Report to the Ministry of Health of Belarus
The assessment of the effectiveness of the scientific research work, fulfilled by the Scientific and Clinical Research Institute for Radiation's Medicine and Endocrinology according to the plan of scientific research work for the year 1998.
Prof. Dr. med Y.I.
Bandazhevsky
The following themes have been assessed:
· theme 3.2.1. "Study of the radioinduced health effects caused by the Chernobyl accident, development of methods and means of diagnostics, treatment and prophylaxis of the diseases affecting different categories of victims ", supervised by Prof. A. G. Mrotchek;
·
theme
3.2.5. " Optimizing of the system of measures to preserve the health of
suffering people and working out the ways of raising its effectiveness",
supervised by Candidate of Medical Science L. N. Rusiaeva;
· theme 3.1.4. "Elaboration of basis for carrying out measures to raise the degree of protection of Belarusian people against the effects of radiation in the period of rehabilitation after Chernobyl accident", supervised by Prof. Y.E. Kenigsberg.
According to the presented documents, theme 3.2.1. "Study of the radioinduced
health effects caused by the Chernobyl accident, development of methods and
means of diagnostics, treatment and prophylaxis of the diseases affecting
different categories of victims " has been divided in 22 programs in 1998 with a
total financing of 13 024,0 million rubles. 7 programs have been devoted to the
study of thyroid gland diseases, for a total investment of 3 521,5 million
rubles.
The excess of new malignant tumors observed in the liquidators of the accident
at the Chernobyl nuclear power plant and in the population residing at the
territory contaminated by radionuclides were considered in two programs, with an
expenditure of 1 400,0 million rubles).
Genetic and cytogenetic research were represented by 4 programs in 1998, with an
expenditure of 1500,0 million rubles.
The other programs were devoted to following problems:
· haematological research (total investment : 400,0 million rubles),
· assessment of the health of children born by liquidators (total investment : 550,0 million rubles),
· study of the peculiarities of liver diseases observed in liquidators and evacuated population (total investment 250,0 million rubles),
· study of the immunological status (total investment : 300,0 million rubles),
· study of the evolution of peptic ulcer observed in liquidators (total investment: 400,0 million rubles),
· study of the psychosomatic status of liquidators and evacuated population and its dynamics (total investment 300,0 million rubles),
· clinical and pathologenic caracteristics of circulatory system diseases in liquidators (total investment: 200,0 million rubles),
· development of principles to create separate blocks of basic parameters for geographical information systems for risks analysis (total investment: 1 254,0 million rubles),
· study of the status of the principal systems of the organism of participants of nuclear weapon testing, living in the republic of Belarus (total investment: 250 million rubles).
As a rule, investigations are supposed to be followed by scientific reports.
Moreover, in the program 3.2.1.01.the protocole required for the installations
of the Ministry of Health (Minzdrav) is missing. For the program 3.2.1.02. an
application for invention needsto be formulated. For the programs 3.2.1.06.,
3.2.1.12, 3.2.1.14, 3.2.1.15, 3.2.1.20, final methodical instructions need to be
worked out, and for the program 3.2.1.21 also a computer analysis.
We assessed the conformity between the titles, goals, objectives of several
programs on the one hand and deductions and conclusions on the other hand. We
assessed also materials and methods considering the investments.
Taking into account the mentioned criteria, we find that the following reports
are worthy of a positive evaluation:
· the report on program 3.2.1.9. "The study of peculiarities of spreading of deseases caused by malignant tumour observed at liquidators of the accident at the Chernobyl nuclear power plant and the population residing at the territory contaminated by radionuclides" (supervised by Doctor in Medical Science A. Okeanov);
· the report on program 3.2.1.11. "The study of the state of health of children born by liquidators" (supervised by Candidate of Medical Science A. Arinchin);
· the report on theme 3.2.1.12. "The study of peculiarities of liver diseases observed at liquidators and settled out population, improvement and introduction of diagnostics and treatment methods" (supervised by Doctor in Medical Science S. Zhavoronok);
The information obtained by the above-mentioned groups is worth to be thoroughly
discussed and may be useful for research and practical work. It should be noted
that the expenses on their implementation were below the average amount of
funding, respectively 300,0, 550,0 and 250,0 million rubles.
Moreover, deductions and conclusions of the other themes do not contain any new,
useful information for public health. The theme 3.2.1.03 can be cited as an
example : "The study of peculiarities of functioning of lymphocytes in cases of
radiation-inducted cancer of thyroid gland observed at children" (supervised by
Candidate of Medical Science T. Vorontsova). The whole amount of financial
support constituted more than 1 billion rubles (1050 million rubles).
To attain the goal which is "to study peculiarities of functioning of
lymphocytes in cases of radiation-inducted cancer of thyroid gland observed at
children", 80 children were examined. The conclusions do not answer the purpose
of the work completely and include facts that are already well known to
pathologists and morphologists.
The first conclusion, in particular, states: "The morphometry of lymphoid cells
in tissues of the thyroid gland showed that in cases of papillary cancer the
amount of microlymphocytes drops abruptly". The second conclusion runs as
follows: "A lymphoid infiltration of the thyroid gland is observed in children
with cancer of thyroid gland". It seems to us that 1 billion rubles have been
spent for nothing as no one can formulate any recommendations based on the
proposed conclusions.
The report on the theme 3.2.1.06. : "To improve the complex programme of
examination and rehabilitation of children with carcinomas of thyroid gland"
(total investment : 1 000 million rubles), supervised by Candidate of Medical
Science V. M. Drozd, was based on the examination of 176 sick children with
analysis of 31 clinical and laboratory findings and concluded as follows : "The
introduction of specialized sessions for children and teenagers with cancer of
thyroid gland, in children's health centers and camps, is one of the methods for
complex rehabilitation. This process should be introduced considering the
anomalies of their psychological, physiological, hormonal, and biochemical
statuses.
3. When organizing social and pedagogical events, it is highly recommended to
take into account an adaptational period to the conditions of a health center
for those children, in order to avoid the development of overstrain.
9. In children and teenagers with carcinoma of the thyroid gland, who suffer
from a chonical hypothyreosis after surgical treatment, 25% are showing stress
reactions.
Is it really necessary to spend 1 billion rubles to find such conclusions ?
The report on the theme 3.2.1.08. "To develop methodology (protocols) for the
identification of increased malignant tumor rates, in liquidators of the
accident at the Chernobyl nuclear power plant", supervised by Prof. I.G. Zhakov
and Prof. Y.G Kenigsberg (total investment : 1 billion 100 million rubles),
intends to develop a unified and scientifically based methodological approach to
find increased quantities of cancers of thyroid gland, lung, stomach, breast in
liquidators.
The conclusion states that when identifying an increase of radiation-inducted
oncopathology, the case rate caused by cancers of the thyroid gland, the lung,
the stomach, and the breast should be compared with the rate observed in
population of the same age categories, residing in territories with the same
risk factors for the above mentioned cancers. Since the period of latency for
radiation-inducted cancer of the thyroid gland had expired before 1993, we can
assume that the indices existing before the accident, showed no real differences
neither on the regional level, nor on the level of the other Belarusians
oblasts.
The report ends with the proposal of a Regulation to be issued by the Ministry
of Health, in order to provide reception and analyzis of the information
necessary to identify an increase of the rate of radiation-induced oncological
sicknesses.
One question arises immediately : what about previous research in this field ?
If nothing has really been done in the past, would it not be too late to help
the suffering population? One can also wonder about the expenditures for this
work. Was it really necessary to spend more than 1 billion rubles to arrive at
conclusions like the following ?:
1. There are a number of regions located in the Vitebsk, Gomel and Minsk oblasts
where an real increase of the rates of cancers of the stomach and the lung was
observed between 1993 and 1996. We note that there was no difference in the rate
of cancers of the breast in woman in the above mentioned regions.
2. The number of cases of stomach, lung and breast cancers, is not correlated to
the rates of general oncologic morbidity.
3. The death rate by stomach, lung and breast cancers, is not correlated to the
level of general death-rate.
The report on theme 3.2.1.21. "To develop the principles aimed at the creation
of separate blocks of basic parameters for geographical information systems for
the analysis of risks", supervised by Y.E Kenigsberg. (total investment : 1 254
million rubles).
Despite an enormous financial support, this work shows a lack of a clear goal
from the beginning (that is to develop the principles aimed at creation of
separate blocks of basic parameters) as well as a statement about the
elaboration of software in the conclusion of the work.
It is impossible to understand what are the principles and what are the separate
blocks that are developed by the authors. And, in general, what kind of risk is
being analyzed and what are the diseases : all kinds, radiation-induced,
oncological or anything else. An enormous space of the report is devoted to
software descriptions, but there is no mention of its use for the attainment of
the stated goals.
Report on theme 3.1.4. theme 3.1.4. "Elaboration of a basis for carrying out
measures to raise the degree of protection of Belarusian people against the
effects of radiation inthe period of rehabilitation after Chernobyl accident",
State programme of the Republic of Belarus, supervised by Prof. Y.E. Kenigsberg.
The time frame is 1996-2000. In 1998 it included, in particular, three
directions of research (total investment: 3 521,5 million rubles).
· 3.1.4.01. "To define the main trends of the dynamics of the formation of internal dose, and to elaborate new national permissible standards for Cs133 and Sr90 concentrations in foodstuffs", supervised by Candidate of Medical Science, E.E. Buglova.
· 3.1.4.02. " To develop recommendations to modernize the existing complex of measures, in order to optimize radiation safety of the population in the period of rehabilitation after the Chernobyl accident", supervised by Candidate of Medical Science A.M. Skriabin
· 3.1.4.03. "To carry out a retrospective evaluation and give a prognosis on the cumulative dose of the internal irradiation received by the population in different Belarusian regions caused by strontium 90 and radioactive isotopes of plutonium".
The joint report on these programs, signed by Prof. Y. E. Kenigsberg, analyzes
the tendencies of the dynamics of the dose formation for internal irradiation,
and the elaboration of new national permissible standards for Cs133 and Sr90
concentrations in foodstuffs in Belarus.
It declares that : "the comparative analysis of levels of absorbed
radionuclides, using Belarusian, Russian and Ukrainian standards, has shown,
that the limitation of doses of the internal contamination of the Belarusian
population is more effective than in Russia and Ukraine.
A comparison restricted only to numeric values of standards, cannot adequately
reflect the degree of the limitation of internal contamination. To carry out a
correct comparative analysis of the various standards, is necessary to estimate
the level of incorporated radioactivity with foodstuff, using typical diets for
the Belarusian population, together with the numerical values of the standards
".
It is difficult to believe, as stated by this document, that the population of
adjacent Belarusian, Russian and Ukrainian regions, had different diets before
the disintegration of USSR and even now now, and that the Ukrainian standards
which are more severe thanthose of the Republic of Belarus for several major
foodstuff (meat: 1996 - in Ukraine 200 Bq/kg, in Belarus - 600 Bq/kg), provide a
worser protection to the Ukrainian population than the Belarusian standards.
This questionable view is followed by a peremptory declaration by the authors of
this study : "No severe measure, aimed at the reduction of the incorporated
contamination can reduce the total dose lower than 1 mSvt/year, asexternal
irradiation accounts for more than a half of it. The Leltchitsky and Yelsky
regions represent an exception, where the contribution of the internal
contamination dose is less than 50 %. Counter-measures can therefore not be
effective, as it is impossible to maintain the limit of dose in this case".
Excerpts from the report on theme 3.1.4.02, supervised by Candidate of Medical
Science A. Skriabin, corroborate such assertions. Theme 3.1.4.02 aims at
following :"To develop recommendations to modernize the existing complex of
measures in order to optimize the radiation safety of the population in the
period of rehabilitation after the Chernobyl accident". The goal of this work is
to develop key proposals for the modernization of the existing systems of
protective measures.
For this purpose, the latest radiological situation in the Gomel oblast has been
analysed. The "critical" population of the inhabitants, amounting approximately
to 1/10 of all the rural population, with an exposure doses over 1 mSvt/year,
was picked out.
For this group, the risk of remote consequences of radiation (fatal cancer) was
estimated. It consisted in an increase of 2 % above the normal level for a
population of similar dimension. A clear conclusion was drawn: for the food
intake, the predominant role belongs to the "gifts" of wood, which are basically
gathered on the restricted, abandoned areas. It was shown, that in principle,
every reasonable measure will fail to bring about a decrease of the incorporated
doses, even if local products are completely excluded from the food intake.
The general scheme proposed for the modernization of the existing protective
measures, refuses every obligatory measure in all concerned zones, and a
transition to voluntary and selective adoption of protective measures. In this
context, it is advised to take into account, as an obligation, all factors of
non-radiative nature (economic, social, psychological).
The recommendations of the authors of this report, who spent 740 million rubles
for their research, amount to abandon the principle of obligatory and universal
protective measures in the affected zones. It is possible to translate this as a
lifeboat ethic - " Everyone for himself and the devil takes the hindmost ", the
State being freed of every responsibility towards the health of the population.
This completely contradicts the Constitution of the Republic of Belarus and the
Public Health Law. Instead of presenting at length authoritative views and
explaining what radio-hygienic rules people must be kept, it is proposed to
change to a voluntary and selective application of protective measures.
In this context, factors of non-radiative nature (economic, social,
psychological,) must necessarily be taken into account. Unfortunately their
significance is not indicated. It is worth to underline, that the procedure for
the acquisition of those data acquisition, have not been put at our disposal for
our assessment (report on theme 3.1.4.01. - "To define the main trends of the
dynamics of the formation of the internal dose, and to elaborate new national
permissible standards of Cs133 and Sr90 content in foodstuff", supervised by
Candidate of Medical Science E. Buglova, who was absent when our assessment of
this work was performed).
Theme 3.2.5. " Optimizing the system of measures to preserve the health of
suffering people and working out ways for raising of its effectiveness",
supervised by Candidate of medical science L.N. Rusiaeva. (total investment : 1
466,0 million rubles.
Theme 3.2.5. included two programs in 1998:
· 3.2.5.01." To create a database and to analyze the causes of the physical disabilities in victims, as compared to similar groups of population ", supervised by L. Rusiaeva.
· 3.2.5.02. " To carry out an analysis of the documents regulating the clinical examinations of various categories of victims, and to elaborate proposals for their improvement, in connection with the basic tendencies of the morbidity ", supervised by N.G. Kravtsova.
· Part 3.2.5.01. has no clear goal nor task description. What does it mean "to create a database"? Is it possible that such information did not exist before in the system of public health service ? As a response, the conclusion of the part includes the basic phrase: "the obtained results can be utilized to elaborate a registry the health of the victims, as well as to evaluate the process towards health improvement measures ".
It is proposed to introduce a medical check up of invalids, and for this
purpose, to establish groups of physical inability for 1-2 years instead of
five-years.
Was it necessary to spend 740 million rubles in one year only to produce such a
conclusion ?
Part 3.2.5.02., (total investment : 760 million rubles), concludes as follows :
" the results of this research permits to recommend for further studies of the
morbidity of the victims, to analyze separately each group of the population
subjected to check ups", and "should serve as a basic information for
supervisors and authorities in decision-making process".
Thus, this scientific team, composed of supervisor N. Kravtsova, Candidate of
Medical Science, a junior research fellow and an engineer, and spending enormous
financial assets, recommends when studying the morbidity of the victims, to
carry out a separate analysis of each group of the population subjected to
regular medical examination .
Therefore the improvement of the system of measures protecting the health of the
suffering people, and the elaboration of the ways of improving effectiveness,
should include, in the opinion of the performers of the work, a change of the
analysis of the morbidity, in order to set up a Registry of the health of the
victims.
To a certain extent, it is probably necessary to take into account those
proposals, but is it reasonable to spend such enormous financial assets for such
conclusions?
General conclusion based on these studies.
The allocation of considerable funds to the
Institutes NIKI, RM and E (more than 17 billion rubles only in 1998) for
scientific programs related to the accident at the Chernobyl nuclear power
plant, has not produced scientific results with economic value, allowing to
ensure a high-grade health protection of victims of Chernobyl accident
Our opinion is that this is connected with a complete absence of effective control by higher instances over the planning of the research work themes in the leading institution designed to study these problems, as regards their urgency, their significance, and their economic feasibility. It is necessary to verify the obtained results, and to assess the applicability of the findings of science to public health services.
As a result of an an irresponsible attitude of thoses Institute's management, regarding the use of funds granted by the State to elaborate solutions of the problems caused by Chernobyl accident, these assets brought no significant contribution to the public health.
Moreover, only already well studied programs were financed, and new research
programs, based on scientific research, have not been developed. As a result,
most of those studies have provided no methodical recommendations applicable to
public health, and no scientific conclusions with international priority.
Hence we propose the following necessary improvements :
1. An immediate revision of scientific programs, related to the alleviation of the consequences of the Chernobyl accident, in such directions able to produce "actual results hwith economic value". For this purpose, a qualified commission must be established, formed by representatives of all state structures and organizations, having a real interest in the solution of the problem.
2. The responsibility of funding the scientific programs, aimed at the
alleviation of the consequences of disaster, should principally rest in the
Ministry of Public Health and Comchernobyl, with a clear control of the
scientific research planning, as regards the urgency, the significance, and the
economic feasibility of the programs, as well as control of their results and
their applicability to public health.
We propose to create a Scientific Council devoted to the Chernobyl problems
composed by Belarusian and international scientists to realize these
improvements
Doctor of Medical Science,
Prof. Y. BANDAZHEVSKY
Gomel state Medical Institute, Rector
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Source: W.T.