Re: Leukemia in Astronauts -Other unusual radiation exposure?

[SSEKIRK@aol.com]

Stewart,

Do you have any estimates of the number of children treated for enlarged
adenoids using x-ray "therapy"? 

S. KIRK

SSEKIRK@aol.com


In a message dated 98-07-23 12:08:11 EDT, you write:

<< here is another potential, and more likely, contributor to radiation health
 effects in early astronauts like Alan Shepard. Each of the original 7 were
 military personnel and  test pilots during the period when Nasal Radium
 Irradiation (NRI)  was commonly used on pilots and military personnel for
 problems with pressure equalization from the nasopharynx to the middle ear.
 Alan Shepard was reported to have had extensive problems with middle ear
 infections which interfered with some of his flights in space. Test pilots
 also had to undergo training where they were subject to explosive
 decompression and ability to equlize pressure in these trainees would be
 critical.
 
 The NRI procedure involved the insertion of encapsulated 50 mg Monel metal
 filtered sources ( 0.3 mm wall thickness) through the nose to the opening of
 the eustachian tube. Each treatment typically lasted 12 min and 3 to 4
 treatments, delivered bilaterally in the US, constituted a course of
treatment
 which would be repeated as needed.  Contact doses to the nasopharynx for a
 four treatment course averaged about 2,000 rad [see Farber, S. "Radium
 exposure in U.S. Military personnel", New England Journal of Medicine, Vol.
 326. No. 1, pp. 71-72, Jan. 2, 1992 which reviews NRI use on an estimated
 5,000 to 10,000 submariners]. The CDC, now that it has been forced to
evaluate
 the NRI issue, recently estimated that between 570,000 and 2.6 million
 children in the US received NRI treatment from 1946 to 1961. However, the
 practice continued well into the 1970s in places like Maryland where it had
 become so entrenched because of the number of physicians trained at Johns
 Hopkins. Last fall the REAP project was contacted following some local news
 coverage by about 1,000 Maryland residents who received NRI and this gave a
 better time line to the use of NRI.
 
 Several studies of children who received NRI have documented elevated rates
of
 various health effects. A 1989 study in the Netherlands [Verduijn, PT,
 Mortality after nasopharyngeal radium irradiation for eustachian tube
 dysfunction", Ann Otol Rhinol Laryngol, Vol. 98, pp. 839-844, 1989] observed
4
 lymphatic/hematopoietic cancer deaths in 1, 448 males followed for about 25
 years on average where 0 were observed in a control group of 1,257 males.
 Because the numbers were small, this excess relative risk was "statistically
 significant" at the p= 0.07 and was not at the time given much note. The
 overall cancer death RR for males was 2.78 but was not judged statistically
 significant. Verduijn in 1996  published an update to his 1989 publication
 reporting on a new review of the original data looking at cancer incidence
not
 cancer mortality. {see Verduijn, "Late health effects of radiation for
 eustachian tube dysfunction: Previous results and ongoing study in the
 Netherlands", Otolaryngology-Head and Neck Surgery, p. 417-421, Nov. 1996].
 This updated report noted" "A statistically significant difference was noted
 only for cumulative all-site cancer incidence, with the exposed having twice
 as many verified cancers as the nonexposed....These findings corroborate the
 hypothesis that there is some risk of tumor induction involved with
 nasopharyngeal radium irradiation at the dose level applied to this
 population"  [NOTE: In the Netherlands, the children were treated with 25 mg
 irradiators vs. 50 mg in the U.S.,  they were treated in one nostril vs. 2 in
 the US, and for shorter periods of time on average.--Overall, this lead to
the
 total mg-min of radium exposure being 3.52 times lower in the Netherlands
than
 in the U.S."
 
 The one study of NRI in the US [a study of only 667 children followed treated
 in Hagerstown, MD at a clinic run by Johns Hopkins] documented a
statistically
 significant excess of brain cancer mortality, which the BEIR V report
reviewed
 as being equal to a Rel. Risk of  5.3. This is based on Sandler, DP,
 "Neoplasms following childhood radium irradiation of the nasopharynx", J.
Nat.
 Can. Inst., Vol. 68, p. 3-8, 1982. The Ph. D. thesis resulting in the report
 cited also found a doubling of benign and malignant tumors of the head and
 neck and an 8.6 fold RR of Graves disease which was highly statistically
 significant (p <<0.01).
 
 More information on this subject can be found at the web site for the Radium
 Experiment Assessment Project noted below. It should be noted that NRI
 experiments conducted on school children in Baltimore by Johns Hopkins and
 experiments on WWII submariners and aviators was reviewed by the Presidents
 Advisory Committee on Human Radiation Experiments (ACHRE) in its Final Report
 to President Clinton in Oct. 1995. NRI treatment of children in the study
 reviewed was judged to have had the highest risk to health [8.4 cancer deaths
 of the head and neck per 1,000 individuals treated vs. a threshold for notice
 of 1 excess death per 1,000]  of any of the 4,000 human experiments reviewed
 and was the only experiment reviewed which exceeded the threshold for medical
 notice and followup. Nevertheless the ACHRE, chaired by Dr. Ruth Faden a
 world-renowned Professor of Bioethics at Johns Hopkins School of Public
 Health, failed to recommend medical notice and followup of the experimental
 group of children in question for reasons that were ethically and  morally
 challenged to say the least. One reason cited was that "Most of the risk [of
 excess cancer mortality] has probably already been expressed"!!!! [emphasis
 added -therefore ignore the issue]
 
 The web page for REAP below includes a link [scroll to bottom of page for
 testimony ["Nasal Radium Irradiation and The Advisory Committee on Human
 Radiation Experiments - A Failure of Process"] on this point I presented in
 March 1996 to the U.S. Senate Government Affairs Committee Hearing on Human
 Radiation Experments. There are also links to a number of articles in the
 medical literature and some background investigative news stories recently
 published on NRI.
 
 It should also be recognized that another eartly astronaut, Deke Slayton died
 of brain cancer, an outcome linked to NRI. Having heard from about 1,500
 individuals treated with NRI, I'm aware of another case where a [non-
Oriental]
 test pilot for Grummen Aircraft had NRI treatments and later developed and
 died of nasopharyngeal cancer.
 
 Overall it appears that the potential use of NRI on test pilots [as well as
 submariners and other cohorts where NRI was commonly used at various times]
 should be carefully documented as part of any investigation of  health status
 and outcomes.
 
 Stewart Farber, MS Public Health
 Director - Radium Experiment Assessment Project
 19 Stuart St.
 Pawtucket, RI 02860
 
 Phone: (401) 727-4947   Fax: (401) 727-2032   E-mail: radproject@usa.net
             Web address: http://www.customforum.com/carsreap
 
 
 The Radium Experiment Assessment Project is a project 
 of the Center for Atomic Radiation Studies, Inc., a not-for-profit 501(c)(3)
 organization. Contributions are tax deductible to the extent permitted by
law.
 
 
 
 
 
 
 
 
 ----------------------- Headers --------------------------------
 Return-Path: <server@romulus.ehs.uiuc.edu>
 Received: from  rly-zb05.mx.aol.com (rly-zb05.mail.aol.com [172.31.41.5]) by
air-zb04.mail.aol.com (v46.19) with SMTP; Thu, 23 Jul 1998 12:08:11 -0400
 Received: from romulus.ehs.uiuc.edu (romulus.ehs.uiuc.edu [128.174.74.24])
 	  by rly-zb05.mx.aol.com (8.8.8/8.8.5/AOL-4.0.0)
 	  with ESMTP id MAA26707;
 	  Thu, 23 Jul 1998 12:07:57 -0400 (EDT)
 Received: (from server@localhost)
 	by romulus.ehs.uiuc.edu (8.8.7/8.8.7) id LAA01573;
 	Thu, 23 Jul 1998 11:09:39 -0500 (CDT)
 Date: Thu, 23 Jul 1998 11:09:39 -0500 (CDT)
 Message-Id: <30e73de5.35b75bf9@aol.com>
 Errors-To: melissa@romulus.ehs.uiuc.edu
 Reply-To: radsafe@romulus.ehs.uiuc.edu
 Originator: radsafe@romulus.ehs.uiuc.edu
 Sender: radsafe@romulus.ehs.uiuc.edu
 Precedence: bulk
 From: RADPROJECT@aol.com
 To: Multiple recipients of list <radsafe@romulus.ehs.uiuc.edu>
 Subject: Re: Leukemia in Astronauts -Other unusual radiation exposure?
 X-Listprocessor-Version: 6.0c -- ListProcessor by Anastasios Kotsikonas
 X-Comment:  RADSAFE Distribution List
 X-Mailer: AOL 3.0 for Windows 95 sub 52
 
  >>