B
Commentary on “Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population”

A monograph authored by Dr. John W. Gofman and dated 1999 was submitted to the committee for its consideration. Dr. Gofman is professor emeritus of molecular and cell biology at the University of California, Berkeley.

In his monograph, Dr. Gofman uses two databases: (1) the database for age-adjusted mortality rates derived from U.S. age-adjusted mortality rates in the decade years from 1940 to approximately 1990—these data are grouped into nine census divisions—and (2) the database for physicians per 100,000 population according to census division obtained from records maintained by the American Medical Association.

Dr. Gofman argues that the number of physicians per 100,000 population may be used as a surrogate for the average dose of medical radiation to the population of each census division. However, no data are presented to support this argument.

In his analyses, Dr. Gofman regresses cause-specific mortality rates on physician population values. Three major causes of death are used: all cancers combined, ischemic heart disease, and all other causes. He demonstrates a positive association of physician population values with all cancer and ischemic heart disease and an inverse association with all other causes. He argues that this evidence “… strongly indicates that over 50% of the death-rate from cancer today, and over 60% of the death-rate from Ischemic Heart Disease today, are xray-induced as defined and explained in Part 5 of the Introduction.”

Comment

The data used by Dr. Gofman share certain limitations with the data used in the committee’s evaluation of environmental radiation and in the consideration of the existence of hormesis in relation to radiation. The primary issue is that so-called ecologic data are used, that is, data on populations rather than data on individuals.

A second limitation of the data used by Dr. Gofman is the assumption that the number of physicians per 100,000 population is a surrogate for the dose of medical radiation received by the population. It is not possible to verify the quantitative nature of this assumption.

Summary

The interpretation that medical radiation has been a major contributor to death from cancer and ischemic heart disease in the United States during the period 1940–1990 is not shared by the committee. There are insufficient data on dose and disease in individuals to lead to this conclusion.



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OCR for page 329
B Commentary on “Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose- Response Studies with Physicians per 100,000 Population” A monograph authored by Dr. John W. Gofman and dated cancer today, and over 60% of the death-rate from Ischemic 1999 was submitted to the committee for its consideration. Heart Disease today, are xray-induced as defined and ex- Dr. Gofman is professor emeritus of molecular and cell biol- plained in Part 5 of the Introduction.” ogy at the University of California, Berkeley. In his monograph, Dr. Gofman uses two databases: (1) Comment the database for age-adjusted mortality rates derived from U.S. age-adjusted mortality rates in the decade years from The data used by Dr. Gofman share certain limitations 1940 to approximately 1990—these data are grouped into with the data used in the committee’s evaluation of environ- nine census divisions—and (2) the database for physicians mental radiation and in the consideration of the existence of per 100,000 population according to census division ob- hormesis in relation to radiation. The primary issue is that tained from records maintained by the American Medical so-called ecologic data are used, that is, data on populations Association. rather than data on individuals. Dr. Gofman argues that the number of physicians per A second limitation of the data used by Dr. Gofman is the 100,000 population may be used as a surrogate for the aver- assumption that the number of physicians per 100,000 popu- age dose of medical radiation to the population of each cen- lation is a surrogate for the dose of medical radiation re- sus division. However, no data are presented to support this ceived by the population. It is not possible to verify the quan- argument. titative nature of this assumption. In his analyses, Dr. Gofman regresses cause-specific mortality rates on physician population values. Three major Summary causes of death are used: all cancers combined, ischemic heart disease, and all other causes. He demonstrates a posi- The interpretation that medical radiation has been a major tive association of physician population values with all contributor to death from cancer and ischemic heart disease cancer and ischemic heart disease and an inverse associa- in the United States during the period 1940–1990 is not tion with all other causes. He argues that this evidence shared by the committee. There are insufficient data on dose “. . . strongly indicates that over 50% of the death-rate from and disease in individuals to lead to this conclusion. 329