INTRODUCTION ENDNOTES

1 . In 1974 the AEC's regulatory activities for civilian nuclear power and the use (including medical research) of radioisotopes produced in nuclear reactors were transferred to the Nuclear Regulatory Commission and its research and weapons-development activities to the Energy Research and Development Administration (ERDA). In 1977 ERDA was incorporated into the new Department of Energy.

2 . Captain C. F. Behrens, ed., Atomic Medicine (New York: Thomas Nelson and Sons, 1949), 3.

3 . Ibid., 7.

4 . Otto Glasser, William Conrad Roentgen and the Early History of the Roentgen Rays (Springfield, Ill., and Baltimore: Charles C. Thomas, 1934), 29; Glasser is quoting O. Lummer of Berlin.

5 . Ibid., 271.

6 . Ibid., 244-282.

7 . Robert Reid, Marie Curie (New York: E. P. Dutton, 1974), 241.

8 . Ibid., 86-87.

9 . P. Curie and M. S. Curie, "Radium: A New Body, Strongly Radio-Active, Contained in Pitchblende," Scientific American (28 January 1899): 60. The term hyperphosphorescence was suggested by Silvanus Thompson. Reid, Marie Curie, 87. See also Susan Quinn, Marie Curie: A Life (New York: Simon and Schuster, 1995).

10 . New York Journal, 21 June 1905, reproduced in David J. DiSantis, M.D., and Denise M. DiSantis, "Radiologic History Exhibit: Wrong Turns on Radiology's Road of Progress," Radiographics (1991): 1121-1138, figure 17.

11 . Henry S. Kaplan, "Historic Milestones in Radiobiology and Radiation Therapy," Seminars in Oncology 6, no. 4 (December 1979): 480.

12 . "Autopsy of a Radiologist," Archives of the Roentgen Ray 18

13 . Reid, Marie Curie, 274; Barton C. Hacker, The Dragon's Tail: Radiation Safety in the Manhattan Project, 1942-1946 (Berkeley, Calif.: University of California Press, 1987), 22-23.

14 . The marketing of one nostrum containing radium, Radiothor, was not officially shut down by the Federal Trade Commission until 1932. "With the institution of regulations, the radioactive patent medicine industry collapsed overnight." Roger M. Macklis, "The Great Radium Scandal," Scientific American 269 (March 1993): 94-99. In the 1920s, the use of capsules containing radium inserted into the nose was introduced as a means of shrinking lymphoid tissue in children to treat middle ear obstructions and infections. During World War II this procedure was used on submariners and Air Force personnel as treatment and, in the case of several hundred submariners, on an experimental basis to test the effectiveness of nasopharyngeal irradiation in shrinking lymphoid tissue and equalizing external and middle ear pressure. In the late 1940s, the observation that no controlled study had ever been conducted to test the treatment's effectiveness in preventing deafness in children led Johns Hopkins researchers to begin the experimental treatment of several hundred children. As the Advisory Committee began its work in 1994, controversy over the long-term effects of this treatment still swirled. Samuel Crane, "Irradiation of Nasopharynx," Annals of Otology, Rhinology, and Laryngology 55 (1946): 779-788; H. L. Holmes and J. D. Harris, "Aerotitis Media in Submariners," Annals of Otology, Rhinology, and Laryngology 55 (1946): 347-371. See chapter 7 and ACHRE Briefing Book, vol. 13, tab E, April 1995, for fuller discussion.

15 . Macklis, "The Great Radium Scandal," 94-99.

16 . The National Council on Radiation Protection began as the American Committee on X Ray and Radium Protection in 1928, under the aegis of the International Congress of Radiology. A private organization, its members were physicians, physicists, and representatives of the equipment manufacturers. Prior to World War II its main function was to issue recommendations on radiological safety, which were published by the National Bureau of Standards (a federal agency). At times this arrangement created confusion, leading people to believe the publications were official recommendations. After the war, the private group was revived as the National Committee on Radiation Protection. In 1956 it was renamed the National Committee on Radiation Protection and Measurements. In the early 1960s, it received a congressional charter and was renamed the National Council on Radiation Protection and Measurements. Throughout its history it has coordinated its activities with other groups, such as the International Commission on Radiological Protection and committees of the National Academy of Sciences (known as the BEAR and BEIR Committees). The most complete record of the NCRP's activities is Lauriston S. Taylor, Organization for Radiation Protection: The Operations of the ICRP and NCRP, 1928-1974 (Washington, D.C.: Office of Technical Information, U.S. Department of Energy.) Lauriston Taylor, a physicist at the National Bureau of Standards, served as the executive director of the organization from its founding in 1928 to 1974. For further background on the history of radiation protection, see Daniel P. Serwer, The Rise of Radiation Protection: Science, Medicine and Technology in Society, 1896-1935(Ph.D. diss. in the History of Science, Princeton University, 1976) (Ann Arbor: University Microfilms 77-14242, 1977); Gilbert F. Whittemore, The National Committee on Radiation Protection, 1928-1960: From Professional Guidelines to Government Regulation(Ph.D. diss. in the History of Science, Harvard University, 1986) (Ann Arbor: University Microfilms 87-04465, 1987); J. Samuel Walker, "The Controversy Over Radiation Safety: A Historical Overview," Journal of the American Medical Association 262 (1989): 664-668; D. C. Kocher, "Perspective on the Historical Development of Radiation Standards," Health Physics 61, no. 4 (October 1994).

17 . Heinz Haber, The Walt Disney Story of Our Friend the Atom (New York: Simon and Schuster, 1956), 152. The German-born Dr. Haber had come to the United States in 1947 to work for the Air Force School of Aviation Medicine and was a cofounder of the field of space medicine. In the early 1950s he joined the faculty of the University of California at Los Angeles. As Spencer Weart, a historian of the images of the atomic age has recorded, the accompanying Walt Disney movie Our Friend the Atom, which was shown on television and in schools beginning in 1957, was probably the most effective of educational films on the perils and potential of atomic energy. "The great storyteller introduced the subject as something 'like a fairy tale,' indeed the tale of a genie released from a bottle. The cartoon genie began as a menacing giant. . . . But scientists turned the golem into an obedient servant, who wielded the 'magic power' of radioactivity. . . ." Spencer R. Weart, Nuclear Fear: A History of Images (Cambridge, Mass.: Harvard University Press, 1988), 169.

18 . Marshall Brucer, Chronology of Nuclear Medicine (St. Louis: Heritage Publications, 1990), 199-200. Radon is a gas at room temperature. Doctors developed an innovative system for capturing radon from used cancer therapy vials and dissolving it in a saline solution, which was then injected.

19 . Haber, Our Friend the Atom, 152.

20 . J. L. Heilbron and Robert W. Seidel, Lawrence and His Laboratory: A History of the Lawrence Berkeley Laboratory, vol. 1 (Los Angeles: University of California Press, 1989). The birth and development of nuclear medicine at the University of California's Berkeley and San Francisco branches is the subject of a case study in a supplemental volume to this report.

21 . John Stanbury, A Constant Ferment (Ipswich, N.Y.: Ipswich Press, 1991), 57-67.

22 . Stafford Warren, interview by Adelaide Tusler (Los Angeles: University of California), 23 June 1966 in An Exceptional Man for Exceptional Challenges, Vol. 2 (Los Angeles: University of California, 1983) (ACHRE No. UCLA-101794-A-1), 421-422.

23 . Manhattan Project researchers focused on polonium in the development of the initiator for the bomb. See Richard Rhodes, The Making of the Atomic Bomb (New York: Simon and Schuster, 1986), 578-580.

24 . Manhattan District Program, 31 December 1946 (book 1, "General," volume 7, "Medical Program") (ACHRE No. NARA-052495-A-1), 2.2.

25 . Stafford Warren in Radiology in World War II, ed. Arnold Lorentz Ahnfeldt (Washington, D.C.: GPO, 1966), 847.

26 . Robert Stone, 10 May 1943 ("Health Radiation and Protection") (ACHRE No. DOE-011195-B-1).

27 . Philip J. Close, Second Lieutenant, JAGD, to Major C. A. Taney, Jr., 26 July 1945 ("Determination of Policy on Cases of Exposure to Occupational Disease") (ACHRE No. DOE-120894-E-96), 1.

28 . Ibid., 3.

29 . Response to ACHRE Request No. 012795-B, Oak Ridge Associated Universities, D. M. Robie to A. ("Tony") P. Polendak, 15 June 1979 ("Storage of records--Shipment 1161").

30 . The story of this early Hanford research is told in Neal D. Hines, Proving Ground: An Account of the Radiobiological Studies in the Pacific 1946-61 (Seattle: University of Washington Press, 1962). As Hines explains, the initial study of the effect of radioactivity on aquatic organisms was undertaken by a University of Washington researcher. The program could not be identified with the Columbia River, and the research was to be conducted in a normal campus setting. The project's name ("Applied Fisheries Laboratory") was selected to disguise its work. The primary researcher initially did not know the true purpose, and the university accepted the work for undisclosed purpose on the assurance that national security required it.

31 . Harold Hodge, interview by J. Newell Stannard, transcript of audio recording, 22 October 1980 (ACHRE No. DOE-061794-A-4), 21-22. Stafford Warren, interview by J. Newell Stannard, transcript of audio recording, 7 February 1979 (ACHRE No. DOE-061794-A), 3.

32 . Henry DeWolf Smyth, Atomic Energy for Military Purposes: The Official Report on the Development of the Atomic Bomb under the Auspices of the United States Government, 1940-45 (Princeton, N.J.: Princeton University Press, 1945).

33 . The organizational history of the Department of Defense is chronicled in The Department of Defense: Documents on Establishment and Organization 1944-1978, eds. Alice C. Cole, Alfred Goldberg, Samuel A. Tucker, Rudolf A. Winnacker (Washington, D.C.: Office of the Secretary of Defense, Historical Office, 1978).

34 . The program expanded from the base of Manhattan Project research sites such as Oak Ridge, Hanford, Chicago, and the Universities of California, Chicago, and Rochester to take in a growing portion of the university research establishment. The minutes of the January 1947 meeting record an ambitious program to focus on the physical measurement of radiation, the biological effects of radiation, methods for the detection of radiation damage, methods for the prevention of radiation injury, and protective measures. There followed an itemized list of the work to be done at Argonne National Laboratory, Los Alamos, Monsanto, Columbia University, and the Universities of Michigan, Rochester, Tennessee, California, and Virginia.

The University of Rochester was to be the largest university contractor, receiving more than $1 million, followed by the University of California (about one-half million for UCLA, where Stafford Warren was dean of the new medical school, and Berkeley, to which Stone had returned to join Hamilton), Western Reserve (to which Warren's deputy Hymer Friedell was headed), and Columbia (more than $100,000). Argonne received an amount comparable to Rochester; other labs, including Los Alamos National Laboratory and Clinton Laboratories (now Oak Ridge National Laboratory), were scheduled for $200,000 or less. Stafford Warren, Interim Medical Committee, proceedings of 23-24 January 1947 (ACHRE No. UCLA-111094-A-26). See also ACHRE Briefing Book, vol. 3, tab F, document H.

35 . "Report of the Board of Review," 20 June 1947, attached to letter from David Lilienthal, Chairman, AEC, to Dr. Robert F. Loeb, Chairman, AEC Medical Board of Review, 27 June 1947 ("At the conclusion of the deliberations . . .") (ACHRE No. DOE-051094-A-191), 3-4.

36 . The Advisory Committee has assembled the minutes of the meetings, and such transcripts as have been retrieved.

37 . Shields Warren, interview by Dr. Peter Olch, National Library of Medicine, transcript of audio recording, 10-11 October 1972, 59.

38 . Harry H. Davis, "The Atom Goes to Work for Medicine," New York Times Magazine, 26 September 1946 (ACHRE No. DOE-051094-A-408).

39 . Marshall Brucer, M.D., Chairman, Medical Division, Oak Ridge Institute for Nuclear Studies, wrote:

Paul Aebersold's isotopes division was the only safely nonsecret part of AEC. Aebersold had unlimited funds, unlimited radioisotopes, and seemingly unlimited energy to promote the unlimited cures that had been held back from the American public for too long. The liberal establishment was in the depths of shame for having ended the war by killing people. Radioisotopes didn't kill people; they cured cancer.

Aebersold spoke at every meeting of one person or more that had one minute or more available on its program. No matter what the meeting's subject, Aebersold's topic was always the same. He sold isotopes.

Marshall Brucer, "Nuclear Medicine Begins with a Boa Constrictor," Journal of Nuclear

Medicine 19, no. 6 (1978): 595. 40 . Isotopes Division, prepared for discussion with general manager, "Present and Future Scope of Isotope Distribution," 4 March 1949 (ACHRE No. DOE-011895-B-1).

41 . Interview with Shields Warren, 10-11 October 1972, 76.

42 . Isotopes Division, 4 March 1949, 2.

43 . See Kaplan, "Historic Milestones," 480.

44 . "Summary of Congressional Hearings on Fellowship Issue," 16 May 1949 (ACHRE No. DOE-061395-D-1).

45 . Advisory Committee for Biology and Medicine, proceedings of 10 September 1949 (ACHRE No. DOE-072694-A), 18.

46 . Ibid, 19.

47 . For a further discussion of the contemplated secret record keeping by the VA, see chapter 10. As noted there, a VA investigation concluded that the "confidential" division was never activated.

48 . The VA provided the Advisory Committee with capsule descriptions of experiments, which appeared in periodic VA reports of the time. In fact, the number of descriptions exceeded 3,000 for the portion of the 1944-74 period the reports covered. However, further information on the vast majority of the experiments was typically unavailable, and the VA noted that some of the descriptions may be redundant (or reflect refunding of a single experiment), and some may not have involved humans. Therefore, the "more than 2,000" reflects a very rough estimate adjusted for these considerations.

49 . Paul C. Aebersold, address before Rocky Mountain Radiological Society, 9 August 1951 ("The United States Atomic Energy Program: Part I--Overall Progress") (ACHRE No. TEX-101294-A-1), 6.

50 . By 1955 the program was receiving 8,000 applications a year, including hundreds from abroad. A July 1955 Aebersold summary of accomplishments pronounced that, as a result of the program, there were now 100 companies in the radiation instrument business, two dozen suppliers of commercially labeled compounds, pharmaceutical companies, hundreds of isotope specialists, a half-dozen waste disposal firms, and ten safety monitoring companies. Also, 2,693 U.S. institutions had received isotope authorization, including 1,126 industrial firms, 1,019 hospitals and private physicians, 220 colleges and universities, 244 federal and state laboratories, and 47 foundations. "Capsule Summary of Isotopes Distribution Program," July 1955 (ACHRE No. TEX-101294-A-2).

51 . Vannevar Bush, Pieces of the Action (New York: William Morrow and Company, 1970), 65.

52 . Ibid.

53 . In addition to direct grants to private institutions the AEC pioneered the creation of research consortia. In 1946, for example, the University of Tennessee and a consortium of southeastern universities urged the Manhattan Project to establish the Oak Ridge Institute of Nuclear Studies (ORINS). Following the creation of the AEC, ORINS operated under AEC contract to train researchers and to operate a clinical research facility focused on cancer. In 1966 ORINS became known by the name of its operating contractor, the Oak Ridge Associated Universities, and the research facility is now known as the Oak Ridge Institute for Science and Education (ORISE).

54 . Donald C. Swain, "The Rise of a Research Empire: NIH, 1930 to 1950," Science 138, no. 3546 (14 December 1962): 1235. The National Institutes of Health began as the Laboratory of Hygiene in 1887. It was renamed the National Institutes of Health in 1948.

55 . Assistant Director, Office of Extramural Research, National Institutes of Health, to Anna Mastroianni, Advisory Committee, 16 July 1995 ("Comments on Draft Chapters of ACHRE Final Report").

56 . Interview with Shields Warren, 10-11 October 1972, 78.

57 . Robert S. Stone, M.D., to Lieutenant Colonel H. L. Friedell, U.S. Engineer Corps, Manhattan District, 9 August 1945 ("In reading through the releases . . .") (ACHRE No. DOE-121494-D-2).

58 . Robert S. Stone, M.D., to Lieutenant Colonel H. L. Friedell, U.S. Engineer Corps, Manhattan District, 9 August 1945 ("As you and many others are aware, a great many of the people . . .") (ACHRE No. DOE-121494-D-1).

59 . Jonathan M. Weisgall, Operation Crossroads: The Atomic Tests at Bikini Atoll (Annapolis, Md.: Naval Institute Press, 1994). For a contemporary account by a doctor who served as a radiation monitor, see David Bradley, No Place to Hide (Boston: Little, Brown and Co., 1948).

60 . Weisgall, Operation Crossroads, 266-270.

61 . "History of the U.S. Naval Radiological Defense Laboratory, 1946-58" (ACHRE No. DOD-071494-A-1), 1.

62 . The Joint Panel was the child of the Committee on Medical Science and Committee on Atomic Energy (hence the term Joint), both of which, in turn, were committees of the Defense Department's Research and Development Board. That board served as the secretary of defense-level coordinator of departmentwide R&D.

63 . The Committee has assembled the charter, agenda, reports, and available minutes of the Joint Panel. ACHRE Research Collection Series, Library File, Compilation of the Minutes of the Joint Panel on Medical Aspects of Atomic Warfare, 1948-1953 (1994).

64 . Howard Andrews, interview by Gilbert Whittemore (ACHRE staff), transcript of audio recording, 3 December 1994 (ACHRE Reseach Project, Interview Series, Targeted Interview Project).

65 . In a February 1950 paper, the Public Health Service explained its role in national defense:

During and since WW II, science and technology have introduced new weapons and whole new industries whose effects on human health have not been precisely determined and effective methods against these hazards have not yet been developed.

If, for example, an atomic bomb were to burst over a large city in this country, tens of thousands of burned and injured people could not be given effective treatment because science has not yet found the practical means. . . . The operation of atomic piles and related facilities also presents a variety of problems as to human tolerance of radiation and the disposition of radioactive substances.

"The U.S. Public Health Service and National Defense," February 1950 (ACHRE No. HHS-071394-A-2), 1.

66 . National Institutes of Health, 2 August 1952 ("Assumptions Underlying NIH Defense Planning") (ACHRE No. HHS-071394-A-1).

67 . Advisory Committee for Biology and Medicine, transcript (partial) of proceedings of 10 November 1950 (ACHRE No. DOE-012795-C-1). While the document is undated, discussion of the meeting appears in the November 1950 ACBM minutes (12); a letter from Alan Gregg, Chairman, ACBM, to Gordon Dean, Chairman, AEC, 30 November 1950 ("The Advisory Committee for Biology and Medicine held their twenty-fourth . . .") (ACHRE No. DOE-072694-A); and a letter from Marion W. Boyer, AEC General Manager, to Honorable Robert LeBaron, Chairman, Military Liaison Committee, 10 January 1951 ("As you know, one of the important problems . . .") (ACHRE No. DOE-040395-A-1).

68 . Behrens, transcript, proceedings of 10 November 1950, 2.

69 . Powell, transcript, proceedings of 10 November 1950, 8-10.

70 . Cooney, transcript, proceedings of 10 November 1950, 6.

71 . Ibid., 7.

72 . Ibid., 6.

73 . Ibid., 7-8.

74 . Warren, transcript, proceedings of 10 November 1950, 13.

75 . Ibid., 14.

76 . Ibid., 15.

77 . Cooney, transcript, proceedings of 10 November 1950, 15.

78 . Ibid., 16.

79 . "Notes on the Meeting of a Committee to Consider the Feasibility and Conditions for a Preliminary Radiological Safety Shot for Operation 'Windsquall,'" 21-22 May 1951 (ACHRE No. DOE-030195-A-1), 41.

80 . Ibid., 40.

81 . Ibid., 19.

82 . T. L. Shipman, Health Division Leader, to Alvin Graves, J-Division Leader, 27 December 1951 ("Summary Report Rad Safe and Health Activities at Buster-Jangle") (ACHRE No. DOE-033195-B-1).

83 . [AEC] Board of Review to the Atomic Energy Commission, 20 June 1947 ("Report of the Board of Review") (ACHRE No. DOE-071494-A-4), 10.

84 . NEPA Medical Advisory Panel, Subcommittee No. IX, "An Evaluation of Psychological Problem of Crew Selection Relative to the Special Hazards of Irradiation Exposure," 22 July 1949 (ACHRE No. DOD-121494-A-2), 20.

85 . Ibid., 27.

86 . Ibid., 22.

87 . Definition of "curie," The Compact Edition of the Oxford English Dictionary (Oxford, England: Oxford University Press, 1971), 3937.

88 . J. Newell Stannard, Radioactivity and Health: A History (Oak Ridge, Tenn.: Office of Scientific and Technical Information, 1988), 9.

89 . Hanson Blatz, ed., Radiation Hygiene Handbook (New York: McGraw-Hill Book Co., 1959), 6-185.

90 . Richard G. Hewlett and Oscar E. Anderson, The New World: A History of the Atomic Energy Commission, Vol. I: 1939-1946 (Berkeley: University of California Press, 1990), reprint of 1962 edition, 107-108.

91 . Eric Hall, Radiobiology for the Radiologist, 4th ed. (Philadelphia: J. B. Lippincott, 1994), 3.

92 . Ibid., 5.

93 . The DNA strand would be about 5 centimeters (cm) long; the average cell diameter is about 20 microns (0.002 cm). Bruce Alberts et al., eds., Molecular Biology of the Cell (New York: Garland, 1983), 385-388.

94 . Hall, Radiobiology for the Radiologist, 4th ed., 9-10.

95 . Ibid.

96 . Ibid., 30.

97 . Ibid., 32-33.

98 . Ibid., 312.

99 . Ibid., 324.

100 . Ibid.

101 . International Commission on Radiological Protection, Recommendations: ICRP Publication No. 60 (New York: Pergamon Press, 1991), cited in Hall, Radiobiology for the Radiologist, 4th ed., 456.

102 . Hall, Radiobiology for the Radiobiologist, 4th ed., 355.

103 . Committee on the Biological Effects of Ionizing Radiation, National Research Council, Health Effects of Exposure to Low Levels of Ionizing Radiation: BEIR V (Washington, D.C.: National Academy Press, 1990), 2-4.

104 . International Commission on Radiological Protection, Recommendations: ICRP Publication No. 60, quoted in Hall, Radiobiology for the Radiologist, 4th ed., 455.

105 . ". . . roentgen equivalent man, or mammal (rem). The dose of any ionizing radiation that will produce the same biological effect as that produced by one roentgen of high-voltage x-radiation." Blatz, ed., Radiation Hygiene Handbook, 2-19.

106 . Hall, Radiobiology for the Radiobiologist, 4th ed., 458.

107 . These include the National Council on Radiation Protection and Measurement (NCRP), the International Commission on Radiation Protection (ICRP), the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the Committee on the Biological Effects of Ionizing Radiation (BEIR) of the National Research Council, and the Environmental Protection Agency (EPA).

108 . In addition, there have been a number of studies of people exposed to low levels of radiation, including military personnel and residents subject to fallout from nuclear weapons testing, workers at and residents near nuclear facilities, patients given diagnostic x rays, and regions with high natural background radiation. Most of these either have not produced convincing positive results or are unsuitable for risk assessment because of the statistical instability of their estimates.

109 . Some indirect estimates have been based on "case control" studies, in which diseased cases are compared with unaffected controls to look for differences in their past exposures that could account for their different outcomes.

General reference works include D. G. Kleinbaum, W. Kupper, and H. Morgenstern, Epidemiologic Research: Principles and Quantitative Methods (Belmont, Calif.: Lifetime Learning Publications, 1982), and J. D. Boice, Jr., and J. E. Fraumeni, Jr., Radiation Carcinogenesis: Epidemiology and Biological Significance (New York: Raven Press, 1984).

110 . Dr. Shirley Fry to Bill LeFurgy, 31 August 1995 ("HRE Draft Final Report"), 8, contained in Ellyn Weiss, Special Counsel and Director, Office of Human Radiation Experiments, DOE, to Anna Mastroianni, ACHRE, 11 September 1995.

111 . "[T]he NTPR dose data are not suitable for dose-response analysis." Institute of Medicine, "A Review of the Dosimetry Data Available in the Nuclear Test Personnel Review (NTPR) Program, An Interim Letter Report of the Committee to Study the Mortality of Military Personnel Present at Atmospheric Tests of Nuclear Weapons to the Defense Nuclear Agency" (Washington, D.C.: Institute of Medicine, May 15, 1995), 2.

112 . Committee on the Biological Effects of Ionizing Radiation, National Research Council, Health Effects of Exposure to Low Levels of Ionizing Radiation: BEIR V (Washington, D.C.: National Academy Press, 1990), 22, 162.

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