already been started. There is a need for harmonizing different documents. For instance different exemption levels are given under different contexts in Europe.

KSP:  why are there such differences in exemption levels in Europe?

RC:  In UK, the Radioactive Substances Act is one of the regulations which is different from The lionizing Radiation Regulation 1985. Health and Safety Executive is reviewing both these. The disposal of radioactive substances comes under the Radioactive Substances Act. The harmonizing of values and concepts and making them consistent is taking some time.

KSP: Was it not because there are some differences in opinions and views?

RC: That is not the reason. Certainly different agencies are at work. Most of the values of exemption levels are given in the European Directives.

KSP: Based on the impression that ICRP may revise the dose limits downward, AERB had its first comprehensive review of occupational exposures in 1989, a year before ICRP 60 was issued. We have implemented the recommendations are similar to those of ICRP except that the maximum dose limit in any year recommended by AERB is 30 mSv instead of 50 mSv recommended by ICRP.

Our experience is that among the various groups using ionizing radiation, industrial radiography is the most important.  In India this field is probably one of the most regulated. The Regulatory Board issue authorization only if certified radiographers, a site-in-charge and appropriate radiation measuring instruments and protective accessories are available at every site.

RC: Industrial radiography has certain peculiarities. In this field, the workers are likely to be exposed to high radiation doses. The field has more potential for accidental exposures. I understand that ionizing radiation occurred in the field of industrial radiography. A man whose film badges did not record any reading but did due to radiation exposure related symptoms.

KSP: He must have been totally careless. I remember that the dose to this worker was evaluated by very advanced dosimeter method using his teeth as sample. What do you propose to make this field safer?

RC: This field is such that it is impossible to supervise them well, as their place of work is distributed in various work environments. For instance, often they work alone in the field while laying gas pipelines. So the only way we can improve the safety status in by imparting appropriate training to the workers. The regulatory organisation should ensure that such dedicated training programme is extended to all the workers.

KSP: Since reducing dose in medical X-ray practice is easier and less expensive, is it not more appropriate to allocate resources more prudently to achieve substantial reduction in collective doses in diagnostic radiology? If I say that there should be more efforts to reduce needless medical exposures, it may be looked upon as an attempt to divert public opinion from exposures in nuclear installation. ICRP should come out with such clear statements on avoiding needless exposure.

RC: We have gone a long way. The International Basic Safety for Protection against Radiation and safety of Radiation Sources has given certain guidance values. The United Kingdom also accepted certain guidelines. With these precautions, the collective dose can be reduced by about 40% But this was more than offset by the predominant use of CT scan units.

KSP: When many States in the US brought out guidelines for typical X-ray examination based on the National X-ray Trend Programmes, UK was less enthusiastic about the concept. Now Basic Safety Standards came out with guidance. What is your general view on this? Can you include the guidance levels in regulation?

RC: I believe that prescribing guidance levels similar to the one stated in BSS is in the right direction. The experience in the UK has been that there has been substantial reduction in collective doses to population at large over the year.

KSP: In your lecture at the International Conference on Medical Physics you spoke about carrying out appropriate evaluation of dose to commercial airline workers under the category of occupational workers. How many countries in Europe have done this?

RC: Cosmic rays obviously come under natural radiation. Under the European law, the member states shall undertake surveys to estimate the magnitude of the radiation exposure due to natural radiation. Currently large groups of persons journey by commercially operated airlines. Because of this, exposure to sensitive groups such as pregnant women may also have to be considered. There is a general thinking that dose contribution to the crew of commercial airline should be quantified by appropriate methods. This cab be done by on-board instrumentation and by considering the number of hours of flying by the airline. The intention is not that all the crew must wear dosimeters but the measurement of exposure will have to be carried out systematically.

KSP: At such high altitudes, the primary component of cosmic rays are high energy protons and neutrons. This is probably one area where we cannot do much about source control. What we can do is that regulated the exposure and the altitude in which the airline flies. The probability of radiation hitting the embryo or foetus will be miniscule. What is your thinking?

RC: I must say that currently the air crew are not subject to dose limits. But the radiation dose should be measured reasonably accurately by asking the number of hours the crew has flown and also by ascertaining the route of travel.

KSP: I understand that the Concord has appropriate monitoring equipment on board way back in 1970. When I was attending the Congress of international Radiation Protection Association at Brighton, I was at the dinner table with a group of scientist from UK who were actually making measurements in the Concord. Have you carried out systematic measurements? Is there anything new published since the special issue of “Radiation Protection Dosimetry” journal was published?

RC: Yes. Radiation measurements have been done and date are available.

KSP: I thought that the exposure is significant only during solar flares.

RC: According to my information the radiation levels on no occasion has increased to such an extent during the past 20 years which led to reducing the altitude of the aircraft to get the benefit of atmospheric shielding.

KSP: ICRP recommendation on pregnant women is known to be too conservative. What was the background information? Was there any re-thinking on this? As the dose limit recommended is different to measure, many institution may decide to withdraw pregnant women from radiation work. I understand that the topic is widely discussed in countries such as Canada where a great proportion of medical radiation workers are women.

RC: ICRP considers that the basis for the control of occupational exposure of women who are not pregnant is the same as that for men. On the other hand if a women is or may pregnant there is a need for additional controls to be considered to protect the unborn child. The considered is at times more prone than the post-natal individual to deterministic injuries caused by radiation and may be more sensitive to the induction of later deterministic effects in the live-born child including significant mental retardation will not happen if the exposure of the mother dose not exceed the dose limits now recommended for occupation exposure regardless of the distribution of the exposure over time.

Accidental high exposure of the mother may be more damaging to the concepts than to the mother.

The commission’s policy us that the methods of protection at work for women who may be pregnant should provide a standard of protection for any concepts broadly comparable with that provided for members of the general public. The commission considers that its policy will be adequately applied if the mother is exposed prior to the declaration of pregnancy under the system of protection recommended by the commission including the recommended dose limits for occupational exposure. This is the basis on which the commission recommended that no special occupational dose limits is needed for women in general.

The ICRP thought the recommendation of 2 mSv measured over the abdomen of a pregnant woman for the entire gestation period is very helpful. But there is some feeling that it is very restrictive.

KSP: In fact in Canada Atomic Energy Control Board (AECB) arranged discussion with woman workers in eight cities and asked for views.  A few hundred women participated.  Many of them argued that there is no reason to change the earlier limit of 10mSv.

RC: The Commission no longer recommends a dose limit of 2 mSv during the gestation period as measured on the abdomen of the pregnant women. The ICRP publication number 75 describes the current ICRP recommendation. Overall risks associated with radiation exposure of men and women are broadly similar. ICRP now sees no need to make any distinction between the two sexes in the control of occupational exposure. But once a worked is known to be pregnant, ICRP recommends higher standard of protection for the concepts.

The advice given in publication No.60 has been interpreted too rigidly. ICRP now recommends that the working conditions of a pregnant worker after the declaration of pregnancy, should be such as to make it unlikely that the addition equivalent dose to the concepts will exceed about one mSv during the remainder of the pregnancy.

It is important to highlight the responsibility of the worker and employer to meet the Commission’s objective. The pregnant worker should declare her pregnancy promptly to the management. The management should then organize the working conditions to make it unlikely that the additional equivalent dose to the concepts will exceed about one mSv during the remainder of the pregnancy.

KSP: Atomic Energy Control Board of Canada had detailed consultations with women groups on the reco0mmendation. I understand they may now recommend an external dose limit of 4 mSv on the abdomen or an intake of 20 percent of the annual limit if intake. ACEB had compared the general risks to the foetus during pregnancy and showed that at 4 mSv it is very low indeed. What is your view on this approach? I feel that if ICRP’s view expressed in publication No.75 is accepted, many employers will discriminate against women being employed in radiation work.

RC: The ICRP position is essentially as it was in publication 60 and elaborated in publication 75. The foetus  to be protected broadly as though it were a member of the public.

KSP: Though conceptually it is clear that exposure at the dose limit is just tolerable, exposing everyone to the dose limit all the tome is not acceptable. Was it not more appropriate for ICRP to recommend a range of values rather than a single value?

RC: The current dose limit of 20 mSv per year average for 5 years offers this operational flexibility. A single number is administratively convenient. It is obvious that the body dies not known whether the exposure occurred in one calendar year or another. Biology does not identify this.

KSP: The recommendations of ICRP are scientifically the best available. But you will agree with me that these recommendation have enormous social impact. Is it justifiable for over a dozen specialists in purely scientific disciplines to take such decisions which have enormous social impact? Don’t you think that the representation in ICRP should be broadened to include social scientists and economists?

RC: There are various components to this question. ICRP recommendations reflect the best scientific information. We do not say what is acceptable to society or not. There is one recent development. ICRP is currently engaged in more and more consultations with specialists by providing drafts of their recommendations to other specialists and concerned people for review. It would certainly reveal whether there is any inconsistency in the concept and approach put forward by ICRP. It will help to find out whether there is any fallacy in our approach. I believe the recent ICRP document bear testimony to this.

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Alcohol at any Level Is Injurious to Health

I  secured my Ph.D from the University of Leeds, UK in 1972. I lived in Leeds from September 1969 to July 1972 as a Colombo Plan study fellow.  Some of my friends developed the habit of  drinking alcoholic beverages regularly. I did not.

A case in point  was that of  a professor of electrical engineering. He was  in the end addicted to alcohol. He used to say that he might find it difficult on return as there was strict prohibition in the district in Tamil Nadu where his college was located. His consolation was  that his residence was close to the border with Kerala where there was no prohibition.

The second case was that of a senior officer from the Food Corporation of India. He  was on deputation and was attending some training programme. He was always seen with a king size mug of beer. He used to drink as early as 7 AM.  He claimed that he cannot weather the weather without some alcoholic drink in his belly!

A third case was that of a very senior officer from the Government of India. He was also on deputation. He was home sick and miserable. He was a strict disciplinarian. He did not start alcohol consumption. He was  concerned about the need for adequate nutrition to survive in the cold weather. He started drinking large quantities of cold milk. His perennial complaint was about loose motion!

This long introduction was to show how people develop certain habits. In the 50s and the 60s people in Kerala used to stand in queues for collecting essential items such as ration and books. Now also many stand in queues patiently. This is primarily to collect their daily quota of drinks!

I believe that the results of a landmark study  published on line on August 23, 2018  in The Lancet, a prestigious British medical journal must persuade any one to discontinue his addiction. The study concluded that “alcohol at any level is injurious to health”.

I summarized the conclusions of the study  in The Wire  on August 27, 2018.

Here is the link:

https://thewire.in/health/theres-no-safe-level-for-drinking-alcohol-but-hold-up-before-you-abstain

 

 

 

 

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Nuclear Legacy Trap: Myths and Reality

https://www.thestatesman.com/opinion/nuclear-legacy-trap-myths-reality-1502625735.html

Home / Opinion / Nuclear Legacy Trap: myths and reality
Nuclear Legacy Trap: myths and reality
K S Parthasarathy | April 22, 2018 1:10 am

Nuclear power plant.

 

General Vinod Saighal’s eminently readable, lucid opinion piece (The Statesman April 2) reflects the concerns of vast sections of the public. He argues persuasively against setting up nuclear power plants because he feels that these plants will form a very expensive nuclear legacy trap for future generations because of decommissioning and nuclear waste disposal issues.
His article highlights the seemingly unbridgeable communication gap between public and the nuclear community. Mired in controversy, the myths about decommissioning and nuclear waste management survive; the realities may remain unknown if nuclear community does not come out of their comfort zones and convey information to all sections of the public. Trust deficit of decision makers at higher levels of Government is not a welcome sign.
A book (The Trap) by Sir James Goldsmith reinforced Saighal’s apprehensions. The 1990 vintage book does not contain information on the latest advances on decommissioning of nuclear power plants and management of nuclear wastes.
Indian scientists have adequate experience in decommissioning of research reactors, reprocessing plants and nuclear facilities.
According to an authentic review (World Nuclear Association-WNA-,March 2018), “over 115 commercial power reactors, 48 experimental or prototype reactors, over 250 research reactors and several fuel cycle facilities have been retired from operation. Some of these have been fully dismantled”.
“Most parts of a nuclear power plant do not become radioactive, or are contaminated at only very low levels. Most of the metal can be recycled. Proven techniques and equipment are available to dismantle nuclear facilities safely and these have now been well demonstrated in several parts of the world.,” the WNA report added.
Scientists have developed technology to incorporate high-level nuclear wastes into glass (vitrification) to make them non-dispersible. Glass is least soluble even in hot, salt water. The vitrified waste after suitable capsulation (for instance in copper canisters) can remain safely in deep underground repositories for thousands of years. By 2025, Sweden and France will move high-level waste (HLW) to their permanent underground sites. Finland will move its HLW in 2020.
Other countries can follow these steps or even outsource waste management to France, Finland or Sweden, the real masters of the technology.
India has been operating vitrification plants for many years. The October 2013 issue of Sadhana, a journal published by the Indian Academy of Sciences vividly describes India’s nuclear waste management programme.
General Saighal rightly talks about the huge funding requirements. The Nuclear Power Corporation of India Ltd (NPCIL) collects two paisa per unit of electricity produced towards decommissioning funds. In 2016-17, NPCIL collected Rs 753 million. Evidently, vast sums will be available for decommissioning the reactors one by one after 40-50 years of operation.
Decommissioning nuclear power plants and nuclear waste management are no more insurmountable; we have the technology and the funds. The current generation need not feel guilty about any “Nuclear Legacy Trap” as feared by General Saighal.
Many NGOs and others published grossly exaggerated reports on Chernobyl and Fukushima In 2005, The Chernobyl forum made up of eight specialized agencies such as the WHO, the International Atomic Energy Agency(IAEA), ILO etc of the UN published Chernobyl’s Legacy: Health, Environmental and Socio-Economic Impacts” a landmark report. It is available online and offers the factual position.
Specialists found that “childhood thyroid cancer caused by radioactive iodine fallout is one of the main health impact of the accident. By 2002, more than 4000 thyroid cancer cases had been diagnosed in this group, and it is most likely that a large fraction of these thyroid cancers is attributable to radioiodine.”
Apart from this, “there is no clearly demonstrated increase in the incidence of solid cancers or leukaemia due to radiation in the most affected populations. There was, however, an increase in psychological problems among the affected population” the report added.
After a comprehensive assessment, “experts on the health risks associated with the Fukushima Daiichi nuclear power plant (NPP) disaster in Japan has concluded that, for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.” ( WHO Press Release,28 February 2013)
“The estimated risk for specific cancers in certain subsets of the population in Fukushima Prefecture has increased and, as such, it calls for long term continued monitoring and health screening for those people”, the experts cautioned. NGOs spread conspiracy theories (such as WHO is under the thumb of IAEA, the promoter of nuclear energy!). It enhances the trust deficit between public and the UN agencies. Radiation specialists know the truth.
Regrettably, General Saighal copied five paragraphs (373 out of 955 words in his article) from Robert Hunziker, who regularly writes in COUNTERPUNCH (claims to do fearless muckracking!) and Professor Bernard Lowen, one of the founders of the International Physicians for the Prevention of Nuclear War (IPPNW) without any attribution. Hunziker’s article is Saighal’s major resource. (Note: General Saighal did attribute the words in question to Hunziker; the attribution was accidentally omitted during editing. – Ed.S.)
The paragraphs quoted by Saighal deal mainly with Chernoyl and Fukushima. Robert Hunziker extensively quotes from Professor Adam Broinoski, another prolific writer whose claims on the plight of “liquidators” at Chernobyl are unfounded. Chernobyl accident was devastating; the site is slowly recovering.
Fukushima site continues to be a challenge. Realizing that this need not be a disincentive against nuclear power, the Japanese started seven nuclear power reactors. They know that Fukushima was preventable. Survival of Onagawa nuclear power plant which faced the same earthquake and 14.3-metre tsunami as against 13.1 meters at Fukushima, because of “safety culture” gives them confidence.
If General Saighal and others for whom anti nuclear sentiment seems to be an article of faith read about Onagawa (The Bulletin of Atomic Scientists,10 March 2014) and appreciate the technological developments in decommissioning of nuclear power plants and waste management, they may change their views or may at least look at nuclear power more benignly.
The writer is a former Secretary, Atomic Energy Regulatory Board.

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