Book Review

Suffering Made Real: American science and the survivors at Hiroshima

N Engl J Med 1995; 333:198-199July 20, 1995

Article

Suffering Made Real: American science and the survivors at Hiroshima
By M. Susan Lindee. 287 pp., illustrated. Chicago, University of Chicago Press, 1995. $29.95. ISBN: 0-226-48237-5

In 287 pages of text and photographs, M. Susan Lindee describes the early history of the Atomic Bomb Casualty Commission in Japan in some detail, with particular reference to its work on possible radiation-induced genetic effects. She appropriately identifies many of the early cross-cultural problems and some obvious errors in the organization and implementation of a large binational epidemiologic study financed by the United States and principally directed by a very competent group of American investigators. Throughout the book, she implies that organizational deficiencies, internal dissension, American research practices, and a policy of not treating atomic-bomb survivors may have contributed to community resistance to the program and to the additional suffering of the survivors. She certainly leaves one feeling that these early problems in Japan may have been responsible for the inaccurate scientific results.

Unfortunately, Lindee has recreated history in accordance with her own interpretation of events during a politically tumultuous period in Japan during the occupation and thereafter. She shows little familiarity with Japanese customs and practices. The book contains technical inaccuracies, quotations out of context from commission letters and interoffice memorandums, references to many lay publications, and statements by people with uncertain political backgrounds. The author shows little understanding of the need for rigid scientific discipline and for the careful selection of matched control populations to determine late radiation effects.

The book contains little or no information about American contributions to the rebuilding of the Nagasaki Medical School; the educational assistance given to many Japanese radiologists, biostatisticians, and clinical investigators; the rigid commission policy of referring patients to Japanese physicians and hospitals for treatment of major medical problems; and the completely sanctioned policy of treating patients at the commission for minor medical problems. A notable omission is any reference to the 12-bed clinical unit at the commission, where, as early as 1953 and for the next 15 to 20 years, both Japanese and American physicians treated patients with leukemia and other hematologic disorders. Lindee gives little credit to the commission for accommodating many Japanese customs and requests, or to the many atomic-bomb survivors whose 70 to 80 percent participation rate in the commission's major adult-health study program even 30 to 40 years after exposure testifies to their recognition of its personal value and its scientific importance to humanity.

Lindee emphasizes possible procedural deficiencies in the search for evidence of untoward pregnancy outcomes and radiation-induced alterations of the sex ratio among children of survivors. For example, a footnote reference in the section on the Japanese midwives assigned to the genetics program concerns infanticide practices of Nazi midwives. This characterization is most unfortunate. Lindee fails to cite the long follow-up study of the first filial generation for evidence of increased mortality, mutation, sex-chromosome aneuploidy, and cancer incidence and the current search for evidence of possible DNA injury. No mention is made of the fact that virtually all major regulatory agencies throughout the world recognize that the results obtained by the commission (renamed the Radiation Effects Research Foundation in 1975) provide definitive and accurate information about possible radiation-induced genetic changes and late somatic effects in humans. The scope of genetic information about radiation exposure has broadened from mice to humans by virtue of these results.

The Japanese government, in recognition of certain scientific achievements and the overall excellence of the program, has given imperial awards to several of the more outstanding long-term American investigators at the commission. In her acknowledgments, Lindee states that most veterans of the commission are not sympathetic to her portrayal of the organization and its history. This is one of her few conclusions with which, as a nine-year veteran of the program, I wholeheartedly agree.

Stuart C. Finch, M.D.
Cooper Hospital–University Medical Center, Camden, NJ 08013