[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
THE FUTURE OF LOW DOSE
RADIATION RESEARCH
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON ENERGY
COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 1, 2017
__________
Serial No. 115-34
__________
Printed for the use of the Committee on Science, Space, and Technology
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Available via the World Wide Web: http://science.house.gov
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COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HON. LAMAR S. SMITH, Texas, Chair
FRANK D. LUCAS, Oklahoma EDDIE BERNICE JOHNSON, Texas
DANA ROHRABACHER, California ZOE LOFGREN, California
MO BROOKS, Alabama DANIEL LIPINSKI, Illinois
RANDY HULTGREN, Illinois SUZANNE BONAMICI, Oregon
BILL POSEY, Florida AMI BERA, California
THOMAS MASSIE, Kentucky ELIZABETH H. ESTY, Connecticut
JIM BRIDENSTINE, Oklahoma MARC A. VEASEY, Texas
RANDY K. WEBER, Texas DONALD S. BEYER, JR., Virginia
STEPHEN KNIGHT, California JACKY ROSEN, Nevada
BRIAN BABIN, Texas JERRY McNERNEY, California
BARBARA COMSTOCK, Virginia ED PERLMUTTER, Colorado
BARRY LOUDERMILK, Georgia PAUL TONKO, New York
RALPH LEE ABRAHAM, Louisiana BILL FOSTER, Illinois
DRAIN LaHOOD, Illinois MARK TAKANO, California
DANIEL WEBSTER, Florida COLLEEN HANABUSA, Hawaii
JIM BANKS, Indiana CHARLIE CRIST, Florida
ANDY BIGGS, Arizona
ROGER W. MARSHALL, Kansas
NEAL P. DUNN, Florida
CLAY HIGGINS, Louisiana
RALPH NORMAN, South Carolina
------
Subcommittee on Energy
HON. RANDY K. WEBER, Texas, Chair
DANA ROHRABACHER, California MARC A. VEASEY, Texas, Ranking
FRANK D. LUCAS, Oklahoma Member
MO BROOKS, Alabama ZOE LOFGREN, California
RANDY HULTGREN, Illinois DANIEL LIPINSKI, Illinois
THOMAS MASSIE, Kentucky JACKY ROSEN, Nevada
JIM BRIDENSTINE, Oklahoma JERRY McNERNEY, California
STEPHEN KNIGHT, California, Vice PAUL TONKO, New York
Chair BILL FOSTER, Illinois
DRAIN LaHOOD, Illinois MARK TAKANO, California
DANIEL WEBSTER, Florida EDDIE BERNICE JOHNSON, Texas
NEAL P. DUNN, Florida
LAMAR S. SMITH, Texas
C O N T E N T S
November 1, 2017
Page
Witness List..................................................... 2
Hearing Charter.................................................. 3
Opening Statements
Statement by Representative Randy K. Weber, Chairman,
Subcommittee on Energy, Committee on Science, Space, and
Technology, U.S. House of Representatives...................... 4
Written Statement............................................ 6
Statement by Representative Bill Foster, Subcommittee on Energy,
Committee on Science, Space, and Technology, U.S. House of
Representatives................................................ 8
Written Statement............................................ 10
Witnesses:
Mr. John Neumann, Director, Science and Technology Issues,
Government Accountability Office
Oral Statement............................................... 11
Written Statement............................................ 14
Dr. Gayle Woloschak, Professor, Radiation Oncology and Radiology,
Northwestern University
Oral Statement............................................... 27
Written Statement............................................ 30
Dr. James Brink, Professor, Radiology, Harvard Medical School;
Radiologist-in-Chief, Massachusetts General Hospital
Oral Statement............................................... 34
Written Statement............................................ 36
Discussion....................................................... 42
Appendix I: Additional Material for the Record
Statement submitted by Representative Eddie Bernice Johnson,
Ranking Member, Committee on Science, Space, and Technology,
U.S. House of Representatives.................................. 62
Statement submitted by Ms. Laura I. Thevenoy, Cheif Executive
Officer, American Society for Therapeutic Radiology and
Oncology (ASTRO)............................................... 64
Letter submitted by Representative Bill Foster, Subcommittee on
Energy, Committee on Science, Space, and Technology, U.S. House
of Representatives............................................. 65
THE FUTURE OF LOW DOSE RADIATION RESEARCH
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Wednesday, November 1, 2017
House of Representatives,
Subcommittee on Energy,
Committee on Science, Space, and Technology,
Washington, D.C.
The Subcommittee met, pursuant to call, at 10:38 a.m., in
Room 2318 of the Rayburn House Office Building, Hon. Randy
Weber [Chairman of the Subcommittee] presiding.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Weber. The Subcommittee on Energy will come to
order.
Without objection, the Chair is authorized to declare
recesses of the Subcommittee at any time.
Welcome to today's hearing entitled ``The Future of Low
Dose Radiation Research.'' I now recognize myself for five
minutes for an opening statement.
Good morning. Welcome to today's Energy Subcommittee
hearing. Today, we will examine the status of U.S. research in
low dose radiation and explore the effects of the previous
Administration's agency-wide reduction in funding for this area
of science.
Last Congress, the Science Committee explored the
Department of Energy's decision to terminate the Low dose
Radiation Research program, which, until its closure in 2016,
was one of the largest and most effective programs in the
world. In the course of staff briefings on this decision, a DOE
employee was fired for speaking out in support of the Low Dose
Radiation Research program. While this employee was eventually
reinstated as a result of Committee oversight, the Department
has yet to restart this important area of research.
The DOE's program explored the health impacts of low levels
of radiation, allowing our Nation's researchers, industry, and
military to safely handle nuclear material, maintain the
nation's nuclear weapons program, and dispose of nuclear waste.
Low dose radiation research can also inform the authorities
who set nuclear safety standards for the public, enabling
federal emergency response agencies to more accurately set
evacuation zones from radiological incidents.
This research is also particularly important to practicing
physicians, who rely on knowledge about the impact of low doses
of radiation to decide when and how to use diagnostics to
detect cancer in patients.
This use-inspired, basic research leads to scientific
discoveries and long-term benefits for the energy industry and
our national defense.
Today's hearing is yet another opportunity to evaluate
whether we as a nation are doing everything we can to ensure
that the regulations, guidelines, and protections we put in
place are indeed grounded in sound science.
We know a lot about the relationship between adverse health
effects and high doses of radiation. At high doses, the dosage
and risk are proportionally related. But the health risks
associated with exposure to low doses of radiation are much
more difficult to observe, and we are a long way away from
understanding and accurately assessing this particular risk.
In the absence of conclusive evidence, scientists use
what's called the linear-no-threshold (LNT) model to
approximate the effects of low doses of radiation on the human
body. This model takes what we know about high doses and
applies it to low doses. Current federal dose limits and
guidelines are based on the LNT model. Because this model is
simply an assumption of the impact, not a validated mechanism
for assigning risk, there is no definitive science to justify
many of our nation's nuclear safety procedures or to set
guidelines for medical treatments.
In order to best serve our nation's energy, medical and
defense needs, we need foundational research in radiology and
biology to directly define the impact of low doses of
radiation.
Here on the Science Committee, we hear a lot of enthusiasm
for next-generation technologies but we cannot forget about the
questions we have left unanswered. The United States should not
rely on a best approximation when it comes to our nuclear
regulatory policies.
DOE must reprioritize basic research in low dose radiation
so we know we are using the best available science to set these
standards.
I want to thank our accomplished panel in advance, our
witnesses, for testifying today, and I look forward to a
productive discussion about the future of American low dose
radiation research.
[The prepared statement of Chairman Weber follows:]
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Chairman Weber. I now recognize the Ranking Member, the
gentleman, for his comments.
Mr. Foster. Thank you, Chairman Weber----
Chairman Weber. I'm sorry. The--you're right, the Ranking
Member.
Mr. Foster. Well, I'm the Ranking Member pro tem, I
believe.
Chairman Weber. I think that's what it is.
Mr. Foster. Well, I guess representing 100 percent of the
Ph.D. scientists in Congress.
Chairman Weber. There we go.
Mr. Foster. Anyway, I want to thank you for holding this
hearing on a really very interesting and important topic, and
thank you to all our witnesses for being here to provide us
with your testimony and your expertise. I'm Congressman Bill
Foster. I'm a scientist and a businessman, so I understand the
importance of regulatory costs and getting the answer right.
This is an important issue because if you make the wrong
decision or a decision not based on the best science, you know,
frankly, people can die. If you set too conservative thresholds
for chest X-rays, then patients may have non-diagnosed
conditions because of X-rays that are not taken. If you, for
example, set too conservative standards for nuclear workers,
then it may impose--or nuclear bystanders--that may impose
large costs on the nuclear industry and cause us to shift our
energy balance, for example, to coal which we know kills tens
of thousands of Americans each year.
And so it's important to get this answer right. The basis
of our regulatory framework around radiation exposure has been
the linear no-threshold model, which I'm sure we'll hear all
about today, and that says the risk of cancer and other bad
effects increases with every incremental increase in radiation
exposure. So this conservative approach to regulation is not
fully justified by the current body of peer-reviewed scientific
literature in the low dose regime and investing into this
research in this field is not just about the development of
regulations, it's all about public understanding of an
important issue.
Federal investments in radiobiology research have resulted
in significant progress in our understanding of the health
effects to low dose radiation, in particular, how cells respond
to radiation exposure on a molecular level.
During the past 17 years, the Low Dose Radiation Research
program at the Department of Energy has been responsible for
several notable shifts in how scientists examine the impacts of
radiation exposure including the impact on radiation not only
on the cells directly deposited with energy but on the cells
surrounding them, so-called bystander cells. There's also a new
technology that has become available. The use of Big Data, for
example, to perform virtual experiments on large human
populations to try to tease out the signal here, or for
example, gene sequencing of blood samples to detect cancer and
precancerous cells at a preclinical level.
This work has informed our physicians and medical
researchers as they try to design better treatments for cancer
patients, and moreover, the implication of this research can be
seen in the number and the breadth of different federal
agencies that are investing in this work. In addition to the
Department of Energy, there have been federal investments in
low dose radiation research at the Nuclear Regulatory
Commission, the FDA, the Environmental Protection Agency, and
the National Institutes of Health, NASA and the CDC. These
agencies all see benefits from this work, and in their own
areas of interest.
Yet the leadership in DOE under the past Administration and
I should note, under the current Trump Administration as well,
has decided to no longer support this research, and I'm happy
to join my Majority colleagues with our questioning of this
position, and we are not alone in our concerns. The GAO's
report on this topic seemed very clear. They recommend that DOE
take the lead in ``the development of a mechanism of
interagency collaboration on research on low dose radiation's
health effects.'' Though I must observe that one of the, you
know, glaring omissions from this hearing is a witness from the
Department of Energy. We're reviewing a report from GAO that
includes key recommendations for DOE, and it is sad that we're
here without a representative from the Department to provide us
with their input on these recommendations, and it's really a
missed opportunity. I'm disappointed that we can't have a more
complete conversation here, and hopefully make real progress in
our oversight of the Department in this crucial area of
research.
I hope the Majority will consider as we move forward with
additional hearings on this topic or others directly under the
purview of DOE the Department's lack of a Senate-confirmed
leadership really shouldn't give us--give them immunity from
Congressional oversight.
And with that said, I'm looking forward to this bipartisan
dialogue on an important topic, and thank you again, Mr.
Chairman and our witnesses.
[The prepared statement of Mr. Foster follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Weber. I thank the Ranking Member pro tem, and now
I'm going to introduce our witnesses.
Our first witness today is Mr. John Neumann, Director of
Science and Technology Issues at GAO. He manages and oversees
both federal R&D programs and federal efforts to support
innovation. Mr. Neumann received a bachelor's degree in
political science from the State University of New York at
Stony Brook, an MBA from American University, and a J.D. from
Georgetown University.
Our next witness is Dr. Gayle Woloschak--am I saying that
right--a Professor of Radiation Oncology and Radiology at
Northwestern University. Additionally, Dr. Woloschak is a
Visiting Scientist at the Bundeswehr Institute for Radiobiology
in Munich, Germany, and a lecturer at Rosalind Frank Medical
School in North Chicago, and a Visiting Professor at Alexandria
University in Alexandria, Egypt. And when do you sleep? She
received a Ph.D. in microbiology at the Medical College of
Ohio, Toledo, OH.
Our last witness is Dr. James Brink, Professor of Radiology
at Harvard Medical School, and Radiologist-in-Chief at
Massachusetts General Hospital. Dr. Brink was elected an
honorary member of the American Association of Physicists in
Medicine and a member of the International Society for
Strategic Studies in Radiology. Currently, he serves as the
Scientific Vice President on the Board of Directors of the
National Council for Radiation Protection. He received a
bachelor's degree from Purdue University and an M.D. from
Indiana University. Dr. Brink joins us today to testify in his
capacity as the Chairman of the American College of Radiology
Board of Chancellors.
I want to say thank you to you all for being here, and we
will begin our testimony, Mr. Neumann, by recognizing you for
five minutes.
TESTIMONY OF MR. JOHN NEUMANN,
DIRECTOR, SCIENCE AND TECHNOLOGY ISSUES,
GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Neumann. Chairman Weber, Ranking Member and Members of
the Subcommittee, thank you so much for the opportunity to be
here today to discuss GAO's report on federal protections
against the harmful effects of ionizing radiation and federal
support for related research.
To protect against cancer and other harmful effects
associated with radiation exposure, the EPA, NRC, and other
federal agencies have established requirements and guidance
that apply to a range of settings in which exposure can occur.
Agencies such as the Department of Energy have also funded
research to determine how low doses of radiation affect human
health. However, uncertainties remain about these effects. For
example, in 2016, the Department of Energy's Biological
Environmental Research Advisory Committee reported that further
research on low dose radiation could decrease uncertainty in
cancer risk estimates.
My statement today summarizes our report on low dose
radiation, which examined two areas: first, how selected
federal agencies have developed and applied radiation
protection requirements and guidance for workers and the
public, and secondly, the extent to which federal agencies have
funded and collaborated on research on the health effects of
low dose radiation.
In our review of how federal agencies developed and applied
radiation protection requirements, we focused on four settings
in which radiation exposure can occur: the operation and
decommissioning of nuclear power plants, the cleanup of sites
with radiological contamination, the use of medical equipment
that produces radiation, and lastly, the accidental or
terrorism-related exposure to radiation, and we found that to
develop radiation protection requirements and guidance for
these four settings, agencies generally relied on the advice of
scientific advisory bodies, and this advice included the use of
the linear no-threshold model, which assumes that the risk of
cancer increases with every incremental increase in radiation.
However, advisory bodies have also recognized challenges in
accurately estimating cancer risks from very low doses of
radiation. For example, much of the data on health effects of
radiation exposure come from non-U.S. populations such as the
Japanese atomic bomb survivors. These populations received a
large exposure to radiation over a short time, and there is
uncertainty about the extent to which the health effects for
them can be extrapolated to a U.S. population that may be
chronically exposed to low doses of radiation.
In looking at federal agency support for research on the
health effects of low dose radiation, we found that seven
agencies obligated a total of about $210 million from fiscal
year 2012 to 2016 but their collective annual funding has
decreased by almost 50 percent over that period.
We also found that agencies collaborated on particular
research projects but they did not collaborate to address
overall research priorities such as the research needs that the
scientific advisory bodies we met with had identified regarding
low dose radiation health effects. Such research needs include
areas related to uncertainties in the linear no-threshold
model, and by extension in the agency's dose limits and
guidance levels that are based in part on that model.
In the past the Department of Energy provided leadership in
this area. However, its leadership role has decreased since
2012 as the Department phased out funding for its main research
program on low dose radiation health effects. We found that no
other agency has stepped forward to fill this role.
Given these findings, we recommended that the Department of
Energy take the lead in developing a mechanism for interagency
collaboration on low dose radiation research. The Department
disagreed with our recommendation, stating that it would be
inappropriate for it to lead because other agencies have their
own budget authorities and research priorities. However, given
the Department's past leadership role, we continue to believe
that the Department of Energy is in the best position to lead
agencies in developing such a mechanism for addressing shared
research priorities. Such an action would be consistent with
the Department's responsibilities under the Atomic Energy Act
to conduct research related to nuclear energy including the
protection of health during activities that can result in
radiation exposure.
This concludes my prepared remarks, and I'm happy to
respond to any questions you may have.
[The prepared statement of Mr. Neumann follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Weber. Thank you, Mr. Neumann.
Dr. Woloschak, you are recognized for five minutes. Thanks.
TESTIMONY OF DR. GAYLE WOLOSCHAK,
PROFESSOR, RADIATION ONCOLOGY AND RADIOLOGY,
NORTHWESTERN UNIVERSITY
Ms. Woloschak. Okay. Thank you. I'd like to mention that I
used to work at Argonne National Laboratory, a DOE facility as
well. I think that's important to mention.
I'm going to let some questions shape my discussion so the
first question I'm going to ask is, what is low dose radiation?
Before I describe what low dose versus high dose radiation
means, I would like to remind everyone that ionizing radiation
surrounds us daily. It is part of the natural background from
sunlight and the Earth's crust, and radioactive chemicals are
present in what we eat, drink and breathe including this cup of
water I just drank. All of this constitutes natural background
radiation, doses of radiation characterized as low dose
radiation are higher than natural background. Most often, low
dose radiation exposures occur when we are close to a nuclear
cleanup site, or they might result from occupational or
accidental exposures or exposure to medical low dose diagnostic
procedures such as CT scans. Any of those low dose exposures
are thousands of times lower than the radiation therapy doses
used to treat cancer patients. These therapy doses belong to
the category of medium- and high-dose radiation.
The next question is, what don't we know and why don't we
understand low dose radiation? The most significant known risk
from exposure to low dose radiation is considered to be cancer.
If I ask a room of radiation biologists what is the risk for
cancer formation from low dose radiation, I get every answer
possible from a little bit of radiation is good for you, go sit
in a radioactive spa and lap up those rays, to radiation risk
for cancer deceases as the dose decreases, to risk from low
doses is worse per unit dose than risk at high doses.
So the question is, we don't actually know the precise
relationship between low dose radiation exposure and cancer
induction. Why is there so much disagreement? Because we have
contradictory data. One source of this problem is that many of
the low dose studies done in the past were performed with cells
in a test tube. A direct leap from cells to humans is never
done in medicine because it is just not accurate. Before
clinical trials of any sort with drugs or with radiation, we
use--numerous animal studies are done in advance. In addition
to the question of cancer risk, some of the recent low dose
studies in Europe, Japan and China suggest that we may need to
explore additional issues such as risk to unborn, risks to
newborns that may have different effects for central nervous
system or cardiovascular system. Until we have more research,
questions will remain.
My next question is, why is closing the gap in
understanding of paramount importance? My response is, our
radiation protection policies deal with low doses of radiation
because that is precisely the level of environmental and
occupational exposures that can and should be regulated.
Radiation protection is designed for a healthy population with
the view of preserving health. With regard to low dose
radiation, these policies are based on the assumptions we make
about low dose radiation effects. It is a matter of course that
citizens must be protected from dangers associated with
radiation exposure, but overprotection may be wastefully
expensive and deplete funds that could be used for other
strategic goals for the Nation.
Next question: What needs to be done in the research
community to solve this issue? What was DOE's role in funding
discoveries in the field? Work resulting from the DOE Low Dose
Program led to many significant findings. For example, some
unique biological responses to low dose radiation were found
that are not evident at high doses. This means that a simple
extrapolation from high-dose to low dose effects would not be
correct. Much of this work was in the discovery phase and thus
was done with cells in culture and never made its way to be
tested in whole animals. This limits our ability to apply this
work to human beings, which of course is our end goal. Since
the time when the DOE Low dose program was terminated,
biomedical science has continued to progress. New technologies
have been developed and new discoveries have been made. Fine-
tuned models could be developed to set the stage for fine-tuned
decisions and evidence-based protection policies.
Before the DOE Low Dose Program, DOE was the leader in the
radiation research science worldwide. Large-scale animal
studies were done ranging from low dose occupational-type
exposure to high-dose nuclear disaster-type exposures. I am in
awe when I look at the volume, planning, design, and structure
of these experiments done with animals for the entire duration
of their lives. For reasons unknown to me, DOE terminated these
studies without really completing a full analysis of the data.
We are talking about data from 50,000 mice, 30,000 rats, 25,000
dogs.
Ultimately, this entire archive came to my laboratory at
Northwestern, and it is the University that has supported it
since the termination of the DOE Low Dose Program. What was the
result of termination of the DOE Low Dose Program? I'm going to
just go into the specifics here. For the U.S. radiation
community, the loss of the DOE Low Dose Program has devastating
effects. First of all, the radiation community for low dose has
been decimated. Low dose radiation biologists participate in
recommendations for radiation protection, for designing
approaches to deal with radiation accidents, for dealing with
population exposures. In the United States today, these
committees are occupied predominantly by retired scientists. We
are not able to train the next generation of radiation
protection scientists in the United States and will be
dependent on foreign support.
Secondly, NASA has a need for low dose work with radiation
types unique to space exposure. Complementary work must be done
with Earth-type radiation exposures. NASA reported to the NASA
Space Radiation Discipline Working Group, which I chaired, that
they were looking for collaborators in Europe to facilitate
their work. In the past DOE was their partner.
We have lost much of the infrastructure to do low dose work
in the United States. Many facilities are antiquated and have
not been updated in some years. Some have even been
decommissioned. In many cases, the capacity to perform this
type of research would take time to rebuild.
Finally, the United States is currently using low dose
exposure effects data from science done in Europe, China, and
Japan to support our regulatory policies. This is of concern
because, one, other countries often have agendas in their
research programs that are not consistent with our agendas.
This is not to say that the research results are not correct,
merely that the research design is set up to examine particular
questions that may not be of equal priority in the U.S. Second,
we do not have the capacity to reproduce any of those findings
in the United States. And finally, in effect we are permitting
other countries to set the radiation agenda for the world.
Thank you.
[The statement Ms. Woloschak follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Weber. Thank you, Doctor.
Dr. Brink, you're recognized for five minutes.
TESTIMONY OF DR. JAMES BRINK, PROFESSOR,
RADIOLOGY, HARVARD MEDICAL SCHOOL;
RADIOLOGIST-IN-CHIEF,
MASSACHUSETTS GENERAL HOSPITAL
Dr. Brink. Chairman Weber, Ranking Member pro tem Foster,
and distinguished Members of the Subcommittee, I want to thank
you for holding this hearing today and for the opportunity to
testify on this important topic. I am Dr. James Brink,
Radiologist-in-Chief at Massachusetts General Hospital and the
Juan M. Taveras Professor of Radiology at Harvard Medical
School. I serve as Vice Chair of the National Academy's Nuclear
and Radiation Studies Board and as Scientific Vice President
for Radiation Protection in Medicine for the National Council
on Radiation Protection and Measurement.
I am testifying today on behalf of the American College of
Radiology as the current Chair of its Board of Chancellors. The
American College of Radiology represents more than 36,000
radiologists, radiation oncologists, interventional
radiologists, medical physicists, and nuclear-medicine
physicians whose patients benefitted from diagnostic and
therapeutic uses of radiation in medicine.
Without doubt, the use of ionizing radiation to diagnose
and treat disease has revolutionized the practice of medicine.
Millions of patients every year benefit from the use of
radiation in diagnostic imaging, image-guided procedures,
radiation therapies, and other applications.
The effects of high-level radiation exposure on the human
body including the link between high-dose radiation and cancer
are relatively well understood. Much of our knowledge is based
on decades of atomic-bomb survivor data and the experiences of
first responders to the Chernobyl disasters. Exposures to high
doses of radiation have been associated with several types of
cancer.
There is much greater uncertainty as to the link between
cancer and exposure to low dose radiation. While exposure to
lower doses may damage or alter a cell's genetic code, such
exposure does not necessarily result in negative health
consequences. This is because of the body's innate ability to
repair itself and recover from cellular damage. This response
is akin to your car's windshield wipers in the rain. In mild
and moderate rainfall, your wipers keep everything relatively
clear. In heavy and severe rainfall, your wipers can be
overwhelmed and your vision blurred.
The National Academy's Board on Radiation Effects Research
has played an integral role in the study of the biologic
effects of ionizing radiation over the last several decades,
having published a series of reports on this topic. These are
frequently cited in the professional literature and in
regulatory and policymaking documents. However, the most recent
report was issued in 2006, and an update is needed to
critically explore the latest research and provide a balanced
perspective on its significance.
As medical providers who use ionizing radiation in the
diagnosis and treatment of disease, we value the role the
National Academies has played in distilling volumes of research
related to ionizing radiation. To that end, the American
College of Radiology endorsed the Low dose Radiation Research
Act of 2015 in the last Congress. As this Subcommittee knows,
the legislation would have required the Director of the
Department of Energy Office of Science to carry out a research
program to enhance our scientific understanding and reduce
uncertainties related to the health effects of low dose
radiation. Further, it would have required the Director to
enter into an agreement with the National Academies to conduct
a study assessing the current status and development of a long-
term strategy for low dose radiation research. We believe it is
important for the National Academies to periodically assess the
status and inform the development of a long-term strategy for
low dose radiation research.
We also believe the Department of Energy and other federal
agencies must be adequately funded to support low dose
radiation research activities. Accordingly, we urge that
similar legislation be introduced and passed in the current
Congress. This is so important because it is very likely that
someone you know will undergo a medical procedure that uses low
dose radiation, and this research is necessary to better inform
the potential risks of those procedures. We at the American
College of Radiology and in the radiology community hope to
continue to be a resource to this Subcommittee moving forward.
Thank you again for the opportunity to testify today and
for holding this hearing on such an important topic.
[The prepared statement of Dr. Brink follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Weber. Thank you, Doctor.
I now recognize myself for questions for five minutes.
Mr. Neumann, your report found that federal funding for low
dose radiation research in the United States had declined by
almost 50 percent from 2012 to 2016. I know some of the other
testimony was about we had to depend on foreign research, as
you heard from Dr. Woloschak, or was it Dr. Brink? What impact
has that decrease in funding, in your opinion, had on the U.S.
leadership in this area of research?
Mr. Neumann. Well, certainly when talking to all the
agencies that are involved in this type of research, they all
agree that there's a need to coordinate and better collaborate
to identify and develop the research priorities to see that
they are met, and so without this leadership, there's a
potential of some of these gaps not being filled.
Chairman Weber. Let me follow up on that. A couple of the
testimonies said that there's no collaborative mechanism, and
so Dr. Woloschak, I'll jump over to you real quick. What does a
collaborative mechanism to you look like?
Ms. Woloschak. So in the days of the DOE Low dose program,
what they would do is, if there was an interest from, say, DOE
and NASA, NASA would help fund the same project. They would
give a bit of the funding and expect that they could take
advantage of the data that resulted from it. That I think was a
very good collaborative arrangement between two different
agencies working together that had similar goals. That's no
longer possible. NASA's working alone. They don't have that
sort of collaborative arrangement. I think similar arrangements
between NIH and DOE actually existed for a period of time too.
So I think those are the kinds of things that are very, very
helpful.
Chairman Weber. Do you agree with that, Dr. Brink?
Dr. Brink. I do indeed.
Chairman Weber. Okay. Now, Dr. Woloschak makes a very
interesting point in her testimony that we don't have the next
generation or whatever the term is of scientists. We're not
getting them trained. Since you have a college nexus there, why
is that, do you think?
Dr. Brink. It's an interesting question. We have noticed
that there's been a relative decline in what we call radiation
professionals over the years, and it's certainly been a concern
of the National Council for Radiation Protection and others,
and it's not exactly obvious why there has been a decline but
we've certainly made efforts to try and rebolster and
reinvigorate interest in this field really for the sake of the
Nation going forward.
Chairman Weber. Are you in possession of the numbers? Do
you know what that looks like? Did we have a thousand
scientists that have now gone to a hundred or fifty, or do you
know what the----
Dr. Brink. I don't. I'd be happy to find some numbers for
you and get those to you.
Chairman Weber. Well, I'm just curious because that's
interesting why we're declining, and to your comments that we
had to depend on foreign countries whose interests may not
exactly align with ours.
Ms. Woloschak. I can comment on that as well. I mean, I
know American Society for Therapeutic Radiation Oncology did a
joint meeting at NIH about two or three years ago to try to
talk about the decline, and I believe that the major result of
that meeting was, was to say it's declining because we don't
have people funded in low dose radiation research, so then to
take students into the lab to do research and learn how to
understand low doses, there were no training grounds.
Chairman Weber. So let me paraphrase that if I understand.
If we were to take and we were to have a more better funded
program, a more collaborative approach where we focused on
this, then we could perhaps induce students to be interested.
Is that what you're saying?
Ms. Woloschak. Oh, absolutely. I see it with my own
students.
Chairman Weber. Okay. I'm going to change gears a little
bit. You said in your testimony that there's a lot of naturally
occurring low dose radiation. You went through some examples.
Do we have any facts and figures as to maybe for the both of
you doctors, do we have any facts and figures on what
percentage of that occurs due to medical exams? I mean, is it
five percent in the general population? Is it three percent.
What percentage actually occurs due to medical exams?
Ms. Woloschak. We actually wouldn't call medical exams part
of natural background.
Chairman Weber. Well, I don't mean natural but natural was
one. You know, you go through airports, you go through
screening.
Ms. Woloschak. So medical exposures make up the highest
percentage of human-made exposures that we have in the United
States.
Chairman Weber. What percentage is that?
Dr. Brink. I think it's about 45 percent.
Chairman Weber. 45 percent. Okay. And it's even in the
water you drink. Before you take another drink, I wanted to
make sure you remember that.
Okay. Another question. Dr. Woloschak, in your testimony
you said you had considered that there were also risks to the
unborn. Is that through the mother or is it through the medical
exams? What do you--how do you consider that?
Ms. Woloschak. Actually the data out of the E.U. right now
is suggesting that there are effects during pregnancy that are
probably coming through the mother in some way, and we don't
actually know the low dose mechanism but it looks as though the
unborn maybe more sensitive, and even the data coming out of
Hiroshima and Nagasaki studies suggest that the very young are
more susceptible to cancer induction than very old from cleanup
sites, from, you know, those sorts of things.
Chairman Weber. Thank you. That reminded me. Two quick
questions. I'm a little over my time.
Nagasaki, Hiroshima and the Japanese-related event, that
population has to be going away because those survivors have to
be diminishing almost daily. Do you know how many of those are
left?
Ms. Woloschak. I don't know the exact numbers but you are
exactly right. They are declining significantly. I was just
there maybe 6 months or 8 months ago, and they are continuing
to study the population as long as they can. But one thing to
realize is most of that population got sort of higher dose,
what we would consider to be low moderate dose, not the very
low doses that we would get, say, from, you know, occupational
exposures here.
Chairman Weber. All right. And then finally, I think it was
you, Dr. Brink, who talked about Chernobyl. Do I remember
right?
Dr. Brink. Yes.
Chairman Weber. So let's jump over to that population. When
was that event, and how many were affected? Do you know that
offhand?
Dr. Brink. I don't know that off the top of my head. I'm
sorry.
Chairman Weber. So it's a more recent study.
Ms. Woloschak. The event was about 30 years ago. The
problem with the Chernobyl studies is that the dosimetry is a
little bit off. There's a lot of work being done with
dosimetry.
Chairman Weber. Right.
Ms. Woloschak. It's hard to analyze easily.
Chairman Weber. Okay. Well, thank you. I'm over my time, so
appreciate you all, and I now recognize Mr. Foster.
Mr. Foster. Thank you, Mr. Chairman.
I'm trying to puzzle out why it's been difficult to sustain
an interagency collaboration on this. There has--you know,
there's sort of--there's a bad reason this could happen, which
is that bureaucracies under financial stress will often try to
get rid of programs, shared programs, that they don't view as
along their core line of business, and it's a natural thing. I
think the only solution to that is to have the Congress say
hey, this is something important that's slipping through the
cracks between our agencies and basically knock heads to make
sure that, you know, those are maintained.
There's another potential technical reason are the real
differences in the type of radiation exposures that are of
interest to different agencies. You know, if you're worried
about healthcare, it's probably different than if you're
worried about space-based exposure versus ingestion of
radioisotopes from nuclear accidents and so on. So how much of
that difficulty has to do with when you sit down to write the
specifications of what you want to learn that you find
different agencies have different specifications. Does anyone
want to----
Ms. Woloschak. Yeah, you're exactly right in that different
agencies do have different needs but a lot of times they
overlap. So for instance, while NASA is going to care about
space radiation and DOE is going to care about Earth-based
types of radiation, you actually almost always need to use the
Earth-based radiation as a control to understand space
radiation. So they should actually be cooperating. They did for
years. You asked the question why they stopped, and I have
absolutely no clue. Probably you're right, having somebody from
DOE at the table would have been useful.
Mr. Foster. Any other comments on sort of the technical
differences between the types of exposures?
Mr. Neumann. Well, in talking the range of agencies that we
met with, they all agree that there were some common areas of
research that would be of use to each of the agencies, so
that's why they would sometimes jointly fund some of these
ongoing studies the Million Person Study and other studies--
where they can get research that would be useful to their
particular settings.
Dr. Brink. Just I agree with Gayle that there's a fair
amount of overlap too which makes it a little bit puzzling but
certainly there's obvious distinctions, NASA being very
interested in cosmic radiation and so forth, but otherwise
there's a fair amount of overlap in just how we address these.
Mr. Foster. Now, the other sort of big question here is,
let's say that you're able to go to a less conservative, you
know, zero intercept model for what you thought the human
danger was. Is there anyone who's done, you know, an
exhaustive, high-quality study of what the health and economic
impact of that would be? Just assume that we declare a higher
level of, you know, a de minimis exposure to be actually safe.
What would be the economic impact? What would be the indirect
health impact in terms of more, you know, more allowable chest
X-rays, a shift in our energy mix, presumably towards nuclear
and so on.
Dr. Brink. It's an interesting question. I'm not aware of
any such analyses but certainly as practicing physicians, most
practicing physicians are still very much recognizing that the
benefits typically outweigh the risks and so I don't know that
there's been a huge reduction in the use of medical imaging,
for example, because of whether there's the linear no-threshold
intercepting the origin of the axis or whether they're
considering there's a threshold effect or even a hormetic
effect. Most physicians are still focusing on the benefits and
practicing appropriately.
Mr. Foster. But there's still some limit. I mean, they
reach a point at which, you've already had, you know, five X-
rays this month and maybe we shouldn't have another one. Is
there a sound scientific basis for that kind of decision?
Dr. Brink. In my opinion, no, there's not, and when I'm
faced with patients who are worried about those kind of
thresholds, I'm going right back to the benefits and saying,
you know, what is the reason why your physician needs these
studies. Because the benefits are clear-cut. The risks are very
much uncertain, and typically in almost all cases when there's
a real sound medical reason to do the study, we're going to
favor doing the study over a theoretical risk.
Mr. Foster. But it's your suspicion that, you know, to the
extent that doctors are limiting, you know, things like X-ray
or PET scans and so on that it's probably the conservatism, you
know, related to radiation doses probably nets out harmful for
patients?
Dr. Brink. Well, we certainly will favor imaging tests that
don't use ionizing radiation when we can so, for example, MRI
or ultrasound don't have the same risks, and we certainly--and
when we do need to use ionizing radiation, we're promoting
using as low as reasonably achievable doses. But in terms of an
economic threshold or economic benefit to a threshold, I'm just
not familiar with any of those studies.
Ms. Woloschak. Yeah, where I would say where the economic
threshold would probably come in, and I don't actually know the
numbers, would be in how far do we have to clean up our
nuclear-waste sites. It's probably a difference of trillions,
at least billions of dollars if we accept the linear non-
threshold or if we have a lower threshold for cleanup. That's
where I would think that there'd be a big savings in money.
Mr. Foster. I recall a paper by Richard Wilson of Harvard
Physics Department who you may know. He was actually I believe
one of the first Westerners allowed at Chernobyl and a real
expert on this. He calculated the optimal radius of evacuation
from Fukushima because you can mess up either way. If you--you
know, there are two effects obviously. People suffer from
exposure to radiation if they're too close. On the other hand,
there's a well-documented probability of having people die,
particular the elderly, if you move them, just relocate them,
and so this allows you to calculate an optimal radius of
evacuation. It was the conclusion of his paper at least that
actually the Japanese evacuated too large a radius and
ultimately had a negative health effect from that decision. And
so this is just another example where getting the science right
here is so important.
And now I'm over time myself so I'm happy to yield back.
Chairman Weber. Okay. Thank you.
I now recognize the gentleman from Oklahoma.
Mr. Lucas. Thank you, Mr. Chairman.
Dr. Woloschak, one of the tendencies whether it's in
Congress or the Executive Branch or, for that matter, anywhere
out in the real world is, sometimes if we don't want the
answer, we don't ask the question. So from that guise, let me
quiz you and ask you for your opinion. The way that this
research was determined to no longer be conducted, is that an
example perhaps of someone not wanting the answers that would
come from it? And if I look at this in the overall context, I
mean, we've discussed health issues, we've discussed terrorism
issues, we discussed the space program. From the perspective of
my constituents back in Oklahoma, it seems that not knowing
this information or taking the research to its ultimate
conclusion puts us in a position to make perhaps decisions
based on inaccurate facts. Could you expand on that a moment, I
mean, from the perspective, say, of NASA? If we're going to the
Moon or if we're going to Mars, we need to know these things,
correct?
Ms. Woloschak. Yes. In fact, when I ask astronauts, they
say exactly that, that they care about the risks for cancer.
They don't care as much about the risk of blowing up on a
Launchpad which puzzles me.
Mr. Lucas. Launchpad is instantaneous; cancer takes a long
time.
Ms. Woloschak. That's what they say.
Mr. Lucas. I appreciate their point.
Ms. Woloschak. But I think you're exactly right. The thing
is, I can't actually speculate for why people don't want to
know the answers to these questions or why it's been sort of
stopped, but I will say it's been a pattern at least from my
experience within DOE because we had a very large-scale
program. I believe it was one of the best in the world for
these--with these animals. They just terminated it, you know,
spontaneously. Then they start up the Low Dose program and then
again they terminated it very, very rapidly. I don't know what
the reason for that is. It could just be something sporadic.
Again, probably from DOE could answer that better than I could.
Mr. Lucas. One of our responsibilities in Congress and most
assuredly in our oversight capacities is to assess these
situations and compel the right actions to take place to help
provide guidance to the Executive Branch. I always remind my
constituents in town meetings, no matter what anyone says at
the other end of Pennsylvania Avenue, we write the laws. No
matter what anyone says, the responsibility is for those laws
to be implemented accurately and efficiently. So I find this a
very concerning issue to me in a variety of ways. We have
debated on this Committee as the Chairman knows and in Congress
for years about how to store waste, whether a facility
underneath a giant mountain in the West should be used, or it's
better to store things down the street from me that I may not
know about because that's where it was created or where we go
ultimately with NASA.
Now, I appreciate your observations and the willingness to
try and preserve as much of this research as could be done. Do
any of your colleagues on the panel wish to address that
question about what the background might or might not be that
led to the decisions that have brought us to this point?
Mr. Neumann. Let me add the best answer we can get from DOE
was that they had other research priorities in the bioenergy
and environmental research that they wanted to fund. What was
curious to us is that in 2016, the advisory committee report
identified a number of areas that DOE thought would be useful
to reduce the risk of cancer and understand better the low dose
risk and also supported convening workshops between agencies to
collaborate on a research agenda. But then the report
ultimately concluded not to continue the research. So we
couldn't get a better answer than that. It's just there were
other research priorities.
Dr. Brink. I have nothing to add to this one.
Mr. Lucas. I think perhaps I've made my point, and I
appreciate that, and I'll yield back the remainder of my time,
Mr. Chairman.
Chairman Weber. Which is by the way why we need a single
collaborative mechanism to make that decision.
I recognize the gentleman from New York, Mr. Tonko.
Mr. Tonko. Thank you, Mr. Chair, and thank you to our
witnesses for joining us today. I'm happy to see the Committee
actively engaging on what I believe is a bipartisan issue where
scientific research has an important role to play. Basic
research on low dose radiation is of vital importance with far-
reaching consequences for human health, future technology,
certainly for human exploration and national security. So
there's still a great deal in this field we do not fully
understand, and I heard, I believe from just about all of you,
that we need more attention to the research piece. Is that an
agreement across the board that more research commitment is
required? Mr. Neumann, I think you're--I see two heads nodded
yes and----
Mr. Neumann. I would just say yes, that we identified--the
agencies identified for us the research priorities, that there
was obviously a number of areas that still had a great deal of
uncertainty, and they believed there would be benefits to
continuing that research.
Mr. Tonko. Okay. Now let's get into the GAO report. Mr.
Neumann, the primary recommendation in the report is that DOE
lead the, and I quote, ``development of a mechanism for
interagency collaboration on research on low dose radiation's
health effects.'' Now, DOE disagreed with your recommendation
saying that it would not be appropriate for the Department to
lead such an interagency initiative. Do you think it would be
inappropriate for DOE to lead this interagency effort?
Mr. Neumann. Not at all. In fact, we thought they were in
the best position to lead this effort given this past
leadership as well as their responsibilities under the Atomic
Energy Act, and it's also consistent with GAO best practices
that we've identified for interagency collaboration that if you
don't have someone leading such a mechanism, it's difficult for
agencies across the government to coordinate and make more-
effective decisions.
Mr. Tonko. Is there a particular precedent you would point
to for DOE to take on this role?
Mr. Neumann. Well, I think Dr. Woloschak also pointed out
in one of her responses that DOE did do that in the past, and I
think that's what we also saw.
Mr. Tonko. And your testimony mentions GAO's previous work
has shown that collaborative mechanisms can serve multiple
purposes, to develop sound science and technology policies. Can
you further elaborate on the specific projects that GAO has
examined to support this conclusion?
Mr. Neumann. Well, I can get back to you with specific
examples but there's been a range of examples in the past in
various settings where there are multiple agencies involved in
research areas that by having collaborative mechanism they can
be more effective in achieving those goals. And without that
leadership, those efforts are likely to not be as successful.
Mr. Tonko. And DOE has already responded that they do not
concur with GAO's recommendation. So are there alternative
options that GAO considers or should consider or have
considered when examining this issue that this Committee should
be aware of?
Mr. Neumann. Well, I think we did consider whether or not
other agencies would be in a position but we came to a
conclusion based on the evidence that DOE was in that best
position. Obviously additional direction from Congress might
also encourage them to take a leadership role.
Mr. Tonko. And in the event that DOE does not implement
your recommendation, are there other coordinating bodies or
mechanisms outside of DOE such as OSTP that could potentially
fill this void?
Mr. Neumann. In some of other work looking at OSTP, they
usually are not in the position to direct agencies in some of
these science efforts. They bring agencies together but then
rely on the agencies to determine amongst themselves how to
lead various efforts. So I would say that having an agency lead
would be very effective.
Mr. Tonko. Thank you.
And Dr. Woloschak and Dr. Brink, most of the conversation
in this field is about the detrimental effects of radiation
exposure. Some researchers have indicated that there may be
positive benefits from exposure to low doses of radiation but
there's still much more that we need to learn. So my question
is, what is your perspective on the possibility that there
could be positive health effects as a result of exposure to low
doses of radiation, and what could some of these positive
effects be? Dr. Woloschak?
Ms. Woloschak. Yeah, so we for sure know that low doses of
radiation boost the immune response, can actually add to health
of people. The problem is, how do you balance that with
potential risks of cancer and other effects. So the risk of
cancer is something that's very questionable at low doses but
there certainly are many studies that have shown that low doses
also do boost an immune response, so it's that balance that I
think is going to be hard to understand.
Mr. Tonko. Okay. Thank you.
And Dr. Brink?
Dr. Brink. So the idea that radiation could actually be
somewhat beneficial at low doses is called the hormetic effect,
and it's yet another step beyond where we are today which is
just accepting that there might be a threshold rather than the
no-threshold hypothesis. So I tend to, as I alluded to in my
windshield wiper analogy, that I tend to think that naturally
occurring processes in many examples in nature do have non-
linear responses whether they be that one or many others we can
think of. And so to my way of thinking just getting to the
point of acknowledging or understanding if there's a threshold
through additional research that might show that would be the
first step before even getting to the hormetic effect.
Mr. Tonko. I thank you all very much, and with that, Mr.
Chair, I yield back.
Chairman Weber. I thank the gentleman.
The gentleman from Illinois is recognized for five minutes.
Mr. Hultgren. Thank you, Chairman. Thank you all for being
here. I appreciate your work and appreciate your testimony
today. Last Congress, the House unanimously passed legislation
that I had sponsored. It was H.R. 35 to authorize a Low Dose
Radiation Program. I was also glad this was included in the
Committee's unanimously passed Energy Research and Innovation
Act earlier this January. Hopefully we can see that get over
the finish line in the Senate and a lot of other things too.
But coming from a state where more than half of our energy
comes from zero-emission nuclear energy, the safe handling and
storage of nuclear material is vital. The University of Chicago
will be also celebrating the 75th anniversary of Chicago Pile-1
next month, so we've got the longest record of work in this
space. Regulations based on science are necessary so that we're
doing what's needed while not overburdening our research
facilities and clean energy industry.
Dr. Woloschak, if I could address my first question to you.
In your prepared testimony, you discuss new technologies that
could be applied to this research. What are some of these new
technologies, and in your opinion, how promising are these
potential applications?
Ms. Woloschak. Yes. So actually the acting--Mr. Foster had
mentioned that there are large-scale data analyses that are
quite possible, and we actually are trying to take advantage of
that now looking at data sets from the United States, combining
them with data sets from the E.U. in fact so we can look at
150,000 mice, being able to look at 31,000 dogs. That sort of
data on a large-scale analysis was not even possible years ago.
So statistical analyses have changed. Computational approaches
have changed. That's one thing that's going to make a very big
change.
The second thing is, is that as was noted before, we can do
single-cell sequencing of cells so I think that that technology
is going to be extremely important. We can also make new kinds
of mice that we couldn't make before so if we wanted to try to
create an animal with particular types of genetic
susceptibilities, we can look at those with a far fewer number
of animals. So there are a lot of new technologies that didn't
exist when this program was even terminated 5 or six years ago.
I mean, science is moving really fast.
Mr. Hultgren. Dr. Brink, in March of 2013, Dr. Paul Cabot
from Harvard Medical School cosigned a letter to the former
Science Advisor, Dr. Holdren, detailing the gaps in knowledge
on low dose radiation and the continuing need for this
research. Do you know what response he received on that?
Dr. Brink. I'm sorry, I do not, but I'd be happy to
investigate and get back to you about that.
Mr. Hultgren. That would be great if you would.
Dr. Woloschak, if I could, you testified that you have
accumulated the archive of referenced animal tissue samples
from DOE's closed Low Dose Program in your lab at Northwestern.
What so far have you been able to determine? You kind of
referenced that, but what else are you seeing? How do you plan
to curate the data to make it publicly accessible to? And if
DOE does restart the program, will that also make it so that
your data--it'll be easier for you to make that public as well?
Ms. Woloschak. Yes, so these data are amazing. I mean,
these were single--I mean, who does a 50,000-mouse experiment
anymore? I mean, nobody--we don't have the capacity to do that.
Twenty-one thousand dogs. I mean, so rather than throw it out,
we actually took the data sets, and because of DOE's support
through the Low Dose program, we were able to put much of that
data up on a publicly available website now. The rat data are
still not up on the website. Not all the dogs are up. We're
trying to make it be publicly available so anybody can study
it. That has been our goal. But the problem is keeping the data
without having the tissues to go back to verify is a problem
and that's why we have tried to keep the tissues as well, and
I'm thankful to my university who has supported us through the
hard times.
Mr. Hultgren. That's great. Also Dr. Woloschak, a 21st
century science workforce is something this Committee has been
focused. We spend a lot of time discussing it, and I want to
make sure that we're ensuring that we have it. In your
testimony, you identified workforce issues in the field that
the majority of radiation scientists are retired and that there
are not enough young scientists to replace them. How do you
recommend that our Nation and our world address this developing
issue?
Ms. Woloschak. The reason why students don't want to go
into radiation biology is because there's no funding so they
feel like they're going into a dead-end position, and honestly,
today, I can't recommend for my students to go into that field.
I also work in nanotechnology, and I push them in that
direction because there's funding there. I believe that more
funding for the field would really enhance capabilities to
generate a workforce.
Mr. Hultgren. That's great. In my last few seconds here,
again, Dr. Woloschak, the National Council on Radiation
Protection has been writing a commentary on recent research
implications for the linear no-threshold model of radiation
protection and expects to put a report out soon. Based on your
review, what have been some of the major recent studies in
radiobiology over the last five years and what impact, if any,
are they likely to have on the current linear no-threshold
model?
Ms. Woloschak. Right. So the report's not out. I'm actually
on the board for the NCRP, and I don't--the report's not quite
out so I'm not at liberty to say what they're going to say but
certainly there have been--I believe they're going to still--
they're using the human data as their primary mode for saying
LNT is still the safest with today's current today. They will
say that more data would be useful.
Mr. Hultgren. Well, thanks again. Thank you all for being
here.
I yield back.
Chairman Weber. I thank the gentleman. The gentleman from
Florida is recognized for five minutes.
Mr. Dunn. Thank you very much, Mr. Chairman, and I want to
thank our panelists. I was fortunate enough to capture them on
the way into the room and had a chance to talk to them earlier,
and I'm grateful for that. I appreciate the work that you do.
And also Mr. Neumann, we didn't get a chance to talk but I
welcome you because I understand that you are the one person in
the room who's most able to direct the Department of Energy to
restart this research, and that's exactly what we would like to
see you do. I think you've gathered that from all of us.
Congressman Foster suggested that we adopt a standard that
has been called, I think Dr. Brink said it as low as reasonably
achievable radiation, and I think that that is a great model
for us to be thinking about. I can tell you as a practicing
surgeon that we had a lot of pressure on us to limit radiation
exposure even at the risk of being ignorant of the patients'
underlying pathologies. So this work is very, very important.
My question--and this will be part Dr. Woloschak on the
therapeutic side but part to Dr. Brink on the diagnostic side.
So have we gone overboard in stressing the risks associated
with the proper use of diagnostic radiation and therapeutic
radiation?
Dr. Brink. May I jump in first? I do think that as you
probably experienced in practice that sometimes patients--
there's been quite a lot of press that patients will be exposed
to about the potential risk and sometimes they'll confound
potential versus actual and will provide a lot of concern about
even getting the necessary imaging that they need. And so very
commonly I'll work hard to try and convince a patient that the
benefit of what they would see from undergoing the test would
greatly exceed the potential risk that they might face, and I
imagine you've faced that in your practice as well.
Mr. Dunn. Every--it was just very, very commonly, and I
think there's a sense of alarmism actually among the patients
and they're getting this information from whatever sources that
we're over-radiating them dangerously, and you're looking at
somebody who might have something as simple as a kidney stone
but if they're obstructed and they're infected beyond the
obstruction, that's a potentially fatal problem.
Dr. Woloschak?
Ms. Woloschak. Yeah, I think for therapeutic radiation
oncology where you're treating patients with cancer, most often
they don't really worry about what the risks are going to be
but where it comes to play is, because you're giving a dose all
over the body, secondary cancers can come about as a result of
the radiation exposure. So after they've been treated, then
they're worrying either about am I going to have a recurrence
or am I going to have a secondary cancer. So it becomes an
issue after the fact. I don't think it influences therapy but
certainly the one thing that does influence therapy is how can
we make that treatment location be as small as possible to
minimize dose to the rest of the body. So we do actually
understand quite a bit about low doses because of the scatter
of the radiation when we give therapeutic doses.
Mr. Dunn. So that's actually interesting subject for us. I
mean, we obviously worry about bladder and rectal cancer
following prostate radiation.
Ms. Woloschak. Absolutely.
Mr. Dunn. Can you give us a sense of how common that is----
Ms. Woloschak. Yeah, I mean----
Mr. Dunn. --rectal and bladder.
Ms. Woloschak. Yeah, I'm not really a radiation oncologist.
I'm a radiobiologist that teaches radiation oncologists, but
the worry is--there is a considerable risk, and in fact, that's
what's affected the way that we deliver. So as you know, we're
now using seed therapies, for instance, because of worries
about radiation damage to the bladder and rectum mostly from
late tissue toxicities that might result. Secondary cancers,
there are quite a few studies that have been done looking at
what percentage that you'll find in the field and then outside
of the field, and there is a pretty considerable risk not as
much to the rectum but to the other abdominal areas associated
with particular prostate cancer.
Mr. Dunn. And finally, if I could--and one of the
confusions is when we're talking about radiation, doses of
radiation, we think we're measuring it in one type of
measurement, and I'd like you to address a little bit either
what measure we should be using or how confusing that subject
is.
Dr. Brink. That's a great question. You know, there's so
many things that need to be investigated in research on low
dose radiation and not the least of which is just how to
measure it. There's much literature that reports the
measurement to the entire body, the organism, the effective
dose and others that really focus on the specific organ that's
irradiated, and this alone actually creates a great deal of
confusion, and some just owing to the uncertainty of the best
way to measure the dose from any particular study or therapy.
Mr. Dunn. Any follow-up on that?
Ms. Woloschak. Yeah, and I would agree with that, and also
add in that it's a big issue for discussion. I mean, at the
National Council on Radiation Protection, we talk about what's
the best way to try to calculate dose and figure out dose. It's
controversial, and believe me, people--you could fill a room
talking about it for days.
Mr. Dunn. So my time has run out but I hope, Mr. Neumann,
what you take away from all of this is that we all are cheering
for you to go, you know, get on this horse and ride it home.
Thank you so much.
I yield back, Mr. Chairman.
Chairman Weber. I thank the gentleman.
Mr. Foster, you're recognized.
Mr. Foster. If I could just--a point of clarification. In
my remarks, I did not specifically advocate for ALARA, a low as
reasonably achievable which is, you know, the rule under which
I worked for many years at a national lab. You know, I view
ALARA as largely an expression of our ignorance. It's what you
do when you say since I do not know whether or not this may be
dangerous, in the absence of better numbers, let us do as much
as reasonably achievable, whatever that means, to minimize
dose, and so it's an example of a real cost of not having the
real numbers on this.
Chairman Weber. You said it's the result of ignorance.
Doesn't that apply to a lot of what Congress does? I'm just
asking.
Mr. Foster. Well, it's also true that we work in the U.S.
Capitol, which has--because of the stone that's used has
radiation levels that would not be allowed for incorporation
into a nuclear facility.
Chairman Weber. Well, see, that explains what I'm talking
about.
We're going to do a round two, and I don't know if the
gentleman from Florida wants to hang for that, but at least Mr.
Foster--are you good, Neal? Thank you.
So we would love to have the DOE in here as part of this
discussion. We'd love to have the Under Secretary for Science
from the DOE but we're waiting on him to get confirmed. So if
we can make that happen, that would be helpful.
I did note in the testimony today that the Atomic Energy
Act--and this is for you, Mr. Neumann. When the DOE said that
they didn't think that they wanted to take that purview, the
Atomic Energy Act of 1954, did they cite reasons from the
Atomic Energy Act, or do you remember why they turned it down?
Mr. Neumann. They did not cite that. We pointed that out in
our response to them, that they do have these responsibilities
but----
Chairman Weber. I saw that. Of course, it is at this point
63 years old so I guess the political question may be in part,
do we need to revisit that Act? Do we need to clarify what
their role might be in this instance?
Mr. Neumann. The language is pretty plain in the Atomic
Energy Act that they're responsible to lead, you know,
radiation research given----
Chairman Weber. Which would include low dose?
Mr. Neumann. Right, which would include a range of--so, you
know, you could always have more specificity but the language
is pretty plain.
Chairman Weber. Okay. Dr. Woloschak, you said that low dose
radiation could boost the immune response.
Ms. Woloschak. There's certainly some studies that have
demonstrated that in the literature, and it looks to be--that
that's true.
Chairman Weber. Okay.
Ms. Woloschak. The problem is, it may also cause cancer,
and so do you want to tell somebody to go sit in a radioactive
spa and enjoy and boost your immune system if at the same time
they're at risk for cancer, and it's those unknowns that make
it be so difficult for what to do with low dose radiation.
Chairman Weber. Right. And is that probably true? One of
the difficult parts of this in that research is because
everybody's DNA makeup is different. How do you decide, you
know, how everybody's going to be affected by that. Is there a
time in a person's life generally speaking and an age--I think
some of the testimony, I don't remember if it was you or Dr.
Brink that said cells repair themselves. I think it was yours.
Ms. Woloschak. Oh, cells always repair themselves.
Chairman Weber. Right.
Ms. Woloschak. So the question is, how much can they
repair.
Chairman Weber. But if they repair themselves
inappropriately--I forget the terminology--then there's a--I
guess they mutate and they create a problem in that regard. Is
there an age-- I mean, do you find that when a person gets
older, midlife? Is it 30 years old, 50 years, 80 years old, or
no? Do you have that research?
Ms. Woloschak. There's a lot of work that says that as
people get older, their repair capacity decreases.
Chairman Weber. Well, I know that's true.
Ms. Woloschak. Yes. We all know that. But the other thing
is that in general, the young are more susceptible for cancer
induction than the old because they're going to live longer.
Chairman Weber. Okay. And then Dr. Brink, you brought up a
new term for me. You said the idea of the beneficial low dose
is called the hormetic effect.
Dr. Brink. Yes.
Chairman Weber. Spell that.
Dr. Brink. H-o-r-m-e-t-i-c.
Chairman Weber. Okay. Would you elaborate on that, please?
Dr. Brink. It's a theory that I think was being alluded to
earlier which is that low dose radiation could in fact be
beneficial either through stimulating the immune system or what
have you, and it's very much a theory at this point.
Chairman Weber. So how did it come about and how long has
it been around?
Dr. Brink. I'm sure I can answer specifically. It's been --
it's not new. The theory's been around for some time.
Chairman Weber. Where does the name hormetic come from?
Dr. Brink. Hormesis is the root term, and I'm sorry, I'm
not a linguist. I'm not sure I can answer that.
Chairman Weber. Okay. You just know that that's the term
that was applied.
In Texas in Andrews County out by El Paso or actually I
think it's maybe further north toward the panhandle is a
company called Waste Control Specialists, and they take on low-
level radiation waste. Are any of you all aware of that
facility or familiar with that facility? So when we're talking
about, you know, doing research on low-level waste, were any of
the low-level radiation waste facilities included in that
research? Do you know?
Dr. Brink. I'm not aware.
Ms. Woloschak. I'm not aware of any.
Chairman Weber. So when we talk about doing research on
low-level radiation, and maybe this is for you, Mr. Neumann,
why wouldn't it be that the DOE or anybody that was involved
prior to 2012 when the funding was starting to be diminished,
why wouldn't they have included those facilities? Any idea?
Mr. Neumann. The research they've been conducted has been
either epidemiological, you know, where they're looking at a
population of people over time, or radiobiological, which
involves lab work that Dr. Woloschak talked about.
Chairman Weber. Right.
Mr. Neumann. That's how they were determining the potential
effects of low dose radiation.
Ms. Woloschak. One approach would be to go to a site like
the one you've mentioned and look at what the doses are, get a
good dosimetry, and then do some lab experiments to try to
answer what those effects might be in addition to studying the
population.
Chairman Weber. Dr. Brink, I think you were going to say
something?
Dr. Brink. Yeah. There certainly have been other efforts to
look at radiation workers for their risks, and a more recent
one is the Million Workers study looking at a million workers
in the nuclear power industry that's underway.
Chairman Weber. Right, and that was the reason I asked
because those are typically associated with high-level
radiation, right?
Dr. Brink. Well, hopefully not for the workers.
Chairman Weber. Well, I mean, you're hoping not but, I
mean, you go in there and you think well, those would not be
considered low dose radiation levels, right?
Ms. Woloschak. The Million Workers study is really about
low dose workers----
Chairman Weber. At nuclear----
Ms. Woloschak. --people that were exposed at low----
Chairman Weber. At nuclear plants?
Ms. Woloschak. Yes.
Chairman Weber. I would think the propensity would be to
be--well, I guess any level--what did you call it? The lowest
risk assessment level? But it's interesting to me that you only
talk about nuclear energy plants, you don't talk about the
waste facilities. Perhaps that's something that should be
included.
So I appreciate that, and I'm going to yield to the
gentleman from California.
Mr. Rohrabacher. Let me apologize that, of course, as
usual, we're scheduled with two important hearings at exactly
the same time, and I will review your testimony later on. So if
I ask a question or two that is repetitive, excuse me for that.
Let me--people are going to the dentist and then they're
taking your pictures or you go to a doctor and they're taking
X-rays of you. Is this the type of low dose radiation that
deserves more research?
Dr. Brink. So when we talk about low dose radiation, those
kind of doses are extremely low, and more commonly, and you
know, they're two or three orders of magnitude lower than the
doses that we call low dose that we're focused mostly from
computed tomography or nuclear medicine.
Mr. Rohrabacher. So we don't--so one thing that came out of
this hearing today is that you're not suggesting that we--this
is a potential danger that needs further investigation in terms
of the type of radiation that we are exposed to in the health
industry, medical health?
Dr. Brink. Well, the topic is very much about doses
administered in the health industry. You were speaking more
specifically I think about dental X-rays or----
Mr. Rohrabacher. Right.
Dr. Brink. --extremity X-rays, which are extremely low
dose. But more commonly, the doses from an imaging procedure
such as a CT scan or a nuclear medicine test would be also low
dose but at a magnitude that we're really speaking about what
would be the--where research would be helpful to understand
better what the potential risk might be. At the moment we only
extrapolate from high-dose exposures to kind of guesstimate
what the risk would be at those kind of doses.
Mr. Rohrabacher. And what about, is this idea that power
lines--I guess power lines wouldn't be--I remember there were
some complaints in the past that power lines could pose some
sort of health threat. Was that due to radiation or something
else?
Ms. Woloschak. You know, I was on a committee that
investigated the effects of electric magnetic power lines, and
that kind of radiation or the quality of radiation is different
than the ionizing radiation that we're talking about now. Now,
in fact, most of those studies said that there were no effects
from living by the high-power lines but this is different type
of radiation.
Mr. Rohrabacher. All right. What about that?
Ms. Woloschak. And it's also a different kind of radiation
than the cell phones have as well.
Mr. Rohrabacher. Okay. So you aren't today testifying that
a warning to all of us to put this on the speaker rather than
next to your ear or that we better watch out when we go to the
dentist or if you're---you have to get something X-rayed so the
dentist--or so the doctor can figure out how to help you, we
don't have to worry about those things?
Ms. Woloschak. So I think what we're trying to say is that
cell phone, that quality of radiation, is something that we're
not concerned about here. What we're concerned about is
ionizing radiation, and ionizing radiation is dangerous because
it breaks bonds, and that's----
Mr. Rohrabacher. Can you give me an example of ionized----
Ms. Woloschak. So the dental X-ray is a type of ionizing
radiation. The other types would be the CT scan, the chest X-
ray, what we find in nuclear power plants, what we use for
nuclear power. All of those would be examples of ionizing
radiation. They're a type of radiation that causes the
breaking--has the potential to break our bonds in our genetic
material.
Mr. Rohrabacher. So is it a fundamentally different type of
radiation that we're talking about?
Ms. Woloschak. It is fundamentally different than the cell
phone or the power line, fundamentally different.
Mr. Rohrabacher. So we're not just talking about dosage,
we're talking about an actual difference in the type of thing
that we're looking at?
Ms. Woloschak. Right.
Mr. Rohrabacher. Well, we do know also--look, I'm here to
learn, okay, so don't think less of me for asking stupid
questions sometimes. Isn't--when you go and you're treated for
cancer, aren't you being dosed with radiation, and if the
cancer--if radiation causes cancer, what are we doing?
Ms. Woloschak. So that becomes one of the biggest questions
in treatment of patients with cancer. You're absolutely right.
The dose we're giving to the cancer to kill it is very, very
high, but what happens is, high doses kill cells. They don't
cause cancer; they kill cells. What causes cancer are lower
doses where the cell still lives but it's picked up mutations.
So when you treat somebody with cancer, you give this whopping
dose, it kills the cells; they're gone. But around that dose
there's often a lower dose, and then there's the risk of
secondary cancer, a second cancer popping up. But the problem
is the person's life is at stake so you just go in and you
treat the cancer because you've got to save the life then, and
then you worry about the effects later. But it is a risk. It is
a risk.
Mr. Rohrabacher. All right. Well, thank you very much for
drawing our attention to this issue. Thank you, Mr. Chairman.
Chairman Weber. Thank you, and I apologize to Mr. Foster. I
should have recognized him next. Bill, you're up.
Mr. Foster. Thank you.
First, I just want to comment on these beneficial effects
of radiation. You know, this has been speculated upon I guess
as long as radiation was known. My mother, when she was growing
up, I guess people thought it was a good idea to treat acne
with very large doses of X-rays for which my mother enjoyed
having various forms of skin cancer towards the later years of
her life. On the other hand, you know, my brother who had stage
IV esophageal cancer benefited tremendously from a focused dose
of radiation on his tumor. And so better scientific
understanding yields better health outcomes here, and one of
the reasons that we really want to keep doing this research.
Now, in regards to the hormetic effects, you mentioned the
immune system is activated in response to radiation dose. Is
there also evidence that this can trigger autoimmune diseases
as well? Is there a danger there as well as cancer?
Ms. Woloschak. Look, I want to stress that we don't
understand enough about low doses to even say yes, there's this
big hormetic effect. What I can say is, in the literature, you
can find reports that when you treat with low doses, you
stimulate animals to have a better immune response. Is there
the possibility of autoimmune disease? You're absolutely right.
That is a possibility that could come with it. So just as much
as looks like there are positive effects, there may also be
negative effects, and that's why we have the need to do
research at that low dose range.
Mr. Foster. Okay. And similarly, DNA repair mechanisms are
modulated by various factors inside biology. Are there
documented effects of radiation on how active the DNA repair
mechanisms are?
Ms. Woloschak. Certainly we know that the repair mechanisms
are sitting there kind of raring to go, and when you irradiate,
they go right to the site within almost nanoseconds to begin to
repair. So the repair process is extremely rapid. It begins
almost immediately following radiation exposure.
Mr. Foster. And it's my understanding that there is some
scientific at least speculation, if not research, that you may
be able to treat astronauts with drugs, for example, that
activate the DNA repair mechanism to make them more radiation-
resistant.
Ms. Woloschak. NASA's looking for mitigators exactly like
that right now, so you're right on target.
Mr. Foster. It's sort of an infinitely complicated problem.
Now, I'd like to actually stand up in favor of DOE a little
bit. It was not a completely thoughtless abandonment of this,
and if I could have unanimous consent to enter into the record
a letter----
Chairman Weber. Without objection.
[The information appears in Appendix I]
Mr. Foster. --a letter to the Secretary of Energy Advisory
Board dated--on this subject dated June 23, 2015, which makes
two interesting observations. The first one is that, quoting
from the letter, ``it's highly unlikely and I would say
impossible that a group of experts would after review and
deliberation of the vast literature on this subject come to a
consensus or that that consensus would resolve this issue to
the satisfaction of the regulatory authorities or the public.''
You know, this has to do with is there a path to success here
even if the science became clear, and I was wondering--I'll ask
you for comments on that.
The second thing I want to point out is that this same
letter from the SEAB says the SEAB does not believe that DOE
should abandon its research on low level radiation effects. So
although it expressed skepticism on a path to success both in
convincing the regulators and the public that this could be a
settled issue, they did also recommend this, and so the letter
is, I think, interesting reading for anyone just trying to
evaluate why the DOE went the way it did.
So any comments on that?
Ms. Woloschak. Yeah. I mean, so as a person that sits on a
number of regulatory boards that discusses these and mostly
makes advisory decisions, I mean, I think it is true to say
that if you don't have data, then you always say well, we can't
imagine what we can get to solve a problem. So DOE is exactly
correct in saying we can't imagine what it would get to solve a
problem. But at the same time what I'll say is, I've seen
policies change because of data. So things I never expected
like to have the limit for the dose for the lens of the eye,
it's dropped because of new data and new results. It's dropped
internationally----
Mr. Foster. The limit dropped in the sense of being more
conservative?
Ms. Woloschak. Being more conservative in that particular
example because cataracts were popping up at lower doses than
people expected, and nobody would have imagine that happening
five years ago. It was just not possible. So I think that it's
easy for DOE to make that statement that things will never
change, but the fact is, data do convince people, and that's
why more data are needed.
Mr. Foster. You know, it used to be popular to tune up
electron beam lines by looking at--staring the beam into your
eyeball and looking at the track of radiation.
Anyway, I just wanted, in the time that I barely have here,
to bring up the issue of money. I mean the reason that
ultimately this program was discontinued is the stress in real
terms of the budgets in the Department of Energy, so I have a
lot of sympathy there. You know, I wish this could be a
uniformly bipartisan issue. I was very disappointed when the
Trump Administration proposed I think a 16 percent cut to the
Department of Energy, and I was unable to get bipartisan
support for a letter urging against that. It is not only
authorization that counts, it is appropriations, and I think
that everyone paying attention to this hearing should
understand to watch votes on budgets and appropriations and not
just authorizations.
Thank you, Mr. Chairman. This has been a really great
hearing, and I yield back.
Chairman Weber. Well, I thank the gentleman. I do want to
point out that we didn't exactly--we're not enamored by those
cuts either in every form, some cuts but not all of them, so I
thank you for saying that.
I do want to ask probably a more technical question, Dr.
Woloschak. Ionizing radiation, you specifically said as used in
dental X-ray, they break bonds. Would you explain what you mean
by that?
Ms. Woloschak. So ionizing radiation is defined by any
radiation that can cause an electron to be ejected from an
atom. That's actually the official definition. So if you think
about the removal of an electron from an atom, so go back to
high school chemistry----
Chairman Weber. It's going to change the structure?
Ms. Woloschak. That ejection process causes bonds to break,
and what we care about most, as a radiation biologist, is
damage to our DNA. So when we break bonds to DNA, then we have
to have processes in our cells that repair it and actually we
have fabulous methods in our cells to repair it. It's
incredible. But that is the definition officially of what
ionizing radiation is.
Chairman Weber. Okay. Are there other types of radiation?
Ms. Woloschak. Sure, sure. So ultraviolet radiation that we
get from the sun when we get a sunburn. That's a different
quality of radiation.
Chairman Weber. So that's low level?
Ms. Woloschak. It's--but it's not ionizing. So we don't--so
that's not what we've been worried about here because it's not
ionizing. We can protect it with sunscreens and things like
that. Electromagnetic radiation that comes from power lines,
that's another type of radiation. It's not ionizing. Radiation
that we get from our microwave is also radiation but it's not
ionizing.
Chairman Weber. I've often wondered about that, the
microwave analogy. How many other types of radiation would you
say? Are there six?
Ms. Woloschak. So yeah, they're probably about--from the
electromagnetic spectrum, we go from extremely low-frequently
radiation from the power lines, we go to radiation from
infrared I mean, so there's a spectrum of probably like seven
or eight types, and it depends on how you divide it.
Chairman Weber. Okay. All right. That's actually probably,
unless you have any other questions?
Mr. Foster. If I could have just one----
Chairman Weber. You bet you.
Mr. Foster. --final comment. You know, this is a reminder
of how great it is to have the GAO around, having an
organization that provides high-quality, nonpartisan analysis
is indispensable. You know, for good or ill, we've taken the
size of Congressional staffs down to dangerously low levels,
and that actually causes us to depend on organizations like
yours, so thank you and thank everyone in your organization for
existing and doing your job so well.
Mr. Neumann. Thank you.
Mr. Rohrabacher. Mr. Chairman?
Chairman Weber. The gentleman from California.
Mr. Rohrabacher. One last comment as well. We all know that
Madame Curie died, right? She died of cancer, I believe, from
her experiments, and that's--we didn't even know anything about
radiation then at all, and she was the one who discovered this,
and about 40 years later, 50 years later, maybe, maybe 40, my
father had cancer, and he was saved. Radiation saved him. He
was one of the first chemotherapy guys, so Madame Curie died
and my father lived, and we've been through this thing where
you go to the shoe store and you're going to buy your shoes, I
remember looking in the X-ray machine, so mankind has a lot to
learn, and we have learned a lot, and I want to thank you guys
for being at the forefront of this important lesson and try and
see how we can use this to our benefit and take care of the
dangers, so thank you very much.
Chairman Weber. Well, thank you. I want to thank the
witnesses for their valuable testimony and the members for
their questions. The record will remain open for two weeks for
additional comments and written questions from members.
This hearing is adjourned.
[Whereupon, at 12:01 p.m., the Subcommittee was adjourned.]
Appendix I
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Additional Material for the Record
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Statement submitted by Ranking Member
[all]