Since many years we have tried to demonstrate that certain scientific writers and environmental campaigners act in accordance with the interests of governments selling petroleum and natural gas [1,2]. Most evident is this tendency in regard to ionizing radiation; while the overestimation of medical and environmental side effects of nuclear energy contributes to its strangulation [3], supporting appeals to dismantle nuclear power plants (NPPs). Apart from economic and ecological absurdity, the cost of dismantling each NPP may reach into billions of dollars [4]. The use of atomic energy for the electricity production is on the agenda today due to increasing needs of the growing humankind. The health risks and environmental damage are maximal for coal and oil, lower for gas and much lower for atomic energy - the cleanest, safest and practically inexhaustible energy resource [3,5].

This review is focused on the radioactive contamination in the Urals, where the consequences have been more severe in the long run than those after the Chernobyl accident [1,2]. Mayak Production Association (MPA), built in 1948, has been the first plutonium manufacturing site in the former Soviet Union (SU). The dumping of radioactive materials into the Techa river, 1957 Kyshtym accident and dispersion by winds from the open repository lake Karachai (1967) led to exposures of residents. The East Urals Radioactive Trace (EURT) cohort includes people exposed after the Kyshtym accident. The difference between contaminations in the Urals and Chernobyl is that the latter was an accident, but the former - a radioactive contamination tolerated since 70 years with several accidents in between [6]. The Chernobyl catastrophe contributed to destabilization of the Soviet society with subsequent privatization of the state property; but it would be a speculation to claim that there was intention. At least, disregard for written instructions and safety rules were the causes of the accident [7-10]. Reactor safety systems were disabled deliberately in order to carry out an experiment [10,11], which might have been a pretext for covering the sabotage. The number of control rods in the reactor was only half the minimum required for safe operation [11]. The weightiest argument against NPPs is that they are potential war targets. Therefore, military threats are reasons against the use of nuclear power for electricity production. Escalation of military conflicts contributes to the maintenance of high fossil fuel prices. The Chernobyl accident was exploited for the same purpose [3], which has been followed by antinuclear protests in many countries [12,13]..

In earlier Russian publications no cancer incidence elevation was reported in cohorts with average exposures <0.5 Sv or among MPA employees in general [14-19]. The absolute risk of leukemia per 1 Gy and 10000 man-years was found to be 3.5-fold smaller in the Techa river cohort compared to the Life Span Study (LSS) of atomic bomb survivors in Japan. This was reasonably explained by a higher efficiency of the acute exposure compared to chronic ones. Later on, the same scientists started claiming similar risks for cancer and other diseases in the Techa river, MPA and EURT cohorts as well as in LSS [20-22]. Analogously, an earlier study found a reduction of cancer mortality in the EURT cohort compared with the general population [17]. A review dated 2004 confirmed the same level of both cancer-related and all-cause mortality in the EURT cohort and the control [15]. In a later report on the same cohort, the authors avoided direct comparisons but fitted the data into a linear model. Configurations of dose-response curves shown in this paper are inconclusive but the authors claimed an elevated cancer risk in the EURT population [23]. An unofficial directive was apparently behind this ideological shift noticed around the year 2005. The trimming of statistics has been not unusual in the former SU [24]. Potential motives have been discussed previously: financing, international help after the Chernobyl accident, publication pressure, writing of dissertations and articles for scientific careers, stirring anti-nuclear protests in other countries and strangulation of nuclear energy for the boosting of fossil fuel prices. Some publications about radioactive contaminations in the former SU have common features: large volume, plentiful details and mathematical computations, but no clear insight into medical consequences. Cancer-related aspects of the problem have been reviewed previously [1,2,25,26]. Cardiovascular diseases and their supposed associations with low-dose low-rate exposures are discussed below. In earlier reports, an incidence elevation of cardio- and cerebro-vascular diseases, if even found in MPA, Techa river and EURT populations, was not accompanied by a mortality increase [27-29]. This can be explained by a greater diagnostic effectiveness in people having higher doses with registration of mild and questionable cases. However, in a recent paper based on the MPA cohort, an increased excess relative risk (ERR/Gy) of death from ischemic heart disease was claimed for the dose range 5-50 mGy/year [30]. It seems that our preceding comments [1,2], though not cited, have been taken into account by some writers. The recent review by Koterov et al. [31] has apparently been influenced by our comments cited by him in [32] and commented [33]; trying, however, to shift the responsibility for biased information onto foreign experts. This can be illustrated by the following quote from the English abstract: “In most sources, 2005-2021 (publications by M.P. Little with co-workers, and others) reveals an ideological bias towards the effects of low doses of radiation … In selected M.P. Little and co-authors sources for reviews and meta-analyses observed both absurd ERR values per 1 Gy and incorrect recalculations of the risk estimated in the originals at 0.1 Gy” [31]. Note that relevant papers with participation of Prof. Little [34-36] used the data provided by co-workers from the former SU. In this connection, the author agrees that the “Russian national mortality data is likely to be particularly unreliable, with major variations in disease coding practices across the country [references], and should therefore probably not be used for epidemiologic analysis, in particular for the Russian worker studies considered here [references]” [37]. Koterov [32] used mistranslations of quotes with a change of meaning in his Russian-language writings, commented in [33]. Enhanced risks of cardiovascular diseases were claimed for Chernobyl, MPA, Techa river and EURT populations, where average dose rates have been comparable with those from the natural radiation background. There are many populated areas in the world where dose rates from the natural background are 10-100-fold higher than the global average (2.4 mSv/year) with no health risks reliably proven [38]. The mean individual annual dose to residents of the Russian Federation in 2020 ranged from 2.47 mSv (Kamchatka) to 9.06 mSv (Altai) with an average of 4.18 mSv [39]. In the above-mentioned cohorts from the Urals the doses have been protracted over decades: studied MPA workers were first employed in the years 1948-1982. For example, the mean dose of gamma-radiation was 0.54 Gy in men and 0.44 Gy among women in a MPA cohort study, where the incidence of arteriosclerosis in lower limbs correlated with the radiation dose [40]. The average doses in the Techa river cohort were 34-35 mGy whereas the follow-up was since the 1950s [41], so that the dose rates were comparable with the natural background. Apparently, the Techa river data do not possess sufficient statistical power to determine the shape of a dose-response curve. The authors acknowledged that the risks for the doses ≤0.1 Gy may be smaller than those calculated on the basis of a linear model [42]. In particular, the uncertain and biased data are unsuitable for computations of the Dose and Dose Rate Effectiveness Factor (DDREF). Earlier Russian publications stressed the higher biological efficiency of acute exposures compared to chronic and fractionated ones [16]. Later on, the same scientists claimed that the International Commission on Radiological Protection (ICRP) underestimates cancer risks from chronic exposures, and recommended the use of DDREF = 1.0 [43], thus implying the equal efficiency of acute and chronic exposures. This recommendation is obviously unreasonable for dose rates comparable with the natural radiation background. The “inverse dose-fractionation effect” (more damage from protracted than from acute exposures), claimed by some researchers for exposures <0.1 Gy [44], was probably caused by bias or artifacts.

It has been rightly noted in the recent review that a “diagnosis (by a physician knowing the patient’s history) could vary with dose” [35]. This notion has been reiterated previously [1,2,25,26]. Mild and borderline derangements are more often diagnosed in people with higher doses due to more thorough examinations and the subjects’ attention to their own health. The high incidence and mortality of cardiovascular diseases in studied populations from Russia [34] can be explained by the screening effect with registration of mild cases and unsubstantiated diagnoses post mortem. At least in the former SU, there is a tendency to use cardiovascular diseases in post mortem diagnoses and death certificates in unclear cases [45]. A recent study based on the MPA cohort analyzed 9469 cases of cerebro-vascular diseases including 2078 strokes. The following statements seem to be contradictory: “Cerebro-vascular diseases incidence was found to be significantly associated with cumulative radiation dose” and “No significant associations of either stroke or its types with cumulative gamma-ray dose of external exposure or alpha-particle dose of internal exposure were found” [46]. It can be reasonably expected that with more arterial occlusions and stenoses there would be more strokes. An explanation for the discrepancy is the dose-dependent diagnostic quality and the screening effect in subjects with higher doses. At that, mild and borderline conditions are recorded more frequently. On the contrary, strokes are usually diagnosed based on distinct morphological and/or clinical criteria, the overdiagnosis being less probable. The authors should have concluded that there was no incidence increase of stroke after the low dose low-rate exposures, which is common knowledge. By including overdiagnosed mild conditions, they were able to generate a headline that low-dose radiation elevates the frequency of cerebro-vascular diseases. The unreliability of data on mild conditions is confirmed by the following. Greater risks of cerebro-vascular diseases at higher doses in females than in males [46] agree with the known tendency that women in Russia care more than men about their health. Middle-aged and elderly men are visibly underrepresented among visitors of healthcare institutions; hence the worldwide greatest gender gaps in the life expectancy: countries of the former SU crown the list (Wikipedia: List of countries by life expectancy). Accordingly, the diagnostics in women is on average more efficient and reliable than in men. This notion does not contradict to the higher percentages in some male groups; cf. Tables 1 and 1S in [46]. The overdiagnosis of mild conditions may occur just because these conditions are expected. The author encountered e.g. descriptions of age- and hypertension-related changes of retinal vessels in a medical record of a middle-aged man after a dispensarization (yearly workplace examination) although his eye grounds had not been inspected. As for post mortems, supposedly age-related changes (aortal, coronary, cerebral or basilar atherosclerosis) have been routinely written into autopsy reports and death certificates without sufficient evidence [45]. Considering the above, in higher-dose groups the diagnostics would be more reliable resulting in a greater screening effect particularly in women but less frequent unsubstantiated recordings especially in men. Moreover: “The estimates of the cerebro-vascular diseases incidence risk significantly decreased with the increasing duration of employment for the entire cohort (p < 0.001)” and, at the same time, “a significant decrease in cerebro-vascular diseases incidence risk with increasing attained age was observed in both males and females” [46]. The incidence of cerebro-vascular diseases increases with age; so that the above citations are compatible with a protective effect of radiation. Apparently, effects of dose fractionation have been confounded by time-related factors, in particular, by the age and time since exposure, neither of which was adjusted for in the studies under discussion. It is likely that lower dose-rate exposures have been accumulated more recently and at older ages, so that dose rates were confounded by time-related factors such as the age and employment duration [44]. The excess relative risk (ERR/Gy) of cerebro-vascular conditions among MPA employees was claimed to be even higher than in LSS [47,48]. Of note, some LSS data assessments are compatible with favorable effects of low doses i.e. hormesis [49-52]. A dose-response association for cancer was detected among atomic bomb survivors who received doses ≤0.5 Sv but not below 0.2 Sv [52-54]. The data about renal cancer in men were compatible with a U-shaped dose-response and negative ERR at low-to-moderate doses [50]. An earlier article by the same researchers showed different dose-response curves for males and females [55]. Other studies found no significant risks for kidney cancer from low doses [56,57]. The inter-study heterogeneity makes assessment of risk problematic [44,58]. Apparently, epidemiological data have too many uncertainties for a reliable evaluation of low-dose effects.    

The following generalizations by Russian scientists create biased impression of risks from low dose low-rate radiation exposures. The statements quoted below, not specifying dose levels, are inapplicable to the cohorts under discussion and to low doses in general. Statements of this kind, reiterated in different papers, indicate that the risks have been exaggerated deliberately. An unofficial directive was probably behind this ideological bias. Trimming of statistics has been not unusual in the former SU [24]. Here follow the examples: “It was shown that ionizing radiation is one of the promoters of the development of atherosclerosis” [59]. “It is concluded that this study provides evidence for an association of lower extremity arterial disease incidence with dose from external gamma-rays” [40]. “This study provides strong evidence [emphasis added] of ischemic heart disease (IHD) incidence and mortality association with external gamma-ray exposure and some evidence of IHD incidence and mortality association with internal alpha-radiation exposure” [60]. “A significant increasing trend in circulatory diseases mortality with increasing dose from internal alpha-radiation to the liver was observed” [61]. “Significant associations were observed between doses from external gamma-rays and IHD and CVD incidence and also between internal doses from alpha-radiation and IHD mortality and CVD incidence” [62]. “Findings are that aortal atherosclerosis prevalence was higher in males and females underwent external gamma-irradiation of total dose over 0.5 Gy, in males and females underwent internal alpha-irradiation from incorporated plutonium of total absorbed radiation dose in liver over 0.025 Gy” [63]. “There was a significantly increasing trend (ERR/Gy) of the IHD mortality with the total absorbed dose to liver from internal alpha-radiation due to incorporated plutonium” [27]. “The incidence data point to higher risk estimates [in MPA workers] compared to those from the Japanese A-bomb survivors” [64]. “The categorical analyses showed that CVD incidence was significantly higher among workers with total absorbed external gamma-ray doses greater than 0.1 Gy [emphasis added] compared to those exposed to lower doses and that CVD incidence was also significantly higher among workers with total absorbed internal alpha-particle doses to the liver from incorporated plutonium greater than 0.01 Gy compared to those exposed to lower doses” [47]. In particular, the risk estimates by Azizova et al. [65] were found to be significantly higher than those by other researchers [66]. Among members of the MPA cohort who received gamma-ray doses >0.1 Gy, the incidence of circulatory diseases was found to be higher than in people exposed to lower doses [47,48]. Cause-effect relationships are improbable at this dose level, considering the dose comparisons presented below. The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) [67] could not reach a final conclusion in regard to causality between exposures >1-2 Gy and cardiovascular diseases. Apparently, the level 1-2 Gy is an underestimation as a result of the screening effect, selection, self-selection, other bias and confounding factors in epidemiological studies. Dose levels associated with cardiac derangements in animal experiments and in humans after radiotherapy have been much higher than averages in the cohorts discussed above [68-72]. Results of experiments are generally not supportive of detrimental effects of low doses, with possible exception of genetically modified cancer-prone or otherwise susceptible animals [72,73]. In certain experimental and epidemiological studies, low doses turned out to be protective against cardiovascular and other adverse effects [71,74-79]. In humans after radiotherapy, myocardial fibrosis developed after exposures ≥30 Gy. An increased risk of coronary disease has been noticed after radiotherapy with doses 7.6-18.4 Gy [69], which is still much higher than averages in the cohorts discussed above. Moreover, cancer patients (and possibly also other diseased individuals) tend to recollect the circumstances related to radiation better than healthy controls (recall bias) thus getting higher dose estimates, contributing to dose-effect correlations [80]. Unrealistic cardiovascular risks at low-dose exposures call in question cancer risks reported by the same researchers. The overtreatment of supposedly radiation-related lesions has been discussed previously [1,24,81]. Mechanisms of damage at low doses remain speculative and the evidence inconclusive [44,82]. Summarizing the above and previously published arguments [1,2], the harm caused by anthropogenic radiation would tend to zero with a dose rate decreasing down to a wide range level of the natural background. The damage and repair are normally in a dynamic equilibrium. Accordingly, there must be an optimal exposure level, as it is for many environmental agents: visible and ultraviolet light, various chemical elements and compounds including products of water radiolysis [83]. Furthermore, evolutionary adaptation to a changing environmental factor would lag behind its current value and correspond to some average from the past. Natural background radiation has been decreasing during the life existence on the Earth [84]. There are many substances and physical factors in the environment that are toxic at some dose level. The lower would be anthropogenic exposure, the less would be its share compared to the natural radioactive background and other environmental factors. In this connection, the following claim is potentially misleading: “When considering the effects of irradiation on human health, it is necessary to clearly distinguish between the effects of increased background radiation to which adaptation can occur over many generations at the population level and the effects of irradiation as a result of accidents or medical procedures” [85]. It is the effective dose and dose rate that are important but not the source natural vs. anthropogenic. It should be also mentioned that there is considerable evidence in favor of hormesis [71,74-79,85-87]. Limitations of many pooled analyses include lacking consideration of the radiation type (acute vs. fractionated or protracted), of confounders and other relevant factors [88]. Some reviews analyzed together papers of different quality and reliability. As mentioned above, heterogeneity complicates any causal interpretation of results [44,58]. Finally, political and economical interests sometimes overweighed scientific objectivity [1,2]. Dose-effect relationships should be clarified in experiments with known doses and dose rates. Animal studies can provide reliable information. Among other species, the pig is a good model to study cardiovascular diseases as it develops spontaneous atherosclerotic lesions [89]. Further work with different species would quantify their radiosensitivity and enable more precise extrapolations to humans. Nuclear power has returned to the agenda because of increasing global energy demands and declining fossil fuel reserves. NPPs emit virtually no greenhouse gases compared to coal, oil or natural gas [5]. Hopefully, nuclear fission will be replaced in the future by fusion, which is intrinsically safer. The fusion should offer a source of clean power generation with a plentiful supply of raw materials [4,90]. Durable peace and international cooperation are needed for construction of NPPs in optimally suitable places, notwithstanding national borders, considering all sociopolitical, geographic, geologic factors, attitude of workers and engineers to their duties. Considering potential vulnerability of large NPPs during armed conflicts, attention should be directed to smaller nuclear reactors, which have some economic advantages. Small mobile reactors can be used also by the military. Nuclear power is the road to a carbon free future [91-94]. The optimal approach to the radiation protection regulations is to determine thresholds and establish regulations to ensure that doses are kept well below the thresholds [49], as low as reasonably achievable taking into account economical realities. According to a recent review, epidemiological data provide essentially no evidence of harmful effects at doses <100 mSv [95]. Artificial neural networks, applied to the LSS data, indicated the presence of thresholds around 200 mSv varying with organs [38,96]. The value 200 mSv has been mentioned in some reviews as a level, below which a cancer risk elevation is unproven [54,97]. In the author’s opinion, the current safety regulations are exceedingly restrictive. Elevation of the limits must be accompanied by measures guaranteeing their observance. Strictly observed realistic safety norms would bring more benefit for the public health and economy than excessive restrictions that would be violated in some countries disregarding laws and regulations.

Studies of human populations exposed to low-dose low-rate ionizing radiation, though important, will hardly add much reliable information on dose-effect relationships and DDREF. Screening effect, selection, self-selection and ideological biases will contribute to appearance of new reports on enhanced risks from a moderate anthropogenic increase of the radiation background, which would not prove causality. Manipulations with statistics have been not unusual in the former SU [24], which must be taken into account by authors of reviews and meta-analyses. Reliable results can be obtained in lifelong animal experiments. The life duration is a sensitive endpoint attributable to radiation exposures [98], which can measure net harm, if any, from low-dose exposures. It seems that some writers and environmental campaigners, exaggerating medical and ecological consequences of the anthropogenic increase in the radiation background, do not realize that they serve the interests of fossil fuel producers. Some of them may have good intentions; others are ideologically biased or serve certain governments or companies. Today there are no alternatives to nuclear power. The energy carriers will become increasingly expensive in the long run, contributing to excessive population growth in fossil fuel producing countries, and poverty elsewhere. The global development of nuclear energy must be managed by an international executive based in the most developed countries.

Declaration

No conflict of interest.

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