Intended for healthcare professionals

Letters Lessons from Fukushima

Patients’ psychological distress

BMJ 2011; 342 doi: (Published 18 April 2011) Cite this as: BMJ 2011;342:d2434
  1. Shizuko Takahashi, obstetrician1
  1. 1Department of Obstetrics and Gynaecology, University of Tokyo Hospital, Tokyo, Japan
  1. shizukoimai{at}
  • Competing interests: None declared.

The challenge now is to learn as much as possible about the medical effects of radiation.1 At the time of the earthquake, I was providing antenatal care in Tokyo. Ironically, I was 36 weeks’ pregnant.

By 15 March, I was swamped with questions about the continuous effect of low dose radiation on pregnant women—levels in Tokyo were 20 times higher than before (0.8 µSv).2 I wrote many permissions for patients to leave the country by air, but many were unable to travel and felt trapped. I gave the only information I knew: a chest radiograph and 12 hours’ air travel both result in comparatively higher exposure to radiation than remaining in Tokyo, but both are considered relatively safe during pregnancy.

I found a review article on cancer incidence after Chernobyl, which suggested a possible risk of leukaemia but lacked data on other cancers from in utero exposure.3 A colleague with 50 years’ experience said he had never seen birth defects from the Hiroshima atomic bomb.

Later, the Japanese Society of Obstetrics and Gynaecology recommended pregnant and nursing mothers to go as far away as possible from Fukushima and for those exposed to >50 000 µSv to take potassium iodide to prevent thyroid cancer.4 Many patients seemed dissatisfied with this information. Like me, they wanted to know the effects of long term chronic low dose, rather than acute high dose, radiation exposure. I felt powerless—I had a responsibility to warn patients of the risks but had no clear way to quantify them.

In providing health advice when evidence is limited, doctors must also consider the psychological stress experienced by patients.


Cite this as: BMJ 2011;342:d2434


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