Radithor - radium concentration

[JMUCKERHEIDE@delphi.com]

Group,

Macklis in "The Great Radium Scandal" in Sci American (Aug 93?) confirms
Radithor  contained the advertised 1 uCi Ra-226 and 1 uCi Ra-228.  Robley
Evans at MIT and the Center for Human Radiobiology (CHR) assign "biological
effectiveness" of Ra-228 as 2.5 times Ra-226. Does each vial of Radithor
therefore consist of 3.5 uCi Ra-226-equivalent? 

If Eben Byers drank the 3-4 bottles/day for 3 years he is said to have
ingested, is it reasonable to say that he ingested up to about 3,000 bottles,
or roughly 10,000 uCi Ra-226-eq? (Rowland 1994, "Radium in Humans: A Review of 
US Studies", refers to an early estimate of 1400 bottles that is "too low"
from findings of body burden in a 1965 exhumation, estimating "systemic
uptake" of about 350 uCi Ra-226 and 600 uCi Ra-228. With Ra-228 2.5x, 1850 uCi 
Ra-226-eq.) 

With "systemic uptake" from ingestion about 20% (Maletskos 1966 and
affirmed/used by the CHR, Rowland 1994), and 10,000 uCi ingested, is it
reasonable to estimate that Byers systemic uptake was in the order of 2000 uCi 
Ra-226-eq? (Rowland says that, at 20% uptake, an estimate of 5000 uCi ingested 
-- but is not clear whether the Ra-228 is x 2.5 as "equivalent"). 

Then, as stated by Robley Evans in the Invited Summary of the Int'l Conf at
Lake Geneva, WI in 1981 (HPJ Suppl 1 1983, Rundo et al Ed.) that there
continues (since the MIT data and his paper "Radium in Man" (HPJ 1974)) to be
no case of a radiogenic cancer at <50 uCi "systemic uptake", or <1000 rad, in
all the exposed US populations data, and the worldwide data presented at the
conference. (This is now again confirmed from followup to the populations by
Maletskos (with Evans, Raabe, Groer and others) in 1994, including our Nov ANS 
sessions, Rowland (1994) and Thomas (1994).)  

Further, Rowland reports that "the lowest dose and longest latency" for a bone 
sarcoma is in a dial painter exposed in 1918, diagnosed in 1981 and died in
1983, with 81.5 uCi Ra-226 and 7.4 uCi Ra-228 (at about 18.5 Ra-226-eq for the 
Ra-228, a total of about 100 uCi Ra-226-eq). This would be an estimated
ingestion of 500 uCi Ra-226-eq which is not substantially different than
Byers, and she is the _lowest_, so many cases equate to and far exceed Byers
(both among the sarcoma cases and the many unaffected cases at higher body
burdens). 

(AND, more confusing, since as indicated in Macklis part of the rationale
about the effect on Byers was that he ingested the Radithor so relatively
quickly, the dial painters typically worked less than 2 years so they also
received their uptakes relatively quickly.) 

Since ingestion of 250 uCi (from Evans in Rundo 1983) (or 500 uCi from
Rowland) is the threshold for no effects in a population of thousands that
includes people with MUCH higher ingestion (ignoring the injection
population), there seems to be a very narrow range between the bone necrosis
(decaying bones) effects, with related complications (abscess of the brain,
secondary anemia, and terminal pneumonia) that caused Byers death (as a
seeming "overdose"), and the ingestion in the dial painters, and other
medicinal ingestions. 

The dial painter and other radium burden population (including injection
cases) caused a few long term sarcomas (85 total in the US studies of 6,675
cases, 64 in the measured burden population of 2,383, and only 5 of 1,991
males), and head carcinomas (from exhaling radon decay products trapped in the 
sinuses) (37 total, 5 of which also had sarcomas, and only 5 in the males).
[Note that these rates include "symptom-selected" cases so direct
epidemiological cancer rates are not valid.] 

Question:  Does anyone know of a discussion of Byers "overdose" death,
including any other early "radium jaw" and bone necrosis cases, vs. the
burdens (and seemingly higher burdens ingested in short times either as dial
painting or medicinal ingestion) at which such devastating effects were not
seen, with risks limited to cancers? 

[As another note of interest, there were 400,000-500,000 vials of Radithor
sold (at 3.5 uCi/vial), and there are a number of Radithor cases in the CHR
records, but Rowland records only 1 sarcoma case (in 85) and 2 carcinoma cases 
(in 37) that were from Radithor in the US cases. Were there other necrosis
cases in that time? Does anyone know whether FDA did any work to follow the
Radithor cases after it got Congressional authority following Byers death?] 

So, if the known cancer cases have a 500 uCi minimum ingestion, and are few in 
a relatively large population, and the Byers case that was the cause of US
fear of radiation, with 10,000 uCi ingestion, why is the radium in drinking
water standard roughly 0.002 uCi/year? (5 pCi/l x 1.1 l/d x 365 d/y)?  Or 2
nCi vs. a 500,000 nCi known threshold? a factor of 250,000 to allow for
"uncertainty"?  (and compare to 10,000,000 nCi ingested by Byers that
initiated public fear?) 

[And why would Macklis, who is a physician and would presumably be able to
understand differences in the order of millions in dosages, relate the Byers
ingestion and dose to concerns about indoor radon?] 

Are there any other dose effect considerations that should be applied to the
radium injestion population? 

Thanks.

Regards, Jim