Nasal Radium Irradiation Technique - Essay Example

ON NASAL RADIUM IRRADIATION TECHNIQUE (NRI INTRODUCTION: Imaging techniques and the developments associated with them-are the result of a need to identify diseases-so that an effective cure to those diseases can be affected. Imaging involves medical analysis of the body tissues and functions by means of both non-invasive and invasive techniques. Imaging with the help of Magnetic Resonance Imaging, Computerized Tomography, Positron Emission Tomography and similar ones-has become very much popular and is in wide spread use-even in developing countries. The evolution of these techniques has been the outcome of the various drawbacks associated with older techniques like Nasal Radium Irradiation and others-which have had their effects-often irreversible, on the people on which they were used. Nasal Radium Irradiation owes its development to Marie Curie-the discoverer of radium. Radium was discovered in 1898 and was widely used in medical techniques in the first half of the nineteen hundreds. Nasal Radium Irradiation was introduced in the United States in the year 1926. It was used especially in children to treat swollen lymphoid tissues. It was considered a generally effective treatment procedure as becomes evident from a quote in "Nasopharyngeal Radium Irradiation (NRI): Fact sheet"- Through the 1960s, NRI was considered good medical practice and effective treatment for a number of medical problems of the head and neck, such as hearing loss and chronic ear infections, and for reducing the size of tonsils and adenoids. In Nasal Radium Irradiation technique two cylinders made of radium sulfate are inserted in the cavity behind mouth and nose-the nasopharyngeal opening. The cylinders generally contain 25 milligrams of radioactive radium sulfate. The time of exposure is around 8.5 minutes. The radium sulfate being radioactive disintegrates and releases three types of ionizing radiations-alpha, beta and gamma. The alpha particles do not penetrate the tissues because they have comparatively lower penetrating ability and hence are blocked by the applicator. The beta particles penetrate the over grown tissues in the nasopharynx. The gamma rays-with the highest penetrating ability are unwanted and are accounted for the incidence of cancer. The organs that are affected by gamma exposure in this treatment are the brain, thyroid gland, pituitary gland and salivary glands. ILL EFFECTS OF NRI TECHNIQUE: Many studies have been conducted to ascertain the incidence of cancer with NRI, but the results that these studies have produced vary widely-without showing any clear cut relation between the incidence of cancer and NRI. One example of a study which indicates that no relationship exists between cancer and NRI is quoted in "Nasopharyngeal Radium Irradiation (NRI): Fact sheet". It says- In one of the earliest studies, Hazen et al. (1966) compared the cancer risk of 417 children receiving NRI treatment, 971 children receiving X-ray treatment, and an untreated control group of 2,746. In follow-up periods averaging 14.6 years, no significantly increased cancer risk was observed among the treated groups compared to the controls. Another study conducted among military personnel indicates that there is no concrete relation between the incidence of cancer and NRI treatment. In the study, the Department of Veterans affairs evaluated whether 1,214 World War II submariners who were treated with NRI against 3,176 submariners who were not treated-for deaths resulting from cancer (Nasopharyngeal Radium Irradiation (NRI): Fact sheet). That there exists no relation between incidence of cancer and NRI becomes evident from- researchers also found a small increased risk of death due to all cancers combined, as well as cancers of the head and neck; these findings were not statistically significant. On the contrary, a study conducted in Maryland indicates that indeed the risk of cancer is high in patients who underwent NRI treatment. A quote made in "Nasopharyngeal Radium Irradiation: Health studies and recommendations" substantiates that- On the basis of a cohort study of 904 exposed and 2021 unexposed persons during 1943-1960 (conducted by Sandler et al. in Maryland), the risk for all head and neck cancers combined was higher among persons who had received the treatment than among persons who had not. However, this finding was based on small numbers of cancers (three brain and one soft palate cancer) and was statistically significant only after categories were combined. Though the studies do not point towards a particular conclusion it is very necessary to seriously consider NRI and its aftermath in the patients. REASONS WHY THE PUBLIC HAS NOT BEEN INFORMED ABOUT NRI AND ITS ILL EFFECTS: There is no clear cut evidence why the public was not been informed regarding the ill effects of NRI treatment. The answer to this is a matter of speculation taking into account the various factors that are associated with it. One of them maybe the that most of the studies conducted to ascertain the ill effects have turned negative-either because of chance or may be due to various other factors involved. This becomes evident from a quote made in "Nasopharyngeal Radium Irradiation: Health studies and recommendations"- the diseases that could be associated with this treatment are rare and the treatment may confer a modest additional risk of those diseases Dereliction on the part of the Government cannot be ruled out regarding this issue. This becomes evident from a remark made by Whitehead (2005) in "Mengele's Legacy Lives On: Inhumane Experiments on Children in America"- From 1948 to 1954, Johns Hopkins conducted an experiment on 582 third graders, testing the effects of Nasal Radium Irradiation. Although it is now known that this procedure places the participant at greater risk for cancer, the government still has not contacted the participants to warn them of this risk. There may be other reasons involved like-mostly the military was involved in the treatment, so little or no information could be leaked out to the general public. Yet the reason why the public was not informed for so long is unclear. REASONS WHY NRI TREATMENT WAS GIVEN TO CHILDREN: Children were administered NRI treatment to shrink swollen tissue in the nasopharyngeal cavity. It was used as a primary means to treat chronic otitis and hearing loss in children. Otitis is a disease characterized by ear inflammation. According to "Workshop on public health response to Nasopharyngeal Radium Irradiation (1995)"- The goal of this approach was to reduce swelling of enlarged lymphoid tissue, which was believed to be a cause of hearing loss Regarding this Cherbonnier (1997) remarks that- Between 1948 and 1954, under a federally-funded grant, Johns Hopkins Hospital administered this treatment to shrink the adenoids of Baltimore City school children in an experiment involving 582 third graders. Regarding the reason behind the treatment she further says- The intent was to gauge the effect of the radium on long-term hearing loss. Children are more susceptible to ill effects like mutations and cancer-this needs to given due consideration. The fact that most of the treated were children further aggravates the concern. IDENTIFICATION OF NRI TREATED INDIVIDUALS: According to the National Cancer Institute estimates- At least 8,000 military personnel and as many as 2.5 million civilians may have been treated with NRI in the United States. NRI therapy also was used in Canada and several European countries, including the Netherlands, where at least 24,500 patients were estimated to have been treated. As the number of patients involved is very large, identification of all the individuals may indeed be a difficult task. To trace the patients, firstly the registries that contain identity of patients who underwent NRI treatment need to be surveyed. Since hospitals specializing in ENT were involved in giving out the treatment, surveying the registries of such hospitals may be useful. The military also was involved in the treatment which implies that searching the military records would be useful to identify the patients. Then using this information, municipal registries may be scanned for finding out the address ad status of the patients. This method may be effective to a large extent as becomes evident from a quote by Ronckers et al (2002) in "Cancer Incidence after Nasopharyngeal Radium Irradiation"- Cohort members were traced through 15 September 1997 at municipal resident registries and other relevant sources to determine vital status and address. In all, 92% were successfully traced. For assessing the incidence of cancer and ill effects that might have resulted, death certificates, cancer registries and information from national cancer surveys about the traced patients may be used. In the study conducted by Ronckers et al- Cancer incidence was assessed through record linkage with the Netherlands Cancer Registry (NCR) for the period 1989-1996, and through a health questionnaire survey coupled with medical verification of self-reported tumors for the period 1945-1988. PROVIDING INFORMATION TO NRI TREATED PATIENTS: The patients treated with NRI need to be given proper information regarding the risk that they are up to because of the radioactive radiations that the treatment involves. They need to be informed about the results of various studies that are being conducted to relate cancer with NRI. The public has the right to know more regarding such issues. Research and documentation regarding the known facts of the issue have to be made publicly accessible. There is a need for making accurate information available to patients and their families. Individuals need to be advised regarding their individual exposure history and health status taking into concern the diseases that they are susceptible to. A comment made by Farber quoted by Maremont (1999) illustrates the urgent need for making more information available to the public- "Brain cancer mortality excess risk among NRI-treated children in any given sized group would exceed total all-site cancer mortality observed in actual study of an identical number of survivors of the atomic bombing of Hiroshima and Nagasaki." WHAT CAN BE EXPECTED FROM THE PATIENTS The information needed from the patients is both technical as well as non-technical. The technical part includes the evaluation of the incidence of cancer and other ill-effects by means of proper screening procedures. The non-technical part consists of information regarding the various treatments that they might have undergone-for which no valid documentation exists in the various registries. Also identification of patients who underwent the treatment but documenting which no records exist can be identified through the patients. This would indeed be useful when concerned with the military as the treatment is usually given to a batch as a whole. The patients have to be advised to undergo regular screening tests for identifying potential cancer threats from the radiation in NRI treatment. Radiation affects the genes present on the chromosomes. The genes are responsible for carrying information for all the life processes that the cell or the organism as a whole performs. When the radiations interact with the DNA molecules-that are the building blocks of genes, the DNA molecules get distorted or mutated. This results in the production of faulty proteins or sends the cells into a stage of continuous undifferentiated cell division. These cells form a lump called tumor. Some of the cells may get torn from the tumor and are carried by the blood stream to other parts of the body. On getting deposited in other parts of the body, they form new tumors there-often obstructing blood vessels leading to circulatory complications. This phenomenon is called Metastasis. The patients have to be advised to regularly go to their doctor because if cancer is detected in earlier stages it can be controlled to some extent, though there is no guarantee that it can be fully cured. PREVENTION OF CANCER AND ILL EFFECTS OF RADIATION: To prevent cancer exposure to carcinogenic agents like radioactive substances, ionizing radiations, mutagenic agents like nicotine, etc should be avoided. Regular screening should be done. This is because early detection of cancer may be useful in preventing premature death by containing the spread and growth of cancerous tissue. The methods of treatment of cancer include-surgery, radiation therapy, chemotherapy, hormone therapy and biologic therapy. Surgery is used to remove a tumor-which is localized, hence surgery is considered as local therapy. In radiotherapy, a high energy radiation is used to destroy the cancerous cells. There is a possibility that the radiations themselves may cause more mutations and lead to adverse effects. In chemotherapy, chemicals are used to kill the cancerous cells. These chemicals have the ability to kill only the cancerous cells and have little effect on healthy cells. Hormone therapy is generally used in cancers that are the result of hormone imbalances. When there is deficiency of hormones in the body, hormones are injected and if hormones are in excess the glands that secrete them are surgically removed to reduce their level. Biological therapy tries to enhance the immunity of the body against the cancerous cells. White blood cells of the body inherently have the capacity to fight antigenic elements like cancerous cells. For preventing ill effects from treatments such as NRI the outcomes that it can lead to, have to be thoroughly examined before treating the general public. BIBLIOGRAPHY: CARS/REAP Forum on Nasal Radium Irradiation and Health. Accessed August 14, 2005 from http://www.farber.info/reap/ Cherbonnier A. (1997). Nasal Radium Irradiation of children has health fallout. Retrieved August 14, 2005 from http://baltimorechronicle.com/rupnose.html Farber S. A. (1996). NASAL RADIUM IRRADIATION & THE ADVISORY COMMITTEE ON HUMAN RADIATION EXPERIMENTS-A FAILURE OF PROCESS. Retrieved August 14, 2005 from http://www.farber.info/reap/sgovt0396.html Maremont M. (1999). One Crusader's Effort to Publicize A Health Risk Finds Little Success: Wall Street Journal. Retrieved August 14, 2005 from http://www.junkscience.com/july99/farber.htm Nasopharyngeal Radium Irradiation (NRI): fact sheet: National Cancer Institute (2003). Retrieved August 14, 2005 from http://www.nci.nih.gov/newscenter/pressreleases/NRI/print Nasopharyngeal Radium Irradiation: Health studies and recommendations. (n. d) Retrieved August 14, 2005 from http://www.cdc.gov/NCEH/radiation/nri/health_studies.htm Ronckers C. M, van Leeuwen F. E, Hayes R. B, Verduijn P. G, Stovall M, and Land C. E. (2002). Cancer Incidence after Nasopharyngeal Radium Irradiation. Epidemiology Vol.13 No.5. Retrieved ONLINE Whitehead J. W. (2005). Mengele's Legacy Lives On: Inhumane Experiments on Children in America. Retrieved August 14, 2005 from http://www.rutherford.org/articles_db/commentary.asprecord_id=335 Workshop on public health response to Nasopharyngeal Radium Irradiation (2005). Retrieved August 14, 2005 from http://wonder.cdc.gov/wonder/prevguid/m0040719/m0040719.asp Read More