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APPENDIX 1. RPHP RECENT PROFESSIONAL PUBLICATIONS

Recent Book Publications

1. Gould JM and members of RPHP. The Enemy Within: The High Cost of Living Near Nuclear Reactors. New York: Four Walls Eight Windows, 1996.
2. Mangano JJ. Low-Level Radiation and Immune System Damage: An Atomic Era Legacy. Boca Raton FL: Lewis Publishers, 1998.
3. Sherman JD. Life's Delicate Balance: Causes and Prevention of Breast Cancer. New York: Taylor and Francis, 2000.

1. Gould JM et al. Strontium-90 in deciduous teeth as a factor in early childhood cancer. International Journal of Health Services 2000;30(3):515-39.
2. Mangano JJ et al. Strontium-90 in newborns and childhood disease. Archives of Environmental Health 2000;55(4):240-4.
3. Gould JM et al. The Strontium 90 baby teeth study and childhood cancer. European Journal of Oncology 2000;5(suppl. 2):119-25.
4. Mangano JJ. Improvements in local infant health after nuclear power reactor closing. Environmental Epidemiology and Toxicology 2000;2:32-6.

APPENDIX 2. RHABDOMYOSARCOMA - RARE MALIGNANCY IN CHILDREN
AND ITS LINK WITH RADIATION EXPOSURE
Appendices 2-6 prepared by Janette Sherman, M.D., RPHP Associates.

Bone, teeth, blood cells, lymphoid tissue, fat cells, muscles, and fibrous tissue all originate from a single layer during fetal development called the mesenchymal. (35) Leukemia and sarcomas are malignancies derived from mesenchymal cells, (36) the latter accounting for five percent of pediatric cancers. (37) Mesenchymal malignancies in children are of particular concern because they are aggressive and result in death of approximately 50% of those affected.

Rhabdomyosarcoma (RMS) is a rare form of sarcoma derived from skeletal muscle cells, (38) with an annual incidence of 4.5 newly-diagnosed cases per million children age 15 or younger. (39) There is no known cause of RMS in children. However, it has been induced in animals exposed to radiation. (40) (31) Moreover, fetuses exposed to X-rays while in utero had twice the risk of being diagnosed with cancer as children. (30)

In a small area of Suffolk County, on New York's Long Island, at least 19 children have developed rhabdomyosarcoma. Seven children younger than 10 years old diagnosed with rhabdomyosarcoma from 1994-99 lived in a small area of eight zip codes located 10 miles west-northwest of Brookhaven National Laboratory, which operated three nuclear reactors. In addition, this area is within 60 miles of eight nuclear power reactors in New York, Connecticut, and New Jersey.

According to the 1990 census, the total population of this area was 119,150, which has not changed much since. Children ages 0 to 10 years old made up approximately 15% of that population, or 17,873 individuals; at a rate of 4.5 per million per year, about 0.48 cases would be expected from 1994-1999. Seven cases represents a rate nearly 15 times greater than expected. In 2000, the Suffolk County legislature authorized a Task Force to explore possible causes of the RMS outbreak.

APPENDIX 3. MECHANISM OF NUCLEAR RADIATION INJURY

Radioisotopes accumulate in various parts of the body and produce damage as they decay by release of alpha, beta, or gamma energy. An isotopes' path through the body and its site of accumulation is dependent upon the chemical family to which it belongs. Beta particles, or high-energy electrons, are quickly slowed by collisions with tissue elements and their kinetic energy converted to thermal (heat) energy. (41) It is this energy, released during nuclear decay, that causes disruption of cellular membranes, alteration of DNA, changes in enzymes, and other adverse effects.

By contrast to nuclear bomb tests, which prolong the inhalation and ingestion of radioactive elements by dispersion into the stratosphere, emissions from nuclear power reactors are dispersed at low atmospheric levels and reach earth in a matter of hours, days, or weeks. Thus, Sr-90 and shorter-lived radioactive emissions enter the air, water, and food chain rapidly. Sr-90 is accompanied by isotopes such as argon, xenon, krypton, cesium, barium, and iodine, some of which have short half-lives and produce radioactive decay products that expose the embryo and fetus as well as the elderly to significant risk.

Geographical deposition of radioisotopes is not uniform, whether it is derived from bomb testing, nuclear power plants, or catastrophes such as Chernobyl and Three Mile Island. Measurement of radioactivity in rain, soil, air, and in food has confirmed an uneven distribution of Sr-90 fallout on the ground. (42) Fallout of Sr-90, Cs-137, and plutonium from the Chernobyl accident demonstrates a gradient of deposition related to distance from the source, and varying with wind, rain, and geography. (43) (44)

APPENDIX 4. RISK FROM LOW-DOSE RADIOACTIVE NUCLIDES

The often held notion that reactions to chemicals and ionizing radiation follow a linear dose-response curve is not supported by fact. While a reaction may be proportional at high doses that impair or kill, a straight-line dose-response is not borne out at low-dose exposures, (45) nor when an insult occurs at the critical periods of fetal development, and during cell division and repair. (46)

Internal exposures to toxic chemicals and radionuclides below the level that kills a cell are critical: such sub-lethal exposures that alter cellular function or structure and are not repaired become expressed as cancer or functional alteration. The DES daughters and sons are prime examples. Diethylstilbestrol (DES) was administered to pregnant women in the misguided idea that it would protect against fetal loss during pregnancy. Children and now grandchildren were born with anatomic and functional genital abnormalities and developed genital cancers when they reached adulthood. (47) Cells undergoing replication are hundreds of times more susceptible to radiation and chemical effects. (48) (49)

Internal radiation may involve exposure to nuclides such as plutonium-239 and strontium-90, some fraction of which stays within a body essentially for life because of long half-lives. It also involves exposure to nuclides with a short half-life such as barium-140, cobalt-57, chromium-51, cesium-134, iodine-131, and others, which release significant amounts of radiation over a period of hours to days.

Many nuclides undergo sequential decay, an ideal condition for sub-lethal damage to promote the induction of genomic instability. (50) Thus, internal decay of such isotopes as plutonium-239 and carbon-14 deliver a biological effect of very long duration and the potential to induce genetically transmitted defects. (51) In addition, very low levels of radiation exposure demonstrate an enhanced, supra-linear effect due to the release of free radicals, resulting in functional and physiological effects, separate from genetic or mutational alteration. (52) (53)

APPENDIX 5. RADIOACTIVE STRONTIUM-90 (SR-90) IN BABY TEETH

Sr-90 is a reliably measured surrogate to determine radiological fallout because of its slow excretion from the body and a long half-life of 28.7 years. With such a lengthy half-life, Sr-90 is persistent in the environment and in the bodies of humans. The uptake of radioactive Sr-90 follows that of calcium and becomes deposited in bones and teeth. The newborn's calcium and Sr-90 are derived from the mother's dietary intake and from her bone stores during pregnancy. (54) (17) But Sr-90 was understood before the first atomic bomb was detonated when it was proposed by Enrico Fermi to use the bone-seeking isotope to poison the food supply of Germany during World War II. (55)

Measurements of Sr-90 deposited in human bones and teeth began after the onset of above-ground nuclear bomb tests in Nevada and were carried out by various governments, including the U.S. (56) (57) (58) (18) An independent, comprehensive study by the Committee for Nuclear Information measured Sr-90 levels in about 60,000 baby teeth collected from children in St. Louis. (54) (59) Comparing 1954 births with those in 1964, Sr-90 levels increased in concentration from 0.77 to 11.03 picocuries per gram of calcium. The risk to health from this contamination and concern for the health of children worldwide led to a ban on above ground nuclear testing by the U.S. and U.S.S.R., a treaty signed by President Kennedy and Premier Khrushchev in 1963.

Testing of St. Louis baby teeth ended in 1976 with the withdrawal of federal support from the project. Government agencies also supported programs of measuring Sr-90 in children's bones (1962-71) and adult bones (1954-82). Again, these programs ended when federal funding ceased.

More recent testing followed Chernobyl releases, when the Otto Hug Institute in Germany documented a ten-fold increase in Sr-90 levels in baby teeth for children born in 1987, compared with those born in 1983-85. (60) The rise in levels are comparable to the rise documented in St. Louis children in the midst of the above-ground nuclear bomb testing era. In 1990, for unknown reasons, the U.S. Environmental Protection Agency program of reporting monthly levels of barium-140, cesium-137, and iodine-131 in pasteurized milk in 60 U.S. cities was discontinued after 33 years. Strontium-90 in levels in pasteurized milk in these cities are limited to only a single annual measurement in July. (61)

APPENDIX 6. NUCLEAR RADIATION AND CHILDHOOD CANCER

The global epidemic of cancer has not lessened despite improvements in diagnosis and treatment. Since World War II, our environment has changed in significant ways. The advent of the Nuclear Age, and the increase in the manufacture, use, and disposal of petrochemical products such as pesticides, solvents, and plastic, often acting synergistically with radioactive elements, has contributed to the burden of cancer in industrialized countries.

Mimicking natural elements, a myriad of radioactive isotopes never existed in our evolutionary history until the detonation of nuclear bombs and the operation of nuclear power plants. These imposters, created in nuclear bombs and power plants, fall to earth where they are taken up in food and water of animals and humans. It is these emissions that are addressed in various articles, including one about the improvements in local infant and child health after the closing of nuclear reactors. (25)

Cell division, and thus human growth, is most accelerated during the fetal and infant periods. Thus, any cell-impairing toxin such as radiation will be most harmful to the youngest humans. Childhood cancer has long been recognized as perhaps the disease most sensitive to radiation.

The adverse effects on humans who were exposed to nuclides were predictable, based upon research in the physiological, biological, chemical, and physical sciences. Thus, removal of sources of carcinogenic exposure should provide relief from the burden of disease. As predicted, improvements in infant/child health occurred dramatically and quickly after reactor closings. The following declines in local infant mortality in the first two years after reactor closing are given below. Counties downwind and less than 40 miles from the reactor are included.

APPENDIX 7. THE RELATION BETWEEN PICOCURIES AND DOSE IN MILLIREMS
Appendix 7 prepared by Ernest J. Sternglass, Ph.D. Chief Scientist, RPHP.

Radioactivity of a substance, or the number of disintegrations per second in which some form of radiation is emitted, is measured in units of Curies or picoCuries. A Curie is the very large number of 37 billion events per second, and a picoCurie is one trillionth of this, or 0.037 disintegrations per second. Thus, Curies or picoCuries are a measure of the quantity of radioactive material. In the case of Strontium-90, which emits only electrons or beta rays, these units give the number of high-energy electrons emitted per second.

Rems or millirems (1/1000 of a rem) by contrast are a measure of the energy absorbed in tissue as a result of the emission of energetic particles like the electrons ejected from the nuclei of Strontium-90 atoms. Thus, they are a measure of the amount of biological damage produced by the radioactive material that leads to mutations or the death of immune system cells.

The damage done as measured in millirems for low levels of Sr-90 radioactivity is not only directly proportional to the radioactivity in picoCuries, but also proportional to the energy of the emitted electrons that can travel a few millimeters in tissue. Moreover, it is also directly related to the length of time during which the emission of powerful electrons takes place. Thus, the biological damage leading to cancer and other diseases is particularly great for Sr-90 because it has a fairly long physical half-life of 28.7 years, and because it also stays in bone for years as measured by its biological half-life, or the time it takes for half the Sr-90 atoms to leave the bone. This biological half-life is about 2 years for infants, and 5-10 years for adolescents and adults, so some Sr-90 will be found in an individual for many years, even when it is not constantly replaced by new ingestion or inhalation.

The dose in millirems produced in bone in the course of a year when the amount of Sr-90 is kept constant at 1 picoCurie per gram of calcium has been calculated at 4.5 millirems per year, as given on page 50 of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) of 1972. A similar result is obtained in a 1977 Nuclear Regulatory Commission publication NUREG 1.109 used by the NRC to evaluate the radiation dose to the public from nuclear plant releases.

To get a feeling for the importance of the dose of 4.5 mr per year produced by the presence of just one picoCurie of Sr-90 per gram calcium in bone, it is important to realize that the dose due to natural sources of environmental radiation, other than radon in some homes, is about 70 to 100 mr per year. Since some individuals have been found to have as much as ten to fifteen pCi/gCa of Sr-90 in teeth at birth, the dose per year was more than ten times the rate of 4.5 mr per year, or more than 45 mr. Thus in the first three or four years of life at continuing intake of Sr-90 from the drinking water, the diet and the air, the cumulative dose to bone was of the order of the range of 100-180 mr.

This dose has to be compared with the theoretically calculated whole-body dose produced to a maximally exposed individual by a nuclear reactor such as one of the Turkey Point Reactors in 1986 of only 0.0038 mr per year, as listed in the 1996 NRC publication "Generic Environmental Impact Statement for License Renewal of Nuclear Plants" (NUREG-1437).

This is 1184 times smaller than the yearly dose due to 1 picoCurie of Sr-90 per gram calcium, and 11,840 times less than the dose from one-year exposure to ten pCi/g Ca. The reason for this huge discrepancy is that in the calculation of the whole body dose by the NRC, Sr-90 is no longer measured in the environmental samples collected around nuclear plants such as milk, as it used to be required in the 1960s and 1970s.

The seriousness of this failure to measure Sr-90 in the environmental samples and thus to ascertain the actual dose to bone and bone marrow, where the cells of the immune system originate, can be illustrated by the fact that laboratory studies by Stokke et. Al. (Acta Radiologica 7:321:1968) showed that significant reduction in the white cells of the immune system were measured at doses of the order of only 10 mr produced by Sr-90.

By only calculating the total body dose theoretically from measurements of the stack releases into the air and not from actual measurements of environmental samples, as done in the Annual Radioactive Effluent Release Reports for the Turkey Point Units 3 and 4 for recent years (1999, 2000), only extremely small values were arrived at, such as 0.0000011 mr per year due to airborne releases -- millions of times less than the actual doses based on measured concentrations found in human teeth.

Thus, by no longer requiring Strontium-90 to be measured, either in environmental samples or humans, it has been possible for the NRC to characterize the radiation threat from the Turkey Point plant and all other nuclear power reactors as "microscopic." In this way, the NRC obscures the true magnitude of the threat to human life and health presented by fission products released into the environment.

APPENDIX 8. STATEMENT BY DR. VICTOR W. SIDEL AND DR. H. JACK GEIGER ON RPHP BABY TOOTH STUDY

After reviewing the initial findings of the Tooth Fairy Project in 1999, Dr. Victor W. Sidel, past president of the American Public Health Association, and Dr. H. Jack Geiger, past president of Physicians for Social Responsibility, stated:

If the levels of Strontium-90 in children's teeth and the variations in levels by geographic area reported in this study are validated by appropriate repetition, these findings would appear to justify intensive follow-up and continuing large-scale surveillance. Given the biological risk associated with body burdens of even small amounts of long-lived radioactive Strontium-90, it would be prudent to regard these findings as suggestive of a potential threat to human health.

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