A perspective on public concerns about exposure to fallout from the production and testing of nuclear weapons.

Exposures of the American public occurred nationwide from the testing of nuclear weapons in the United States, the Pacific, and the former Soviet Union. After decades of diminished public awareness on the subject of health risks resulting from exposure to fallout, the release of the National Cancer Institute's 1997 report on nationwide exposure to 131I from the Nevada Test Site (NTS) has led to renewed interest. Public requests for information are focused on individual and family health problems, the right to credible and full disclosure of information, and the need for medical care and assistance for exposure-related health problems. Public concerns have been raised regarding: (a) the lack of information on the potential health risks from exposure to all biologically significant radionuclides in fallout; (b) the lack of independent oversight that includes public participation; (c) governmental portrayal of exposures averaged over very large segments of the population without identification of much larger values for individuals or population subgroups likely to be at highest risk; and (d) a governmental response to known or suspected human exposures that consumes large periods of time and devotes considerable funding to various research-related activities before serious consideration is given to addressing health care responsibilities to exposed individuals. To some extent, these complaints and concerns are rooted in the legacy of government secrecy surrounding the development and testing of nuclear weapons, public distrust of government sources of information about radiation exposures and health risks, and the imposition of past exposures without informed consent. Members of the public participating in the oversight of dose reconstruction projects and epidemiologic studies are requesting information on the total impact from all relevant sources of exposure at each site that might contribute significantly to an individual's risk, including exposure to local releases and to NTS and global fallout. Information is being requested on individual doses and risks from these cumulative exposures, with estimates of uncertainty, including estimates of the absorbed organ dose (as opposed to the effective dose), the risk of disease incidence as opposed to the risk of a cancer fatality, and the chance that a person's diagnosed disease was caused by past exposure (i.e., the probability of causation). This paper attempts to address some of these concerns. We conclude by noting that many individuals exposed in childhood during the 1950's to 131I in fallout from nuclear weapons production and testing would qualify for compensation and medical care if the present rules for the adjudication of claims for atomic veterans and radiation workers at DOE sites were to be extended to the public.