POTASSIUM IODIDE (KI)
Better active today than
WHERE DO I GET KI?
1. State: Massachusetts Department
Public Health, Radiation Control Program: 90 Washington Street- Dorchester,
Carter Wallace Laboratories, Thyro-Block
NEW: Memo to NRC Commissioners documenting NRC's efforts to block stockpiling Potassium Iodide (KI) and mislead the public and authorities about KI's safety & effectiveness- a sad and important record.
(Note at the end of the document is a
hyperlink to more information on emergency planning)
Peter Crane / 6545 27th Ave. NW / Seattle, WA 98117 / firstname.lastname@example.org / 206-783-8485 (home), 206-819-2661 (cell)
July 18, 2011
MEMORANDUM FOR: Chairman Gregory B. Jaczko
Commissioner Kristine L. Svinicki
Commissioner George Apostolakis
Commissioner William D. Magwood, IV
Commissioner William C. Ostendorff
FROM: Peter Crane
Counsel for Special Projects, USNRC (retired)
On July 13, the NRC issued press announcements on two unrelated matters: the public release of the report of the NRC staff’s Task Force on the Fukushima accident (news release No. 11-127), and the Commission’s directive to the staff “to examine feasibility and need of study on radiation doses to public from nuclear medicine” (news release No. 11-128).
The Task Force report touches on, though only very minimally, the use of potassium iodide (KI) as a thyroid blocking agent; the directive on nuclear medicine relates directly to the issue of the release of patients with high doses of radioactive iodine-131 in their systems. Both as an NRC employee and as a retiree, I have been involved with these two subjects for many years – nearly 30 years, in the case of KI, and almost 20 years, with respect to radioactive patients – and I have considerable institutional knowledge in these areas.1 I feel obligated to the current Commissioners, the agency, and the public, to share some of this history with them, and explain why the July 13 issuances are problematic. Since I see that the schedule calls for the Task Force to brief the Commission on July 19, I will in the interest of time deal with the first today and the second in a memorandum to be submitted in the near future.
The charter of the NRC staff Task Force on Fukushima was set forth in a March 23, 2011, tasking memorandum from Chairman Jaczko to R. W. Borchardt, the Executive Director for Operations (Appendix B to the report, p. 77), and the March 30, 2011, memorandum from Mr. Borchardt to Martin Virgilio and Charles Miller (Appendix C to the report, p. 79). The Task Force was given the specific task of considering, among other things, “Emergency preparedness (e.g. emergency communications, radiological protection, emergency planning zones, dose projections and modeling, protective actions).” [Emphasis added.]
Protective actions include, as the report acknowledges, potassium iodide. The following seem
like obvious questions: How widely was potassium iodide distributed in Japan? How far away from Fukushima did radioactive iodine show up in foodstuffs, water, and air? What kind of radiation doses to the thyroid were received by Japanese citizens, especially children, and at what distances from the reactors? What does this suggest about the need for KI beyond the 10 mile radius in which the NRC now offers it?
These are all questions that can be answered, to a greater or lesser extent, by any informed citizen who reads the newspapers and has access to a computer, but anyone whose only source of information is the NRC Task Force, which was in theory addressing such issues, would be out of luck. Indeed, such a person would not even realize that these issues existed, for the Task Force has tiptoed around them.
The Task Force must surely be aware that the NRC has come under sharp criticism for its role in preventing the implementation of a law, Section 127 of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which would have extended the availability of KI out to a 20-mile radius. A January 2008 decision by the President’s Science Advisor, Dr. John H. Marburger III, declined to implement that portion of the Act. The Task Force must also know that a bipartisan group of some 30 Members of Congress, including Rep. Ed Markey, the law’s sponsor, has called on the President to revisit that decision and authorize the broader stockpiling and distribution of the drug, and that this issue is under reconsideration by the Administration.
But no reader of this report would realize any of that, or find a scintilla of information that might shed light on the question of whether current policy needs revision. What is more, an Associated Press story on March 31, 2011, quoted Patricia Milligan, the NRC’s senior expert on KI matters, as saying that the NRC was “absolutely confident” that the 10 mile radius for stockpiling of KI was sufficient. Considering that the accident was still unfolding rapidly at that time, this was highly premature. It was only on March 23, after all, that Chairman Jaczko had directed the staff to examine, among other things, “emergency planning zones” and “protective actions.” If the staff had completed its review of the KI issue in the intervening eight days, this was quick work indeed.2
The Marburger decision and the NRC’s role in it deserve further discussion here. As the
Commission is probably aware, the legislation authorizing the expansion of KI distribution from
10 to 20 miles from nuclear power plants was passed by an overwhelming margin in 2002 and signed into law by President Bush. The White House, in a 2002 statement, hailed the result, saying that henceforth, KI, which it called “crucial” and “critical,” would be available wherever needed, not just within what it termed the “artificial ten-mile barrier.” The Department of Health and Human Services was given the task of implementing the law, which NRC had opposed.
But to begin distribution of KI, which HHS was eager to do, for it saw a plain need to improve protection for America’s children, it was required to publish guidelines. Opponents of the law prevailed on the Office of Management and Budget to withhold its approval of those guidelines, and thereby delay implementation of the law, to the great frustration of HHS.
The same law directed the National Academies of Science to perform a study of KI. Published in 2004 under the title Distribution and Administration of Potassium Iodide in the Event of a Nuclear Incident, it made clear, inter alia, that “children are most likely to benefit from KI prophylaxis” (p. 4); that thyroids are at risk in a nuclear incident from “inhalation of contaminated air or ingestion of contaminated food or milk” (p. 3); that “KI should be available to infants, children, and pregnant and lactating women” (p. 5); that though KI distribution to date focused only on the 10-mile Emergency Planning Zone utilized by the NRC, the variation from site to site meant that “no single best solution exists,” and that a specific incident might require KI “beyond the EPZ as well” (p. 161); and that as a result, “KI distribution programs should consider predistribution, local stockpiling outside the emergency planning zone (EPZ), and national stockpiles and distribution capacity.” (p. 160, emphasis in the original)
In a November 1, 2005, letter to HHS, the NRC brazenly misrepresented the findings of the NAS report. Writing to Dr. Robert Claypool of HHS, William F. Kane, NRC Deputy Executive Director for Reactor and Preparedness Programs, asserted – purportedly on the basis of the NAS report – that the only pathway of concern beyond the 10-mile radius would be ingestion, which could be controlled by interdiction of foodstuffs, and, in a particularly egregious distortion, declared that “the Academy raised questions about the usefulness of expanded distribution of KI.”3
HHS Secretary Michael Leavitt responded with a letter to NRC Chairman Nils Diaz4, dated March 27, 2006, which though couched in superficially civil terms was an acid rebuke that made clear that NRC had quoted snippets of the NAS report out of context to produce a misleading impression. He quoted the actual words of the NAS report back to Diaz: “A specific incident might call for protective actions to be restricted to a small part of the EPZ or require that they be implemented beyond the EPZ as well,” boldfacing the last 11 words for emphasis.5 Secretary Leavitt’s letter plainly did not faze the NRC, however, which in an April 10, 2006, letter to Senator George Voinovich, responding to questions arising from a recent oversight hearing, repeated the assertion that the NAS supported the NRC position on the undesirability of stockpiling KI beyond ten miles, and attached the Kane letter.6 (The answer came in response to a question from Sen. Isakson.) By now, there was no excuse for inaccuracy. If the staff had somehow contrived to misread the NAS report at the time it wrote to Dr. Claypool in November 2005, any such misunderstanding had been cleared up by Secretary Leavitt, in his letter of March 27, 2006.
With his declared intention of implementing the law and providing KI in the 10 to 20- mile radius, Secretary Leavitt was on a collision course with the NRC and the nuclear industry. The White House was persuaded to forget or ignore what it had said in 2002 about eliminating the “artificial 10 mile barrier” to the distribution of this “crucial” and “critical” drug. On July 2, 2007, President Bush signed an order that stripped Leavitt of his authority over the law and transferred it to the NRC and to his own Science Advisor, Dr. Marburger, who would have the final say on whether to implement the law.
At Marburger’s request, a technical evaluation paper on KI was prepared by the Potassium Iodide (KI) Subcommittee of the Federal Radiological Preparedness Coordinating Committee (FRPCC), an interagency group. On October 23, 2007, FRPCC Chair Vanessa Quinn, of FEMA, transmitted the paper to Marburger, with a cover letter that made plain the leading role of the NRC staff in the effort.7
Marburger’s decision, issued on January 22, 2008, predictably found no need to implement the 2002 law. This is not the place to get into the legal question of whether his refusal to do so was consistent with Congressional intent and a proper reading of the statute, though I have strong views on that point; I would like instead to stay with the technical and policy bases for his decision.
Perhaps the most extraordinary thing about the Marburger decision was that the President’s Science Advisor felt able to issue a 13-page decision on a drug for the prevention of cancer without ever using the word “cancer.” Instead, he referred euphemistically to “adverse thyroid conditions.” From the chief scientist in the United States Government, this defies comprehension. Is it conceivable that any Government official would issue a decision on the use of Sabin vaccine without ever employing the word “polio”? Of course not. But when the subject is KI and thyroid cancer, this happens again and again.8
Let us now look at the important question of what exactly Marburger was relying on. At p. 12 of his decision, he wrote:
Some concerned citizens groups criticize meteorological analyses that assume a wind that blows constantly in a single direction, suggesting that variable trajectory models would better account for complex wind patterns, leading to accident consequences extending beyond current projections. In fact the opposite is true. The NRC and FEMA outline their strategies for emergency planning in the 2002 study Assessment of the Use of Potassium Iodide (KI) as a Supplemental Public Protective Action during Severe Reactor Accidents (NUREG 1633)fn, which addresses the effect of meteorology on accident consequences, specifically its effect on where the offsite release goes....
The footnote included a citation to this document, which states on its cover page that it was “Prepared by P. A. Milligan/NRR.”9
What Marburger evidently did not know was that officially, this document was in the dumpster. In November 2002, the Commission had decided, on a 4-1 vote, with Commissioner Dicus the lone dissenter, that it was unfit for publication, and that no more resources should be spent on bringing it up to standard. Commissioners’ comments on it were not gentle. Commissioner McGaffigan noted that although it was the 9/11 attacks that had spurred states’ interest in KI stockpiling, “the draft NUREG is silent on the subject.” Commissioner Diaz wrote:
The draft NUREG now before us is the third version we have been asked to review since mid1998. (The first version was withdrawn by the Commission and we disapproved the second one.) ... In my opinion, it’s time to pull the plug.10
I do not know where Dr. Marburger got his copy of the draft NUREG – perhaps it was not from the NRC at all – but surely he could and should have been warned by his NRC advisor that the document had been rejected by the Commissioners and therefore had no place in his decision.
Relying as it did on an invalid document, Marburger’s decision must therefore be considered at least partially tainted. Its pernicious effects, moreover, have extended far beyond the question of implementing the 2002 law. After its issuance, the interagency group that maintains the Strategic National Stockpile removed KI from the arsenal of protective drugs that comprise that stockpile, to which it had been added after 9/11.11 I am told that the group felt that it had no choice, in light of the Marburger decision.
At a time at which in every other sphere of life, America is increasing its preparedness against terrorism, the NRC has thus been instrumental in diminishing our country’s preparedness to deal with acts of nuclear terrorism or other nuclear catastrophes. It must be borne in mind what the consequences of insufficient preparedness will be, if such a disaster occurs: an increased incidence of thyroid cancer, especially in children who were very young, or still in the womb, at the time of exposure.12
I would be the last person to argue that KI is a panacea for protection against radiological disasters. Indeed, in the early days of the Fukushima accident, I went on television in Seattle to say that it would “irresponsible scaremongering” to suggest that anyone in the U.S. should now be taking KI to protect against the releases from Japan. But it is likewise irresponsible in the extreme not to have adequate supplies on hand in this country, for accidents or acts of terrorism occurring here, and of all the possible reasons for failing to stockpile it, protecting the public image of the nuclear power industry is surely the rock-bottom worst.13
The real question is whether KI would be useful in the event of a major release, for if not, there is no point in having it, regardless of its low cost. The opponents of KI stockpiling have long maintained that KI is unnecessary, because the whole problem of thyroid protection can be solved by instructing people to refrain from drinking milk after a major nuclear release. For example, in the early days of the Fukushima accident, a March 13 article in the New York Times quoted a radiation expert at Columbia, Dr. David Brenner:
Dr. Brenner said the iodine pills were protective, but were “a bit of a myth” because their use is based on the belief that the risk is from inhaling radioactive iodine. Actually, he said, 98 percent of people’s exposure comes from milk and other dairy products.
“The way radioactive iodine gets into human beings is an indirect route,” he said. “It falls to the ground, cows eat it and make milk with radioactive iodine, and you get it from drinking the milk. You get very little from inhaling it. The way to prevent it is just to stop people from drinking the milk.” He said that the epidemic of thyroid cancer around Chernobyl could have been prevented if the government had immediately stopped people from drinking milk.
I have no idea where Dr. Brenner got this 98% figure; most sources I have seen think that 70 or 80 percent of the Chernobyl exposures came from the milk pathway, not more. At any rate, once I-131 began showing up in Tokyo’s tap water, I wrote a letter to the New York Times, published on March 26, that was implicitly a slap at Dr. Brenner and the reporter who had so uncritically relied on him.14
Whether for that reason or some other, Dr. Brenner’s public position on KI changed almost instantaneously. On the afternoon of the same day, March 26, a glowing profile of him, “Countering Fears With Just the Facts,” was posted on the New York Times website (it appeared in print on March 29), which included the following:
Potassium iodide pills are widely recommended to protect the thyroid gland from radioactive iodine, but Dr. Brenner said it was better just to stop drinking milk until the threat had passed.
His message changed, however, when radioactive iodine turned up in tap water in Tokyo. Though the public was advised that babies, children and pregnant women should not drink the water, Dr. Brenner conceded that some exposure might still be hard to avoid, and that using potassium iodide was a reasonable precaution.
“I’ve been maybe a little overstrong in saying that potassium iodide doesn’t have a role to play,” he said. “But usually the problem is milk. To me, the levels in water came as a surprise.”
But is it really a “myth,” as Dr. Brenner suggested in the earlier article, that inhalation of I-131 after a radiological release is a danger?
Nearly 20 years ago, the Environmental Protection Agency issued a “Manual of Protective Action Guides and Protective Actions for Nuclear Incidents,” EPA 400-R-92-001 (May 1992)15, that included the following, at p. 5-20: “If a major release of radioiodine or respirable particulate materials occurs, inhalation dose will be the controlling pathway.” [Emphasis added.] It recommended, among other things, consideration of the use of KI. It made the point that though evacuation in an emergency is the ideal option, you can get a radiation dose while evacuating, and that automobiles offer only about 10% shielding.
The Food and Drug Administration issued guidance on KI in 2001.16 At p. 8, after noting that the post-Chernobyl exposures to radioiodines came “largely” from the milk pathway, it said:
In this or similar accidents, for those residing in the immediate area of the accident or otherwise directly exposed to the radioactive plume, inhalation of radioiodines may be a significant contributor to individual and population exposures. ... The risk depends on factors such as the magnitude and rate of the radioiodine release, wind direction and other atmospheric conditions, and thus may affect people both near and far from the accident site. [Emphasis added.]
There was also a useful report from the International Atomic Energy Agency in 2002.17 At p. 52, the joint IAEA/WHO committee that prepared it makes the point that “iodine prophylaxis is intended primarily as a protective action against inhalation,” in the short term, and suggests amending the International Basic Safety Standards to reflect this. [Emphasis added.]
In 2003, the Medical Preparedness and Response Sub-Group of the Department of Homeland Security Working Group on Radiological Dispersal Device Preparedness prepared a report saying that if terrorists detonated a radiological dispersal device containing radioiodine or a 10-kiloton improvised nuclear weapon, millions of doses of KI might be needed to deal with the fallout. It said, at p. 62: “Urgent consideration for giving KI to pregnant women (especially 2nd and 3rd trimesters) and children is appropriate.”18
On June 30, 2011, in response to a Freedom of Information Act request, the NRC placed a large number of documents relating to the Fukushima accident onto the ADAMS system.19 They include a March 25, 2011, email from Elmo Collins, Regional Administrator in NRC’s Region IV, to Linda Howell, as he prepared to leave for Japan. The subject line is “Japan,” and it reads, in its entirety, as follows: “I’ll need to pick up some KI and make sure I have my dosimetry as needed – what dose meter would be good for me to take? Thanks, Elmo.”
Of course Mr. Collins provided himself with KI, and rightly so. NRC personnel are not reckless when it comes to their own safety or that of their children, nor should they be.20 But if ever there is a nuclear catastrophe in this country, whether caused by terrorism or an accident, and Americans living more than 10 miles from a nuclear power plant discover that their children have been inadequately protected against radioactive iodine owing to the NRC’s unremitting, no-holds-barred battle to prevent or limit KI stockpiling – a battle that has included misrepresenting, including to Congress, the findings of a Congressionally mandated study of the issue by the National Academies of Science, and working to ensure that the sensible recommendations of the NAS were rejected by the President – the consequences would be devastating, not only for the affected children, but also for the NRC.
What would the country say when it learned that KI had been removed from the Strategic National Stockpile, with the result that we are less well prepared to cope with the medical effects of a nuclear disaster than we were a few years ago? The NRC Chairman and Commissioners would probably find themselves having to explain their actions not only to Congressional committees but to grand juries. Under those circumstances, it is hard to imagine that the Nuclear Regulatory Commission would even survive for long, at least under that name.21 More likely, it would be abolished and replaced by some new regulatory body, as is currently happening in Japan.22
Press reports indicate that radioiodine from Fukushima has turned up in air, water, and foodstuffs far from the damaged nuclear plants.23To continue to insist that KI stockpiling in this country be limited to a 10 mile radius around nuclear plants, and then only in states which request the drug, would be irresponsible beyond measure. The sooner the NRC faces up to this reality, the better, and not only for the American public, but also for its own sake. The Task Force should be told to address the KI issue thoroughly and promptly. In addition, the Inspector General should be asked to investigate the staff’s handling of KI matters in recent years, including, but not limited to, the appearance of NUREG-1633 in the Marburger decision, the accuracy of the 2005 Kane letter to HHS, and the 2006 response to Senator Voinovich.24
What I have described in this memorandum are facts as I understand them, as informed by nearly 30 years of observing the NRC’s handling of the KI issue. It has been prepared in a spirit of trying to be of service both to the American people and to the NRC. In this case, dealing as it does with a medication, a quotation from Gotthold Lessing’s 18th Century play “Nathan the Wise” is particularly apposite: “It is medicine, not poison, that I am handing you.”
Peter Crane, Counsel for Special Projects (retired)
cc: Senator George Voinovich
Senator Johnny Isakson
Senator Thomas Carper
Representative Ed Markey
Representative Henry Waxman
Appendix -- My Service with NRC
For the benefit of Commissioners who do not know me, I joined the NRC in early 1975, when it was 10 weeks old, and spent 27 years serving the agency in various capacities. I had been hired as a legal assistant, GS-12, by Commissioner (later Chairman) Marcus A. Rowden. In those days, it was standard for Commissioners to have two assistants, one technical and one legal, and two secretaries. (The Chairman at the time had a staff of seven: one technical assistant for reactors, another for materials, a legal assistant, an executive assistant, and three secretaries.) For the first year I was there, however, Commissioner Rowden made do with just a single assistant, me, until he added Hugh Thompson as a technical assistant in 1976.
I moved to the Office of General Counsel on the expiration of Chairman Rowden’s term in 1977. Over the next 24 years (there was a one-year break in service, during which I was an administrative judge in Micronesia), I defended the NRC’s actions in court with vigor and conviction. My first case, in the D.C. Circuit, involved the Mark II containment; my last, in the Sixth Circuit, resulted in a decision upholding the NRC regulatory scheme for approving the design of dry casks for spent fuel storage.
In the Ninth Circuit, some 30 years ago, I briefed, argued, and won a case defending the adequacy of the fixes that the NRC ordered in Babcock and Wilcox reactors after the Three Mile Island accident. At one point in the 1980's, I served very briefly as Acting General Counsel, in which capacity I called on the Solicitor General, the late Rex Lee, to ask him to take to the Supreme Court a case which I had briefed, argued, and lost in the D.C. Circuit. It involved the NRC’s refusal to treat the “psychological impacts” of the resumed operation of Three Mile Island Unit 1 as environmental impacts within the meaning of the National Environmental Policy Act. Lee was fully in accord. He took the case to the Supreme Court, which reversed the D.C. Circuit and upheld the NRC position on a unanimous vote.
I was made Counsel for Special Projects in the mid-1980's and retired with that title in 1999. In 2001, I was brought on as a contractor to write speeches for then Chairman Meserve, and I continued in that function under Chairman Diaz until 2005. During my long tenure with NRC, I was privileged, in addition to my usual legal duties, to write speeches, testimony, and/or personal statements for Chairmen Rowden, Palladino, Hendrie, Zech, Jackson, Selin, Meserve, and Diaz, including Senate confirmation testimony for three of those just named.
While at NRC, I was invited to speak at a United Nations conference in Moscow in 1997 on responding to man-made disasters. In 1998, in my private capacity, I was a speaker at a conference at Cambridge University in England on the U.S. Government’s handling of the KI issue. The conference was co-sponsored by the university, the European Commission, the National Cancer Institute, and DOE. The paper I presented may be found in published form in the 1999 volume Radiation and Thyroid Cancer, edited by G. Thomas, A. Karaoglou, and E. D. Williams.
1In an appendix, I will describe my 27-year service at NRC.
2 Normally the NRC’s consideration of KI policy is measured in years. When the NRC Commissioners, over the fierce opposition of the NRC staff, granted my petition for rulemaking on KI in early 2001, changing the NRC’s regulations and also offering supplies of KI to states, it was the culmination of a process that had begun with a Differing Professional Opinion that I had filed 12 years earlier.
3 This letter may be found on the NRC’s ADAMS system, using accession no. ML052790498.
4 I have so far been unable to find this letter on ADAMS, except as an attachment to a letter that Professor Frank von Hippel of Princeton University and I sent to Senator Joseph Lieberman on September 26, 2007, with a copy to the NRC, which may be found as LTR-07-0685 on the ADAMS system. If Secretary Leavitt’s letter is not on the system in its own right (and if not, one may ask why not), it should be added.
5Secretary Leavitt also wrote:
Section 127 of the Bioterrorism Preparedness and Response Act of 2002 requires the President to make KI available to State and local governments for stockpiling and distribution, and to establish guidelines for the stockpiling of KI and for its distribution and utilization in the event of a nuclear incident. Additionally, subsection 127(f) states that these requirements “cease to apply as requirements if the President determines that there is an alternative and more effective prophylaxis or preventive measures for adverse thyroid conditions...” The President has not made the necessary determination here. Rather, as the President stated in 2002 when forming the Department of Homeland Security, “...one Department would be responsible for distributing Potassium Iodide to citizens exposed - no matter where they lived. There would no longer be an artificial ten-mile barrier to treatment.” Currently, we do not believe there are “alternative and more effective... measures” than to make KI available up to 20 miles from a nuclear facility, in conjunction with the protective measures established by the NRC. [Emphasis in the original.]
Unaware at the time of HHS Secretary Leavitt’s letter to NRC, I drew the Kane letter’s mischaracterization of the NAS report to the attention both of the Commission, by email, and the NRC’s Office of Inspector General. This was, as usual, fruitless. The EDO, Luis Reyes, replied a few weeks later with a short note that neither mentioned the NAS report nor gave a direct answer to the charge that the Kane letter had mischaracterized its findings. Instead, he wrote that “the Commission believes that Mr. Kane’s letter reflected the NRC's well-considered, scientifically-based position on expanded distribution of KI.” Apparently, it was a matter of indifference whether the Kane letter was factual, so long as it supported the Commission’s position.
OIG declined to investigate. Its Allegations Coordinator, George Mulley, explained to me on the telephone that the first thing that OIG did, when examining an allegation, was to ask what federal law had been broken, and that there was nothing in the U.S. Code that made it illegal to deceive another federal agency. This was, I submit, an unduly pinched view of OIG’s mandate.
But it was hardly surprising. OIG’s record of mishandling allegations concerning the staff’s treatment of KI matters goes back many years, and includes one occasion on which, contrary to OIG procedures, Inspector General David Williams disposed of an allegation with no written record, and without even informing his head of investigations, Leo Norton, that the allegation had been received. Norton, an honorable and candid person, agreed with me that this was an “off the books” handling of an allegation, and said that I could quote him to that effect. It was unique in his experience, he said, and “no way to do business.” For more on OIG and KI, see also the joint letter from Professor Frank von Hippel and me to Senator Joseph Lieberman, dated 9/26/2006, with copies to the NRC, cited above, and accessible through ADAMS as LTR-07-0685.
I might add that though the concurrence page on the Kane letter, as it appears on the NRC website, indicates that the originator of the document was Patricia Milligan, the responsibility for it extends to all who reviewed and signed off on it. The same applies to those who, after seeing Secretary Leavitt’s letter, nevertheless approved the response to Senator Isakson’s question, which will be discussed shortly.
6 The relevant section of the letter, at pp. 29-30, reads as follows, and may be found on the NRC website using accession no. ML060930353:
QUESTIONS FROM SENATOR ISAKSON:
During the hearing, I brought up the issue of potassium iodide, but didn’t get a chance to pursue my question with the Commission. It is my understanding that the Department of Health and Human Services (HHS) has made a recommendation to expand the stockpiling of potassium iodide beyond the 10-mile radius around a nuclear facility which is the current requirement. Please provide the Commission’s position on the HHS’s recommendation for the record.
Based on the NRC’s decades of experience with nuclear power plant emergency preparedness and radiological protection of the public, it is the NRC’s conclusion that expanded distribution of potassium iodide (KI) is unnecessary. Expanded distribution of KI is unnecessary because of the current, well-established, and scientifically sound framework of the NRC’s emergency preparedness regulations. This framework includes predetermined protective actions for populations within the 10- and 50-mile ingestion exposure pathway Emergency Planning Zones (EPZs) to provide the necessary protection of public health and safety. These predetermined protective actions include interdiction of contaminated milk, food, and water, as well as protective measures for livestock. NRC’s conclusion is supported by a January 2004 study by the National Academy of Sciences, which found that food testing and interdiction programs in place throughout the United States are more effective preventive strategies than expanded distribution of KI for ingestion pathways. Additionally, many States and other interested entities, including Federal agencies, have expressed opposition to the distribution of KI beyond the existing 10-mile EPZs.
Additional detail on the Commission’s position on HHS’s draft guidelines for expanded KI distribution are [sic] provided in the November 1, 2005 letter from Mr. William Kane, NRC’s Deputy Executive Director for Reactor and Preparedness Programs, to Dr. Claypool of HHS’s Office of Mass Casualty Planning, which is attached
(Attachment 7) for your convenience.
7Quinn wrote: “I would be remiss if I did not specifically mention the hard work and effort put into this project by Trish Milligan, KI Subcommittee Co-Chair. Her technical knowledge and willingness to spearhead the overall coordination of this technical evaluation paper was invaluable.” Just the day before, October 22, 2007, an article in USA Today, entitled “White House may stop plan for anti-radiation pills,” included the following: “Patricia Milligan, the NRC’s senior adviser for preparedness, says the commission opposes broad distribution of the pills because the best way to eliminate risk is to make sure people don’t eat contaminated food. She also says the NRC is concerned about undermining the reputation of the nuclear industry. ‘It’s always a concern that if you expand the distribution (of the pills), you don’t have confidence in the plants,’ she says. ‘We have studies that show the safety of our plants.’”
8 This is certainly true at NRC as well. For example, at NRC headquarters, on July 1, 1997, anyone whose office windows faced west might have seen a television crew, with the familiar eye of the CBS Evening News on its videocamera, interviewing me in front of the building. Four hours later, the NRC, under Chairman Shirley Jackson, issued a press release stating that agency would buy KI for any state that wanted it. (At the time, the matter had been pending for seven years.) But the news release was careful not to use the word “cancer,” and therefore was less helpful to readers than it might have been. It probably made little difference, however, for the NRC did nothing to implement this commitment, and two years later, still under Chairman Jackson, the Commission retracted its promise, saying that budget constraints did not allow expenditures on new initiatives of this kind.
10The story of the three rejected versions of NUREG-1633 is a curious one. The first version managed not to include, in its 37 pages, the fact that the Food and Drug Administration had found KI to be “safe and effective.” (This was comparable to the FDA issuing a report casting doubt on the safety of a particular nuclear power plant without mentioning that there was an organization called the NRC that had found this plant to be safe.) The document strove to raise anxieties about the safety of the drug, and to warn of the lawsuits that would be faced by any state that gave it out in an emergency. It also asserted that American can authorities cautioned against giving the drug to children and pregnant women, whereas in reality, it is universally recognized, here and abroad, that the principal benefit of the drug is to children and pregnant women. (I should in fairness mention that NUREG-1633 was not wrong about everything, however. For example, it said of Chernobyl, at p. 14: “[I]nhalation most like was a major source of the dose received in some areas near the plant.” This contradicts an assertion often made by opponents of KI: that virtually all the post-Chernobyl thyroid cancers resulted from drinking contaminated milk.)
The Commission soon received scathing comments from state health officials and others. Dr. Karim Rimawi, director of the Bureau of Environmental Radiation Protection in the New York State Health Department, wrote on September 29, 1998, that the Department “had looked forward to NRC’s report in the hope that it would assist us,” but found that it had been “prepared to justify a position advocating against the use of KI for public protection, rather than as an objective review of the relevant information.” “This bias,” he wrote, “raises doubt as to the value of the document.” He also commented: “It selectively references sources that support that point of view and ignores others that tend to justify the use of KI.”
Shortly afterwards, the Commission ordered NUREG-1633 withdrawn. Commissioner Ed McGaffigan, in a memorandum quoted in the October 12, 1998, issue of Inside N.R.C., wrote: “As I admitted at the public meeting, I had not read enclosure 8 [draft NUREG-1633] in any detail when I agreed to put it out for public comment and peer review as the SRM was drafted. I made the mistake of thinking no harm could come from just putting a document out for public comment. I was wrong.” (At p. 8.)
Revision of the NUREG was entrusted to a large Core Group, headed by Aby Mohseni. It was on his watch that the entire Core Group, during a particularly a cold February in Rockville, spent a week at NRC expense in Tempe, Arizona. This second version was also rejected, and the project then passed into the hands of Patricia Milligan, who produced the third and final version. By the time the Commission rejected it in 2002 and “pulled the plug,” in Commissioner Diaz’s words, the NRC had spent a small fortune on NUREG-1633, with nothing of value to show for it.
12If the example of Chernobyl is an accurate guide, we will begin seeing the first post-Fukushima childhood thyroid cancers in about five years.
13Even if we assume for purposes of argument that stockpiling KI would cause Americans to worry about the safety of nuclear power plants (and after Fukushima, it seems unlikely that KI would play any significant role in any such worries they may have), that is separate from the question of whether we should have the drug on hand as part of preparedness for acts of terrorism. The public relations needs of the nuclear power industry regarding power plant safety should have no bearing on whether we are ready to cope with a nuclear device exploded by terrorists.
14 To the Editor:
The detection of radioactive iodine 131 in Tokyo’s drinking water (“Anxiety Up as Tokyo Issues Warning on Its Tap Water,” front page, March 24), in amounts considered unhealthy for children, makes clear that potassium iodide must be administered if children are to be adequately protected against thyroid cancer caused by ingested and inhaled iodine 131. Interdiction of milk supplies, though important, is plainly insufficient.
Japan’s apparent preparedness with potassium iodide contrasts with the situation in the United States. In response to 9/11, Congress passed a law to create stockpiles of potassium iodide for populations within a 20-mile radius of nuclear reactors, rather than the 10-mile radius within which the Nuclear Regulatory Commission offers it to states that request it.
But the N.R.C., which had opposed the law, fought successfully to keep it from taking effect. In 2008 President George W. Bush’s science adviser, John H. Marburger III, declared that potassium iodide was not needed beyond the 10-mile radius, and that the law therefore would not be implemented.
The events in Japan demand that the Obama administration act quickly to reverse this unjustified rejection of a sensible law.
Seattle, March 24, 2011
19 For this information, I am indebted to David Lochbaum, an NRC alumnus now with the Union of Concerned Scientists.
20By the same token, consider a March 4, 1994, letter from Jim Martin, an NRC retiree, to Hugh Thompson, then Deputy Executive Director for Operations, which was placed in the Public Document Room at that time:
Please hold the bottom line: do not require that utilities distribute KI to the general public as a license condition. This was my bottom line over many years of discussions of the subject at the staff and the commission levels. As I said to Peter Crane at one time: If I lived near a nuclear plant, I’d have some KI for my family (it’s so cheap!), but I think it would be legally obscene to require KI predistribution to the public as a condition of a license. If Peter wants KI available in the schools, then let the PTAs run car washes and buy some! At the time, they cost only 2-3 cents apiece.
I recall this meeting well; Mr. Martin made the point that for the price of the pack of cigarettes in his shirt pocket (at the time, in 1983, they sold for about $.75 a pack in the D.C. area), he could protect his whole family with KI, and he would be “crazy” not to do so. Please understand: I do not by any means intend to demonize Mr. Martin, whose letter, if read in its entirety, which I recommend, is more thoughtful and balanced than this one passage, taken in isolation, might suggest. The problem with his proposed solution, however, is that unless people are told that KI is desirable, the PTA’s of America are not going to know to hold such bake sales, and in an actual emergency, only knowledgeable insiders, such as NRC personnel and their families, will be protected.
Incidentally, Mr. Martin made another observation in his letter, from which it can be inferred that the site at which KI would be of greatest value in preventing cancer is Indian Point (IP): “The major technical basis document at the time was the Blond & Aldrich report on the efficacy of KI. Indeed, it showed that a ‘national’ KI predistribution program would not be cost effective in terms of cancers avoided (half or more of the calculated cancers arise beyond 50 miles at most sites – all except for IP, as I recall, so the emphasis must be on the area beyond 50 miles, for the cancer issue).” [Emphasis added.]
21 After 9/11, Commissioner McGaffigan called me to tell me that I had “saved the NRC from itself,” through the efforts that resulted in the NRC’s rule change on KI, a few months earlier.
23 Consider this excerpt from an article carried by National Public Radio on March 20, at http://www.npr.org/2011/03/20/134705754/japans-efforts-to-ease-nuke-crisis-hit-setback:
Government Admits Mistake
Officials have begun distributing protective potassium iodide pills to people from the area around the power plant. But one official in Fukushima, Kazuma Yokota, told reporters that the government now realizes it should have distributed the pills earlier last week.
Potassium iodide protects people against thyroid cancer if they have been exposed to radioactive iodine, but it must be taken promptly.
The pills help reduce chances of thyroid cancer, one of the diseases that may develop from radiation exposure, by preventing the body from absorbing radioactive iodine. The official, Kazuma Yokota, said the explosion that occurred while venting the plant's Unit 3 reactor last Sunday should have triggered the distribution. But the order came only three days later.
"We should have made this decision and announced it sooner," Yokota told reporters at the emergency command center in the city of Fukushima. "It is true that we had not foreseen a disaster of these proportions. We had not practiced or trained for something this bad. We must admit that we were not fully prepared."
24 If need be, the Commission should explain to the Inspector General that his office’s mandate in conducting investigations of “fraud, waste, and abuse” is not confined, as Mr. Mulley of OIG appeared to believe, to cases in which a federal crime appears to have been committed. Of course, federal law requires NRC communications to Congress to be accurate.