For two days we have considered various aspects of measurements, and several speakers felt it necessary to point out that dosimetry was not an art form in itself but has an important relationship to what happens in the human dimension. For the last two sessions we have been talking about the human dimension, and I think some of the tenseness of some of the recent discussion symbolizes that transition from what you might call pure objective science to something which has a very con-siderable subjective element in it. The public has from time to time an almost mystical belief in doctors. This varies in time and place but it puts an enormous burden on my profession. Some people are convinced that presenting a possibly damaged body to a physician is in itself a constructive act. This has moved on to a situation where some of us feel that the whole business of screen-ing needs to be looked at much more intellectually and much more strictly scientifically, a point which was elo-quently put by Dr. Gus'kova in her statement.
One extremely interesting suggestion, which Dr. Mettler has summed up three times so I do not need to do so again, was that the details of the very strict methodology employed ought to be carefully recorded.
It was worth spending time yesterday to talk about such details as making sure that the glassware all came from one particular batch, that the reagent came from one par-ticular batch, and so on, in very great detail. There is a very real danger of what you might call in other terms 'snatch samples1 for epidemiology. It has to be very, very rigorous.
I think Dr. Mettler was right when he said yesterday that this has been an unprecedented review. I am not aware of anything on this scale that has ever been done before. He was also at great pains to point out that you had to have a marriage, if that is the right word, between biological propositions and statistics. It is no good just going fishing in a pond and seeing what fish come out;
you must have a very systematic review. I do not intend to go through all the parts of the presentations — that would take too long — but I'll just highlight one or two points.
Dr. Royal pointed out, and it was mentioned again in the discussion afterwards, that there is a danger that if you look carefully enough you always find something, and if you look more carefully you find even more. That is a lesson which has to be related to the strictness of the design and execution of these studies. Dr. Kuramoto pointed out that one of the by-products of this type of study was that sometimes — often — it was possible to pick up individual problems and help individual cases.
But, you know, although it is a rather unpopular topic, we ought to make it quite clear that there is a cost
involved in all this. It is not good enough to say: "Yes, I did this huge study, and I found one man who had one leg shorter than the other." You have to be able to show that there is a real benefit from any studies undertaken.
We also heard about the Cuban findings, but, without more details about the population studied, and without studying the published findings, I cannot usefully com-ment. Then, in yesterday's discussion, Dr. Gonzalez emphasized the importance of ensuring that any study undertaken is of sufficient statistical power, i.e. high enough doses and enough people. The importance of this was pointed out again when the Conclusions and Recom-mendations were discussed. I wonder if I would be step-ping outside my present limited role if I make a plea for this to be foremost in people's minds when they are talk-ing about epidemiology. One problem we have encoun-tered in many countries is that small studies with no real prospect of success have been pursued. These, of course, produce ambiguous results but have been quoted all over the world, depending on how anyone wishes to interpret them.
At the opening of the Conference we heard about the World Health Organization's developments at Obninsk and it seems to me that these have a vitally important co-ordinating role. This calls for a lot of scientific humility.
It is quite natural for a scientist to want to guard his or her own data and to want the fame of publishing in his or her name, but it is wrong if this leads to a lot of small, fragmented studies when a bit of planning, which I think is being offered, could lead to a really effective, large scale study. We do need it. I am quite sure that much of the doubt and ambiguity running through all the discus-sions of the last two days are related to this kind of scien-tific uncertainty.
Today we heard from Dr. Mettler about the difficul-ties of reporting and definition when talking in terms of abortions, malformations and all the various confound-ing factors. Dr. Parr then told us about the nutritional aspects, and about some of the non-radiation factors, the possibility of lead as a confounding factor, and so on.
Then we came to Professor Lee's paper. One thing is certain, that this accident has had profound psycho-logical consequences; that is beyond debate. But I think it would be wrong to treat that fact on its own, because the whole problem of radiological protection has pro-found psychological overtones. This is merely an extreme example of the phenomenon.
It is customary for doctors and scientists, when they are faced with the unpleasant publicity which this field often attracts, to turn round and savage the nearest media person, whoever it may be. It is not entirely fair to blame journalists, broadcasters and people of that sort 48
Health Impact: Discussion
because they have been given a pseudo-authority by pseudo-scientists in very many cases; this was made quite clear in some of yesterday's discussion.
There is a great burden of responsibility on scientists to speak only in scientific terms. Not reputation, not fame, not money, but only honesty matters. As to the future, Dr. Gus'kova, in her statement, talked about the need for further education, and we have all been agree-ing with her. Perhaps because of her medical back-ground, which I share, I was much impressed by her emphasis of the fact that you can have great campaigns, you can have educational programmes, you can publish as much as you like, but in the last analysis it is one person talking to another and getting the trust of that other person. This places a heavy burden on the medical profession who, rightly or wrongly, is trusted to do that well. Therefore the first responsibility (who guards the guards?) is to make sure that the medical profession is trained well enough to take on that heavy task success-fully. I have been struck by the humanity and scientific humility of the people making presentations here today and yesterday. There has been no attempt to overstate what this Project has achieved.
We have seen that ridiculous word 'radiophobia' con-signed to the wastepaper basket, or whatever is used in a modern office, and we shall go on later to talk about costs and benefits, whichever is relevant. It seems to me, and I make no apology for repeating what several people have said, that there are three conclusions I would like to leave you with:
(1) The best must be done for those affected, whether in the mind or in the body. (It is far more difficult to evaluate what is the best than always to listen to the loudest voice. There are many things to consider in deciding what is best for the individual or the group.)
(2) There are lessons to be learned in order to ensure, not that no accident will ever happen again, but that we learn from our mistakes as we have done through the long years of history.
(3) The huge task of education and information goes ahead, nationally and internationally, dispassion-ately, without faction, without rancour and with as many facts as the scientists and the doctors can pro-vide for its implementation.