Re: A dose of reality, continued

["Peter G. Crane" <pgcrane@erols.com>]

The recent uproar on the listserv may have obliterated all memory of 
the exchanges on the topic of potassium iodide (KI) for thyroid 
protection.  Some weeks ago, Jim Muckerheide, Commonwealth Nuclear 
Engineer for the State of Massachusetts, informed the Advisory Council 
on Radiation Protection of Massachusetts that there had been only a 
three-fold to four-fold increase in childhood thyroid cancer in the wake 
of Chernobyl.  When I asked him through RADSAFE to provide his sources, 
he responded that I should look the topic up for myself -- an answer 
less helpful to other RADSAFErs than I would have expected of him.
   In the meantime, I telephoned Dr. Jacob Robbins, Scientist Emeritus 
at the National Institutes of Health, and a world-renowed expert in the 
field of thyroid cancer generally, and radiation-caused thyroid cancer 
in particular.  He responded that in the most affected portions of 
Belarus, near Gomel, the rate of childhood thyroid cancer rose from a 
pre-Chernobyl rate of .2 per 100,000 to a 1991 rate of 11 per 100,000.  
By 1993, the rate had dropped to 9-10 per 100,000.  Dr. Robbins cited an 
article published in "Endocrinology and Metabolism Clinics of North 
America," 1996, vol. 25, p. 197 (see graph p. 205).  
   Pat Milligan (Sullivan) contributed a thoughtful and balanced posting 
on March 30.  I, for one, would not for a moment dispute the proposition 
that statistically, it is far better to develop thyroid cancer than 
cancer of the reproductive system.  The relevant comparison, however, is 
not between two types of cancer, one normally worse than the other, but 
between being healthy, on the one hand, and on the other, having a 
cancer with a low mortality rate.  
   Is the issue one of a "pound of prevention rather than an ounce of 
cure", as Pat suggests it may be?  (That was also the basis of the NRC 
staff's cost-benefit approach that led to the 1985 policy statement.)  
If that is the case, why does the NRC require sirens and emergency 
exercises, which cost vastly more than stockpiling?  
   Pat doesn't claim that thyroid cancer is always curable, but rather 
that it has a "low fatality, high cure success rate."  Considering that 
the NRC staff estimated in 1994 that a program of KI preparedness for 
the whole country would cost at most several hundred thousand dollars, I 
wonder how many non-fatal thyroid cancer cases, and how many fatalities, 
could be considered an acceptable price to pay for avoiding having to 
buy that "pound of prevention."
   Though Pat did not mention this, I understand that she has been given 
the task of leading the NRC's KI Core Group, taking over from Aby 
Mohseni, who has been detailed to the Senate Committee that oversees the 
NRC.  Mr. Mohseni was a principal author of Draft NUREG-1633, the NRC 
staff technical assessment of KI that had to be withdrawn by the 
Commissioners and removed from the NRC website.  (Among other things, it 
omitted to mention that KI had been found "safe and effective" by the 
FDA.)  I'm sure her arrival on the scene will be a change for the 
better.
   The task of the KI Core Group is to revise NUREG-1633 and render it 
fit for publication.  The group has met twice so far, the second time in 
Tempe, Arizona, last winter -- a week-long trip to the sunshine that was 
ultimately paid for out of ratepayers' electric bills.  (That was BEFORE 
Pat took over the group, I hasten to say.)  Maybe Pat could tell us when 
to expect a reissuance of NUREG-1633, and whether (and if so when) the 
Core Group plans to hold another meeting.
   I would like to offer a suggestion:  that because there was so much 
misinformation in Draft NUREG-1633 (principally about the safety of KI 
use, for children and pregnant women in particular), and because some of 
that misinformation has got into circulation, the revised NUREG-1633 
should clearly identify those errors, to correct the erroneous 
impressions that readers of the earlier document might have picked up.
   -- Peter Crane, pgcrane@erols.com
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