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THE RADIOISOTOPE INDUSTRY:

A N A L Y S I N G N U C L E A R M E D I C I N E A N D T H E R A D I O I S O T O P E I N D U S T R Y One way of proceeding with an analysis of future radioisotope production and supply scenarios for Australia would be to consider each medical radioisotope currently produced by H I F A R , collating information on the feasibility of

importation, domestic cyclotron production, or replacement with alternative radioisotopes or non-radioisotope procedures. H o w e v e r this analysis proceeds from a different direction, from a broader analysis of global production of and trade in radioisotopes. Such a general understanding is essential for an adequate assessment of future supply scenarios for Australia, and it provides a framework from which analysis of any specific radioisotope can proceed. The only

radioisotope discussed in detail is technetium-99m (Tc-99m) and its parent radioisotope molybdenum-99 (Mo-99). Tc-99m is used in 70-80% of all nuclear medicine procedures.

There is very little academic work concerning nuclear medicine or the radioisotope industry, and the few studies that exist are more useful for

information than insight (e.g. Russell, 1979; Hamilton, 1982; Bronzino et al., 1990, ch.7). Social analysts of nuclear industries rarely say m u c h about the radioisotope industry. In s o m e studies, radioisotope production is discussed in the context of the various industrial, medical, and research activities of nuclear agencies (e.g.

Moyal, 1975). Such studies give s o m e insight into the links between radioisotope production and other aspects of nuclear programs. H o w e v e r that alone is

insufficient for m y purposes since m a n y aspects of the radioisotope industry -such as processing, transport, and marketing - involve institutions other than nuclear agencies and social and economic dynamics other than those which shape the nuclear industry.

Nor is there much of relevance in the medical sociology literature. This literature tends to focus m o r e on the use and consumption of medical technologies, less on

production and trade. Studies of medical use and consumption take u p issues such as the development of usage organisations and practices, professional strategies used to advance or retard the development of a particular technology, and medical technology evaluation. S o m e of this literature is useful. For example use/consumption studies bridge into studies of technology regulation and

evaluation, in which the roles of state institutions and private companies c o m e into view alongside the m o r e c o m m o n focus on medical personnel and

institutions. Moreover there is interaction between production and consumption, supply and demand: for example professional struggles (turf battles) over the use of medical radioisotopes have consequences for radioisotope d e m a n d which, in

turn, affects production. H o w e v e r in the following analysis I d o not look closely at the level of professional practice, or medical micropolitics m o r e generally; the issue of future radioisotope supply scenarios for Australia invites an analysis focused largely o n the levels of radioisotope production and trade.

There are some sociological analyses of medical imaging modalities such as x-radiology, computerised tomography, and magnetic resonance imaging (e.g.

Littrell, 1989), and there are hagiographic "in-house" histories of all of them. O n c e again the focus is generally o n the use and impact of imaging technologies rather than production and trade. Nuclear medicine tends to be given little or no

attention in this literature. A typical example is Hamilton's (1982) Medical

Diagnostic Imaging Systems, a study of a range of imaging technologies including nuclear medicine. This book has m u c h useful information and s o m e useful

insights but it lacks any clear overall analysis of medical imaging and it deals only with the U S market. Hamilton's book illustrates another blind-spot in the

literature: the discussion on nuclear medicine is focused solely on imaging equipment and computers, with n o discussion at all o n radioisotope production and trade. Another illustrative example is the lengthy and largely descriptive account of medical imaging in Bronzino et al. (1990, ch.7). Insofar as this account moves from description to analysis, the concern is with "lumpy" investment decisions and other issues which concern imaging equipment not radioisotopes;

the comments o n radioisotope production are brief and purely descriptive and technical.

Medical sociology bridges into studies more clearly identifiable as STS-inspired.

Once again the STS literature dealing with medical imaging technologies is of little value for this thesis. Barley's (1986) analysis of the introduction of

computerised tomography scanners into t w o different hospital radiology departments is illuminating in its analysis of the different social dynamics occasioned by computerised tomography vis a vis the division of labour in radiology - but the w o r k is narrow in scope. Similarly, the historical analysis of the development of cyclotrons by Baird and Faust (1990) is narrowly focused. Their aim is to urge a conception of scientific knowledge broad enough to include

scientific instruments and instrumental techniques; that is, a conception of

scientific knowledge which includes but goes beyond theory. That m a y be of s o m e interest in relation to the construction and negotiation of boundaries between science and technology, but it has n o relevance for the questions to be addressed in this thesis. The analyses of the historical development of ultrasound b y Yoxen (1987) and K o c h (1993) offer s o m e useful insights - concerning for example the

transfer of military technology to medicine - but mostly they rehash the well-w o r n themes of constructivist technology studies.

An STS analysis which is certainly of use is Stuart Blume's (1992) Insight and Industry. A s discussed in chapter one, Blume's book does not directly address nuclear medicine but the overall analysis of medical imaging is useful and

suggestive. Blume's analysis needs to be reworked in relation to the radioisotope industry. B l u m e emphasises the evolution of an interorganisational structure at the centre of which are the symbiotic interests of the producers (manufacturing companies), purchasers (mostly hospitals), and users (radiologists) of imaging equipment. A major difference between the radioisotope industry and the medical imaging equipment markets analysed b y B l u m e is the central involvement of state-controlled nuclear agencies in radioisotope production. Whereas Blume's analysis draws primarily from theory o n the economics of innovation, and from medical sociology, an analysis of the radioisotope industry will also need to be alert to the sociology of nuclear development.

Of direct relevance to this thesis is the analysis of the global radioisotope industry by Frans Berkhout (1993), an academic w h o has written widely on nuclear issues.

His study w a s commissioned by the Sutherland Shire Council for inclusion in the Council's submission to the Research Reactor Review. Berkhout analysed the level of concentration and competition in the radioisotope industry, and he m a d e projections about future production levels. His analysis is particularly useful in relation to radioisotope processing and retailing - in this d o m a i n he discusses the changing structure of the industry, such as the shift towards regional

radiopharmacies and unit-dose supply of radiopharmaceuticals to hospitals, and the vertical integration of the industry. Berkhout's study is brief, and it is focused exclusively on the Mo-99/Tc-99m industry, but it is useful nonetheless - all the more so since it w a s focused explicitly on the issue of future supply of the

Australian market.

In view of what has been said, analysis of the radioisotope industry must take account of the following broad features. Firstly, analysis of the economics of the industry is essential. Radioisotope production is often carried out on a non-commercial basis, but international trade is invariably carried out on a

commercial basis even where production is largely controlled by state institutions.

Secondly, the important role of nuclear agencies in radioisotope production m u s t be considered. Thirdly, the idiosyncrasies of medical markets - for example the insulation of both sellers and buyers from price signals as a result of third-party payment systems - m u s t be considered.

One last aspect of the analysis that should be mentioned is that for the most part I assume the value of nuclear medicine and focus on the evaluation of alternative production and supply scenarios. This is the approach adopted in virtually all discussion on nuclear medicine in relation to the HIFAR replacement

controversy, whether from proponents or opponents of a new reactor. However the issue is reframed at various stages in the following chapters, with some critical analysis of the importance of nuclear medicine and its alleged irreplaceability vis a vis alternative medical technologies. Thus some issues are addressed which arise from structural critiques of medicine under capitalism - in particular iatrogenesis and overuse. As for alternative technologies, claims that nuclear medicine is unique as a functional diagnostic imaging technology, and thus immune from competition in this medical domain, are scrutinised, and other aspects of

competition between imaging modalities are discussed. I also scrutinise the claim that research reactors and cyclotrons are complementary rather than competing radioisotope sources.

5.2. THE HISTORY OF RADIOISOTOPE

PRODUCTION A N D NUCLEAR MEDICINE