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to the real-time recording of morbidity dts Auhile
protecting employee confidentiality). This will serve as
an early-warning system for detecting changes in worker
health and will facilitate epidemiologic studies of mor-
bidity to supplement the present focus on mortality
studies.
of surrogate indicators, such as the number of unne
6. Establish a National Registry of Nuclear Weapons
Production and Cleanup Workers. A national registry
of nuclear weapons production and “cleanup” workers
should be established immediately and maintained prospectively, in cooperation with the Social Security Ad-
ministration, national and state death and cancer
registries and other appropriate agencies to facilitate
the monitoring of these cohorts throughouttheirlife-
times.It is essential that this recommendation(and the
two previous recommendations) apply to the employees of contractors and sub-contractors, who may currently be omitted from surveillance, as well as the
employees of the DOEitself. Contractors and subcontractors should be bound by the same regulations
and the sameprotocols for data collection and recording that apply to the DOE.
While it is beyond the immediate purview of our
study, we note that the inclusion in this registry of
workers in commercial nuclear powerplants and nuclear
shipyard workers would extend the umbrella of surveillance and,by substantially increasing cohort size,facili-
tate scientific investigation of the health effects of
low-dose ionizing radiation.
7. Update data and conductfollow-up studies. Pnonty
should be given to (a) updating, computenzing and
linking radiation dosimetry, mortality and other data—
nowoften manyyears out of date at a number of DOE
facilities—and to (b) studies which “re-visit” worker
cohorts to extend the follow-up periods, in view of
recent studies which suggest excess cancer mortality
(and longer than expected latency periods) after longer
follow-up.
8. Improve research methods. To the fullest extent
permitted by the flawed radiation dosimetry procedures and incomplete worker coverage of past decades
of DOE epidemiologic research, further studies of
the nuclear weapons workforce should: a) present
individual-specific radiation dose data; b) include all
workers at potential nsk; and c) differentiate the experiences of workers with longer length of employment
(and presumably length of exposure) and higher cumulanve doses from the experiences of those with
shorter lengths of employment and those with lower or
no doses. Pooling the data on these categones of
workers tends to dilute the exposed fraction of the
study members,biasing the results downward from any
actual radiation effect and causing observed results to
understate the actual risk.
14
Where possible, dose reconstruction should be understood to include and specify external, internal and
organ doses. Since nuclides are not uniformlydistnibuted within the body, use should be made of standardman models developed by the International Commission
on Radiological Protection. Greater use should be made
tests for internal exposure, to stratify workers by risk of
exposure. Data on medical irradiauon, backgroundra-
diation, smoking and otherlifestyle factors should be
collected and utlized.
9. Enhance environmental monitoring for sttespecific health investigations. There is at present no
coherent strategy for adequate investigation ofthe possible health effects in all the communities exposed to
off-site radioactive or other toxins released from the
nuclear weapons complex. Large-area studies, especially when used to measure death rates, are far too
insensitive. If good prospective epidemiologic studies
of populations near weaponsfacilities are to be under-
taken, an effort must be made to estimate levels of
exposure. The establishment of accurate environmental monitoring networks in every such community 1s
necessary to permit good dose measurement. Only
site-specific investigations based on such data can prop-
erly evaluate possible links between environmental contamination from the weapons complex and health effects
in a particular community. Such off-site monitoring
and off-site investigations should be coordinated and
directed by the proposed Radiation and Toxins Health
Assessment Office.
10. Provide complete and unrestricted access to data.
Complete and unqualified access to DOE and contrac-
tor records, and to ail other relevant epidemiologic
data, must be guaranteed both to HHS and subsequently, and in a timely fashion, to independent, nongovernmental scientific researchers, with no restraint
on publication or presentation offindings other than
the normal processes of peer review.
Il. Improve the link between research findings and
occupational safety programs. Systems should be developed to assure rapid transmission and communication of relevant research findings to those DOE and
contractorOfficials, including in-plant physicians, health
physicists, managers and administrators, with responsibility for occupational health andsafety.
12. Expand the budget and resources for radiation
and toxins health research. Congress should mandate
a substantially expanded budget for weapons complexrelated epidemiologic, occupational and environmental research. Substantial additonal numbers ofhighly
qualified epidemiologists, biostatisticians, specialists in
occupational and environmental health and other
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