Friday, April 25, 2014

Bernard Cohen and the Risk of Low Level Radiation

In the 4th edition of Intermediate Physics for Medicine and Biology, Russ Hobbie and I discuss the work of physicist Bernard Cohen (1924-2012). In Chapter 16 (Medical Use of X Rays), we describe the dangers of radon gas, and show a picture from a 1995 study by Cohen studying lung cancer mortality as a function of radon gas level (our Fig. 16.57). Interestingly, the mortality rate goes down as radon exposure increases: exactly the opposite of what you would expect if you believed radiation exposure from radon caused lung cancer. In this blog entry, I consider two questions: who is this Bernard Cohen, and how is his work perceived today?

Cohen was a professor of physics at the University of Pittsburgh. An obituary published by the university states
Bernard Cohen was born (1924) and raised in Pittsburgh, PA and did his undergraduate work at Case (now Case Western Reserve Univ.). After service as an engineering officer with the U.S. Navy in the Pacific and the China coast during World War II, he did graduate work in Physics at Carnegie Tech (now Carnegie-Mellon Univ.), receiving a Ph.D. in 1950 with a thesis on “Experimental Studies of High Energy Nuclear Reactions” – at that time “high energy” was up to 15 MeV. His next eight years were at Oak Ridge National Laboratory, and in 1958 he moved to the University of Pittsburgh where he spent the remainder of his career except for occasional leaves of absence. Until 1974, his research was on nuclear structure and nuclear reactions .… His nuclear physics research was recognized by receipt of the American Physical Society Tom Bonner Prize (1981), and his election as Chairman of the A.P.S. Division of Nuclear Physics (1974-75).

In the early 1970s, he began shifting his research away from basic physics into applied problems. Starting with trace element analysis utilizing nuclear scattering and proton and X-ray induced X-ray emission (PIXE and XRF) to solve various practical problems, and production of fluorine-18 for medical applications, he soon turned his principal attention to societal issues on energy and the environment. For this work he eventually received the Health Physics Society Distinguished Scientific Achievement Award, the American Nuclear Society Walter Zinn Award (contributions to nuclear power), Public Information Award, and Special Award (health impacts of low level radiation), and was elected to membership in National Academy of Engineering; he was also elected Chairman of the Am. Nuclear Society Division of Environmental Sciences (1980-81). His principal work was on hazards from plutonium toxicity, high level waste from nuclear power (his first papers on each of these drew over 1000 requests for reprints), low level radioactive waste, perspective on risks in our society, society’s willingness to spend money to avert various type risks, nuclear and non-nuclear targets for terrorism, health impacts of radon from uranium mining, radiation health impacts from coal burning, impacts of radioactivity dispersed in air (including protection from being indoors), in the ground, in rivers, and in oceans, cancer and genetic risks from low level radiation, discounting in assessment of future risks from buried radioactive waste, physics of the reactor meltdown accident, disposal of radioactivity in oceans, the iodine-129 problem, irradiation of foods, hazards from depleted uranium, assessment of Cold War radiation experiments on humans, etc.

In the mid-1980s, he became deeply involved in radon research, developing improved detection techniques and organizing surveys of radon levels in U.S. homes accompanied by questionnaires from which he determined correlation of radon levels with house characteristics, environmental factors, socioeconomic variables, geography, etc. These programs eventually included measurements in 350,000 U.S. homes. From these data and data collected by EPA and various State agencies, he compiled a data base of average radon levels in homes for 1600 U.S. counties and used it to test the linear-no threshold theory of radiation-induced cancer; he concluded that that theory fails badly, grossly over-estimating the risk from low level radiation. This finding was very controversial, and for 10 years after his retirement in 1994, he did research extending and refining his analysis and responding to criticisms.
Although he died two years ago, his University of Pittsburgh website is still maintained, and there you can find a list of many of his articles. The first in the list is the article from which our Fig. 16.57 comes from. I particularly like the 4th item in the list, his catalog of risks we face every day. You can find the key figure here. Anyone interested in risk assessment should have a look.

No doubt Cohen’s work is controversial. In IPMB, we cite one debate with Jay Lubin, including articles in the journal Health Physics with titles
Cohen, B. L. (1995) “Test of the Linear-No Threshold Theory of Radiation Carcinogenesis for Inhaled Radon Decay Products.”

Lubin, J. H. (1998) “On the Discrepancy Between Epidemiologic Studies in Individuals of Lung Cancer and Residential Radon and Cohen’s Ecologic Regression.”

Cohen, B. L. (1998) “Response to Lubin’s Proposed Explanations of the Discrepancy.”

Lubin, J. H. (1998) “Rejoinder: Cohen’s Response to ‘On the Discrepancy Between Epidemiologic Studies in Individuals of Lung Cancer and Residential Radon and Cohen’s Ecologic Regression.’”

Cohen, B. L. (1999) “Response to Lubin’s Rejoinder.”

Lubin, J. H. (1999) “Response to Cohen’s Comments on the Lubin Rejoinder.”
Who says science is boring!

What is the current opinion of Cohen’s work. As I see it, there are two issues to consider: 1) the validity of the specific radon study performed by Cohen, and 2) the general correctness of the linear-no threshold model for radiation risk. About Cohen’s study, here is what the World Health Organization had to say in a 2001 publication.
This disparity is striking, and it is not surprising that some researchers have accepted these data at face value, taking them either as evidence of a threshold dose for high-LET radiation, below which no effect is produced, or as evidence that exposure of the lung to relatively high levels of natural background radiation reduces the risk for lung cancer due to other causes. To those with experience in interpreting epidemiological observations, however, neither conclusion can be accepted (Doll, 1998). Cohen’s geographical correlation study has intrinsic methodological difficulties (Stidley and Samet, 1993, 1994) which hamper any interpretation as to causality or lack of causality (Cohen, 1998; Lubin, 1998a,b; Smith et al., 1998; BEIR VI). The probable explanation for the correlation is uncontrolled confounding by cigarette smoking and inadequate assessment of the exposure of a mobile population such as that of the USA.
Needless to say, Cohen did not accept these conclusions. Honestly, I have not looked closely enough into the details of this particular study to provide any of my own insights.

On the larger question of the validity of the linear no-threshold model, I am a bit of a skeptic, but I realize the jury is still out. I have discussed the linear no-threshold model before in this blog here, here, here, and here. The bottom line is shown in our Fig. 16.58, which plots relative risk versus radon concentration for low doses of radiation; the error bars are so large that the data could be said to be consistent with almost any model. It is devilishly hard to get data about very low dose radiation effects.

Right or wrong, you have to admire Bernard Cohen. He made many contributions throughout his long and successful career, and he defended his opinions about low-level radiation risk with courage and spunk. (And, as the 70th anniversary of D-Day approaches, we should all honor his service in World War II). If you want to learn more about Cohen, see his Health Physics Society obituary here, another obituary here, and an interview about nuclear energy here. For those of you who want to hear it straight from the horse’s mouth, you can watch and listen to Cohen's own words in these videos.

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