The new study of UK nuclear test veterans

Nations that aspire to be great powers must have the atomic bomb. So, at least, believed British politicians of both parties in the aftermath of the Second World War. Despite austerity and a shortage of resources, a programme was set up to develop a British atomic bomb, and, when it became clear that this was no longer the ultimate deterrent, a hydrogen bomb (Gowing and Arnold 1974a, 1974b). The development of these weapons needed a test programme. This eventually involved over 20 000 men from all three Armed Forces and civilian scientists. During the 1950s, fission devices were, with the agreement of the Australian Government, tested in Australia and more powerful fusion devices around Christmas Island in the Pacific. Minor trials to investigate various aspects of weapons design and safety were also conducted in Australia. A full account of the British Weapons programme has been given by the nuclear historian, Lorna Arnold (2001, 2006) and a summary has been published in the Journal (Kendall et al 2004, Muirhead et al 2004). The first suggestions of ill health in test participants were in 1970 (Hansard 1970). But was this ill health a consequence of test involvement, or was it the natural result of a population of fit young men passing into middle age? Concerns continued and, in response to a British Broadcasting Corporation (BBC) TV programme, preliminary investigations were undertaken (Knox et al 1983a, 1983b). However, these were inconclusive and a full epidemiological study to investigate this question was set up. The (then) National Radiological Protection Board was commissioned to undertake it and Dr Sarah Darby was to lead the project. In 1984 she moved to Oxford’s Clinical Trials Support Unit. This had the great benefit of bringing Sir Richard Doll into the study. Doll was, of course, the epidemiologist most responsible for changing the public view of smoking from a harmless pleasure with great benefits to the exchequer, to a public health disaster that was responsible for the premature deaths of half of those who indulged. Understandably this was not a reappraisal that was readily embraced by the many vested interests (Keating 2009), and Doll’s involvement was a guarantee, if one were needed, that the study would lead where the evidence indicated. Establishing as complete a cohort as possible of test participants was an essential and huge task. It was necessary to have a clear definition of what constituted ‘test participation’ and to enrol such participants in a way that did not depend on their subsequent health. This meant the use of contemporary documents. But it was not enough just to set up a cohort of test participants. Because test participants were selected for foreign service, they were fitter than the general population and would be expected to have better health (McLaughlin et al 2008). To detect any effects of test participation, comparisons should be made with a control group of servicemen and civilians, similar to the test participants in as many aspects as possible except that they had not taken part in the tests. This meant that comparisons could be made both with the general population (using standardised mortality ratios (SMRs) or, for cancer incidence, standardised incidence ratios (SIRs)) but also directly with the control group (using relative risks (RRs)).