I believe any undesired effects of NPI would have shown long ago. Also they should be much less likely than illness from NOT having either that or adenotonsillectomy (to enable normal breathing, unblock eustachian tubes, restore appetite, etc).
Howard Long
Jim Otton wrote:
Radsafe:As one who apparently received NRI while a preadolescent (about 1956 or 1957) from the family pediatrician in Baltimore, I am interested in knowng if there is a concensus among Radsafers on the risk associated with this exposure. If the risk is significant, what should I have my current Kaiser physician be alert to during physical examinations?Jim Otton-----Original Message-----Radsafe:
From: owner-radsafe@list.vanderbilt.edu [mailto:owner-radsafe@list.vanderbilt.edu]On Behalf Of SAFarberMSPH@CS.COM
Sent: Friday, December 21, 2001 12:05 PM
To: tedrock@CPCUG.ORG; radsafe@list.vanderbilt.edu
Subject: Re: Ship Yard Workers - Journal Publication vs. Report/Thesis Findings Issue
In a similar fashion, the US Centers for Disease Control [CDC] also over a period of many years has refused to consider radiation effect research documented in Ph.D. theses related to the adverse effects of Nasopharyngeal Radium Irradiation [NRI] because it was not "published" in a peer reviewed journal. It appears that research whether indicating adverse effects of lack of effects is ignored by agencies depending on their unspoken agenda.
Concerning NRI adverse effects, in the first case the Sandler, 1979 Ph.D. thesis at the Johns Hopkins School of Public Health on 667 children treated with NRI at a Johns Hopkins run clinic which had a RR = 8.6 for thyrotoxicosis [Graves Disease] with a p value < 0.01 was ignored in reviews by the CDC and statements were made to the contrary in CDC publications from 1994 to present that NRI had no significant "benign or malignant" health effects based on published studies. The Sandler, 1979 Ph.D. findings in her Ph.D. thesis at Hopkins were reported in a 1980 Bureau of Rad Health [BRH] and HEW publication on Radiation Bioeffects research of papers presented in June, 1979 at a BRH sponsored conference in Bethesda, BUT the research findings of Sandler were not considered peer reviewed and the findings of harm related to thyroid disease conveniently never reported in a journal article. Sandler at the 1979 Bethesda conference reported the 8.6 RR for thyro! toxicosis was "highly statistically significant and deserving of follow-up study" since it indicated the NRI procedure appeared to have caused pituitary damage which upset thyroid function. However, the recommendation went unheeded.
In a subsequent Ph.D. study at Johns Hopkins School of Public Health [Yeh, awarded June 1997] of the Sandler, 1979 cohort of 583 children treated [and traceable] with NRI and brought forward in time to document health outcomes, the 1997 Ph.D. documented research by Yeh demonstrated per the author's own statements in the Ph.D. thesis a highly statistically significant adjusted RR = 30.9 [ a mere 2,990% increase] for benign and malignant brain tumors [7 cases in the treated] vs. the control group [0 cases].
Nevertheless from 1997, the CDC up to the present has continued to maintain there were no adverse impacts of the NRI procedure in its use on young children [and no need for screening recommendations to be issued for adults at risk of head and neck cancer, thyroid disease, brain cancer, brain tumors, and other adverse effects related to thyroid disease], and refused to evaluate the Yeh, 1997 thesis. The CDC clings to its technically insupportable [and erroneous] recommendation that there have been no documented "significant benign or malignant health effects from NRI".
The Yeh Ph.D. findings were published in the April 15, 2001 issue of the American Journal of Epidemiology with substantial word-engineering to minimize the impact of the adverse findings in the Abstract. The CDC has still, to my knowledge, not evaluated the Yeh, 2001 published results or modified its earlier "recommendations" to do nothing on the issue related to prudent guidance to the population as risk which is of vital importance to the 570,000 to 2.6 million individuals the CDC has estimated in its own published research [see Mellinger-Birdsong, 1996] received NRI treatments in the US from 1945 through 1961 [although the treatment continued into the 1970s in some locales like Maryland where it was exceeding popular with physicians. For those that want to estimate doses delivered to children in this procedure, it typically involved the insertion of a 50 mg Monel [0.3 mm encapsulated to maximize beta dose] sealed Ra-226 capsules through ea! ch nostril to the opening of the Eustachian tube for a series of 3 to 4 twelve minute treatments. In standard medical lingo the total "dose" would be about 2 gm-min of Ra-226. Calculations of contact doses to the nasopharynx exceed 2,000 rad, with doses beyond the first cm of depth falling off sharply, but still delivering substantial gamma dose which I have published in a letter to the editor of the New England Journal of Medicine, "Radium Exposure in U.S. Military Personnel", [Farber & Ducatman, Jan. 2, 1992].
It is quite clear that across the board, government agencies tasked with radiation protection responsibilities ignore major studies and at times the major studies and at time the most relevant research findings, if the findings has not been published in a peer reviewed journal for one reason or another. The so-called "gray literature" of DOE reports or Ph.D. theses findings are simply ignored when convenient.
Stewart Farber, MS Public Health
Public Health Sciences
[203] 367-0791
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In a message dated 12/21/01 9:51:53 AM Pacific Standard Time, tedrock@CPCUG.ORG writes:
> Since when did "publish" mean peer reviewed?John:
DOE, NCRP, ICRP, BEIR committees, et al. seem to hold to this definition,
since they do not include this study in their reports, although it is
clearly the best study available on the subject and was under the same
technical direction (Arthur Upton).Ted Rockwell