Re: A Dose of Reality

[Jim Muckerheide <jmuckerheide@delphi.com>]

"Peter G. Crane" wrote:
> 
> Jaroslav Franta deserves thanks for posting, on March 16, the Reuters
> news story describing the recent study, published in the American Cancer
> Society's journal "Cancer", of childhood thyroid cancer in Belarus,
> resulting from Chernobyl.  The study indicates that the greatest hazard
> of radioiodine-caused thyroid cancer is in children under two years old,
> who are more likely than older children to develop the disease, and in
> whom the disease is more likely to have spread.  The cancer had spread
> beyond the thyroid in 62% of the patients under two years old.
> 
> Also on March 16, RADSAFER James Muckerheide of the Massachusetts
> Emergency Management Agency, faxed to the Massachusetts Advisory Council
> on Radiation Protection, of which he is a member, his reasons for
> believing that the stockpiling of potassium iodide for thyroid
> protection is unnecessary and undesirable.  His statement including the
> following:
> 
> "5. Thyroid cancer is readily and commonly treatable, without long term
> consequences other than taking thyroxin to provide the necessary thyroid
> hormone.  This is a common condition.  The few deaths from thyroid
> cancer were caused by failing to provide adequate medical care.

> "6. Even with these high doses, primarily to children exposed from about
> 5 months before birth to 5 years old, with most of the remaining cases
> in children that were below about 10 years old, the increase in thyroid
> cancer is small.  The reported factor of 3 to 4 increase is from 1 case
> in about about 300,000 children, results in 3 or 4 cases in 300,000, or
> about 1 additional case in 100,000+ children."
> 
> As an old thyroid cancer patient, I beg to differ.  I recall years ago,
> when I was being treated at the National Institutes of Health for a
> recurrence that required 700 millicuries of I-131 to eradicate, I met an
> NIH doctor who was himself a thyroid cancer patient.  I mentioned to him
> that at my agency (the NRC, from which I have since retired), there were
> those who thought that it was not worth having KI to protect against
> thyroid cancer, because the disease was not that big a deal.  He turned
> red with anger in an instant and snapped, "They ought to have it!"

Nonsense from a Dr. is still nonsense. From the rest of my statement, I-131
exposure from LWRs (I plates out in wet environment; inside a containment),
with evacuation (AND not eating contaminated food/milk), by people who are not
I-deficient, provides no basis to link Chernobyl experience at all. But EVEN
the Chernobyl experience has minimal effect from removing the containment and
burning the core for 4 days, not evacuating people, allowing consumption of
contaminated food/water/milk - where MOST of the dose came from (who are
severely I-deficient), etc.

> I've known many thyroid cancer patients, and I can't think of a single
> one who would agree with Jim Muckerheide's characterization of the
> disease.  

My daughter - and her medical advisors and support group! 
She's waited till after her recent 4th child to schedule removal of the
remainder of her thyroid etc.

'See' a segment on NPR "All Things Considered" aired yesterday:
"Cancer Athlete (14.4 | 28.8) -- Noah speaks with Karen Smyers, a triathelete
who is postponing cancer treatment so that she can participate in the Olympic
trials next week in Hawaii. She joins us today from her home in Lincoln,
Massachusetts.(3:00)"

She's 38, thyroid cancer, surgically removed, on thyroid hormone replacement
(hit it just right on the first try), with doctors approval is deferring
radiation treatment until as late as May in Australia to train/compete for the
women's triathalon (training includes swimming 25,000 yards/week :-) since
subsequent problems are "low-risk," "slow growing," etc. She describes
communications with a Canadian woman rower: Diagnosed in Nov 98; Surgery Jan
99; Radiation in March; New world record in June.

The segment is at:
http://search.npr.org/cf/cmn/cmnpd01fm.cfm?PrgDate=03/23/2000&PrgID=2
The next to last segment in the 3/23 program; just 3 minutes, about half
related to the cancer, etc. (Can order a transcript if you can't get
RealAudio.)
[Also, you should listen to the last segment on an HMO experience if you have
a minute. There's a certain parallel to the rad protection experience :-)]

>Granted, it doesn't often kill -- though there are exceptions,
> like Senator Tom Harkin's brother, or the young professor of Russian at
> Cornell whom my brother remembered from summer camp (like me, the
> professor was part of the group that received radiation treatments to
> the head and neck at Chicago's Michael Reese Hospital in childhood).  In
> fact, there are about 1000 such exceptions in the United States each
> year, and they are not all dying for want of adequate medical care.
> 
> I once mentioned to an NRC colleague, who was also a thyroid cancer
> patient, the propaganda about how inconsequential the disease was.  He
> laughed:  "Right!  I used to climb stairs on all fours for the fun of
> it."  I knew exactly what he was talking about:  the exhaustion and
> weakness, almost unbelievable to anyone who has not experienced it, that
> patients feel when they are taken off all thyroid hormone in advance of
> an I-131 treatment.  (To ensure maximum uptake of the I-131, the patient
> is made extremely hypothyroid, beginning several weeks before
> treatment.)

Normally, one I-131 treatment shortly after removal; not necessary to go to
extremes in going off thyroid hormone! Once in your life after original
treatment? Otherwise normal? 

> Like Jim Muckerheide, I am no physician.  But I have talked with many
> physicians who have treated thyroid cancer.  In England, at the
> Cambridge University conference on radiation and thyroid cancer where I
> gave a paper in 1998, I met a doctor who was marveling -- if that is the
> word -- that there were people trying to make the case that the disease
> was of minor significance.  "If they had they seen the children I have
> seen, and some of them could not be saved...."  He shook his head.

And most Dr's were 'marveling' at this Dr. making it out to be of great
significance? Vested interest? More than 3 that 'could not be saved?' Due to
extreme conditions and inadequate intervention, from days of dry releases from
burning graphite, to no evacuation, to consuming contaminated food, to
inadequate medical attention and intervention. What would be the prognosis
here?

> Jim Muckerheide began his comments to the Massachusetts Advisory Council
> on Radiation Protection by saying that Mary Lampert, an advocate of KI
> stockpiling, had provided negligible new scientific information about
> the drug.  He continued:  "However, since the previous science
> literature review, there have been additional studies.  They confirm the
> initial results."  Perhaps he could give RADSAFERS a clarification on
> this point:  what additional studies is he referring to, and what
> initial results do they confirm?

Easy. Go to PubMed and search on "Chernobyl" and "thyroid."  Discount a few
polemical sources dredging for funds. Review papers that provide hard data on
real patients, from various medical centers, etc.

> Peter Crane, pgcrane@erols.com

You really should consider more facts and less polemics, even as only a lawyer
:-) Despite your training, 'winning' by rhetoric should not be paramount in
sound public policy. But, from the experience of working for/dealing with
government agencies I can see why that isn't very clear to most of us any more
:-)

Regards, Jim
muckerheide@mediaone.net
========================
************************************************************************
The RADSAFE Frequently Asked Questions list, archives and subscription
information can be accessed at http://www.ehs.uiuc.edu/~rad/radsafe.html