question on M. Brucer's P-32 vignette

["Jaro" <jaro-10kbq@sympatico.ca>]

I searched the Radsafe archives and ORAU's history pages, but while there

was a fair bit of text about Brucer himself, I couldn't find any additional

information on the subject discussed in his vignettes, in his book "A

Chronology of Nuclear Medicine," Heritage Publications, Inc., St. Louis,

Missouri, 1990, specifically on p. 259 ("Chronology from 1940 to 1953 -

Vignettes on Manhattan District Days and Atomic Medicine.")



The text went as follows, below.

What I would like to know is whether P-32 therapy is still unavailable in

the US, and whether it is still "the treatment of choice in England" and

"the world wide therapy of choice for polycythemias."



I am also thinking of posting this Brucer vignette on a web site, but

getting permission to do so may be difficult, given that Brucer is no longer

with us.

Any helpful suggestions would be appreciated.



Thank you very much.



 Jaro



http://www.cns-snc.ca/branches/quebec/quebec.html



^^^^^^^^^^^^^^^^^^^^^



<begin quote>

P-32 is a Victim of Radiation Hysteria



By the time (c1950) the new AEC had got around to making P-32 available to

physicians, P-32 therapy of the chronic leukemias and of polycythemia was

well accepted. Then in 1952 the Atom Bomb Casualty Commission (ABCC)

described a leukemic death in 47 of 110,000 survivors. The next year L.

Heilmeyer announced that he had a chemotherapy as good as P-32. In private

the word was spread that chemo was better than radioactive therapy because

you didn’t need a special license with examinations in physics. Also AEC

licensers might be snooping in your medical records, thus violating the

sacred patient-physician relationship.



Radioactive fallout from A-bomb tests in Nevada was being reported in ever

more hysterical terms by newspapers. Hysteria prompted Congress’s Joint

Committee on Atomic Energy to hold full scale hearings in 1957. In a pious

display of concern for the people’s health, radiation hysteria was pushed to

full swing. Then headlines said 99 survivors of the atom bomb had died of

leukemia (eventually it would be about 110 or 0.1%). A few of the patients

who had been treated with P-32 died in acute remission; naturally, commented

Lawrence, that’s how most patients not treated with P-32 die.



The Success is “Limited” by Politics



In 1958 Lawrence pointed out that 80%, of his P-.32 treated lymphoblastoma

patients lived a normal life span. (Ann Int Med, 1958) Osgood felt he was

seeing the same thing, and hired a biostatistician to review his series. He

found that chronic leukemia patients treated with P-32 had a life expectancy

equal to that of the US , population. (J Nuc Med 5:139, 1964)



However the NIH, already dominated by fund raising cancer societies, was

pushing a new marginally successful “chemotherapy.” It did not require

special AEC license. During the 1950s the 0.01% of Hiroshima atom bomb

survivors developed “leukemia” in the glare of world wide publicity. When

added to P-32 licensure the black stain was enough to stigmatize Leukemia

therapy with P-32. A couple of offshoots of Lawrence’s discovery survived.

Their story concerns polcythemia, barely mentioned in Lawrence’s first

written report. (Rad 35:51, 1940) Polycythemia vera is still (1988) treated

with P-32. Thrombocythemia P-32 treatments were added in 1958. The

popularity of P-32 increases as the radiophobia of the 1970s relaxes.

<snip>



Reaction to P-32 Therapies



With the initial declassification of MED reports (Manhattan Engineering

District Declassified Documents), D. Anthony revealed that the LD50 of IV

P-32 for man (derived from animal data) was in the range of 270 mCi (10

GBq). Even with a tremendous error for translation from animal to man, this

data made P-32 a very safe drug. By 1955 J. Harman said P-32 was the

treatment of choice in England (BRIT MED J, 1955). After over 15 years

followup J. Lawrence said his patients were living a normal life span. In

1958 J. Fountain began treating thrombocythemia patients with equal success.

(BRIT MED J, 1958)



The occasional death from leukemia of an atom bomb survivor became, in 1960

newspapers, a 100% certainty of radiation leukemia after even minimal

exposure to radiation. (Actually, 40 years later it turned out to be an 0.2%

chance of leukemia and only in those surviving >200 R exposure.) A number of

patients given P-32 were reported, in great flares of publicity, to have

died of acute leukemia. In 1959 J. Lawrence pointed out that a flare-up of

acute leukemia was the expected cause-of-death in polycythemia. The high

incidence in patients not treated with P-32, and so few in patients treated,

suggested that P-32 prevented the acute leukemia death. Then in 1960, E.

Lesli, working from a long series of patients, gave statistical proof that

P-32 prolonged the life span of polycythemia patients. (CR, 1960)



Radiophobia and the Decline of P-32



During the 1970s P-32 gradually lost its popularity for reasons easily

understood. Every hematologist needed only one license to do chemotherapy;

however, in order to use P-32 on even an occasional polycythemia patient he

had to have an MD plus a second “license to use radioisotopes.” A recent

(1983) issue of Current Therapy points out that the choice therapy must be

given by a physician with a special license. Along with each radioisotope

license came inspection by arrogant, often insulting, inspectors and

increased insurance rates.



In 1984 the Sixth International Colloquium on Radioimmunoassay at Lyons,

France, reported that chemotherapy has its own morbidity; it is dreaded by

many patients, and subtracts rather than adds to the life span. The major

fault of radioactivity as choice therapy, they said, was government

bureaucracy.



Much the same story of avoiding the stifling AEC licensure occurred after J.

Fountain announced “cures” of thrombocythemia. (BRIT MED J, 1958) The

licensure criteria forbids use in normal patients, but the recommendation is

for dosage even before the patient becomes symptomatic. Chemotherapy was

slightly successful in treating the chronic leukemias, but nobody has yet

repeated Osgood’s feeling that his P-32 patients were actually living

longer, and healthier, lives than the controls in his series.



In a 15 April 1986 NY Times story on the results of the billions of’ $$$

wasted in the War-on-Cancer, the GAO (General Accounting Office) found no

improvement in 20 years, but much exaggeration, in the treatment of chronic

leukemias. However, the patient’s discomfort from chemotherapy cannot match

his doctor’s discomfort with the Nuclear Regulatory Commission.



A Remnant of the P-32 Success Story



Lowell Erf’s first patient, as an intern on John Lawrence’s service in

Berkeley, was one of the first to receive therapeutic P-32. After the

secrecy of all things nuclear subsided around 1950, P-32 became the world

wide therapy of choice for polycythemias. After 50 years it remains so

except in the USA, where an insane regulatory mania and newspaper

radiophobia has minimized its use.

<end quote>



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