By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Wednesday, June 12, 2002

ARTICLES
Publication Date: June 12, 2002

"LIFE JACKETS ISSUED TO ALL AMERICANS FOR SOME REASON" was the headline of a recent article on the humor website TheOnion.com. "Everything is fine. You have nothing to worry about," the spoof continued, quoting Homeland Security Director Tom Ridge: "Still, just to be l00 percent on the safe side, I would urge all Americans to keep these life vests on at all times."

Those headlines are parody, but the ones telling us that the Nuclear Regulatory Commission, as a public health measure, is now distributing free potassium iodide pills to states with nuclear reactors is for real. Officials in Vermont, New Hampshire, and Westchester County, New York, among others, have already begun distribution of these pills to radiation-skittish citizens who would seek to protect themselves in the case of a terrorist attack (particularly a suicide attack by a small plane) on a nuclear power plant. Is the distribution of "anti-nuke" medication scientifically based and rational? Or is it in the same category as equipping all Americans, as the Onion did, with life vests, "just in case"?

The answer is: a little bit of both.

First, a calm, objective assessment leads one to the conclusion that our country's power plants are not likely to pose a threat to our safety and health either in times of peace or in this time of terrorism. According to Richard Meserve, Chairman of the U.S. Nuclear Regulatory Commission, "Nuclear power plants have an inherent capability to protect public health and safety through such features as robust containment buildings, redundant safety systems, and highly-trained operators. These plants are among the most hardened structures in the country and are designed to withstand extreme events, such as hurricanes, tornadoes, and earthquakes. It is not expected that the impact of a small plane into a site structure would result in a serious threat to public health and safety."

There are a few reasons that the current pill distribution plan misallocates our energies:

First, one might argue that if there is a real concern about radiation exposure, priority for distribution of any "anti-nuke" medications should given to densely populated, urban areas which have no such built-in security and are thus theoretically vulnerable to so-called "dirty bombs," created from stolen radioactive materials This would be true specifically in the (unlikely) event that radioiodine were present in the device.

Second, there is no such thing as a medication that can fully protect the human body from the health devastation of excessive exposure to radiation. Intense exposure causes immediate tissue damage and results in acute radiation fatalities. Lower doses can increase the risk of cancers, including, as we learned from nuclear events of World War II, leukemia. The most effective means of reducing risks from radiation contamination are evacuation, shelter, and protection of the food supply — immediately.

Third, it is well known that the thyroid gland is vulnerable to the delayed effects of radioiodine in fallout. Exposed fetuses, infants, and other children are particularly at risk. Even very small amounts of inhaled or ingested radioiodine can do serious damage, since it will always concentrate in and be retained by the thyroid gland, increasing the risk of thyroid cancer.

There is sound, uncontested, scientific evidence that taking potassium iodide (also known as KI) just before or immediately after radiation exposure will saturate a person's thyroid gland with safe, stable iodine and "fill it up" so that there is literally no room for the radioactive iodine to settle in. This is the only protective effect of KI. KI does not offer any overall protection from the hazards of radioactivity.

The April l986 Chernobyl nuclear plant accident in the Ukraine caused a scattering of radiation across hundreds of miles. The Russian government did basically nothing to protect the health of its citizens. Radioactive iodine fell on fields, cows ate the grass, and kids drank the milk. Four years later, epidemiologists documented a major increase in childhood thyroid cancers. By contrast, at the time of the Chernobyl disaster in nearby Poland, officials gave nearly 20 million children and adults at least one dose of KI. The risk of thyroid cancer in children was much lower than it was in the USSR. This intervention proved that KI can effectively protect against thyroid cancer — particularly in babies and children — caused by inhalation or ingestion of radiation-contaminated air or food.

The debate here is not about whether the "anti-nuke" pills work; they do, but only in reducing the risk of thyroid cancer, mostly for children and young adults (persons over forty are at risk of radiation-induced thyroid cancer only if the exposure is very high). The questions we must ask are: Who, if anyone, should be given these medications, when, and by whom? Are there risks to widely distributing this drug?

The answers here are not crisp and clear and are colored by one's personal perception of risk.

But one point is clear: Government officials should not use their authority to distribute KI in anticipation of disaster. It will unnecessarily heighten anxiety about what now are purely hypothetical risks. Further, a government imprimatur on KI will convey false assurances and may decrease planning for evacuation, providing shelter, and monitoring of a potentially contaminated food supply.

There is also little justification for government stockpiling of KI for distribution after the fact given that the drug is effective only if only if administered within a few hours of radiation exposure. In l979, when there was fear of dangerous radiation exposure at Three Mile Island (which never did occur), stockpiles of KI took more than twenty-four hours to reach the targeted population. Luckily, they never needed it.

Who is behind the push for the unjustified government intervention here? Certainly anti-nuclear activist groups like the Union for Concerned Scientists have played a role, motivated as much by a desire to raise anxieties about nuclear power as they are by a desire to protect public health.

On the other hand, given the low cost, relative safety, over-the-counter status, and proven efficacy of KI, Americans should continue to have full access to it via the private sector, with full disclosure of all benefits and limitations. For some, having the drug in their medicine cabinets might offer relief from an otherwise overwhelming sense of powerlessness in the face of potential disaster, much in the same way that having Cipro on hand may have eased fears for some during the anthrax crisis. But rather than encourage the whimsical pursuit of a non-existent form of "nuke proofing," Uncle Sam, M.D. should butt out.

Dr. Whelan, President of ACSH, holds doctoral and master's degrees in public health.