Alice Stewart

The Woman Who Knew Too Much is an estimable book about the life of Alice Stewart and her role in the long, painful effort to understand and control the health effects of radiation.

Gayle Green, a professor of women's studies at Scripps College, does not cover the technical history of the scientific controversies surrounding radiation health effects. Nor does she attempt to present the scientific arguments of Stewarts more responsible critics. But her account of Stewarts major scientific studies and explanations of countervailing opinions about the effects of low-level radiation provide readers with a good sense of what some of the fighting is about.

A brilliant iconoclast, Stewart has compiled an impressive body of scientific work despite being denied the recognition or institutional support that most researchers take for granted. Stewart, who is now 94, is a fragile-looking woman of great energy, warmth, and charm. Her persona contrasts with her reputation, which in some health physics circles is akin to that of Darth Vader. In other, more generous scientific communities she is referred to with the furtive nervousness used when speaking of a lunatic relative who might at any moment break out of the attic and embarrass the family.

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Stewart's courageous struggle to uncover the truth about radiation effects demonstrates how individuals can accomplish a great deal outside the mainstream of institutional power. But the independence that enabled Stewart to pursue her own scientific agenda also left her without a recognized status or the support of colleagues within the scientific community. If she had received such support, her ideas might have had more leverage and influence. Stewart's first major work on the health effects of radiation was a study she coauthored while at Oxford about the increasing rates of leukemia among children. Called the Oxford Study of Childhood Cancer, the work was published in Lancet in 1956.

The study was a landmark in the history of radiation science, the first epidemi-ological study to examine the health effects of small doses of radiation. Using detailed questionnaires administered to the mothers of study subjects, Stewart compared prenatal exposures among children who had died of leukemia with those of children who had died of other forms of cancer. She then compared these data to results from living controls matched for age, sex, and region. Children from both cancer groups had received twice the amount of prenatal X-rays as had the living children. Stewart and her colleagues concluded that the effect of a single diagnostic X-ray, which was a mere fraction of what was considered a “safe” dose at that time, doubled the risk of childhood cancer. Stewart remarked to her biographer, “That was what we found and that finding has determined the course of my life ever since.”

Although the initial reviews of Stewart's findings were complimentary, criticism of the report grew rapidly. Critics assaulted everything from the potential of recall bias arising from the authors' technique of administering questionnaires, to Stewart's sanity. Wrote one critic, “Stewart used to do good work, but now she's gone senile.”

However, Stewart persisted with her research and continued to accumulate data. A second report appeared in the British Medical Journal in 1958. This analysis—which tracked 80 percent of all childhood cancers occurring in Britain between 1953 and 1955— confirmed the earlier findings.

The Oxford study was published at the peak of atmospheric nuclear weapons testing. Concerns about the consequences of nuclear fallout were rife in both the United States and Britain, and Stewart's findings landed her in the middle of controversies about radiation effects. These controversies are as bitterly debated today as they were half a century ago. The scientific “truth” about the effects of low-level radiation remains confused and difficult to unravel.

Stewart's work includes analyses of data about Energy Department workers and investigations of the data on the atomic bombings in Japan, which are now managed by the Radiation Effects Research Foundation (RERF)— an institute jointly funded by the Energy Department and the Japanese government. The RERF data are considered the “gold standard” of radiation epidemiology, largely because of the massive number of people studied and the length of the observations. Stewart's critique of this data set has important implications and deserves more serious attention than it has received thus far.

She contends that the bomb survivors included in the RERF analyses are not representative of the population affected by the bomb, or of humans generally. The RERF studies began five years after the bombings— by which time, according to Stewart, many of those who survived the immediate horrors of the explosions had died of wounds or other causes. She argues that the RERF data selectively describe radiation effects among an atypically hardy subsection of the community and are a poor basis from which to derive radiation protection standards for the world at large.

Stewart's interpretations of radiation effects conflict with prevailing wis-dom—and the science that has determined the world's exposure standards. Greene contends that there has been an international “campaign” to denigrate Stewart's work, although Stewart has never been confronted directly. In fact, officials from the Energy Department and the nuclear industry have never asked Stewart to explain her conclusions. This absence of a straightforward investigation of Stewart's findings by organizations that work with radiation or are charged with protecting people is puzzling.

During the Cold War, most government and industry officials were principally concerned about defending nuclear work, and the adverse consequences of radiation exposure were covered up for national security reasons. But this argument is not valid today, and the evidence is clear that the Energy Department denied the ill effects of radiation among workers to avoid financial liability and adverse publicity. But the department also employed scientists and technical people who should have been more responsible—more curious.

At one point in the book, a friend speculates that the most tragic consequence of Stewart's professional isolation was the absence of colleagues and mentors who could have forced her to be more precise and clear about her ideas before publication. In person, Stewart is stunningly eloquent. I have heard her deliver a two-hour lecture on the intricacies of complex epidemiology, complete with numbers, without a note or pause or misplaced participle. Stewart's written work, however, is extremely difficult to follow— many experts claim it is incomprehensible. The statistical methods she employed in her investigations of Energy workers are especially hard to decipher.

In fairness, it must be said that few articles on epidemiology or radiation science make for scintillating or casual reading. As our understanding of molecular biology expands and statistical analysis becomes more sophisticated, research on radiation health effects has become increasingly difficult to interpret and evaluate.

In 1986 Stewart received the “Right Livelihood Award”—known in Europe as the “alternative Nobel”—in recognition of her “work on practical and exemplary solutions to the most urgent problems of today.” The British embassy in Stockholm refused to acknowledge her honor and did not even send a car to pick her up at the airport or accord her the attention and courtesies customary for most recipients. (The award is presented by the Swedish Parliament on the day before the Nobel ceremony.)

Stewart has never held a prestigious academic post or received the kind of accolades and honors one would expect of a scientist of her caliber. Yet she is a hero to many, and activists regard her with awe. Stewart has selfless-ly testified at numerous hearings on workers' compensation and has spoken at dozens of gatherings for a minimal or no fee.

Greene's biography can be read on a number of levels. On the one hand, it is the story of a remarkable woman— that Stewart is both a female scientist and a caring mother is not incidental to her experiences or her way of moving through the world. One comes away from this book with a deep admiration for Stewart's brains and guts—and for her decency and generosity.

Stewart's life is also a cautionary tale that warns us that our institutions are not adequately structured to deal honestly or creatively with the forces unleashed by modern technologies. The institutional backdrop of Stewart's life—universities, professional societies, government agencies, and the science community—are displayed as sexist, exploitative, incapable of constructive adjustment to change, and largely devoid of leadership.

Finally, this book serves as a reminder of the foolish, lamentable, and repugnant ways government agencies, professional organizations, and private industry have dealt with the unintended consequences of nuclear energy. Had these groups behaved more honestly when faced with unwelcome data about radiation health effects, the current debates about what to do with nuclear waste, how to weigh the dangers of nuclear power, and the health and environmental costs of nuclear weapons production might be better informed, and the chances of reaching sensible consensus considerably higher.

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“I never watch television, but sometimes television watches me.”