J'accuse : the continuous failure to address radiophobia and placing radiation in perspective - IOPscience
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Journal of Radiological Protection
OPINION ARTICLE • OPEN ACCESS
‘J’accuse.!’: the continuous failure to address radiophobia and placing
radiation in perspective
To cite this article: John C H Lindberg 2021 J. Radiol. Prot. 41 459
View the article online for updates and enhancements.
This content was downloaded from IP address 46.4.80.155 on 13/07/2021 at 17:11Journal of Radiological Protection
J. Radiol. Prot. 41 (2021) 459–469 (11pp) https://doi.org/10.1088/1361-6498/abf9e2
Opinion Article
‘J’accuse.!’: the continuous failure to
address radiophobia and placing radiation
in perspective
John C H Lindberg
Department of Geography, King’s College London, London, United Kingdom
Department of Surgery and Cancer, Imperial College London, London,
United Kingdom
E-mail: john.lindberg@kcl.ac.uk
Received 2 December 2020; revised 13 April 2021
Accepted for publication 20 April 2021
Published 1 June 2021
Abstract
As far as carcinogens are concerned, radiation is one of the best studied, hav-
ing been researched for more than 100 years. Yet, radiation remains feared
in many contexts as a result of its invisibility, its relationship with cancers
and congenital disorders, aided by a variety of heuristics and reinforced by
negative imagery. The strong socio-psychological response relating to nuc-
lear energy has made radiation a classical case in the risk literature. This is
reflected clearly following the nuclear accidents that have taken place, where
the socio-psychological impacts of the clear dissonance between real and per-
ceived health effects due to radiation exposure have caused considerable health
detriment, outweighing the actual radiological impacts. Despite considerable
efforts to normalise humankind’s relationship with radiation, there has been
little shift away from the perceived uniqueness of the health risks of radiation.
One consistent issue is the failure to place radiation within its proper per-
spective and context, which has ensured that radiophobia has persisted. The
radiation protection community must get better at placing its research within
the appropriate perspective and context, something that is far too rarely the case
in discussions on radiation matters outside of the scientific community. Each
member of the radiation protection community has an ethical, professional and
moral obligation to set the record straight, to challenge the misconceptions
Original content from this work may be used under the terms of the Creative Commons Attribution
4.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the
title of the work, journal citation and DOI.
© 2021 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved
1361-6498/21/+11$33.00 Printed in the UK 459J. Radiol. Prot. 41 (2021) Opinion Article
and factual errors that surround radiation, as well as putting it into the proper
perspective and context. Failing to do so, the well-established harms of radio-
phobia will remain, and the many benefits of nuclear technology risk being
withheld.
Keywords: radiation protection, risk perception, low-dose radiation, ALARA,
perspective
1. Introduction
The title of this piece is deliberately provocative, reflecting upon the longstanding issue of
radiophobia and the role played by a consistent failure by members of the radiation protec-
tion community in terms of placing radiation into proper perspective. In 1988, Nobel Prize
laureate Rosalyn Yalow published an opinion piece in Medical Physics, charging the scientific
community with failing to challenge exaggerated and unscientific claims regarding the health
impacts of ionising radiation, and therefore contributing to ‘radiation phobia’ [1]. However,
in the intervening 32 years following Yalow’s article, there has been no discernible change in
the approach to exaggerated or uncontextualised reports about radiation health effects from
the radiation protection community. Therefore, following the tradition set by the great French
naturalist writer Emile Zola, ‘J’accuse’ the radiation protection communities of having failed
to uphold their moral and ethical obligations towards the general public in regard to low-dose
radiation, and of allowing radiophobia to reign unchecked.
Radiophobia is by no means a new term, with its first known use in 1903 [2]—initially
concerned with radios and radio waves—and acquired its association with ionising radiation in
the late 1950s [3]. When comparing the anxiety, dread and emotive responses to radiation with
the diagnostic criteria for different clinical phobias or other mental illnesses [4], it is evident
that radiophobia is a misnomer. Nevertheless, radiophobia is a useful conceptual tool, which
the author elsewhere defined as ‘the socio-psychological and cultural relationship between
individuals and ionizing radiation, characterised by a clear mismatch concerning the actual
and perceived health effects of radiation exposure’ [5]. After all, it is well-established that
the general public’s relationship with ionising radiation is complex, with a clear ‘perception
gap’ between the risk perception of experts vis-à-vis the public, with the public consistently
overestimating the risks of nuclear power and nuclear waste, whilst underrating other radiation
risks [6–9].
This ‘perception gap’, and radiophobia, is fuelled by various mental processes—
heuristics—which humans use to aid decision-making and to make sense of the surrounding
environment. Most of the time, this decision-making relies on a ‘system’ which is automatic,
involuntary, intuitive, nonverbal, narrative and experiential, using images, narratives and meta-
phors to encode our reality [10]. Images, both actual and recalled from memory, are corner-
stones to both the conscious and subconscious mind [11] and play an important role in cog-
nitive and perceptual-motor tasks [12]. Marks argues that our ability to create visual imagery
is crucial ‘whether it is the everyday problem-solving required for stability, safety, and sur-
vival at home, in the workplace, or in the community’ [13]. Imagery, however, does not exist
in a vacuum, and the intersection between emotions, affect and imagery (including symbolic
and perceptual imagery) is crucial to decision making. The somatic marker hypothesis, argues
that images acquire ‘somatic markers’, i.e. feelings—either positive or negative—which are
linked to bodily reactions. In other words, when an image ‘…which defines a certain emotional
response is juxta- posed to the images which describe a related scenario of future outcome,
and which triggered the emotional response via the ventromedial linkage, the somato-sensory
460J. Radiol. Prot. 41 (2021) Opinion Article
pattern marks the scenario as good or bad’ [14]. Once judged, the images and their somatic
markers are pooled, the intensity of these images’ markers vary in strength, and are consulted
when making a judgment [15]. This associative pool and its imagery ‘…come laden with asso-
ciations in the form of feelings, e.g. attraction, calm, tranquility, fear, anger, or anticipation’
[13] and upon subsequently encountering an image, different emotions would be triggered. A
negative marker would, upon the encounter with a previously-known image, raise awareness
and alarm, whereas an image with a positive marker would, conversely, act as an incentive
[14, 16].
Radiation, especially within the context of nuclear power, have in many parts of the world
acquired very powerful, and very negative, imagery. This imagery is partially linked to nuclear
war, partially linked to cancers and the notion that radiation poses a threat to future genera-
tions, as well as the notion of nuclear accidents being catastrophic, high-fatality events [17].
This mental imagery has been reinforced by the fact that in the aftermath of nuclear acci-
dents, be it Three Mile Island, Chernobyl or Fukushima, there has been claims about con-
siderable numbers of fatalities due to radiation exposure [18–21]. These often rely on a dis-
credited application of collective dose which calculates health detriments by multiplying very
low doses (often in the microsievert range) with large populations, without accounting for
uncertainties or background rates. These claims are often highly publicised and often presen-
ted without the appropriate context or perspective being offered to the audience. However,
as a result of radiation’s invisibility to the senses, the public is entirely reliant on the inter-
pretations and the expertise of the scientific community—especially the radiation protection
community [22]. The historic communication failures of the radiation protection community
have given the impression that such alarmistic reports reflect the views of the broader scientific
community. Given the importance of imagery and emotions, it is not surprising that nuclear
power causes feelings of dread and anxiety—it would perhaps be more peculiar if people did
not fear radiation.
2. Fuelling radiophobia: the low-dose controversy
The long-standing debate around potential health effects of low-dose radiation, has played a
crucial role in reinforcing radiophobia. There are few areas of the natural sciences that are as
well-researched and as well-understood as radiation, with the research into its health effects
having been studied for more than 100 years. The debate surrounding the potential health
detriments associated with low-dose radiation is one which has been ongoing for many dec-
ades [23–27], and it is unlikely epidemiological evidence about health effects at or below
background doses and at low rates will be forthcoming in the near future. However, it is well-
established that large doses of ionising radiation can be dangerous, equally, we know that
exposure to radiation doses at or below background levels have very low impacts. Whereas
the academic debate pertaining to the exact nature of the dose-response below 100 mSv will
continue there are three sets of conclusions that the radiation protection community should be
able to agree on:
(a) The health effects of the exposure to low-dose radiation, especially at low dose-rates,
would be very small. Assuming that the linear no-threshold (LNT) model holds true down
to background levels of dose, the ICRP risk factor applied to fatal cancer of 5% per Sv
[28], implies a risk from annual exposure of around 0.015%, a very small addition to the
overall risk of dying from cancer (28% of UK deaths) [29]. Any such risk would be lower
than many risks routinely encountered by individuals, including lifestyle factors, such as
461J. Radiol. Prot. 41 (2021) Opinion Article
obesity or smoking, and environmental factors, such as exposure to significant air pollution
[30], many of which can be reduced by the application of nuclear technologies;
(b) There is no epidemiological evidence of heritable effects in humans due to irradiation of
parental germ cells [31–38] although it is considered prudent to assume a very small risk at
low doses and the ICRP [39] use a value that is less than 5% of the very low cancer risk (i.e.
0.0002% per mSv). Whilst there is evidence of cancer risks, including childhood cancers,
as a result of irradiation in utero [39, 40], the risk estimates for low doses are very low and
excesses are highly unlikely to be observable in populations exposed following nuclear
accidents. Malformations following in utero exposures occur above dose thresholds and
would not result from low doses received following nuclear accidents, despite claims to
the contrary [19, 41–43];
(c) Collective dose assessments for calculating health impacts for the purposes of risk projec-
tions should be approached with great caution, especially at doses which are at or below
background levels. Consideration of background rates and uncertainties will show that
predictions of possible cancer cases at low doses without context will be meaningless and
misleading [39, 44].
The connection between these three points and radiophobia? By not placing radiation risks
into perspective, as is customary with other risk assessments, the perceived uniqueness of
radiation risks remains, thanks to heuristics and socialisation. It is crucial that the community
acknowledges—irrespective of one’s view on the LNT debate—that radiation doses at or below
background levels (and at low dose rates) would be very small. In order to ensure effective
radiation protection, radiation risks must be assessed within a proper context and perspective,
ensuring that a proper balance between risks and the many beneficial applications of nuclear
technology. The basic idea of radiation protection is, after all, that reduction in radiation risks
should do more good than harm, ensuring economic and social factors are taken into account
[39]. However, this is not always the case, where the application of the As Low As Reason-
ably Achievable (ALARA) principle, where dose optimisation sometimes morphs into dose
minimisation [45]. A pursual of a radiation minimisation-at-any-cost policy towards radiation
protection undermines effective radiation protection and inevitably creates risks and uninten-
ded consequences elsewhere. It also has resulted in considerable fiscal resources being dedic-
ated to reducing radiation doses. This is the result of a failure to challenge radiophobia, and
a failure to place radiation within perspective, and has come with considerable detrimental
consequences in terms of public health. This has been especially noticeable following nuclear
accidents.
3. Fallout of radiophobia: psycho-social effects following nuclear accidents
and air pollution
The negative psychosocial effects and associated health detriment following nuclear acci-
dents are well-established. Stigmatisation of populations affected by radiation has been seen
in the aftermath of all major radiological events, be it Hiroshima, Nagasaki, Chernobyl or
Fukushima, where the affected population has been discriminated against due to perceived
radiation contamination [6, 46, 47]. A range of different factors, such as the dread fear, cognit-
ive links with nuclear weapons and cancers, and the uncertainty about potential health effects
of radiation exposure have caused significant mental health issues in populations impacted by
nuclear accidents [48, 49]. It has been found that ‘…the mental health impact of Chernobyl is
the largest public health problem unleashed by the accident to date’ [41]. Following Chernobyl,
462J. Radiol. Prot. 41 (2021) Opinion Article
anxiety and stress were found 100% above controls, with the self-reporting of health issues
being three to four times higher than controls. However, diagnoses of mental health condi-
tions had not increased in the 20 years following the accident, pointing clearly towards a stress
response amongst the patients, stemming from the effects of evacuation and (perceived) radi-
ation exposure, as well as feelings of helplessness and overall fatalism [41, 50, 51]. Similar
findings have been made following the Fukushima accident [52].
Following Chernobyl, there was an observed increase in induced abortions, due to anxieties
stemming from the perceived risk that even minute doses of radiation might pose to the foetus,
despite no evidence supporting such claims [42, 53]. This anxiety was clearly fuelled by the
perception which the LNT model has resulted in, aided by assorted heuristics. Anecdotal evid-
ence suggests significant anxiety amongst expectant mothers which, especially in the Eastern
Bloc, resulted in elective abortions following the Chernobyl accident [54, 55]. However, due
to methodological issues and uncertainties, it will be difficult to ascertain with any certainty
the number of abortions across the world as a result of post-Chernobyl anxiety. It has been
found that abortions did increase following the accident in e.g. Denmark [56], Italy [57] and
Finland [58], with some estimates stating that between 10000 and 200 000 foetuses were abor-
ted following receiving incorrect medical advice [59]. This phenomenon was not seen in all
parts of Europe—for instance, there was no statistical increase in abortions in e.g. Sweden
[60], Norway [61] or Hungary [62]. There were fears that a similar picture would emerge
following the nuclear accident at Fukushima Daiichi; however, evidence so far suggests that
this is not the case [63–65]. Nevertheless, the current perception of radiation risk causes con-
siderable harm, harm which could be prevented if a normalisation of radiation risks were to
be achieved. The risk perception of radiation also causes harm in the way governments may
respond to nuclear accidents. Following the Fukushima accident, more people died (2259) as a
result of ‘disaster-related deaths’, i.e. evacuation following the nuclear accident, than from the
earthquake and tsunami itself (1829 reported deaths, some 20 000 across Japan) in Fukushima
prefecture [66]. Analysis of four different response scenarios during the Fukushima accident,
found that the risk (loss of life expectancy) posed by rapid evacuation (which took place) was
significantly higher than the radiation risk, even in the high-exposure scenarios [67]. Indeed,
Waddington and colleagues found in their analysis that the evacuation was unnecessary from a
radiological viewpoint, and that other measures should have been taken instead, such as shel-
tering in place. Similarly, the same study concluded that the majority of evacuations following
Chernobyl were unjustifiable on the grounds of radiological health benefit [68]. Whilst it is
important to acknowledge that there will always be uncertainties during nuclear accidents, the
harms of evacuation and relocation are well-established. However, these actions further high-
light the failure to place radiation risks into proper perspective where actions taken to reduce
radiation doses (however small), cause more harm than the risk posed by radiation.
A further example of unintended consequences of radiophobia is the issue of air pollu-
tion. Air pollution is a considerable public health issue, playing a major contributory role
in the development of diseases such as lower respiratory infections, ischaemic heart disease,
ischaemic stroke, haemorrhagic stroke, and chronic obstructive pulmonary disease [69]. The
Global Burden of Diseases, Injuries, and Risk Factors Study 2015 ranked ambient and indoor
air pollution as leading causes of global disease burden [69], and the World Health Organiza-
tion has identified air pollution as one of the top three global risk factors causing illness and
contribution to increase mortality [70]. The combustion of fossil fuels (especially coal) for
electricity generation, cooking, and transport are significant contributors to particulate (PM2.5 )
air pollution, and it has been estimated that these emissions caused 10.2 million premature
deaths in 2012 [71]. Unlike coal-fired power plants, nuclear power emits virtually no air pol-
lutants during operation [72]. Modelling suggests that the use of nuclear power has prevented
463J. Radiol. Prot. 41 (2021) Opinion Article
approximately 1.84 million premature deaths related to air pollution, by way of displacing
mostly coal as an electricity generator, and could—depending on the magnitude of nuclear
deployment and the amount of fossil fuels it would replace—prevent further air pollution-
related premature deaths by 2050 [73].
However, whilst there is ample evidence to suggest that air pollution have significant popu-
lation health effects, the impacts on individuals are often small, with many confounding factors
and associated uncertainties [74], not unlike chronic exposure to low-dose radiation. In the
broader spirit of this paper, it would be equally pertinent to ensure that the potential risks of
low levels of air pollution be put into perspective, with any remedial actions against air pollu-
tion accounting for uncertainties and, ultimately, doing more good than harm. Whilst there are
uncertainties related to low levels of particulate air pollution, meta-analyses of the available
cohort studies on PM2.5 and mortality showcases a clear, statistically significant association
between the two [75], and not undertaking measures to decrease especially the highest con-
centrations of air pollutants on the grounds of uncertainty would be unjustified [74]. From this
perspective, it is clear that deployment of nuclear reactors would provide the greatest benefits
from a public health perspective in regions with the highest levels of particulate air pollution
(Asia, especially China and India, and the Middle East) [76], as well as in areas where increased
access to electricity would likely depend on fuel sources with high particulate emissions (e.g.
Sub-Saharan Africa).
The example of air pollution is instructive as it serves to highlight the importance of placing
radiation risks into perspective, whereby any risks associated with the operation of nuclear
power plants must be compared with the risks associated with other electricity generators.
Looking at radiation risks in isolation (or any public health risks generally), whilst appropriate
in some settings, is not appropriate in the realm of policy or public debate, as it only aids in
reinforcing the notion of radiation as uniquely dangerous, and could hamper policy actions to
counter activities that are associated with greater risk. Nuclear power can act as a response to
air pollution, especially in areas currently suffering from high levels of air pollution (remedial
action), and areas likely to suffer from high levels if current developments continue as a result
of increased access to electricity (preventative action).
4. Discussion
It is crucial that the radiation protection community places its work and research within the
appropriate perspective and context, something that is far too rarely the case in discussions on
radiation matters outside of the scientific community. A recent example of this is the contro-
versy surrounding the radioactive water being stored at the Fukushima Daiichi site. Following
the approval of the Japanese government (and a review by the International Atomic Energy
Agency) to allow TEPCO to release the water into the ocean, Greenpeace published a report
criticising the decision. The report claims that the release of the water, which contains small
amounts of tritium and carbon-14, would pose a significant public health risk and that there-
fore the water could not be released into the ocean [77]. One passage in the report serves as a
helpful illustrative point: ‘… carbon-14 is a major contributor to global human collective dose
over time, and doses in an exposed population can be converted into the corresponding num-
ber of health effects. It is integrated in cellular components, such as proteins and nucleic acids,
particularly in cellular DNA. The resulting DNA damage may lead to cell death or potentially
inheritable mutations.’ [77].
A quick survey of nine major news outlets from across the world that covered the issue
[78–86] found that many of the outlets were running with headlines along the lines of
464J. Radiol. Prot. 41 (2021) Opinion Article
‘Fukushima water release could damage DNA’. Given the extremely low radiation doses that
the radioactive elements would theoretically result in, it is fair to say that any impact on DNA
would be far below background radiation and could—de facto—be considered negligible. Nev-
ertheless, the vast majority of the outlets in the sample did not attempt to contextualise these
claims, and did not bring in radiation experts to provide a much-needed perspective. This only
serves to reinforce already-held views on radiation by the public, as well as implicitly surren-
dering the duties of scientific interpretation to interest groups—in this case Greenpeace—a
long-standing opponent to the use of nuclear power.
We must not forget that radiation protection is not a goal in itself, but is rather an integral
part of activities which are associated with different benefits, be it the early discovery of poten-
tial cancers or the generation of low-carbon electricity by way of nuclear energy. Radiophobia
harms people and poses a real threat to the long-term provisions of many of these activities,
and we all have a responsibility to challenge it. Choosing not to speak up against the excess-
iveness that has come to define the public conversation surrounding radiation is a failure by the
radiation protection community to exercise its professional duty of care towards the general
public. This decision, whilst perhaps motivated by a fear of reprisals or becoming targeted by
anti-nuclear groups, ensures the survival of radiophobia. Each member of the radiation protec-
tion community has an ethical, professional and moral obligation to set the record straight, to
challenge the misconceptions, the myths, and the lies that surround radiation, as well as putting
it into the proper perspective and context. The public discourse on radiation should be based on
facts, rather than sensationalist claims. Such a discursive change will prove crucial in address-
ing the public perception issues faced by nuclear technologies which, unless improved, might
risk the many benefits of these technologies being withheld. Equally, the radiation protection
community must acknowledge the facts alone will never change the conversations that will
take place around radiation. The vivid imagery that radiation has acquired over decades will
provide a significant challenge, and the fact that radiation is scary to many of the public must
be acknowledged. By doing so, and by incorporating the many breakthroughs seen in psy-
chology, cognitive science, and the social sciences, significant progress towards establishing
a more balanced discourse about radiation will be possible.
Whilst some uncertainties still exist about the exact health effects of low-dose radiation,
enough is known to do so. The harms of radiophobia, especially following nuclear accidents,
are well-established. The radiation protection community has, inadvertently, aided the emer-
gence and survival of radiophobia, and has a duty to help address it. Unless the community
starts to speak up with a strong, unified voice, the harms of radiophobia will remain. As pointed
out by Paul Slovic, a pioneer in the fields of risk perception and risk communication, follow-
ing the Fukushima accident: ‘Enough is known about radiation and risk communication to
enable experts to design effective messages…the challenge is that communication strategies
must be considered a priority—in terms of time and money—to be effective. Messages should
be created and tested before the next emergency. If they are not, the next disaster response will,
in hindsight, cast a harsh light on officials who failed to prepare for the known communica-
tion challenges’ [6]. The gauntlet has thus been thrown, the radiation protection community
now needs to respond, and by placing radiation risk into its proper perspective and context,
significant progress will be made.
Acknowledgments
The author would like to acknowledge Prof Geraldine ‘Gerry’ Thomas and Agneta Rising for
their thoughtful discussions on these topics, as well as their helpful comments and suggestions
465J. Radiol. Prot. 41 (2021) Opinion Article
on earlier versions of the manuscript. The author would also like to thank two anonymous
reviewers for their very useful comments which has considerably strengthed this article. Any
remaining errors are, naturally, my own.
Elements of this paper are based on a presentation ‘An appraisal of the impacts of “radio-
phobia” on effective radiation protection, and the need for a new communications paradigm’,
given in November 2020 at the International Conference on Radiation Safety, hosted by the
International Atomic Energy Agency.
This research has been supported by the UK Economic and Social Research Council, grant
number 2104527.
The author is affiliated (through part-time employment) with the World Nuclear Associ-
ation, a trade body representing the global nuclear industry. This article is written in a personal
capacity, and the views and opinions expressed in this piece are those of the authors and do not
necessarily reflect the official policy or position of any other agency, organisation, employer,
or company.
ORCID iD
John C H Lindberg https://orcid.org/0000-0002-5758-9624
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