[ RadSafe ] Montgomery Burns Award, 2016

Mon May 16 11:30:27 CDT 2016

Andy, the best information on the safety of KI in actual use comes from a paper published by Janusz Nauman of Warsaw and Jan Wolff of NIH on the Polish experience with the drug in the immediate aftermath of Chernobyl. Here is the cite: Am J Med. 1993 May;94(5):524-32.
Iodide prophylaxis in Poland after the Chernobyl reactor accident: benefits and risks.
Nauman J1, Wolff J.

The Poles gave out 18 million doses, and managed to protect 97 percent of the nation's children. The serious side effects were limited to two adult men, both of whom took the drug despite having known allergies to iodine. They were hospitalized briefly and released. Dr. Nauman told me, "We asked them, why did you take this, when you had been warned not to? They replied that they thought it was a matter of life and death."

Back then, the NRC staff official who had the lead on KI was telling people far and wide that because he took blood pressure drugs, KI would kill him if he took it. I reported that to Dr. Nauman, who snorted, "Blood pressure medications are the most widely prescribed drugs in Poland. If that had been true, the ground would have been littered with corpses." 

FDA puts the risk of serious adverse effects at one in 10 million. Says that the benefits far outweigh the risks, especially for the young.

I gave a paper at Cambridge University in 1998 at a conference on "Radiation and Thyroid Cancer" co-sponsored by the European Commission, USDOE, the National Cancer Institute, and the university. Titled "Potassium Iodide Prophylaxis and the United States Government: A Case Study," it can be found in the volume "Radiation and Thyroid Cancer," edited by Thomas, Karaoglou, and Williams, published by the European Commission in 1999. 

The point of my recent post is that the authoritative word on KI and safety is from FDA, which first found KI "safe and effective" for use in nuclear emergencies in 1978. Unless someone has something better to rely on, something published and authoritative, that should be considered definitive. I still have heard nothing from the NEI people.  

The NRC technical staff fought KI stockpiling for many years -- from 1982 on. At various times, it tried to convince other government agencies that its use was dangerous, contrary to what FDA said. The key word was "liability." If you can persuade the states that giving out KI would expose them to lawsuits, then the states will tell the NRC that they wouldn't take KI even if it were offered. This can then be used to persuade the NRC Commissioners that there is no point in offering KI to the states, since they don't want it. 

Another ploy on the part of the NRC staff was to tell FEMA that the NRC was opposed to KI stockpiling, and tell the NRC that FEMA was opposed. (Middlemen can sometimes get away with that.) But when James Lee Witt, head of FEMA, learned that FEMA's position was being reported in that way, he blew his stack. If you consult the transcript of a November 5, 1997, meeting at the NRC, at which FEMA was represented, you will see the NRC staff apologizing to FEMA for having "misrepresented" its position.

Finally, the NRC Commissioners decided, in early 2001, to make KI available at NRC expense to those states requesting it, for the population within a ten-mile radius of nuclear plants. The NRC technical staff never stopped fighting, however. They put together a purported technical analysis, called NUREG-1633, that managed to get through the first 8 pages without ever mentioning cancer. That's like discussing the merits of the Sabin vaccine without using the word polio. And in 40 pages, they never mentioned Chernobyl or the Polish experience with KI. Nor did they mention the fact that the FDA had found KI to be "safe and effective" for use in nuclear emergencies as long ago as 1978. The idea was to create rival documentation that could be used to foster public doubts about the desirability of KI.

So the NRC Commissioners rejected NUREG-1633 and ordered it removed from circulation. The NRC staff went back to work and came up with a redraft. It was an expensive effort, that included taking the whole team out to Tempe, Arizona, to spend a week in the sunshine one February. That version too was rejected by the NRC Commissioners. Nothing daunted, the staff came up with yet a third version. This time, the Commissioners not only rejected it, they ordered work on it to stop, saying, in the words of one Commissioner, "It's time to pull the plug."

Fast forward to 2002. Congress is looking for ways to beef up protection against terrorism. Nearly unanimously, they pass an amendment that would expand the radius of KI stockpiling to 20 miles. The White House hails this, saying that now, KI will be available wherever needed, instead of just within the "arbitrary" 10-mile boundary. The NAS is told to study the issue, and they come up with a report saying that in an actual emergency, KI might be needed, depending on conditions, in either a smaller or a larger area than the 10 mile radius.

But the NRC opposed the expansion bitterly, and used the levers of government (OMB) to delay implementation.  George W. Bush's HHS Secretary, Michael Leavitt, loses patience with the NRC's obstructionism, and says that he intends to proceed with implementation. The result is an order from Bush that strips HHS of authority over KI and transfers it to the NRC and the President's Science Advisor. The Science Advisor issues a decision declining to implement the law, explaining that it isn't needed, and citing, among other sources,  NUREG-1633, a document that officially did not even exist. The NRC Commissioners thought they had buried that document not once but three times, but evidently they had failed to put a stake through its heart.

There is much more to tell, but this should do for now.

-- Peter Crane
NRC Counsel for Special Projects (retired)

--------------------------------------------
On Mon, 5/16/16, KARAM, PHILIP <PHILIP.KARAM at nypd.org> wrote:

 Subject: RE: [ RadSafe ] Montgomery Burns Award, 2016
 To: "Peter Crane" <kinderhook46 at yahoo.com>, "The International Radiation Protection (Health Physics) Mailing List" <radsafe at health.phys.iit.edu>
 Date: Monday, May 16, 2016, 8:04 AM

 According to Table 12D-1
 of BEIR VII, the thyroid sensitivity to radiation drops
 dramatically with age. In particular, looking at cancer
 incidence (cases per 100,000 after exposure to a single dose
 of 0.1 Gy), the number of thyroid cancers is 115 (age 0), 76
 (age 5), 50 (age 10), 33 (age 15), 21 (age 20), 9 (age 30),
 3 (age 40), 1 (age 50), and less than 1 for later ages.

 You can interpret these
 numbers in many ways. For example - you can certainly make a
 case that no protective measures are needed at all after age
 20, when the sensitivity drops by a factor of almost 6
 compared to an infant. If you're more cautious, you can
 also point to age 50, when the sensitivity is almost
 entirely absent (or, more likely, when the latency period is
 longer than the expected remaining lifespan). It depends on
 what your own threshold for action is.

 What I do not know is the expected risk from
 taking KI at various ages - whether due to allergic reaction
 or accidental overdose. It would make sense to cease
 administering KI at the point where the risk from taking it
 exceeds the risk from not taking it. Whether that's at
 age 20, 40, 50, or some other age is what I don't know.
 Any KI experts out there who can fill us in on that item?

 Andy

 -----Original Message-----
 From: radsafe-bounces at health.phys.iit.edu
 [mailto:radsafe-bounces at health.phys.iit.edu]
 On Behalf Of Peter Crane
 Sent: Friday, May
 13, 2016 11:36 AM
 To: RADSAFE
 Subject: [ RadSafe ] Montgomery Burns Award,
 2016

 Ten days ago, I wrote
 to Mark Flanagan, who edits "Nuclear Notes" for
 the Nuclear Energy Institute, and followed up later that day
 with an email to Ellen Anderson, the chief health physicist
 for NEI, to point out an inaccuracy in a blogpost dealing
 with the effects of radioactive iodine. To date, neither one
 has responded in any way.

 I
 have been following the efforts of the nuclear industry to
 win the hearts and minds of the American people for 41
 years, since the days when John Simpson of Westinghouse led
 the Atomic Industrial Forum. I'd like to suggest the
 establishment of a Montgomery Burns Award, for those who
 speak for the nuclear power industry but do so in a way that
 only fosters public distrust of the industry and the
 technology. Mr. Flanagan can be the first recipient.

 The messages follow.

 1.  Dear Mr.
 Flanagan,

 I recently read
 your post from 2011, "Iodine-131: Not an Issue in the
 United States," in which you wrote that  except for
 pregnant women, there is no risk from I-131 to anyone over
 20. Can you tell me your source for that? Everything else I
 have read, in some 33 years of following this issue, says
 that the risks are minimal once one reaches 45, but not
 below that age.

 Lest you
 think me some reflexive anti-nuke, I am on record as
 believing that nuclear power should be part of this
 country's energy mix, and that eliminating it, in an age
 of global warming, would be reckless. I was also on
 television in Seattle in March 2011, saying that it was
 "irresponsible fearmongering" to suggest that
 people should be buying and taking potassium iodide in the
 U.S. on account of Fukushima. But I feel strongly that the
 case for nuclear power can and should be made on the basis
 of a scrupulously accurate analysis of risks and benefits,
 with no distortion of the underlying facts.

 I look forward to hearing from
 you.

 -- Peter Crane, NRC
 Counsel for Special Projects (retired)

 Seattle

 2. Dear Ms.
 Anderson,

 I realized
 belatedly that I should have copied you in on the message
 that I sent to Mark Flanagan earlier today. His statement
 that there is no risk to anyone over 20 from I-131
 contradicts the FDA guidance on potassium iodide from 2001,
 which calls for administering KI to all those under 40, and
 even to those over 40 if the potential thyroid dose is high
 enough to result in hypothyroidism. I am not aware that this
 guidance has been changed since then, or that there is any
 new scientific information suggesting that it ought to be.
 Could it be that Mr. Flanagan intended to write
 "40" and that the "20" that appeared was
 a typographical error? 

 I
 hope you will discuss this with him. Thank you.

 -- Peter Crane, NRC Counsel
 for Special Projects (retired)
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