China & India

"In China, a meticulous study measured the radon level for 1 year in the houses of several hundred women with lung cancers and in homes of a similar number of healthy women. The results demonstrated at a 95% confidence level that women who lived in high-level radon houses (more than 350 Bq/m^3) had an 80% lower lung cancer risk than those living in low-level radon houses (4 to 70 Bq/m^3). For perspective, the EPA considers that remedial action at any level down to 70 Bq/m^3 would be cost effective, even for the cost of reducing the level from 150 to 70 Bq/m^3 at about $2 million per hypothetical life saved. (Schiager 1992)." [Blot, W.J., et al. Indoor radon and lung cancer in China. Journal of the National Cancer Institute, 82, 1025, 1990.]

"While the poorly fed coastal population in Kerala, India, receives 400% - 800% more background radiation than neighboring areas, the people have a higher fertility rate with the fewest neonatal deaths of any other Indian state." [Auxier, J.A., Reactions to BRC. Health Physics Society Newsletter, 16, 5, 1988.]

Brazil

• No unusual congenital abnormalities, stillbirths, or changes in live births could be found in a Brazilian study of 44,000 pregnancies, even though the background radiation was five to ten times "normal."
• (From the same investigation) "The high terrestrial radiation, 9 mGy/year [900 mrem/yr], in Espirito Santo, Brazil did not affect the fertility of 8,000 couples in this study. [Freire-Maya, A. and Kreiger, H. Human genetic studies in areas of high natural radiation. Health Physics, 34, 61, 1978.]
• The beaches of Guarapari have 25%-35% monazite sand giving a dose to vacationers (who bury themselves in it) of 0.03 mGy/hr (at least 30 mrem per ten-hour day - 420 mrem for a two-week vacation). Though it's illegal, the tourists steal the rocks and sand for their bedrooms at home. [Cullen, T.H., et al. Two decades of research in the Brazilian areas of high natural radioactivity. Radiation Protection: A Systematic Approach to Safety, Pergamon Press, Oxford, 1980.]

United States

Sources of significant background radiation in the United States are (1) terrestrial sources, such as granite and certain other types of rocks; (2) radon and its progeny from the decay of thorium, uranium and other radionuclides; and (3) cosmic radiation - which doubles each 6,000 feet in altitude in the temperate latitudes. Several of the Rocky Mountain states, particularly Idaho, Colorado and New Mexico, have higher than normal levels of each of these categories, combined to make a significant difference between these states and others, especially the Gulf Coast states of Louisiana, Mississippi and Alabama.

We'll take a look at the cancer rates in these areas (American Cancer Society 1998 data) and compare them with background sources. The Linear No-Threshold (LNT) theory would predict an increase in cancer; the hormesis model forecasts a decrease in cancer - and other diseases or conditions affected by immune competence - as the radiation levels increase in the hormetic range. You be the judge.

Jagger investigated the average background exposures and cancer death rates among the 5.84 million people living in Idaho, Colorado and New Mexico, compared with the same factors for the 10.83 million residents of Louisiana, Mississippi and Alabama. His results are shown in Figure 25. While the study does not examine the large number of confounding factors that could possibly influence the data, it does illustrate a trend diametrically opposite to the LNT and is strongly indicative of hormesis. [Jagger, H. Natural background radiation and cancer death in Rocky Mountain states and Gulf Coast states. Health Physics, 75(4), 1998.]

Source for Figure 25: Background Radiation vs. Cancer Rate: Jagger, H. Natural background radiation and cancer death in Rocky Mountain states and Gulf Coast states. Health Physics, 75(4), 1998. Cancer data from the American Cancer Society, 1998.

If you are unaccustomed to reading graphical data, please note that Figures 25 and 26 show two different parameters - radiation dose and cancer rate - for two different geographical areas. The scale on the left side of the graph relates to the bar graphs, while the right-hand values pertain to the cancer deaths per 100,000 persons, as shown by the data points and connecting trend line. What is intended to be shown is the increase in cancer rate (as evidenced by the upward sloping line) compared with the decrease in background radiation indicated by the magnitude of the bar graphs.

A 1994 study by Cohen compares the average radon level and lung cancer rate in the Rocky Mountain states with that in the Gulf Coast states. Radon data come from state agencies, the EPA, and University of Pittsburgh researchers; cancer data are from the American Cancer Society. [Cohen, B. Dose-response relationship for radiation carcinogenesis in the low-dose region. Int. Arch. Occupational Environmental Health, 66, 1994.]

Source for Figure 26: Residential Radon vs. Lung Cancer Rate: Cohen, B. Dose-response relationship for radiation carcinogenesis in the low-dose region. Int. Arch. Occupational Environmental Health, 66, 1994.

Were the data, plotted in Figure 26, to show that lung cancer increased with increasing radon levels, one would have to concede as very likely that the higher residential radon levels were a cause of cancer. Since the evidence shows the exact opposite, one might expect our regulatory agencies to take note and consider revising their policies accordingly. Unfortunately, they apparently don't think they should be bothered with such trivial matters as evidence. "It is the radiation protector's task to protect people from radiation, regardless of whether the radiation has bionegative or biopositive effects."

Craig and Seideman studied the rate of leukemia and lymphocytic lymphoma versus altitude in the United States. [Craig, L. and Seidman, H. Leukemia and lymphoma mortality in relation to cosmic radiation. Blood, 17, 1961.] This, of course, should be a "no brainer" - everyone knows that leukemia is caused by radiation. Since there is about a 4,000 foot difference between the low data points and the high point - and thus a near doubling in cosmic radiation - we will no doubt find, in Figure 27, a doubling of radiation-sensitive cancers like leukemia, right?

Source for Figure 27: Leukemia and Lymphocytic Lymphoma vs. Altitude (U.S.): Craig, L, and Seidman, H. Leukemia and lymphoma mortality in relation to cosmic radiation. Blood, 17, 1961.

Oops. Something is obviously wrong here. I guess it's back to the old drawing board again for the LNTers. Really, this does go on and on. Allow me to mention a few of the more interesting cases - without the plots, since I suspect you're starting to tire of graphs and charts.

Japan

Spring waters have often been found to have significant amounts of dissolved radon. This seems particularly true at springs that are considered "health spas," such as Bad Gastein in Austria, where the activity from radon and its progeny reaches 16,200 pCi/l - a mere 73,600% higher than the "contaminated milk" of such great concern to the media at Three Mile Island. A case in point are the radon springs at Misasa, Japan, where Mifune et al. [Mifune, M., et al. Cancer mortality survey in a spa area (Misasa, Japan) with a high radon background. Japan Journal of Cancer Research, 83, 1, 1992], investigated the prevalence of cancer mortality in Misasa versus that in the nearby town of Beppu Spring, a village with minimal waterborne radon. Also, used as a control, were the Standard Mortality Ratios for all Japan. Data were collected during the period 1952-88.

Caption for Figure 24: Japanese Mortality vs. Radon Prevalence: Mifune, M., Sobue, T., Arimoto, H., Komoto, Y., Kondo, S. and Tanooka, H. Cancer mortality survey in a spa area (Misasa, Japan) with a high radon background. Japan Journal of Cancer Research, 83, 5, 1992.

Stomach cancer mortality is singled out and plotted in Figure 24, since it might be expected from ingesting radon in the water. Obviously there is a significant negative correlation between radon exposure and cancer - in conflict with the LNT and in good agreement with hormesis expectations.

One unusual feature of the data concerns female responses. Often the observed beneficial effect of radiation is less in females than in males. The Misasa data, however, indicate SMRs for colon/rectum and lung cancer that are signficantly lower for women.

Dr. Mifune, regarding a study much like that of Misasa, comments, "Similarly, in one region of Japan with an average indoor level of 35 Bq/m^3, the lung cancer incidence was 51% of that in a low-level radon region (11 Bq/m^3), and the mortality caused by all types of cancers was 37% lower." By the way, to convert Bq/m^3 to pCi/l, you divide by thirty-seven - which means both of the above cited areas have relatively low indoor radon. (Just wait until you see what Bernard Cohen says about all this in chapter 20.)

Table 12
Standard Mortality Ratios for Residents of Misasa, Japan
	Male	Female
Total Cancer	.538	.463
Stomach	.400	.452
Colon/rectum	.296	.142
Lung	.475	.187
Leukemia	.445	.534
Source: Mifune, M. et al. Cancer mortality survey in a spa area (Misasa, Japan) with a high radon background. Japan Journal of Cancer Research, 83, 1, 1992.

India

Indian researchers K.S.V. Nambi and S.D. Soman collected an analyzed cancer mortality data from a number of state hospitals along with the average background radiation in each locality. (Hospitals in Delhi, Kerala, Maharashtra, Pondi and Tamil Nadu were excluded as they are regional centers that take patients from several states.) A plot of these data, shown in Figure 23, show an unmistakable negative correlation between background radiation and overall cancer mortality. In an extended study, the investigators found a significant inverse relationship (the more radiation, the less cancer) between background radiation and all types of female cancers except those of the mouth and cervix. [Nambi, K.S.V., and Soman, S.D. Further observations on environmental radiation and cancer in India. Submitted to Health Physics, 1990.]

Source for Figure 23 Cancer Mortality vs. Background Radiation (India) Nambi, K.S.V. and Soman, S.D. Environmental radiation and cancer in India. Health Physics, 52, 653, 1987.

China

There are two geographical areas involved in both of the following investigations. The "Low Background" areas has a background rate similar to the Gulf Coast states in the United States, i.e., about 100 mrad (0.1 cGy) per year; the "High Background" locations have exposures of approximately 300 mrad - very near the U.S. average. The early study, illustrated in Figure 21, is for relatively large cohorts with a "High" group of 74,000, compared with the "Low" control cohort of 77,000 inhabitants. Since "all radiation is dangerous and unhealthy," we should see the low-background contingent outshining their radiated countrymen in all facets of health and well-being.

Source for Figure 21 Chinese Cancer Morality: Zhai, S., Lin, X., Pan, T., He, W., Feng, R., Chen, M., Li, S., Chen, L.R., and Yie, H. Report of survey on mortality from malignant tumors in high background area of Guangdong. Journal of Radiation Research (Japan), 22, 48, 1982.

Au contraire! The data of Figure 21 support just the reverse. As can be seen in this study by S. Zhai et al., eight of the ten cancers investigated are higher in the low-radiation group.

A second Chinese study compared several reproduction related criteria for the two groups. In this case the "high" population consisted of 13,425 peasants [their word], with the control "lows" numbering 13,987. Figure 22 shows the relative percentages of reproductive "problems" between the groups. Unless there are some unknown confounding factors at work here, it is evident that living in a low-background radiation area is not conducive to large families.

If high-background radiation caused an increase in spontaneous abortion, neonatal mortality, or infertility, there would be no end to regulators and the protection bureaucracy attempting to move us all to new locations, dig up the farm, and bury it somewhere. But since all three of these factors are decreased with an increase in background radiation, no one seems to notice.

Source for Figure 22 Chinese Reproductive Data: High Background Radiation Research Group (HBRRG). Aspects of environmental radiation and dosimetry concerning the High Background Radiation Area in China. Journal of Radiation Research (Tokyo), 22, 88, 1981. Also in Science, 209, 877, 1981.

"Why Don't They Evacuate Norway?"

"Why don't they evacuate Norway?" - a question by UN Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Member Dr. Zbigniew Jaworowski in noting that the limits set for evacuating people from around Chernobyl were below the average background radiation in Norway, and far, far below the high background areas of Norway and many other places in the world.

On a planet where virtually nothing is distributed equally, we should be surprised if terrestrial sources of background radiation were somehow evenly allocated. And they are definitely not. As noted in Table 10 (in chapter 11), some places have more than 130 times the average background radiation of the United States, and since the U.S. average is considerably higher than the ambient radiation inn other locations, there is easily a factor of 150 difference between points on the earth.

Believers in the Linear No-Threshold (LNT) hypothesis tell us that all radiation is dangerous, and that the danger is proportional to the dose received. Hey, since we have all these different levels of background radiation across the globe, all they have to do to prove their theory is to demonstrate that as the background radiation increases, so does cancer incidence - and perhaps even other maladies that we haven't yet even considered might be caused or aggravated by additional exposure.

Sadly (for them), this is demonstrably untrue. More than that. There is a large body of evidence that points in the opposite direction - that we are "underexposed" and that exposure to additional radiation will increase our health and vitality. This chapter intends to show some of that evidence.

I Say There, Old Chap

A final study on weapons workers and nuclear power workers comes from England's National Radiological Protection Board. The study, involving 95,100 workers over 3,237,378 person-years was conducted by G.M. Kendall, et. al. and caused a recent stir in the United States. [Kendall, G.M., et al. Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers. British Medical Journal, 304, 220, 1992.]

T.D. Luckey has taken exception to the manner in which the data was presented, in particular that it dramatically increased the apparent cancer risk by not differentiating between the doses received by certain workers. The English authors have objected to Luckey's objection and are apparently unwilling to undertake any revision that would jeopardize their conclusion. [Not only are they uninterested in considering a revision, they don't want Luckey doing so either and have refused to supply specific age information, as it might identify particular workers. (Interestingly, in the report, fewer than 2% of the workers requested anonymity.)]

What conclusion is that?

"There is evidence for an association between radiation exposure and mortality from cancer, in particular leukemia (excluding chronic lymphatic leukemia) and multiple myeloma, although mortality from these diseases in the study population was below that in the general population." [Emphasis added.]

So, considering the data presented in Figure 20, how can the report claim a positive correlation between radiation and cancer? You guessed it: "There is strong evidence of a healthy worker effect." Why? Because, according to the report, "Mortality is lower in radiation workers than in the general population of England and Wales - overall and for most specific causes, including cancer."

Caption and source for Figure 20 Mortality Among British Nuclear Workers: The "lagged analysis excludes the first two years (leukemia) or first ten years (other cancers) after the start of radiation work. Source: Kendall, G.M., Muirhead, C.R., MacGibbon, B.H., O'Hagan, J.A., Conquest, A.J., Goodill, A.A., Butland, B.K., Fell, T.P., Jackson, D.A., Webb, M.A., Haylock, R.G.E., Thomas, J.M., and Silk, T.J. Mortality and occupational exposure to radiation: first analysis of the National Registry for Radiation Workers. British Medical Journal, 304, 220, 1992.

One might suggest there is a case of circular reasoning here: There is evidence of healthy worker effect since the workers are healthier. As in the study by Dr. Gilbert, no controls of unexposed co-workers were used; nor was any consideration given to the possibility of hormesis.

The LNT dies hard.

For those who have, or may contemplate, working around radioactive materials, you might be pleased to read the following:

There was a 66% decrease in the death rate from infection and parasitic disease in exposed workers at the Savannah River Plant when compared with unexposed controls within the same area. [Cragle, D.L. et al. Mortality among workers in a nuclear fuel products facility. American Journal of Industrial Medicine, 14, 397, 1988.]

Los Alamos workers exposed to greater than 1 mGy (100 mrem) were compared with the U.S. population. The exposed group had only 58% as much total cancer mortality as controls, although brain cancer mortality exceeded controls by 17%. Other cancer categories were: lymphopoietic, 56%; respiratory, 57%; digestive, 67%; leukemia, 75%; no thyroid or bone cancer mortality was found in exposed persons. [Acquavella, J.F., et al. A melanoma case-control study at the Los Alamos National Laboratory, Health Physics, 45, 587, 1988.]

"The total number of deaths experienced by Union Carbide employees in the three Oak Ridge atomic energy facilities over the past 16 years, 1950 through 1965, was compared with the deaths which would be expected or predicted by applying U.S. Bureau of Vital Statistics (BVS) mortality rates to the employee population over this period of time. There were 692 deaths among the plant population over this period, which involved over 200,000 man-years of employment. Based upon the BVS mortality rates, one would have predicted 992 deaths. It is therefore concluded that these employees are experiencing a signficantly lower death rate than the average of the white population [the employees were predominately white] throughout the United States." [Larson et al. Comparison of Union Carbide employees in Oak Ridge atomic energy facilities with U.S. Bureau of Vital Statistics Mortality, UCC Report K-A-708, issued June 9, 1966.]

"Up-to-date cancer incidence data for those cohorts [weapons plant workers] are reviewed and continue to show rates below those expected in the general population. This, in a population of workers exposed during their occupations over many years to radiation doses that would be considered unacceptable today, and studied as a 'bellwether' for predicting risk to current workers, there is evidence at a cellular level of their having received that exposure, but as yet no evidence of unpredicted harm." [Emphasis added.] [Berry, R.J., et al. Biological markers, morbidity, and mortality in a long-serving radiation worker population. American Nuclear Society Transactions, November 1994.]

Mortality studies of plutonium workers at Rocky Flats [Colorado] involving 7,112 workers from 1952 to 1979 gave cancer deaths at 64% of the expected number in the general population. [Nuclear News, December 1981, pp. 135-38.]

***

I would hate to be a regulator these days and to be required to continually come up with excuses as to why the data are wrong, and why my opinion is right. But then, perhaps things would look differently if my prestige and paycheck were on the line.

The Most Toxic Substance on Earth?

One of the noisiest guns in the anti-nuclear arsenal has been the cultivated fear of plutonium. "The most toxic substance known to man," so the mantra goes - in complete disregard to toxicity studies showing the element to be about as toxic as caffeine and 1/1,000,000,000,000 the toxicity of botulism toxin. Even in the health physics field, however, there has been a great deal of concern over inhaled plutonium, because it is an alpha emitter shooting nuclear cannon balls directly into adjacent lung tissue. If you presume radiation is a major cause of cancer, it is only logical to see chronic exposure from an alpha source within the lungs as extremely dangerous. But just as with radon exposure in mining environments, plutonium may not be nearly as dangerous as earlier believed.

During the urgent atomic bomb development period of 1944-45, some workers were exposed to plutonium fumes and extremely fine dust, which accumulated primarily in lung tissue. Twenty-six of these exposed males were followed with regular examinations every five years starting in 1952. When the initial study of these examinations began in 1973 [Hempelmann, L.H. et al. Manhattan Project plutonium workers. A twenty-seven year follow-up study of selected cases. Health Physics, 25, 461, 1973], one subject had already died of a heart attack. Anti-nuclear scientists, such as John Gofman, predicted shortened life spans from radiation-induced lung cancer. [Gofman, J.W., Radiation and Human Health, Sierra Clue Books, San Francisco, 1981.]

But apparently, someone forgot to tell the workers.

At the time of the 1986-87 examination period, with an average of age of sixty-six years, twenty-two of the twenty-five subjects had refused to die on Gofman's schedule. One had died in an automobile accident, another of a heart attack at age sixty-two, and the third - a pack-a-day-plus smoker - had succumbed to lung cancer in his seventy-second year. (It may be of some interest that this person, identified as Subject #10, was in the lower half of estimated plutonium deposits.)

Because only twenty-six individuals were involved, the study has no statistical significance - which is to say that chance could have been at work selecting certain men who were unusually tolerant to the effects of inhaled plutonium. But the data is also suggestive of a lesser response to plutonium than the LNT dose-response would predict.

Anti-nuclear activists are fond of saying that "a single gamma ray can lead to cancer." Eight of the atomic bomb workers - all living at the end of 1987 - had received a dose of more than 2,000,000,000,000,000 alpha particles, which is the equivalent of 8,000,000,000,000,000 gamma rays (assuming a Q of 4). Not only were the "victims" alive, but they were healthier than their peers who weren't lucky enough to inhale plutonium dust more than forty years earlier.

If this study were the only one indicating a biopositive dose-response from plutonium ingestion, it might be written off as an anomaly. But, quoting from a paper by Voelz and Lawrence [Voelz, G.L. and Lawrence, J.N.P. A forty-two-year medical follow-up of Manhattan Project plutonium workers. Health Physics, Vol. 61, 1991. For more information, you might also refer to Voelz, G.L. et al. Mortality study of Los Alamos workers with higher exposures to plutonium. Epidemiology applied to health physics. Proceedings of the Health Physics Society, Albuquerque, N.M. Report CONF-83010, 318, 1983]:

"Other studies of Pu-exposed workers have not demonstrated excesses of lung cancer. In 224 white male Pu-exposed workers, selected on the basis of each having a 1974 estimated Pu deposition in excess of 370Bq (10 nCi), only one death from lung cancer occurred over at 33-year follow-up period. The SMR for lung cancer based on U.S. rates was 0.2 (95% C.I.=0,1.1)."

Lest you have forgotten the definition, an SMR of 0.2 means that the lung cancer rate for the workers exposed to plutonium was one-fifth that of the general population.

Don't take this as an indication that plutonium is never dangerous when ingested. All the heavy metals are toxic to some degree, and though a relatively benign alpha emitter, it has the potential for being dangerous in large amounts. Several studies noted by Voelz in which beagles were exposed to very high doses produced extremely severe consequences. But hormesis is about the differences in effects of a toxin depending on the dose and/or dose rate. Evidence in these studies clearly suggests that plutonium may be an effective hormetin.

American Weapons Plant Workers

In the first of several planned efforts to combine data on workers at all Department of Energy facilities, this 1989 study was supervised by Dr. Ethel Gilbert of the Pacific Northwest Laboratory. [Gilbert, E.S., et al. Analysis of Combined Mortality Data on Workers at the Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Nuclear Weapons Plant. Radiation Research, 120, 19, 1989.]

Table III of the report gives a breakdown of Causes of Deaths for 3,368 workers out of a total exposed population of 35,933; these data are summarized in Figure 19.

Source for Figure 19 Combined Mortality Data: Gilbert, E.S., Fry, S.A., Wiggs, L.D., Voelz, G., Cragle, D., and Gilbert, G.R. Analysis of Combined Mortality Data on Workers at the Hanford Site, Oak Ridge National Laboratory, and Rocky Flats Nuclear Weapons Plant. Radiation Research, 120, 19, 1989. Also American Journal of Epidemiology, 131, 917, 1990.

The report summary has some interesting observations:

"These combined analyses provide no evidence of a correlation between radiation exposure and mortality from all cancer or from leukemia. Of eleven other specific types of cancer analyzed, multliple myeloma was the only cancer found to exhibit a statistically significant correlation with radiation exposure. Estimates of the excess risk of all cancer and of leukemia, based on the combined data, were negative." [Emphasis added.]

Sounds terrific for LNT opponents! Could it ever be made more clear than by saying "the analyses provide no evidence of a correlation between radiation exposure and mortality from all cancer or from leukemia"? No doubt the report conclusions will cast aspersions on the LNT and set the stage for hormesis resarch, right? Well, not exactly. It continues:

"SMRs for all cancers were significantly less than one in all three populations, probably because of selection bias and other factors related to the healthy worker effect." [Emphasis added.]

You would think that in a study that expects to "provide a direct assessment of health risk" from exposure to low-level radiation, a provision would be made to eliminate the healthy worker effect. Certainly there were enough non-exposed personnel at these facilities to provide a control cohort. The question is, "Why wasn't this done?"

Ruling out conspiracy and stupidity, one is left with only one possibility I can think of: It was expected that the data would show a cancer mortality rate higher than predicted by the standardized rate - which would be the case if the LNT and collective dose were true. No provision was made for the "unexpected result," thus leaving the study with the extremely weak conclusion that the data showed a negative correlation probably because of well, eh, ah... you know. Almost without doubt the researchers were honest, intelligent, dedicated people. But one thing was simply overlooked in analysis of the data: All results that showed evidence of hormesis were simply ignored.

Leukemia in Male Employees of Atomic Energy of Canada, Ltd.

A later study by M.A. Gribbin et al. examined leukemia mortality of 9,997 male employees of Atomic Energy of Canada, Ltd., with an average exposure of 4.9 cSv (4,900 mrem) compared to 5,504 unexposed co-workers. [Gribbin, M.A., Howe, G.R. and Weeks, J.L. A study of the mortality of AECL employees, V, The second analysis: Mortality during the period 1950 - 1985, Report No. AECL-10615, p48, Atomic Energy of Canada, 1992. Also quoted by Z. Jaworowski in "Stimulating effects of ionizing radiation: New issues for regulatory policy." Regulatory Toxicology and Pharmacology, 22:2, 1994.]

Figure 18 presents the data in the form of standard mortality ratios for the various types of leukemia.

Source for Figure 18 Leukemia Mortality of AECL Employees: Gribbin, M.A., Howe, G.R. and Weeks, J.L. A study of the mortality of AECL employees, V, The second analysis: Mortality during the period 1950 - 1985, Report No. AECL-10615, p48, Atomic Energy of Canada, 1992.

Commenting on this study, Dr. Jaworoski states: "As shown in Table 6 [from which the graph data was taken], the mortality due to all leukemias in the exposed group was only 32% of that in the general Canadian population. The observed mortality among employees of AECL from all cancers and from all non-cancer diseases was also less than expected." [Zbigniew Jaworowski, professor emeritus at the Central Laboratory for Radiological Protection (Poland) and a member of the U.N. Scientific Committee on the Effects of Atomic Radiation (UNSCEAR).]

While this is a relatively small study, the consistently lower leukemia mortality rate - previously considered the established sign of excessive radiation exposure - seems to be a powerful argument for hormesis at work.

On to Ontario

In a 1983 study by J.D. Abbatt et al., the standard mortality ratios (SMRs) of 4,000 nuclear workers were compared with those of 21,000 unexposed "thermal" workers and to those of the general population of nearby Ontario, Canada. [Abbatt, J.D., et al. Epidemiological studies in three corporations covering the Canadian nuclear fuel cycle. From: Biological Effects of Low Level Radiation, International Atomic Energy Agency, STI/PUB 646, Vienna, 1983.]

Exposures for the nuclear cohort in this investigation, which covered twenty years of plant operation, averaged 7 cGy (7,000 mrad) or about twenty-three years of additional annual background radiation per worker.

Hold the phone. Just what is a "standard mortality ratio" (SMR)? And what does HWE mean? (It hasn't come up yet, but it's getting ready to.) Glad you asked.

First the SMR: If, in the United States, it is observed that 20,000 of the 1 million makes aged fifty-nine die per year, we can say that the rate of deaths for this group is 2% and that becomes the basis for comparison of other smaller groups of fifty-nine-year-old, left-handed Presbyterians, there are only ten deaths, giving us a death rate of 1%. To obtain the standard mortality ratio of the Presbyterian lefties we divide its 1% rate by the 2% rate for the total population, yielding the ratio 0.50.

If we wanted to know the reason for this lesser mortality ratio, we'd call in an epidemiologist. This special type of statistician might note that most U.S. Presbyterians are Caucasians, who have a lower death rate at age fifty-nine than that of the population in general. Hence race would be considered a confounding factor that explains, in part or in total, the difference in the death statistics.

One of the most often used confounding factors in attempts to rebut the hormesis phenomenon is that of the healthy worker effect (HWE).

Any employer requiring reliable workers will want to know, at the time of employment negotiations, the health history of the prospective employee. [Politicians who pander to certain groups attempt to thwart such reasonable actions - as seen by several Federal laws making health questions illegal.]

Since the healthy applicants, who tend to have a history of less health-related absenteeism, are the first hired, it is logical to assume that the workforce will be healthier than a group of people including those who had applied but were not hired for health reasons. In studies relating to, for instance, tooth decay, we would generally tend to find that the employed contingent had sounder teeth than the total population, some of whom might have lifestyles that didn't include the use of a toothbrush. It would be appropriate in this case to attribute the better dental health to the fact that the individual in question was a "healthy worker."

There is a case, however, where LNT proponents use this confounder to confuse: It is when the employees are drawn from the same pool and work in the same or very similar work areas. Since there is no screening test for cancer, there is no way to predict whether the prospective employee will contract it. How, then, can an employee be hired on the basis that he will not contract cancer later? We shouldn't discount the HWE, but we shouldn't let others use it to discount the hormesis phenomenon when it is not applicable. Please pardon the interruption, and now back to our story.

The close agreement shown between the thermal worker SMR and that of the general population in Figure 17 would indicate a high degree of reliability for the overall study with a slight degree of "healthy worker effect" (HWE) noted for the non-nuclear cohort. Since there is no HWE in the comparison of nuclear and thermal workers - both being drawn from the same pool - the only difference in the cohorts is the additional radiation exposure of the nuclear workers. This, it would appear, strongly indicates a beneficial effect of low-level radiation exposure - which, of course, is our definition of radiation hormesis.

Source for Figure 17 Cancer Mortality of Nuclear Plant Workers: Abbatt, J.D., Hamilton, T.R., and Weeks, J.L. Epidemiological studies in three corporations covering the Canadian nuclear fuel cycle, in Biological Effects of Low Level Radiation, International Atomic Energy Agency, Vienna, 351, 1983.

Do Nuclear Workers Glow in the Dark?

Mortality study of plutonium workers at Rocky Flats involving 7,112 workers from 1952 to 1979 gave cancer deaths at 64% of the expected number in the general population. - Nuclear News, December 1981

While the workers building bombs and those involved in electric power generation are in entirely different industries (except in the minds of anti-nuclear protesters), there are many similarities in their work environments. Of particular interest to us are the radiation levels (which are in the area where we would anticipate hormesis), the relatively accurate dosimetry (a fancy scientific word for measuring radiation exposure), and excellent follow-up on the health and longevity of the "participants." We'll look first at two Canadian studies of power plant workers and then at investigations of weapons plant workers by both American and British researchers.

Just in case I forget to mention it three or four times in the next few chapters, none of these investigations had any intention of even considering the possibility of hormesis. They were all expecting to prove a positive correlation between radiation and cancer. That's what a "smart" researcher does: makes sure the report comes out to reaffirm what the political authority footing the bill already believes. [Most experimentalists are dedicated scientists who let the data speak for themselves. But as in all other facets of life, there are some who play it "smart" to make sure they stay on the government payroll. It is these few that I refer to here.]

As you'll see, some researchers show data that offer evidence of the hormesis version of dose-response, but they conclude that there is a linear relation between radiation and exposure and any particular cancer you'd like to worry about.

All Cancer Mortality in A-Bomb Survivors

The "all cancer mortality" curve of Figure 16, taken from the work of H. Kato, et al. [Kato, H., et al. Dose-response analysis among bomb survivors exposed to low-level radiation. Health Physics, 52, 645, 1987], is noticeably similar to the preceding curve, which depicts leukemia deaths. While the "all cancer" graph (Figure 16) is more indicative of hormesis, both figures are in absolute conflict with the Linear No-Threshold (LNT) theory.

Source for Figure 16: All Cancer Mortality in Japanese Bomb Survivors: Kato, H., Schull, W.J., Awa, A., Akiyama, M., and Otake, M. Dose-response analyses among atomic bomb survivors exposed to low-level radiation. Health Physics, 53, 645, 1987.

So what has been happening in this continuing saga? By now most Japanese scientists and a sizable portion of the public are aware of the increase in longevity of the bomb survivors. But has this caused any change in the way radiation is viewed by the Japanese regulators? Have we seen any statement from the Radiation Effects Research Foundation (RERF) suggesting a change in the rules that "have been used by numerous international bodies as a basis for establishing radiation protection standards"? [From "Greetings from the Chairman and Vice-Chairman," RERF web site, www.rerf.or.jp/]

Perhaps I missed the announcements.

It is interesting, however, to observe some of the LNT politics in Japan, as we will see a marked similarity to what is happening in the United States and other countries. As I understand it, the Japanese government is even more bureaucracy-bound than ours. So when we ask the question: "Who has an interest in maintaining the present protection standards?" we get the same answer: the government and its minions who are busy, busy, busy at protecting everyone. They couldn't care less about changing the rules to make their "protection" quite unnecessary.

We shouldn't leave Japan without touching on the RERF. Established in 1972 as a continuation of the Atomic Bomb Casualty Commission, the organization has a history of being quite anti-nuclear in its outlook and pronouncements. (Maybe with pictures of total devastation of the two cities on every wall, that is somewhat understandable.) One burr under the saddle of researchers is the secrecy in which exposure data is held even after six decades. Then, too, there are charges that some data have been "adjusted" to give results more like what the 300 or so people with the foundation prefer to see. Funding for the RERF is shared by the Japanese and U.S. governments, the latter being divided between the Department of Energy and the National Academy of Sciences. (One scientist who should know declares that funding has been cut since it became evident that bomb survivors were outliving their unexposed peers, but I have not been able to confirm this.)

While the Japanese government may be reluctant to challenge the LNT, that is not the case for the privately owned utilities and for independent researchers at about a dozen Japanese universities. You will no doubt be amazed and astounded by the current studies from Japan brought to you in chapter 18.

***

Have you ever wondered about the dangers posed from being a radiation worker in a nuclear power or weapons plant? Maybe you should be so lucky! See the next chapter for details.

Leukemia Mortality Among Survivors

Leukemia is a family of cancer involving the white blood cells. With the exception of lymphocytic leukemia - which is often erroneously included - the disease can be induced by ionizing radiation, and hence is the model of a radiation-engendered disorder. One would therefore expect a sizable increase in leukemia as the exposure level increases from background level of 0.1 cGy as shown in Figure 15. The data - taken from M. Delpha's "Fear of nuclear power could be met with data from Hiroshima" [Delpha, M. Nuclear Europe, 42, 3 1989] - indicate that the leukemia mortality rate shows a minimum at 3.5 cGy, or about ten times the average annual U.S. background level. Only a single data point gives and indication of hormesis; however, a threshold is positively demonstrated, and a clear difference in the effect of low- and high-level radiation is evident - both in conflict with expectations of the LNT.

Source of Figure 15: Leukemia Mortality Among A-Bomb Survivors: Delpha, M. Fear of nuclear power could be met statistically with data from Hiroshima. Nuclear Europe, 42, 3, 1989.

Longevity of Nagasaki Survivors

In an earlier study, Mine had compared the observed deaths of the survivors with the expected number and found all age groups from forty-five year to eighty-plus-years had significantly longer life expectancies - just the opposite of what had been predicted by the LNT.

Figure 14 is plotted from "Observed and expected annual rates of deaths (1970-76) from all causes among atomic bomb survivors in Nagasaki." [Note for Figure 14: Longevity of Nagasaki Survivors: By definition, the ratio of observed to expected deaths in the general population is 1. In this example, only 38% of the expected number of survivors above eighty years old died, as compared with 100% of a similar group in the general population. Source: Mine, M., Nakamura, T., Mori, H., Kondo, H. and Okajima, S. The current mortality rates of A-bomb survivors in Nagasaki City, Japan Journal of Public Health, 28, p337, 1981. (In Japanese with an English abstract.)]

The vertical axis gives the ratio of the observed deaths of male survivors compared with the expected deaths from the general population (who are assumed to be unexposed). Except for the age range of fifty-five to fifty-nine - which had a mortality 12% above the general population - all age groups older than forty-five have less than expected mortality, with the effect increasing with increasing age. [Data from Mine et al. The current mortality rates of A-bomb survivors in Nagasaki City, Japan Journal of Public Health, 28, 337, 1981. N values for data starting at 45-49 are 113, 87, 184, 299, 508, 816, 825, 869.]

Returning to Kondo: "The ratio of observed to expected numbers of deaths shows that the mortality of exposed people was slightly lower than or equal to that of unexposed people at all four low to intermediate doses, 1-49, 50-99, 100-149 and 150-199 rad, and that a significant increase in deaths occurred only in the high dose range, 200-599."

This confirms what we already know - that radiation in huge doses is not something to trifle with. But it also suggests that low-level exposure poses no danger and may be helpful.

They Lived to Tell About It

The A-bomb survivors are living longer than the controls despite the 400 radiation-induced cancer deaths. - Professor John Cameron, University of Wisconsin School of Medicine

On the morning of August 6, 1945, Hiroshima, Japan, exploded into the first and largest high-level radiation test laboratory in the world. Three days later, because skies over the Kokura Arsenal on the north coast of Kyushu were overcast, Nagasaki became the second. Most victims died from the intense heat or the blast effect, but hundreds were to succumb later to effects of radiation - while thousands of survivors were instantaneously hit with trillions of neutrons and gamma rays.

In the early 1950s, studies of the effects of radiation were needed by the U.S. military and civilian defense authorities because of the threat of nuclear war with the Soviet Union. A joint U.S.-Japan program was initiated to analyze radiation effects on the populations.

Doses to survivors were estimated by their locations at the time of the blasts, with a "health handbook" being kept by each exposed person in which his medical history was meticulously recorded. Of great importance were the potential mutagenic effects (the original concern over "nuclear monsters"), since it was well known that radiation had a mutational effect on fruit flies and other lower organisms and, therefore, was expected to affect humans at high levels. No such consequences were ever found. In fact, not only were the offspring of survivors not negatively affected, but there were benefits that we might now attribute to a hormetic effect of the radiation.

But the primary concern was cancer. Earlier studies of 15,000 people in Great Britain, who had been exposed to upwards of 400 rems in treatment of spinal ailments, had shown a link between high levels of radiation and cancer in a significant percentage of the exposed. The Japanese study, among others, would further refine this relationship to be a 0.018% increase for every absorbed rem. (This is added to the approximately 20% risk of cancer for the average American.) For example a survivor who suffered radiation sickness from an initial pulse of 100 rems would have his or her chance of cancer increased from about 17% to 18.8%. (Remember, this is a dose equal to four times the average lifetime exposure for U.S. residents, occurring in a few seconds or minutes.)

Indeed, there were several hundred excess cancer deaths in Japan among those who received high doses of radiation. [RERF statistics estimate 339 excess cancer deaths (out of 4,687 total cancer deaths) through 1990. John Cameron estimates the projected total at 400.]

And because of the much greater number of persons receiving lesser amounts (typically equivalent to a lifetime of background radiation absorbed in a few seconds) it was feared, on the basis of the newly adopted Linear No-Threshold and collective dose theories, that these survivors were in for even more tragedy. Leukemia would be kicking in in about three to ten years after exposure, with the other cancers occurring within twenty or, at most, thirty years.

But a funny thing happened on the way to the graveyard: The bomb survivors were outliving their unexposed peers. As Dr. Sohei Kondo put it in his 1993 book entitled Health Effects of Low-Level Radiation, "The age-specific rates of death from all causes (observed deaths) [for exposed survivors] in people over sixty years of age were significantly lower than those for people without the health handbook (expected deaths) presumed to be unexposed." [Mentioned earlier in regard to his apoptosis research, Dr. Kondo is professor emeritus of biology, Osaka University and senior researcher, Atomic Energy Research Institute, also in Osaka.] [Kinki University Press, Osaka, 1993, and Medical Physics Publishing, Madison, Wisconsin, 1993. Any serious researcher must have this book. It is the definitive work on the Japanese atomic disaster.]

In short, the exposed had a significantly lower death rate than those who were fortunately out of town for the war-ending fireworks.

Figure 13 demonstrates the classic hormesis-curve shape for death rates of bomb survivors as a function of absorbed dose. [Notes for Figure 13: Death Rates of A-Bomb Survivors in Hiroshima and Nagasaki (1950-85) 1. "Relative Risk is the number of people who have died in a particular exposed cohort compared with (divided by) deaths in a similar group of the general population. 2. These data are for male survivors. 3. Only the acute dose resulting from the blast radiation is considered; external and internal doses by fission products, which would enhance the data, are not included. Source: Mine, M. Okumura, Y., Ichimara, M., Nakamura, T., and Kondo, S. Apparently beneficial effect of low to intermediate doses of A-bomb radiation on human life span. International Journal of Radiation Biology, 58:1035, 1990.]

Up to approximately 70 rems (or cSv), the death rate for exposed persons is lower than unexposed. [Mine et al. Apparently beneficial effect of low to intermediate doses of A-bomb radiation on human life span. International Journal of Radiation Biology, 58:1035, 1990.]

(Not shown on this graph, the relative risk for 325 rems is 1.28.) Note that these data were from forty years after Hiroshima and Nagasaki - concluding well past the established latency time for cancer onset from effects of radiation.

Very Strange - But I Don't Make the Data; I Just Report Them

The next figure is about mice that were not subjected to radiation but who had fathers that had been exposed prior to becoming a mouse-parent. (Yes, I realize this may be sounding a little like Psychic Hotline.) Figure 12 shows the life span of unexposed mice who were fathered by mice (naturally) that had received 30, 70, 100 or 150 cGy of X-rays at sixteen weeks of age. (Irradiating the mother mice had no effect on the life span of their progeny.)

Caption for Figure 12: Life Span of Mice Whose Sires Were Irradiated Spaulding, J.F., Brooks, M., and McWilliams, P. Some effects of X irradiation in successive generations on an inbred and hybred [sic] population of mice. Genetics, 50(Suppl.), 1179, 1964. Also in Effects of ionizing radiation in reproduction, Carlson, W.D. and Gassner, R.X., eds., Pergamon Press, London, 1963.

How do I explain such a phenomenon? I haven't the foggiest idea... and I don't think anyone else does either. But if there were a possibility I could add 20% - 40% to the life span of my child by exposing myself to 100 cGy of radiation, that wouldn't be much of a decision. It is questions like these that we should be setting the stage for future generations to answer. Instead we are planning how to waste some $1 trillion cleaning up "nuclear dumps" that are less radioactive than the natural soil in many parts of our world.

You're probably tiring of mousy data, and I said we'd get on to humans after a couple more reports on rodent experiments. We'll just breeze right through these and let you practice your mental conversion from cGys to rads or cSvs to mrems (they are all the same for the radiation in all these citations).

• "The effect of neutron exposure [3.2 cGy-6.3 cGy] upon the combined sexes showed low doses decreased the natural incidence of all tumors." (emphasis added) [Meweissen, D.J. and Rust, J.H. Reticuloendotheial neoplasms in C57 black mice after fast neutron irradiation at low doses. US Atomic Energy Commission Conference 740930, Oak Ridge, 1976.]
• Mice exposed to 150,000 mrem at five and twelve days following infection with "friend [sic] virus" recovered while all of the controls died within forty days. [Shen, R.N., Hornback, N.D., Lu, I., Chan, L.T., Drahms, Z., and Droxmeyer, H.E., Low dose total body irradiation; a potent antiviral agent in vivo. International Journal of Radiation Oncology and Biological Physics, 10, 185, 1989.]
• "[Studies on mice] in the dose range 0-3 Gy by two independent research groups at Oak Ridge and at Casaccio near Rome leads, for gamma radiation and X-rays, to a statistically significant decrease of the cancer rate at low doses and therefore to biphasic relationships for tumors of the reticular tissue, for several solid tumors, as well as for cancer as a whole." (emphasis in the original) [Weber, K. Biphasic dose-effect relationships in experimental studies of radiation cancer in animals. [English summary.] Strahlenbiologie und Strahlenshutz, Hannover. October 1996. IRPA, Progress in Radiation Protection.]
• "Male mice exposed to acute doses of 2 Gy for 82 successive generations showed no abnormal offspring; this acute dose is equivalent to 50 times background radiation for humans from the time of the Roman Empire to present." [Spaulding, J.F., Brooks, M., and McWilliams, P. Some effects of X irradiation in successive generations on an inbred and hybred [sic] population of mice. Genetics, 50(Suppl.), 1179, 1964. Also in Effects of ionizing radiation in reproduction, Carlson, W.D. and Gassner, R.X., eds., Pergamon Press, London, 1963.]
• "Urinary testosterone of chronically irradiated mice, 5,000 to 10,000 mrem of X-rays per day, was increased 264% above controls." (Look out, Viagra.) [Liu, S.Z. Effects of low dose ionizing radiation on defense and adaptive mechanisms. Conference on High Background Area Research, Taishan, Nov 1988; China Medical Journal, 102, 750, 1989.]
• Of the offspring of 124 male mice exposed to 276,000 mrem of X-rays and 124 control mice, 20 of 3,990 pumps from exposed males were stillborn, as compared to 45 of 3,418 control pups. [Luning, K. Studies of irradiated mouse populations. Hereditas, 46m 668, 1960.]
• In an experiment involving 3,505 autopsied mice with acute exposures of 18 cGy or more, the age-specific lymphocytic lymphoma rate was 16% of controls for 36 cGy exposures and 3% for those exposed to 18 cGy. [Meweissen, D.J., Rust, J.H., Harem, J., and Clement, M.J. Assessment of dose-response relationships in carcinogenesis following low radiation dosage. In Late effects of ionizing radiation. International Atomic Energy Agency, Vienna, 1978, 291.]
• Radio-resistance - the resistance to high levels of radiation exposure - in mice was enhanced by previous exposure to lower levels of X-rays. Survival of mice exposed to 700,000 mrem increased from 10% in the control group to 25%, 50%, and 82% for exposures to 120,000 mrem at one, two and three weeks of age, respectively. [Kochanski, W., et al. Immunologic analysis of the condition of increased resistance of organisms exposed to ionizing radiation. Medical Radiology, (Moscow) 1, 43, 1956. (Hmm, why would they have been interested in such a subject?)]
• Mice that had been exposed - from weaning through breeding - to 1 cGy/day had shorter generation times and higher birth rates that unexposed controls. (A later experiment on "deer mice" by the same researchers gave similar results.) [French, N.R. and Kaaz, H.W. The intrinsic rate of increase of irradiated Peromyscus in the laboratory. Ecology, 49, 1172, 1968.]
• "For newborn mice exposed to 180 rad at 0.07 R/day, the life span was significantly longer than it was for controls. At all dose levels the 2-month age group lived significantly longer than did the median controls." [Patterson, H. Wade, editor of the Health Physics Journal, elucidating experimental data by Spalding, J.F., Thomas, R.G., and Tiejen, G.L. in Life Span of C57 Mice as Influenced by Radiation Dose, Dose Rate and Age at Exposure, Report No. UC-48; LA-9528, Los Alamos National Laboratory, 1982.]
• "Male AKR mice were irradiated with 5 cGy three times a week or 15 cGy two times a week for 11 weeks from age 40 weeks. The incidence of thymic lymphoma was 80.6% in sham-irradiated mice [controls], 67.5% in mice irradiated with 5 cGy three times a week, and 48.6% in mice irradiated with 15 cGy twice a week." [Ishii, K. and Watanabe, M. Participation of gap-junctional cell communication on the adaptive response in human-cells induced by low-dose of X-rays. International Journal of Radiation Biology, Vol. 69, Issue 3, 1996.]

***

Gee, I could go on about mice for hours... unfortunately I wouldn't have any readers. So let's move on to the evidence that alerted so many people to the truth of Dr. Luckey's claim of radiation hormesis: the Japanese survivors and their stubborn refusal to die on the LNT schedule.

Radio-Resistance in Mice Previously Exposed to Hormetic Levels

We are aware that inoculations strengthen the immune system by mildly stressing it and causing antibodies to arise that fight any further intrusion of a similar type of invader. In effect, vaccinations are examples of hormesis: Small doses of poison are stimulatory. The poison in this case is a virus, not an inorganic toxin. Hans Seyle (chapter 4) doesn't care what it is. As long as it stresses the host organism, it starts an alarm reaction that stimulates a defense mechanism.

If radiation hormesis is a valid concept, we might expect small doses of radiation to ward off the bio-negative effects of higher doses - obviously not through the creation of antibodies but by some currently unknown mechanism. Figure 11 illustrates just such a phenomenon.

In this 1990 experiment by M. Yonezawa et al. [Yonezawa, M., Takeda, A., and Misonoh, J. Acquired radioresistance after low-dose x-irradiation in mice. Journal of Radiation Research, 31, 256, 1990], mice were irradiated with a low dose of X-rays (50 cGy or 50,000 mrad) two weeks before a second potentially lethal dose of 740 cGy (740,000 mrad). The survival rates of the irradiated group were compared with the unexposed controls. There isn't much question as to which mouse group I'd want to line up with on "innoculation day."

Table 8 (in chapter 8 - or see below) shows the dose-response for humans is similar to that which Yonezawa finds for mice - at 700 mrem, we're both dead or close to it. Would humans have a similar radio-resistance response? We don't know and aren't likely to until the knee-jerk reaction to anything nuclear is abated by scrapping the LNT. If I were a nuclear worker - involved in changing fuel elements where high-level (but so far, nonfatal) accidents have occurred, or an astronaut potentially subjected to a cosmic radiation barrage, or perhaps a soldier with the potential for high-level exposure from a neutron bomb, I think I'd want someone to look into the radio-resistance phenomenon who wasn't committed to the LNT hypothesis and likely to state at the outset, "All radiation is harmful - and it's our job to keep you from having any."

Table 8 – Acute Radiation Syndrome
Subclinical Range 0 – 100 rads		Therapeutic Range 100 – 500 rads			Lethal Range 500+ rads
		100 – 200	200 – 300	300 – 500	500 – 2000	2000+
Appropriate Action	None	Clinical surveillance	Therapy effective	Therapy promising	Therapy palliative (comfort patient only)
Incidence of Vomiting	None	100 rads: 5% 200 rads: 50%	75%	75%	100%	100%
Delay Time	n/a	3 hours	2 hours	1 hour	3 min.	3 min.
Main Organs Affected	None	Blood Forming Tissue			Gastro-intestinal Tract	Central Nervous System
Characteristic Signs	None	White Blood Cell Decrease	Fatigue, infection, erythema, sterilization, loss of hair above 300 rads, hemorrhage		Diarrhea, fever, electrolyte imbalance, bleeding	Convulsion, coma, loss of muscle control, lethargy, tremors
Critical Period	n/a	n/a	4 – 6 weeks		5 – 14 days	1 – 48 hours
Post-exposure Therapy	Assure of Safety	Blood analysis; assure of safety	Blood transfusion; anti-biotics	Possible bone marrow transplant	Maintain electrolyte balance	Sedatives
Outlook	Excellent	Excellent	Good	Guarded	Hopeless	Hopeless
Convalescent Period	None	Several weeks	1 – 2 months	Long	n/a	n/a
Death Rate	None	None	0% - 40%	40% - 100%	90% - 100%	100%
Death Within	n/a	n/a	2 – 4 weeks		2 weeks	2 days
Cause of Death	n/a	n/a	Hemorrhage, infection		Dehydration	Respiratory failure; heart attack