President Barack Obama made the correct and courageous decision to visit Hiroshima later this month with Japanese Prime Minister Shinzo Abe. The goal: to promote a nuclear-free world.
Anything that triggers discussion about the U.S. decision to drop atomic bombs on Hiroshima and Nagasaki, the world's first and only use of nuclear weapons, unleashes hardened feelings about its necessity on both sides of the Pacific. Obama's visit to the city—the first-ever by a U.S. president—also comes in an election year, in which the president and his party will face renewed charges from the political right that he's on an endless apology tour.
To fend off such charges, White House Deputy National Security Adviser Ben Rhodes immediately announced the president will not “revisit the decision to use the atomic bomb at the end of World War II.”
It's an interesting historical question, of course—one that received an excellent overview the day after Obama's decision by David Sanger of the New York Times, who was the Tokyo bureau chief for that paper during the run-up to the 50th anniversary of the atomic bombings. At the time, I held the same position for the Chicago Tribune.
I vividly recall the day in the spring of 1995 when I first visited Hiroshima to see the shattered concrete dome near ground zero and toured the one-sided Peace Museum. But I also visited a place where few Western correspondents ventured—the Radiation Effects Research Foundation (RERF), the successor organization to the commission jointly created by both governments in 1947 to study the effects of radiation on the hundreds of thousands of people who survived the initial bomb blasts.
Over the past seven decades, the RERF has dutifully documented where every survivor—they call themselves hibakusha or “explosion-affected people”—was standing, sitting or sleeping when the bombs went off. Its researchers recorded their medical histories until the day they died.
It's probably the most comprehensive medical registry on earth. Studies using RERF's records demonstrate the power of record-rich epidemiological research. They've been used many times to create much of what medical science now knows about the short- and long-term effects of radiation exposure.
While nearly 200,000 people died in the two bombings, another half million who were exposed to the blast, heat and radiation survived. Incredibly, more than 180,000 of them are still alive in that long-lived society.
But over the decades, like clockwork, some hibakusha suffered premature mortality, mostly from various forms of cancer. Leukemia appeared in larger-than-expected numbers within five years of the blasts.
After a decade, excesses of solid tumors began appearing in the population, largely determined by the cell growth rates of exposed organs. Excesses of thyroid cancer began appearing in 1955; breast and lung cancer in 1965; stomach and colon cancer in 1975. The cancer rates were up to six times higher than comparable groups in the general population. Later studies among workers who faced excessive doses of radiation at nuclear facilities and the civilian population surrounding the 1986 Chernobyl nuclear power plant disaster confirmed those findings.
The impact on popular consciousness of that research shouldn't be underestimated. It scientifically legitimized fears about the effects of environmental radiation exposure, and led the U.S., Soviet Union and other nuclear powers to sign the first arms control agreement, which in essence was a public health measure. The Test Ban Treaty of 1963 prohibited above-ground or ocean nuclear-weapons testing.
Unfortunately, the extraordinary research initiative didn't lead to a deeper appreciation for the power of well-documented epidemiological research among medical scientists. Many researchers still balk at sharing data; clinicians still hesitate to enroll patients in registries; and healthcare systems are only now beginning to track medical outcomes on a population-wide basis.
In his Hiroshima speech, Obama—whose legacy will inevitably be tied to the healthcare law that bears his name—might want to offer a few thoughts about what healthcare in the U.S. can learn from the hibakusha.