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HEALTH INQUIRY

(Cancer)

SATURDAY, OCTOBER 3, 1953

HOUSE OF REPRESENTATIVES,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D. C. The committee met pursuant to adjournment at 10 a. m. in the committee room of the House Committee on Interstate and Foreign Commerce, Hon. Charles A. Wolverton (chairman) presiding.

The CHAIRMAN. The committee will come to order.

In order to conserve time, I will make my opening statement pending the arrival of other members of the committee.

No American can fail to be aware of the tremendous importance of atomic energy in our daily lives. We know atomic energy principally as a weapon of mass destruction, developed and used during World War II and continuously extended and perfected since that time, in order that we may be able to defend ourselves against attack by those world forces which seek to destroy our way of life. We know that the enemy is engaging us in a race of atomic weaponsand while we pray God that the time will never come when these weapons will again be turned against mankind, as Americans we believe that free nations will never permit tyranny to rule, with coercion of groups and subjugation of the individual replacing the rights of free men.

It is in the American tradition that the very knowledge needed to create these deadly weapons is applied in equal measure to peaceful pursuits—to industrial uses, to agriculture, and to health and medicine.

This committee is now engaged in a broad study of health. We have undertaken this inquiry not only because the committee has legislative responsibilities in this field, but also because we feel it is important to inform the American public of certain basic facts relating to the important diseases of today—what progress has been made, the magnitude of the disease problems today, and what hope there is for the future, what can be done to speed up the prevention and control of these diseases which exact such a tremendous toll in human suffering and in economic loss.

Yesterday, we heard some splendid testimony by scientists and interested laymen on the general subject of cancer.

We were informed, among other things, that radiation can be both a cause of and a cure for cancer. One cannot think of radiation or of atomic energy without talking almost in the same breath of the Atomic Energy Commission. This committee was particularly proud and pleased that the Atomic Energy Commission agreed enthusiastically to participation in these hearings and has sent us today some of its most distinguished representatives to discuss the medical and biological effects of radiant energy.

The Atomic Energy Commission, as is well known, has the huge responsibility of controlling atomic energy for the welfare of man. At the same time, it has the obligation to explore its nature, its implications, and its applications.

The members of this committee are very pleased to have your testimony, gentlemen. The pattern that has been established for these hearings is one of extreme informality. We hope you will feel free to discuss all the ways in which atomic energy relates to health, whether or not it has to do specifically with cancer. The other groups that have been before us have nominated a discussion leader and have conducted, in effect, an informal symposium, based on a prepared agenda. I understand that Dr. John C. Bugher is prepared to act as discussion leader for this group. It would be appreciated, Dr. Bugher, if you would identify yourself for the record, and if your colleagues would do the same, in order that the reporter may be able to identify each speaker.

Dr. BUGHER. Thank you, Mr. Chairman. I believe the reporter has had the names of the participants.

The CHAIRMAN. Would you be kind enough to speak just a little louder, please?

Dr. BUGHER. Yes, sir.

The CHAIRMAN. I would suggest that after you have finished giving your background and your official position, and so forth, that you call on each one of the members of your group who are here today and have them rise and give their background and position, or you may do it, according to the way you think it would be better. STATEMENT OF DR. JOHN C. BUGHER, DIRECTOR, DIVISION OF

BIOLOGY AND MEDICINE, ATOMIC ENERGY COMMISSION, WASHINGTON, D. C.

Dr. BUGHER. May I present myself, then, as presently Director of the Division of Biology and Medicine of the Atomic Energy Commission and formerly with the Rockefeller Foundation in New York City.

On my left is Dr. Charles L. Dunham, who is Chief of the Medical Branch of this Division and in charge of all its medical activities.

Next to Dr. Dunham is Dr. Robert Hasterlik, of the Argonne Cancer Research Hospital in Chicago, affiliated with the University of Chicago. Next to him is Dr. Shields Warren, the first Director of the Division of Biology and Medicine of the Atomic Energy Commission, its organizer and the leading spirit in the medical application of atomic energy in this work, who has now returned to his regular post as professor of pathology at Harvard Medical School and pathologist to the Deaconness Hospital in Boston. Next to him is Dr. Marshall Brucer, director of the Oak Ridge Cancer Hospital, pertaining to the Oak Ridge Institute of Nuclear Studies. And, finally, Dr. John T. Godwin, pathologist for the medical department of the Brookhaven National Laboratory on Long Island.

The CHAIRMAN. We express to you, Dr. Bugher, and your associates who are here this morning our very great appreciation for your willingness to come to the committee and give of your knowledge as the result of your study and experience in matters which have held your attention and activity. We appreciate that it means some inconvenience for you to be here, and for that reason we appreciate it all the more your appearance here today among us.

Now, Dr. Bugher, you may proceed in whatever way you desire to develop the information that it is your purpose to bring to the attention of the committee; and when each one has fininshed his statement, we would appreciate the opportunity of members of the committee, if they so desire, to ask questions.

We also want the members of the panel who are here today to feel free to ask questions of each other if they wish to do so for the purpose of clarification or emphasis, so that we will be able to get the greatest possible amount of worthwhile information as the result of having you here together this morning.

You may proceed, Dr. Bugher. Dr. BUGHER. Thank you, Mr. Chairman. On behalf of Chairman Strauss of the Atomic Energy Commission and the other members of the Commission, I wish to express their appreciation of the invitation of this committee to present the atomic-energy program in cancer.

On behalf of myself and my colleagues, we are honored at being allowed to appear before you and very deeply appreciate the privilege which we have been given.

In the testimony of yesterday the magnitude and complexity of the cancer problem was very effectively brought out. The general subdivisions of the broad attack on the disease and the manner in which the various resources of the country are being brought to bear have been outlined by various organizations and agencies that are so deeply concerned.

It is possible, therefore, to be very brief in stating the mission of the Atomic Energy Commission with respect to its responsibilities in this field. The great reasons are twofold: First, cancer is one of the specific industrial hazards of the atomic age and second, the unique reactors, the accelerators, and the radioactive substances, which are the result of the Atomic Energy Commission's activities, hold great promise for useful applications to medicine generally and to the treatment of cancer in particular.

So, we envision two primary responsibilities and concerns: One, with radioactive materials as causative agents of cancer and the other with the application of new sources of radioactivity to the treatment of cancer. There is a twofold approach therefore to this problem. The approach of the Division of Biology and Medicine of the Atomic Energy Commission is one devoted entirely to research in these two broad aspects of the cancer problem. It is not the objective of the Division to operate programs in the control of cancer nor to conduct mass treatment of the disease. These functions pertain to other agencies and organizations which have appeared before you. Our purposes are to increase the understanding and knowledge of the causation of cancer and to develop new and hitherto unknown applications of nuclear energy and to make them generally available for cancer therapy. Cancer research, therefore, constitutes about 10 percent of our entire research activity in biology and medicine.

I think it is pertinent to add here that this general medical program of the Atomic Energy Commission is applicable both in peace and war. Its greatest motivations are peacetime applications. The results of the research are almost entirely in the unclassified field. So that they are available generally to the medical profession and are published normally in the regular means of dissemination of knowledge with reference to medical sciences generally.

Now on the question relative to the causation of cancer, among the many extrinsic factors—that is the factors affecting the individual from without—in the causation of cancer we now recognize nuclear radiation as being among the most important. The occurrence of skin cancer in persons subjected to prolonged X-ray exposure has been known for many years. In fact, the very first persons working with X-ray became severely burned, and as you will recall, many of them subsequently developed skin cancer as the result.

At a later date it was further realized that astonishingly small amounts of radium deposited in the bones may give rise to highly malignant bone cancers after many years of such exposure. As our knowledge has advanced, we have come to appreciate that the time interval between the original injury and the ultimate appearance of cancer due to this injury may be very long and measured in years. Thus, we must give particular attention to all those activities within the atomic-energy program as the result of which individuals may be exposed to radioactive substances either through the inhalation of radioactive dusts or the ingestion of food and water containing these substances.

In effect, this means that we are concerned with all stages of the atomic-energy program from the initial mining of uranium ores to the remote effects resulting from the detonation of atomic weapons, as in the extensive studies of the Atomic Bomb Casualty Commission in Japan by the Atomic Bomb Casualty Commission operated by the National Academy of Sciences.

So, our concern begins with the problem of the miner in getting the ore from the ground, and it does not end until we have evaluated the long-term effects of exposure of radiation whether from bomb, reactors, or whatever type of origin such radiation may have. At many points our responsibilities overlap and merge with those of the United States Public Health Service, the State health departments and other agencies. You will find, therefore, that the Atomic Energy Commission, the United States Public Health Service and various State departments are actively pursuing cooperative studies in the possible hazards of inhalation of dust in uranium mines.

We are also conducting extensive research in the national laboratories and in many universities on the effects of inhalation and ingestion of fission products resulting from the operation of reactors or by the detonation of weapons. By fission products I refer to the atomic fragments which result from the fission of the uranium nucleus, so that resulting from that fission we have a great number of elements, most all of them for the time being at least are highly radioactive. So, that not only the original materials, but the results of the fission reaction itself, become highly important in this general area.

Furthermore, the dynamic drive of physical research into the nature of the world about us and in the structure of the atomic nucleus itself has resulted in the production of elements unknown in the natural world. Some of these, such as plutonium, are being produced

in a large quantity. Being alpha emitting elements and thus similar to radium, they present profound problems in the protection of health. By the expression alpha emitting I am referring to the spontaneous emission of charged particles which are actually

nuclei of the helium atom, and all of the elements being concerned having the capability of carrying large amounts of energy a short distance. The distances are very short and are measured in one-thousandth of an inch, but all of these elements, such as plutonium, radium, and so on, have this property of spontaneous radioactivity. The production of alpha particles may be very important when taken internally, and we have a lot of these new elements which we can mention including not only plutonium, but such things as americium and curium, elements which do not exist in nature and which have been entirely manmade. The number is constantly growing and each one presents unique problems of toxicity as well as various aspects which are quite new to our sciences.

So much for the general introduction of the program dealing with the causation of cancer. The other side is the research in the treatment of cancer—the therapy of the disease, and as was mentioned in the beginning, the Atomic Energy Commission's program has made possible the existence of unique devices and substances

whose applicabilities in the treatment of cancer must be explored. Some of these applications have great promise, but with a disease of such complexity as cancer—which is actually a host of many diseases—we cannot expect a simple answer to the problem of treatment but, rather, the development of many methods, each with special virtues in particular situations. The clinician needs many and highly diverse tools at his disposal if the whole capabilities of modern science are to be made fully effective in this field.

I think it has been made clear in the previous testimony here that there are various ways in which one may attack the problem of cancer in the cancer patient, each way having the objective of destruction of the cancer cell

. We do not see any one way in which that may be accomplished, but rather a variety of ways, and the more varied the resources of the physician in the treatment of his patient, the more effective should be the result.

These therapeutic resources in the atomic-energy field have in common the production of nuclear radiations which may consist of the electromagnetic gamma radiation similar to the X-ray, or of the charged nuclear particles such as the alpha particle which I mentioned, or the beta particles which are actually electrons and uncharged particles which are called neutrons. In other words, there are several different kinds of radiation which may be emitted from a single atomic nucleus.

There exist for the future the possible application of other nuclear elements such as mesons, but we know very little of such forms of radiation as yet, and we will have nothing more to say of such nuclear particles at the present time. These radiations may be emitted or produced in various ways.

The reactor or the atomic pile is the chief source of neutrons at the present time, the neutron being the uncharged nuclear particles. Likewise, the reactor is the means of producing the radioactive isotopes, of which we hear much in the cancer field today. Then, too, radiations of medical value may be produced by acceleraters such as the cyclotron, the

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