Cesium and cardiac effects

Dear Reader,

I am aware that some people from the antinuclear lobby have started to ask the question of “does radioactive cesium damage the heart ?”. I hold the view that in science a question which is testable is a good thing to have. I hold the view that a true scientist tests a hypothesis (fancy term for a theory) in an experiment using a research question.

To my mind the research question which these people who are opposed to nuclear power have raised up is “Does radioactive cesium damage the heart ?”. This is an interesting question but I must warn my readers that very little has been written on the subject. It has been shown in goats by M. Kaikkonen et. al. (Acta Physiologica Scandinavica, 2005, volume 183, pages 321-332) that cesium tends to concentrate in the kidneys (x 50 plasma concentration), urine (x 5 to 28 plasma concentration), salivary gland (x 11 plasma concentration), cardiac muscle (x 7 plasma concentration) and small intestine (x 6 plasma concentration). The fact that the cesium concentration in the urine / kidney is higher than it is in the plasma of the animal suggests that the goats will lose a lot of the free cesium in them via the urine and that it might be a better idea to look for kidney damage in humans who have been exposed to radioactive cesium.

I hold the view that anyone who wants to prove that radioactive cesium damages the heart needs to do the following.

1. Prove that Cs-137 (or Cs-134) in the diet of animals causes some harmful change to the heart, use two groups of animals one fed radioactive cesium and the other group fed no radioactive cesium.

2. Prove that the effect of the radioactive cesium is not due to a toxic effect exerted by normal stable cesium. I know that a sudden change in the plasma concentration of potassium will cause a heart attack in humans. Part of the lethal injection which the americans use to kill convicts is an injection of potassium chloride. So as potassium cations have an effect we can not rule out that cesium will have an effect.

3. Prove that the effects of internal exposure to radioactive cesium is more harmful to the hearts of the experimental animals than external exposure to the gamma rays from cesium-137. I am sure that at very high doses of external gamma rays that it is possible to damage the heart (or any other organ for that matter).

But lets think about point two for a moment, stable cesium has been used for some time in some alternative cancer treatments. Petr Melnikov and Lourdes Zélia Zanoni have written a review paper on the subject of the toxic effects of stable cesium. This paper had the title “Clinical Effects of Cesium Intake” and was published in Biological Trace Element Research (2010, volume 135, pages 1 to 9). The authors of the paper state that cesium salts do not cure cancer, they also do warn that large amounts of (nonradioactive) cesium salts do cause the heart to behave in an abnormal way. I would like to suggest that anyone considering treating themselves for radioactive cesium contamination should not try to flush the radioactive cesium out of them with stable cesium, instead I would suggest that you use prussian blue to greatly increase the rate at which cesium is lost from the gut.

A friend of mine used to work on cesium in farmyard animals, the work done years ago indicates that small doses of cesium in the diet do not work well as a means of flushing out the cesium from pigs. So if it fails to work on pigs then the use of stable cesium in humans is unlikely to work.

Molecular boxes

OK a bit more about prussian blue and what are known as coordination polymers. The idea of a coordination polymer is that it is a repeating network where bridging ligands link each metal centre to the next, thus making a polymer.

To understand them we need to build up to it, it is not a good idea to try to run before you walk. Lets start with a metal complex which has lone pairs poking out into space ready to bind to something else. Err Oh Err how about [CpFe(PR₃)(CN)₂]^- this is a 18 VE complex. For those of you who do not know what the 18 VE rule is then I suggest that you read Tony Hill‘s book which will explain the 18 VE rule. A copy of organotransition metal chemistry by Anthony Hill can be obtained from the RSC.

Here is a picture of the anion, you can see it has the two nitrile groups which each have a lone pair on the nitrogen atom.

The cyclopentadienyl iron triphenylphosphine dicyanide anion

Now here is a complex where the Cu(PCy₃) group is used, this group is a weak lewis acid so it has the ability to bind to lewis bases such as the lone pairs of the cyanide groups of the iron fragment.

You can now see the square-ish arrangement of two copper atoms (green) and two irons (yellow), what you are looking at may be a bit of an “atomic fog” but do not worry yourselves too much.

The diiron dicopper square complex

As I feel kind here is a picture of the inner core of the complex, I have removed the carbon groups attached to the phosphorus atoms.

Copper iron square complex without some of the groups to give you a better look

Now if we use three cyanides to link a metal to three other metals we can make a cube, well it is a bit of a distorted cube. I am sure that the more able minded persons reading this can understand how this is step towards a infinite solid with lots of cubes in it. Here is a picture of it. Before you ask the cage is anionic, and the atom at the centre of the cage is a potassium. This complex was published by T.B.Rauchfuss in the Journal of the American Chemical Society, 2007, 129, 1931.

The cube of eight cobalt atoms bridged by 12 cyanide ligands

The cube is capped with cyclopentadienyl and tetramethylcyclobutadiene ligands. For those of you who can not see through the atomic soup (or atomic fog) here is the cube without the capping ligands.

The cobalt cage without the capping groups

* If as a university teacher you do not get on with Tony Hill’s book then you can always replace this with another book.

Prussain blue

Dear Reader,

I have explained how cyanide can bind to metals such as iron to form complexes, these complexes have lone pairs poking out which can bind to other metals. Here is a picture of a unit cell of prussian blue.

A unit cell of a cesium nickel iron cyanide

The carbons are black, the nitrogens are blue, the irons are purple, the nickels are gold coloured and the green atoms are the cesium.

More about Prussian Blue

Dear Reader,

I would like to enlighten you further about this wonder solid, in the last post I explained what cyanide is and how it has the right orbitals for bonding to metals. I have shown you the orbitals on cyanide and how I will show you how they bind to metals to do things.

Firstly one of the sp orbitals (green) on the cyanide forms a sigma bond to the metal.

Sigma bond formation between the cyanide and the metal

The next picture has the red and blue orbitals on the cyanide and the metal which interact to form the pi bond between the metal and the cyanide. This is at the same time as the sigma bond forms, in this way while electron density is transferred onto the metal from the cyanide through the sigma bond the cyanide removes electron density from the metal into the antibonding pi orbital. This is why cyanide is known as a pi-acid ligand, it also makes the ligand field of the cyanide very strong.

The green sp orbital is left behind and it pokes out into space to allow the bridges to be formed to the next metal.

The p orbitals in red and blue which form the pi bond between cyanide and the metal and the sp orbital (green) which forms the lone pair which allows bridges to be formed to the next metal

Why and how does Prussian Blue form

Dear Reader,

Welcome back and I have to warn you fine folk that I am still thinking about Prussian blue the wonder substance which helps us to manage the radioactive cesium from the Fukushima accident.

While on a boat crossing the north sea I asked myself the question of why does Prussian blue form and how. I think that I have come up with an answer. It is important for us to start with the unfriendly sounding molecule hydrogen cyanide. It goes backward and forwards. It is refined, very much maligned and misunderstood. Go easy on this fellow, he must never be abused. He gets the metals going and you find him fizzing in the corner in the bleach bin.

Some of you may have spotted the reference to 1980s culture, those of you who have not then do not worry. All will become clear soon. It is important to bear in mind that Prussian blue will not give you cyanide poisoning.

HCN is a very refined fellow, the modern and green way to make the dinitrile required for the production of the 1,6-diaminohexane required for nylon-6.6 production is to use hydrogen cyanide (with a nickel catalyst) rather than using sodium cyanide. So the next time some asks you to name a green reagent you can say “hydrogen cyanide” in a truthful way. While it is a toxic reagent it is more green than sodium cyanide as its use forms less toxic solid waste which is hard to deal with.

For a process to be truly green it must satisfy three things.

1. Be economically sustainable (Eg process for making aspirin at £ 10 per gram will not be OK)

2. Be environmentally sustainable, it must not guzzle resources or spew out vast amounts of waste for a small amount of product (Eg if I have to cut down a square mile of rainforest and kill five rare birds to make you an egg sandwich then this method is not an OK egg production system)

3. Be socially sustainable (Eg if a process requires small children to climb up chimneys then it will not be considered morally acceptable. As a result it will be impossible to sustain the process in today’s Soceity)

Next HCN is a very maligned and misunderstood substance; it is a toxic gas but if we want to base our vilification of gases on purely their toxicity then hydrogen sulphide beats it in the top ten worst ever gases. My own view is that carbon monoxide is more of a fright gas as CO has absolutely no smell and is much more common (check your when your gas appliances were last checked by a service engineer). But as a result of the fact that HCN was the poison gas used at some Nazi extermination camps, in the American gas chamber and in many detective stories hydrogen cyanide has acquired a super nasty reputation. It is interesting to note that carbon monoxide was also used by the Nazi murderers (the gas van), but why then has CO not become viewed with equal horror by the public ?

I would say that as a chemist or an industrial worker it is important to avoid breathing in or otherwise absorbing HCN, it is bad for your health. As well as the dire short term effects which are well known it can have some horrible long term effects which are sometimes seen in parts of Africa where people tend to live on a vegetable known as cassava. If you prepare this food wrongly then you will get a dose of cyanide in every meal, this can lead to chronic cyanide poisoning which causes among other things trouble with the nervous system. So my advice is to “go easy on your body” when working with cyanide. Do not abuse your body by forcing it to endure the stress of having to metabolize cyanide, take that bit of extra care to lower your occupational intake of cyanides.

The cyanide anion is a very strong ligand for many transition metals, indeed it does get the metals going. Sometimes in very much the wrong way, some time ago there was a large spill of cyanide waste in eastern Europe. It ended up in a river where it then killed the fish, one of the problems with cyanide it binds to an iron complex in mitochondria which then stops oxygen binding. As a result the fish could no longer use oxygen, as a result they died. But we need to understand why does cyanide bind to metals so well, the binding of cyanide to metals is much stronger than the binding of most simple monodentate ligands.

Monodentate ligands is a fancy term for a molecule or atom which binds through one atom onto a metal.

A snake which grabs you with its mouth is a monodentate animal

A crab which grabs you with both claws is a bidentate animal

A scorpion which grabs you with both claws and applies the stinger to you is a tridentate animal

The reason is the “backwards and forwards”, hydrogen cyanide when deprotonated forms the cyanide anion which uses a lone pair on the carbon to form a sigma bond to a metal. It also uses its empty pi* orbitals to suck electron density off of metals thus forming pi bonds to the metal.

Now we need to look at the orbitals of the hydrogen cyanide, the orbitals of the cyanide anion are almost identical.

Lets start with the HOMO, this is not a sexual term it means Highest Occupied Molecular Orbital in chemistry. Those of you who were expecting something sexual here, I am sorry but I am going to disappoint you, this blog is not about sexual matters. But feel free to carry on reading as you might find the chemistry interesting.

The HOMO of HCN

Here you should be able to see that on the nitrogen atom (blue atom) a lobe of the orbital pokes out into space away from the CH group, this part of the orbital will form the lone pair which allows the nitrogen to bind to things. Around the hydrogen atom is a big blue lobe. When the HCN loses a proton this will form a cloud of electron density which also pokes out into space. Here is another view which may make it more clear, the lone pair on the nitrogen and the blue blob on the carbon will allow it to form the sigma bonds which go to metal atoms.

Alternative view of HCN's HOMO

Here is a view of the HOMO of the cyanide anion, look at how similar it is to the HOMO of hydrogen cyanide.

Next here are two alternative views of the HOMO of the cyanide anion to allow you to have a better idea of the shapes of the orbitals.

The next thing to look at is the p orbitals of HCN, I have calculated these orbitals for the cyanide anion and they are the same shape so I will only show you one set. Here is one of the them.

One of the pi bonding orbitals of HCN

The hydrogen cyanide molecule has two occupied pi orbitals which look like a pair of sausages arranged parallel with the line between the carbon and the nitrogen. Here is a view of the other one.

A view of the other pi orbital

Next we have the pi* antibonding orbitals.

LUMO of HCN

HCN LUMO +1

I guess they looked the same to you, so here is the end view. Note that they are at ninety degrees to each other.

HCN LUMO

HCN LUMO +1

Now to understand antibonding, I want you to think of a nice person. How about St Francis of Assisi, after a wayward youth he grew up to be a man known for being kind to poor people and taking care of animals.

The anti-St Francis would be a nasty man who steals bread from staving single mothers and homeless men, for fun he throws
animals down the well.

The anti-St Francis is the total opposite of St-Francis, everything good about St-Francis has been turned into something horrible in the anti version. In the same way all the energy lowering effects of the bonding orbitals are turned into energy increasing effects in an antibonding orbital. Typically an antibonding orbital is more antibonding than the bonding orbital is bonding. So if you fill up both orbitals with electrons then overall the sum of the two orbitals is antibonding.

In case you want to see some of the other orbitals of HCN then here they are.

LUMO +3

LUMO +2

 

LUMO +1

LUMO

HOMO

HOMO -1

HOMO -2

HCN HOMO -3

HCN HOMO -4

I hope to bring you some more about our new friend (Prussian Blue) soon.

More about prussian blue

Dear Reader,

Now some of my readers have become interested in Prussian blue, this is the miracle drug which removes cesium from human bodies. I was recently reading the work of Peter W. Stephens et. al., Inorganic Chemistry, 2010, 49, pages 1524 to 1534. His paper is about the crystal structures and magnetic properties of mixed oxidation state manganese versions of Prussian blue. This has allowed us to use X-ray technology to look inside a prussian blue crystal.

Here is a chance to look at the potassium version of the prussian blue, it is clear that the potassium atoms are in channels which run through the solid.

K2Mn{Mn(CN)6}

The way in which the prussian blue works is to allow out the potassium, the cesium ions then diffuse in to take the place of the potassium ions. When the potassium ions are replaced in this solid with cesium the larger cesium ions cause the solid to change slightly. Here is a picture of the cesium solid.

Cs2Mn{Mn(CN)6}

I checked the literature and other prussian blue like model compounds have similar structures, one early report was made by R. Rigamonti, Gazzetta Chimica Italiana, 1938, 68, 803-809. Where this italian reported a potassium salt of Co[Fe(CN)6]. I think that due to the ligand field energy effects this was a simple cubic solid which looked just like the cesium one which I showed above.

Now I am going to tell you the story about how I found out about Prussian blue, years ago in 1999 I went on an adventure to eastern europe. I joined Josef Novosad’s research group for a while. While I worked with Josef on phosphorus chemistry (we both share an affinity for this element), between making some interesting compounds which may have improved our understanding of dithioimidodiphosphinates and enjoying the delights of Brno (it is a very wonderful place) we did talk about chemistry.

One of the things which Josef told me about was what he did in his youth, he told me that he was given a job by the communists working on uranium in farmyard animals at a research centre close to Brno. But after the Chernobyl accident he was moved onto cesium in farmyard animals. What used to happen at Josef’s research site was that an animal would be given a dose of 1 MBq of Cs-137, then using additives to the animal’s feed the workers would then try to remove the cesium from the animal.

Before anyone gets worried about the effect of the cesium on the farmyard animal lets do an estimate of the dose which the animal gets. If we assume that the animal is identical to a typical human in size and that it is identical to a human then we can use the data for humans. Using the radiation protection advice from a US university we can get a thing called an ALI for oral exposure to Cs-137. The ALI is the Annual Limit of Intake which for Cs-137 in the US is 100 microcuries. As 1 Ci = 37 GBq this works out as a dose of 3.7 MBq to the animal being the limit. The US limit is worked out based on a 5 rem dose to the body. So the animal will get 1.35 rem. Now some of you might be getting a bit confused with the different radiation units. Here is a look up sheet

100 rem = 1 Sv

100 rad = 1 Gy

1 Curie = 37 GBq = 37000 MBq = 37000000 KBq = 37000000000 Bq

1 milli Curie = 37 MBq

1 microcuries = 37 kBq

So our “animal” will have got a 13.51 mSv dose, this dose is far too small to cause “radiation sickness”. If we repeat the calculation using the ALI value used in Sweden (based on a 20 mSv dose) which is 1.5 MBq then our animal gets a dose of 13.33 mSv. This is not a dose which will make the animals die of radiation sickness and if we use the accepted dose to chance of cancer conversion factor of 5 % for a 1 Sv dose then if we assume that the LNT model is right then if the animal was a human then it would have a 1 in 1500 chance of getting cancer as a result of the cesium intake. As most farmyard animals weigh more than a human the real dose to the animal would be likely to be lower.

To put it in perspective if I got a dose of 13.3 mSv at work then I know that my radiation protection officer would be very very concerned about me but I would not have gone over the yearly limit for a classified radiation worker, but if I got that dose in one month in Sweden then it would trigger an investigation into me. Such a dose is in the range where the national radiation protection authority would want to know what I was doing and how I got the dose. However if a member of the public got that dose at work then I imagine that the national radiation protection would be hopping mad to say the least ! The occupational dose for a non radiation worker is only 1 mSv per year, as a non-radaition worker is unlikely to be wearing a film or TLD badge then it might take quite a lot of extra work to work out the dose compared with the effort needed to estimate a dose for a dosemeter wearing radiation worker.

But lets get back to the prussian blue.

Josef told me that he tried almost every transition metal, I think that he did not try using nickel as nickel is toxic. He then used the batches of the “prussian blues” to try to clean the animals up. What Josef found was that no two batches of prussian blue which he made worked quite the same way in the experiments. So my advice to anyone planning on making prussian blue for medical use in Japan is that the production of the medical grade solid is not a simple matter, I have to confess that I do not know how to reliably make medical grade prussian blue.

If you want to read about Josef’s cesium work then see  H. Prochazka, J. Jandl, J. Novosad, O. Neruda, J. Hejzlar and S. Spelda, Veterinarni Medicina, 1991, 36, 341 to 348. The paper is entitled “Affection of Radiocesium Retention in Miniature Pigs”

The abstract of this paper comments that stable cesium (1 mg per kilo of body weight) is not effective as a means of removing cesium from pigs. Josef and J. Jandl published another paper in which they used a modified zeolite to treat sheep which were contaminated with cesium. This paper can be found at “In-Vivo Reduction of Radiocesium by Modified Clinoptilolite in Sheep”, Veterinarni Medicina, 1995, 40, pages 237-241.

Have the sunflowers failed

Dear Reader,

I have read that the sunflower plants in Japan have failed to remove much cesium from the soil, it was reported in a Japanese news paper that suggested that if 10 kilos of sunflowers are grown per square meter that only 0.2 % of the cesium will be removed. The problem with phytoremediation is that ability of the sunflower plants to remove the cesium will depend a lot on the Kd value for the soil. I know that sunflowers which are grown under soil free (hydroponic) conditions are very good at absorbing the cesium.

This failure of the sunflowers to absorb the cesium may in some ways be a good thing, it may suggest that the Kd value for cesium on the Japanese soil is very high. In some ways a high Kd value for cesium is good, if the cesium sticks like glue to the soil then it will be less able to enter plants. The best possible soil for the Japanese to have would be a potassium rich soil which has plenty of clay in it.

I predict that for farming that this year will be the worst for cesium, this year cesium will have been able to absorb through leaves and the other surfaces of plants which are above the ground. In future years the cesium will have to pass through the soil, the soil will act as a filter which will reduce the uptake of the cesium by the plants.

The Japanese have found that by removing the top layer of the soil that they are able to greatly lower the cesium contamination level, but they will create vast amounts of contaminated soil. I would suggest that for the worst hot spots that the Japanese should scrap the soil but for less contaminated areas they should deep plough the soil to put the cesium out of reach of the roots of grass. An alternative is to only grow oil crops like sunflowers / rape or plants which have very deep root systems.

It has been shown that sunflowers can be grown on radioactive land with very little of the cesium entering the plants, which sets us up well for biodiesel production.

Very little cesium is transferred into the part of the plant which is pressed to provide the oil. So the sunflowers could play a role in the cleanup of the area. The farms near to the stricken reactors could be used to grow vast fields of oilseed rape. This oilseed rape could then be pressed to give oil which will be very low in cesium. The oil could then be converted into FAME diesel, the conversion process is likely to lower the cesium content yet further.

The FAME biodiesel could help Japan as it normally has to import lots of motor fuel, so the product of these farms would have a use rather than being a crop which has no use. So maybe together with things like prussian blue the sunflowers may have a role to play in the recovery.

Cesium maps for Japanese farmland

Dear Reader,

The Japanese government have issued maps of cesium contamination on farmland in the areas near to the Fukushima reactor accident. The main map of that area of Japan is here. Based on a google translate examination of the text with the map the soil has been taken from paddy fields at up to 15 cm depth while for upland soils it is the top 30 cm of soil. If any of my readers can read Japanese then I would be very grateful if they could give me a translation of the text from the Japanese Agriculture, Forestry and Fisheries Research Information Technology Center.

The bad news is that the cesium level in some areas is high, but the good news is that there are things which normal farmers can do which will lower the transfer of cesium to the food crops. I think that farms are going to need to learn a few new skills to allow them to farm in a safe and healthy way using their contaminated land.

Cesium in beef

Dear Reader,

I have discovered from the news that radioactive cesium has been found in beef (http://news.yahoo.com/more-radioactive-beef-shipped-japan-161903589.html), it appears that the cattle were fed straw which was contaminated with cesium.

This looks to me like a classic case of contamination being passed via animal food to animals and then onto humans. I think that the affected cattle should have prussian blue added to their diet to lower their cesium content.

If the cattle are put on a cleaner diet and/or fed prussian blue then it is possible to lower the cesium levels in the food which finally is put on a plate in front of a human.

Now that the rate at which the reactors emit cesium into the air has gone down greatly, I think it is time to start to clean the land which the cattle graze from. I think that where possible the land should be deeply ploughed to bury as much of the cesium as possible out of reach of the roots of the grass.

One possible method of dealing with the cesium problem would be for clean food (grain ?) to be supplied to cattle farms this year while the pastures are dug up to deal with the cesium problem. This change to grain might however push up the price of beef at the farms where the feed has been changed.

Who is giving out advice on how to deal with an act of nuclear warfare

Dear Reader,

I have noticed that one web site is offering advice on what to do if some horrible persons let off an atomic bomb near your bomb or if a reactor accident occurs.

http://www.ki4u.com/guide.htm and http://www.ki4u.com/illwind.htm

While the advice contains some very good points such as

1. If you see a bright flash (which you suspect might be an atom bomb) do not go to the window to take a good look at it. Instead seek shelter under a table or a desk.

2. Make sure you store plenty of water (I have paraphrased both bits of advice)

It is important to bear in mind that many people who give out advice have a vested interest which is likely to colour the advice. I think that KI4U is a company which wants to make some money out of marketing potassium iodide pills, Geiger counters and fallout shelters. I saw a photo of a underground blast and fallout shelter (ready for sticking in the ground) all painted in a rather fetching yellow.

At the other end of the spectrum the antinuclear lobby have in the past suggested that the best advice is to campaign for a world free of atom bombs and for an end to the nuclear industry. For example Edward Palmer Thompson edited a book named “Protest and Survive” which was a parody of the UK government’s advice booklet to the general public on nuclear warfare which was named “Protect and Survive”. The title of this book suggests that the way to survive is to protest and demand a nuclear free world.

The antinuclear movement gave and does seem to give out the message that the only action which people can take to protect themselves is to demand an end to all nuclear activities.

To my mind it is like trying to protect children from being run over by cars by banning cars rather than teaching them to cross the road in a safe manner. I would like to point out that Marie Curie’s husband (Pierre) was run over and killed by a horse drawn cart so banning cars will not stop road deaths.

In the time after the Japanese reactor accident I saw a blog entry which suggested that a “Quiet death awaited children” because cesium had entered the drinking water in “Tokio’s groundwater”, the blog was little more than a link farm which included an article which suggested a tiny trace of Cs-137 was in the drinking water (less than 1 Bq per litre, http://www.bloomberg.com/news/2011-07-04/radioactive-cesium-is-found-in-tokyo-water.html) and a self citation to a blog post which seemed long and full of silly ideas (http://tekknorg.wordpress.com/2011/03/19/effect-of-cesium-and-strontium-on-japanese-children-japanese-officals-irresponsible/),

The blog claimed that a Dr Dörte Siedentopf of the IPPNW stated that “The cesium is biological similar to the potassium and the human body can not distinguish between the good potassium and cesium. The body takes it on the breath and the food. You can not protect yourself.”

I sincerely hope that the medical doctor is being misquoted, while in the human body (and many other organisms) cesium can act as a replacement for potassium it is possible to protect humans and animals from the effects of cesium.

1. Through adjustment of the diet (mushroom and wild game soup will be much worse than most things)

2. Prussian blue can be used to increase the rate of cesium being lost from humans and animals, also the cesium bonded to prussian blue does not leach out into soil.

3. Farming methods can be altered to reduce the transfer of cesium to humans.

To me the idea of a medical doctor giving out the advice that a person’s condition is untreatable while in fact it is very treatable is an outragous breach of the Hippocratic oath. It reminds me of the unethical experiment in the USA where black men were experimented on in the Tuskegee Syphilis Experiment. In this experiment effective medical treatment was withheld from the men, and they were not even told the nature of their condition thus placing others at risk.

The text of the oath is

“I swear by Apollo, the healer, Asclepius, Hygieia and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and
similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation
to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and
in all times; but if I swerve from it or violate it, may the reverse be my lot.“

I have placed in bold the part of the text which I think deals with the doctor who withholds treatment or medical advice. I think that if the members of the IPPNW want to be experts on the field who offer advice then they should offer better advice than bland statements that “Nuclear power is bad for your health”. They should also provide real and useful advice for people who are living in contaminated areas which allow them to reduce their intake of radioactivity.

If they are not able to do so then I suggest that they leave the whole nuclear area alone, years ago I read a book from the IAEA on industrial radiographic work which has the joyous title of “lessons to be learnt from accidents in industrial radiography”. My pet name for this book is “the little book of horrors”, it is a book which is all about what can go wrong when men and women go out into the field armed with moderate sized (circa 1 to 10 curie) gamma sources to do radiographic work. One of the bits of advice which the IAEA issue is

“Radiographers should refuse work which they is either not trained or equipped for” (My paraphrase)

I hold a view that this advice applies equally well to other areas of life, I think that the medical doctors of the IPPNW should refuse to comment on nuclear matters if they lack training / experience in the field. It is important to bear in mind that dealing with the medical effects of something is not guaranteed to give you an education in the innermost details of the thing which caused the injury or the disease.

In the same way clinical experience in treating bullet / shrapnel injuries does not qualify a person to work with firearms / explosives, a clinical experience of cancer does bestow on a doctor a deep insight into either the chemical and nuclear industry. I hold the view that I am part of the solution rather than part of the problem, so if any members of the IPPNW who either want to improve the training materials they use on medical students or to educate themselves then please feel free to contact me. I can supply suggestions for text books and other things which can be used to provide a person with a proper view of the subject.