Wednesday, 30 March 2011

Moratorium on Nuclear Power

Finally, Physicians for Global Survival takes a stand. We aren't calling for a cease and desist order for nuclear power, but we are calling for a moratorium on new nuclear power plants. And here is the statement:

With its United States affiliate, Physicians for Global Survival today called for a moratorium on new nuclear reactors in Canada and a suspension of operations at the nuclear reactors on fault lines. PGS cited the medical risks associated with radiation exposure and stressed that, unlike x-rays which expose a person for a limited time, radioactive emissions from nuclear power plants expose entire populations and are the “gifts that keep on giving”.

"There is no safe level of radiation exposure," said Michael Dworkind, MD, immediate past president of Physicians for Global Survival. “Only recently scientists discovered that background natural radon was responsible for an estimated 20% of lung cancers in Canadians; the same scientists estimate that 20% of childhood leukaemia occur as a result of exposure to natural radiation.” “We cannot continue to expose human populations to increased radiation from nuclear power plants,” he said.

Human fallibility being what it is, the only way to avoid nuclear accidents is to not build nuclear reactors," said Dr. Birkett, a long time member of the board of Physicians for Global Survival.

According to the US National Academy of Sciences, any exposure to radiation increases a person's risk of developing cancer. In the case of the Japanese Fukushima reactors, the primary radionuclides of concern are:

Tritium, which is indistinguishable from hydrogen as far as biological systems are concerned and can be incorporated into every cell of a body.

Iodine-131, which causes thyroid cancer when absorbed through inhalation and ingestion.

Cesium-137, which behaves like potassium and when ingested spreads throughout the body. At Chernobyl, Cesium-137 was taken up by lichen and plants, and animals which consumed those plants became radioactive.

Strontium-90, which is deposited in bone and teeth where it remains for decades; it causes bone cancer, and leukaemia.

Plutonium-239, which causes lung cancer and remains a severe threat for thousands of years.

Cesium-137 and Iodine-131 are fairly easy to measure and were used to mark the extent of the Chernobyl radiation contamination, but, in fact, there are more than 47 radioactive elements being released during the Fukushima disaster. Physicians are concerned that external radiation exposure does not adequately account for the effects of internal emitters.

Medical treatment for radiation exposure is limited, at best. Iodine pills provide only limited protection against the absorption of Iodine-131, mostly in children. It does not offer protection against gamma irradiation from Iodine-131.

The public health risk from a large radioactive release from Canadian reactors near densely populated areas around Toronto is substantial.

Physicians for Global Survival is also deeply concerned about the financial effects of an accident at a Canadian nuclear power plant because the federal government would be liable for the environmental and human costs.

Physicians for Global Survival applauds the increased safety measures that have been taken by the Canadian Nuclear Safety Commission but maintains that nuclear power cannot be made completely safe. “Clean renewable energy is the only sustainable option” said Dr. Richard Denton, President.

Physicians for Global Survival calls upon the Government of Canada and the Canadian Safety Nuclear Commission to:

  • Implement a moratorium on new nuclear reactor licensing and design certification without delay.

  • Suspend operations at nuclear reactors on fault lines while a safety review is conducted.

  • Establish a rolling stewardship for spent fuel pools and onsite fuel and waste storage for all reactors which will engage the expertise of current operators for their lifetimes and that of their successors for generations.

  • Eliminate subsidies for new reactors, especially loan guarantees, and prioritize safe, clean renewable energy sources that can meet today's energy needs.

Monday, 21 March 2011

No Immediate Danger

No Immediate Danger!

Physicians usually weigh risks and benefits when they expose patients to radioactivity through x-rays, CT scans and radioisotopes but recently even they were shocked to find out that the low levels used to examine the arteries of the heart increased the risk of cancer.

Industry and government repeat the mantra that there is “no immediate risk to human health”. Physicians for Global Survival agrees that there is no immediate danger to individual health or life from radioactivity unless the amount is enormous or prolonged.

Humans are constantly exposed to natural radioactivity from the sun, radon in the air, and naturally occurring radioactive ions such as carbon-14. People mostly don't get cancer, auto-immune diseases such as lupus and rosacea or have miscarriages or children with birth defects. There is no doubt in the minds of medical experts, however, that increasing the global burden of radioactivity will increase the incidence of cancer.

What is happening in Japan is happening to our biosphere because wind and water travel the globe. There is a complex soup of elements released by the damaged nuclear power reactors but three are of particular concern.

Tritium, a gas, enters the environment around most nuclear power plants by planned releases or in accidents. Tritium is bound with oxygen in water which makes it extremely dangerous. Living organisms cannot distinguish between radioactive water and normal water and will absorb the radioactive water to use as biological building blocks, enzymes and genetic material. Tritium has a half-life of twelve years which means that 2 tonnes released to the atmosphere becomes 1 tonne after 12 years.

Iodine-131 has a half-life of eight days releasing beta and gamma radiation in its decay. One of the risks of treatment of cancer of thyroid with this isotope is an increase of other cancers. It is especially toxic to children and fetuses because it targets the normal thyroid in growing animals. The damage to the thyroid can be mitigated by taking potassium iodide but there is no protection for the full body gamma radiation effects.

Cesium-137 is unarguably the biggest threat. Cells treat it like potassium, allowing it to literally bathe every cell in the body and concentrate it in soft tissues, muscles and bones. Double threat cesium-137 decays by beta emission to barium-137m which emits gamma radiation before becoming stable barium 137. It can affect enzymes and DNA, disrupt normal cellular function, affect germ cells and increase the risk of cancer. The United States Environmental Protection Agency says that once dispersed in the environment, cesium-137 “is impossible to avoid”. It has a half-life of 30 years.

Physicians for Global Survival and its parent body, International Physicians for Prevention of Nuclear War, have taken the position that nuclear power cannot be made safe enough to risk the health of this planet. Dispersal of background radiation will inevitably affect human health, and the health of succeeding generations. “No immediate danger” is a short-sighted perspective.

Saturday, 12 March 2011

On Call

A day out of the rest of my life.

There are a lot of reasons that a 24 hour call becomes less attractive as I age. One day is really two days out of the rest of my life. Not all that important when I was 36 but now that I am 67 and outliving some of my friends, each day becomes more precious.

I arrived to start work on Thursday and saw 17 patients, signed off about 30 lab reports, spoke with a specialist at her request and to one about my patient, dealt with an abusive patient in the ER and was begging milk from my next door colleague for my tea at 18:35. The nurse in the ER called for advice or confirmation of his treatment four separate times, each for several patients. At 22:15, I had to go to the hospital for a maternity who thought she was in labour; she was not but other patients came in. Two more maternity patients, a man with chest pain and a hopeless resuscitation in process by the EMTs commanded my attention. I was in bed at 1:30 am.

One phone call interrupted my sleep. At 5:15 the nurse asked me to come in to see an elderly man.

My head felt as though I'd just arrived from an overseas 16 hour flight. It was a challenge to get motion into stiff joints. The patient was a cancer patient whose daughters were very anxious about treatment. Sympathy was difficult

I signed off the pile of unseen charts and was home by 7:50. I called the incoming physician for handover.

After a shower and something to eat, it was time to make up for the lost sleep – my sluggish brain made it apparent that I would not be doing anything else. Daytime sleeping is always a bit difficult for me so I prepare with earplugs and eye cover. Exactly ten minutes after the loss of consciousness and deeply asleep, the phone rings and rings. Eventually I am awake enough to answer it. The day nurse needs a signature! I told him that it could wait for 24 hours but the call had destroyed sleep. And now I had a dull headache. I'm whining about my osteoarthritis; my healing fracture burns.

I never did get the day back. It was lost. Now don't get me wrong, I did a few things but, like the pecking of a hen, a little here a little there, and couldn't get clearness back. An afternoon nap helped but now it was too late to call Eastern Canada for the business that I wanted to do.

And now, at 8:00 am on Saturday, I am back on call.for another 24 hours. It is hard to think positively about the next 48 hours.

Thursday, 10 March 2011

"Three Little Birds"

"Ever little thing is going to be all right" (Bob Marley) What makes two people wake in the morning with the same song in their heads? "Three Little Birds", the previous evening would do it!

The stage play by Kenneth T. Williams laced with Bob Marley is funny and emotionally charged. It opens with Tantoo Cardinal's soliloquy as Annie in her home on the reservation. She is dying with a painful cancer and has no grandchildren Her "take charge" only child, Kerry, played by Ntara Curry, has spurned relationships and clings to her identity as a professional. There are fire works between the two of them which blaze into a storm after Troy, Aaron Stonechild, falls into the house though a window! With a baby in his arms.

Laughter seems almost inappropriate to the subject matter but wells up frequently and unexpectedly.

The stage lighting was faulty but the actors were so professional that the audience was left to ponder over the meaning of the intermittently darkened stage! Spirits at work? Passage of time?

Aaron Stonechild was remarkably convincing as the teen father who wanted to do right by his baby girl, Anne-Marie, played by what appeared to be a short roll of cloth with off-stage recorded crying (it did mostly work).

Tantoo Cardinal was exquisite with just enough lightness to keep us convinced that she was, indeed, in pain and dying. Seeing her off stage, it was remarkable how convincingly she had become a dumpy frumpy old woman who just wanted to become a cookum before she died.

Ntara is our daughter so I cannot really be very objective about her stage work. I always like watching her! She had a most difficult role - convincingly career-driven, upset and angry for the entire first act having to soften up on cue - a bar in Toronto, at her dying mother's bedside. It was courageous for Lorne Cardinal to cast a white girl in a Metis role.

Criticisms? Two. It came as a compete surprise that rez-born Aaron was illiterate; neither his script nor his accent were convincing. And missing was the sense that Tantoo and Ntara cared enough for one another to want to spend more time together. There are a couple of precious moments where they come together but not much softness between them.

"Three Little Birds" - see it if you can! It's good. (I wish that it was accessible to the cookums and others that I see in La Loche.)

(Find about Tantoo's social activism at

Wednesday, 9 March 2011

Steam Generators

Getting steamed up about steam generators? I am.

Bruce Power wants to send 16 old radioactive steam generators, each the size of a railroad car, to Sweden where they will be melted down and separated into low radioactive and highly radioactive waste. The highly radioactive waste will be shipped back to Halifax where it will be trucked back to the Western Waste Management Facility near Kincardine, Ontario. The low radioactive material will be mixed 1:10 with scrap metal and sold to be made into anything - children's toys, cutlery, etc. The levels will be almost too low to be measured.

Is that a bad thing? After all, we have to get rid of the radioactive waste somehow. And Bruce Power wants to be a good citizen and recycle!

It is a very bad thing. Most of us are exposed to between 2 and 4 milliSeverts per year naturally - cosmic rays, radon gas for example, or medically as in x-rays and CT scans. Research shows that there is a linear response - the higher the amount of exposure, the more likely the biological changes. Most of us do not get cancer; the lag period between exposure and disease can be very long. However, the connection was first discovered in studies that showed that leukemia is 7x more frequent in children whose mothers were x-rayed while they were in the womb due to the greater sensitivity of the fetus. However, some of us do get cancer and none of us want to get cancer. Cancer occurs when something interferes with the normal brakes on cell growth and the cells grow wildly and out of control.

There are three (four if you count cosmic-rays) types of radiation. Gamma radiation is very much like x-rays which pass right through us but potentially dislodge ions in DNA. Alpha radiation can be blocked by skin. Which doesn't happen if it is ingested or inhaled. The little alpha-producing particle lodges in lungs, kidneys or wherever the body uses or disposes of the particular substance. There is also beta radiation which lies between the other two in terms of penetration and potential to cause damage.

The Steam Generators are highly radioactive containing a soup of radioactive salts. In 2006, Bruce Power said that they were too radioactive to transport and that they would keep them on site practically in perpetuity. They admitted in hearings in September 2010 (I was there) that they did not have a plan in place in the event that a ship capsized but that dilution would take care of the problem - well they didn't really say that about dilution but it was implied. Each tritium release to the environment and every uranium atom spread on the surface of the globe adds to background radiation. And the effect will not be reversed for thousands of years. Just as dioxins used as pesticides ended up in the fatty tissue of polar bears so the depleted uranium used in the military and the radon gas released from mining will enter the entire biosphere.

Steam generators. That's our power company at work. Potentially polluting the Great Lakes - source of drinking water for millions of people - and certainly adding more radioactivity to our environment by "re-cycling" radioactive waste.

Tuesday, 8 March 2011

World Woman's Day- remembering

This morning I heard a young woman on CBC:the Current. She prefaced many of her statements with the benefits that had been derived from the woman's movement and intimated that feminism was no longer needed. She had found no barriers to her career and extrapolated that no woman of her generation had any reason for failure to advance their careers other than their own determination. How little she knew of the past, the present or even the future! How far we have come and yet how far we have yet to go to achieve equity under the sky.

During medical school, I was constantly reminded of my inferiority - subject to hormone rages, likely to have babies at the drop of a hat or at least loss of a condom, unlikely to attract female patients to my practice because for unknown reasons women were more likely to want a real man as their physician and unlikely to have men in my practice because what self-respecting male would want to be examined by a woman. Not a promising outlook (and we all know how incorrect it was).

I started rural practice in 1980 in Wynyard. One of my colleagues grabbed my butt when we were standing in front of the entire high school assembly, another openly derided my skills. The head nurse was so antagonistic to a woman doctor that, years later, the nursing staff apologized for her behaviour. (Fortunately, I was thick-skinned; I knew that she did not like me but I had not know the extent.)

Within one year, 80% of the deliveries were being done by me. There had to be changes to delivery protocols - the lithotomy position had to be the choice, not the rule, erythromycin had to be used in place of silver nitrate drops, daily hgb on both mother and babe had to be discontinued, mothers were to be allowed to walk both before and after the delivery - and, who can forget the battles over rooming-in? The shit hit the fan when one of my patients came into the hospital, delivered at 9:00 am and asked to go home the same day - and I let her!! My medical judgment was questioned - and, of course, the nurse could find physicians to support her position that women should remain in the hospital for five days after delivery. For the first time, I had to explain myself to the College of Physicians and Surgeons.

My skill as a GP anaesthetist were in demand by the guys - but they were horrified when I insisted upon intubating the T&A's. (In fact, told the nurse not to fill my order for endotracheal tubes! 1981) As late as 1988, any IV push meds that I wanted to give were run past the older doc, male of course (who attended CME on cruises). One remarkable case, following the cardiologist's orders! (So I called local doc and told him to call the cardiologist and explain himself.)

Regional drug dinners? Male brag fest about their financial prowess. Or whine about the government. (Some things might not change too much.) And then in 1991 or 2 some recently graduated BC woman physician bragged in the Med Post how she "got where she was without any input from the woman's movement" - really pissed me off. When I was in first year medical school in Manitoba, there were only four women in a class of 75 people. That was "getting into mediclne without the woman's movement", getting into medicine in the mid-1980's was walking into medicine upon the backs of our foremothers (including me!).

I recognized that discrimination in the 80's was just part of the times. I became secretary to the Regional Medical Society but I refused to learn how to make coffee on the basis that it was an equal opportunity situation. On a separate and rather interesting note, Old Man Doc and I remain on, and are even friendly, speaking terms. I was enlisted as the primary and palliative physician for the other Old Man Doc in his retirement years. The third Doc, the bum grabber, seems to have bounced around the province (maybe grabbed too many bums?).

These are some of the lowlights of the 80's; one of the sad things for me is that there are still women experiencing these types of discrimination in medicine; fine researchers who don't get the plums, excellent orthopedic surgeons who put up with obsolete sexist comments, and so on.

There is evidence that people who respond to injustices with social activism are healthier, have less hypertension and gastro-intestinal disorders than those who either accept injustice as "just doing business" or normative or those who perpetrate the injustices. This is a good thing. It applies to women and men who believe in a partnership model of how the world should be run.

Monday, 7 March 2011

Painfree - NOT!

A recent discussion on a doctor's listserv started with the topic of opiate prescribing and worked its way around to a discussion on what contributes to pain and the more philosophic discussion about how different people experience pain differently.

I have chronic pain; I have had it almost all of my adult life. Most of the time I use various distraction techniques to deal with it and most of the time one or the other works.

When our father was dying of amyotrophic lateral sclerosis, some of his children donated blood to a Winnipeg specialist who was doing a genetic study on auto-immune diseases. (We never did know what happened to the study.) I was a first year medical school student so, without the assistance of doctor Google, didn't know enough to ask exactly what he had tested. When each of us returned for results, the doctor predicted that two of us, one sister and I, had a 50/50 chance of developing an auto-immune rheumatological disease. My sister developed lupus in 1991. The lumps on my fingers and the x-ray changes of my joints tell my doctor that I have osteoarthritis.

Back when we were in our early 40's, we sat around the table with our friends sharing our experiences of entering our "middle age". What perspectives had changed? Almost everyone had children so the changing attitudes towards child-rearing made for some of the conversation. Wrinkles and grey hair started a round of the changes that we had in physical expectations. When it came my turn to share,"my hot joints became painful". Someone giggled but everyone looked at me, "hot joints? What do you mean, 'hot joints'". I was surprised to learn that joints which felt "hot" were not a universal experience.

When did the sensation begin? I think that it was in my early 20's. I broke my sacrum in a freak direct-blow sledding accident when I was 18 so back pain was always with me causing great problems when Marlene and I flew, sailed, trucked, trained or bussed around South America in 1966.

By the time I was 40 years of age, I was popping pain pills. By 46, I had discovered that NSAIDs had a positive effect on menorrhagia but my stomach was a mess. Acetaminophen with codeine caused constipation, stomach cramps and an annoying peri-oral hypaesthesia. Acetaminophen by itself caused a central headache. I vomited with morphine and had incredibly distracting dreams with oxycodone. Tiaprofenic acid, a discontinued NSAID, helped. Generally, I was miserable. When I wasn't busy, I drank beer or wine. 

In 1989, I picked up a pamphlet on exercises for the ailing back. There was probably nothing new about the activity - if literature would have removed the chronic back pain, I'd have been cured for I had collected practically every piece of literature on back cures. This time was different because I actually started to do the exercises. To my surprise I started to experience a decrease in pain so I went to a physiotherapist for more exercises.

In April 1991, I had a back-pain-free week! Getting rid of back pain, however, gave me a chance to experience joint pain. On the basis that exercise will do no harm and probably would do good things, I now have a 50 minute back/yoga exercise routine in the morning and about 30 minutes in the evening.

When I injured my back three years ago, investigations showed a 60 degree rotoscoliosis and severe osteoarthritis as well as osteocytopenia. The broken sacrum with its irregular healing could be seen. The x-ray looked like that of a woman much older than I.

While my back is not often the primary site of pain nowadays, it always lingers in the background. If I fail to do my morning exercises, I can predict that it will be back. Other joints behave like OA, right now my hot painful swollen joints are my CMCs and my MCPs (both of the joints on the both thumbs) but the pain in my knees, ankles, and hips is present as well, just not as noticeable as the thumbs.

How do we measure pain? By the truly subjective method of comparing the "worst pain ever experienced with the current pain"! The worst pain that I've had was after the reimplantation of an amputated distal digit. If that is rated a "10", my usual pain is a "3". Some mornings it is a 5 or a 7.

I think that pain is part of being alive.