Ireland: Anti-Radiation Pills For Everyone
by Brian Lavery
began sending potassium iodide tablets to households
across the country for use in case Ireland is exposed to
radioactive fallout from a terror attack or an accident
at the British nuclear reprocessing plant at Sellafield,
across the Irish Sea. The tablets prevent the thyroid
gland from accumulating radioactive iodine, which was
reported to have caused at least 2,000 cases of thyroid
cancer after the Chernobyl nuclear disaster in
Tiny Tablet, Big Possibilities
by Ellis Henican
I am going to make your
children safer today. In the event of an accident or
a terror attack at a nuclear plant - say at Indian
Point, 35 miles up the Hudson River from midtown
Manhattan - this column just may save their lives.
Over the next few hundred
words, I will convince you to stock the family medicine
chest with something called potassium iodide. You will
want to make sure the drug is readily available at
school and day care too.
Think of potassium iodide as
the little white tablet that, if we're all very lucky in
this terror-prone era, no one will ever have to take.
But I promise, this is one medication you'll want to
have handy should the need arise.
I don't own stock in the
company, a tiny operation run by two ex-New Yorkers. I
met them just last week. But after three days of
speaking with experts, asking tough questions and
reading background reports, I am now convinced: In a big
radiation leak, whether by accident or terrorism, this
drug is still the best protection available against
thyroid cancer, a key risk in a nuclear disaster,
especially for kids.
But don't believe me. Believe
Irwin Redlener, president of the Children's Health Fund
and president of the Children's Hospital at Montefiore
Medical Center. Redlener, who just may be America's
leading advocate on child-health issues, is as gung-ho
on potassium iodide as I am.
"We must be serious as we
approach this new world of ours," Redlener was
saying at week's end. "Potassium iodide is one of
the few things we can do that will, without question,
save lives if there is some kind of nuclear
Low-cost, easy to take,
potentially hugely beneficial. "It should be in the
medicine chest, right next to the ipecac," the
poison-response medicine, Redlener said. "And not
just in the area directly around a nuclear plant. We
should think about a radius of 100 to 200 miles."
More of Redlener later. Some
science, some history and some nuclear politics first.
Potassium iodide works by
saturating the thyroid with stable iodine. Then when the
radioactive stuff tries to seep in, the saturated
thyroid will not absorb it.
enough, but for a quarter century now,
the Nuclear Regulatory Commission has been giving the
cold shoulder to potassium iodide.
The World Health Organization,
the U.S. Food and Drug Administration, the American
Thyroid Association - they've all been calling potassium
iodide a potential lifesaver in a nuclear accident.
But the NRC has had a ready
answer for that: The chance of a accident at a nuclear
plant was so remote, the federal regulators said, there
wasn't any need for the pills. They'd only scare people.
And if an accident did occur, a massive evacuation would
The 1979 accident at Three Mile
Island did rattle some officials at the NRC, focusing
attention on the drug. But only briefly. An emergency
shipment was rushed by Air Force jet into Harrisburg,
Pa. Local officials quickly realized, however, that the
supply was nowhere near enough for everyone in harm's
way. The pills were locked in a warehouse and never
The Chernobyl accident in 1986,
the worst so far, raised the question of potassium
iodide again. According to the United Nations
International Thyroid Project, that accident had led to
11,000 cases of children's thyroid cancer by the year
2000, with thousands more expected in the next few
Interestingly, 97 percent of
those cases occurred more than 30 miles from the plant,
some as far as 200 miles away. Why not in the immediate
vicinity? The Soviets distributed potassium iodide to
the people in 19 close-in villages. The drug seemed to
It took Sept. 11 to really
focus U.S. attention on the threat of a massive
radiation leak at a nuclear plant. Now it wasn't just
accidents the neighbors could worry about. There was
also the genuine threat of a terror attack.
Before the end of last year,
the Nuclear Regulatory Commission ordered 6 million
potassium-iodide tablets and offered stockpiles to the
35 states with nuclear-power plants. New York State has
requested 1.2 million pills, 500,000 of which are going
to Westchester County, home of Indian Point.
The Centers for Disease Control
purchased another 1.7 million tablets. A supply of
potassium iodide was shipped to Utah for the Winter
Olympics. The bulk, per-tablet rate? 17.8 cents.
These sales were progress,
obviously. But the process raised as many questions as
it answered. Who will get these pills?
Who might need them?
And how should they be kept: in
government warehouses, or distributed house by house?
No one is closer to the center
of the swirling debate over potassium iodide than Alan
Morris. He and partner Bruce Rodin are
the founders of AnbexInc., a tiny drug company that is
the federal government's sole supplier of potassium
iodide and the only company with FDA approval to sell
the drug to the public, under the brand name IOSAT. They
have been focused on this drug since shortly after Three
Mile Island. They've been trying to get it accepted -
and widely sold - ever since.
"That 7.7 million tablets
the government has already ordered, it's a start,"
said Morris, the company president and by far the more
gregarious of the two. "But given the need out
there, it is absurdly low."
Morris and Rodin sat in a
midtown restaurant the other day and spoke about the
raucous debate they're now in the middle of. "The pro-nuclear people
hate us," said Morris. "They say, 'If we allow
this to become widely known and used, people will say,
ah-ha, nuclear power is dangerous. You see? You have
this medicine.' They think it will erode public
confidence in nuclear power."
"They hate it even
more," Morris said. "IOSAT cuts the legs out
of their basic argument. Their argument is that nuclear
power is so dangerous, there's nothing you can do to
protect yourself - other than shut down the plants at
once. Well, we're talking about a medicine that will
protect people from the danger of the plant. They don't
want to hear that at all." But 9/11 has opened some eyes.
"Even if you believe a
nuclear accident is impossible," Morris said,
"no one can say these plants are protected against
terror attacks, not when you find plans for nuclear
plants in caves in Afghanistan. The U.S. is the only
major nuclear power in the world with a major stockpile
of this drug." And increasingly local citizens
are demanding it.
That's happened in Westchester.
The rumbles are spreading from there. Twenty-two million
people live within 50 miles of Indian Point. How far
will those 500,000 tablets go, when the FDA recommends
one tablet a day for 14 days?
"Where are we going to
move 22 million people and keep them for three weeks and
not shut this country down?" Morris asked.
"For 17.8 cents a tablet, we can avoid that."
And what about those people who
live 50, 100, 150 miles away? That includes a big patch
of the Northeast. And what about the other 103
nuclear plants in the United States?
Morris has a way of answering
that. "The second-worst thing is not to have
potassium iodide," he said. "The worst thing
is not to have enough. If it's not enough, the half that
doesn't have it will go crazy. Why not me? Am I the
wrong color or the wrong ethnicity or the wrong sexual
preference? They only gave it to the white people in
Westchester. They didn't give any to us working-class
people in Brooklyn and Queens. What are we gonna do? Are
we gonna let our kids get cancer?" Ugly stuff.
Irwin Redlener, for one, is
already thinking about all this. "If you look at a map of
the nuclear plants and draw 200-mile circles around
them, it basically covers the whole East Coast," he
said. "We would recommend that every single family
stock potassium iodide tablets. It is not good enough to
be in a central repository. If you don't take them very
shortly after exposure - within a couple of hours - they
lose their efficacy. If it's more than six hours, it
does nothing. Don't bother."
Obviously, some public
education is needed between here and there. "There has to be a
protocol that everyone understands and everyone signs
onto," Redlener said. "It makes no sense not
to do. This is one thing that will actually do some
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Stockpile of Anti-Radiation Doses
By Justin Gillis
lacks stockpile of special drug anti-radiation
doses. The goal has been unmet since 1979. A generation ago, as a nuclear
disaster unfolded in central Pennsylvania and 140,000
people fled the area, pharmaceutical executives were
rousted from bed in the middle of the night by a plea
At the federal government's
request, they cranked up a production line in Illinois
at 3 a.m., and hours later, thousands of bottles of
potassium iodide, an anti-radiation drug, were secretly
rushed to Harrisburg by military jet. Ultimately the
nuclear reactor at Three Mile Island was brought under
control and the drug was not needed, but it was a close
call. When it was over, policymakers in Washington vowed
to stockpile the drug, saying they would not be caught
short again. It never happened.
Terrorists have spoken
longingly of their desire to blow up the United States'
nuclear plants and poison the land with radiation. But
if a nuclear disaster were to occur today, whether by
terrorist strike or otherwise, the government might well
be in the same position it was in1979, trying to scare
up supplies of the drug on short notice.
Potassium iodide is often
billed on the Internet as a panacea for a nuclear
emergency. It is nothing of the sort, offering no
protection for most types of radiation exposure. But
there is strong scientific evidence that it can protect
the thyroid gland, the most radiation-sensitive part of
the body, from absorbing trace amounts of radioactive
iodine, particularly in young children.
Despite that finding, there has
long been a serious debate about how valuable stockpiles
of the drug would be in a real-world emergency, since it
is most effective when taken within a couple of hours of
radiation exposure. Unless people already had it in
their houses, skeptics argue, getting it to them that
quickly would be difficult, at best. Most European
countries and four U.S. states stockpile the drug for
general public use, while the rest of the states and the
federal government do not.
That policy is under renewed
scrutiny since the Sept. 11 attacks and the anthrax
scare that followed. The federal government was better
prepared for the anthrax emergency, in fact, than it
would be to distribute potassium iodide for radiation.
It had stockpiled millions of doses of antibiotics and
was able to draw on those stores when thousands of
exposed people needed preventive medicine. The lack of a
potassium iodide stockpile irks many doctors and other
experts who have delved into the issue.
"The first thing is, there
are none available," said David Becker, a Cornell
University specialist in thyroid diseases. "Some of
us in organizations like the American Thyroid
Association have been yelling and screaming for 15 years
about this. It seems to me it doesn't make any sense for
the U.S. not to have any at all."
Potassium iodide is not
expensive, nor is it difficult to manufacture or store
for long periods. The drug is approved for thyroid
protection by the Food and Drug Administration, a
position the agency reiterated earlier this month.
One reason for the lack of a
stockpile is that, however cheap it may be, potassium
iodide is also controversial. The nuclear power industry,
which stocks potassium iodide to protect workers in its
plants, has long opposed a large public stockpile,
carrying as it would the implication that nuclear power
might be unsafe.
Some experts charged with
protecting the public from radiation oppose it, too,
fearing the drug would be seen as a cure-all. These
experts contend that evacuation and careful monitoring
of the food supply would be better ways to protect
In the halls of Congress and
elsewhere in the nation, these arguments are being
scrutinized anew. The Nuclear Regulatory Commission,
after going back and forth for years, has adopted a
policy that is mildly favorable toward potassium iodide.
The Health and Human Services Department is considering
whether to add the drug to its national anti-terrorism
Under the new NRC policy,
states must decide whether to tap NRC funds to create
regional or local stockpiles. This means a public
discussion of the drug and its potential usefulness is
likely to occur in virtually every state over the next
The drug is a hot political
issue in some communities. Alabama, Arizona, Maine and
Tennessee already have some form of stockpiling. The
citizens of Duxbury, Mass., who live near a nuclear
plant, passed a stockpiling plan last year. Vermont
recently pledged an expanded stockpile, and a vigorous
debate is underway throughout New England and in some
towns in New York.
The World Health Organization
recommends stockpiling for every country with nuclear
reactors operating within or near its borders. Ireland
just announced plans to send the drug to every household
in the country.
Potassium iodide availability
is one of those issues that rarely rises to public
awareness, but it has a long underground history that
has played out in Washington and in state capitals over
decades. The arguments being heard today are familiar
ones to participants in that debate, with fear of
terrorism as the new twist.
"In the immortal words of
Yogi Berra, it's d?j? vuall over again," said
Jerome Halperin, the man who rousted pharmaceutical
executives from bed during the Three Mile Island crisis.
He was then an officer of the FDA, and he has a hard
time believing the nation has no stockpile 22 years
after the federal government promised to build one.
"It's the appropriate,
rational, public-health-preparedness thing to do,"
he said. "Why wouldn't we expect it?"
But others are skeptical of the
value of stockpiling. Illinois, for instance, has 11
nuclear reactors operating on six sites, more than any
other state, and it has made some of the most elaborate
plans in the nation for responding to a radiation
emergency. They call for people to evacuate or take
shelter when necessary to escape a radiation plume, but
they do not call for potassium iodide. Most other states
that have considered the issue have adopted the same
The Nuclear Energy Institute, a
trade association for the nuclear industry that has long
opposed stockpiling, says it can live with the new NRC
policy, but its experts remain skeptical of the
real-world value of potassium iodide. "Concern No.
1 is that people not get confused that this is some sort
of panacea for any kind of radiation exposure,"
said Ralph Andersen, chief health physicist at the
The value -- and the
limitations -- of potassium iodide have been known to
researchers for decades, and there is little dispute on
the scientific points.
Nuclear reactors produce many
radioactive substances that can harm people. One,
radioactive iodine, poses a particular worry because the
human thyroid gland uses iodine as a fundamental
building block of hormones that play critical roles in
metabolism. The body cannot distinguish the safe form of
iodine present in food and table salt from the
radioactive form that comes from nuclear reactors.
It has been known since the
1950s that young children are acutely sensitive to
radioactive iodine, but the point was illustrated
dramatically when the Chernobyl nuclear plant in Ukraine
blew up in 1986, scattering radiation across hundreds of
For those living at a distance
from the plant, virtually the only known health effect
has been a huge spike in cases of thyroid cancer among
children. At least 2,000 "excess" cases in
Ukraine, Belarus and nearby areas have been attributed
to Chernobyl radiation. Thyroid cancer can usually be
treated, but that may require surgery, regular
monitoring and lifetime medication.
The idea behind potassium
iodide is that the thyroid gland can store only so much
iodine. A potassium iodide pill given near the time of
radiation exposure floods the gland with safe iodine and
reduces or eliminates the absorption of radioactive
iodine. Potassium iodide is the same chemical used to
add iodine to table salt, but the pills contain higher
doses. Anyone can buy the pills, though they are not
widely available in stores and most people do not know
Potassium iodide can protect
people only from radioactive iodine, not other kinds of
radioactive fallout. Bearing that in mind, skeptics say
the much-preferred course, in an accident, would be to
get people out of the radioactive plume or into
shelters. Advocates of the drug tend to agree, they but
argue that if evacuation plans went awry, potassium
iodide would be better than nothing.
Whatever the merits of these
positions, there is no doubt that during Three Mile
Island, the nation's closest brush with nuclear
disaster, the government wound up scrambling to round up
supplies of the drug at the last minute.
In that episode, a partial
"meltdown" at a nuclear plant led to the
release of small amounts of radioactive material,
including iodine. For several days there was fear the
reactor would explode, and state evacuation plans turned
out to be woefully inadequate. Given the prospect of
widespread radiation exposure, the FDA decided midway
through the disaster to rush a supply of potassium
iodide to Pennsylvania.
Hunkered down at an FDA
emergency center, Halperin and colleagues spent the
evening of March 30, 1979, desperately calling
pharmaceutical and chemical companies. Finally
Mallinckrodt Inc. of St. Louis said it had bulk drug on
hand and could package it at a plant in Illinois. The
first bottles were flown to Harrisburg the next evening
by Air Force jet.
To forestall a riot, no public
announcement was made about the drug. The emergency
passed without it being used, and eventually the
stockpile grew old and was discarded.
A presidential commission that
investigated the accident, appalled by this frantic
episode, recommended broad stockpiling of the drug in
the areas around nuclear reactors, and the NRC agreed.
But as memories of the emergency faded, the agency
backed out of that commitment, and the issue has been
periodically debated ever since.
Many opponents of stockpiling
acknowledge that Chernobyl provides compelling evidence
of the risk of thyroid cancer from a radiation disaster,
but they say a comparable degree of exposure would be
unlikely in this country.
When Chernobyl blew up, the
Soviet Union spent days lying about the accident and
failed to halt distribution of contaminated food. There
is evidence that much of the radioactive exposure came
from this failure. The radioactive iodine fell on
fields, cows ate the grass, and children drank milk from
the cows. Safety experts say the United States, by
contrast, would almost certainly move quickly to block
The most recent federal policy
change on potassium iodide came before the terrorist
attacks of Sept. 11, but the issue has taken on a new
urgency since those attacks.
The change was initiated from
within the NRC itself. Peter Crane, then a lawyer on the
agency's staff, was a thyroid-cancer victim who thought
the failure to stockpile could not be defended. He filed
a petition as a member of the public in 1995, then spent
years prodding the agency. It eventually adopted a
compromise under which it has pledged to pay for
potassium iodide for states that want it.
The NRC is still finalizing
plans to implement that policy. Meanwhile, the Health
and Human Services Department is considering buying some
of the drug to add to its own anti-terrorism stockpiles.
However, there is debate about whether the drug could be
distributed from these regional stockpiles quickly
enough to do any good.
The most aggressive plan would
be to follow several European countries in distributing
the drug to every household. But American experience
suggests that would be a difficult policy to maintain
over the long term. Tennessee launched such a program in
the early 1980s for people living near nuclear plants,
but participation has dropped to about 5 percent of
Tennessee maintains stockpiles
near its emergency shelters, however, and is confident
it could make the drug available quickly to large
numbers of people.
"It doesn't seem like very
much of a burden, what we're doing," said Ruth
Hagstrom, the state health administrator who would give
the order if potassium iodide ever had to be used in
Tennessee. "We're sort of happy with the way we do
things, and we wonder why everybody else doesn't do it,
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Protecting Postal Workers
December 3, 2002
The Postal Service said
it was buying nearly 1.6 million potassium
iodide pills to protect workers against thyroid
cancer in the event of a radiological emergency.
The pills would help only if a dirty bomb used
radioactive iodine instead of other radioactive
substances and then only for people close to the
explosion. The potassium iodide tablets will be
offered to all 750,000 postal workers
Endorses Potassium Iodide for Radiation Emergencies
statement is supported by the American Association of
Clinical Endocrinologists, the Lawson Wilkins Pediatric
Endocrine Society, and the Thyroid Foundation of
American Thyroid Association (ATA) endorses the use of
potassium iodide (KI) to protect people from absorbing
radioactive iodine released during a nuclear emergency.
High levels of radioactive iodine exposure can cause
thyroid cancer, especially in babies and children up to
18 years of age. KI reduces the risk of thyroid cancer
in exposed populations. ATA advocates KI as an essential
adjunct to evacuation, sheltering, and avoiding
contaminated food, milk, and water.
December 2001, the U.S. Nuclear Regulatory Commission
wrote to the 34 states that have or are located within
10 miles of a nuclear power plant, offering two free KI
pills for every person living within 10 miles of a
plant. Beginning in June 2003, the newly enacted
bioterrorism bill (Public Health Security and
Bioterrorism Preparedness and Response Act of 2002)
creates a mechanism to extend the radius of distribution
to communities within 20 miles of nuclear plants. As
described below, ATA recommends a 200-mile radius of KI
distribution, and therefore favors legislation that
further broadens stockpiling.
can predict how far radioactive iodine might spread
after being released in a fallout cloud from a nuclear
power plant during an accident or attack. Thus, no one
can predict how far from a nuclear plant the government
should distribute KI if it is to protect every person
who might be exposed to radioactive iodine. Because
there is no right answer, ATA recommends three levels of
coverage, determined by distance from the nuclear plant:
KI in advance ("predistribute") to
individual households, with extra stockpiles
stored at emergency reception centers
KI in local public facilities such as schools,
hospitals, clinics, post offices, and police and
fire stations, for distribution upon
notification by local health officials
KI available from the Department of Health and
Human Services' National Pharmaceutical
supports the Food and Drug Administration's dosage
guidelines for KI. ATA believes that only city and state
health authorities can recommend when to take KI and how
much to take. Not every radioactive release includes the
radioactive iodine that can cause thyroid cancer, and KI
cannot protect against absorption of any materials
besides radioactive iodine. Only health officials can
determine which isotopes are released during a nuclear
event, and, if radioactive iodine is released, what is
the safe and effective dose of KI to take.
logistics of effective KI stockpiling, distribution, and
use are still being worked out. The agencies that
distribute KI should be responsible for providing
instructional materials and programs that explain how to
use the pills and the reasons why they must be used as
the American Thyroid Association recommends that:
iodide should be part of an emergency plan that
includes evacuation, sheltering, and avoiding
contaminated food, milk, and water
priority for potassium iodide use and all other
emergency measures should be given to babies,
children up to 18 years of age, and pregnant women.
iodide should be made available to populations
living within 200 miles of a nuclear power plant.
iodide should be "predistributed" to
households within 50 miles of a plant.
iodide should be used only under regulatory guidance
Important documents about potassium iodide.
State information about potassium iodine.