The Story of Mancuso & Stewart by Alvarez. Water Under the Bridge?

This story directly relates to the previous post

The Story of Mancuso & Stewart by Alvarez. Water Under the Bridge?

When I first met Dr. Thomas F. Mancuso in the fall of 1977, he was poring over computer print-outs in his small, cluttered L-shaped office at the University of Pittsburgh.
Spry, with a trim mustache and horn-rimmed glasses, Mancuso’s passion for data collection often compelled him to bring his work home. Despite his efforts to transform his large spacious home into a research archive, Mancuso’s wife, Rae, kept the place spotless. Occasionally, data would be strewn on the dining room table, but most of the records were kept in dozens of filing cabinets in the basement, like a highly guarded treasure.

Since 1945, he had mastered the art of assembling millions of bits of information into groundbreaking studies to determine long-term workplace health hazards. Before his pioneering research, “the major focus on workplace health dealt with on-the-job injuries,” said Bernard Goldstein, Dean of the Pittsburgh University School of Public Health in 2004. Mancuso “developed techniques to look at the long-term health effects of working.” 1

Having given away his car to one of his children several years before, the bespectacled physician walked every day to his office in the somber Graduate School building, often stopping first to attend Catholic mass. In contrast to his contemplative side, Mancuso’s temper was legendary. But his stubborn quest for perfection was more than offset by his loyalty and kind generosity. These qualities had served him well over the years, but now they were being sorely tested in a struggle over the effects of ionizing radiation on nuclear workers.

Conflict over his studies was nothing new. But it was the unprecedented ferocity of this assault against his research that surprised him. Now as he approached the closing years of his illustrious career, Mancuso had not expected that his tedious sorting of statistics would put him at odds with the US nuclear weapons program, one of the most powerful scientific establishments in the world

Early Radiation Exposure Problems
Since World War II, the amassing of nuclear arms resulted in the creation of one of the largest and potentially most dangerous industrial enterprises in the nation. At the outset, the hazardous magnitude of nuclear weapons work was recognized by the scientific members of the Manhattan Project. These concerns led to the creation of the Health Division of the Manhattan Project led by Dr. Robert Stone, chairman of the Radiology Department at the University of California Medical School in San Francisco. According to Stone:

It was estimated that the pieces of uranium that would have to be removed from the pile [reactor] after fission had occurred would contain materials far more radioactive than any that had been encountered in the radium industry. The chemical process of separating the plutonium from other extremely radioactive elements was recognized as another tremendously hazardous procedure. The effect that plutonium itself might have on workers was unknown.2

During the war, Stone concluded that, “the whole clinical study of the personnel is one vast experiment.” 3 Like Stone, other officials, such as John Wirth, Medical Director at the Oak Ridge, TN, recognized that the health consequences to workers could result in “the unexpected appearance of dangerous changes months or years after exposure.”4 Wirth recounted problems where “minute invisible fragments might make an entire building uninhabitable. . . . It is always amazing what widespread contamination can be caused by a minute quantity of hot material once it has been allowed to get out of a container.”5

The Manhattan Project had standard worker compensation insurance, which only covered illnesses or disabilities that appeared within 90 days of an accident or 30 days after leaving the project. But Cyril Stanley Smith, chief metallurgical chemist at Los Alamos, denounced it as “inhumane, unethical and unfair,” as he and his fellow chemists refused to work without extra insurance. Bending to their wishes, the US government set up a secret one million dollar fund for the plutonium chemists at Los Alamos.6

Ordinary workers in the Manhattan Project fared less well. Ted Lombard was an enlisted man in the US Army assigned to work at the Los Alamos Laboratory during the war who recalled less-than-ideal working conditions:

We used to go to Fort Douglas, Utah in ambulances [to] pick up uranium and plutonium. We carried dosimeter badges in our pockets because you couldn’t display them. . . . Then [after the badges were turned over to an officer] we would proceed to unload uranium and plutonium barehanded . . . the fumes and dust were constantly in the air; there was no ventilation system. The dust was on the floor. Uranium chips would be in your shoes that you continued to wear. You went to eat with the same clothes on. You went to the barracks with the same clothes and sat on the beds.7

Given widespread exposure problems, concerns over financial and legal liabilities also influenced radiation protection decisions. An overriding concern according to Stafford Warren, medical advisor to General Leslie Groves, military chief of the Manhattan Project, was to protect “the government interests” against legal claims.8

(I’ll break in here to say that the SA Minister of Mines needs to think about what he has said to the “Paydirt 2011″ Uranium Conference in Adelaide recently. He aint Stafford Warren, who actually, some people think, was not a very nice person either.)

(I will leave out the personal medical stories Alvarez relates. They gave permission to Alvarez to tell the stories, not to me.)

……..At the time, fears over liability and lack of public trust that might result from disclosure of workplace hazards was of dominant concern. In a memo regarding possible declassification of a study suggesting that occupational radiation exposure levels “may be too high,” the head of the Insurance Branch of the AEC declared:

We can see the possibility of a shattering effect on the morale of the employees if they become aware that there was substantial reason to question the standards of safety under which they are working. In the hands of labor unions the results of this study would add substance to demands for extra-hazardous pay . . . knowledge of the results of this study might increase the number of claims of occupational injury due to radiation.13

By June 1949, the ACBM was informed of excessive exposure to workers in uranium processing plants. 14 Some workers were being exposed at levels 125 times greater than the default standard adopted in World War II.15 By this time it was recognized that this standard was not protective against radiation hazards.16

The Mancuso Study
Although high-ranking officials were aware of potentially serious health risks to workers and were urged by its advisors to conduct health studies, the Atomic Energy Commission did not initiate occupational epidemiological research until 1964. That year Dr. Thomas F. Mancuso, Professor of Occupational Medicine at the University of Pittsburgh, was approached by staff of the AEC’s Division of Biology and Medicine in 1964 to undertake a feasibility study. According to Mancuso, the AEC staff asked him if there were sufficient data to “answer a basic question, that is, whether there were or were not any effects of low-level ionizing radiation.” 18 Based on a review of records at 14 AEC facilities, Mancuso concluded it was possible, and was awarded a five-year research contract in 1965.

By that time, Mancuso had established himself as a highly respected figure in the field of occupational epidemiology. While serving as chief of the Ohio Division of Industrial Hygiene between 1945 and 1962, Mancuso published a series of ground-breaking studies showing the toxicological and carcinogenic effects of cadmium, manganese, mercury, hydrogen sulfide, asbestos, aromatic amines, and chromate. 19 20 21 With the encouragement of his mentor, Wilhelm Huper, at the National Cancer Institute, 22 Mancuso designed and published the first cohort mortality studies on occupational cohorts in the United States. 23 In doing so Mancuso invented a revolutionary methodology using Social Security death benefit claims that enabled researchers for the first time to follow exposed workers over the many years necessary to detect latent diseases such as cancer. 24 In 1961, he had been given a career award by the National Cancer Institute for his impressive body of work.

Mancuso was also known for his honesty and fierce independence. In the 1950s, Phillip Carey Corp., a manufacturer of asbestos insulation hired Mancuso with the expectation that he would provide evidence refuting compensation claims by workers dying from respiratory diseases following exposure to asbestos. Instead Mancuso’s research supported the worker’s claims. He strongly advised the company that it had a responsibility to inform the workers of potential risks. Because Phillip Carey ignored Mancuso’s warning throughout the 1960s, his research was subsequently used by claimants. 25

What motivated the AEC officials to approach Mancuso? A key factor was that the national security imperative to exercise control over radiation heath effects research was loosening as Cold War tensions reduced. Moreover, the AEC suffered a serious blow to its credibility in 1963, when the United States, Great Britain, and the Soviet Union ratified the Limited Nuclear Test Ban Treaty, which prohibited atmospheric nuclear weapons tests.

Beginning in the1950s, a major and often contentious debate was sparked by scientists, such as Nobel Prize winners Herman Mueller and Linus Pauling who warned that radioactive fallout from testing was harming human health across the globe. The AEC and its scientists vigorously defended the tests claiming they posed little if no harm. “There developed what I consider to be a strange psychological frame of mind,” Dr. Karl Z. Morgan, founder and director of the AEC’s Oak Ridge Health Physics Lab reflected several years later. “It became unpatriotic and perhaps unscientific to suggest that atomic weapons testing might cause deaths throughout the world from fallout.” Morgan found many of his AEC colleagues holding “onto untenable and extremely shallow arguments [and making] comparisons with medical and natural background exposures as if they were harmless.” 26 Official repudiation of the AEC’s claims about fallout came in 1997, when the National Cancer Institute (NCI) revealed that atmospheric nuclear weapons detonations at the Nevada Test Site resulted in significant radiological contamination of the nation’s milk supplies. NCI researchers estimated that fallout exposure to Iodine–131 from Nevada tests might cause 11,000 to 212, 000 excess thyroid cancers in the United States. 27

By 1964, the US nuclear arsenal was shrinking as more accurate delivery systems were deployed. This in turn significantly reduced demand for plutonium and highly enriched uranium—leading to the closure of several large production reactors and radiochemical processing facilities.
Concurrently, dozens of new power reactors were now planned for construction in the United States. The AEC, which was responsible for commercializing nuclear energy was gearing up to accommodate this major growth, while setting the stage for a new generation of reactors that would use plutonium as fuel. To pave the way for these developments, the AEC needed to strengthen its credibility. In particular, the formalization of occupational radiation protection standards in 1959, which limited annual external exposure to 5 rem28 per year, provided a necessary framework for both the continuation of civilian and military nuclear energy activities.

AEC managers received assurances from its scientific advisors that Mancuso’s work would not lead to unpleasant surprises. In his 1980 paper about the Mancuso affair, Theodore D. Sterling, public health professor at Simon Fraser University in Canada, explores this concern and concludes: “It was firmly believed by all scientific advisors and by management that the study design was not adequate to lead to [findings of adverse effects]. Rather, the study was implemented and supported for frankly admitted political reasons” (original emphasis). 29 After initiating the study, some AEC officials referred to it as “Mancuso’s folly” and openly viewed it as a public-relations sham. 30 The political need to have Mancuso continue this study is reflected in review comments made in November 1967, by Dr. Brian MacMahon, an AEC consultant from Harvard University:

In my opinion this study does not have, and never (in any practical sense) will have any possibility of contributing to knowledge of radiation effects in man. I recognize that much of the motivation for starting this study arose from the “political” need for assurances that AEC employees are not suffering harmful effect. 31

During the 1960s and early 1970s, Mancuso compiled data on workers at several facilities. He focused on the Hanford site in Washington State and the Oak Ridge site in Tennessee because they were the oldest and largest federal nuclear facilities. Throughout this period, AEC officials were eager for him to publish. “Repeatedly …I had been urged by [the AEC and its successor the Energy Research and Development Administration—now the Department of Energy] to publish in scientific journals, the negative findings of the progress reports, and I refused to do so,” stated Mancuso. “I believed that the findings would be misleading, no matter how well qualified in the presentation and could be misused.”33

By February 1973, Dr. Sidney Marks, Mancuso’s AEC worker study contract officer grew frustrated and suggested “early replacement of the contractor.”

Nonetheless, AEC officials tolerated Mancuso’s reluctance to publish until the situation was abruptly transformed in late June of 1974. This is when Dr. Samuel Milham, an epidemiologist with the Washington State Department of Social and Health Services, met with AEC officials to report findings of a study he had just completed. Encompassing 300,000 deaths from 1950 to 1974, Milham compared the mortality of different occupations in the state and found that:

Men who worked at the Atomic Energy Commission Hanford facility in Richland, Washington showed increased mortality from cancer, especially in men under age 64 at death. An excess was seen for cancer of the tongue, mouth, and pharynx, colon, pancreas, lung and bone. Excess mortality was also seen for aplastic anemia and amyotrophophic sclerosis.35

He concluded that, “since the Hanford facility is involved in the handling, fabrication, processing and storage of an array of radioactive materials, most of which are of proven carcinogenicity, I suggest that these materials are the most likely source for the observed cancer excess.” 36At the meeting in Richland, Washington, Milham recalled that the atmosphere was “like a funeral, quiet, no smile. . . . The impression I got at the meeting with the AEC was that the release of my finding might cause concern and problems in the industry.”37 After the meeting Milham decided to not to publish his findings, “because I was convinced that the appropriate population-based studies were in progress [under Mancuso’s direction]. I felt that publication of my findings at this time might disturb the continuity of the study in progress and might cause undue concern in workers.”38

Shortly after, Mancuso “was on the phone by the hour over a period of weeks” with AEC officials in the Division of Biology and Medicine. Dr. Sidney Marks, Mancuso’s AEC contract officer, urged Mancuso to endorse a draft press release which stated “there is no evidence of cancer or other deaths attributable to ionizing radiation occurring more often among Hanford workers.”39 But Mancuso refused, explaining to Marks that Milham’s findings could not be dismissed because they were based on more recent mortality data Mancuso had yet to obtain. Furthermore, Milham’s study included construction workers at the Hanford site, which were not part of the AEC-sponsored study. Hanford construction workers, according to Mancuso, were “acknowledged to have more exposure” than operators, and his repeated attempts to have this group incorporated into his study over the years were denied.40

It was then that AEC officials started to end their relationship with Mancuso. In the summer of 1974, the AEC initiated a process to transfer a major portion of Mancuso’s study to Oak Ridge Associated Universities (ORAU) in Tennessee. For several years AEC, the National Aeronautics and Space Administration (NASA) and the Defense Department sponsored studies involving total body irradiation of animals and dozens of human patients in specially designed radiation chambers at ORAU, but funding for the research program was about to end. According to a 1975 report to NASA, ORAU study director, Dr. Clarence C. Lushbaugh, justified the experiments in part because, “unbiased clinical observations were sorely needed to defend existing environmental and occupational exposure constraints from attack by well-meaning but impractical theorists.”41……

Alex Fremling, the AEC Manager at the Hanford also reached a much different conclusion than Gilbert when he reported:

There is a relationship between cancer as a cause of death and the total dose of external radiation received. . . . The message is clear that Battelle’s data suggests that Hanford has a higher proportion of cancer deaths for those under 65 than the US. . . . Even more disturbing from our standpoint [is that] the analysis tends to show a much higher incidence of certain types of cancer [at doses below official limits]. . . . We hoped to get a good answer to the Milham report, and instead it looks like we have confirmed it.49

The Battelle study remained buried until it was submitted into the record by Dr. Milham in 1978 at a hearing of the US Congress.50
……………………(This sort of burying of information is implied as a possibility in the SA Minister of Mines statements regarding health effects to the PAYDIRT 2011 conference in Adelaide recently) Surely the Minister is aware of the dozens of ordered by politicians and Goverment managers over the years to present only optimist statements of safety. Such cannot be achieved without suppression of data. PJL) …….

In March of 1976, Mancuso asked Dr. Alice M. Stewart and George Kneale, her statistician from the University of Birmingham in England, to analyze his data. Dr. Stewart, a member of Mancuso’s advisory committee, was internationally recognized as establishing the link between fetal x-rays and childhood cancers. Since 1955, when she and her colleagues first reported this finding, Stewart had constructed one of the world’s largest epidemiological studies of low-dose ionizing radiation, the Oxford Survey of Childhood Cancers.

By the summer of 1976, Mancuso, Stewart, and Kneale produced a cohort analysis based on 3,710 deaths among Hanford workers collected up to 1973. They found a 5 to 7 percent excess in cancer deaths attributable to radiation. Workers exposed after the age of 45 showed higher sensitivity to cancer. Most significantly, the risk of dying from radiation-induced cancer appeared to be about ten times greater than current protection standards assumed. As soon as the analysis was finalized Mancuso and his colleagues briefed the Energy Department in October 1976. 54 “They were clearly unhappy,” Mancuso said. “They urged us not to publish. . . . My job in their eyes was simply to transfer the data to them.”55 Present at the meeting was Sidney Marks. After helping to orchestrate Mancuso’s firing, Marks left his government employment in June 1976 to administer the Hanford worker study at Battelle, where Ethyl Gilbert worked under his supervision.56

By the fall of 1977, Mancuso‘s research funds had run out. In November, he published his paper in Health Physics, creating a firestorm of controversy. Though he continued to draw a salary from the University of Pittsburgh, Mancuso had no funds with which to continue his research. Though it was a bare fraction of what was needed, Mancuso began cutting into his personal retirement money to continue working on the Hanford study. Meanwhile the federal government persisted in its attempts to take the data away from him and most disturbingly, to destroy data Mancuso had collected.

(Yep, that has happened here. PJL. Radiological Monitoring of SA Drinking Water. 1957-1963. British Data repeated refused release by the SA Government. PJL) (What is the Radiological Safety Protection Act actually protecting, Mr Rann? The SA Minister of Mines has simply stated things on the basis of past events here. It is easy to be Cross about this. They actually have a duty to release the data in the public interest. FOI should be free. The statement by the SA Minister of Mines at PAYDIRT 2011 is depressing and hardens my resolve. See later posts. PJL)

Upon assuming control over the DOE worker study in 1977, Dr. Lushbaugh, Chief of Radiation Studies at ORAU, proceeded to shred and incinerate medical records from the Oak Ridge Hospital preserved by Mancuso.57 All told, 21 out of 40 filing cabinets spanning the period 1952 to 1961 were destroyed. Mancuso took custody of the records after the old hospital, owned by the federal government, was transformed into the Methodist Medical Center. In November 1985, when allegations were made about the destruction, Lushbaugh claimed “we would never destroy these records.”58 Several days later, ORAU officials conceded that the records were destroyed and they were unaware they had been set aside by Mancuso. In his final report to the DOE in November 1977, Mancuso had clearly identified these records as part of his research program.59

( PJL)

Congressmen Paul Rogers (D-FL.) and Tim Lee Carter (D-KY.) subsequently reported to Energy Secretary Schlesinger, that the justifications for the decision to fire Mancuso were “not supported” and the decision to transfer Mancuso’s study to Oak Ridge was “highly questionable at best.” The whole process, they said, reflected “serious mismanagement and is of highly questionable legality.”63

In 1979, in response to Congressional hearings regarding the handling of Mancuso’s contract and revelations about radiation exposure to military personnel and civilians from US atmospheric nuclear weapons tests, a Federal Interagency Taskforce on Ionizing Radiation was convened by President Carter. The Taskforce, chaired by Health, Education, and Welfare Secretary, Joseph Califano, reported in 1980 that the Department of Energy maintained a virtual monopoly over the funding of radiation health effects research; and that DOE had a potential conflict-of-interest between its missions of military and civilian nuclear energy development and assessing their health impacts. Califano proposed removing radiation health effects research from DOE’s control and placing it in public health agencies.64 Even so, Mancuso continued to face opposition. He managed to continue the study through private donations and his retirement money until labor unions pressured the National Institute of Occupational Safety and Health to reinstate the study in August 1979. This lasted until the spring of 1981 when the Reagan administration informed Mancuso his funding would once again be terminated.

Despite the difficulty in obtaining funding, Mancuso, Stewart, and Kneale persisted in their research and publications in the scientific literature.65 By 1990, the Three Mile Island Public Health Fund, established as part of a legal settlement resulting from the Three-Mile Island nuclear accident in 1979, funded the continued work of Dr. Stewart and Kneale. While strongly supportive of their efforts, Dr. Mancuso had effectively withdrawn from the work, as a result of the difficult experience. However, in 1993, Mancuso published an analysis of Hanford workers, which clearly indicated that he had not given up the struggle:

The search for the biological effects among worker cohorts has been mostly in terms of mortality experience. Yet it is well known that the primary and secondary causes of death on a death certificate do not reflect the diseases or illnesses which may have occurred prior to death. . . .The consequences have been the underestimation of the true nature and magnitude of occupational health effects when based solely on death certificates. . . . The death certificate provides a gross underestimate of the biological effects which may have occurred in that population.66


All told, workers at fourteen DOE facilities were found to have increased risks of dying from various cancers and nonmalignant diseases.68 The facilities include:

• Hanford nuclear materials production site in Washington
• Oak Ridge National Laboratory in Tennessee
• Oak Ridge Tennessee Eastman Electromagnetic Separation facility (TEC)
• Oak Ridge Y-12 weapons facility
• Oak Ridge K-25 Gaseous Diffusion Plant
• Feed Materials Production Center in Fernald, Ohio
• Los Alamos National Laboratory in New Mexico
• Linde Air Products uranium processing operation in New York
• Mallikrodt Chemical Works in Missouri
• Mound Laboratory in Ohio
• Rocky Flats facility in Colorado
• Savannah River Site in South Carolina
• Rocketdyne/Atomic International Facility in California
• Lawrence Livermore National Laboratory in California

By the end of the twentieth century, the Department of Energy occupational epidemiological studies constituted one of the world’s largest and most extensive follow- ups of people exposed to low-level ionizing radiation and other substances. Dr. Mancuso had put in place a foundation that eventually provided a basis for the study of some 600,000 people who worked for federal contractors at industrial and research sites.

In December 2000, the United States enacted the Energy Employee Occupational Illness Compensation Act.

(at that, one wonders what the motivation of the SA Minister for Mines actually is.)

Alvarez, Robert, “The Risks of Making Nuclear Weapons”. Pdf distribution from Research Ethics. org
Chapter 7)

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