m Pars a oe Fh. an =e t 8 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be given to (a) updating, computenzing and linking radiation dosimetry, mortality and other data— nowoften manyyears out of date at a number of DOE facilities—and to (b) studies which “re-visit” worker cohorts to extend the follow-up periods, in view of recent studies which suggest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 DEAD RECKONING Pere POtrem m2 F Rev ON ale Beets bo Es