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The Arctic Aeromedical Laboratory's
Thyroid Function Study:
A Radiological Risk and Ethical Analysis
Committee on Evaluation of 1950s Air Force Human Health Testing
in Alaska Using Radioactive Iodine i3{
Polar Research Board
Commission on Geosciences, Environment, and Resources
in cooperation with
Board on Health Promotion and Disease Prevention
Institute of Medicine
Board on Radiation Effects Research
Commission on Life Sciences
National Research Council
NATIONAL ACADEMY PRESS
Washington, D.C. 1996
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NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn from
the councils of the National Academy of Sciences, the National Academy of
Engineering, and the Institute of Medicine. The members of the committee
responsible for the report were chosen for their special competence and with regard
for appropriate balance.
This report has been reviewed by a group other than the authors according to
procedures approved by a Report Review Committee consisting of members of the
National Academy of Sciences, the National Academy of Engineering, and the
Institute of Medicine.
Support for this project was provided by the United States Air Force under
Contract Number F41624-94-C-2003.
Front: These masks were made by Alaska Natives out of all natural materials
that are available in many villages in Alaska. The man was designed by Ruth RulIand
and the woman was designed by Rhoda Ahgook.
Copies available from
National Academy Press
2101 Constitution Avenue, N.W
Box 285
Washington, D.C. 20055
(800) 624-6242
(202) 624-6242 (in the Washington Metro area)
B-704
.
Library of Congress Catalog Card No. 95-72623
International Standard Book No. 0-309-05428-1
Copyright 1996 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
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COMMITTEE ON EVALUATION OF 1950s AIR FORCE HUMAN HEALTH
TESTING IN ALASKA USING RADIOACTIVE IODINE 131
CHESTER M. PIERCE, Chair, Harvard Medical School, Boston, Massachusetts
DAVID BAINES, St. Maries Family Medicine Clinic, St. Maries, Idaho
TNDER CHOPRA, University of California at Los Angeles, School of Medicine,
loos Angeles, California
NANCY M. P. KING, University of North Carolina School of Medicine, Chapel
Hill, North Carolina
KENNETH L. MOSSMAN, Arizona State University, Tempe, Arizona
Staff
CHRIS ELFRING, Polar Research Board, Study Director (after July 1995J
LOREN W. SETLOW, Polar Research Board, Study Director (through July 19959
TONI GREENLEAF, Polar Research Board, Senior Project Assistant
MICHAEL STOTO, Board on Health Promotion and Disease Prevention
JOHN ZIMBRICK, Board on Radiation Effects Research
. . .
zzz
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POLAR RESEARCH BOARD
DAVID L. CLARK, Chair, University of Wisconsin, Madison
KNUT AAGAARD, University of Washington, Seattle
JOHN B. ANDERSON, Rice University, Houston, Texas
DAVID R. BAINES, St. Maries Family Medicine Clinic, St. Maries, Idaho
ERNEST S. BURCH, Consultant, Camp Hill, Pennsylvania
GORDON F.N. COX, Amoco Eurasia Petroleum Company, Houston, Texas
ROBERT LEE DEZAFRA, State University of New York, Stony Brook
BERNARD MALLET, University of Washington, Seattle
DOYAL A. HARPER, Yerkes Observatory, University of Chicago, Williams Bay,
Wisconsin
DAVID M. MITE, Consultant, Anchorage, Alaska
DIANE M. MCKNIGHT, U.S. Geological Survey, Boulder, Colorado
DONAL T. MANAHAN, A. Hancock Foundation, University of Southern Californian
Los Angeles
WALTER C. OECHEL, San Diego State University, San Diego, California
IRENE C. PEDEN, University of Washington, Seattle
GLENN E. SHAW, University of Alaska, Fairbanks
DONALD B. SINIFF, University of Minnesota, St. Paul, Minnesota
JUNE L. SIVA, Arco Production Company, Los Angeles, California
ROBERT M. WALKER, Washington University, St. Louis, Missouri
Ex-Officio Members
CHARLES R. BENTLEY, Alternate U.S. Delegate, Scientific Committee on
Antarctic Research, International Council of Scientific Unions (SCAR/ICSU)
ELLEN MOSEEY-THOMPSON, Chair, Committee on Glaciology
ROBERT RUTFORD, U.S. Delegate, Scientific Committee on Antarctic Research,
International Council of Scientific Unions (SCAR/ICSU)
ORAN R. YOUNG, U.S. Council Member, International Arctic Science Committee (lASC)
Staff
CHRIS ELFRING, Acting Director
TONI GREENLEAF, Project Assistant/Financial Assistant
KELLY NORSINGLE, Project Assistant
IV
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COMMISSION ON GEOSCIENCES, ENVIRONMENT,
AND RESOURCES
M. GORDON WOLMAN, Chair, The Johns Hopkins University, Baltimore, Maryland
PATRICK R. ATKINS, Aluminum Company of America, Pittsburgh, Pennsylvania
JAMES P. BRUCE, Canadian Climate Program Board, Ottawa
WILLIAM L. FISHER, University of Texas at Austin
GEORGE M. HORNBERGER, University of Virginia, Charlottsville
DEBRA KNOPMAN, Progressive Foundation, Washington, D.C.
PERRY L. MCCARTY, Stanford University, California
JUDITH E. MCDOWELL, Woods Hole Oceanographic Institution, Massachusetts
S. GEORGE PHILANDER, Princeton University, New Jersey
RAYMOND A. PRICE, Queen's University at Kingston, Ontario
THOMAS C. SCHELLING, University of Maryland, College Park
ELLEN SILBERGELD, University of Maryland Medical School, Baltimore, Maryland
STEVEN M. STANLEY, The Johns Hopkins University, Baltimore, Maryland
VICTORIA I. TSCHINKEL, Landers and Parsons, Tallahassee, Florida
NRC Stay
STEPHEN RATTIEN, Executive Director
STEPHEN D. PARKER, Associate Executive Director
MORGAN GOPNIK, Assistant Executive Director
GREGORY SYMMES, Reports Officer
JAMES E. MALLORY, Administrative Officer
SANDRA S. FITZPATRICK, Administrative Associate
SUSAN SHERWIN, Project Assistant
v
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The National Academy of Sciences is a private, nonprofit, self-perpetuating
society of distinguished scholars engaged in scientific and engineering research,
dedicated to the furtherance of science and technology and to their use for the general
welfare. Upon the authority of the charter granted to it by the Congress in IS63, the
Academy has a mandate that requires it to advise the federal government on scientific
and technical matters. Dr. Bruce M. Alberts is president of the National Academy of
Sciences.
The National Academy of Engineering was established in 1964, under the
charter of the National Academy of Sciences, as a parallel organization of outstanding
engineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineering
programs aimed at meeting national needs, encourages education and research, and
recognizes the superior achievements of engineers. Dr. Harold Liebowitz is president
of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in the
examination of policy makers pertaining to the health of the public. The Institute acts
under the responsibility given to the National Academy of Sciences by its
congressional charter to be an advisor to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Kenneth I.
Shine is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of
Sciences in 1916 to associate the broad community of science and technology with the
Academy's purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy of
Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Council
is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce
M. Alberts and Dr. Harold Liebowitz are chairman and vice chairman, respectively,
of the National Research Council.
Vl
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Preface
With the end of the Cold War has come more freedom to step back and examine its
legacy. In May 1993, experts and public officials met at the Arctic Contamination Conference
in Anchorage, Alaska, to discuss problems relating to the post-World War II era of human
occupation of the Arctic. The conference was sponsored by 14 federal agencies that participate
in the Interagency Arctic Research Policy Committee, and it focused attention on radiation and
chemical experunentation and contamination of the Arctic.
One issue raised at the Anchorage meeting was a 1956-1957 study conducted by the U.S.
Air Force s former Arctic Aeromedical Laboratory (AAL) about the role of the thyroid gland
in acclimatization of humans to cold. The study used Iodinei3i (Ii3'), a radioactive medical
tracer, to measure thyroid activity in 121 people-102 Alaska Natives and 19 military personnel.
When the research came to light at the conference, serious questions were raised: How were the
research subjects selected? Did the subjects fully understand the purpose of the research? Were
they informed of the risks? To help resolve the controversy, Congress, under the leadership of
Senator Frank Murkowski (A-Alaska), asked the National Research Council (NRC) and Institute
of Medicine (IOM) to review the AAL thyroid function study (Public Law 103-160~. The
National Research Council and Institute of Medicine (NRC/TOM) appointed the Committee for
Evaluation of Air Force 1950s Human Health Testing in Alaska Using Radioactive Iodinei3i to
fulfill that request. The Committee was charged to investigate whether the study was conducted
in accordance with generally accepted guidelines in the 1950s for use of human participants in
medical experimentation and whether the I'3' doses used were administered in accordance with
radiation exposure standards of the 1950s, as well as how the dosages would compare to modern
standards. The Committee was also asked to examine whether the AAL thyroid function study
had followed guidelines regarding informing participants about possible risks and whether
subsequent studies of the participants should have been conducted to determine whether any
suffered long-term ill effects.
Given that the events at issue occurred some 40 years ago, the Committee s charge was
not an easy one. The Committee first met by teleconference in June 1994 and began an
intensive effort to gather records and information about the research and to locate the subjects
tested. One Committee member (a physician) and an NRC staff member then traveled to two
rural Alaska villages in July 1994 to interview Native subjects. Immediately following those
. .
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. . .
Vlll
Preface
field interviews, the filet Committee met in Fairbanks, Alaska, to hear from a wide range of
people at a public hearing. Speakers included Native study participants, a military participant,
doctors who worked at the Air Force laboratory in the 1950s, the physician that led the study
(by phone from Norway), a medical historian, and representatives of state, local, and tribal
government agencies. This report is the Committee's careful analysis of this information and
its best judgment about the difficult issues that this research brings to light.
The Committee would like to thank all those who participated in the hearing and other
information-gathering activities this personal input was critical. The Committee did its best
to sort through the sometimes wide-ranging testimony and to focus on the AAL thyroid function
study. It was clear from the public hearing, however, that many Alaskans are concerned with
issues broader than this one study questions about other experiments on Alaska Natives. Many
at the public hearing expressed great frustration, and even rage, at the lack of information and
explanation of what was done to them during this and other past research. Yet despite this
anger, they were exceedingly generous in their willingness to help the Committee in its
. · .
1nvestl~at~on.
_ ~, ~
While the Committee's review of the AAL thyroid research was ongoing, information
about other medical studies of the 1950s was coming to light. One important effort was
undertaken by the President's Advisory Committee on Human Radiation Experunents (ACHRE).
ACHRE was established in 1994 to provide advice on ethical and scientific issues related to
government-sponsored human radiation experiments, that is, experiments designed to understand
the impacts of intentional exposure to ionizing radiation (excluding common and routine clinical
practices) and experiments involving intentional environmental releases of radiation. ACHRE
has raised significant questions about the conduct of such experiments (Advisory Committee on
Human Radiation Experiments, 1995), and, although the use of a radioactive medical tracer
presents far less risk and involves different objectives, the lessons from the ACHRE report have
some bearing here.
The AAL thyroid research must be seen in the context of the era when it was conducted.
The methodology was not unusual and the researchers interacted with the people who served as
subjects in the manner and tone that was typical of the times. The diagnostic use of {~3} was
routine in medical practice across America in the 1950s. Research has not shown any link
between small doses of li31 and thyroid cancer. Given these facts, why should a single study
using diagnostic amounts of the tracer cause so much concern? In a June 1994 letter to the
Committee, Senator Murkowski explained: "Unfortunately, the Todinei3i tests almost 40 years
ago" even if they were safe, well intentioned, and conducted in accordance with the standards
of the day have contributed to an atmosphere of conflict and mistrust between the indigenous
peoples of the Arctic and the community of scientists and researchers who work in the Arctic.
That is troubling and unfortunate, because science is critically important to Alaska and its
future." He hoped an honest appraisal of the AAL thyroid function study would improve the
relationship between the scientific and indigenous communities.
The Committee bears full responsibility for the content and opinions presented in this
document. However, we would like to acknowledge the many people who provided assistance.
The Committee would like to thank the NRC staff for their support, including their diligent
search for archival records and willingness to pursue cold trails for relevant information. The
Committee also must thank the U.S. Air Force's Office of the Surgeon General, the Mayor of
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Preface
IX
the North Slope Borough and his staff, the Tanana Chiefs Conference in Fairbanks, and the
Indian Health Service for their assistance in searching for and locating medical study subjects,
and the U.S. Air Force for its financial support of the project. The Committee also received
valuable assistance from the Oak Ridge Associated Universities Institute for Science and
Education in calculating thyroid gland doses from administered Ii3i and from many others who
spoke to us, reviewed our drafts, and provided other input. In addition, the Committee wishes
to thank ACHRE for helping us review historical documents related to the conduct of medical
research by the U.S. military in the 1950s. And, finally, I would like to thank personally the
members of the Committee for their devoted participation in this activity.
Although it is difficult and relatively unsatisfying to comment after the fact on what
should have been done at a point some 40 years in the past, the Committee felt that this
investigation into past actions is Important. Lessons from the past can lead to better research
today, especially when it comes to cross-cultural studies. In addition, understanding the past can
help set aright the continuing and long-term effects of a perceived betrayal of trust between the
Alaska Native peoples and the incoming, dominant culture-represented in this case by the
scientific community. This study and the public dialogue that occurred in the course of the study
are a positive step in making complete information available and meeting modern standards of
accountability .
Chester Pierce, Chair
Committee on Evaluation of 1950s Air Force
Human Health Testing in Alaska Using Radioactive Todinei3i
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Contents
EXECUTIVE SUMMARY
INTRODUCTION
The Committee's Charge, 9
The AAL and The Thyroid Function Study, 1 1
Conduct of the Study: Sample Size and
Distribution, 12
Conduct of the Study: Subject Selection, 14
Study Results, 20
The Committee's Methods, 21
Common Themes from the Public Session, 24
HEALTH EFFECT OF Il3l ADMINISTRATION IN HUMANS
Radiological Background of the AAL Study, 27
Overview of Epidemiological Evidence regarding
Radiation-Induced Thyroid Cancer, 27
Calculations of Radiation Risk, 33
Risk Estimates for the AAL Study, 36
Significance of Calculated Risks of
Radiation-Induced Thyroid Cancer, 37
Radiation Guidelines for IN Usage- Then and Now, 38
The Evolution of our Understanding of
Radiation Health Effects, 40
3
4
s
THE ETHICS OF HUMAN SUBJECTS RESEARCH
Background, 44
Conclusion, 60
CONCLUSIONS AND RECOMMENDATIONS
REFERENCES
x
1
8
26
43
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The AAL Thyroid Function Study
6
Xl
APPENDICES
A. Thyroid Function in Health and Disease 75
B. Summary of the Public Session 81
C. Thyroid Radiation Dose Estimates ll3} as
Determined by the Radiation Internal Dose
Information Center 87
D. Secretary of Defense Letter 88
E. Informed Consent Elements of Disclosure 92
F. Principles for the Conduct of Research in the Arctic 95
G. Biographical Sketches of Committee Members 99
H. Glossary 101
1
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