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Article on Stockpiling of KI

This appeared in today's Washington Post.  Sorry for the length.

-- John

John Jacobus, MS

Certified Health Physicist

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Bowie, MD 20715-2024

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U.S. Lacks Stockpile of Special Drug

By Justin Gillis

A generation ago, as a nuclear disaster unfolded in central Pennsylvania and

140,000 people fled the area, pharmaceutical executives were rousted from

bed in the middle of the night by a plea for help.

At the federal government's request, they cranked up a production line in

Illinois at 3 a.m., and hours later, thousands of bottles of potassium

iodide, an anti-radiation drug, were secretly rushed to Harrisburg by

military jet. Ultimately the nuclear reactor at Three Mile Island was

brought under control and the drug was not needed, but it was a close call.

When it was over, policymakers in Washington vowed to stockpile the drug,

saying they would not be caught short again.

It never happened.

Terrorists have spoken longingly of their desire to blow up the United

States' nuclear plants and poison the land with radiation. But if a nuclear

disaster were to occur today, whether by terrorist strike or otherwise, the

government might well be in the same position it was in1979, trying to scare

up supplies of the drug on short notice.

Potassium iodide is often billed on the Internet as a panacea for a nuclear

emergency. It is nothing of the sort, offering no protection for most types

of radiation exposure. But there is strong scientific evidence that it can

protect the thyroid gland, the most radiation-sensitive part of the body,

from absorbing trace amounts of radioactive iodine, particularly in young


Despite that finding, there has long been a serious debate about how

valuable stockpiles of the drug would be in a real-world emergency, since it

is most effective when taken within a couple of hours of radiation exposure.

Unless people already had it in their houses, skeptics argue, getting it to

them that quickly would be difficult, at best. Most European countries and

four U.S. states stockpile the drug for general public use, while the rest

of the states and the federal government do not.

That policy is under renewed scrutiny since the Sept. 11 attacks and the

anthrax scare that followed. The federal government was better prepared for

the anthrax emergency, in fact, than it would be to distribute potassium

iodide for radiation. It had stockpiled millions of doses of antibiotics and

was able to draw on those stores when thousands of exposed people needed

preventive medicine. The lack of a potassium iodide stockpile irks many

doctors and other experts who have delved into the issue.

"The first thing is, there ain't none available," said David Becker, a

Cornell University specialist in thyroid diseases. "Some of us in

organizations like the American Thyroid Association have been yelling and

screaming for 15 years about this. It seems to me it doesn't make any sense

for the U.S. not to have any at all."

Potassium iodide is not expensive, nor is it difficult to manufacture or

store for long periods. The drug is approved for thyroid protection by the

Food and Drug Administration, a position the agency reiterated earlier this


One reason for the lack of a stockpile is that, however cheap it may be,

potassium iodide is also controversial.

The nuclear power industry, which stocks potassium iodide to protect workers

in its plants, has long opposed a large public stockpile, carrying as it

would the implication that nuclear power might be unsafe.

Some experts charged with protecting the public from radiation oppose it,

too, fearing the drug would be seen as a cure-all. These experts contend

that evacuation and careful monitoring of the food supply would be better

ways to protect public health.

In the halls of Congress and elsewhere in the nation, these arguments are

being scrutinized anew. The Nuclear Regulatory Commission, after going back

and forth for years, has adopted a policy that is mildly favorable toward

potassium iodide. The Health and Human Services Department is considering

whether to add the drug to its national anti-terrorism stockpile.

Under the new NRC policy, states must decide whether to tap NRC funds to

create regional or local stockpiles. This means a public discussion of the

drug and its potential usefulness is likely to occur in virtually every

state over the next year.

The drug is a hot political issue in some communities. Alabama, Arizona,

Maine and Tennessee already have some form of stockpiling. The citizens of

Duxbury, Mass., who live near a nuclear plant, passed a stockpiling plan

last year. Vermont recently pledged an expanded stockpile, and a vigorous

debate is underway throughout New England and in some towns in New York.

The World Health Organization recommends stockpiling for every country with

nuclear reactors operating within or near its borders. Ireland just

announced plans to send the drug to every household in the country.

Potassium iodide availability is one of those issues that rarely rises to

public awareness, but it has a long underground history that has played out

in Washington and in state capitals over decades. The arguments being heard

today are familiar ones to participants in that debate, with fear of

terrorism as the new twist.

"In the immortal words of Yogi Berra, it's déjà vuall over again," said

Jerome Halperin, the man who rousted pharmaceutical executives from bed

during the Three Mile Island crisis. He was then an officer of the FDA, and

he has a hard time believing the nation has no stockpile 22 years after the

federal government promised to build one.

"It's the appropriate, rational, public-health-preparedness thing to do," he

said. "Why wouldn't we expect it?"

But others are skeptical of the value of stockpiling. Illinois, for

instance, has 11 nuclear reactors operating on six sites, more than any

other state, and it has made some of the most elaborate plans in the nation

for responding to a radiation emergency. They call for people to evacuate or

take shelter when necessary to escape a radiation plume, but they do not

call for potassium iodide. Most other states that have considered the issue

have adopted the same position.

The Nuclear Energy Institute, a trade association for the nuclear industry

that has long opposed stockpiling, says it can live with the new NRC policy,

but its experts remain skeptical of the real-world value of potassium

iodide. "Concern No. 1 is that people not get confused that this is some

sort of panacea for any kind of radiation exposure," said Ralph Andersen,

chief health physicist at the nuclear institute.

The value -- and the limitations -- of potassium iodide have been known to

researchers for decades, and there is little dispute on the scientific


Nuclear reactors produce many radioactive substances that can harm people.

One, radioactive iodine, poses a particular worry because the human thyroid

gland uses iodine as a fundamental building block of hormones that play

critical roles in metabolism. The body cannot distinguish the safe form of

iodine present in food and table salt from the radioactive form that comes

from nuclear reactors.

It has been known since the 1950s that young children are acutely sensitive

to radioactive iodine, but the point was illustrated dramatically when the

Chernobyl nuclear plant in Ukraine blew up in 1986, scattering radiation

across hundreds of miles.

For those living at a distance from the plant, virtually the only known

health effect has been a huge spike in cases of thyroid cancer among

children. At least 2,000 "excess" cases in Ukraine, Belarus and nearby areas

have been attributed to Chernobyl radiation. Thyroid cancer can usually be

treated, but that may require surgery, regular monitoring and lifetime


The idea behind potassium iodide is that the thyroid gland can store only so

much iodine. A potassium iodide pill given near the time of radiation

exposure floods the gland with safe iodine and reduces or eliminates the

absorption of radioactive iodine. Potassium iodide is the same chemical used

to add iodine to table salt, but the pills contain higher doses. Anyone can

buy the pills, though they are not widely available in stores and most

people do not know about them.

Potassium iodide can protect people only from radioactive iodine, not other

kinds of radioactive fallout. Bearing that in mind, skeptics say the

much-preferred course, in an accident, would be to get people out of the

radioactive plume or into shelters. Advocates of the drug tend to agree,

they but argue that if evacuation plans went awry, potassium iodide would be

better than nothing.

Whatever the merits of these positions, there is no doubt that during Three

Mile Island, the nation's closest brush with nuclear disaster, the

government wound up scrambling to round up supplies of the drug at the last


In that episode, a partial "meltdown" at a nuclear plant led to the release

of small amounts of radioactive material, including iodine. For several days

there was fear the reactor would explode, and state evacuation plans turned

out to be woefully inadequate. Given the prospect of widespread radiation

exposure, the FDA decided midway through the disaster to rush a supply of

potassium iodide to Pennsylvania.

Hunkered down at an FDA emergency center, Halperin and colleagues spent the

evening of March 30, 1979, desperately calling pharmaceutical and chemical

companies. Finally Mallinckrodt Inc. of St. Louis said it had bulk drug on

hand and could package it at a plant in Illinois. The first bottles were

flown to Harrisburg the next evening by Air Force jet.

To forestall a riot, no public announcement was made about the drug. The

emergency passed without it being used, and eventually the stockpile grew

old and was discarded.

A presidential commission that investigated the accident, appalled by this

frantic episode, recommended broad stockpiling of the drug in the areas

around nuclear reactors, and the NRC agreed. But as memories of the

emergency faded, the agency backed out of that commitment, and the issue has

been periodically debated ever since.

Many opponents of stockpiling acknowledge that Chernobyl provides compelling

evidence of the risk of thyroid cancer from a radiation disaster, but they

say a comparable degree of exposure would be unlikely in this country.

When Chernobyl blew up, the Soviet Union spent days lying about the accident

and failed to halt distribution of contaminated food. There is evidence that

much of the radioactive exposure came from this failure. The radioactive

iodine fell on fields, cows ate the grass, and children drank milk from the

cows. Safety experts say the United States, by contrast, would almost

certainly move quickly to block radioactive food.

The most recent federal policy change on potassium iodide came before the

terrorist attacks of Sept. 11, but the issue has taken on a new urgency

since those attacks.

The change was initiated from within the NRC itself. Peter Crane, then a

lawyer on the agency's staff, was a thyroid-cancer victim who thought the

failure to stockpile could not be defended. He filed a petition as a member

of the public in 1995, then spent years prodding the agency. It eventually

adopted a compromise under which it has pledged to pay for potassium iodide

for states that want it.

The NRC is still finalizing plans to implement that policy. Meanwhile, the

Health and Human Services Department is considering buying some of the drug

to add to its own anti-terrorism stockpiles. However, there is debate about

whether the drug could be distributed from these regional stockpiles quickly

enough to do any good.

The most aggressive plan would be to follow several European countries in

distributing the drug to every household. But American experience suggests

that would be a difficult policy to maintain over the long term. Tennessee

launched such a program in the early 1980s for people living near nuclear

plants, but participation has dropped to about 5 percent of households.

Tennessee maintains stockpiles near its emergency shelters, however, and is

confident it could make the drug available quickly to large numbers of


"It doesn't seem like very much of a burden, what we're doing," said Ruth

Hagstrom, the state health administrator who would give the order if

potassium iodide ever had to be used in Tennessee. "We're sort of happy with

the way we do things, and we wonder why everybody else doesn't do it, too."


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