Re: KI Pills

[JMUCKERHEIDE@delphi.com]

Vargo writes, in response to advice by David Mozley, MD:

>           Regarding the use of KI pills, Mozley writes: "The risk of 
>           anaphylaxis to KI is low, but the consequences for any occurence 
>           are potentially catastrophic.  If you distribute pharmacological 
>           doses of KI to a large enough segment of the general population, 
>           you risk killing a few, and making even more pretty sick."
>           
>           This risk was considered in NCRP Report 55, Protection of the 
>           Thyroid Gland in the Event of Releases of Radioiodine."  Section 

>           4.5.  Using data provided from pharmaceutical manufacturers 
>           (therapeutic doses of iodide manufactured per year) and the 
>           incidents of adverse drug reaction rate reported to FDA, the NCRP 
>           estimates the rate of adverse reaction for 300-mg doses 
>           therapeutic doses of iodide to be 5E-7/y.  (Note:  the NCRP 
>           recommendation for protection of the thyroid gland is 130 mg/d.)  
>           This report also considers other possible complications from 
>           long-term use, or use by persons with special medical conditions. 
>           Most of these adverse effects are associated with dosage and 
>           frequency far in excess of the NCRP recommendation. 

It's almost funny to quote NCRP, which has essentially zero medicine or health 
knowledge or expertise, is not even qualified as a public health function, in
the face of an MD, and in the face of the pharmacological data and medical
package insert documentation on SSKI. 

Note that the package insert contains a number of side effects and especially
contraindications on the use of SSKI as a prescription medicine. 

Note also the irresponsibility of even considering the "idea" of wholesale
distribution of such a prescription medicine by non-physicians with no medical 
traiining or supervision in the face of a total inability to consider the
medical conditions of the individuals, and the inability to provide medical
followup for the individuals (especially in the face lawsuits when the near
certain cases of adverse effects would be filed on the "prescribers"). Talk
about "practicing medicine without a license"! 

The idea that if SSKI were a rational consideration, that issued in wholesale
would be taken with care to prescription limits in the general population, or
NOT given in excess to children, or NOT taken by pregant women (for whom its
use is contraindicated) when pregnancy raises the greatest fear fostered by
NCRP as seen in the 100,000-200,000 abortions following Chernobyl, is not
reasonable. 

Obviously, the idea that radioiodine from a reactor accident would be
sufficient to consider use of KI when US policy is to evacuate is faulty. The
data on radioiodine transport in a humid environment shows that our
"conservative estimates" of radioiodine release to and in the atmosphere are
orders of magnitude in excess of any reasonably expected reality. 

Current data also indicates that SSKI has a significant risk to the thyroid.
SSKI may be more effective than radioiodine at 50-100 cGy at causing adverse
thyroid conditions. Therefore we would propose to put everyone at risk for
adverse to "save" the risk to the rare few who MIGHT be exposed to >100 cGy. 

KI may yet be found to be involved in the greater-than-expected excess and
unusually agressive adverse thyroid conditions seen in the Chernobyl
population, compared to known thyroid response to radioiodine in medical
patients and fallout populations. This includes the Lucky Dragon fishermen,
among whom there are no known adverse thyroid conditions after at least 25
years, and the Marshall Islanders, with a few, both groups of which were
exposed to direct hydrogen weapons fallout (Bikini, 1954), sufficient to have
caused extensive beta burns to exposed skin, with WB doses of >100 cGy).  One
fisherman died at 204 days with an estimated 640; the second died after 21
years from unrelated conditions; and the others were still living and healthy
after 25 years. (Does anyone have more current data?) Providing SSKI in
wholesale doses would have much greater adverse health risks than radioiodine. 

Note that this doesn't apply to emergency personnel whose individual condition 
SHOULD be known, who SHOULD HAVE BEEN examined by a physician prior to being
put in a position of being issued SSKI, who SHOULD consent with informed
knowledge of the risks and only with reasonable expectation that he/she would
be actually exposed to significant concentrations/potential doses from
radioiodine, and who can and must be medically followed by individual with
knowledge of the specific doses received.   

>           NCRP also makes one other important point concerning adverse 
>           effects:
>           
>           "Although there are many individual reports of complications of 
>           iodide administration in medical literature, these are anecdotal 
>           in that they list a number of cases with the complications, but 
>           do not give the number of patients taking iodides from which the 
>           cases demonstrating abnormalities are drawn." 

This is also pretty funny when you consider that NCRP "predicts" adverse
consequences to the thyroid at low doses when there are none in large
populations. BEIR V itself acknowledges that there are NO adverse in large
populations of medically exposed patients and other available data, then does
NOT simply fabricate a linear response (as it does with other cancers), but
disingenuously simply then reports that NCRP does predict a linear response
(presumably with the same lack of scientific foundation) (see BEIR V, p.
287-291). 

>           George J. Vargo
>           Pacific Northwest National Laboratory
>           
>           Usual disclaimers...

Me too!

Regards, Jim Muckerheide
jmuckerheide@delphi.com