After the accident of the Fukushima Daiichi nuclear power plant, children's health is seriously concerned because they have been exposed to radiation.
According to Article 13 of "the Statute on Protection and Support for the Children and other Victims of Tokyo Electric Power Company Nuclear Power Plant Disaster," "the country shall take necessary means to provide periodic screening to the victims, and continue to investigate the potential effects of radiation on human bodies."
Regarding children who have resided in the areas with a certain level of radiation exposure, it is stipulated that the country shall implement policies in order to ensure them the periodic health examination for their entire lifetime.
However, the Statute is a basic law and no practical measure has been implemented.
On the other hand, in the field, sufficient health investigation is not conducted, and the right of access to medical treatment as well as the right to know about one's own body has been seriously denied.
1. It is reported by the related countries that the number of children's thyroid cancer increased significantly after the accident of Chernobyl. From the past experience, to prevent thyroid cancer, it is required that the state and the prefectures will take all necessary measures of examination and medical treatment for the early recognition, treatment and follow-up. In addition, regarding other concerned health disturbances, it is required to take preemptive measures by conducting periodic health check.
In this regard, Fukushima prefecture entrusts such as Fukushima Medical University to conduct the thyroid examination.
According to the prefecture, during October 2011 and the end of March 2014, the first thyroid (ultrasonic) examination is practiced to those who were 0-18-year-old as on 11 March 2011. [1]
However, at this pace, three years since the accident will have passed until every child can take the thyroid examination. Then, the full-scale thyroid (ultrasonic) examination will take place after April 2014 every two years for those who are younger than 20-year-old, and every five years for those who are older than that.
It has to be said that this is the slowest pace from the viewpoint of the early detection of childhood cancer.
Furthermore, the thyroid examination is limited to people under 18-year-old, and other examinations including blood examination and urine testing of cesium toxicity, that have to be conducted along with the thyroid examination, are not practiced. [2]
The number of people who could take the internal exposure examination by the whole body counter remains tens of thousands [3], and the system of free and periodic examination has not implemented yet.
From the current situation, it cannot be said that the testing system is sufficiently formulated for the long-term monitoring of the health influence of radiation.
2. Fukushima prefecture published the result of children's thyroid examination in March 2012.
According to this, the prefecture conducted the thyroid examination to 38,114 people. Among them, 24,468 people (64.2%) were not recognized neither thyroid nodules nor cysts (A-1 level); 13,460 (35.3%) were recognised thyroid nodules under 5.0mm or thyroid cysts under 20.0mm (A-2 level); and 186 (0.5%) were recognized thyroid nodules above 5.0mm or cysts above 20.0mm (B level). [4]
However, people who will be the subject to the second examination are only those who became above B level. People at the A-1 or A-2 level cannot take the second examination, and will be monitored until the next examination (later than 2014).
First of all, the criteria, which determines that people are not subject to the second examination unless they have thyroid modules above 5.1mm or thyroid cysts above 20.1mm, was set by Fukushima prefecture, and was not complied with the international standard or checked by the third-party organization. There is no persuasive evidence showed to prove the "safety."
This is a serious problem while recognizing thyroid nodules or cysts, evaluating safety based on the arbitrary criteria, and not providing the opportunity of the more precise examination.
In general, the progression of childhood cancer is really rapid, thus, from the standpoint of preventive medicine, "early detection, rapid cure" is required.
When the thyroid nodules or cysts are recognized, it is necessary to follow-up the case carefully, and to check the progress by such as periodic ultrasound examination.
For those children who were recognized abnormal condition by the thyroid examinations, it is required to realize the testing system to examine them at least once a year.
3. The even more serious issue is that some people represented by Mr. Shunichi Yamashita, or the vice-president of the Fukushima Medical University (and the president of the Radiation Medical Science Center for the Fukushima health management survey, at the University), are trying to force other doctors who belong to the Japan Thyroid Association to use the same criteria.
On 16 January this year, Mr. Yamashita sent an announcement to the doctors in the Japan Thyroid Association.
This announcement tells that in Fukushima, "those people who do not have abnormal condition, as well as those who have the thyroid nodules less than 5.0mm or cysts less than 20.0mm are not subject to the detailed examinations like cytodiagnosis or to the treatment." Furthermore, regarding the individual counseling to the doctors belonging to the Association, it is stated that "please understand that the additional examination is not necessary as long as people do not notice any symptom by themselves, and please explain it to the patients."
A certain number of cases are reported that many doctors refused the additional thyroid examination based on the announcement regardless of the requests from children and
their parents who are worried about the influence of the nuclear power plant accident. This is an unacceptable action that prevents the access of nationals and citizens to the medicine and medical treatment, and that deprives the opportunity of second-opinion.
There is no disadvantage around the examinations without invasive potential like ultrasound examination, therefore, there is no legitimate reason of the paternalistic regulation by the public administration.
4. Furthermore, the way of information provision regarding the test result is another serious issue. In the Fukushima thyroid examination, people those who were at the A-2 level were only announced to be "generally fine," or "small nodules or cysts were find, but the second examination is not necessary," but the detailed explanation was not provided.
Fukushima prefecture answered to the HRN's inquiry and stated that recently, it improved the way of information provision, and information about the size and the number of nodules or cysts are now provided (28 August 2012).
However, the medical record and the image of ultrasound examination are not disclosed to the examinees, and the printed image is also unavailable (same as above).
Moreover, information disclosure about examinations is not allowed unless the information disclosure procedure is taken based on the law. Even if the procedure is taken, the digital data of the ultrasound examination is not disclosed, and people can only get a still image copied on a photocopying paper. [5]
Under such condition, children as well as their parents cannot access to the important information about children's health condition even if some abnormalities are found, and they are prevented from self-determination about their own body. In addition, the opportunity of asking for the second opinion and of taking examination or treatment is deprived, thus, the situation can be irreparably serious.
Medical records belong to first-person, but not to the examination institutes. The examinees have a right to get the disclosed examination information, based on the right to know and the right to control information about his/herself as guaranteed in the Japanese Constitution (Articles 13 and 21).
Medical institutions, which accepted a consignment of the examination, have an obligation to disclose the retained personal information, as clearly stated in Article 25 of the Act on the Protection of Personal Information as well as in the "Guidelines for the Appropriate Treatment of Personal Information on the Medical and Nursing Professionals." [6] Also, the "Guiding Principles on the Information Provision of the Medical Examination" of the Ministry of Health, Labour and Welfare clearly states that "in principle medical professionals have to disclose medical records when requested by the patients. When patients request the supplemental explanation along with the provision of the medical record, the medical professions have to provide the explanation as early as possible." [7]
The examination result (the sonogram) should be showed to first-person or their parents, and explanation should be provided when requested by them. Also, all documents of the examination result should be disclosed whenever without the procedure of information disclosure. In addition, the information should be stored for long term for the follow-up and the comparison of the symptom. [8]
5. Since the prefecture expresses that it would conduct the thyroid examination only every two years, some municipalities are trying to conduct the supplemental examinations. However, the prefecture refuses to share the examination data to those municipalities because of "personal information."
There is no official financial aid for these supplemental examinations. Therefore, it is extremely difficult for municipalities to conduct the thyroid examination even they got the compelling requests from residents.
6. What is necessary now is to continue the transparence monitoring system about health influence, to prevent residents' health hazard, and to find abnormalities in an early stage and provide an appropriate treatment.
Then, it is also required to provide the test result to the examinee promptly, and to secure the access to the information about their bodies.
However, the current examination system of Fukushima prefecture, against these requests, deprives residents of their right to take medical treatment, and prevents the access to the information about their own bodies.
The fundamental change of the examination system is strongly required to monitor the influence of radiation exposure in a long-term, and to realize the early treatment.
HRN requests to Fukushima prefecture to:
1. Conduct the thyroid examination for children at least once a year for the "early identification" and "early treatment." Especially when the thyroid nodules or cysts are recognized, establish and implement the system quickly;
2. Expand the thyroid examination to adults, and also conduct the blood and urine examinations;
3. Provide information of the thyroid examination and others (such as blood examination and thyroid sonogram) conducted by the prefecture to first-person or their parents, and provide explanation if requested;
4. Store the result of the thyroid examination over a long period of time for the future follow-up and comparison, and disclose the information of the examination result when requested by the examinees or their parents, without asking the information disclose procedure. Also, take necessary measures so that other municipalities and medical institutes that will provide the health examinations can share the data.
HRN requests to the state to:
1. From the position of protecting the residents' rights to health around the nuclear power plant accident, as a responsibility of the state, construct the guidelines regarding health checks, examination, and medical treatment promptly. In the course of that, take into account the international perception and the good practice of medical policies, taken by the related countries of the Chernobyl accident;
2. Publish guidelines about the information disclosure of the result of health examinations including the thyroid examination, and instruct the prefecture;
3. As a state, commit to the health checks of the prefecture, and request the drastic reform and improvement of the examination system, based on the above mentioned recommendations towards Fukushima prefecture;
4. Provide a financial support to the municipalities in Fukushima prefecture to enable them to establish the examination systems including the thyroid examination and the internal exposure examination; secure the base hospitals of the health examinations including the thyroid examination in all areas in Japan, and provide a financial support so that the affected people are able to take necessary examinations, such as thyroid and internal exposure examinations, for free at least once a year, regardless of their living place.
HRN requests to Mr. Shunichi Yamashita (the head of the Exploratory Committee on the "Fukushima Health Management Survey," the vice-president of the Fukushima Medical University, and the president of the Radiation Medical Science Center for the Fukushima health management survey) to:
1. Officially withdraw the announcement (dated 16 January 2012) sent to the members of the Japan Thyroid Association.
These recommendations are all important to protect the right to people's health (Article 25 of the Constitution, and the International Covenant on Economic, Social, and Cultural Rights), therefore, prompt improvement and implementation are required.
Period.
[1] http://www.pref.fukushima.jp/imu/kenkoukanri/koujyou.pdf
[2] The blood and urine examination is limited to the residents living in certain areas such as evacuation area, and the urine testing of cesium toxicity is not practiced. http://www.pref.fukushima.jp/imu/kenkoukanri/kenkousinsa.pdf
[3] Among them, the majority is the Minami-soma Municipal General Hospital and the private Hirata Chuo Hospital. http://www.wa-dan.com/article/2012/06/post-830.php
[4] Among them, 184 people (0.48%) had the thyroid nodules above 5.1mm, 201 (0.53%) below 5.0mm; 1 person (0.003%) had the thyroid cysts above 20.1mm, and 13,384 (35.1%) below 20.0mm.
http://www.pref.fukushima.jp/imu/kenkoukanri/koujyosen- ketuka2403.pdf
[5] The Mainichi newspaper at http://news.livedoor.com/lite/article_detail/6890172/, and the HRN's inquiry to the Fukushima prefecture (28, August, 2012).
[6]http://www.mhlw.go.jp/topics/bukyoku/seisaku/kojin/dl/170805-11a.pdf
"Medical and nursing professionals, when requested by first-person to disclose the retained personal data, should disclose the data without delay." (page 30)
"It is desirable that the request for the information disclosure would be done in writing. However, in order not to prevent the free request by the patients and users, it is inappropriate to ask the reasons of information disclosure by setting the column of reasons on the document, or by questioning the reasons." (35 page)
[7] http://www.med.or.jp/nichikara/joho2.html, See also Article1 (4) of the Medical Care Act
[8] Article 24 of the Medical Care Act decides that the medical records (so-called the medical chart) should be stored for 5 years. Article 21 decides that the other documents such as clinic journals, prescriptions, the records of operation, and the images of ultrasound X-ray, should be stored for 2 years. The currently concerned ultrasound examination belongs to the medical record such as X-rays, thus, the 2-year storage is required.
[9] Regarding the relationship with Article 23 of the Act on the Protection of Personal Information, the "Guidelines for the Appropriate Treatment of Personal Information on the Medical and Nursing Professionals" mentions about the measures to obtain the consent. http://www.mhlw.go.jp/topics/bukyoku/seisaku/kojin/dl /170805-11a.pdf
Human Rights Now (3 September 2012)
