RE: "Scientific misconduct"/ IOM Report

[carol marcus <csmarcus@ucla.edu>]

At 02:00 PM 12/20/99 -0600, you wrote:
>As the author of a rather scathing review of the NAS/IOM report, I must take
>slight exception with Carol's comments:
>
>The IOM report was extremely flawed in that it was mainly a history and
>commentary with very little supporting data or analysis.  Basically, the
>recommendations were not supported by the information in the report.  In
>fact, it's recommendations were so obviously biased against the NRC as to
>make it impossible for the NRC to accept the report.  Who knows, that may
>well have been the intent of the IOM (since it allows Carol and other's such
>wonderful ammunition).  Regardless of intent (and this has been refuted by
>several of the authors), the document LOOKS like it was a pre-planned
>assassination job, not a considered review.
>
>Note that I substantially agree with large portions of the IOM's (and
>Carol's) recommendations.  As such, I was extremely disappointed in the IOM
>because they had a chance to "get things fixed" and instead pushed through a
>non-credible document. Also note that several recommendations require major
>changes that CAN NOT happen in 5 years (but maybe could in 10 - if properly
>handled) - one can't ignore legislative reality no matter how much one
>dreams of Utopia.
>
>NOTE:  I think Carol believes in a paired solution that often gets
>separated: (1) Only allow extremely qualified physicians (e.g., Board
>Certified in Nuc Med) to direct the use of radioactive material in humans;
>and (2) get out of their way.  Also note that most statutes of radiation
>protection require agency's to protect workers, the public and the
>environment.  This is the fundamental contention that must be worked out.
>
>Wes
>
>Wesley M. Dunn, CHP
>International Isotopes, Inc.
>Wdunn@intiso.com <mailto:Wdunn@intiso.com> 			
>Corporate Website:  http://www.intiso.com <http://www.intiso.com> 
>
>
>	-----Original Message-----
>	From:	carol marcus [SMTP:csmarcus@ucla.edu]
>	Sent:	Monday, December 20, 1999 10:22 AM
>	To:	Multiple recipients of list
>	Subject:	Re: "Scientific misconduct" in gov't data
>
>
>	Dear Jim:
>
>
>	The National Academy of Sciences-Institute of Medicine undertook an
>exhaustive
>	study of NRC's dysfunctional "Medical" Program and recommended that
>NRC's
>	statutory authority be removed for byproduct medicine and biomedical
>	research.  That's how bad the NAS-IOM thought the Program was, and
>it was
>	right.  The Report, "Radiation in Medicine: A Need For Regulatory
>Reform"
>	was published in 1996.  NRC lied about what it said to every
>Governor in the
>	United States, and when accused of lying, refused to even speak to a
>member
>	of the NAS-IOM committee who volunteered to explain to the
>Commissioners
>	what the Report actually said.  And what happened? 
>
>	Ciao, Carol
>
>	<csmarcus@ucla.edu>
>
>	  
>	
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Dear Wes:

The documentation used by the NAS-IOM was extensive.  While it was alluded
to in terms of reference sources, there was much too much to include in the
report---the report was 350 pages long without most of it.  However, the
huge amount of documentation was all there, at the NAS-IOM building, if
anyone wanted it.  The NRC never bothered to look. The building is in
Georgetown, and not that far away from Rockville. If you went to the
meetings, as I did, a large quantity of the documentation was copied and
could be picked up by anyone who wanted it. In addition, ACNP/SNM sent its
huge NAS-IOM package chock full of documentation to each Commissioner to
read.  That's all we can do---we can't make the Commissioners read and
understand it.  

The NAS-IOM solution to the problem was not a "set-up".  The NAS-IOM studied
the problems very carefully.  However, when Chairman Selin and Commissioner
De Planque were saying THE SAME THING as the SNM and the ACNP, it was not
surprising that the NAS-IOM took those suggestions very seriously. Did you
know that Selin and De Planque agreed with us?  Did you know that before the
report even came out, when Selin realized he was leaving the Commission and
would not be there to resolve the disastrous problems with the "Medical"
Program, that he called ACNP/SNM and volunteered to push legislative
language that would get NRC out of our hair?   

As far as my attitude toward Authorized Users is concerned, I have never
wanted to limit nuclear medicine practice to physicians board certified in
nuclear medicine.  However, I expect those who are not board certified to
understand the same basic nuclear and radiation science material as a board
certified nuke, and the same clinical material as a board certified nuke for
those procedures that are being performed.  That is patently not the case;
NRC is selling licenses to almost anyone who will pay a User Fee, because
NRC is desperate for the bucks to keep its bureaucracy going.  The last
thing that it cares about is patient welfare.  There are many diagnostic
radiologists and cardiologists whose understanding of nuclear medicine is
poor, and their practices are consequently poor. Not all---but many.  As far
as I am concerned, if you are a physician and do not know what 10 CFR Part
20 is, or do not know enough science to set up a practice to comply with it,
you are not qualified to have a license to practice any or all of nuclear
medicine.  If you were the patient, and you will be some day---the average
American has 3 nuclear medicine procedures during his lifetime, and 95% of
Americans will have at least one---whom do YOU want doing your procedure?  A
qualified professional or some ignoramus who lets a tech practice medicine
for him?  

Once only qualified physicians get licensed, you don't need Part 35 or NRC's
lunatic licensing requirements.  All you need is the standards of Part 20,
and you set up a practice around that.  That's what the NAS-IOM said, and it
is fine.  Instead, we have medically, pharmaceutically, and SCIENTIFICALLY
incompetent NRC bureaucrats concocting pseudomedical nonsense whose sole
funtion is to perpetuate NRC jobs.  The new Part 35 and associated licensing
will cost about $500 million to $1 billion the first year.  However, no
third party medical payers will pay for this, because it is medically
unnecessary.  The economic future of nuclear medicine is at risk.  If people
stop their practices because they are losing money, and patients don't get
the care they need, NRC will be responsible for consequent morbidity and
mortality.  This is not a good situation. 

The situation in which NRC sells licenses to poorly qualified physicians,
and then justifies byzantine and draconian requirements to "correct" for
this incompetence, is terribly dangerous.  The dumbest doctor is better at
practicing medicine than the smartest physicist, and there aren't any smart
physicists involved in the "Medical" Program anyway.  In addition, the
criminalization of human error, much of which is insignificant and all of
which is rare, is venomous, perverted, and terminally dysfunctional.  It is
amazing that the Commissioners cannot get this simple idea through their
skulls.  You cannot make human error disappear by criminalizing it.  It only
drives licensees to cover up errors, instead of admitting them and repairing
the system that caused them, which most of the time is a poorly qualified
physician AU who is not managing his practice because he has no idea how to
do it.

It is interesting that NRC basically requires board certification in
radiation oncology to perform teletherapy with Co-60 or brachytherapy with
sealed sources of byproduct material.  Then, the NRC only requires TWO WEEKS
"training" to use NaI-131 unsealed material for nuclear medicine therapy.
Clearly, the NRC is incompetent and does not understand what constitutes
necessary knowledge for this activity.  You cannot possibly learn what you
need to know in 2 weeks.

Ciao, Carol
<csmarcus@ucla.edu>

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