We are grateful to Dr Facius for his comments regarding our article that appeared in the ARCHIVES in the section for epidemiology.1 Dr Facius uses the title of our article as a basis for his own interpretations of our work and seems to overlook the epidemiological comprehension of the risk concept. We agree with Dr Facius that the exposure of the pilots to cosmic radiation is about 50% “due to energetic neutrons with poorly defined relative biological effectiveness (RBE) for cataractogenesis at low doses.” Relative biological effectiveness was defined in an attempt to help us to understand the harmful effect of ionizing radiation; however, if the exposure of commercial pilots to cosmic radiation leads to nuclear cataracts, this might call for reevaluation of the RBE for neutrons. New knowledge on the health effects of radiation has been emerging over a long time, as the history of the International Commission on Radiological Protection shows,2 and has led to the recommendation as recently as 1991 that the natural radiation exposure of air crews should be regarded as occupational exposure.3
Rafnsson V, Olafsdottir E, Hrafnkelsson J, Sasaki H, Arnarsson A, Jonasson F. No Evidence for the Causation by Cosmic Radiation of Nuclear Cataracts in Pilots—Reply. Arch Ophthalmol. 2006;124(9):1370–1371. doi:10.1001/archopht.124.9.1370
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