DISCUSSION
Du. CIIA1IAN : \Vhen the fallout
prob-1cm became a matter of pressing public
in-terest in 1961, a group of us gathered at
Harvard, in Dr. Ceorge Thorn’s office to be precise, at the call of a subcomittee of the
National Advisory Council. The question
asked was, how little iodine is needed by
mouth to inhibit the uptake of iodine” by
the thyroid? No one knew the answer nor
could it be found in the medical literature. As a result of this I volunteered to direct an
experimental program designed to answer
tile question. The work was done in the fall
of 1961 and winter of 1962 and resulted in
a publication in Science, October 19, 1963,
entitled, “Minimal Dosage of Iodine’” by
Normal Thyroid.” The measurements on
the children in residence at the Wroentham
State Hospital were done by Krishna M.
Sazena, who has since returned to New
Delhi, India.
In brief, we chose children with normal thyroid function under a controlled environ-ment witil a stable diet, using iodine-free salt. Tracer doses were given orally before
and every 2 weeks during iodine
adminis-tration until either the uptake decreased to
approximately 5% or there was a
demon-strable change in successive uptakes.
lo-dide was then discontinued and one or
more measurements of iodine” were made
in subsequent weeks.
A maximum suppression was achieved
\Vitll a dose of iodide of 1.5 to 2 mg/M’ per day. On this dose the minimum uptake of
about 5% was reached in 2 to 4 weeks, at
which point the neck-thigh ratio was 1.
After even higher doses were stopped, the
uptakes rebounded in 2 weeks to
pretreat-ment levels. Increasing the doses over 2.0
mg per day did not increase either the rate or the degree of suppression.
The response was related to magnitude
of the doses, which in turn were related to
the size of the individual regardless of age.
For this reason we employed the surface
area of tile body as an index of the thyroid mass. Thus, for an adult the minimal
effec-tive daily dose is 3 to 4 mg, and for cliii-dren it is 1 to 2 mg. Suppression begins
al-most immediately after the oral dosage and
by 24 hours a 50% reduction is achieved.
The subsequent decrease in uptake to a
minimal value occurs in 4 to 6 weeks. The
rapid rebound on omission of iodide
mdi-cates the necessity for protection of
individ-uals exposed to possible contamination
with iodine”. Toxic effects of iodide from
such doses are extremely unlikely. Whether this dosage will be advised as an additive
for milk, water, or lollipops
(
asrecom-mended in England
)
will perhaps bedie-tated by our T\7 sponsors.
DR. RIVERA: I have a single question
di-rected to Dr. Chadwick. Do you have any
answers to the questions raised by Dr.
Charles? \Vhat is the federal government doing to assign responsibilities and see to it there is definite responsibility and actual
plans in the event that in certain areas of
the country the protective action guides are exceeded?
DR. CHADWICK: Let me answer that
question as follows : The federal
govern-ment doesn’t really assign responsibilities to the states. The responsibility for this is a state responsibility. The question as to how far the state can go in developing plans for
countermeasures is not an easy one to
an-swer. From what I have been able to
ob-serve, the public interest in these matters is very variable. When there is a fallout epi-sode people are very interested in the
fail-out problem and want to do something
about it. However, in the intervening
pe-nod the basic support necessary to help
agencies to carry out these responsibilities may not be forthcoming. It might be
desir-able to translate some of the concern into
effective support for health agencies in
SUPPLEMENT 319 milk supplies within a state, one cannot set
up a countermeasure plan. So it involves
adequate support for the public health
agencies, such that they can mount
pro-grams of this sort and develop these plans. The state health agencies with all the many
health problems thay have to deal with
often times do not have adequate resources to carry out the kind of detailed planning
and implementation that would be
neces-sary to prepare an effective countermeasure
program. I don’t know if Dr. Ingraham or
Dr. Thompson agree with this answer.
DR. INGRAHAM: I agree very largely with what you said. I think it is the responsibil-ity of the states to be prepared to take ac-tion in any emergency that affects health.
We do have adequate authority for that
purpose. The great difficulty is lack of
knowledge. Although we have developed
general guide lines, I don’t see how, on the
basis of what we know at the present time,
we can draw up detailed plans in advance
as to just what we would do for each
situa-tion that may arise. On the other hand,
when we are dealing with a localized
mci-dent-geographically localized-I think it is
perfectly possible to assess the problem and take action at the time indicated. The
van-ables are such that I think we lack the
knowledge to draw up a plan that says one,
two, three, this is what we are going to do. On the other hand, it is something that has
to be considered. I know in our own
de-partment we have sat down many times
and discussed how we might proceed
with-out ever trying to put down on paper
exact-ly what we would do. We felt that we
could consider the information constantly flowing in, but we have never been in a po-sition to be able to visualize, as yet, every possibility and put it down in writing.
DR. CHADWICK: I really hate to draw the
analogy with the shelter program, but there really is an analogy. All the experts agree that, if we were to burrow underground, we could protect ourselves from a nuclear war, but no one is willing to disrupt the na-tion to the extent that would be necessary
to put an effective shelter program into
effect. I realize this is not a good example,
but it indicates that, even though we may
know how to deal with a given problem, we
are often not willing to put the necessary amount of steam, support, and ptisi into it.
Da. HAYNIE: I want to clarify one point.
Dr. Saenger indicated 10 rads are delivered to the thyroid at a rate of 580 pCi per liter of
milk. Doesn’t that assume that the infant
gets a liter of milk per day every day for a year to deliver 10 rads to the thyroid gland?
One doesn’t ingest 580 pc in a liter of milk and deliver, thereby, 10 nads to the thyroid.
How long a period of ingestion does that
require?
DR. ToIPKINs: That particular value
was based on the calculation of the total
intake, including the build-up to a peak of
84 nCi per liter, and as a total intake from a single event in which the total intake is 580 pCi. From a single event the time required is of the order of 6 to 8 weeks or more. It is not a steady state type correlation.
DR. FARR: I wish to reinforce a remark
that Dr. Ingraham made in which he stated
that the health authorities needed the
confidence of the people in order to carry
out these measures. I think this is one of tile
key points we are discussing. How do
health authorities obtain this confidence
and maintain it? One of their prime
sup-porting groups should be the medical
profession. In order to give effective sup-port to the health departments, the
piwsi-cian must know what the programs are. Not
only must they know them, but they must
understand them. I think this is part of the
problem Doctor Charles was getting at,
that frequently the information, while tech-nically it has been unassailable and correct,
has not been of a kind that the average
physician could assimilate. I think this is a very important point. Also, Dr. Ingraham.
you commented on surveillance. Yesterday
I enquired about carbon’4 and tnitium, and, again, I raise a question relative to these
isotopes. We have been talking about
carbon” in our environment and do you have any measures that you are taking in
order to determine whether this is coming
into types of compounds which are much
more likely to have effects upon the
mdi-vidual?
DR. INGRAHAM: No, we have sampled for
tritium background throughout the state
and more intensely around the nuclear
waste area in Catteraugus County.
DR. ChADwICK: I would like to say for the record that the U. S. Public Health
Ser-vice has developed techniques for the
gen-eral monitoring of carbon’ and tritium
along with techniques used with other
ra-dionuclides and these are gradually going to be put into effect as resources are available.
Dn. HAYNIE: I had one more point I
wanted to make. To me it is not necessarily
bad to have surveillance without action. I
think in a situation the more information and data we have, the more logical conclu-sions we can reach. Therefore, I wouldn’t think that just because we have surveillance
we have to have action, because I don’t
think that necessarily follows. One point
with regard to the countermeasures is that
they are not necessarily without risk
them-selves. We do know from medical
experi-ence that use of this potassium iodide in
pulmonary conditions has been associated
with the development of goiter and
hy-pothyroidism.
Da. STERNBERG: Dr. Filer, you presented
data regarding the amount of cesium and
strontium in the soy bean formula. Are there any data available regarding the
other radio contaminants in soy bean
for-mula? After weaning, in other baby foods
commercially available, what are the levels of radio contaminants-strontium, cesium and the others? Also, I would like to know the ratio of the other formulas importance as possible sources of radio contaminants. That is, formulas other than milk or soy bean formulas.
DR. FILER: I think that the spectrum on
the trace in the counter of the formula did
not reveal any peaks, with the exception of radium in one or two, but we did not know
whether this is a laboratory error or not. In
respect to other infant foods, Dr. Forbes
showed analyses of a composite diet, at
least for strontium9’. He had figures for
cer-eal and vegetables and for the bone in the
chicken broth. Those figures are reliable. I obtained diet information from 8,000 moth-ens in the United States by mail
question-name for 6-month-old infants. It is
inter-esting to relate the information I get from the mother to the sales figures of the
Ger-ber Food Company. I can predict their
sales as well as they, simply by talking with mothers. It would be possible to obtain the
information you want by getting one of the
large food manufacturers to give you the
quantities of food they sell under such and such a label.
DR. RIVERA: We do have data on gamma ray spectroscopy from Dr. Gustafson’s
labo-ratory for several years, and in our own
laboratory we have run analyses for
stron-hum”0, radium”6, stable strontium, and
cal-cium, and we will probably run them for a
whole lot of other things.
I disagree with Doctor Haynie that
sur-veillance for its own sake without a view
toward action is very valuable. In the event
that the surveillance system shows there
may be a problem, if there is no plan for ac-tion, I think this is scandalous.
DR. EISENBUD: Dr. Rivera almost
an-swered my question and perhaps he can.
We have found that soybeans in general
have more radium than any other food, and
any increase in the soybean content of the
diet would offset by gain in radium the re-duction of the strontium”#{176} content.
DR. RIVERA: I have no data on soybeans. DR. MArrIsoN: I wish to add one point on comprehensive planning. Many years as a health officer led me to believe that it was much easier to get people and money for
action and service programs than for
plan-ning. This is a complex problem and we
need both money and people to do good planning. There is a bill which has just been introduced, S-3008, which for the first
time would provide states with a
SUPPLEMENT 321
health planning. There is nothing different about the lack of good comprehensive plans in radiological health from the whole series
of other program areas. We need it for air
pollution, water pollution, housing hygiene,
and a dozen other things. I hope this new
legislation will provide us with the where-withal to do this planning.
DR. THOMPSON : Good surveillance gives
one the basis for action or no action, but
one needs a plan in case one needs to take
action. Without good surveillance no
confident base exists for not taking action.
Not taking action is just as important as
taking action. I think the various types of disasters that might occur from fallout are a bit out of proportion. On one hand is disas-ter with tremendous fallout from a nuclear attack. This is not the area of surveillance, for it is a gross type of contamination with
high level dosage and obviously will not
come within the Utah surveillance system.
Yet, we are tying our surveillance system
into this type of disaster. We are giving, for the first time, to the Civil Defense people
competence to operate equipment, to
main-tam it, to have it currently in operational
form. They did not have competence until
our networks came into being, so they do
integrate.
If there is a nationwide fallout, it will
be-come a national problem. Local means
state wide and if there be a statewide epi-sode, we could not cope with it without
as-sistance; but, we could cope with a
sub-stantial episode with our present
capabili-ties. We might need additional man power.
We have, through this network, a basis to
get to the point of the trouble. In 1962 we didn’t know where it was as we did not have an adequate network then that would tell us where to go. Otherwise, we would have known within the firstday or two and
within a week could take action to cover
75% of the episode. I think the cost of
maintaining this network, which is a factor,
has to be related to the ultimate value of
this network in being able tofocus attention.
This produces a lower cost at the time you
have to take action.
DR. SPENCER: In reference to the
ques-tionable value of metabolic studies in
eluci-dating radioisotope metabolism in man, the
data obtained by total body counting are of
great importance since they indicate the
overall retention of a radioisotope.
How-ever, they do not give any information on
the pathways of the radioisotope in the
body. The delineation of the pathways,
especially in humans, is an important
pre-requisite for instituting measures of decon-tamination or of enhancement of
radioiso-tope excretion, for instance, in cases of
acute exposure to a radioisotope. An exam-pie of these prerequisites is the necessity to
correlate the interdependence between
cal-cium and radiostrontium metabolism in a
particular individual. For instance, it has
been shown that the radiostrontium
excre-tion is very low in persons with a tendency to retain calcium
(
e.g., young adults and inpersons with osteoblastic metastases
)
andcan be increased many fold by inducing an
increase in urinary calcium excretion. In
order to obtain meaningful data which will
be helpful in delineating measures of
de-contamination, these studies have to be
performed under strictly controlled dietary and metabolic conditions for a prolonged period of time. By their nature, short-term studies
(
3-day studies),
such as those per-formed in babies, are difficult to performand offer only limited information;
how-ever, they give an indication of the metabo-lism of a particular element in the infant.
Since we are concerned with the retention
of radioisotopes in children, it would be
most desirable to get information on the
