URCLASSIFIEE data on radiation and toxic releases, and on workers’ exposures and health. Thus,independentscientific studies ofillness and deaths in potenually affected workers and nearby communities were impossible. The Development of Epidemiologic Studies Occupational and public health in the weapons plants were the responsibility of the DOE and its predecessors, the Atomic Energy Commission (AEC) and the Energy Research and Development Administration (ERDA), directly and through their contractors, as part of a process ofinternal regulation, surveillance and scientific study. One essential elementofthis effort was epidemiologic study. This involves: (1) the precise and continuous definition and measurement of radiation and other toxic exposures; (2) careful and long-term measurementofthe distribution ofillness and death in worker (and surrounding community) populations; (3) meticulous comparison with the health outcomes of less-exposed or unexposedindividuals. This is the most certain (if imperfect) route to the identification ofpreviously unknownrisks, the more precise quantification of those that are known, the design of protective measures, and the recognition of clues to the biological and environmental modes of action of the radiation and other toxins involved. Causal relationships between exposure and disease may be inferred if the data on exposure doses are precise, if other potentially confounding risk factors such as smoking are measured and adjusted for, if follow-up on health status is accurate and long enough to detect diseases which may have a long-delayed onset or latency period, and if the cohorts (the groups of exposed people studied) are large enough to permit securetests ofstatistical significance. Additionally, doseresponse calculations, a measure of the nsk associated with intensity and duration of exposure, may be made. Even whenall of these conditions cannot be fully met, as is often the case in epidemiologic studies, findings of excess disease and death may constitute signals ofserious possible danger and indicate the need, at theleast, for additional studies and for consideration of measures to reduce permissible exposure levels. Shortly after the end of World War II, the Atomic Energy Commission initiated extensive research into the health effects of radiation by supporting the Atomic Bomb Casuairy Commission (reorganized in 1975 asa binational U.S.-Japanese venture, the Radiation Ef- fects Research Foundation [RERF]) to explore the carcinogenic and other consequences of the (primarily acute, high-dose) exposures among Japanese survivors of the Hiroshima and Nagasaki bombings.? That effort has continued to the present; since 1945, approximately half of total radiation research expendimures by the DOEand its predecessor agencies have gone to RERF and half to studies of the (primarily low-dose and cumulative) radiation exposures and their consequences among nuclear weapons workers. Although the measurement of workers’ radiation exposures began in the earliest years of the Manhattan Project, the planning and conduct of large-scale epidemiologic studies of the workforce was not built .prospectively into theinitial stages of the development and growth ofthe government’s nuclear weapons complex, nor was this effort a prominent feature of the early decades of research, production and testing. Not * until the mid-1960s, with the award of a contract to Dr. Thomas Mancuso andhis colleagues at the University of Pittsburgh for studies at Hanford, Oak Ridge National Laboratory, and the Y-12 Plant and K-25 gaseous diffusion plant at Oak Ridge, was any major effort undertakenin the analysis of radiation exposures and health outcomesin the nuclear weapons workforce. However, whenpreliminary (and controversial} reports from the Mancuso team suggested a significant in- crease in cancerrisk estimates over then-currentbeliefs, the Mancuso contract was abruptly cancelled. Epidemiologic research was transferred and confined to the agency’s own laboratories (thus raising the real possibility of conflict of interest) and divided among them, rather than conducted as an integrated effort. In the decades since, large numbers of scientists have been employed, either directly by the DOEor through contracts with a limited numberof laboratories and uni- versities which the DOEselected anddirectly supervised, and a large body of epidemiologic work was undertaken and published.!° Secrecy and DOE Epidemiology Just as the wall of secrecy shielded all other aspects of the nuclear weapons program, these epidemiologic and related scientific studies were not subject to the usual conventions of open scientific or academic inquiry. While several scientific advisory committees intermittently consulted with or reviewed DOE epidemiology, the “culture of secrecy” permeating the entire nuclear weapons complex kept this work from outside scrutiny. This meant that AEC/ERDA/DOEandcontractor epidemiologists formulated their overall research plans, designed and organized their studies, decided which data to collect, made choices of measurement and monitoring techniques and instruments, and analyzed and interpreted their data as part of “an enterprise that has operated in secrecy for decades, without any independent oversight or meaningful public scrutiny.”"! While someresults from manyof the affected or poten- tially affected sites have been published in the open scientific literature, meeting the test of peer review, the basic data sets are stil] not generally available to independentresearchers, andit is unclear how manystudies were done but have never been released to the public. DEAD RECKONING apcieup 5. UNLESSoe ISB "