Most likely those reading this editorial will have seen Oppenheimer, the 2024 Academy Award–winning film about J. Robert Oppenheimer, who led the Manhattan Project as it developed the first atomic bombs and launched the atomic age. Beyond the tragic consequences of the Hiroshima and Nagasaki bombings, the nuclear age that began with the Manhattan Project has had profound implications for the health of nuclear workers and the public throughout the world.
Let’s start with the atomic bomb survivors, many participating in epidemiological studies that began in the late 1940s. The survivors receive medical care and other support under the Japanese government’s Atomic Bomb Survivors’ Support Law. They, and their children, have contributed to the world by allowing their health to be tracked. We have learned from them how radiation increases cancer risk; that information has long been the foundation for radiation protection. Following the bombings, the survivors experienced an almost immediate epidemic of acute leukemia followed later by a radiation dose–related rise in risks of most adult cancers.
Decades after the blasts, the survivors experienced an unexpected increase in heart disease risk and a general shortening of their life spans. For the survivors’ children, a critical and still incompletely addressed question is whether they will experience transgenerational effects. These studies are carried out by a unique Japan–US binational organization, the Radiation Effects Research Foundation. Looking forward, the foundation’s researchers will build on the survivors’ legacy by using 21st century science and more than 2 million biological samples (e.g., blood) to deepen understanding of how radiation injures the body.
The starting point for making nuclear weapons is uranium. After World War II, demand for uranium soared as the nuclear arms race drove the buildup of ever larger stockpiles of bombs. The launching of nuclear power added to the need for uranium. By the 1950s, thousands worked underground as miners and aboveground as millers, operating the mills that produced yellowcake.
As uranium mining took off in the Colorado Plateau, historical evidence indicted radon as a potential cause of lung cancer, and the US Public Health Service undertook an epidemiological study of miners in the region. By the early 1960s, that study showed excess lung cancer. Because all uranium was mined for the Atomic Energy Commission through 1971, the US government had jurisdiction for protecting the miners’ health but did not do enough. A radon exposure standard for miners was eventually implemented but too late, and it was not low enough to prevent a still ongoing lung cancer epidemic among the former miners. The millers were exposed to radon and also to uranium and are at risk for cancer as well as lung and kidney problems. There is also a legacy of environmental contamination at uranium-mining and -milling sites, a particular concern for the Navajo Nation.
There are other points for radiation exposure in the cycle of producing and testing nuclear weapons. At the start of the atomic age, there were fatal accidents during the Manhattan Project at Los Alamos, New Mexico. Workers were exposed to radiation in other Manhattan Project facilities. Workers at Rocky Flats were exposed to plutonium and beryllium. Military personnel, stationed as observers at test blasts, are another broad class of exposed individuals, as are people (the downwinders) in communities where the fallout drifted. Nuclear fallout spread globally from testing by the United States and five other countries.
Thus, nuclear weapons have harmed the health of diverse groups in the United States: the “atomic veterans,” the downwinders, the Atomic Energy Commission and later Department of Energy workers, and uranium miners and millers. Compensation schemes are in place for these groups, albeit too late for many. The Department of Energy workers are covered for beryllium-related problems and radiogenic cancers. The Atomic Veterans can participate in a Veterans Administration program and are also eligible for compensation from the Radiation Exposure Compensation Act (RECA).
RECA, first passed in 1990, was amended in 2000, and was extended for two years in 2022. It expired in 2024. It covered downwinders, those exposed to radiation at test sites, and uranium miners (and later millers). It includes an apology: “The Congress apologizes on behalf of the Nation to the individuals described in subsection (a) and their families for the hardships they have endured.” That apology was included because the government had not acknowledged the risks to the downwinders or protected the uranium miners and millers.
Unfortunately, it is clear that the production of nuclear weapons will continue—in the United States and elsewhere. There are currently nine countries with nuclear weapons, totaling almost 13 000. The existence of nuclear weapons has been posed as a deterrent to major conflicts and wars because the consequences of their use is civilization ending. We have enough postapocalyptic fiction and film to help imagine the planet after an exchange of atomic weapons. For the present, there are people who have been harmed by the production and testing of nuclear weapons; many were bystanders. We should continue fair and just compensation.
53 Years Ago
Abortion—1970
The recent changes in the abortion laws have opened a veritable Pandora's Box from which myriads of problems are spewing forth. These are urgent problems requiring rapid solutions—solutions that will tax the ingenuity of the consumer, the health professional, the legal and administrative community, and government, at national, state, and local levels. Can the public be adequately served? Can professional standards be maintained in the face of increasing demand? Are current patterns of health care delivery and current patterns of payment for services still applicable or are they now outmoded? Do we go the in-hospital route or the “come-and-go” outpatient route? Is professional manpower sufficiently available to cope with demand? Is there need for a new type of health professional? Will conventional maternity care and family planning services suffer a relapse? Will illegitimacy, unwanted pregnancy, and illegal induced abortion be reduced or eliminated? Will legal abortion be available and within the financial reach of all socioeconomic and ethnic groups? It was to these questions that the symposium, “Abortion-1970,” directed itself.
From AJPH, March 1971, pp. 487–488
53 Years Ago
Logistic Problems of Legal Abortion
Traditionally, therapeutic abortions in the United States have been carried out by qualified obstetrician-gynecologists with admission of the patient to an accredited hospital for two to three days, and with adjudication of her case by appropriate consultation. The latter two requirements are part of the restrictiveness of even the new, liberalized California law, since it requires the use of an accredited hospital and adjudication of the case by a two- two- or three-member hospital committee. Where then are California hospitals suddenly to find about 120,000 extra bed-days this year, and the personnel necessary to man- hospital committees and to carry out the procedures? … [M]any hospitals have found their usual hospital and operating room activities disrupted…Hospital committees have been overwhelmed by the numbers of cases to review…. Already, however, we are seeing material public health benefits. A recent study at our county hospital in San Francisco documents a precipitous drop in the incidence of septic abortion patients. And, for the first time in that hospital's history, during the year 1969 there were no abortion-related maternal deaths-which had heretofore been the most common single type of maternal death in California.
From AJPH, March 1971, pp. 496–498
Biography
