This is Part 4 of a series.
Readers will be pleased to learn this is the final installment of my reviews of the HBO Chernobyl miniseries, which just ended its TV run June 3. The series, which has received extraordinary critical acclaim, had a vast global audience.
Some have called it the best TV of the year, and one or more Emmys are surely in store. Lest I seem a curmudgeon, I join the critics and most viewers in thanking Craig Mazin and his colleagues for bringing the story of Chernobyl NPF accident back to public attention.
Although the story presented was generally accurate, there were important conceptual and factual errors, some of which I discussed in previous reviews. Are these errors important? No, and yes.
No, because the 10,000-meter view of the accident is what really matters. Screenwriters need a simple storyline: A really bad thing happened in a bad place and now, thousands or millions of people, maybe all of us, will suffer for decades from birth defects, genetic abnormalities, cancer and more (try three-headed goats).
But is this really the message we should take from the Chernobyl accident? I would argue no. What it shows is the fallibility of humans, not physics, something we see every day—design a complex machine poorly, override safety controls, allow politicians to ignore science, etc. Sound familiar? A Ferrari is amazing technology, but a potentially dangerous machine if you put a 6-year-old in the driver’s seat. Should we ban Ferraris, or restrict who can drive them?
There is a second reason the errors in the miniseries are important. Many readers of The Cancer Letter have written questioning several technical details. For example, were the emergency personnel dangerously radioactive? No. Their predominant exposure was to external radiations. After surface decontamination, they posed little threat to us or to the public.
The Chernobyl situation is unlike the accident we faced Goiania, Brazil, where victims ingested large amounts of 137-cesium and were highly-radioactive. Initially, we treated them behind lead shields wearing protective gear. We quickly found we could not care for these critically-ill persons properly, especially the children. Moreover, we found the shielding protection was offset by the longer time it took us to deliver care, because the shielding was heavy and slowed our movement. Off it went. As you know, physicians are invincible (until they’re not).
The most common question I received was about the pregnant wife of a firefighter, who supposedly lost her child from radiation she received whilst caring for her injured and supposedly highly radioactive husband. Earlier, I described how this is impossible for many reasons.
First, none of the firefighters was dangerously radioactive. Obviously, we should never expose a pregnant woman, or anyone, to even a low radiation dose, unless there is a perceived benefit. We use ultrasound rather than abdominal X-rays in pregnant women, unless absolutely needed.
However, a pregnant woman’s body is a reasonably effective shield against low-dose external radiations to the fetus, especially radiations from alpha particles (stopped by a piece of paper) and electrons, as portrayed in the scenes from the Chernobyl miniseries. I also discussed the rarity of birth defects in children of pregnant women exposed to the A-bombs: that these abnormalities were limited to cognitive disability, and that they occurred only in children exposed to radiation in the second trimester.
In the miniseries, the woman is told her child received 25 roentgens. What exactly does this mean, and does it make sense? A roentgen (an antiquated term) is a measure of radiation in air (the electric charge freed by radiation in a specified volume of air divided by the mass of that air). Obviously, it’s the dose absorbed in a tissue or organ, which determines the amount of damage caused by radiation—a dose is measured in gray (the absorbed dose) or sievert (equivalent dose adjusted for the type of radiations), not the dose in air. If we stick with the miniseries, we can very roughly calculate that 25 roentgens is about 250 millisieverts.
If the fetus received this dose, the dose to the mother would have had to be substantially higher, more than the average A-bomb survivor. This is, of course, somewhere between highly unlikely and impossible. More importantly, in utero radiation exposure does not cause liver fibrosis or congenital heart defects in animals or humans.
Why focus on this issue? Because readers may be asked by a pregnant woman about radiation risks to a fetus in the event of a nuclear terrorist attack or radiation accident. They need to give advice based on scientific data, not a book (even from a Nobel laureate) or TV miniseries.
I’m very sorry this woman’s child had these birth abnormalities and died, but these problems are extraordinarily unlikely to have anything to do with radiation exposure. Readers should recall, about 3% of normal births in the U.S. are associated with congenital/birth defects according to the U.S. Centers for Disease Control and Prevention. Congenital heart disease occurs in about 1% of normal births in the U.S. resulting in about 20% of infant deaths. Because the liver receives about 25% of the heart output, congenital heart defects are sometimes associated with liver abnormalities from, for example, portal hypertension.
A third common question was whether there was or will be an extraordinary increase in cancers, especially amongst the mitigation workers (dare I say liquidators), as portrayed in the miniseries. Are these men (and some women) really doomed?
Obviously, no. A worst-case scenario is a 1% increase in lifetime cancer risk above baseline from 43% to 44% in men and from 39% to 40% in women. Hardly a death sentence, and nothing compared with other health risks such as cigarette smoking and excessive drinking, both common amongst the liquidators.
I recall lecturing a group of Fukushima-Daiichi mitigation workers concerned about health consequences of exposure to 50 millisieverts of radiation (emergency worker limit in Japan). Everyone in the room was a smoker and most reported smoking two or more PPD for many years. I pointed out their 10-20-fold increased risk of lung cancer, many other cancers, chronic obstructive pulmonary disease (COPD), and arteriosclerotic cardio-vascular disease (ASCVD). I also mentioned lung cancer in smokers is caused, at least in part, by radiation by inhaling 210-polonium, which contaminates tobacco leaves.
No one seemed impressed by this information (perhaps my Japanese is not as good as I think), and certainly no one stopped smoking during my lecture, even though the risk of death from smoking three cigarettes (total, not per day) is equivalent to the risk of death from one chest X-ray.
Most readers are likely to have been trapped behind someone at airport security refusing to go through a screening device. First, screening devices at most U.S. airports use millimeter wave scanners, which do not emit ionizing radiations. Second, the amount of radiation this person is exposed to every 2 minutes from background sources—like radionuclides in granite or marble floors (thorium, radium, uranium) and cosmic radiations—whilst arguing with the TSA supervisor, is equivalent to the radiation dose they will receive from 2 seconds of flying at 12,000 meters (if they make it through security).
If you’re afraid of radiation, don’t worry about screening. Don’t fly. And don’t get me going on porcelain tooth veneers, which are also radioactive. A prolonged kiss with someone with these has a risk equivalent of death due to skydiving (which, admittedly, I do).
These examples illustrate the exaggerated fear most people, educated or not, have about radiation, including makers of the Chernobyl miniseries. Are they fearmongers? I doubt it. Misinformed is more likely.
But back to the final episode of the HBO Chernobyl miniseries. The last topic requiring correction is the mostly inaccurate portrayal of the Soviet government officials, scientists, and health care workers.
With a few exceptions (Legasov and Khomyuk), the portrayals are caricatures of evil, mean-spirited, deceptive nincompoops. Were most people in the Soviet Union like this, it’s unlikely they could have built an atomic bomb, launched Sputnik, contributed importantly to mathematics, physics and computer science, and much more. Were we to take the persona in the miniseries as real, it’s a wonder the Soviet Union survived much beyond October 1917, or avoided blowing up the planet, perhaps several times, with nuclear disasters (bombs and NPFs) over the next several decades.
Was the Soviet Union really an Evil Empire bent on destroying America? Not in my opinion. Yes, there was repression of human rights, forced labor camps, exile to Siberia, and the Gulag archipelago so dramatically portrayed by Solzhenitsyn; a police state.
But read Russian literature, say Dostoevsky, Tolstoy or, my favorite, Bulgakov, and you will see nothing really changed over hundreds of years. When Brezhnev became General Secretary of the Communist Party and told his mother how he lived in the Kremlin, she said: “I’m happy for you, Leonid, but what will happen if the communists come to power?”
Were Soviet citizens fundamentally different than us? Not really. Sadly, they got stuck with a terrible political system doomed to failure. Marx and Lenin’s target for communism was England, not Russia, but politicians take what they can get. The rest is history. As Winston Churchill said: “Democracy is the worst form of Government except all those other forms that have been tried from time to time.”
I’m certain many, if not most, readers will disagree with my view of the Soviet Union, but let me try to defend my position in the context of the Chernobyl NPF accident. Sure, the Soviet government tried to conceal the accident, but let’s consider what happened when their cover was blown. Ask yourself how many governments would have accepted my offer to try to save lives of the accident victims. Details of a nation’s nuclear program are typically secrets. No American had ever entered the Institute for Biophysics or Hospital 6, certainly not one with a KGB dossier.
I discussed this unexpected openness with my Soviet colleagues, and eventually, with General Secretary (later President) Gorbachev. What they told me was they could not conscience these brave young firefighters dying, when there might be medical interventions which might save at least some. How many governments would have acted similarly?
Of course, not everyone was on board with this decision. One government newspaper described me as the greatest spy since Kim Philby, a left-handed compliment at best.
And another example: In Part II, I described a previously untried therapy for radiation damage (sargramostim) and how I offered to inject myself with it to convince the Soviets to let us use it. Although I knew the biology of this drug, academician Andrei Vorobiev, a distinguished hematologist and 20 years my senior, did not. Yet, he insisted I also inject him. He almost died, but that’s a different story.
There is insufficient space to fully describe the tireless efforts of Soviet physicians and nurses on our team over many months, including my late colleagues, Profs. Angelina Guskova and Alexander Baranov, whom I miss dearly. And I was not the only foreigner quickly admitted following the accident, including Hans Blix and a team from the U.N. International Atomic Energy Agency.
Try to imagine these invitations after a major nuclear event during the current U.S. administration. Forgetaboutit. A 4 month-old Mexican infant was recently separated from his parents.
I knew each of the firefighters intimately, including the 29 who died. I never heard one of them express regret over what they had done to contain the Chernobyl disaster. These men are the real heroes.
In the miniseries, the liquidators are portrayed as being coerced into their mission. I interviewed many of them at the time of the accident, not 30 years later. Almost everyone I spoke with volunteered. Anyone with knowledge of Russians will recognize how these people respond to adversity. Recall Napoleon’s 1812 excursion into Russia, or the Nazi invasion of the Soviet Union in WWII. These people are tough; 20 million Soviets died fighting the Nazis. The notion that most liquidators were conscripted against their will shock people who know Russians respond to adversity: they thrive on it.
About six weeks after the accident, I felt a press conference was needed to brief the world on what was really going on with the victims and at the NPF. I suggested this to several Soviet officials. I warned them that rumors were flying of thousands of deaths and other nonsense. Absent credible information, people create their own facts.
To my surprise, the government asked me to speak at the press conference, without restriction. Again, I ask readers to consider the likelihood of similar invitation to this happening to a Russian physician after a huge U.S. nuclear accident. So, there I was on the podium, facing more than 1,000 foreign journalists, unscripted.
In the Soviet Union at that time, reporters had to write their questions on slips of paper, which were given to the speaker. I received a stack of about 50 questions, the first of which said, “Why are Americans lying about consequences of the Chernobyl accident, claiming thousands of people died?” An obvious plant by the KGB or some government official. However, I had the microphone and quickly realized no one else could see what was written on the first note. So, I turned it around and said, “The first question is: Why, despite the Cold War, are Americans so willing to help the Soviet people respond to this tragedy?” My point is, the Soviets were not perfect, but neither were they monsters.
The scene I just described repeated itself when I met with President Gorbachev in the Kremlin a few weeks later. After some pleasantries, he pulled out the front page from the New York Daily News with the headline banner, “Thousands Dead From Chernobyl,” and asked me, “Why your government publishes such lies?”
I responded that the U.S. government doesn’t control the press in America (despite recent attempts), which I’m sure he knew. He then showed me about 20 envelopes he’d received from American citizens with notes of sympathy—some containing donations of $5 or $10. He was clearly touched, as was I.
The point of all of this is to try to give viewers of the Chernobyl miniseries a more nuanced, accurate impression of what really happened during the days, weeks, and months after the Chernobyl NPF accident.
Did the Soviet government initially try to hide the accident? Yes. But when they realized this was hopeless—a radiation cloud does not respect international boundaries—they acted in what I regard as a decent, humane way, and not terribly differently from other governments I’ve dealt with, such as Brazil and Japan.
And so my review of the HBO Chernobyl miniseries ends. I thank the editors of the The Cancer Letter for the invitation to set the record straight, and give readers facts about the accident and background about ionizing radiations, which I hope they enjoyed and will share with others. Chernobyl was a unique NPF accident which could not occur at a Western nuclear reactor. Some will immediately say I’m wrong, “Look at Fukushima.”
As I tried to explain, what happened at Fukushima is entirely different than what happened at Chernobyl. The medical consequences are also extraordinarily different. But NPFs are not the real problem, global warming is. There is no realistic alternative to reversing or at least slowing global warming other than using nuclear energy. We should, of course, develop alternative energy sources, conserve energy, and pray someone can figure out how to harness nuclear fusion, but there is no other immediately available energy choice. It always surprises me environmentalists are not the strongest advocates for nuclear energy.
But I want to close with two equally urgent challenges: nuclear terrorism and nuclear war. Prof. Jim Armitage and I discussed the imminent threat of nuclear terrorism recently, in an article in The New England Journal of Medicine for those wanting more information.1
More troubling is the increasing threat of a nuclear war. The U.S. recently withdrew from the Joint Comprehensive Plan of Action (JCPOA), unofficially known as the Iran Nuclear Deal. In response, Iran threatened this week to restart uranium enrichment and increase its stockpiles. And after decades of nuclear arsenal downsizing, the U.S., Russia and most other nuclear states have committed to upgrading their nuclear weapons capabilities and their missile delivery systems.
And it gets worse. In February, the U.S. gave official notice of withdrawal from the INF treaty in six months; Russia responded in kind. Other risks are continued development of nuclear weapons by North Korea, and China’s increasing nuclear arsenal. Even more worrisome is Pakistan’s dispersion of its nuclear warheads throughout the country. The recent conflict between India and Pakistan over Kashmir has brought two nuclear-armed nations into active conflict. And the Middle East with a nuclear-armed Israel is a mess.
Prof. David Nathan and I review these issues in a forthcoming article in the ASCO Post.2 Our conclusion: physicians need to focus on this extraordinary threat to mankind and re-engage in efforts to prevent a nuclear war, especially a new Cold War between the U.S. and Russia and/or China.
In closing, I apologize for covering some complex radiation-related issues so superficially, but this is The Cancer Letter, not the Bulletin of the Atomic Scientists and I was asked to review a TV miniseries, not produce a nuclear physics textbook. Readers wanting a more detailed description of several topics I discussed can start with a recent book by Eric Lax and me: Radiation: What you need to know.3
I get 5 cents for every copy you buy. With six children, I need it.
Gale RP, Armitage JO. Are we prepared for nuclear terrorism? N Engl J Med. 2018; 378:2449-50.
Gale RP, Nathan DG. Physicians and the threat of nuclear war. ASCO Post. July 10, 2019.
Gale RP, Lax E. Radiation: What it is. What you need to know. A. Knopf. New York. 2013. ISBN-13: 978-0307959690.