6.1 Lack of Transparency

One major issue following the earthquake concerned the management of information. Japanese television broadcasting companies, that is all local channels and NHK, the public broadcasting company, continuously broadcast calming imagery, and only made known a small part of the damage. At the same time, the media overseas broadcast images of corpses washed out to sea by the tsunami, or the terrifying conditions of the sites that experienced the earthquake. It was in fact the overseas coverage that created the main impetus for so many to offer international support for restoration and recovery.

The flow of information concerning the status of damage at the Fukushima Daiichi Nuclear Power Plant was infuriating, even to the Japanese media. Detailed, accurate, and real-time information was hidden, particularly by Tokyo Electric Power Company (TEPCO), and residents of Fukushima, who had already been shaken by the disasters were left uninformed, as the area descended further into chaos. There were, in fact, some parallels with what happened 1986 in Chernobyl, but the experiences and lessons learned there were not applied in Fukushima.

The evacuation policy was also poor. After learning of the radiation leak, the government issued an evacuation directive for residents within 20 km of the plant one day after the earthquake. Approximately one month later, this area was designated a ‘high alert zone’ and effectively sealed off. A colleague and I examined these measures from an ethical perspective and argued that if the government’s aim was to avoid health risks posed by radiation exposure, then ordering compulsory expulsion of all residents cannot be ethically justified [1]. It is possible that the government may not have ordered the mandatory evacuation solely based on health risks, but rather to maintain public order. Careful scrutiny of the case revealed that this intervention involved an objective completely unrelated to public health, and that disguising these policies using the purpose of public health made it easier to justify undue restriction of individual liberty.

6.1.1 Closedmindedness, Impenetrability and Secrecy Are Significant Characteristics of Japanese Society

As Oe criticized Kawabata’s stance (Chap. 5), likening it to the “flight of Japan to its own vague world, where the possibility for foreigners to gain a correct understanding of Japan is closed off,” this impenetrability is evident throughout Japan’s history. Japan closed its doors to the rest of the world for over 200 years (1639–1854). During that period, the West made great leaps forward in modernization through the industrial revolution. This “impenetrability” is still present in Japan, even in the age of globalization.

After the Fukushima accident occurred, local residents experienced great distress. However, there was one good that might have emerged: namely, the collection of scientific evidence using empirical and epidemiological methods to measure the (still unclear) effects of low-dose radiation exposure on thyroid cancer development in children. Having observed the confusion between the government and TEPCO immediately after the Fukushima accident, it was my belief that Japan could not singlehandedly conduct such an epidemiological survey. I therefore, through the journal Science, called for international collaboration in this research [2].

Given the current confusion and disorder, it would be difficult for Japanese researchers and the Japanese government to execute such a study singlehandedly. However, they should not have to organize the effort alone. The risk of childhood exposure to radiation is a real one for people living in any region of the world. It is time to organize an international joint research team supported by countries worldwide to uncover lessons to be learned from Fukushima for the sake of future humanity (p. 696).

The response from overseas was overwhelming, and some researchers even offered funding. When invited to serve as a committee member to determine governmental support of the survey of the post-earthquake Tohoku/Fukushima area, I approved governmental support under the following conditions: (1) appropriate relationships are cultivated with residents of Fukushima, (2) sufficient informed consent protocols are conducted, and (3) international cooperation was sought. The principal investigator agreed to all of my stipulations.

However, while foreign researchers were included as advisors, the group in Japan did not seek to make this project an international collaborative study. The most plausible reason for this is that they thought, “What could we gain from these foreigners? They are neither natives of the nuclear disaster-stricken country, nor did they experience the nuclear disaster themselves.” This is an example of the closedmindedness of Japanese society

6.2 The Fukushima Thyroid Screening Study

How much valuable scientific data on low-dose radiation effects have been obtained, or might be obtained through this Fukushima thyroid screening study? In January 2019, a group from Fukushima Medical University (FMU) published the results of the first (2011–2013) and second (2014–2015) rounds of screening for thyroid cancer in JAMA Otolaryngology-Head & Neck Surgery [3]. My colleagues and I pointed out several concerns [4].

First, this cohort study was originally designed to obtain scientific data on the effects of low-dose radiation exposure on the thyroid gland in children. Thus, the protocol previously had control groups in Aomori, Yamanashi, and Nagasaki prefectures, which are far from Fukushima prefecture and unaffected by the radiation. However, the sample size (n = 4,365) in the control areas was too small to serve as a legitimate comparison to the sample size of those in Fukushima (n=360,000). Therefore, this design has been subject to criticism [5]. Without large-scale controls, the effect of low-dose radiation is difficult to analyze. The FMU group chose to abandon the small control group, and instead used data from the first and second rounds as a baseline. Following the Chernobyl accident, which involved high-dose radiation exposure, the latency of the onset of thyroid cancer was short, roughly 3–4 years after exposure. The estimated latency among people who are iodine sufficient at the time of radiation exposure is thought to be longer, at 5–10 years [6]. Accordingly, the FMU group expected the latency period for the development of thyroid cancer in Fukushima to be 5–10 years, and considered data from the first round (2 years post-disaster) and second round (4 years post-disaster) as the baseline [6]. However, the FMU group paper [3] concluded that ‘Large-scale mass US (ultrasound) screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power plant accident,’ as if the detected thyroid cancer cases and low-dose radiation exposure were highly unlikely to be related.

There is another serious issue aside from the FMU group using data from the first and second rounds as the baseline. As stated above, if the latency period for the development of thyroid cancer is expected to be 5–10 years, then any effects of the low-dose radiation exposure would begin to show at this time. However, participation rates declined from 81.7% in the first round (2011–2013) and 71.0% in the second round (2014–2015) to 64.6% in the third round (2016–2018). Nonetheless, the FMU authors decided not to show the results from the third round, even though they were available at the time of submission of the manuscript. With this decline in participation rates, precise detection of changes in the onset of thyroid cancer in subsequent rounds is difficult to track.

Among the 202 participants diagnosed with cancer by the second round, more than 80% have undergone surgery. It is highly likely that the participation rates will be much lower for the fourth and fifth round screenings, which will cover 10 years since exposure. This low participation rate is a critical concern.Footnote 1

In maintaining its ‘closemindedness,’ Japan failed to collect valuable scientific data, potentially the one major contribution to the betterment of humankind that could have been achieved through this disaster.

6.3 Why Less Scientifically Meaningful Data? What About the Victims?

Scientifically speaking, an even more problematic epidemiological survey was undertaken, supported by public funding. Some readers may remember the term, ‘Fukushima 50,’ which was a label given to the many workers who helped to restore the contaminated site. As they exposed themselves to a highly radioactive environment, they were applauded as heroes. From March 2019, a cohort study targeting those emergency workers was commenced, funded by the Japanese government and conducted by the Radiation Effects Research Foundation based in Hiroshima.

My colleagues and I objected to this study on ethical grounds [7].

Firstly, the low study participation rate is a serious problem. As of March 2018, of the 19,808 workers, 3,400 (17.2%) refused to participate, 7400 (37.4%) did not respond, and 1700 (8.6%) could not be reached. This leaves only 7000 (35.3%) participating workers, most of whom are TEPCO employees. We suspect that the low participation rate may be due to social stigma and fear concerning nuclear power.

Secondly, the unscientific nature of the cohort design further undermines the ethical basis for conducting it. Given the normal statistical variability in cancer incidence and other risk factors, it is unlikely that such increased incidence of cancer due to irradiation would be discernible. The question remains: why did Japanese epidemiologists defend this large-scale cohort study?

We believe that the study should be terminated and the public funding applied instead to activities that truly benefit the workers at the power plant, such as free lifelong health care services and financial compensation.

The Village Society Again: The Case of the Young Woman.

It was my personal experience with a particular young woman that led me to write this chapter.

The story dates back to when I worked part-time at a mental health clinic. To protect the privacy of personal information, the patient’s identity and other details are not revealed, but I have tried to present the patient’s words exactly as they were spoken. I have also obtained the patient’s written informed consent to use her words.

6.3.1 Case

In late 2018, 7 years after the earthquake, I met with a single female patient in her early 30s who had been subjected to harassment in her workplace. She was suffering from insomnia, anxiety, and mild depression. I surmised that she was suffering from an adjustment disorder and began filling out her medical chart accordingly. It was when we got to questions on family composition that I learned that her mother had died, and her father was disabled due to high blood pressure and diabetes. She began to explain that her hometown was in Iwate (Tohoku prefecture). She then shared that the tsunami from the 2011 earthquake not only demolished her entire house, but also washed her mother and a younger female cousin out to sea. Since then, her younger sister had not worked, and instead stayed at home locked up inside, taking care of their father, who is weakened by illness. At this point, my patient began crying uncontrollably. She told me that at her previous workplace, a superior told her, “You are using the earthquake as a crutch.” She began to exhibit signs of panic, as I had unintentionally evoked a flashback. This is a typical presentation of PTSD.

My patient told me that she felt her supervisor’s statement: “You are using the earthquake as a crutch” was incredibly insensitive. She noted that “when I remember this, I realize that my current workplace is somewhat better than the previous workplace,” thus changing her initial complaint.

Hearing the words of her former supervisor made me painfully aware of the reality that Japan’s village society possesses a system of cultural stigma in common with most other village societies. To her superior, this woman is not his family, so her emotional state is someone else’s problem. The plight of the 2011 earthquake victims was in no way the fault of the victims themselves. However, through this tragedy, the victims came to be differentiated from non-victims, and isolated themselves from the community. This is typical behavior in a village society, in that a portion of the community that has been set apart for whatever reason is discriminated against or ostracized. The government has been more than willing to invest massive amounts of public funding into post-disaster research studies that are merely epidemiological investigations posing as health surveys, but has not reached out to the many victims who still suffer from the after-effects of the earthquake.

6.4 Animal Ethics and Intergenerational Ethics

Finally, let me address animal ethics and intergenerational ethics. As of April 2019, a large area of Fukushima has been designated as a ‘high alert zone’ and sealed-off. However, animals including pets, livestock and wildlife had all been left in area where there was high radiation. This in it of itself is unethical from the perspective of animal ethics. One research group has examined raccoon teeth to test the presence of a ‘dicentric chromosome,’ an abnormal chromosome which appears after radiation exposure. In Fukushima, 0.6% of raccoons exhibited this abnormality, while the percentage was 0.0% among raccoons in Aomori (control area, 430 km north of Fukushima).

This finding concerning animal radiation exposure has significant implications for the next generation. Firstly, one imminent issue is that radiation exposure in animals will directly lead to nuclear contamination in surrounding areas. As animals move freely from Fukushima to other regions outside of the high radiation zone, those with high levels of radiation could end up anywhere in Japan. This is problematic for humans and animals alike

Secondly, there is no information on the effects of nuclear radiation exposure on the reproductive systems of small animals. Even larger animals like cows could have reproductive damage that could be passed down to future generations.

By 2020, a wide swath of the area surrounding Fukushima Daiichi Nuclear Power Plant will remain a no-entry zone due to high levels of radiation. Japanese people living today will be leaving the next generation to bear this negative inheritance. Intergenerational ethics is also a globally important issue. Will this culture of “closedmindedness” prioritize “the responsibility for the next generation” or “the values of those of us living now”?