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The National Research Council was asked by the Centers for Disease Control and Prevention (CDC) to review the draft report of the National Cancer Institute (NCI)-CDC's working group charged with revising the 1985 radioepidemiological tables. To this end, a subcommittee was formed consisting of members of the Council's Committee on an Assessment of the Centers for Disease Control and Prevention Radiation Programs and other experts. The original tables were mandated under Public Law 97-414 (the "Orphan Drug Act") and were intended to provide a means of estimating the probability that a person who developed any of a series of radiation-related cancers, developed the cancer as a result of a specific radiation dose received before the onset of the cancer. The mandate included a provision for periodic updating of the tables. The motivation for the current revision reflects the availability of new data, especially on cancer incidence, and new methods of analysis, and the need for a more thorough treatment of uncertainty in the estimates than was attempted in the original tables.
The Radiation Exposure Compensation Act (RECA) was set up by Congress in 1990 to compensate people who have been diagnosed with specified cancers and chronic diseases that could have resulted from exposure to nuclear-weapons tests at various U.S. test sites. Eligible claimants include civilian onsite participants, downwinders who lived in areas currently designated by RECA, and uranium workers and ore transporters who meet specified residence or exposure criteria. The Health Resources and Services Administration (HRSA), which oversees the screening, education, and referral services program for RECA populations, asked the National Academies to review its program and assess whether new scientific information could be used to improve its program and determine if additional populations or geographic areas should be covered under RECA. The report recommends Congress should establish a new science-based process using a method called "probability of causation/assigned share" (PC/AS) to determine eligibility for compensation. Because fallout may have been higher for people outside RECA-designated areas, the new PC/AS process should apply to all residents of the continental US, Alaska, Hawaii, and overseas US territories who have been diagnosed with specific RECA-compensable diseases and who may have been exposed, even in utero, to radiation from U.S. nuclear-weapons testing fallout. However, because the risks of radiation-induced disease are generally low at the exposure levels of concern in RECA populations, in most cases it is unlikely that exposure to radioactive fallout was a substantial contributing cause of cancer.
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Dr. Oliver Wendell Holmes was once asked, "When should the training of a child commence?" "A hundred years before birth" was the reply. Indeed it is this perspective on life through posterity that underlies the maturing field of international health, embracing as it does a respon sibility for and an awareness of the needs of all peoples. The concepts of international health are increasingly revitalizing modern medicine as it attempts to relieve mankind of the burden of disease. Curative medicine, once the paradigm, took a relatively benefi cient approach to treatment. But epidemiological recognition of the fre quency of disease on a global basis-and an appreciation of the vast number of those afflicted-evoked a humiliating backlash of awareness that curative medicine alone neither constrains disease nor permanently advances human health, happiness, or longevity. The growing reliance on truly international health strategies by national and international agencies, including the more definite and extended practice of preven tive medicine, has provided the means to achieve significant gains in the quality of health in years to come. A redeeming feature of contemporary failures in science and medi cine is that-once intelligently studied, analyzed, and evaluated-even these failed efforts may provide real insights that can mold our capacity and determination. So it is that, more than in any bygone age, the past ten years have seen the implementation of a sound and systematic in frastructure for international health undertakings, thus paving the way for improved health for all.