Present Status

Whatever the blueprint or plan of operation originally provided, it seems either to have been indistinct or has been lost in the successive changes of staff, lack of indoctrination, and varied motivation. The present activities center in the detection of abnormalities which may be found by clinical and pathologic examination of exposed persons. Recently an epidemiologic study of deaths has been active. There is little of the research attitude.

The professional staff, other than Japanese, is small. It has been, and is, primarily made up of persons on short-term appointments who have been willing to help meet the operative needs. There is not a common background of interest in long-term radiation injury, or in research. Nor is there a common understanding of purpose. There is not a strong supporting organization in Japan or in the United States to provide the sense of a career undertaking to the staff or a consistent advisory policy. Consequently, continuity of view has not developed.

The staff comprises separate departments whose efforts, beyond the basic requirements, are likely not only to be independent of each other, but may also be essentially unrelated. The activity of the Research Committee, which could provide cross-stimulation and interdepartmental consideration of problems and objectives, is limited. There is no strong stimulus to exploration on an integrated plan. The medical personnel are apparently too busy with routine requirements to engage in analyses of accumulated data or to initiate new studies. It would be of great help if the Committee on Atomic Casualties would provide information from studies on radiobiology which could suggest leads to be explored in this population.

Certain unstable features were also inherent to the character of the study. There were shifting populations in and out of the cities resulting in an uncertain degree of completeness in registration. In addition, the populations involved in certain of the continuing studies were being changed. The comparisons with nonexposed persons were eliminated. Surveys were sometimes made without adequate knowledge of the population concerned. Other programs have been instituted without adequate provision for the necessary analyses. Furthermore, the entire emphasis might be shifted with the arrival or departure of a department head. The loss of respondents from selected study groups has also been a serious disturbance, leading at times to the replacement with other subjects. Repeated censuses of one kind or another have been needed to enumerate, locate, and identify the proposed study populations.

During the entire time the Department of Statistics has been the major unit with continuing personnel and knowledge of the programs of the study. They have maintained the responsibility for defining the population and the establishment of the study groups. Unfortunately, the design of a study has not always been subjected to their guidance. There has been a deficiency in trained analysts, and in the conducting of analyses which required medical assistance in their making. Consequently, much of the accumulated data which would provide guidance to selective studies have not been examined for correlations on a sufficiently contemporary basis to be of value at the time.

Moreover, the Department of Statistics has been responsible for the field operations which include the identification of subjects, both exposed and controls, of scheduling their examinations, of locating them and bringing them to the clinics. This, of itself, is an extensive operation.

The current philosophy of the environment is that the early cream has been skimmed, that the obvious, anticipated results of radiation have been detected. It is recognized that the procedures employed have provided sound information with respect to the severity of radiation on the occurrence of leukemia, cataracts and on the development of children exposed in utero. The data indicating the absence of obvious changes of genetic character in first offspring appear satisfactory. There are, however, early indications that menarche and menopause in heavily exposed individuals are temporally altered. Although the original conclusion was that general hematologic changes were not occurring, certain data from Nagasaki suggest that premature aging effects may be evident in them. The studies of death certificates, while defective in controls, have been thought to indicate a shortening of the life span in the heavily exposed population, especially males.

Nevertheless, the impression currently prevalent is that significant disturbances are not appearing at present. It is suggested that in adults they cannot be detected in the incipient stages by present examinations, that they are really not occurring, or that it is still too early to expect delayed effects. But if these are of limited numerical frequency it is possible that they lie in data which have not been analyzed. It is fully accepted that a valid negative result is of great importance. The concurrence is that the present is a period of small return which is to concentrate on the collection of satisfactory clinical and pathologic data acceptable for subsequent analysis. In this situation there is little experimental viewpoint. Here again, the lack of cross-communication is evident.

In this atmosphere there has developed a great interest in the teaching and training of Japanese internists and pathologists. In the event that the ABCC program should be given over to the Japanese by circumstance or otherwise, this can be a valuable contribution. However, in terms of continuing American retention of responsibility, it is obviously a diversion from the objective, and much of the time and effort given on these lines is a small contribution to the primary objective. It is expected, however, that these efforts can result in an increased rapport with the local medical professions and public which would enhance their interest and active participation in the consecutive observation of the study population.

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