21.7.09

Professor ALICE STEWART MD FRCP : Obit.

Dr Alice Stewart

Thorn in the side of the nuclear industry

ALICE STEWART was one of Britain's foremost epidemiologists until her retirement, at the age of 90, five years ago. Early in her career she showed that X-raying foetuses, a common way of monitoring pregnancy in the 1950s, caused childhood leukaemia. She went on to show that the harmful effects of exposure to low-level radiation were far more serious that had been officially accepted, and championed the caused of nuclear-industry workers.

Alice Mary Naish, epidemiologist: born Sheffield 4 October 1906; First Assistant, Nuffield Department of Medicine, Oxford University 1942-47, First Assistant, Department of Social Medicine 1947-53, Reader in Social Medicine 1953-74; Senior Research Fellow, Department of Social Medicine, Birmingham University 1974-96, Honorary Professor 1996-2002; married 1933 Ludovick Stewart (one daughter, and one son deceased; marriage dissolved); died Oxford 23 June 2002.
Alice Stewart was one of Britain's foremost epidemiologists until her retirement, at the age of 90, five years ago. Early in her career she showed that X-raying foetuses, a common way of monitoring pregnancy in the 1950s, caused childhood leukaemia. She went on to show that the harmful effects of exposure to low-level radiation were far more serious that had been officially accepted, and championed the caused of nuclear-industry workers.

Her parents, Lucy and Albert Naish, were paediatricians who worked in the Sheffield slums and became local heroes for their dedication to children's welfare. She inherited her mother's intuition and gift for problem solving and her father's analytic intelligence and talent for diagnosis. Dashing and beautiful, she inherited too their intelligence, intuition, commitment to the betterment of society and willingness to sacrifice financial gain for the prevention of disease.

She entered the Cambridge medical school as one of four women among 300 men, who stamped their feet when the women entered the lecture theatre and slammed their desk lids when they sat down. However, she made many friends among the arts students, including the poet William Empson. Her relationship with him lasted 60 years until his death in 1984, although she married someone else.

Barred from hospital work as she was a woman, she went to the Royal Free for her clinical training. After the Second World War she moved to the Nuffield Department of Clinical Medicine at Oxford, investigating the effects of exposure to TNT in munitions-factory workers, the effects of carbon tetrachloride, and the curious prevalence of TB in the footwear industry. Having shown her mettle, she was brought into the Oxford child health surveys.

The incidence of child leukaemias was increasing and no one knew why. She suspected that the mothers might remember something the doctors did not, so she interviewed them and rapidly saw the correlation with X-rays, which she demonstrated statistically. X-rays were medicine's new toy and were being used for everything from examining the position of the foetus to treating acne; even shoe shops had X-ray machines where customers could see how their footwear fitted. This was at the height of the arms race, when the British and US governments were trying to build up public trust in the friendly atom and did not want people to get the idea that low-dose radiation could kill their children.

The leukaemia-pregnancy link was briefly resisted by the medical establishment but soon led to a ban on X-rays on pregnant women. It was, however, fiercely opposed by many physicists and radiobiologists, the UK National Radiation Protection Board, the International Commission for Radiation Protection, and by the powerful nuclear lobbies, within and outside government, that ICRP seemed to serve. Stewart's findings implied that low-level radiation, which had become an everyday part of life for nuclear workers, the armed forces and sometimes even the public, could be far more harmful than had been thought or admitted.

She survived opposition to become Director of the Nuffield Institute of Social Medicine. It was most unusual for women to be in senior positions at Oxford at the time and she stood out both intellectually and for her beauty and vivacity in the dowdy academic world of the time.

In 1974, when she was 68 and about to retire from Oxford and relocate to Birmingham University, she and her statistician colleague George Kneale were contacted by Dr Thomas Mancuso, who had been appointed by the US Atomic Energy Commission to study the health of nuclear workers at a plutonium-manufacturing complex in Hanford, Washington. Since the industry was required by law to work within the exposure levels laid down by the ICRP, the study was also seen as a test of these standards. The Stewart-Kneale-Mancuso analysis revealed over 10 times the cancer incidence predicted from A-bomb survivor studies.

An immediate and damning official outcry ensued. Mancuso was deprived of his directorship by the US government and the use of outside consultants was promptly banned. Stewart and her colleagues, undaunted, published a major report in 1977 and added to it over the following years.

When she returned to England with the Hanford data, there was an inquiry about whether the nuclear installation at Sellafield should be expanded. Stewart assumed that the nuclear industry would be eager to know what she and Mancuso had turned up about the Hanford workers, but she was wrong. "They were sending out refutations of us behind our backs, but never once did they consult us directly." She was, however, contacted by anti-nuclear groups from around the world. She infuriated the Establishment by pointing out that, until the nature of radiation damage to genes was understood at the molecular level, predictions of second-generation and long-term genetic effects were premature.

She spent 20 years as Senior Research Fellow at Birmingham university, working from a caravan, professionally isolated and attacked, paid a pittance and starved of research funding. In the mid-Eighties – when she was 80 – she was awarded a $2m grant from the Three Mile Island Public Health Fund.

Her energy and determination never flagged. She was in demand at conferences, hearings, inquiries throughout England, Europe and the United States. She testified for nuclear workers seeking compensation, for British and American veterans of atomic testing, for women arrested protesting the siting of cruise missiles at Greenham Common.

She was only the ninth – and youngest – woman to become, in 1946, a Fellow of the Royal College of Physicians. (She, her brother John and her father were Fellows all at the same time.) In the 1990s Professor Nicholas Kurti proposed her for Fellowship of the Royal Society but was unable to overcome the opposition.

Alice Stewart loved her home, family, garden and countryside, and always had time for her children and grandchildren. She was the subject of a biography by Gayle Greene, The Woman Who Knew Too Much: Alice Stewart and the secrets of radiation (1999).

Caroline Richmond

Professor ALICE STEWART

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Low-Level Radiation
The Effects on Human and Non-Human Life


Lecture by Dr. Alice Stewart MD FRCP
Dr. Alice Stewart, Great Britain. Medical doctor,
Professor for Social Medicine, expert on low-level
radiation, Alternative Nobel Prize.



You will find that the advocates of nuclear power are very fond of reminding us of two things: The first is that from the very moment of conception to the moment when we die we are going to be exposed to natural background radiation. And the second thing they like to remind us of is that actually even a small part of our tissue is radioactive, this, of course, referring to the fact that a fraction of an important chemical called potash has still a little residual radioactivity in it. So their argument goes as follows: If we have this much exposure to natural radiation and, by implication nothing is happening -- nothing bad is happening --, as a result of this, why are we making any fuss about other small doses of radiation?
Well, of course they've had to admit that radiation is a cause of mutations -- by mutation we mean a disturbance of the behavior of a cell brought about by damage to the DNA --, and they've had to admit that there is no such thing as a dose of radiation which is too small to cause this damage and that the damage, once incurred on a cell, as long as the cell lives and continues to divide, will be passed on to daughter cells, so they've had to admit that there is some element of danger here. But now, we all change our tune and refer -- I'm still talking on behalf of the advocates of nuclear power -- to the experience of a well-defined population that was in fact exposed to radiation and even exposed to major doses of radiation or at least estimates of it, namely the Japanese atomic bomb survivors. And they will refer to a long, drawn-out study where they failed to find any effect of low doses. They admitted, of course, that high doses could actually kill you immediately, or they could cause acute radiation damage. But at the end of a very long follow-up, they finally decided that the people who had been exposed to -- I'll give you a rough figure -- about ten times background radiation -- which was considered of course very low -- had not only not suffered at all, but actually were slightly better off. This started another train of thought that perhaps, as a result of human beings having been exposed to radiation, ever since the race was there and back into geological time history, perhaps we have developed some sort of immunity to radiation and actually it could be arguable that perhaps a little radiation could do you good. So there's even a thesis in the literature on this subject.

Now, that is one side of the story, and it's far, far and away the most important. But, of course, there is the other side of the story, and that is the story in which a person like myself who has to try and find out where the truth lies of people who have exaggerated the effects of low-level radiation. They've tried to ascribe to small events or happenings in their lives some exaggerated notion of what has gone wrong as a result of being exposed to radiation. I wouldn't quote this, but I'm sure you're well aware that a natural anxiety would lead to this and might lead to some, scientifically speaking, slightly unfortunately exaggerated remarks. So I'm really trying to spend the few minutes I have with you today to try and explain to you some of the difficulties that face somebody trying to find out exactly where we do lie with regard to low-level radiation.

I want, first of all, to tell you that my heart is with you. I would be against nuclear energy for all the instinctive reasons that one has, that we human beings are playing with a very, very, very dangerous toy. The benefit of any doubt should be given to the people who -- should be against, strongly against anybody who says there is no danger. In other words, there should be an instinctive feeling amongst us that this might be a mistake, that there was a danger that they had failed to detect on the grounds of one thing alone: Can you, or is it at all easy to, detect a small effect?

Now, that is going to be the thesis of my lecture: I'm going to explain to you why it is so difficult to establish this and why it's been so easy for the other side to say that there has been no effect. And there are three things that I would like you, especially anybody among you who is a real activist on this subject and has to go out from this room and tell other people about, that there are three reasons why it is so hard to actually establish that there is a danger from very low-level radiation in spite of natural background radiation being inescapable.

The first and most obvious reason is, of course, that any small-dose effect is bound to be weak. You're looking for something very small -- small and rare. It's not going to be obvious. And any idea that you're going to get an epidemic springing up as a result of leakage, say, small leakage from a radioactive nuclear power station or anything of that order, please dismiss from your minds at all. You are looking for evidence of a small, very rare event. That's the first difficulty.

The second difficulty is that this event is going to be long delayed. What does it matter whether a cell that I've told you about has a damaged form of behavior? Does it matter? Can't it live with all the other cells in your body and not necessarily do any harm? You've got millions, billions of these cells. Does it matter? Well, of course, the reason why it matters is two-fold. There are two situations: If it's what we call a somatic cell, a body building cell, then as a result of this damage the cell doesn't obey the full central instructions of the body as a whole, and should circumstances change or should there be a gradual deterioration in general health, which inevitably comes about with age, the effects of age and changing circumstances may be such that the cell becomes liberated from the usual restraining influences and causes what we all know to be under the general heading of cancer. By cancer, of course, I include leukemia, but leukemia is just one form of cancer -- it's a blood cancer, and the others are cancers of other tissues. You can get a cancer in any tissue. You don't need to be a human being to get a cancer, you can be an animal and you can be a plant. Any living organism in this world is at risk of a mutation at some longish delayed period of time getting free from the restrictions that make you function as a whole being and end up with a cancer. Now, I've said "a long time". Is it measurable? Well, it turns out it's not only long but it's very, very variable. You could be very unlucky and be hitting these particular circumstances and go off fairly soon. So, this is for purposes or people who are looking for this trouble we're now up against two difficulties: A rare event that is going to occur almost any time thereafter in the form of cancer. And I mean that. It can -- in very rare circumstances of an embryo being attacked -- it can occur within a year. But usually, in adults it might be delayed 80 years.

And I must come back to the second stream of thought that if it's germ cell-damage, it's going to skip a generation before you see anything, and it's not only going to skip one generation, it's going to skip one, two and three generations, because it's got to meet up with a pair before it shows that the damage has been done. So, the time scale of the thing you're looking for is astronomically large imposing all sorts of difficulty for the investigator.

And what will be the effect of the germ cell-damage? And this I want you to bear in mind: If there's any proof that a cancer is there, there's going to be an implication, a certain implication, a certainty, that there will be a genetic damage that may not express itself for several generations, but when it does it will lead to the deterioration of the unique human development, namely the brain. You're going to feed into the genetic pool of human genes damage which will deteriorate the one thing for which we are famous, namely that we have the capacity to think for ourselves.

Those are two reasons. I promised you a third one, and the third one is perhaps the most difficult of all to conceive. It is that this event that you are looking for, which is rare and long delayed, is also going to be a very common, natural event. This follows from the concept of there being any effect to background radiation. You'll notice, that if there's going to be a low-level radiation effect, there's bound to be a background radiation effect. Therefore, the thing you're looking for is a natural phenomenon, isn't it? It must be there, must be happening all the time. You know we're all whirling around in space, but we all have the impression that we are sitting quietly, absolutely still in this hall. This is exactly the same impression that we're getting from any ill effect of background radiation, that it isn't there. But it is there. But we're all suffering from it equally or sufficiently equally for all practical purposes not to show.

Now you've got three things that are going to make it extremely difficult to prove that low-level radiation has any bad effect. It's going to be rare, it's going to be long-delayed and follow two tracks, either the track of cancer or the track of the defective inherited gene, and it's going to be an everyday event. How on earth do you ever establish any proof that this is so at all, never mind, say, that you'll require this before you're going even to contemplate the idea that nuclear could be dangerous?

Well, the reason I am here on this platform is really a fluke. But it is also in the context of saying that it has something to do with women and I think a rather nice fluke. First of all, of course, I'm a woman, but that wasn't the point. What led to the discovery, the first and to this day the only most certain effect of a very low dose of radiation in the human population was the result of my saying: "Why don't we go and ask the mothers?"

The situation was as follows: Way back in the 1950's, there was a worldwide increase in leukemia. I can tell you today that this was an unnecessary alarm. It was an alarm due to the fact that because anti-biotics had come into our lives, we were seeing for the first time very many cases of leukemia, and normally don't. These children -- or adults, for that matter -- would have died of infections before you realized that they were truly suffering from a latent form of a blood cancer. But (..?) the anti-biotics in these cases emerge? Now, we didn't know this, but what we did notice -- we as medical people -- we noticed that children between two and four were suffering more than any other age group. And we were sufficiently expertised to know that this was very unusual. If children get troubles -- they either get them as babies; new born babies are very vulnerable, or they get trouble after they go to school, which is usually at the age of five and they are meeting other children -- why children between two and four?

And this was where I said: "Why don't we go and ask the mothers?" And we picked out -- we needed all the cases in Britain -- we got the death certificates of every child who had died of leukemia in the last three years; we had as control groups every child who died of any other form of cancer, and a live child for each dead child. And I must now tell you . . . we set out to do a survey -- it's known as the "Oxford Survey of Childhood Cancers" because that was where I was actually working at the time --, and it set out to interview the mothers of children who had recently died, either from leukemia or from another malignant disease, and for each dead child we had a live child. And it was from what the mothers told us of these children that it became recognized that the children who had died of cancer -- let's say an early death from cancer, before the age of ten as it happened -- had been twice as often x-rayed before they were born as the live children. X-ray, just an x-ray photograph. We've seen the cameras clicking 'round this hall all this morning. It's difficult to imagine a dose of radiation that is as small, as temporary as an x-ray photograph. Click -- it's over.

By the end of the time we did the survey -- we met of course with terrible opposition when we produced this fact, but we've been given now 30 years to establish what everybody now agrees to, and that is, that if single, non-repeated exposure to a small dose of ionizing radiation before you are born is sufficient to increase the risk of an early cancer death, and that the sooner this event happens after conception, the nearer you are to conception, the more dangerous it is. Probably every childhood cancer, except the man-made ones from x-rays, could be due to background radiation. Are you going to play with that ball of fire and say it's safe? Are you going to introduce into the human race the possibility of causing not only -- shall we put it into technical terms -- adding to population loads of cancer? Are you going to be happier by adding to population loads of defective genes for future generations?

Naturally, I'm on your side.



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BOOK: The WOMAN WHO KNEW TOO MUCH.

6 x 9. 360 pgs. 32 photographs. (1999)

Paper
978-0-472-08783-9
$18.95S Available


The Woman Who Knew Too Much
Alice Stewart and the Secrets of Radiation

Gayle Greene
Foreword by Helen Caldicott


The life story of the epidemiologist who discovered the harmful effects of fetal X rays and other radiation exposure.

This biography illuminates the life and achievements of the remarkable woman scientist who revolutionized the concept of radiation risk.

In the 1950s Alice Stewart began research that led to her discovery that fetal X rays double a child's risk of developing cancer. Two decades later—when she was in her seventies—she again astounded the scientific world with a study showing that the U.S. nuclear weapons industry is about twenty times more dangerous than safety regulations permit. This finding put her at the center of the international controversy over radiation risk. In 1990, the New York Times called Stewart "perhaps the Energy Department's most influential and feared scientific critic."

The Woman Who Knew Too Much traces Stewart's life and career from her early childhood in Sheffield to her medical education at Cambridge to her research positions at Oxford University and the University of Birmingham.

Gayle Greene is Professor of Women's Studies and Literature, Scripps College.