Don't panic: it's only a leaky reactor

The scaremongers are wrong - a little radiation may even be good for you

<strong>Horizon: nuclear

As a child, I must have caught the tail-end of the pro-nuclear age, for I remember mild excitement being generated in the supermarket aisles by a new washing powder called Radion, a detergent that didn't actually claim it irradiated rather than washed your smalls, but still managed to sound, you know, pretty scientific. All did not go well for the Radion brand, however, and by the time of the 1979 Three Mile Island nuclear reactor accident, it was being pronounced on TV commercials with a short, northern "a". I don't remember seeing it at all after the Chernobyl disaster in 1986, although I do remember Brits at the time getting so scared that they stopped buying chicken Kievs from Marks & Spencer.

Despite there not having been a remotely comparable accident in the following two decades, you still have to be a very brave ecologist - ie, James Lovelock - to dare to suggest that nuclear power stations rather than, say, windmills, might save the planet without first poisoning us. The brave among them can afford to be a little braver now, following the most recent Horizon: nuclear nightmares (13 July, 9pm).

It did not, obviously, try to persuade us that the fallout from Hiroshima and Nagasaki was harmless, but it did put up a powerful argument that the relatively low levels of radiation emitted from even the worst nuclear accidents cause much less damage than scientists believed. We followed Tatyana Lukina, a Ukrainian woman evacuated from her home near Chernobyl, as she returned with her daughter to her desolate home town. The daughter, now 20 years old, was lucky to be going anywhere, as her mother had been warned that the fallout would have serious effects on her unborn child. She recalled that the local hospitals became abortion factories. Some 200,000 foetuses were aborted. Yet here was her daughter, looking perfectly normal.

All the dire predictions, it turned out, were off. The statistics forecast 9,000 deaths. Some 1,800 members of the clear-up gang alone were meant to die from radiation cancers; to date 47 have done so. Going further out, it was forecast that another 6,800 would expire, yet only 56 people have so far died of radiation-related diseases - less than Britain's weekly road cull.

It is not as if the radiation is not out there. Ron Chesser, a Texan scientist, went out to survey the Chernobyl wildlife and now boasts of having in his stuffed-animal collection the most radioactive weasel in the world. As he held a Chernobyl vole to a Geiger counter, the machine clicked madly. Yet Chesser was amazed to find a huge diversity of wildlife caught in his traps and no genetic damage to any of them: "We all sat down and asked what we did wrong."

What was done wrong, it seems, was the extrapolation made from Hiroshima. Taking as its model the death rates in Japan, a 1958 study plotted a straight line on a graph between increased cancer risk and exposure to radiation. The trouble was that the US bomb was so big - and Japan so small - that there was no data available from people who lived far enough away to have been exposed to very small, Chernobyl-type levels of irradiation. None the less, the scientists completed the line on the graph down to zero. They should not have done. As Antone Brooks, another American professor, concluded: "Low doses of radiation are a piss-poor carcinogen."

It seems that Tatyana was subjected to the trauma of deracination for nothing and that the 200,000 sheep grazing in our own Lake District and deemed, because of Chernobyl, too radioactive for human consumption, should be turned into lamb chops immediately.

Some scientists on the show went even further - and suggested that a little bit of radiation might actually stimulate the genes that protect against cancers. And so the programme went full circle, back to its early images of 1930s products that used "radium" as we use "platinum" now, to indicate classiness. In those innocent days, you could buy radium condoms, radium cigarettes, even radium shoe polish. A newspaper ad read: "Vidor Radium Suppositories. Weak, discouraged men! Now bubble over with joyous vitality through the use of glands and radium." It was all nonsense, of course, but no greater nonsense than the headlines of the summer of 1986: "Victims glow in the dark"; "Metal sticks to amazing boy"; "Mums give birth to babies that look like chimps". I think the Horizon producer Nick Davidson may have hit on a new journalistic genre: whatever the opposite of scaremongering is.

Andrew Billen is a staff writer for the Times

Pick of the week

Sunday, 9pm, BBC2
Weather-beaten explorer Bruce Parry joins an Ethiopian tribe and sacrifices an unfortunate cow.

The Man With 80 Wives
Wednesday, 10.50pm, Channel 4
First programme in the Tainted Love series investigates a polygamous cult leader in, where else, the States.

Cooking in the Danger Zone
Tuesday, 8.30pm, BBC4
Foodie antics in questionable taste: Stefan Gates samples US army Meals Ready to Eat in Afghanistan.

Andrew Billen has worked as a celebrity interviewer for, successively, The Observer, the Evening Standard and, currently The Times. For his columns, he was awarded reviewer of the year in 2006 Press Gazette Magazine Awards.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide