A Surprising Disclosure During the Ninth Session of the Ministry of the

Environment Expert Meeting
Shigenobu Nagataki appeared to be low-keyed during the ninth session of the Expert Meeting
Regarding the Status of Health Management of Residents Following the Tokyo Eletri Fukushima
!aiihi Nulear "ower "lant #ident held on #ugust $
th
% &'()* "erhaps he was still reeling from the
aftermath of the last session
i

ii
% held on +uly (,
th
% when he was bombarded with fi-e outspoken expert
witnesses*
!uring the ninth session% Nagataki.s demeanor was hesitant yet asserti-e% trying to build a onsensus as
a hairman* #t one point he reiterated the purpose of the Expert Meeting as the plae for experts to
seriously onsider what is really the best way to manage the health of those who were affeted by the
disaster% as if he were trying to remind himself* He also made a few statements suggesti-e of imposing
a burden of responsibility on eah ommittee member*
Howe-er% it almost seemed as if he were beginning to alienate some of the ommittee members due to
the unreasonable way he was arrying out the proeedings* He seemed in a hurry to wrap up the dose
assessment portion of the disussion% but some of the ommittee members expressed ob/etions to the
dose assessment summary
iii
% prepared by the M0E to be inluded in the interim report% iting too many
unertainties regarding the dose assessment itself to draw a hasty onlusion* This was the summary
whih Nagataki was working hard to ha-e endorsed by the ommittee* 1n partiular% Toshimitsu Honma
from +apan #tomi Energy #geny 2+#E#3 pointed out the prepared summary ould be misleading%
sine it inluded two ontraditory statements whih ould not oexist sientifially4 0ne statement
was that it was unlikely that residents were exposed to doses o-er ('' mS-% while the other was that
the possibility of someone reei-ing o-er ('' mS- exposure dose ould not be ruled out*
1n short% the table seemed to be turned4 Nagataki no longer appeared to be in ontrol*
#nother ommittee member% Hiromi 1shikawa from +apan Medial #ssoiation% suggested that the
ommittee mo-e onto disussions on health sur-ey and medial measures% as he has been told there
would only be two more session sheduled* Honma added on% stating that the ompletion of dose
assessment and risk assessment isn5t neessarily re6uired for the disussion on health sur-ey* The
Ministry of the En-ironment 2M0E3 offiial 6uikly delared that they weren5t limited to /ust two more
sessions* 1t appeared that the entire atmosphere of the Expert Meeting shifted to allow for more time
for future disussion*
Meanwhile% the iti7ens5 group from the 8anto area% omprising of onerned parents from 1baraki
"refeture% western 9hiba "refeture and eastern Saitama "refeture where hot spots an be found%
submitted to the M0E :ie-Minister Tomoko ;kishima a formal re6uest to remo-e Nagataki as a
hairman* 1n addition% a few members of the audiene% under the strit prohibition from -oali7ing any
opposition% silently held up signs

stating% <=e don5t need a skewed hairman> and <!o you ha-e any
onsiene?> 21nidentally% these ations possibly led to e-en more strit and tightened guidelines
i-
for
the audiene for the next session on #ugust &@% &'()% absolutely prohibiting any sort of display of
opinions% -erbal or written% and re6uiring the audiene andidate to agree to suh a ondition when they
enter their names into a lottery seleting the atual audiene*
#lso during the ninth session% there was an unexpeted dislosure of ruial information from one of
the two expert witnesses% #kira Miyauhi% a thyroid% breast% and endorine surgeon from 8uma
Hospital% a hospital in 8obe% Hyogo "refeture% whih speiali7es in thyroid illnesses* First% as an
expert witness% he ga-e an o-er-iew of thyroid miroarinoma
-
* He emphasi7ed that the data was from
adults and therefore it might not be extrapolated to hildren% and that there was -ery little data a-ailable
for pediatri miroarinoma of thyroid gland% in general as well as at 8uma Hospital*
=hen Nagataki asked
-i
if an early detetion of small thyroid aner would mean hemithyroidetomy%
where only a half of the thyroid gland is remo-ed% preser-ing some thyroid funtion and eliminating
the need for administration of thyroid hormone% Miyauhi stated%>"apillary thyroid aners tend to
our in multiples* Therefore% e-en though the thyroid aner might be diso-ered when small% it might
still be neessary to ondut a total thyroidetomy Ameaning the remo-al of the entire thyroid glandB*
Remo-ing smaller 2C to D mm3 aners would signifiantly inrease the number of total
thyroidetomies performed* To be honest with you% e-en though the ompliation rate might be low% an
inreased number of total thyroidetomies would ine-itably lead to some ases of permanent
hypoparathyroidism* Therefore% 1 don5t think it is a good idea to operate on e-ery ase* <
Fukushima Medial ;ni-ersity :ie "resident Masafumi #be himed in to defend the -alidity of
thyroid aner ases whih ha-e been operated on so far* <Fukushima Medial ;ni-ersity has been
onduting thyroid ultrasound examination% and so far there are a total of D' onfirmed or suspeted
malignant ases* 0f these% $( had surgeries and $' were onfirmed to be aner% inluding
miroarinoma smaller than (' mm* 0ur faility is only operating on ases whih are deemed high
risk*>
Miyauhi followed% <To supplement what was /ust stated% 1 am also a member of the !iagnosti
9riteria 1n6uiry Subommittee of the Thyroid Examination Expert 9ommittee* The day before
yesterday 1 attended the subommittee meeting where the information about the surgial ases at
Fukushima Medial ;ni-ersity was presented* #ording to the presentation% at least o-er @'E of the
ases had onditions whih would be ordinarily onsidered appropriate for surgery% based on our
urrent standard of are% suh as the tumor si7e o-er ( m% the presene of lymph node metastases% or
some aggressi-e ases with distant metastases* Regarding the remaining C'E% !r* Su7uki explained
that those ases were operated on as they were what we onsider high risk% suh as being near the
reurrent laryngeal ner-e or ontating the trahea*>
This statement by Miyauhi immediately aught e-eryone.s attention% espeially in the soial stream
timeline for the ;stream hannel for 0ur"lanet-T:
-ii
% where the 1nternet audiene was writing in
omments while wathing the Expert Meeting in real time* !etails regarding the !iagnosti 9riteria
1n6uiry Subommittee% established on September (F% &'((% ha-e been skethy* 1ts existene was
mentioned during the fourth session of the "refetural 0-ersight 9ommittee Meetings for Fukushima
Health Management Sur-ey
-iii
* 1t was established to bring onsisteny to examinations on e-auees
residing outside Fukushima "refeture% and omposed of thyroid speialists% endorine and thyroid
surgeons% pediatri endorinologists% and ultrasound speialists* =hat is known up to this point was
that the subommittee onsisted of the following se-en organi7ations4
• +apan Thyroid #ssoiation
ix
• +apan #ssoiation of Endorine Surgeons
x

• +apan Soiety of Thyroid Surgery
xi

• The +apan Soiety of ;ltrasonis in Mediine
xii

• The +apan Soiety of Sonographers
xiii

• The +apanese Soiety for "ediatri Endorinology
xi-
• The +apan #ssoiation of Greast and Thyroid Sonology
x-
Howe-er% no reord ould be found% at least on the 1nternet% regarding the proeedings of the
<!iagnosti 9riteria 1n6uiry Subommittee*> # freelane /ournalist% Ryuihi 8ino% tweeted that the
doument obtained through information dislosure was hea-ily redated% with the names of the
subommittee members blaked out*
Miyauhi5s self-admittane that he was a subommittee member% therefore% was a pleasant surprise* He
was dislosing information that was not readily pro-ided by Shinihi Su7uki% a thyroid surgeon at FM;
in harge of the thyroid examination% at the third session of the Thyroid Examination #ssessment
Subommittee% held on +une ('% &'()% when 8en/i Shibuya% an epidemiologist and a publi health
speialist from the ;ni-ersity of Tokyo% raised a possibility of o-er-diagnosis and o-er-treatment
x-i
* #t
the time% all Su7uki would admit% defending the deision to operate% was that some ases had lymph
node metastases or hoarseness Awhih indiates the in-ol-ement of the reurrent laryngeal ner-eB*
Su7uki would not gi-e the perentage of the ases whih atually had lymph node metastases or
hoarseness* He e-en said he wasn5t the one who deided not to re-eal the information*
Miyauhi5s re-elation essentially -alidated the surgeries performed at FM; so far% dispelling the
ritiism that the sreening was harmful and not really warranted*
Then% 6uite uriously% Nagataki started off the 6uestion and answer session by presenting a hypothetial
situation to Miyauhi% saying% <For instane% if we ondut a sreening% some aners would always be
diso-ered* 1f we ontinue on with the sreening and remo-e all the aners we find e-en though some
may not ha-e risks Aof beoming aggressi-eB beause there is a sense of seurity in simply remo-ing
anything that might remotely be dangerous% ultimately one in ten or one in one hundred hildren in
Fukushima might end up getting their thyroid glands remo-ed* Some might say that would be
aeptable as long as it brought a sense of seurity* =hat do you think about suh an idea?>
Miyauhi 6uikly said% as if reprimanding Nagataki% <1 think the numbers you /ust ga-e are rather
extreme*>
Then Miyauhi ontinued% <#s 1 mentioned earlier% 1 am a member of the !iagnosti 9riteria 1n6uiry
Subommittee of the Fukushima Thyroid Examination Expert 9ommittee% so 1 am 6uite familiar with
why the thyroid sreening is being onduted in Fukushima "refeture* #s we know that pediatri
thyroid aner notably inreased after the 9hernobyl aident% and most members of the general publi
are aware of it and worried whether thyroid aners would also inrease in Fukushima* Hi-en suh a
onern% for one thing% a sientifi assessment had to be arried out to see if there would atually be an
inrease* The other thing is to monitor the health of the residents* 1 understand both of these issues are
rather diffiult issues* Gased on these onditions% as mentioned earlier% what should be done is to do
e-erything aording to ertain riteriaI to ondut an examination aording to a ertain riterion% to
read the ultrasound image aording to a ertain riterion% to deide whether or not to ondut fine
needle aspiration biopsy aording to a ertain riterion% and so on* This is what is happening in
Fukushima "refeture* For instane% our hospital has examined Fukushima residents who mo-ed to the
8ansai area% at the re6uest of FM;* The ultrasound examination data is not assessed by us* 1nstead% it is
sent to FM; to be read aording to a ertain riterion* 1f the fine needle aspiration biopsy is needed%
we will ondut the biopsy based on instrutions from FM; and send the speimen to FM;* So my
understanding is that they are making an effort to maintain a ertain standard in e-ery way possible*>
Mass sreening is almost always aompanied by a possibility of o-er-diagnosis and o-er-treatment* 1n
ase of thyroid aner% surgery is not risk-free* 1n the pre-ious sessions of the M0E Expert Meeting%
pros and ons of aner sreenings were disussed% espeially in relation to adult aner sreenings%
gi-en the fat the residents had onerns regarding their health after ha-ing been exposed to the
radioati-e releases from F!N""* Hen Su7uki suggested the exposure dose was too low to warrant the
sreening* The onsensus of the se-enth session of the M0E Expert Meeting% iting the low exposure
doses% appeared to be on the passi-e side in regards to offering health hekups% inluding aner
sreenings% to the Fukushima residents outside of the e-auation 7one as well as the residents of
neighboring prefetures*
There e-en appeared to be mo-ements% both by a ertain group of iti7ens and iti7en sientists on
Twitter and by some experts% like the ;ni-ersity of Tokyo researhers% to do away with the thyroid
ultrasound examination of those who were (F or younger at the time of the aident% laiming o-er-
diagnosis and o-er-treatment*
Howe-er% the biggest issue was that Fukushima Medial ;ni-ersity laked transpareny to dislose
information neessary for the outside experts to properly e-aluate the situation*
Miyauhi5s statement at least -alidates the way Fukushima Medial ;ni-ersity is handling surgial
ases* Howe-er% his statement also raises a onern that there are so many thyroid aners whih are
onsidered high risk* #fter all% Shunihi Jamashita and Shinihi Su7uki kept saying that these aners
were onsidered latent aners whih would not be diso-erable until muh later in life* The reality is
that these are linially ob-ious aners% and the 6uestion would be why there are so many suh ases*
The go-ernment and Fukushima Medial ;ni-ersity ha-e maintained that the thyroid abnormality
rates% suh as nodules% ysts% and e-en aner% do not differ between Fukushima "refeture and the rest
of the nation 2iting the M0E study in Jamanashi% #omori and Nagano "refetures
x-ii
3% in an attempt to
dispel any relationship between the thyroid abnormalities and radiation exposure*
0n #ugust &)% &'()% the sixteenth session of the #ssessment 9ommittee for the Fukushima "refeture
Health Sur-ey is to be held* 1t is expeted that the full report of the first round 2FJ&'((-&'(C3 of the
thyroid ultrasound examination will be released% along with some of the result from the seond round
whih has already begun*
=e must keep lose tabs on how the number of thyroid aner ases might hange from the first to the
seond round* 1f it.s truly a sreening effet% the seond round should not yield as many thyroid
aners* Meanwhile% FM; needs to be more transparent% sharing some ruial information with the
medial and sientifi ommunities% of ourse% with a full onsideration to preser-e patient
onfidentiality* Su7uki mentioned that FM; was aumulating all sorts of data from the thyroid
examination% inluding the radiation exposure data% so that studies ould be published* He said that was
the way FM; was trying to fulfill its soial responsibility* Howe-er% their soial responsibility really
should rest on the residents first% not so muh the publiation of sientifi paper*
i http4KKfukushima-oie-eng&*blogspot*omK&'()K'FKthe-ministry-of-en-ironment-expert*html
ii http4KKfukushima-oie-eng&*blogspot*omK&'()K'@Kfrom-/uly-&&-tokyo-shimbun-artile*html
iii http4KKwww*en-*go*/pKhemiKrhmKonfKonf'(-'DKmat'(*pdf
i- http4KKwww*en-*go*/pKpressKpress*php?serialL(F)'F
- http4KKwww*en-*go*/pKhemiKrhmKonfKonf'(-'DKext'(*pdf
-i https4KKwww*youtube*omKwath?-Lire!o:gbTMfeatureLyoutu*beMtL(h)$mFs
-ii http4KKwww*ustream*t-KreordedK$'D,FF@C
-iii http4KKwww*pref*fukushima*lg*/pKuploadedKattahmentK,)D,*pdf
ix http4KKwww*/apanthyroid*/pK
x http4KK/aes*umin*/p
xi http4KKs6uare*umin*a*/pKthyroidsK
xii http4KKwww*/sum*or*/p
xiii http4KKwww*/ss*orgK
xi-http4KK/spe*umin*/pK
x- http4KKwww*/abts*netK
x-i http4KKourplanet-t-*orgK?6LnodeK(@DC
x-iihttp4KKwww*nbi*nlm*nih*go-KpmKartilesK"M9CF@(,F@K