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 for help.
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 ain't 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 public health.
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 stockpile.
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 year.
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 déjà 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 position.
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 nuclear institute.
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 miles.
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 about them.
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 radioactive food.
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 households.
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, too."
© 2001 The Washington Post Company
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