Hiroshima Peace Memorial, Hiroshima, Japan.
The Atomic Bomb Casualty Commission (ABCC) was established by President Harry Truman in 1945, shortly after the surrender of Japan at the end of World War II, with the goal of developing knowledge regarding the long-term effects of atomic radiation. However, the chaos in Japan immediately following the end of the war hindered the initial attempts to develop a scientifically useful study. Thereafter, Dr. Thomas Francis, a physician, virologist and epidemiologist at the University of Michigan, was asked to design an epidemiologic investigation. His committee’s recommendations in 1955 stressed continuity and well-defined study groups, which George Darling, ABCC director from 1957 to 1972, applied quite seriously. The Francis Report proposed that the Japanese census ask where all citizens were on August 6th and 9th, 1945. With this information, ~100,000 individuals who had been in Hiroshima or Nagasaki on those dates respectively were asked to volunteer to participate in a long-term study, the Life Span Study (LSS).
Individuals were grouped according to the distance they had been from the hypocenter of the two atomic explosions. Although there is a lack of knowledge regarding the amount of radiation released by either of the two weapons, distance has been used as a surrogate measurement for radiation exposure. A subset of ~20,000 persons, including individuals close to and farther away from the blasts, was asked to participate in the Adult Health Study (AHS) which conducted biannual medical and laboratory examinations at the ABCC’s Hiroshima and Nagasaki facilities. The remaining 80,000 persons were to be followed until death, at which time the cause of death was to be established by autopsy and/or death certificate. A third study was initiated on children in utero at the time of the bombing, as was a fourth investigation on the health of the F1 generation consisting of children not in utero in August 1945 but subsequently born to parents who had been irradiated during the explosion. Similar to the AHS, subsets of participants in each of the studies on children were followed with regular clinical examinations.
My experience at the ABCC, 1962-1964
The department of medicine at Yale, where I was a resident in internal medicine, had agreed to supply both senior and junior staff to the ABCC. The University of California, Los Angeles (UCLA) was responsible for supplying senior and junior pathology staff. As I was eligible for the physicians draft and with no wish to perform physical examinations of inductees to the armed services, I volunteered with my wife’s encouragement to do my national service as a member of the US Public Health Service (USPHS) at the ABCC. The two years in Hiroshima from 1962 to 1964 were delightful. Japan is a beautiful country that my wife and I had time to explore. In 1962 medical residents were paid roughly $2000/year. As a lieutenant commander in the USPHS my salary was approximately $6000/year, in an economy that at the time was about half as costly as the US economy. Thus, we could afford to travel, which we did during vacations to Hong Kong, Thailand and India.
By 1962 Hiroshima and Nagasaki were rebuilt, thriving cities. Hiroshima had a population of about half a million, more than double the estimated population immediately following WWII . The ABCC facility was built in Hijiyama Park overlooking the harbor and the Inland Sea. My duties consisted of supervising the Japanese physicians who conducted biannual examinations of the AHS participants. The participation of the Japanese population was amazing. Close to 90% of the selected individuals spent a half-day every two years undergoing tests at the ABCC facilities, and a large percentage of the families of 80,000 persons in the LSS agreed to postmortem examinations. Although these exams were the primary focus of the facility at Hijiyama Park, ABCC also maintained a 6-bed inpatient unit where we cared for patients with hematologic malignant disease, which, 17 years later, was the primary manifestation of radiation exposure .
Study findings and impact
The heavily exposed individuals closest to the hypocenter of the explosions showed higher incidences of cataracts and thyroid cancer as well as of hematologic malignancy . Children in utero at the time of bombing had microcephaly but relatively few other congenital abnormalities. The F1 generation, those children subsequently born to irradiated parents, have not shown an increased propensity for any disease to date [4-5]. The entire investigation was jointly funded by the US and Japanese governments and continues today as the non-profit Radiation Effects Research Foundation (RERF) .
In addition to continuing the ABCC studies discussed above, RERF maintains multidisciplinary studies on radiation biology and epidemiology. However, the foundation’s impact goes further than studying radiation and the survivors of radiation exposure. RERF collaborated with Russian scientists following the nuclear power plant disaster in 1986 at Chernobyl; in response to the 2011 nuclear disaster in the Fukushima prefecture, too, RERF provided radiation advice to civilians and dispatched experts to measure radiation in the disaster area. The foundation also contributed knowledge and experts to the establishment of the Fukushima Health Management Study, currently operating from Fukushima Medical University in Japan. RERF, which began as the ABCC, is an excellent example of international scientific cooperation and of the value of a simple, well-designed epidemiologic investigation.
1. The Atomic Bombings of Hiroshima and Nagasaki Report, June 29, 1946; Available from: http:// www.atomicarchive.com/Docs/MED/index.shtml Accessed Jan 25, 2014.
2. Hsu, W.L., et al., The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950- 2001. Radiat Res, 2013. 179(3): p. 361-82.
3. Ozasa, K., et al., Studies of the mortality of atomic bomb survivors, Report 14, 1950-2003: an overview of cancer and noncancer diseases. Radiat Res, 2012. 177(3): p. 229-43.
4. Douple, E.B., et al., Long-term radiation-related health effects in a unique human population: lessons learned from the atomic bomb survivors of Hiroshima and Nagasaki. Disaster Med Public Health Prep, 2011. 5 Suppl 1: p. S122-33.
5. Cullings, H.M., Impact on the Japanese atomic bomb sur- vors of radiation received from the bombs. Health Phys, 2014. 106(2): p. 281-93.
Further information on ABCC and RERF
RERF Publication List
National Academy of Science, ABCC Archive List
John Phair, MD joined the faculty of Northwestern Medical School in 1976 as director of the Division of Infectious Diseases. He led the Multicenter AIDS Cohort Study (MACs), an NIH-funded observational epidemiologic investigation of HIV infection and disease in men who have sex with men, from 1984 until 2012. From 1992 to 1994, Dr. Phair served as Chair of the Executive Committee of the AIDS Clinical Trials Group (ACTG), a network of academic centers evaluating antiretroviral therapy. In 2000 he stepped down as director of the Division of Infectious Diseases and assumed Emeritus status, but he continues to participate as an investigator in the MACs.