The Million Person Study: Whence It Came and Why

A screenshot of the article
“How Sound is the Model Used to
Establish Safe Radiation Levels?”
on the website physicsworld.com.

Last fall, physicsworld.com published an editorial by Robert Crease asking “How Sound is the Model Used to Establish Safe Radiation Levels?” This question is addressed in Chapter 16 of Intermediate Physics for Medicine and Biology, and I have discussed it before in this blog. Crease begins

Ionizing radiation can damage living organisms, that’s clear. But there are big questions over the validity of the linear no-threshold model (LNT), which essentially states that the risk of cancer from radiation and carcinogens always increases linearly with dose. The LNT model implies, in other words, that any amount of radiation is always dangerous and that zero risk is present only at zero dose.

Crease notes that alternative models are the threshold model in which there is a minimum dose below which there is no risk, and the hormesis model which says that small doses are beneficial by triggering repair mechanisms. He explains that by adopting such a conservative position as the linear no-threshold model we may cause unforeseen negative consequences.

What sort of negative consequences? One of the most urgent and dire health hazards faced by humanity is climate change. Addressing the danger of a warming climate, with all its implications, must be our top priority. Climate change is caused primarily by the emission of greenhouse gasses such as carbon dioxide that result from the burning of fossil fuels to generate electricity, warm our homes, power our vehicles, or make steel and concrete. One alternative to burning fossil fuels is to use nuclear energy. But nuclear energy is feared by many, in part because of the linear no-threshold model, which implies that any exposure to ionizing radiation is dangerous. If, in fact, the linear no-threshold model is not valid at the low doses associated with nuclear power plants and nuclear waste disposal then the public might be more accepting of nuclear power, which may help us in the battle against climate change. Crease concludes

One of the many reasons for the need to study the validity of LNT is that convictions of its accuracy continue to be used as an argument against nuclear power plants, in connection with their operation as well as their spent fuel rods. Nuclear power may be undesirable for reasons other than this. But the critical need to find a workable alternative to fossil fuels for energy production requires an honest ability to assess the validity of this model.

In my opinion, determining if the linear no-threshold model is valid at low doses is one of the greatest challenges of medical physics today. It’s a critical example of how physics interacts with medicine and biology. We need to figure this out. But how?

Screenshot of The Million
Person Study website.

One way is to conduct an epidemiological study of low-dose radiation exposure. But such a study would have to be huge, because it’s looking for a tiny effect influencing an enormous population. What you need is something like The Million Person Study. Yes, medical physics has its own “big science” large-scale collaboration. The Million Person Study’s website states

There is a major gap in epidemiological understanding, however, of the health effects experienced by populations exposed to radiation at lower doses, gradually over time.

The foundation of the Million Person Study is to fill that gap, using epidemiological methods of assessing rate and quality of mortality on a study group of one million persons exposed to this type of radiation.

The website notes that there are many reasons to assess the risk of low doses of radiation, including determining 1) the side effects of medical imaging procedures such as computed tomography, 2) the danger of nuclear accidents or terrorism (dirty bombs), 3) the safety of occupations that expose workers to a slight radiation dose, 4) the hazards of environmental exposure such as from radon in homes, and 5) the uncertainty of space and high altitude travel such as when sending astronauts to Mars. The Million Person Study not only focuses on the level of exposure, but also on the duration: was it a brief exposure as if from an nuclear accident, or a low dose delivered over a long time?

The cover of a special issue of the
International Journal of Radiation Biology
about The Million Person Study.

Want to learn more about The Million Person Study? See the paper by John Boice, Sarah Cohen, Michael Mumma, and Elisabeth Ellis titled “The Million Person Study: Whence it Came and Why,” published in the International Journal of Radiation Biology in 2022 (Volume 98, Pages 537–550). Its abstract is printed below.

Purpose: The study of low dose and low-dose rate exposure is of immeasurable value in understanding the possible range of health effects from prolonged exposures to radiation. The Million Person Study (MPS) of low-dose health effects was designed to evaluate radiation risks among healthy American workers and veterans who are more representative of today’s populations than are the Japanese atomic bomb survivors exposed briefly to high-dose radiation in 1945. A million persons were needed for statistical reasons to evaluate low-dose and dose-rate effects, rare cancers, intakes of radioactive elements, and differences in risks between women and men.

Methods and Materials: The MPS consists of five categories of workers and veterans exposed to radiation from 1939 to the present. The U.S. Department of Energy (DOE) Health and Mortality study began over 40 years ago and is the source of ∼360,000 workers. Over 25 years ago, the National Cancer Institute (NCI) collaborated with the U.S. Nuclear Regulatory Commission (NRC) to effectively create a cohort of nuclear power plant workers (∼150,000) and industrial radiographers (∼130,000). For over 30 years, the Department of Defense (DoD) collected data on aboveground nuclear weapons test participants (∼115,000). At the request of NCI in 1978, Landauer, Inc., (Glenwood, IL) saved their dosimetry databases which became the source of a cohort of ∼250,000 medical and other workers.

Results: Overall, 29 individual cohorts comprise the MPS of which 21 have been or are under active study (∼810,000 persons). The remaining eight cohorts (∼190,000 persons) will be studied as resources become available. The MPS is a national effort with critical support from the NRC, DOE, National Aeronautics and Space Administration (NASA), DoD, NCI, the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), Landauer, Inc., and national laboratories.

Conclusions: The MPS is designed to address the major unanswered question in radiation risk understanding: What is the level of health effects when exposure is gradual over time and not delivered briefly. The MPS will provide scientific understandings of prolonged exposure which will improve guidelines to protect workers and the public; improve compensation schemes for workers, veterans and the public; provide guidance for policy and decision makers; and provide evidence for or against the continued use of the linear nonthreshold dose-response model in radiation protection.

 Lead on Million Person Study, and thank you for your effort. We need those results!

Black Carbon and Radon

Drawdown

In a previous post, I reviewed the book Drawdown: The Most Comprehensive Plan Ever Proposed to Reverse Global Warming. Sometimes I visit the book’s associated website, drawdown.org, because it has so much to teach me about climate change. Recently, I read one of their publications about Reducing Black Carbon. The executive summary begins:

Black carbon—also referred to as soot—is a particulate matter that results from the incomplete combustion of fossil fuels and biomass. As a major air and climate pollutant, black carbon (BC) emissions have widespread adverse effects on human health and climate change. Globally, exposure to unhealthy levels of particulate matter, including BC, is estimated to cause between three and six million excess deaths every year. These health impacts—and the related economic losses—are felt disproportionately by those living in low- and middle-income countries. Furthermore, BC is a potent greenhouse gas with a short-term global warming potential well beyond carbon dioxide and methane. Worse still, it is often deposited on sea ice and glaciers, reducing reflectivity and accelerating melting, particularly in the Arctic and Himalayas.

Therefore, reducing BC emissions results in a triple win, mitigating climate change, improving the lives of more than two billion people currently exposed to unclean air, and saving trillions of dollars in economic losses.

As I learned more, I found that black carbon is only one type of fine particles in the air. I begin to wonder “where have I heard about the risk of particulate matter before?” Then it hit me: Section 17.12 of Intermediate Physics for Medicine and Biology, which is about radon. Russ Hobbie and I wrote

Uranium, and therefore radium and radon, are present in most rocks and soil. Radon, a noble gas, percolates through grainy rocks and soil and enters the air and water in different concentrations. Although radon is a noble gas, its decay products have different chemical properties and attach to dust or aerosol droplets which can collect in the lungs. High levels of radon products in the lungs have been shown by both epidemiological studies of uranium miners and by animal studies to cause lung cancer.

Aha! Perhaps black carbon is an effective carrier of radon decay products into the lungs. This is just a hypothesis, but I did find a reference that supported the idea (Wang et al., “Particle Radioactivity from Radon Decay Products and Reduced Pulmonary Function Among Chronic Obstructive Pulmonary Disease Patients,” Environmental Research, Volume 216, Article Number 114492, 2023). Below I present part of their introduction (references removed)

Consistent with the existing literature on ambient particulate matter (PM) exposure, our previous studies found that indoor PM was associated with increased systemic inflammation and oxidative stress and reduced pulmonary function among [chronic obstructive pulmonary disease] patients in Eastern Massachusetts. It has recently been recognized that an attribute of PM with potential to promote pulmonary damage after inhalation is radionuclides attached to PM, referred to as particle radioactivity (PR). Though ionizing radiation has many sources (e.g., cosmic radiation and medical procedures), the majority of natural background radiation (and, thus, of PR) is from radon (²²²Rn), which decays into α-, β-, and γ-emitting decay products. Although radon gas itself is rapidly exhaled, freshly generated radon decay products (also referred to a radon progeny) can rapidly attach to particles in the ambient and indoor air and be inhaled into the airways. After deposition, particles continue to emit radiation in the lungs with a residence time that can range from several days to months. Compared to β- and γ-emissions from radionuclides, α-emitting particles are considered the most toxic due to their high energy and large mass. Since α-radiation cannot penetrate the intact epidermis, inhalation is the predominant route of exposure, and evidence that α-radiation may cause pulmonary damage is suggested by its effects on inducing inflammation and reactive oxygen species in human lung fibroblasts as well as up-regulating gene pathways in human pulmonary epithelial cells associated with inflammatory and respiratory diseases.

I didn’t find any mention of radon in Drawdown’s publication Reducing Black Carbon or in the World Health Organization’s publication Health Effects of Black Carbon. I don’t know if radon is an important part of the mechanism by which black carbon causes health hazards. Yet, I wonder. I know that radon is a more serious hazard among smokers compared to nonsmokers, and smoking should have similarities to breathing soot. This black carbon/radon hypothesis raises some interesting questions. Is black carbon more effective than other types of particulate matter in transporting radon decay products? Does global warming increase lung cancer? Is black carbon more dangerous in areas with high radon concentrations? Is black carbon more hazardous for people living in poorly ventilated buildings rather than in well-ventilated buildings or outdoors?

Soot is clearly bad news. As drawdown.com says, it’s a triple threat: climate, health, and well-being. They offer several ideas for reducing black carbon:

1. Urgently implement clean cooking solutions
2. Target transportation to reduce current—and prevent future—emissions
3. Reduce BC from the shipping industry
4. Regulate air quality
5. Include BC in nationally determined contributions and the United Nations Framework Convention on Climate Change
6. Improve BC measurements and estimates

The item about regulating air quality makes me speculate if a positive feedback loop could underlie the impact of black carbon on the climate: Soot in the air increases global warming; increased global warming increases the number of forest fires, and an increased number of forest fires increases the amount of soot in the air. Again, this is just a hypothesis, and I don’t know it’s true. But I do know that in my 25 years living in Michigan, the only serious problem with air pollution and soot I’ve experienced was caused by last summer’s Canadian forest fires, and such fires appear, at least to me, to be related to global warming.

 

Black carbon may be one of the places where climate change and IPMB intersect. It’s an important topic and deserves closer study.