After the accident at the Fukushima Daiichi nuclear power plant, on March 11th, 2011, there are serious concerns regarding children’s health as a result of exposure to radiation.
According to Article 13 of “the Statute on Protection and Support for the Children and other Victims of the 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.”
It is stipulated that for children who have resided in areas with over a certain level of radiation exposure, the country shall implement policies in order to ensure them periodic health examinations for their entire lifetime.
However, the Statute is a basic law and no actual practical measure has so far been implemented.
Sufficient health investigations are not being conducted, and the right of access to medical treatment as well as the right to know medical information about one’s own body has been seriously denied.
1. It has been reported by related countries that the number cases involving children’s thyroid cancer increased significantly after the accident at Chernobyl. In order to prevent thyroid cancer, it is required that the state and relevant prefectures take all necessary measures for examination and medical treatment to ensure the early recognition, treatment and follow-up of suspected cases. In addition, regarding other health concerns, it is required that authorities take preemptive measures by conducting periodic health checks on affected people.
In this regard, Fukushima prefecture entrusts bodies such as Fukushima Medical University to conduct thyroid examinations.
According to prefectural authorities, during the period from October 2011, to the end of March 2014, the first thyroid (ultrasonic) examination is due to be completed on those who were 0-18 years old on March 11th, 2011. [1]
However, at the current pace, three years since the accident will have passed until every child will take the thyroid examination. Following the forst examination, a full-scale thyroid (ultrasonic) examination is due to be scheduled every two years from April 2014, onwards for those who are younger than 20 years old, and every five years for those who are older.
In terms of early detection of childhood cancer, this is the slowest rate.
Furthermore, the thyroid examination is limited to people under 18 years old, and other examinations, including blood examinations and urine testing for cesium toxicity, that have to be conducted along with the thyroid examination, are not being practiced. [2]
The number of people who could take the internal exposure examination for the whole body counter remains tens of thousands [3], and a system of free and periodic examination has not been implemented.
The current testing system is not sufficiently formulated for the long term health monitoring for the affects of radiation.
2. Fukushima prefecture published the results of children’s thyroid examinations in March 2012.
According to these results, the prefecture conducted thyroid examinations on 38,114 people. From this group, 24,468 people (64.2%) showed no recognizable signs of thyroid nodules or cysts (A-1 level); 13,460 (35.3%) showed no recognisable signs of thyroid nodules under 5.0mm or thyroid cysts under 20.0mm (A-2 level); and 186 (0.5%) showed no recognizable signs of thyroid nodules above 5.0mm or cysts above 20.0mm (B level). [4]
However, only those who above B level are scheduled to be subject to a second examination. People at the A-1 or A-2 level cannot take a second examination, and will be monitored until the next examination (due after 2014).
Firstly, criteria that determines people are not to be subject to the second examination (unless they are diagnosed with thyroid modules above 5.1mm or thyroid cysts above 20.1mm), was set by authorities in Fukushima prefecture, and was not complied in accordance with international standardsor checked by third party organizations. There is no persuasive evidence that shows this to be a safe level.
This poses serious problems in recognition of thyroid nodules or cysts, by both evaluating safety based on arbitrary criteria, and not providing the opportunity for more precise examination.
In general, the progression of childhood cancer is rapid, and thus, from the standpoint of preventive medicine, “early detection, rapid cure” is required.
In cases where thyroid nodules or cysts are recognized, careful follow up is necessary, and progress of the illness should be checked periodically via ultrasound examination.
For those children who are recognized as having abnormal conditions by the thyroid examinations, it is required that the testing system continues to monitor their condition, examining them at least once a year.
3. Furthermore, a serious issue arises from the representation of Mr. Shunichi Yamashita, 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), and the pressure on other doctors who belong to the Japan Thyroid Association to utilize the same criteria.
On January 16th, this year, Mr. Yamashita sent an announcement to members of the Japan Thyroid Association.
This announcement deatils that in Fukushima prefecture, “those people who do not have abnormal conditions, as well as those who have thyroid nodules less than 5.0mm or cysts less than 20.0mm are not subject to detailed examinations such as cytodiagnosis or to treatment.” Furthermore, regarding individual counseling to the doctors belonging to the Association, the announcement stated “please understand that additional examination is not necessary as long as people do not notice any symptom by themselves, and please explain this to the patients.”
A certain number of cases reported that many doctors refused additional thyroid examination based on the announcement, regardless of the requests from parents who are worried about the affects of the nuclear power plant accident. This is an unacceptable action that prevents access of citizens to medicine and medical treatment, and deprives them the opportunity of a second-opinion.
There is no disadvantage in use of noninvasive examinations such as ultrasound examinations, therefore, there is no legitimate reason for this kind of paternalistic regulation by the public administration.
4. Furthermore, information provision regarding the test results is another serious issue. In the Fukushima thyroid examination, people at the A-2 level were determined to be “generally fine,” or “small nodules or cysts were found, but a second examination is not necessary,” but detailed explanations were not provided.
Fukushima prefecture answered HRN’s inquiry by stating that it had recently improved its methods of information provision, and information about the size and the number of nodules or cysts are now being provided (August 28th, 2012).
However, medical records and ultrasound examination images are not disclosed to the examinees, printed images are also unavailable.
Moreover, information disclosure about examinations is not allowed unless information disclosure procedures are undertaken based on the law. Even if the procedure is undertaken, digital data of the ultrasound examination is not disclosed, and people can only obtain a photocopy of a still image. [5]
Under such conditions, parents and their families cannot access important information about children’s health conditions, even when abnormalities are found, and they are prevented from the right to self-determination about their own body. In addition, this also deprives them of the opportunity to ask for a second opinion and of seeking further examination or treatment.
Medical records belong to first person, not to examination institutes. Examinees have a right to access undisclosed 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 this retained personal information, as 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 state that “in principle, medical professionals have to disclose medical records when requested by the patients. When patients request a supplemental explanation along with the provision of the medical record, the medical professional has to provide an explanation as early as possible.” [7]
The examination result (the sonogram) should be shown to the individual or their parents, and an explanation should be provided when requested by them. Also, all documents from the examination result should be disclosed whenever requested, without the need for undertaking a procedure of information disclosure. In addition, the information should be stored for a long period to aid the comparison of the symptoms at the follow-up examination. [8]
5. Since the prefecture announced that it would conduct thyroid examinations only once every two years, some municipalities are attempting to conduct 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 thyroid examinations, even in the event of compelling requests from residents.
6 What is necessary now is to continue a transparent monitoring system about the influence on health, and to identlify abnormalities at an early stage and provide appropriate treatments. Test results should be provided promptly, to secure the right to access information about patients own bodies.
However, the current examination system in Fukushima prefecture, deprives residents of their right to medical treatment, and prevents access information about their own bodies.
Fundamental changes to the examination system is strongly required in order to monitor the influence of radiation exposure over the long-term, and to realize the need for early treatment.
Human Rights Now requests Fukushima prefecture to:
1. Conduct thyroid examinations of children at least once a year to ensure “early identification” and “early treatment.” Especially when thyroid nodules or cysts are recognized, and to establish and implement the system quickly;
2. Expand the thyroid examination to adults, and also conduct blood and urine examinations;
3. Provide information from the thyroid examination and others (such as blood examination and thyroid sonogram) conducted by the prefecture to individuals concerned, and provide explanations if requested;
4. Store the results of thyroid examinations over a long period of time for future follow-up and comparison, and to disclose information from the examination results when requested by the examinees or their parents, without demanding information disclose procedure. Also, take necessary measures so that other municipalities and medical institutes that provide health examinations can share data obtained.
Human Rights Now requests the state to:
1. Take a position of protecting the residents’ rights to health around the nuclear power plant accident, as a responsibility of the state, construct guidelines regarding health checks, examination, and medical treatment promptly; while taking into account international opinions and good practice of medical policies, such as those taken by countries after the Chernobyl accident;
2. Publish guidelines about information disclosure health examination results, including thyroid examinations, and disseminate relevant professionals;
3. As a state, commit to the health checks of the prefecture, and request drastic reform and improvement of the examination system, based on the above mentioned recommendations towards Fukushima prefecture;
4. Provide financial support to municipalities in Fukushima prefecture, to enable the establishment of examination systems; including thyroid examination and internal exposure examination; secure base hospitals for health examinations including thyroid examinations in all areas in Japan, and provide financial support so that affected people are able to take necessary examinations, such as thyroid and internal exposure examinations, free of charge at least once per year, regardless of their location.
HRN requests Mr. Shunichi Yamashita (head of the Exploratory Committee on the “Fukushima Health Management Survey,” vice president of the Fukushima Medical University, and president of the Radiation Medical Science Center for the Fukushima health management survey) to:
1. Officially withdraw the announcement sent to the members of the Japan Thyroid Association (dated January 16th, 2012).
The above recommendations are important steps to protect the right to health (Article 25 of the Constitution, and the International Covenant on Economic, Social, and Cultural Rights), therefore, prompt improvement and implementation are required.
[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)